WorldWideScience

Sample records for incisive world-class tools

  1. World Class Teachers.

    Science.gov (United States)

    Mitchell, Rosalita

    1998-01-01

    School communities are challenged to find ways to identify good teachers and give other teachers a chance to learn from them. The New Mexico World Class Teacher Project is encouraging teachers to pursue certification by the National Board for Professional Teaching Standards. This process sharpens teachers' student assessment skills and encourages…

  2. World Class Facilities Management

    DEFF Research Database (Denmark)

    Malmstrøm, Ole Emil; Jensen, Per Anker

    2013-01-01

    Alle der med entusiasme arbejder med Facilities Management drømmer om at levere World Class. DFM drømmer om at skabe rammer og baggrund for, at vi i Danmark kan bryste os at være blandt de førende på verdensplan. Her samles op på, hvor tæt vi er på at nå drømmemålet.......Alle der med entusiasme arbejder med Facilities Management drømmer om at levere World Class. DFM drømmer om at skabe rammer og baggrund for, at vi i Danmark kan bryste os at være blandt de førende på verdensplan. Her samles op på, hvor tæt vi er på at nå drømmemålet....

  3. Achieving world class maintenance status

    Energy Technology Data Exchange (ETDEWEB)

    Tomlingson, P.D. [Paul D. Tomingson Associates (United States)

    2007-08-15

    The article written by a management consultant, discusses the art of successful planning and operation of maintenance in mines considering factors such as benchmaking, key performance indices (KPIs) and frequency of procedures which can help achieve 'world class maintenance'. 1 fig.

  4. QUALITY IN WORLD CLASS MANUFACTURING

    Directory of Open Access Journals (Sweden)

    Slavko Arsovski

    2011-12-01

    Full Text Available The World Class Manufacturing (WCM is a contemporary concept that is applied by the world leaders in the business. In this concept, one of the nine pillars is directly related to the quality and the other eight are related to it indirectly. That is why is very important to investigate relations between this concept and concept of model of quality. In the end of this paper are appointed the examples of best practice.

  5. Navy Medicine - World Class Care... Anytime, Anywhere

    Science.gov (United States)

    Search Saturday, May 26th, 2018 Home About Disclaimer Search Navy Medicine Navy Medicine World Class Care... Anytime, Anywhere Home Disclaimer Navy Medicine WebSite About Leadership Readiness Health Partnerships Inside Navy Medicine Dental Corps Hospital Corps Medical Corps Medical Service Corps Nurse Corps

  6. World class manufacturing in metallurgical enterprise

    OpenAIRE

    B. Gajdzik

    2013-01-01

    World Class Manufacturing (WCM) assumes increase of efficiency of the company by elimination of all the losses, wastage and dangers of safety. In ArcelorMittal the concept of WCM is implemented in particular enterprises within the capital group. In this publication the activities conducted in some of those enterprises are described.

  7. World class manufacturing in metallurgical enterprise

    Directory of Open Access Journals (Sweden)

    B. Gajdzik

    2013-01-01

    Full Text Available World Class Manufacturing (WCM assumes increase of efficiency of the company by elimination of all the losses, wastage and dangers of safety. In ArcelorMittal the concept of WCM is implemented in particular enterprises within the capital group. In this publication the activities conducted in some of those enterprises are described.

  8. Transferring World Class Production to Developing Countries

    DEFF Research Database (Denmark)

    Bruun, Peter; Mefford, Robert Neil

    1998-01-01

    Strategic reasons for firms to transfer world-class production methods and technology to developing countries are discussed and the importance of the management aspects of technology transfer are emphasized. A five stage model of the technology transfer process which bases the choice of the produ....... The barriers and challenges of implementation are considered, and a socio-technical systems approach is proposed as a way to addapt to local conditions....

  9. Performance measures for world class maintenance

    International Nuclear Information System (INIS)

    Labib, A.W.

    1998-01-01

    A main problem in maintenance in general, and in power plants and related equipment in particular, is the lack of a practical, consistent, and adaptive performance measure that provides a focused feedback and integrates preventive and corrective modes of maintenance. The presentation defines concepts of world class and benchmarking. Desirable features in an appropriate performance measure are identified. It then, demonstrates current practices in maintenance and criticises their shortcomings. An alternative model is presented through a case study. The model monitors performance from a general view, and then offers a focused analysis. The main conclusion is that the proposed model offers an adaptive and a dynamic framework, and hence production and maintenance are integrated in a 'real time' environment. The system is also flexible in working with any other criteria whether they are of a quantitative or a qualitative nature. (orig.) 16 refs

  10. Performance measures for world class maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Labib, A.W. [Department of Mechanical Engineering, University of Manchester, Institute of Science and Technology, Manchester (United Kingdom)

    1998-12-31

    A main problem in maintenance in general, and in power plants and related equipment in particular, is the lack of a practical, consistent, and adaptive performance measure that provides a focused feedback and integrates preventive and corrective modes of maintenance. The presentation defines concepts of world class and benchmarking. Desirable features in an appropriate performance measure are identified. It then, demonstrates current practices in maintenance and criticises their shortcomings. An alternative model is presented through a case study. The model monitors performance from a general view, and then offers a focused analysis. The main conclusion is that the proposed model offers an adaptive and a dynamic framework, and hence production and maintenance are integrated in a `real time` environment. The system is also flexible in working with any other criteria whether they are of a quantitative or a qualitative nature. (orig.) 16 refs.

  11. Performance measures for world class maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Labib, A W [Department of Mechanical Engineering, University of Manchester, Institute of Science and Technology, Manchester (United Kingdom)

    1999-12-31

    A main problem in maintenance in general, and in power plants and related equipment in particular, is the lack of a practical, consistent, and adaptive performance measure that provides a focused feedback and integrates preventive and corrective modes of maintenance. The presentation defines concepts of world class and benchmarking. Desirable features in an appropriate performance measure are identified. It then, demonstrates current practices in maintenance and criticises their shortcomings. An alternative model is presented through a case study. The model monitors performance from a general view, and then offers a focused analysis. The main conclusion is that the proposed model offers an adaptive and a dynamic framework, and hence production and maintenance are integrated in a `real time` environment. The system is also flexible in working with any other criteria whether they are of a quantitative or a qualitative nature. (orig.) 16 refs.

  12. Brazil's Exception to the World-Class University Movement

    Science.gov (United States)

    Alperin, Juan Pablo

    2013-01-01

    The continued importance of university rankings has only served to fuel the growth of the "world-class" university movement. There is a growing impression that, in a globalised and interconnected world, no country can do without a world-class university. No country, that is, except Brazil. While Brazil has the resources necessary to…

  13. Using EB-QFD to achieve competitive advantages for world class manufacturing

    Directory of Open Access Journals (Sweden)

    Rahman Mostofi

    2012-10-01

    Full Text Available This paper introduces a tool named EB-QFD used for electronic business planning in strategic issues. Nowadays, the challenges of manufacturing sectors for achieving global competition will depend on their speed to change from domestic to world class manufacturing organizations, also the rapid global deployment of electronic business, information technology and their benefits have required managers to make decision, which look for a balance world class manufacturing factors with strategic business goals. To ensure that selected e-business strategies meet world class manufacturing requirements, organizations should simultaneously explore and communicate the relationship between world class manufacturing and electronic business. Electronic business planners can achieve competitive advantages through the implementation of an integration of quality function deployment (QFD with electronic business (EB called EB-QFD. This study is based on data collected from an Iranian auto parts manufacturing company and the implementation of EB-QFD. In this research, EB-QFD contains two parts named EB-WHATs as needs of Electronic Business and EB-HOWs as resources for EB-WHATs. Statistical analysis points that there are positive relationships between using EB-WHATs and EB-HOW and world class manufacturing factors as competitive advantages. We used electronic business systems for EB-WHATs and resource based view (RBV for EB-HOWs.

  14. World class performance: the outage/operating cycle continuum

    Energy Technology Data Exchange (ETDEWEB)

    Remphal, M. [Ontario Power Generation, Darlington, Ontario (Canada)

    2011-07-01

    It's all about Performance! Predictable and sustainable high performance is the key to public and stakeholder confidence in the nuclear industry. Why? Because nuclear is unique and safe, reliable operation each and every day is required to keep public trust. What better way to demonstrate this predictability than in breaker to breaker operating runs? Delivering on what was promised is the essence of our OPG accountability model: 'Say it, Do it'. This presentation is drawn from practical experience gained during the most recent planned maintenance outages at Darlington Nuclear. Key elements for outage success that will be discussed include; Human Performance: Ensuring each action is deliberate and executed right the first time; Continuous Learning: Recent examples demonstrating how drawing from lessons learned and operating experience worldwide can dramatically improve outage performance; Teamwork and Partnership: Recognizing our industry is too complex for a single; individual or organization to run on its own; Scope Selection: Darlington currently has an industry leading 0.5% Forced Loss Rate (FLR). If right work is selected and executed at the right time then ultimately the plant speaks and it shows up in low FLR and high Nuclear Performance Index; Planning: Ask and anticipate what can go wrong, what options exist and then pre-decide what path you would take. Some practical tools will be provided which have been recently used to plan out surprises; Oversight: An outage left to run its own course will have a surprise outcome. Strong management oversight is required to meet the goals of outage execution. Tips on how to improve communication and accountability will be discussed. Trust is built on confidence and confidence is built on sustainable performance. World class sustainable performance requires using all the tools available. This discussion will provide insight on these very tools. (author)

  15. World class performance: the outage/operating cycle continuum

    International Nuclear Information System (INIS)

    Remphal, M.

    2011-01-01

    It's all about Performance! Predictable and sustainable high performance is the key to public and stakeholder confidence in the nuclear industry. Why? Because nuclear is unique and safe, reliable operation each and every day is required to keep public trust. What better way to demonstrate this predictability than in breaker to breaker operating runs? Delivering on what was promised is the essence of our OPG accountability model: 'Say it, Do it'. This presentation is drawn from practical experience gained during the most recent planned maintenance outages at Darlington Nuclear. Key elements for outage success that will be discussed include; Human Performance: Ensuring each action is deliberate and executed right the first time; Continuous Learning: Recent examples demonstrating how drawing from lessons learned and operating experience worldwide can dramatically improve outage performance; Teamwork and Partnership: Recognizing our industry is too complex for a single; individual or organization to run on its own; Scope Selection: Darlington currently has an industry leading 0.5% Forced Loss Rate (FLR). If right work is selected and executed at the right time then ultimately the plant speaks and it shows up in low FLR and high Nuclear Performance Index; Planning: Ask and anticipate what can go wrong, what options exist and then pre-decide what path you would take. Some practical tools will be provided which have been recently used to plan out surprises; Oversight: An outage left to run its own course will have a surprise outcome. Strong management oversight is required to meet the goals of outage execution. Tips on how to improve communication and accountability will be discussed. Trust is built on confidence and confidence is built on sustainable performance. World class sustainable performance requires using all the tools available. This discussion will provide insight on these very tools. (author)

  16. Strategic Planning towards a World-Class University

    Science.gov (United States)

    Usoh, E. J.; Ratu, D.; Manongko, A.; Taroreh, J.; Preston, G.

    2018-02-01

    Strategic planning with a focus on world-class university status is an option that cannot be avoided by universities today to survive and succeed in competition as a provider of higher education. The objective of this research is to obtain exploratory research results on the strategic plans of universities that are prepared to generate world-class university status. This research utilised exploratory qualitative research method and data was collected by in-depth interviews method. Interview transcripts were analyzed by using thematic content analysis through NVivo software analysis and manual systems. The main finding of interview shows that most interviewees agreed that UNIMA has been engaged in strategic planning. Contribution from faculties and schools are acknowledged and inform the planning process. However, a new model of strategic planning should be adopted by UNIMA due to the shift towards a “corporate university”. The finding results from documents, literature review and interview were the addition of world-class university characteristics and features to current strategic planning of UNIMA and how to upgrade by considering to use the characteristics and features towards world-class university.

  17. Six world-class research teams to investigate overcoming ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Six world-class research teams to investigate overcoming therapeutic resistance in high fatality cancers. 26 octobre 2017. Together with our partners the Canadian Institutes of Health Research, the Azrieli Foundation and the Israel Science Foundation we are pleased to announce the recipients of the Joint Canada-Israel ...

  18. A World-Class Teaching Profession. Consultation Response

    Science.gov (United States)

    National Foundation for Educational Research, 2015

    2015-01-01

    Between 9 December 2014 and 2 February 2015 the Government conducted a consultation into its vision for a world-class teaching profession and the establishment of a College of Teaching. The Government is committed to improving teacher quality as a key part of our plan for education. The teaching profession is fortunate to include many thousands of…

  19. Competencies, Roles and Effective Academic Leadership in World Class University

    OpenAIRE

    Elham Shahmandi; Abu Daud Silong; Ismi Arif Ismail; Bahaman Bin Abu Samah; Jamilah Othman

    2011-01-01

    How an academic leader can become more effective? This research question is examined in the context of middle level leadership in research universities that includes the Deans and Head of Departments. It is based on a review of literature that focuses on the investigation of effective academic leadership. In the present situation of globalization, academic excellence is often related to being World Class University. Leadership effectiveness is more related to situational leadership style in r...

  20. Integrating MRP (materiel requirements planning) II and JIT to achieve world-class status.

    Science.gov (United States)

    Titone, R C

    1994-05-01

    The concepts and principles of using manufacturing resource planning (MRP II) for planning are not new. Their success has been proven in numerous manufacturing companies in America. The concepts and principles of using just-in-time (JIT) inventory for execution, while more recent, have also been available for some time, and their success in Japan well documented. However, it is the effective integration of these two powerful tools that open the way to achieving world-class manufacturing status. This article will utilize a newly developed world-class manufacturing model, which will review the aspects of planning, beginning with a business plan through the production planning process and culminating with a master schedule that drives a materiel/capacity plan. The importance and interrelationship of these functions are reviewed. The model then illustrates the important aspects of executing these plans beginning with people issues, through total quality control (TQC) and pull systems. We will then utilize this new functional model to demonstrate the relationship between these various functions and the importance of integrating them with a total comprehensive manufacturing strategy that will lead to world-class manufacturing and profits.

  1. STRATEGI MENUJU WORLD CLASS UNIVERSITY (WCU PADA UNIVERSITAS SEMARANG

    Directory of Open Access Journals (Sweden)

    S Susanto

    2014-01-01

    Full Text Available University Semarang (USM is now 26 years old (founded in 1987. It stands to USM achievement, both national and international. Although at the regional level in Central Java USM has become the leading private universities, but at the national level has not been fully encouraging, let alone the world level. Academically, USM is not yet in a world university ranking methods, such as: Academic Ranking of World Universities (ARWU, The Times Higher Education Supplement (THES and Webometrics. Only in Webometric lah, world university ranking USM entered electronically although not entirely encouraging. Apparently, we need to work harder in order to reach World Class University category.

  2. The validity of world class business criteria across developed and developing countries

    Directory of Open Access Journals (Sweden)

    Andre J. Parker

    2010-11-01

    Research purpose: To assess the validity of the general assumption in the literature that world class criteria are equally applicable worldwide. Motivation for research: The possibility exists that developing countries require an adjusted mix of world class criteria and practices to become globally competitive. Research design, approach and method: A quantitative field survey research approach was adopted. A web-enabled questionnaire was designed, covering 35 world class practices grouped under 7 world class criteria. A cross-section of the senior management from 14 developing and 20 developed country’s organisations partook in the study. Main findings: It was empirically confirmed that the majority of world class practices posited in the literature are used by participating organisations; that world class criteria do not apply equally across developed and developing countries; and that more important than country location, is the deliberate choice by an organisation’s leadership to become world class. An empirically based model of ascending to world class was proposed. Practical/managerial implications: Regardless of country location, the leadership of an organisation can make their organisation world class by applying the proposed world class model. Contribution/value add: A reliable web enabled instrument was designed that can be used to assess an organisation’s world class standing; the assumption that world class criteria are equally valid across developing and developed countries was proven partially incorrect; since becoming or being world class is also a leadership choice regardless of location.

  3. Proposition Factor Model of World Class Manufacturing in Brazilian Enterprises

    Directory of Open Access Journals (Sweden)

    Paulo Sergio Gonçalves de Oliveira

    2016-05-01

    Full Text Available The present paper aims to develop a model of World Class Manufacturing, to achieve this goal was elaborated a questionnaire with 35 assertive divided in 7 areas suggested by literature review. This questionnaire was send to manufacture specialists, product developers and technician through LinkedIn the participants was select by researchers in discussion groups taking in consideration their experience using the professional profile. About 1000 invite was send to professional from metal-mechanic sector which returned 180 valid questionnaires. The data was analyzed through factor analyses and was obtained 7 constructs, which explained 67% of data variance. The KMO was 0,84, which is considered good for, analyzes purpose. The seventh factor was eliminated because it Cranach’s Alpha was below 0,6 and the remained factor was nominated as: Lean Manufacturing, Human Resources Management to achieve flexibility, Marketing Integration, Costs Reduction and Flexibility.

  4. Metrics help rural hospitals achieve world-class performance.

    Science.gov (United States)

    Goodspeed, Scott W

    2006-01-01

    This article describes the emerging trend of using metrics in rural hospitals to achieve world-class performance. This trend is a response to the fact that rural hospitals have small patient volumes yet must maintain a profit margin in order to fulfill their mission to the community. The conceptual idea for this article is based largely on Robert Kaplan and David Norton's Balanced Scorecard articles in the Harvard Business Review. The ideas also come from the experiences of the 60-plus rural hospitals that are using the Balanced Scorecard and their implementation of metrics to influence performance and behavior. It is indeed possible for rural hospitals to meet and exceed the unique needs of patients and physicians (customers), to achieve healthy profit margins, and to be the rural hospital of choice that employees are proud to work for.

  5. The World-Class Multiversity: Global Commonalities and National Characteristics

    Institute of Scientific and Technical Information of China (English)

    Simon MARGINSON

    2017-01-01

    World-Class Universities (WCUs) are nationally embedded comprehensive higher education institutions (HEIs) that are closely engaged in the global knowledge system.The article reviews the conditions of possibility and evolution of WCUs.Three interpretations are used to explain worldwide higher education:neoliberal theory,institutional theory,and critical political economy,which give greater recognition than the other theories to the role of the state and variations between states.World higher education is evolving under conditions of globalization,organizational modernization (the New Public Management),and in some countries,marketization.These larger conditions have become manifest in higher education in three widespread tendencies:massification,the WCU movement,and organizational expansion.The last includes the strengthening of the role of the large multi-disciplinary multi-purpose HEIs ("multiversities"),in the form of both research-intensive WCUs with significant global presence,and other HEIs.The role of binary sector and specialist HEIs has declined.Elite WCUs gain status and strategic advantage in both quantity and quality:through growth and the expansion of scope,and through selectivity and research concentration.The balance between quantity and quality is now resolved at larger average size and broader scope than before.The final section of the article reviews WCUs in China and considers whether they might constitute a distinctive university model.

  6. Thoughts on the Role of Government in the Development of World-Class Universities in China

    Science.gov (United States)

    Guangcai, Yan

    2011-01-01

    Looking at the rise of world-class universities through history, creating an institutional environment in which universities are relatively autonomous, while also ensuring effective material support from the government is essential for the formation of world-class universities. It is worth examining the deteriorating academic environment in China…

  7. World-Class Visualizations in GMAT, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Today's mission designers rely on state of the art tools with modern GUI elements and real-time 3D interactive graphics to visualize their trajectories and orbit...

  8. World-Class Visualizations in GMAT, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Today's mission designers rely on state of the art tools with modern graphical user interface (GUI) elements and real-time 3D interactive graphics to visualize their...

  9. Knowledge Management and World Class Manufacturing: an initial approach based on a literature review

    Directory of Open Access Journals (Sweden)

    Rafael de Carvalho Mendes

    Full Text Available ABSTRACT This paper presents the partial results of an ongoing research on the proposal of a methodology for the integration between Knowledge Management (KM and World Class Manufacturing (WCM. The initial investigation of theoretical and conceptual nature aimed at developing a comprehensive and current vision on KM, WCM, and how (or "whether" these constructs relate to one another. The primary sources for the literature review were Web of Science, Scopus, Emerald, Ebsco, SciELO and Spell, and the time frame was 2000 to 2016. The analysis of the selected papers showed that, although the initial WCM model evolved into a "new WCM" in the 2000s, the literature is still focused on the broad conceptual aspects and basic methods and tools, such as Total Quality Process, Total Productive Maintenance and Just-in-Time, conceived in the Toyota Production System, which shows the need for more studies focused on the current scenario of companies associated with the "new WCM" and its Methods and Tools. Only one article explicitly addressing the interaction between KM theories with WCM was found in the databases surveyed, thus reinforcing the lack of theoretical approximation of these constructs.

  10. Investigating the Cellular and Metabolic Responses of World-Class Canoeists Training: A Sportomics Approach

    Directory of Open Access Journals (Sweden)

    Wagner Santos Coelho

    2016-11-01

    Full Text Available (1 Background: We have been using the Sportomics approach to evaluate biochemical and hematological changes in response to exercise. The aim of this study was to evaluate the metabolic and hematologic responses of world-class canoeists during a training session; (2 Methods: Blood samples were taken at different points and analyzed for their hematological properties, activities of selected enzymes, hormones, and metabolites; (3 Results: Muscle stress biomarkers were elevated in response to exercise which correlated with modifications in the profile of white blood cells, where a leukocyte rise was observed after the canoe session. These results were accompanied by an increase in other exercise intensity parameters such as lactatemia and ammonemia. Adrenocorticotropic hormone and cortisol increased during the exercise sessions. The acute rise in both erythrocytes and white blood profile were probably due to muscle cell damage, rather than hepatocyte integrity impairment; (4 Conclusion: The cellular and metabolic responses found here, together with effective nutrition support, are crucial to understanding the effects of exercise in order to assist in the creation of new training and recovery planning. Also we show that Sportomics is a primal tool for training management and performance improvement, as well as to the understanding of metabolic response to exercise.

  11. Initiatives for Change in Korean Higher Education: Quest for Excellence of World-Class Universities

    Science.gov (United States)

    Kang, Jean S.

    2015-01-01

    The establishment of World-Class Universities (WCUs) is noted as a paramount development in the realm of international higher education. The integration of higher education into a more international scheme has enabled for higher education institutions (HEIs) to have a broader impact on the states and their respective citizens. This study examines…

  12. The Global Quest to Build World-Class Universities: Toward a Social Justice Agenda

    Science.gov (United States)

    Rhoads, Robert A.; Li, Shuai; Ilano, Lauren

    2014-01-01

    This chapter provides a critical perspective on the global quest to build world-class universities (WCUs), including global "ranking mania," excessive emphasis on university branding, and the attending threats to the traditional public good mission of the university. Alternatively, we offer suggestions on how rankings may be used to…

  13. In the Shadow of Celebrity? World-Class University Policies and Public Value in Higher Education

    NARCIS (Netherlands)

    Cremonini, Leon; Westerheijden, Donald F.; Benneworth, Paul Stephen; Dauncey, Hugh

    2014-01-01

    The growing popularity of the concept of world-class universities raises the question of whether investing in such universities is a worthwhile use of public resources. Does concentrating public resources on the most excellent universities improve the overall quality of a higher education system,

  14. Can BRICS Build Ivory Towers of Excellence? Giving New Meaning to World-Class Universities

    Science.gov (United States)

    David, Solomon Arulraj; Motala, Shireen

    2017-01-01

    This paper aims to map the landscape of higher education transformation in the BRICS (Brazil, Russia, India, China and South Africa) nations while exploring the status of BRICS nations in some of the global university rankings and analysing their potential to give new meaning to notions such as excellent and world-class universities. The study…

  15. WCOM (World Class Operations Management) why you need more than lean

    CERN Document Server

    Ballerio, Noela

    2016-01-01

    This book deals with World Class Operations Management (WCOM), detailing its principles, methods and organisation, and the results that this approach can bring about. Utilising real-world case studies illustrated by companies that have adopted this model (interviews with Saint-Gobain, L’Oréal, Tetra Pak, Bemis, and Bel Executives), it describes common patterns drawn from decades of hands-on experience, so as to present a theoretical approach together with the concrete application of its principles. WCOM, adopted by several multinational companies, is one of the more innovative management practises, as it integrates the best Continuous Improvement approaches (Lean, Total Productive Management, World Class Manufacturing) as well as the most innovative approaches in human dynamics like Change Leadership, Performance Behavior, Shingo Model, to name a few. Maximising reader insights into the successful implementation of such an approach, and explaining not only its potentialities, but also its implementation dy...

  16. No Evidence of a Common DNA Variant Profile Specific to World Class Endurance Athletes

    Science.gov (United States)

    Wolfarth, Bernd; Wang, Guan; Sarzynski, Mark A.; Alexeev, Dmitry G.; Ahmetov, Ildus I.; Boulay, Marcel R.; Cieszczyk, Pawel; Eynon, Nir; Filipenko, Maxim L.; Garton, Fleur C.; Generozov, Edward V.; Govorun, Vadim M.; Houweling, Peter J.; Kawahara, Takashi; Kostryukova, Elena S.; Kulemin, Nickolay A.; Larin, Andrey K.; Maciejewska-Karłowska, Agnieszka; Miyachi, Motohiko; Muniesa, Carlos A.; Murakami, Haruka; Ospanova, Elena A.; Padmanabhan, Sandosh; Pavlenko, Alexander V.; Pyankova, Olga N.; Santiago, Catalina; Sawczuk, Marek; Scott, Robert A.; Uyba, Vladimir V.; Yvert, Thomas; Perusse, Louis; Ghosh, Sujoy; Rauramaa, Rainer; North, Kathryn N.; Lucia, Alejandro; Pitsiladis, Yannis; Bouchard, Claude

    2016-01-01

    There are strong genetic components to cardiorespiratory fitness and its response to exercise training. It would be useful to understand the differences in the genomic profile of highly trained endurance athletes of world class caliber and sedentary controls. An international consortium (GAMES) was established in order to compare elite endurance athletes and ethnicity-matched controls in a case-control study design. Genome-wide association studies were undertaken on two cohorts of elite endurance athletes and controls (GENATHLETE and Japanese endurance runners), from which a panel of 45 promising markers was identified. These markers were tested for replication in seven additional cohorts of endurance athletes and controls: from Australia, Ethiopia, Japan, Kenya, Poland, Russia and Spain. The study is based on a total of 1520 endurance athletes (835 who took part in endurance events in World Championships and/or Olympic Games) and 2760 controls. We hypothesized that world-class athletes are likely to be characterized by an even higher concentration of endurance performance alleles and we performed separate analyses on this subsample. The meta-analysis of all available studies revealed one statistically significant marker (rs558129 at GALNTL6 locus, p = 0.0002), even after correcting for multiple testing. As shown by the low heterogeneity index (I2 = 0), all eight cohorts showed the same direction of association with rs558129, even though p-values varied across the individual studies. In summary, this study did not identify a panel of genomic variants common to these elite endurance athlete groups. Since GAMES was underpowered to identify alleles with small effect sizes, some of the suggestive leads identified should be explored in expanded comparisons of world-class endurance athletes and sedentary controls and in tightly controlled exercise training studies. Such studies have the potential to illuminate the biology not only of world class endurance performance but

  17. An implementation of infrared thermography in maintenance plans within a world class manufacturing strategy

    Directory of Open Access Journals (Sweden)

    Todorović Petar M.

    2013-01-01

    Full Text Available The objective of the paper is to show the implementation of infrared thermography within World Class Manufacturing (WCM maintenance strategy. The results from infrared thermography inspections in a food processing and packaging solutions company were presented. Applicability of the infrared thermography, during a two-year period, caused a substantial reduction the potential breakdown in the pilot area. Upon feasibility confirmation, the proposed method was spread to other production equipment of the company.

  18. No Evidence of a Common DNA Variant Profile Specific to World Class Endurance Athletes.

    Directory of Open Access Journals (Sweden)

    Tuomo Rankinen

    Full Text Available There are strong genetic components to cardiorespiratory fitness and its response to exercise training. It would be useful to understand the differences in the genomic profile of highly trained endurance athletes of world class caliber and sedentary controls. An international consortium (GAMES was established in order to compare elite endurance athletes and ethnicity-matched controls in a case-control study design. Genome-wide association studies were undertaken on two cohorts of elite endurance athletes and controls (GENATHLETE and Japanese endurance runners, from which a panel of 45 promising markers was identified. These markers were tested for replication in seven additional cohorts of endurance athletes and controls: from Australia, Ethiopia, Japan, Kenya, Poland, Russia and Spain. The study is based on a total of 1520 endurance athletes (835 who took part in endurance events in World Championships and/or Olympic Games and 2760 controls. We hypothesized that world-class athletes are likely to be characterized by an even higher concentration of endurance performance alleles and we performed separate analyses on this subsample. The meta-analysis of all available studies revealed one statistically significant marker (rs558129 at GALNTL6 locus, p = 0.0002, even after correcting for multiple testing. As shown by the low heterogeneity index (I2 = 0, all eight cohorts showed the same direction of association with rs558129, even though p-values varied across the individual studies. In summary, this study did not identify a panel of genomic variants common to these elite endurance athlete groups. Since GAMES was underpowered to identify alleles with small effect sizes, some of the suggestive leads identified should be explored in expanded comparisons of world-class endurance athletes and sedentary controls and in tightly controlled exercise training studies. Such studies have the potential to illuminate the biology not only of world class endurance

  19. Confirmatory factors analysis of science teacher leadership in the Thailand world-class standard schools

    Science.gov (United States)

    Thawinkarn, Dawruwan

    2018-01-01

    This research aims to analyze factors of science teacher leadership in the Thailand World-Class Standard Schools. The research instrument was a five scale rating questionnaire with reliability 0.986. The sample group included 500 science teachers from World-Class Standard Schools who had been selected by using the stratified random sampling technique. Factor analysis of science teacher leadership in the Thailand World-Class Standard Schools was conducted by using M plus for Windows. The results are as follows: The results of confirmatory factor analysis on science teacher leadership in the Thailand World-Class Standard Schools revealed that the model significantly correlated with the empirical data. The consistency index value was x2 = 105.655, df = 88, P-Value = 0.086, TLI = 0.997, CFI = 0.999, RMSEA = 0.022, and SRMR = 0.019. The value of factor loading of science teacher leadership was positive, with statistical significance at the level of 0.01. The value of six factors was between 0.880-0.996. The highest factor loading was the professional learning community, followed by child-centered instruction, participation in development, the role model in teaching, transformational leaders, and self-development with factor loading at 0.996, 0.928, 0.911, 0.907, 0.901, and 0.871, respectively. The reliability of each factor was 99.1%, 86.0%, 83.0%, 82.2%, 81.0%, and 75.8%, respectively.

  20. Some concepts of favorability for world-class-type uranium deposits in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Adler, H.H.

    1981-03-01

    An account is given of concepts of favorability of geologic environments in the eastern United States for uranium deposits of several major types existing elsewhere in the world. The purpose is to convey some initial ideas about the interrelationships of the geology of the eastern United States and the geologic settings of certain of these world-class deposits. The study and report include consideration of uranium deposits other than those generally manifesting the geologic, geochemical and genetic characteristics associated with the conventional sandstone-type ores of the western United States.

  1. Some concepts of favorability for world-class-type uranium deposits in the northeastern United States

    International Nuclear Information System (INIS)

    Adler, H.H.

    1981-03-01

    An account is given of concepts of favorability of geologic environments in the eastern United States for uranium deposits of several major types existing elsewhere in the world. The purpose is to convey some initial ideas about the interrelationships of the geology of the eastern United States and the geologic settings of certain of these world-class deposits. The study and report include consideration of uranium deposits other than those generally manifesting the geologic, geochemical and genetic characteristics associated with the conventional sandstone-type ores of the western United States

  2. How to develop a world class electrical utility for the free markets of electrical energy?

    International Nuclear Information System (INIS)

    Aaltonen, J.E.; Takala, J.A.

    1995-01-01

    The electricity distribution in Finland is going to the new stage where the electrical energy market will be gradually free from competition. The purpose of this study is to analyze the concept of the world class utility. A feasibility study was made to research the condition in logistics and suitable methods for the implementation. Some ideas have been piloted to verify and find acceptable approaches of the implementation to practice. Utilities improved the cost efficiency and strategical business logistics in a customer oriented and flexible way. The methods and findings can be used on other public and industrial areas, too

  3. Monkman, B.C., area shaping up as world class gas play

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that Canadian operators are expanding a world class natural gas play in the Monkman area of eastern British Columbia. The area, in the foothills of the Canadian Rockies near Fort St. John, B.C., has yielded a string of significant gas discoveries. A number of companies-the most active BP Resources Canada Ltd. and Ocelot Energy Inc., Calgary-are playing a 30 mile wide by 50 mile long trend centering on two main producing horizons. The new successes are being scored in an area that first attracted the attention of explorationists in the 1950s. And the play's extent is still far form defined

  4. Developing world class leader-managers for the evolving nuclear industry

    International Nuclear Information System (INIS)

    Konettsni, A.L.

    2010-01-01

    The author discusses the problems of educating and training the world-class leaders for nuclear industry. He specifies the leader's characters, emphasizing that common high standards of performance have been the hallmark of the industry for years. Rapid growth in the nuclear industry could diminish the self-discipline that has been developed over decades. He lists the US Naval Nuclear Propulsion Program fundamental principles developed over six decades. The author also dwells on corporate self-motivation, self-control, self-expectancy of optimism and company's image [ru

  5. Area near Monkman, B.C., becoming world class exploration play, BP says

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports on two major oil companies in the western Canada sedimentary basin which have completed several significant gas discoveries, including a well with one of the highest flow rates ever in Canada. BP Canada Inc. completed discoveries at its Brazion and Burnt River wells in the Monkman area of northeastern British Columbia. The Monkman area is developing into a world class natural gas exploration play. Meanwhile, Amoco Canada Petroleum Co. Ltd. completed four Alberta gas discoveries in 1991 and participated with BP and PetroCanada Inc. in four British Columbia discoveries

  6. Networking to build a world-class bioenergy industry in British Columbia

    Energy Technology Data Exchange (ETDEWEB)

    Weedon, M. [BC Bioenergy Network, Vancouver, BC (Canada)

    2009-07-01

    This presentation described the role of the BC Bioenergy Network and its goal of maximizing the value of biomass resources in British Columbia (BC) and developing a world-class bioenergy industry in the province. Established in March 2008 with $25 million in funding from the BC government, the BC Bioenergy Network is an industry-led association that promotes the development of near-term bioenergy technologies and demonstration of new bioenergy technologies that are environmentally appropriate for the province of BC. The following technology areas require funding support: solid wood residues, pulp and paper residues, harvesting and pelleting, agriculture residues, municipal wastewater, municipal landfill waste, municipal solid waste, and community heating-electricity greenhouse systems. This presentation demonstrated that BC is well positioned to become a major player in the global bioenergy sector, as it has one of the largest forested areas in the world, and is a leader in biomass to value-added wood products. The opportunities, challenges, and requirements to build a world class bioenergy industry in British Columbia were discussed along with successful Canadian, US, and European collaborations with industry, research, and government. tabs., figs.

  7. Race walking gait and its influence on race walking economy in world-class race walkers.

    Science.gov (United States)

    Gomez-Ezeiza, Josu; Torres-Unda, Jon; Tam, Nicholas; Irazusta, Jon; Granados, Cristina; Santos-Concejero, Jordan

    2018-03-06

    The aim of this study was to determine the relationships between biomechanical parameters of the gait cycle and race walking economy in world-class Olympic race walkers. Twenty-One world-class race walkers possessing the Olympic qualifying standard participated in this study. Participants completed an incremental race walking test starting at 10 km·h -1 , where race walking economy (ml·kg -1 ·km -1 ) and spatiotemporal gait variables were analysed at different speeds. 20-km race walking performance was related to race walking economy, being the fastest race walkers those displaying reduced oxygen cost at a given speed (R = 0.760, p < 0.001). Longer ground contact times, shorter flight times, longer midstance sub-phase and shorter propulsive sub-phase during stance were related to a better race walking economy (moderate effect, p < 0.05). According to the results of this study, the fastest race walkers were more economi cal than the lesser performers. Similarly, shorter flight times are associated with a more efficient race walking economy. Coaches and race walkers should avoid modifying their race walking style by increasing flight times, as it may not only impair economy, but also lead to disqualification.

  8. Analysis of speed, stroke rate, and stroke distance for world-class breaststroke swimming.

    Science.gov (United States)

    Garland Fritzdorf, Stephen; Hibbs, Angela; Kleshnev, Valery

    2009-02-15

    Speed in aquatic locomotion is determined by stroke distance and stroke rate, but it does not always follow that an increase in stroke rate will lead to an increase in speed. Kleshnev (2006) developed a method to evaluate the relationship between speed and stroke rate during rowing - the effective work per stroke. In this case study, the effective work per stroke was determined for a male world-class 100-m breaststroke swimmer for seven races in major championships and compared between: each of the seven races; each quarter within each race; and the best swims of this case study and seven other world-class swimmers. The effective work per stroke was related to race performance, with the fastest race having the highest effective work per stroke and lowest stroke rate, with slower races having low effectiveness and high stroke rate (R(2) = 0.85). The effective work per stroke was reduced in a race as the swimmer fatigued. The within-race standard deviation of effectiveness was lower in fast swims (R(2) = 0.84). This analysis has identified some characteristics of fast swimming: high effectiveness, optimal stroke rate, and a flat effectiveness profile. Training and racing strategies can now be devised to improve performance by increasing the sensitivity of assessment of strengths and weaknesses in individuals.

  9. The inverted Batman incision: a new incision in transcolumellar incision for open rhinoplasty.

    Science.gov (United States)

    Nakanishi, Yuji; Nagasao, Tomohisa; Shimizu, Yusuke; Miyamoto, Junpei; Fukuta, Keizo; Kishi, Kazuo

    2013-12-01

    Columellar and nostril shapes often present irregularity after transcolumellar incision for open rhinoplasty, because of the contracture of the incised wound. The present study introduces a new technique to prevent this complication, and verifies its efficacy in improving cosmetic appearance. In our new method, a zig-zag incision with three small triangular flaps is made on the columella and in the pericolumellar regions of the bilateral nostril rims. Since the shape of the incision resembles the contour of an inverted "batman", we term our new method the "Inverted Batman" incision. To verify the effectiveness of the Inverted Batman incision, aesthetic evaluation was conducted for 21 patients operated on using the conventional transcolumellar incision (Conventional Group) and 19 patients operated on using the Inverted Batman incision (Inverted Batman Group). The evaluation was performed by three plastic surgeons, using a four-grade scale to assess three separate items: symmetry of bilateral soft triangles, symmetry of bilateral margins of the columella, and evenness of the columellar surface. The scores of the two groups for these three items were compared using a non-parametric test (Mann-Whitney U-test). With all three items, the Inverted Batman group patients present higher scores than Conventional Group patients. The Inverted Batman incision is effective in preserving the correct anatomical structure of the columella, soft triangle, and nostril rims. Hence, we recommend the Inverted Batman incision as a useful technique for open rhinoplasty.

  10. Minimal abdominal incisions

    Directory of Open Access Journals (Sweden)

    João Carlos Magi

    2017-04-01

    Full Text Available Minimally invasive procedures aim to resolve the disease with minimal trauma to the body, resulting in a rapid return to activities and in reductions of infection, complications, costs and pain. Minimally incised laparotomy, sometimes referred to as minilaparotomy, is an example of such minimally invasive procedures. The aim of this study is to demonstrate the feasibility and utility of laparotomy with minimal incision based on the literature and exemplifying with a case. The case in question describes reconstruction of the intestinal transit with the use of this incision. Male, young, HIV-positive patient in a late postoperative of ileotiflectomy, terminal ileostomy and closing of the ascending colon by an acute perforating abdomen, due to ileocolonic tuberculosis. The barium enema showed a proximal stump of the right colon near the ileostomy. The access to the cavity was made through the orifice resulting from the release of the stoma, with a lateral-lateral ileo-colonic anastomosis with a 25 mm circular stapler and manual closure of the ileal stump. These surgeries require their own tactics, such as rigor in the lysis of adhesions, tissue traction, and hemostasis, in addition to requiring surgeon dexterity – but without the need for investments in technology; moreover, the learning curve is reported as being lower than that for videolaparoscopy. Laparotomy with minimal incision should be considered as a valid and viable option in the treatment of surgical conditions. Resumo: Procedimentos minimamente invasivos visam resolver a doença com o mínimo de trauma ao organismo, resultando em retorno rápido às atividades, reduções nas infecções, complicações, custos e na dor. A laparotomia com incisão mínima, algumas vezes referida como minilaparotomia, é um exemplo desses procedimentos minimamente invasivos. O objetivo deste trabalho é demonstrar a viabilidade e utilidade das laparotomias com incisão mínima com base na literatura e

  11. Craniosynostosis incision: scalpel or cautery?

    Science.gov (United States)

    Wood, Jeyhan S; Kittinger, Benjamin J; Perry, Victor L; Adenola, Adeyemi; van Aalst, John A

    2014-07-01

    There is an ongoing debate regarding the optimal instrument for scalp incisions: the scalpel or electrocautery. The argument generally focuses on improved healing after an incision made with a knife and decreased bleeding when using electrocautery. This study compares the use of scalpel and electrocautery in making coronal incisions for patients undergoing surgical correction of craniosynostosis. The outcome metric used is wound healing within 6 months after surgery. All patients presenting to the University of North Carolina Children's Hospital with craniosynostosis between July 1, 2007 and January 1, 2010 requiring a coronal incision for surgical correction were prospectively enrolled. In all of these patients, half of the coronal incision was made with knife; the other half, with needle tip cautery. Side of the incision was specified at the time of surgery in the operative report. Patients were excluded from the study if the instrument for incision was not specified or if only 1 modality was used for the entire incision. Sixty-eight patients underwent cranial vault reconstruction, of which 58 met inclusion criteria. Of the 58 matched pairs, 55 were analyzed statistically. The 3 excluded cases were those who had midline complications. There were 17 wound complications (15%): 8 in the knife group, 6 in the cautery group, and 3 at midline (with indeterminate side for the problem). We found no statistically significant difference in wound healing between incisions made with a knife or with electrocautery.

  12. The fourth incision: a cosmetic autopsy incision technique.

    Science.gov (United States)

    Patowary, Amarjyoti

    2010-03-01

    Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such, there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies. So, autopsy incisions should be such that, we can get maximum possible visualization of the body cavities, particularly the thorax and abdomen, and at the same time the incision as well as the stitch marks are also hidden. This article is aimed to describe few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden.

  13. Salivary Hormones Response to Preparation and Pre-competitive Training of World-class Level Athletes

    Science.gov (United States)

    Guilhem, Gaël; Hanon, Christine; Gendreau, Nicolas; Bonneau, Dominique; Guével, Arnaud; Chennaoui, Mounir

    2015-01-01

    This study aimed to compare the response of salivary hormones of track and field athletes induced by preparation and pre-competitive training periods in an attempt to comment on the physiological effects consistent with the responses of each of the proteins measured. Salivary testosterone, cortisol, alpha-amylase, immunoglobulin A (IgA), chromogranin A, blood creatine kinase activity, and profile of mood state were assessed at rest in 24 world-class level athletes during preparation (3 times in 3 months) and pre-competitive (5 times in 5 weeks) training periods. Total mood disturbance and fatigue perception were reduced, while IgA (+61%) and creatine kinase activity (+43%) increased, and chromogranin A decreased (−27%) during pre-competitive compared to preparation period. A significant increase in salivary testosterone (+9 to +15%) and a decrease in testosterone/cortisol ratio were associated with a progressive reduction in training load during pre-competitive period (P athletics training. PMID:26635619

  14. The advanced neutron source - A world-class research reactor facility

    International Nuclear Information System (INIS)

    Thompson, P.B.; Meek, W.E.

    1993-01-01

    The advanced neutron source (ANS) is a new facility being designed at the Oak Ridge National Laboratory that is based on a heavy-water-moderated reactor and extensive experiment and user-support facilities. The primary purpose of the ANS is to provide world-class facilities for neutron scattering research, isotope production, and materials irradiation in the United States. The neutrons provided by the reactor will be thermalized to produce sources of hot, thermal, cold, very cold, and ultracold neutrons usable at the experiment stations. Beams of cold neutrons will be directed into a large guide hall using neutron guide technology, greatly enhancing the number of research stations possible in the project. Fundamental and nuclear physics, materials analysis, and other research pro- grams will share the neutron beam facilities. Sufficient laboratory and office space will be provided to create an effective user-oriented environment

  15. Brain anatomical networks in world class gymnasts: a DTI tractography study.

    Science.gov (United States)

    Wang, Bin; Fan, Yuanyuan; Lu, Min; Li, Shumei; Song, Zheng; Peng, Xiaoling; Zhang, Ruibin; Lin, Qixiang; He, Yong; Wang, Jun; Huang, Ruiwang

    2013-01-15

    The excellent motor skills of world class gymnasts amaze everyone. People marvel at the way they precisely control their movements and wonder how the brain structure and function of these elite athletes differ from those of non-athletes. In this study, we acquired diffusion images from thirteen world class gymnasts and fourteen matched controls, constructed their anatomical networks, and calculated the topological properties of each network based on graph theory. From a connectivity-based analysis, we found that most of the edges with increased connection density in the champions were linked to brain regions that are located in the sensorimotor, attentional, and default-mode systems. From graph-based metrics, we detected significantly greater global and local efficiency but shorter characteristic path length in the anatomical networks of the champions compared with the controls. Moreover, in the champions we found a significantly higher nodal degree and greater regional efficiency in several brain regions that correspond to motor and attention functions. These included the left precentral gyrus, left postcentral gyrus, right anterior cingulate gyrus and temporal lobes. In addition, we revealed an increase in the mean fractional anisotropy of the corticospinal tract in the champions, possibly in response to long-term gymnastic training. Our study indicates that neuroanatomical adaptations and plastic changes occur in gymnasts' brain anatomical networks either in response to long-term intensive gymnastic training or as an innate predisposition or both. Our findings may help to explain gymnastic skills at the highest levels of performance and aid in understanding the neural mechanisms that distinguish expert gymnasts from novices. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Analysis of lower limb work-energy patterns in world-class race walkers.

    Science.gov (United States)

    Hanley, Brian; Bissas, Athanassios

    2017-05-01

    The aim of this study was to analyse lower limb work patterns in world-class race walkers. Seventeen male and female athletes race walked at competitive pace. Ground reaction forces (1000 Hz) and high-speed videos (100 Hz) were recorded and normalised joint moments, work and power, stride length, stride frequency and speed estimated. The hip flexors and extensors were the main generators of energy (24.5 J (±6.9) and 40.3 J (±8.3), respectively), with the ankle plantarflexors (16.3 J (±4.3)) contributing to the energy generated during late stance. The knee generated little energy but performed considerable negative work during swing (-49.1 J (±8.7)); the energy absorbed by the knee extensors was associated with smaller changes in velocity during stance (r = .783, P < .001), as was the energy generated by the hip flexors (r = -.689, P = .002). The knee flexors did most negative work (-38.6 J (±5.8)) and the frequent injuries to the hamstrings are probably due to this considerable negative work. Coaches should note the important contributions of the hip and ankle muscles to energy generation and the need to develop knee flexor strength in reducing the risk of injury.

  17. Kajian Budaya Organisasi Bina Nusantara University Menuju “A World Class University”

    Directory of Open Access Journals (Sweden)

    Amia Luthfia

    2013-10-01

    Full Text Available University is an important institution that would form the nation culture and responsible for the culture transmission. The assessment of a good organizational culture is an important part in the study of organizational culture. The research objective is to analyze organizational culture of Bina Nusantara University comprehensively, the strengths and weaknesses of its effort to become “The World Class University". The research methodology is qualitative with method combination of FGD, in-depth interviews and covert observation. The research outcome shows that Bina Nusantara University has had elements of modern organization characteristic such as innovative management (centralized non-academic function and decentralize academic function; transparent and results-oriented management system with clear and measurable target; detail operational procedure. It has been able to create healthy working environment that supports high integrity, working ethics, dedication, loyalty, opened communication and high sense of belonging. It utilizes information and communications technology through a comprehensive and integrated system called Binusmaya as its ikon and identity.As an educational institution, Bina Nusantara University should develop 3 other elements which are role model, spirit and character building. Former rector (the founder was an inspired role model that provided a profound influence to the attitudes and behaviors of its members. 

  18. Comparison of between-training-sessions recovery strategies for world-class BMX pilots.

    Science.gov (United States)

    Marquet, Laurie-Anne; Hausswirth, Christophe; Hays, Arnaud; Vettoretti, Fabrice; Brisswalter, Jeanick

    2015-03-01

    To assess the impact of between-training-sessions recovery strategies (passive [PAS], active [ACT], cold-water immersion [CWI], and ingestion of a recovery drink [NUTR]) on maximal cycling performance, perceptions of delayed-onset muscle soreness (DOMS), and fatigue in world-class BMX riders. Eleven elite BMX athletes, members of the French national team (top country in the 2011 international ranking, 4 medals at the 2012 World Championships, top European country), participated in the study, which involved standardized training periods. Athletes performed 3 maximal-sprint power tests: the first day of the week before the training session and before and after training on the third day of the week (D3). The recovery strategy was randomly assigned to each participant on day 2 immediately after the last training period of the day. Perceptions of DOMS and general fatigue were recorded on D3. After training on D3, the decrease in maximal-sprint power (Pmax) was significantly greater for PAS than with CWI (P=.02) and NUTR (P=.018). Similar results were found with ACT (vs CWI P=.044, and vs NUTR P=.042). Self-reported DOMS and fatigue were significantly greater after PAS than after other strategies. For elite BMX riders, between training days, nutritional and/or CWI recovery strategies appear to be best for reducing muscle fatigue and increasing the capacity to withstand the training schedule.

  19. Memory skills mediating superior memory in a world-class memorist.

    Science.gov (United States)

    Ericsson, K Anders; Cheng, Xiaojun; Pan, Yafeng; Ku, Yixuan; Ge, Yi; Hu, Yi

    2017-10-01

    Laboratory studies have investigated how individuals with normal memory spans attained digit spans over 80 digits after hundreds of hours of practice. Experimental analyses of their memory skills suggested that their attained memory spans were constrained by the encoding time, for the time needed will increase if the length of digit sequences to be memorised becomes longer. These constraints seemed to be violated by a world-class memorist, Feng Wang (FW), who won the World Memory Championship by recalling 300 digits presented at 1 digit/s. In several studies we examined FW's memory skills underlying his exceptional performance. First FW reproduced his superior memory span of 200 digits under laboratory condition, and we obtained his retrospective reports describing his encoding/retrieval processes (Experiment 1). Further experiments used self-paced memorisation to identify temporal characteristics of encoding of digits in 4-digit clusters (Experiment 2), and explored memory encoding at presentation speeds much faster than 1 digit/s (Experiment 3). FW's superiority over previous digit span experts is explained by his acquisition of well-known mnemonic techniques and his training that focused on rapid memorisation. His memory performance supports the feasibility of acquiring memory skills for improved working memory based on storage in long-term memory.

  20. Shoulder pain -- a common problem in world-class badminton players.

    Science.gov (United States)

    Fahlström, Martin; Yeap, Joo Seng; Alfredson, Håkan; Söderman, Kerstin

    2006-06-01

    Badminton is a sport that requires a lot of over-shoulder motion, with the shoulder in abduction/external rotation. This questionnaire study on 188 international top-level badminton players during the World Mixed Team Championships showed that previous or present shoulder pain on the dominant side was reported by 52% of the players. Previous shoulder pain was reported by 37% of the players and on-going shoulder pain by 20% of the players. There were no significant differences in the prevalence of shoulder pain between men and women. The majority of the shoulder pain had started gradually. The pain was usually associated with shoulder activity, and stiffness was a common, associated symptom. Furthermore, the shoulder pain was associated with consequences such as sleeping disturbances, changes in training and competition habits, and it also affected activities of daily living. The majority of the players had sought medical advice and had been given different kinds of treatment. The study showed that shoulder pain is a common and significant problem in world-class badminton players, and the consequences are most likely of importance for their training and playing capacity.

  1. Small-Town Touch, Big-City Innovation, World-Class Aspirations.

    Science.gov (United States)

    Forgey, Warren L; Dye, Tammy

    2015-01-01

    The healthcare system in the United States is at a critical crossroads. Costs are rising, measures of healthcare quality are well below those of other industrialized nations, and public and regulatory scrutiny is increasing. Healthcare leaders are searching for more effective, efficient, and sustainable operational models to address the mounting challenges they face. We at Schneck Medical Center in Seymour, Indiana, chose the Baldrige Excellence Framework to guide our organization, to accelerate our performance improvement journey, and to create sustainable results in our core services. The Baldrige Framework uses a systematic approach to innovation and improvement in seven key management areas. These seven areas were leadership; strategic planning; customer focus; measurement, analysis, and knowl- edge management; workforce focus; operations focus; and results (Baldrige Performance Excellence Program 2015). In this article, we describe our Baldrige journey. We address why we chose to use the Framework, how we engaged our key stakeholders, and what challenges we faced and lessons we learned along the way. In addition, we detail how Schneck's focus on performance improvement has resulted in significant returns to the organization. Throughout the article, we refer to our pursuit of performance excellence as a "journey," and it is indeed just that. Quality improvement takes time, because it is a transformation with many steps. World-class performance is attainable only with years of work and constant refinement.

  2. Liquid in the major incision

    International Nuclear Information System (INIS)

    Herrera Jaramillo, Diego Alberto; Ortega Jaramillo, Hector

    2003-01-01

    We present the case of a patient with spill pleural extending in the left major incision. In the chest thorax PA, we could observe one of the complex radiographic appearances that take the reconfiguration of fluid in this localization, being this appearance dependent of the patient's position. Some points are also discussed on the anatomy of the major incisions and some of their radiographic characteristics

  3. Seeking a Roadmap to Becoming World Class: Strategic Planning at Peking University. Research & Occasional Paper Series: CSHE.11.13

    Science.gov (United States)

    Guangkuan, Xie

    2013-01-01

    Strategic planning plays an important but sometimes controversial role in higher education. This paper examines how strategic planning works in Chinese universities, using Peking University as a case study. This essay discusses the rationale for why Peking University (PKU) decided to pursue status as a world-class university along with objectives…

  4. Increased Blood Lactate Level Deteriorates Running Economy in World Class Endurance Athletes.

    Science.gov (United States)

    Hoff, Jan; Støren, Øyvind; Finstad, Arnstein; Wang, Eivind; Helgerud, Jan

    2016-05-01

    Blood lactate accumulation is associated with development of muscle fatigue and negatively correlated to endurance performance. No research has quantified the effects of lactate presence at moderate levels of lactate accumulation. The purpose of this study was to test whether 2 moderate blood lactate concentration levels affect running economy (RE) when running at the individual lactate threshold (LT). Seven male world class endurance athletes with an average V[Combining Dot Above]O2max of 80.7 ± 2.7 ml·kg·min or 5.8 ± 0.5 L·min participated in this study. After the V[Combining Dot Above]O2max test, the subjects were resting or walking and in a random order tested for RE at their LT velocity when the blood lactate level reached either 3 mmol·L or 5 mmol·L. After a new 5-minute exercising period at maximal aerobic velocity, the crossover lactate value RE testing was performed. Running economy was significantly (p ≤ 0.05) deteriorated from 0.668 ± 0.044 to 0.705 ± 0.056 ml·kg·m or 5.5% (p ≤ 0.05) for blood lactate level of 3 mmol·L compared with 5 mmol·L, respectively. Increased lactate level from 3 to 5 mmol·L is thus accompanied by deteriorated RE at LT running velocity. The deteriorated RE at moderate levels of lactate concentration emphasizes the importance of avoiding intensities above LT in the early parts of a dominantly aerobic endurance competition. It also emphasizes the importance of a high V[Combining Dot Above]O2max for aerobic endurance athletes and may partly explain the V[Combining Dot Above]O2 slow component as impaired RE.

  5. Up to code: does your company's conduct meet world-class standards?

    Science.gov (United States)

    Paine, Lynn; Deshpandé, Rohit; Margolis, Joshua D; Bettcher, Kim Eric

    2005-12-01

    Codes of conduct have long been a feature of corporate life. Today, they are arguably a legal necessity--at least for public companies with a presence in the United States. But the issue goes beyond U.S. legal and regulatory requirements. Sparked by corruption and excess of various types, dozens of industry, government, investor, and multisector groups worldwide have proposed codes and guidelines to govern corporate behavior. These initiatives reflect an increasingly global debate on the nature of corporate legitimacy. Given the legal, organizational, reputational, and strategic considerations, few companies will want to be without a code. But what should it say? Apart from a handful of essentials spelled out in Sarbanes-Oxley regulations and NYSE rules, authoritative guidance is sorely lacking. In search of some reference points for managers, the authors undertook a systematic analysis of a select group of codes. In this article, they present their findings in the form of a "codex," a reference source on code content. The Global Business Standards Codex contains a set of overarching principles as well as a set of conduct standards for putting those principles into practice. The GBS Codex is not intended to be adopted as is, but is meant to be used as a benchmark by those wishing to create their own world-class code. The provisions of the codex must be customized to a company's specific business and situation; individual companies' codes will include their own distinctive elements as well. What the codex provides is a starting point grounded in ethical fundamentals and aligned with an emerging global consensus on basic standards of corporate behavior.

  6. Qualitative Video Analysis of Track-Cycling Team Pursuit in World-Class Athletes.

    Science.gov (United States)

    Sigrist, Samuel; Maier, Thomas; Faiss, Raphael

    2017-11-01

    Track-cycling team pursuit (TP) is a highly technical effort involving 4 athletes completing 4 km from a standing start, often in less than 240 s. Transitions between athletes leading the team are obviously of utmost importance. To perform qualitative video analyses of transitions of world-class athletes in TP competitions. Videos captured at 100 Hz were recorded for 77 races (including 96 different athletes) in 5 international track-cycling competitions (eg, UCI World Cups and World Championships) and analyzed for the 12 best teams in the UCI Track Cycling TP Olympic ranking. During TP, 1013 transitions were evaluated individually to extract quantitative (eg, average lead time, transition number, length, duration, height in the curve) and qualitative (quality of transition start, quality of return at the back of the team, distance between third and returning rider score) variables. Determination of correlation coefficients between extracted variables and end time allowed assessment of relationships between variables and relevance of the video analyses. Overall quality of transitions and end time were significantly correlated (r = .35, P = .002). Similarly, transition distance (r = .26, P = .02) and duration (r = .35, P = .002) were positively correlated with end time. Conversely, no relationship was observed between transition number, average lead time, or height reached in the curve and end time. Video analysis of TP races highlights the importance of quality transitions between riders, with preferably swift and short relays rather than longer lead times for faster race times.

  7. Single incision pediatric endoscopic surgery: advantages of relatively large incision

    International Nuclear Information System (INIS)

    Yilmaz, E.; Afsarlar, E.; Karaman, I.

    2015-01-01

    To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

  8. A Model Proposal and Implementation Concerning Occupational Health and Safety within the Framework of World Class Manufacturing

    OpenAIRE

    GÜMÜŞOĞLU, Şevkinaz; TEPEKULE, Esin Tuba

    2017-01-01

    The approach, which aims atbecoming the best in every application and operation realizing every strategythat it has at a perfect level, has been referred to as World ClassManufacturing (WCM).  The synergic effectof WCM inherent in application and strategies will be helpful in takingbusinesses’ strength to the desired level in the current competitiveenvironment. For businesses in applications of Occupational Health and Safety(OHS) to perform at the top level will contribute to become the best,...

  9. Superficial parotidectomy via facelift incision

    NARCIS (Netherlands)

    Lohuis, Peter J. F. M.; Tan, M. Liane; Bonte, Katrien; van den Brekel, Michiel W. M.; Balm, Alfons J. M.; Vermeersch, Hubert B.

    2009-01-01

    The stigma of a visually prominent facial scar following parotid surgery can be distressing to a young patient. The surgical technique of parotidectomy via a facelift incision is described and evaluated. Thirty patients with a benign lesion of the parotid gland underwent a partial superficial

  10. Effects of the Competitive Season on the Isokinetic Muscle Parameters Changes in World-Class Handball Players.

    Science.gov (United States)

    Maurelli, Olivier; Bernard, Pierre L; Dubois, Romain; Ahmaidi, Said; Prioux, Jacques

    2018-05-25

    Maurelli, O, Bernard, PL, Dubois, R, Ahmaidi, S, and Prioux, J. Effects of the competitive season on the isokinetic muscle parameters changes in world-class handball players. J Strength Cond Res XX(X): 000-000, 2018-The aim of this study is to investigate the effects of the competitive season on isokinetic muscular parameters of the lower limbs in world-class handball players. Nineteen, male, world-class, handball players (age, 26.6 ± 5.4 years) participated in the study. Two bilateral isokinetic tests of knee joint flexors (H; hamstring) and extensors (Q; quadriceps) were performed in the beginning and end of the competitive season to determine the peak torque (PT), the mean power, and agonist-antagonist ratio, dominant-nondominant ratio (DNDR), and combined ratio. The results showed a significant decrease in PT values at low angular velocity (60°·s) in concentric mode for Q on dominant leg (p handball players. Accordingly, this study should help trainers to modify their planning to maximize strength and power qualities of the lower limbs of their players in addition to avoiding injuries.

  11. Postoperative Granulomas at Liposuction Incision Sites.

    Science.gov (United States)

    Weniger, Frederick G; White, Peter F; Barrero Castedo, Carlos E

    2016-02-01

    Since most liposuction incisions heal uneventfully, difficult healing in such incisions must be investigated. In the cases of two gynecomastia liposuction patients in which a water-based lubricating gel was used on the liposuction incisions, the incisions failed to heal. For both patients, workup uncovered palisading granulomas at the lateral inframammary fold incision sites several months after otherwise successful surgeries. These two cases are presented and the previous literature is reviewed, with consideration given to the etiology and prevention of such granulomas. LEVEL OF EVIDENCE 5: Risk. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  12. Developing World-Class Customer Service at Navy Field Contracting Activities: An Assessment of the FISC San Diego Regional Contracts Department

    National Research Council Canada - National Science Library

    Allen, Robert

    1997-01-01

    .... The thesis defines world-class customer service and then describes various aspects of service quality including the customer's perspective on service, how service is delivered, how to effectively...

  13. Concurrent Development of Endurance Capacity and Explosiveness: Training Characteristics of World-Class Nordic-Combined Athletes.

    Science.gov (United States)

    Tønnessen, Espen; Rasdal, Vegard; Svendsen, Ida S; Haugen, Thomas A; Hem, Erlend; Sandbakk, Øyvind

    2016-07-01

    Performing at an elite level in Nordic combined (NC) requires both the explosiveness required for ski jumping performance and the endurance capacity required for cross-country skiing. To describe the characteristics of world-class NC athletes' training and determine how endurance and non-endurance (ie, strength, power, and ski jumping) training is periodized. Annual training characteristics and the periodization of endurance and non-endurance training were determined by analyzing the training diaries of 6 world-class NC athletes. Of 846 ± 72 annual training hours, 540 ± 37 h were endurance training, with 88.6% being low-, 5.9% moderate-, and 5.5% high-intensity training. While training frequency remained relatively constant, the total training volume was reduced from the general preparatory to the competition phase, primarily due to less low- and moderate-intensity training (P ski-jump-specific training (908 ± 165 ski jumps and ski-jump imitations). The proportion of non-endurance training increased significantly toward the competition phase (P ski-jump training. These data provide novel insight on how successful athletes execute their training and may facilitate more-precise coaching of future athletes in this sport. In addition, this information is of high relevance for the training organization of other sports that require optimization of 2 fundamentally different physical capacities.

  14. Self-reported symptoms and risk factors for digital ischaemia among international world-class beach volleyball players.

    Science.gov (United States)

    Van De Pol, Daan; Alaeikhanehshir, Sena; Maas, Mario; Kuijer, P Paul F M

    2016-01-01

    The prevalence of ischaemia-related symptoms is remarkably high among elite indoor volleyball players. Since the exposure to sport-specific demands may be higher in beach volleyball compared to indoor volleyball, the aim of this study was to assess the prevalence of ischaemia-related symptoms and associated risk factors among world-class beach volleyball players. Therefore, a questionnaire survey was performed among beach volleyball players active during the 2013 Grand Slam Beach Volleyball in the Netherlands. In total, 60 of the 128 beach volleyball players (47%) participated: 26 males and 34 females from 17 countries. The self-reported prevalence of cold or blue or pale digits in the dominant hand during or immediately after practice or competition was 38% (n = 23). Two risk factors were independently associated with symptoms of blue or pale digits: more than 14 years playing volleyball (odds ratio (OR) 4.42, 90% confidence interval (90% CI) 1.30-15.07) and sex (female) (OR 4.62, 90% CI 1.15-18.57). In conclusion, the prevalence of symptoms associated with digital ischaemia is high among international world-class beach volleyball players. Female sex and the length of the volleyball career were independently associated with an increased risk of ischaemia-related symptoms. The high prevalence of these seemingly innocuous symptoms and possible associated risk factors warrant regular monitoring since early detection can potentially prevent thromboembolic complications and irreversible tissue damage.

  15. Levels of Management Commitment: A Moderator the Structural Relationships among Critical Success Factors of TQM, World-Class Performance in Operations, and Company Financial Performance

    Directory of Open Access Journals (Sweden)

    Wakhid Slamet Ciptono

    2012-01-01

    Full Text Available This study investigates the moderating impacts of the three levels of management commitment (top, middle, and low levels on the structural relationships among the constructs— six critical success factors of TQM (quality improvement program, supervisory leadership, supplier involvement, management commitment, training to improve products/services, cross-functional relationships; world-class performance in operations (world-class company practices, operational excellence practices, company non-financial performance; and company financial performance. It uses a sample of 1,332 managers in 140 strategic business units (SBUs within 49 oil and gas companies in Indonesia. The empirical results indicate that the goodness-of-fit of the unconstrained model is much better than that of the constrained model, and this is an indicative that the three level of management moderates the structural relationships among the constructs. Those are, three levels of management act as a moderator variable between critical success factors of TQM, world-class company practices, operational excellence practices, company non-financial performance, and company financial performance. Results further reveal that world-class performances in operations (world-class company practices, operational excellence practices, and company non-financial performance were positively mediated the impact of critical success factors of TQM on company financial performance. Results also point out that five of six critical success factors of TQM positively associated with world-class company practices and operational excellence practices under the three levels of management (top, middle, low. World-class company practices and operational excellence practices have direct and significant effects on company non-financial performance (productivity, operational reliability. Furthermore, empirical results suggest that there is a positive and significant relationship between company non

  16. Levels of Management Commitment: a Moderator the Structural Relationships Among Critical Success Factors of TQM, World-Class Performance in Operations, and Company Financial Performance

    OpenAIRE

    Slamet Ciptono, Wakhid

    2008-01-01

    This study investigates the moderating impacts of the three levels of management commitment (top, middle, and low levels) on the structural relationships among the constructs— six critical success factors of TQM (quality improvement program, supervisory leadership, supplier involvement, management commitment, training to improve products/services, cross-functional relationships); world-class performance in operations (world-class company practices, operational excellence practices, company no...

  17. Modified tubularized incised plate urethroplasty

    Directory of Open Access Journals (Sweden)

    Shivaji Mane

    2013-01-01

    Full Text Available Aim: To share our experience of doing tubularized incised plate urethroplasty with modifications. Materials and Methods: This is a single surgeon personal series from 2004 to 2009. One hundred patients of distal hypospadias were subjected for Snodgrass urethroplasty with preputioplasty. The age range was 1 to 5 year with mean age of 2.7 years. Selection criteria were good urethral plate, without chordee and torsion needing complete degloving. Main technical modification from original Snodgrass procedure was spongioplasty, preputioplasty, and dorsal slit when inability to retract prepuce during surgery. Results: Average follow-up period is 23 months. Seven (7% patients developed fistula and one patient had complete preputial dehiscence. Phimosis developed in three (3% patients and required circumcision. Dorsal slit was required in seven patients. One patient developed meatal stenosis in postoperative period. All other patients are passing single urinary stream and have cosmesis that is acceptable. Conclusions: Modified tubularized incised plate urethroplasty with preputioplasty effectively gives cosmetically normal looking penis with low complications.

  18. Heart-Rate Variability During Deep Sleep in World-Class Alpine Skiers: A Time-Efficient Alternative to Morning Supine Measurements.

    Science.gov (United States)

    Herzig, David; Testorelli, Moreno; Olstad, Daniela Schäfer; Erlacher, Daniel; Achermann, Peter; Eser, Prisca; Wilhelm, Matthias

    2017-05-01

    It is increasingly popular to use heart-rate variability (HRV) to tailor training for athletes. A time-efficient method is HRV assessment during deep sleep. To validate the selection of deep-sleep segments identified by RR intervals with simultaneous electroencephalography (EEG) recordings and to compare HRV parameters of these segments with those of standard morning supine measurements. In 11 world-class alpine skiers, RR intervals were monitored during 10 nights, and simultaneous EEGs were recorded during 2-4 nights. Deep sleep was determined from the HRV signal and verified by delta power from the EEG recordings. Four further segments were chosen for HRV determination, namely, a 4-h segment from midnight to 4 AM and three 5-min segments: 1 just before awakening, 1 after waking in supine position, and 1 in standing after orthostatic challenge. Training load was recorded every day. A total of 80 night and 68 morning measurements of 9 athletes were analyzed. Good correspondence between the phases selected by RR intervals vs those selected by EEG was found. Concerning root-mean-squared difference of successive RR intervals (RMSSD), a marker for parasympathetic activity, the best relationship with the morning supine measurement was found in deep sleep. HRV is a simple tool for approximating deep-sleep phases, and HRV measurement during deep sleep could provide a time-efficient alternative to HRV in supine position.

  19. Modified incision for maxillectomy: our experience.

    Science.gov (United States)

    Bhavana, Kranti; Tyagi, Isha; Ramani, Mukesh Kumar

    2012-06-01

    Radical maxillectomy has usually been done by the classical Weber Ferguson incision since age old times and still is being used widely due to its advantage of excellent exposure and minimal scarring as the incision follows the natural skin crease. In our modification of radical maxillectomy incision we avoid a scar on the midface by performing a midface degloving and combining it with a subconjunctival eye incision thus avoiding any cosmetic deformity and associated eye complication. It also avoids the late complication of cutaneous fistula following radiotherapy to these areas and due to early healing of the wound, early radiotherapy can be started.

  20. A world class nuclear research reactor complex for South Africa's nuclear future

    International Nuclear Information System (INIS)

    Keshaw, Jeetesh

    2008-01-01

    South Africa recently made public its rather ambitious goals pertaining to nuclear energy developments in a Draft Policy and Strategy issued for public comment. Not much attention was given to an important tool for nuclear energy research and development, namely a well equipped and maintained research reactor, which on its own does not do justice to its potential, unless it is fitted with all the ancillaries and human resources as most first world countries have. In South Africa's case it is suggested to establish at least one Nuclear Energy Research and Development Centre at such a research reactor, where almost all nuclear energy related research can be carried out on par with some of the best in the world. The purpose of this work is to propose how this could be done, and motivate why it is important that it be done with great urgency, and with full involvement of young professionals, if South Africa wishes to face up to the challenges mentioned in the Draft Strategy and Policy. (authors)

  1. A world class nuclear research reactor complex for South Africa's nuclear future

    Energy Technology Data Exchange (ETDEWEB)

    Keshaw, Jeetesh [South African Young Nuclear Professional Society, PO Box 9396, Centurion, 0157 (South Africa)

    2008-07-01

    South Africa recently made public its rather ambitious goals pertaining to nuclear energy developments in a Draft Policy and Strategy issued for public comment. Not much attention was given to an important tool for nuclear energy research and development, namely a well equipped and maintained research reactor, which on its own does not do justice to its potential, unless it is fitted with all the ancillaries and human resources as most first world countries have. In South Africa's case it is suggested to establish at least one Nuclear Energy Research and Development Centre at such a research reactor, where almost all nuclear energy related research can be carried out on par with some of the best in the world. The purpose of this work is to propose how this could be done, and motivate why it is important that it be done with great urgency, and with full involvement of young professionals, if South Africa wishes to face up to the challenges mentioned in the Draft Strategy and Policy. (authors)

  2. Lean health care: what can hospitals learn from a world-class automaker?

    Science.gov (United States)

    Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Billi, John E

    2006-05-01

    With health care costs continuing to rise, a variety of process improvement methodologies have been proposed to address the reported inefficiencies in health care delivery. Lean production is one such method. The management philosophy and tools of lean production come from the manufacturing industry, where they were pioneered by Toyota Motor Corporation, which is viewed as the leader in utilizing these performance improvement methods. Lean has already enjoyed tremendous success in improving quality and efficiency in both the manufacturing and the service sector industries. Health care systems have just begun to utilize lean methods, with reports of improvements just beginning to appear in the literature. We describe some of the basic philosophy and principles of lean production methods and how these concepts can be applied in the health care environment. We describe some of the early success stories and ongoing endeavors of lean production in various health care organizations. We believe the hospital is an ideal setting for use of the lean production method, which could significantly affect how health care is delivered to patients. We conclude by discussing some of the potential challenges in introducing and implementing lean production methods in the health care environment. Lean production is a novel approach to delivering high-quality and efficient care to patients, and we believe that the health care sector can anticipate the same high level of success that the manufacturing and service industries have achieved using this approach. Hospitalists are primed to take action in delivering care of greater quality with more efficiency by applying these new principles in the hospital setting. (c) 2006 Society of Hospital Medicine.

  3. Mediation Analysis Using the Hierarchical Multiple Regression Technique: A Study of the Mediating Roles of World-Class Performance in Operations

    Directory of Open Access Journals (Sweden)

    Wakhid S. Ciptono

    2010-05-01

    mediating roles of the contextual factors of world-class performance in operations (i.e., world-class company practices or WCC, operational excellence practices or OE, company nonfinancial performance or CNFP, and the company financial performance would enable the company to facilitate the sustainability of TQM implementation model. This empirical study aims to assess how TQM—a holistic management philosophy initially developed by W. Edward Deming, which integrates improvement strategy, management practices, and organizational performance—is specifically implemented in the oil and gas companies operating in Indonesia. Relevant literature on the TQM, the world-class performance in operations (world-class company and operational performance, the company performance (financial and non-financial performances, and the amendments of the Law of the Republic of Indonesia concerning the oil and gas industry, and related research on how the oil and gas industry in Indonesia develops sustainable competitive advantage and sustainable development programs are reviewed in details in our study. The findings from data analysis provide evidence that there is a strong positive relationship between the critical factors of quality management practices and the company financial performance mediated by the three mediating variables, i.e., world-class company practices, operational excellence practices, and company non-financial performance.

  4. World-Class Leaders

    Science.gov (United States)

    Weinstein, Margery

    2012-01-01

    Future leaders' creativity and problem-solving skills have been honed in leadership courses, but that doesn't mean they are ready to use those skills to further a company's place in the world. With emerging markets in Asia, South America, and other areas of the world, a workforce needs to have an understanding of and interest in cultures beyond…

  5. Desempenho Logístico de Gerenciamento de Ativos na Ótica do Modelo World Class Logistics

    Directory of Open Access Journals (Sweden)

    Helton Cristian de Paula

    2012-09-01

    Full Text Available O objetivo do artigo consiste em acompanhar a evolução de indicadores de eficiência do desempenho logístico na competência Mensuração com enfoque no gerenciamento de ativos em companhias abertas brasileiras com ações negociadas na Bolsa de Nova Iorque no período de 2004 a 2008, na ótica do modelo World ClassLogistics. A Competência Mensuração do modelo possibilita a verificação empírica em dados públicos divulgados pelas companhias que negociam ações na NYSE em função de exigências maiores quanto ao disclosure em relação aos padrões brasileiros. Esta competência é composta por indicadores de Serviços aos Clientes, Custos, Produtividade e Gerenciamento de Ativos. Empresas do setor de produção e comércio compuseram a amostra e a análise dos dados foi realizada por meio de estatística descritiva segmentada em conglomerados. Os resultados indicaram desempenho melhor nos indicadores Nível de Estoque, ROE, ROI e ROA para as companhias do Conglomerado 1. As companhias do Conglomerado 2 apresentaram melhores resultados no indicador Giro de Estoque.

  6. Building a World-Class Safety Culture: The National Ignition Facility and the Control of Human and Organizational Error

    International Nuclear Information System (INIS)

    Bennett, C T; Stalnaker, G

    2002-01-01

    Accidents in complex systems send us signals. They may be harbingers of a catastrophe. Some even argue that a ''normal'' consequence of operations in a complex organization may not only be the goods it produces, but also accidents and--inevitably--catastrophes. We would like to tell you the story of a large, complex organization, whose history questions the argument ''that accidents just happen.'' Starting from a less than enviable safety record, the National Ignition Facility (NIF) has accumulated over 2.5 million safe hours. The story of NIF is still unfolding. The facility is still being constructed and commissioned. But the steps NIF has taken in achieving its safety record provide a principled blueprint that may be of value to others. Describing that principled blueprint is the purpose of this paper. The first part of this paper is a case study of NIF and its effort to achieve a world-class safety record. This case study will include a description of (1) NIF's complex systems, (2) NIF's early safety history, (3) factors that may have initiated its safety culture change, and (4) the evolution of its safety blueprint. In the last part of the paper, we will compare NIF's safety culture to what safety industry experts, psychologists, and sociologists say about how to shape a culture and control organizational error

  7. The physiological and biomechanical differences between double poling and G3 skating in world class cross-country skiers.

    Science.gov (United States)

    Sandbakk, Øyvind; Leirdal, Stig; Ettema, Gertjan

    2015-03-01

    The current study compared differences in cycle characteristics, energy expenditure and peak speed between double poling (DP) and G3 skating. Eight world class male sprint skiers performed a 5-min submaximal test at 16 km h(-1) and an incremental test to exhaustion at a 5% incline during treadmill roller skiing with two different techniques: DP where all propulsion comes from poling, and G3 skating where leg skating is added to each double poling movement. Video analyses determined cycle characteristics; respiratory parameters and blood lactate concentration determined the physiological responses. G3 skating resulted in 16% longer cycle lengths at 16% lower cycle rates, whereas oxygen uptake was independent of technique during submaximal roller skiing. The corresponding advantages for G3 skating during maximal roller skiing were reflected in 14% higher speed, 30% longer cycle length at 16% lower cycle rate and 11% higher peak oxygen uptake (all p skating. This was done by major increases in cycle lengths at slightly lower cycle rates and a higher aerobic energy delivery. However, the oxygen uptake for a given submaximal speed was not affected by technique although higher cycle rate was used in DP.

  8. Metabolic rate and gross efficiency at high work rates in world class and national level sprint skiers.

    Science.gov (United States)

    Sandbakk, Øyvind; Holmberg, Hans-Christer; Leirdal, Stig; Ettema, Gertjan

    2010-06-01

    The present study investigated metabolic rate (MR) and gross efficiency (GE) at moderate and high work rates, and the relationships to gross kinematics and physical characteristics in elite cross-country skiers. Eight world class (WC) and eight national level (NL) male sprint cross-country skiers performed three 5-min stages using the skating G3 technique, whilst roller skiing on a treadmill. GE was calculated by dividing work rate by MR. Work rate was calculated as the sum of power against gravity and frictional rolling forces. MR was calculated using gas exchange and blood lactate values. Gross kinematics, i.e. cycle length (CL) and cycle rate (CR) were measured by video analysis. Furthermore, the skiers were tested for time to exhaustion (TTE), peak oxygen uptake (VO(2peak)), and maximal speed (V(max)) on the treadmill, and maximal strength in the laboratory. Individual performance level in sprint skating was determined by FIS points. WC skiers did not differ in aerobic MR, but showed lower anaerobic MR and higher GE than NL skiers at a given speed (all P higher V(max) and TTE (all P better technique and to technique-specific power.

  9. Single Incision Laparoscopic Splenectomy: Our First Experiences

    Directory of Open Access Journals (Sweden)

    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  10. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  11. What can we learn from fluvial incision in high mountains?

    Science.gov (United States)

    Fuchs, Margret; Gloaguen, Richard; Krbetschek, Matthias

    2013-04-01

    High and actively deforming mountain ranges attract the attention of geoscientists as they provide natural laboratories of fast evolving process-response systems. Tectonic compressional settings, often linked to perpendicular extension, control the topographic growth and hence, erosion, transport pathways and sedimentation. High altitude differences within short horizontal distances promote material re-organisation and high rates of surface processes. Furthermore, high mountains constitute orographic barriers that affect atmospheric circulations as well as host different climate regimes similar to those of widely separated latitudinal belts. Both cause a high sensitivity of surface processes to changes in climatic conditions. However, feedbacks between climatic and tectonic forcing are complex. Additionally, the dominance of one or the other varies in space and also over time, inheriting various traces of the paleo-morphodynamic conditions to the subsequent process regimes. To unravel the forces driving the evolution of relief in active mountains, numerous studies employ the drainage network of the corresponding mountains as a proxy of landscape evolution. Especially the rates of river incision provide a powerful tool to characterize the surface response and infer causes behind it. Several parameters of river incision are available to describe the fluvial incision at individual sites (e.g. terrace incision rates), along the river course (e.g. longitudinal river profiles, Hack index) and in its perpendicular dimension (e.g. valley cross sections, valley shape ratios). But they require careful interpretation. They are sensitive to both, climatic and tectonic forcing. Therefore, the synopsis of such indices for fluvial incision is essential to evaluate the role of climatic versus tectonic forcing. Here, we use the Panj river system, the major river draining the Pamir mountains of Central Asia, as an example. The Panj experiences high altitude changes of more than 4000

  12. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

    Directory of Open Access Journals (Sweden)

    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  13. Building World Class Universities in China: Exploring Faculty's Perceptions, Interpretations of and Struggles with Global Forces in Higher Education

    Science.gov (United States)

    Kim, Dongbin; Song, Quirong; Liu, Ji; Liu, Qingqin; Grimm, Adam

    2018-01-01

    Employing a glonacal (global, national and local) heuristic as a theoretical lens, and a qualitative analysis with interview data, this study highlights how Chinese faculty members interpret the definitions and implications of pursuing world class universities (WCUs) and struggle with the multiple dimensions of their academic lives across global,…

  14. DNA Methylation Modulates Nociceptive Sensitization after Incision.

    Directory of Open Access Journals (Sweden)

    Yuan Sun

    Full Text Available DNA methylation is a key epigenetic mechanism controlling DNA accessibility and gene expression. Blockade of DNA methylation can significantly affect pain behaviors implicated in neuropathic and inflammatory pain. However, the role of DNA methylation with regard to postoperative pain has not yet been explored. In this study we sought to investigate the role of DNA methylation in modulating incisional pain and identify possible targets under DNA methylation and contributing to incisional pain. DNA methyltranferase (DNMT inhibitor 5-Aza-2'-deoxycytidine significantly reduced incision-induced mechanical allodynia and thermal sensitivity. Aza-2'-deoxycytidine also reduced hindpaw swelling after incision, suggesting an anti-inflammatory effect. Global DNA methylation and DNMT3b expression were increased in skin after incision, but none of DNMT1, DNMT3a or DNMT3b was altered in spinal cord or DRG. The expression of proopiomelanocortin Pomc encoding β-endorphin and Oprm1 encoding the mu-opioid receptor were upregulated peripherally after incision; moreover, Oprm1 expression was further increased under DNMT inhibitor treatment. Finally, local peripheral injection of the opioid receptor antagonist naloxone significantly exacerbated incision-induced mechanical hypersensitivity. These results suggest that DNA methylation is functionally relevant to incisional nociceptive sensitization, and that mu-opioid receptor signaling might be one methylation regulated pathway controlling sensitization after incision.

  15. Single scrotal incision orchiopexy - a systematic review

    Directory of Open Access Journals (Sweden)

    Hugo Fabiano Fernandes Novaes

    2013-06-01

    Full Text Available Objective To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery. Results A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%, there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. Conclusions Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.

  16. Injury risk is low among world-class volleyball players: 4-year data from the FIVB Injury Surveillance System.

    Science.gov (United States)

    Bere, Tone; Kruczynski, Jacek; Veintimilla, Nadège; Hamu, Yuichiro; Bahr, Roald

    2015-09-01

    Little is known about the rate and pattern of injuries in international volleyball competition. To describe the risk and pattern of injuries among world-class players based on data from the The International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female). The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior). The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions. Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Transconjunctival incision for total maxillectomy--an alternative for subciliary incision.

    Science.gov (United States)

    Goyal, Amit; Tyagi, Isha; Jain, Shilpa; Syal, Rajan; Singh, Alok Pratap; Kapila, Rajeev

    2011-09-01

    A subciliary incision may be associated with various complications of the lower eyelid when it is used during a total maxillectomy. The use of the transconjunctival incision instead is an alternative in suitable patients. The records of 17 patients were reviewed in whom a transconjunctival incision was used during total maxillectomy. These included 13 in whom the Weber-Ferguson incision was used, and 4 who had a sublabial incision. There was mild conjunctival oedema in all the cases during the immediate postoperative period but it did not last for more than two days. Four patients had mild to moderate oedema of the lid that resolved within two days. One had mild ectropion with transient epiphora, which was caused by early removal of the medial canthal sutures. We found the approach to be cosmetically acceptable as it avoids a scar in the subciliary region. The transconjunctival incision can be used in place of the subciliary incision for lateral exposure during total maxillectomy. There are few complications associated with the lower lid, and it has good cosmetic results; if it is combined with a sublabial incision in suitable patients, the maxillectomy is virtually scar-free. Copyright © 2010 British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery.

    Science.gov (United States)

    Jauhari, Nidhi; Chopra, Deepak; Chaurasia, Rajan Kumar; Agarwal, Ashutosh

    2014-01-01

    To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS). A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software. The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant. Inverted V (Chevron) incision gives minimal SIA.

  19. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  20. The Laguna Verde Central by it results in maintenance and operation consolidates it position of world class enterprise

    International Nuclear Information System (INIS)

    Rivera C, A.

    2008-01-01

    This work has the objective of showing the results of the Laguna VerdeCentral in the maintenance and the operation that in the short term the generation of electricity in Mexico by nuclear means is a viable option, in virtue of their positioning like Company of World Class, when winning March 25, 2008 the National Prize of Quality with the more high qualification in the history of this prize, same that allows us to be very optimistic in increasing the possibility to that the Nuclear Industry in Mexico grows. The focus of the comparative graphs, with official data of the Comision Federal de Electricidad (CFE), it is so that it is observed that the Laguna Verde Central is above those the other types of generation like they are the Coal power stations, Thermoelectric, Hydroelectric, likewise they can see that we are for up of the Independent Producers of Energy. The information of the electric power generation is presented by reactors nuclear at world level that is growing, in having 31 Generating Units in the construction process that favors the decisions making in the Government federal, likewise contributed data of the increment projected for 2016 in the country of 380,102 GWh that equivalent to 63% of growth, where it exists without place to doubts a good opportunity for the nucleoelectricity. The Investment Works Program of Public Sector (POISE), it shows the information that 6,178 Mwe will be installed settled of a Non-defined Technology in Mexico, information that specifies the opportunity to be a viable option, because the one Plant Factor, the Production of Electric power, and the Variable Cost of Production, the energy generation by nuclear means is the more competitiveness. Finally this work stood out the effort that communitary works are developed to benefit to the society and the environment to be one Viable option not only for their high performance, or competitive for those more low costs, but also to improve the public opinion with the sustainable

  1. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn

    2016-01-01

    incision between January 1995 and June 2012 were reviewed. Horses with a laryngotomy incision closed in three layers for primary healing were included. Descriptive data on healing characteristics and complications of laryngotomy wounds were collected from the medical records and via follow......The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

  2. Developing framework to analyze world-class maintenance (wcm) indicators: gap analysis to highlight challenges and opportunities for the Norwegian petroleum industry

    OpenAIRE

    Imam, Syeda Fahmida

    2012-01-01

    Master's thesis in Offshore Technology World-class Maintenance (WCM) is a unique business process which actually does not cost, rather pays back. This study was an initial attempt to understand the extent of WCM concept being utilized in the Norwegian industry. The aim of the study was to develop a framework for analyzing the WCM indicators. For this purpose, the study was focused to: identify measurable WCM indicators, find the trends of WCM in the Norwegian sector, and find gap betwee...

  3. Small Incision Cataract Surgery (SICS with Clear Corneal Incision and SICS with Scleral Incision – A Comparative Study

    Directory of Open Access Journals (Sweden)

    Md Shafiqul Alam

    2014-01-01

    Full Text Available Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3% was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of

  4. How Do World-Class Nordic Combined Athletes Differ From Specialized Cross-Country Skiers and Ski Jumpers in Sport-Specific Capacity and Training Characteristics?

    Science.gov (United States)

    Sandbakk, Øyvind; Rasdal, Vegard; Bråten, Steinar; Moen, Frode; Ettema, Gertjan

    2016-10-01

    To compare sport-specific laboratory capacities and the annual training of world-class Nordic combined (NC) athletes with specialized ski jumpers (SJ) and cross-country (XC) skiers. Five world-class athletes from each sports discipline were compared. Ski jump imitations were performed on a 3-dimensional force plate in NC athletes and SJ, whereas XC skiing characteristics were obtained from submaximal and maximal roller ski skating on a treadmill in NC athletes and XC skiers. In addition, anthropometrics and annual training characteristics were determined. NC athletes demonstrated 9% higher body mass and showed 17% lower vertical speed in the ski jump imitation than SJ (all P ski-jumping-specific sessions and outdoor ski jumps compared with SJ. NC athletes performed 31% less endurance training, mainly caused by lower amounts of low- and moderate-intensity training in the classical technique, whereas high-intensity strength and speed training and endurance training in the skating technique did not differ substantially from XC skiers. To simultaneously optimize endurance, explosive, and technical capacities in 2 different disciplines, world-class NC athletes train approximately two-thirds of the XC skier's endurance training volume and perform one-half of the ski-jump-specific training compared with SJ. Still, the various laboratory capacities differed only 10-17% compared with SJ and XC skiers.

  5. Advantages and Disadvantages of 1-Incision, 2-Incision, 3-Incision, and 4-Incision Laparoscopic Cholecystectomy: A Workflow Comparison Study.

    Science.gov (United States)

    Bartnicka, Joanna; Zietkiewicz, Agnieszka A; Kowalski, Grzegorz J

    2016-08-01

    A comparison of 1-port, 2-port, 3-port, and 4-port laparoscopic cholecystectomy techniques from the point of view of workflow criteria was made to both identify specific workflow components that can cause surgical disturbances and indicate good and bad practices. As a case study, laparoscopic cholecystectomies, including manual tasks and interactions within teamwork members, were video-recorded and analyzed on the basis of specially encoded workflow information. The parameters for comparison were defined as follows: surgery time, tool and hand activeness, operator's passive work, collisions, and operator interventions. It was found that 1-port cholecystectomy is the worst technique because of nonergonomic body position, technical complexity, organizational anomalies, and operational dynamism. The differences between laparoscopic techniques are closely linked to the costs of the medical procedures. Hence, knowledge about the surgical workflow can be used for both planning surgical procedures and balancing the expenses associated with surgery.

  6. The boomerang incision for periareolar breast malignancies.

    Science.gov (United States)

    Tan, Mona P

    2007-11-01

    Breast-conservation surgery has been shown to be equivalent to mastectomy in terms of long-term survival for the treatment of breast cancer. Various techniques have been described on how to achieve clear margins and good cosmetic outcomes and therefore expand the indications for breast conservation. A novel incision is detailed to augment the options already available.

  7. Single scrotal incision orchidopexy for palpable undescended

    International Nuclear Information System (INIS)

    Ahmad, A.; Safdar, C.A.; Yasir, U.; Rasool, N.; Kanwal, S.; Boota, M.; Rehman, J.U.

    2014-01-01

    To retrospectively asses the results of single scrotal incision orchidopexy (SSIO) performed at our centre with ligation of the patent processus vaginalis in children having palpable undescended testes (UDT). Study Design: Quasi-experimental with retrospective data. Place and Duration of Study: Department of Paediatric surgery Military Hospital Rawalpindi, from April 2007 to December 2011. Patients and Methods: After making a single transverse incision at superior scrotal border, the testis was identified; gubernaculums and the sac were dissected to the highest level and divided. The testis was placed into the scrotum and fixed to the scrotal fascia/skin. All patients were assessed at 2 weeks, 2 months and 6 months post operatively, and then yearly. Results: A total of 38 orchidopexies were performed in 33 patients. The patients age ranged from 14 months to 7 years (mean:2.1 years). Bilateral UDT were found in 5 patients (15.1%). Operative time ranged from 20 to 45 minutes (mean: 36 minutes). The single scrotal incision technique was successful in all 38 cases (100%). All testes were easily fixed in the scrotum. Two patients (5.2%) developed scrotal haematoma and one patient (2.6%) developed stitch abscess. All showed good an atomical and cosmetic results up to a minimum of six months of follow-up. Conclusion: Single scrotal incision orchidopexy for palpable undescended testis is a simple and safe technique. It has shown to consume shorter time and give good cosmetic results. (author)

  8. Radiological findings after endoscopic incision of ureterocele

    International Nuclear Information System (INIS)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang; Cheon, Jung Eun; Seok, Eul Hye; Cha, Joo Hee; Choi, Guk Myung

    2001-01-01

    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required

  9. Modelling channel incision and alpine hillslope development using laser altimetry data

    NARCIS (Netherlands)

    Anders, N.S.; Seijmonsbergen, A.C.; Bouten, W.

    2009-01-01

    This paper presents a new approach to simulate drainage basin evolution and demonstrates that high resolution elevation data can be used as useful tool for a dynamic simulation of Alpine landscape development, in which channel incision is incorporated in high spatial detail. A vector channel

  10. Incision integrity and postoperative outcomes after microcoaxial phacoemulsification performed using 2 incision-dependent systems.

    Science.gov (United States)

    Vasavada, Vaishali; Vasavada, Abhay R; Vasavada, Viraj A; Srivastava, Samaresh; Gajjar, Devarshi U; Mehta, Siddharth

    2013-04-01

    To compare incision integrity and clinical outcomes of 2 microcoaxial phacoemulsification systems. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized clinical trial. Eyes were randomized to have phacoemulsification using a 1.8 mm clear corneal incision (CCI) system (Group 1, Stellaris system) or a 2.2 mm CCI system (Group 2, Intrepid Infiniti system). Incision enlargement at end of surgery was measured. At the conclusion of surgery, trypan blue was applied over the conjunctival surface, anterior chamber aspirate withdrawn, and ingress into anterior chamber measured. Postoperative observations included evaluation of the CCI using anterior segment optical coherence tomography (AS-OCT), change in central corneal thickness (CCT), and anterior segment inflammation at 1 day, 1 week, and 1 month and endothelial cell loss and surgically induced astigmatism (SIA) at 3 months. Incision enlargement (P.05). At the end of surgery, it is not the initial incision size alone but also the distortion of the incision during subsequent stages of surgery that determine the integrity of the CCI. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  11. COMPARISON OF POSTOP SIA IN MSICS WITH STRAIGHT INCISION VERSUS FROWN INCISION

    Directory of Open Access Journals (Sweden)

    Shayana Bhumbla

    2017-05-01

    Full Text Available BACKGROUND Surgically-Induced Astigmatism (SIA is one of the commonest causes of poor postoperative vision even after uneventful cataract surgery. Recent advances have led to a newer concept of “refractive cataract surgery.” The aim of the study is to study the comparison of postop SIA in Manual Small Incision Cataract Surgery (MSICS with straight versus frown incision. MATERIALS AND METHODS 50 patients of cataract were divided into 2 groups (25 each - group A underwent MSICS with 6 mm straight incision, group B underwent MSICS with 6 mm frown incision. BCVA, keratometry readings were recorded with auto kerato-refractometer preop, at 1 week, 1 month, 3 months and SIA was calculated with SIA calculator version 2.1, a free software program. RESULTS Mean SIA in group A and B were - 1.14D versus 0.92D at 1 week; 1.26D versus 0.97D at 1 month; 1.29D versus 0.95D at 3 months. The difference was statistically significant at each follow up visit (p<0.05. CONCLUSION Frown incision gives lesser SIA than straight incision in MSICS.

  12. Current Status of Single-incision Laparoscopic Surgery

    DEFF Research Database (Denmark)

    Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo

    2012-01-01

    Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future...

  13. Higher Incision at Upper Part of Lower Segment Caesarean Section

    Directory of Open Access Journals (Sweden)

    Yong Shao

    2014-06-01

    Conclusions: An incision at the upper part of the lower segment reduces blood loss, enhances uterine retraction, predisposes to fewer complications, is easier to repair, precludes bladder adhesion to the suture line and reduces operation time. Keywords: caesarean section; higher incision technique; traditional uterine incision technique.

  14. Ninth Annual NASA/Contractors Conference on Quality and Productivity. World Class Excellence: The Journey Continues. Conference presentations

    Science.gov (United States)

    Templeton, Geoffrey B. (Editor); Stewart, Lynne M. (Editor)

    1992-01-01

    The topics covered include the following: The George M. Low Trophy; total quality assessment and measurement; using award criteria to improve organizational effectiveness; results--keeping an eye on the bottom line; capturing customer satisfaction; moving from management to leadership; leadership versus management; transforming the management team; leadership success stories; success stories in the quest for excellence; small business successes; education success stories; government success stories; tools and techniques for total quality management (TQM) integration; planning and organizing for TQM integration; successful stories for implementing system level TQM/CI tools; assessing TQM results; establishing an environment for continuous improvement at NASA; empowerment; synergism of partnering; and partnerships in education.

  15. Exploring the Linkages Between Deming’s Principle, World-Class Company, Operational Excellence, and Company Performance in an Oil and Gas Industry Setting

    Directory of Open Access Journals (Sweden)

    Wakhid Slamet Ciptono

    2005-06-01

    Full Text Available This study explores the linkages between Deming’s Principle, World-Class Company, Operational Excellence, and Company Performance in the Indonesia’s oil and gas industry. The aim of this study is to examine the causal relationships model between the Deming’s Principle (DP, World-Class Company (WCC, Operational Excellence (OE, and Company Performance (Monetary Gain Performance or MGP and Value Gain Performance or VGP. The author used 140 strategic business units (SBUs in 49 oil and gas companies in Indonesia. The survey was administered to every level of management at each SBU (Top, Middle, and Low Level Management. A multiple informant sampling unit is used to ensure a balanced view of the relationships between the research constructs, and to collect data from the most informed respondents on different levels of management. A total of 1,332 individual usable questionnaires were returned thus qualified for analysis, representing an effective response rate of 50.19 percent. Path analysis and structural equation modeling (SEM are used to analyze the effect of Deming’s principle on company performance and to investigate the interrelationships between Deming’s principle, world-class company, operational excellence, and company performance. The results show that Deming’s Principle has significant positive and indirect effect on company performance (monetary gain performance and value gain performance. Although the Deming’s Principle has no significant direct effects on company performance, the Deming’s Principle has significant positive effects on the intervening variables (world-class company and operational excellence. The result also shows that a complete model fit and the acceptable parameter level that indicate the overall parameter are good fit between the hypothesized model and the observed data. By concentrating on a single industry (oil and gas, SEM specification of the causal relationship model between five constructs can be

  16. Small incision guarded hydroaspiration of iris lesions.

    Science.gov (United States)

    Singh, Arun D

    2017-11-01

    To describe the technique and results of a minimally invasive surgical technique for resection of small iris lesions. Consecutive case series of 22 patients with localised, small iris lesions that were resected using the described surgical technique that composed of multiple, small corneal incisions created to allow for internal iris resection with 23-gauge horizontal vitrectomy scissors, followed by guarded tumour aspiration through a clear plastic tubing (diameter 3.5 mm) primed with viscoelastic agent. The mean largest basal diameter was 3.0 mm (range 1.5-5.0 mm; median 3.0 mm) and mean thickness was 1.3 mm (range 0.5-2.5 mm; median 1.0 mm). Use of multiple (2-4) small corneal incisions (range 2.0-3.0 mm; mean 2.8 mm) allowed reduced postoperative morbidity (significant hyphema (0%), hypotony (0%), wound leak (0%), >2 line change in best corrected visual acuity at postoperative 1 week (4.5%) and mean corneal astigmatism of 1.0 D (range 0.14-2.99 D; median 0.8 D) at postoperative 4-12 weeks. The tumour could be resected with clear surgical margins in all neoplastic cases (benign (2), borderline (1) and malignant (16)). Local recurrence or metastases were not observed in any melanoma case over a mean follow-up of 33.0 months (range 1.0-90.0 months; median 33.5 months). Small incision guarded hydroaspiration is a minimally invasive surgical technique for resection of select small iris lesions. Use of multiple small corneal incisions avoids morbidity associated with a single large corneoscleral incision, and use of guarded aspiration may eliminate the risk of wound contamination by the malignant tumour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Comparison of electrocautery incision with scalpel incision in midline abdominal surgery - A double blind randomized controlled trial.

    Science.gov (United States)

    Prakash, Lalgudi Dorairajan; Balaji, Nitesh; Kumar, Sathasivam Suresh; Kate, Vikram

    2015-07-01

    To compare the electrocautery incision with scalpel incision in patients undergoing abdominal surgery using a midline incision with respect to incision time, blood loss during incision, postoperative incision site pain and wound infection. Patients undergoing midline abdominal surgery were randomized into electrocautery and scalpel groups. The incision dimensions, incision time and blood loss during incision were noted intraoperatively. Postoperative pain and wound infection were recorded on every postoperative day for one week. 41 patients in each of the two groups were analyzed. Gender and age distribution was similar in both the groups. The mean incision time per unit wound area in the electrocautery group and scalpel group was 9.40 ± 3.37 s/cm(2) and 9.07 ± 3.40 s/cm(2) (p = 0.87) respectively. The mean blood loss per unit wound area was significantly lower in the electrocautery group at 6.46 ± 3.94 ml when compared to that of 23.40 ± 15.28 ml in the scalpel group (p= electrocautery and scalpel groups (14.63% vs. 12.19%; p = 0.347). With a comparable Postoperative incision site pain, wound infection rate and significantly lower blood loss with the equal time taken for the incision, electrocautery can be considered safe and effective in making skin incision in midline laparotomy compared to scalpel incision. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Electrocautery skin incision for neurosurgery procedures--technical note.

    Science.gov (United States)

    Nitta, Naoki; Fukami, Tadateru; Nozaki, Kazuhiko

    2011-01-01

    The reluctance to incise skin with electrocautery is partly attributable to concerns about excessive scarring and poor wound healing. However, recently no difference was reported in wound complications between the cold scalpel and electrocautery scalpel. We assessed the safety and efficacy of electrocautery skin incision in 22 scalp incisions, including 4 cases of reoperation. Electrocautery skin incisions were created using a sharp needle electrode. The generator unit was set on cutting mode, with power of 6 W and 330 kHz sinusoid waveform. Subcutaneous dissections also used the sharp needle electrode, set on coagulating mode, with power of 10 W and 1 MHz pulse-modulated waveform. Galea incisions used a standard blade tip, set on coagulating mode, with power of 20 W and 1 MHz pulse-modulated waveform. Skin incision with the sharp needle electrode caused no charring of the wound. Little bleeding or oozing were observed and skin clips were not necessary. No wound complication such as necrosis or infection occurred. Electrocautery skin incisions for re-operations were also performed safely without complications. Electrocautery skin incision is sufficiently safe procedure not only for first operation but also for re-operation. Electrocautery skin incision is efficacious, especially for extended operation times, because of little blood loss from the edges of skin incision and possible avoidance of skin edge necrosis or alopecia caused by skin clips.

  19. A single incision transaxillary thoracoscopic sympathectomy

    Directory of Open Access Journals (Sweden)

    Marić Nebojša

    2014-01-01

    Full Text Available Background/Aim. Primary hyperhidrosis causes are unknown. The disorder begins in early childhood. It intensifies in puberty and maturity. It is equally present in both sexes. The symptoms exacerbate when the body temperature rises and due to emotional stimuli affecting the sympathetic nerve system. The aim of this study was to demonstrate that videoassisted thoracoscopic surgery (VATS sympathectomy is a method for primary focal hyperhidrosis permanent treatment. The single incision method in properly selected patients maximizes the intervention effectiveness and minimizes aesthetic side effects. Methods. This prospective study analysed the findings in patients who had been operated on due to primary focal hyperhidrosis (face, palms, and armpits using a single small transaxilarry incision in the third inter-rib space at the level of the anterior axillary line with two 5 mm flexible ports. All the patients, with T2-T5 thoracoscopic sympathectomy of the sympathetic chain using a single small incision in the third inter-rib space in the anterior axillary line, were analysed in the period from September 2009 to November 2010 regarding the postoperative morbidity and outcomes of the operation (clinical evaluation and visual analogue scale with a view to assessing the effectiveness of the surgery conducted in this manner. Results. A total of 47 patients (18 men, 29 women, 18 to 48 years old (29 on average had underwent 94 bilateral video-assisted thoracoscopic sympathectomies. The sympathectomy was indicated in cases of facial blushing and sweating (6.38%, palmary sweating (34.04%, axillary sweating (14.89% or both palmary and axillary sweating (44.68%. The largest percentage of patients (98.6% had left the hospital the following day. The postoperative 30 day’s mortality was 0 and the conversion into open surgery was not necessary. As for complications, there had been an occurrence of partial pneumothorax in two patients treated by means of

  20. Small-incision lenticule extraction (SMILE)

    DEFF Research Database (Denmark)

    Hansen, Rasmus Søgaard; Lyhne, Niels; Grauslund, Jakob

    2016-01-01

    surgery was 0.07 ± 0.03 (logMAR). However, 12 eyes (1.6 %) lost 2 or more lines of CDVA from before surgery to 3 months postoperatively. Simultaneous treatment of up to 3.00 D of astigmatism was not associated with less predictable refractive outcomes. CONCLUSIONS: In the short term, SMILE seemed......PURPOSE: To study the outcomes of small-incision lenticule extraction (SMILE) for treatment of myopia and myopic astigmatism. METHODS: Retrospective study of patients treated for myopia or myopic astigmatism with SMILE, using a VisuMax(®) femtosecond laser (Carl Zeiss Meditec, Jena, Germany...

  1. Flexible single-incision surgery: a fusion technique.

    Science.gov (United States)

    Noguera, José F; Dolz, Carlos; Cuadrado, Angel; Olea, José; García, Juan

    2013-06-01

    The development of natural orifice transluminal endoscopic surgery has led to other techniques, such as single-incision surgery. The use of the flexible endoscope for single-incision surgery paves the way for further refinement of both surgical methods. To describe a new, single-incision surgical technique, namely, flexible single-incision surgery. Assessment of the safety and effectiveness of endoscopic cholecystectomy in a series of 30 patients. This technique consists of a single umbilical incision through which a flexible endoscope is introduced and consists of 2 parallel entry ports that provide access to nonarticulated laparoscopic instruments. The technique was applied in all patients for whom it was prescribed. No general or surgical wound complications were noted. Surgical time was no longer than usual for single-port surgery. Flexible single-incision surgery is a new single-site surgical technique offering the same level of patient safety, with additional advantages for the surgeon at minimal cost.

  2. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  3. Two-Step Incision for Periarterial Sympathectomy of the Hand

    Directory of Open Access Journals (Sweden)

    Seung Bae Jeon

    2015-11-01

    Full Text Available BackgroundSurgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.MethodsA total of 40 patients (17 men and 23 women with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS and the Wake Forest University rating scale.ResultsThe total patient score was 8.59 (range, 6-15 in the two-step incision group and 9.62 (range, 7-18 in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034 but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03.ConclusionsCompared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  4. Temporal versus Superior Limbal Incision: Any difference in visual ...

    African Journals Online (AJOL)

    Aim: To compare the visual outcome of a superiorly placed limbal incision with a temporal limbal incision in extracapsular cataract surgery. The main outcome measures are visual acuity and the degree of stigmatism based on refraction. Method: A retrospective non randomized comparative study. Medical records of 40 ...

  5. Transurethral incision of urethral diverticulum in the female

    DEFF Research Database (Denmark)

    Miskowiak, J; Honnens de Lichtenberg, M

    1989-01-01

    A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.......A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time....

  6. Mini transverse versus longitudinal incision in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Korkmaz, M.; Cepoglu, M.C.

    2013-01-01

    Objective: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. Study Design: Analytical study. Place and Duration of Study: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. Methodology: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. Results: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. Conclusion: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision. (author)

  7. Incisive canal deflation for correct implant placement: case report.

    Science.gov (United States)

    Spin-Neto, Rubens; Bedran, Telma Blanca Lombardo; de Paula, Wagner Nunes; de Freitas, Rubens Moreno; de Oliveira Ramalho, Lizeti Toledo; Marcantonio, Elcio

    2009-12-01

    This article is a case report of a patient in whom the prosthetic planning indicated the necessity of an incisive canal deflation for the correct installation of an implant that is to be osseointegrated. In the reopening phase after the bone graft installation, the incisive canal deflation (biopsy of its content) was done and titanium implants were installed with one of them invading the anatomical space occupied previously by the incisive canal. The biopsy analysis showed fragments of the incisive artery and nerve, which are responsible for the anterior upper-tooth pulp, the periodontium vascularization and the innervation. From the anastomosis present along with other structures allied with the absence of teeth in the region, there was no detriment to the patient caused by the deflation. Incisive canal deflation is a viable technique in implantology. It can permit ideal prosthetic planning with no detriment to the patient.

  8. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J

    2001-01-01

    , and late complications (incisional hernia). RESULTS: Eleven randomised controlled trials and seven retrospective studies were identified. The transverse incision offers as good an access to most intra-abdominal structures as a vertical incision. The transverse incision results in significantly less......OBJECTIVE: To reach an evidence-based consensus on the relative merits of vertical and transverse laparotomy incisions. DESIGN: Review of all published randomised controlled trials that compared the postoperative complications after the two main types of abdominal incisions, vertical and transverse....... SETTING: Teaching hospital, Denmark. SUBJECTS: Patients undergoing open abdominal operations. INTERVENTIONS: For some of the variables (burst abdomen and incisional hernia) it was considered adequate to include retrospective studies. Studies were identified through Medline, Cochrane library, Embase...

  9. River longitudinal profiles and bedrock incision models: Stream power and the influence of sediment supply

    Science.gov (United States)

    Sklar, Leonard; Dietrich, William E.

    The simplicity and apparent mechanistic basis of the stream power river incision law have led to its wide use in empirical and theoretical studies. Here we identify constraints on its calibration and application, and present a mechanistic theory for the effects of sediment supply on incision rates which spotlights additional limitations on the applicability of the stream power law. On channels steeper than about 20%, incision is probably dominated by episodic debris flows, and on sufficiently gentle slopes, sediment may bury the bedrock and prevent erosion. These two limits bound the application of the stream power law and strongly constrain the possible combination of parameters in the law. In order to avoid infinite slopes at the drainage divide in numerical models of river profiles using the stream power law it is commonly assumed that the first grid cell is unchanneled. We show, however, that the size of the grid may strongly influence the calculated equilibrium relief. Analysis of slope-drainage area relationships for a river network in a Northern California watershed using digital elevation data and review of data previously reported by Hack reveal that non-equilibrium profiles may produce well defined slope-area relationships (as expected in equilibrium channels), but large differences between tributaries may point to disequilibrium conditions. To explore the role of variations in sediment supply and transport capacity in bedrock incision we introduce a mechanistic model for abrasion of bedrock by saltating bedload. The model predicts that incision rates reach a maximum at intermediate levels of sediment supply and transport capacity. Incision rates decline away from the maximum with either decreasing supply (due to a shortage of tools) or increasing supply (due to gradual bed alluviation), and with either decreasing transport capacity (due to less energetic particle movement) or increasing transport capacity (due less frequent particle impacts per unit bed

  10. A world-class act

    International Nuclear Information System (INIS)

    Richards, Sherrilynne; Thomas, Ron.

    1992-01-01

    In the autumn of 1991, a school on food irradiation held at AECL's Whiteshell Laboratories was attended by 14 food scientists from 12 countries. More than 30 countries have now approved food irradiation. In Canada, Nordion is a world leader with its cobalt-60 irradiators

  11. Influence of Incision Location on Transmitter Loss, Healing, Incision Lengths, Suture Retention, and Growth of Juvenile Chinook Salmon

    Energy Technology Data Exchange (ETDEWEB)

    Panther, Jennifer L.; Brown, Richard S.; Gaulke, Greggory L.; Woodley, Christa M.; Deters, Katherine A.

    2010-05-11

    In this study, conducted by Pacific Northwest National Laboratory for the U.S. Army Corps of Engineers, Portland District, we measured differences in survival and growth, incision openness, transmitter loss, wound healing, and erythema among abdominal incisions on the linea alba, lateral and parallel to the linea alba (muscle-cutting), and following the underlying muscle fibers (muscle-sparing). A total of 936 juvenile Chinook salmon were implanted with both Juvenile Salmon Acoustic Tracking System transmitters (0.43 g dry) and passive integrated transponder tags. Fish were held at 12°C (n = 468) or 20°C (n = 468) and examined once weekly over 98 days. We found survival and growth did not differ among incision groups or between temperature treatment groups. Incisions on the linea alba had less openness than muscle-cutting and muscle-sparing incisions during the first 14 days when fish were held at 12°C or 20°C. Transmitter loss was not different among incision locations by day 28 when fish were held at 12°C or 20°C. However, incisions on the linea alba had greater transmitter loss than muscle-cutting and muscle-sparing incisions by day 98 at 12°C. Results for wound closure and erythema differed among temperature groups. Results from our study will be used to improve fish-tagging procedures for future studies using acoustic or radio transmitters.

  12. Assessment of corneal astigmatism following frown and straight incision forms in sutureless manual small incision cataract surgery

    Directory of Open Access Journals (Sweden)

    Amedo AO

    2016-04-01

    Full Text Available Angela Ofeibea Amedo, Kwadwo Amoah, Nana Yaa Koomson, David Ben Kumah, Eugene Appenteng Osae Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Abstract: To investigate which of two tunnel incision forms (frown versus straight in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through >12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients’ cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P<0.05; frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P>0.05. Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher’s exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P>0.05. Keywords: cataract, residual corneal astigmatism, frown incision, straight incision

  13. Cosmetic effects of skin-crease camouflage incision versus longitudinal incision following carotid endarterectomy.

    Science.gov (United States)

    Kazimierczak, Arkadiusz; Rybicka, Anita; Rynio, Pawel; Gutowski, Piotr; Wiernicki, Ireneusz

    2018-03-01

    Despite the increasing use of carotid angioplasty and stenting (CAS), carotid endarterectomy (CEA) nonetheless remains a more medically beneficial method of treatment for carotid artery stenosis. Therefore, one possibility for progress within this procedure may be to use minimally invasive carotid surgery, especially when the scar is in plain sight: the use of the natural wrinkles (skin crease) as a camouflage of the skin incision provides significant cosmetic improvements. To compare the cosmetic effects of classic and trans-wrinkle CEA. To assess the distance between the carotid artery bifurcation (CAB) and the skin-crease incision whilst attempting CEA. It was a randomized prospective study with two groups: patients undergoing classic surgery (control group; n = 100) and skin-crease trans-wrinkle camouflaged CEA (study group; n = 100). Follow-up was at 2 months and 1 year. The medical results of the treatment were similar in both groups. The cumulative count of strokes and myocardial infarctions was 0.5% within 30 days, and after one year 3.5% (and 5.5% including cases of death). The superiority of the transverse crease being hidden compared to the conventional longitudinal technique was proven in the Patient and Observer Scar Assessment Scale (POSAS) score, respectively 11.4 ±1.0 vs. 14.1 ±3.4 (p = 0.0001) after 2 months and 13.5 ±2.8 vs. 14.1 ±3.4 (p = 0.039) after a year. Trans-wrinkle incision gives better cosmetic results, can be safely performed in most cases, and offers a comfortable approach during CEA.

  14. A skin abscess model for teaching incision and drainage procedures.

    Science.gov (United States)

    Fitch, Michael T; Manthey, David E; McGinnis, Henderson D; Nicks, Bret A; Pariyadath, Manoj

    2008-07-03

    Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure. We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report. This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstrating abscess incision and drainage. This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.

  15. Morphodynamic Model of Submarine Canyon Incision by Sandblasting

    Science.gov (United States)

    Zhang, L.; Parker, G.; Izumi, N.; Cartigny, M.; Li, T.; Wang, G.

    2017-12-01

    Submarine canyons are carved by turbidity currents under the deep sea. As opposed to subaerial canyons, the relevant processes are not easy to observe directly. Turbidity currents are bottom-hugging sediment gravity flows of that can incise or deposit on the seafloor to create submarine canyons or fans. The triggers of turbidity currents can be storms, edge waves, internal waves, canyon wall sapping, delta failure, breaching and hyperpycnal flows. The formation and evolution mechanisms of submarine canyons are similar to those of subaerial canyons, but have substantial differences. For example, sandblasting, rather than wear due to colliding gravel clasts is more likely to be the mechanism of bedrock incision. Submarine canyons incise downward, and often develop meander bends and levees within the canyon, so defining "fairways". Here we propose a simple model for canyon incision. The starting point of our model is the Macro Roughness Saltation Abrasion Alluviation model of Zhang et al. [2015], designed for bedrock incision by gravel clasts in mixed bedrock-alluvial rivers. We adapt this formulation to consider sandblasting as a means of wear. We use a layer-averaged model for turbidity current dynamics. The current contains a mixture of mud, which helps drive the flow but which does not cause incision, and sand, which is the agent of incision. We show that the model can successfully model channel downcutting, and indeed illustrate the early formation of net incisional cyclic steps, i.e. upstream-migrating undulations on the bed associated with transcritical (in the Froude sense) flow. These steps can be expected to abet the process of incision.

  16. Diathermy versus scalpel incisions for open cholecystectomy comparative study

    International Nuclear Information System (INIS)

    Ali, M.A.; Niazi, W.A.K.

    2014-01-01

    The aim of the study was to make a comparison between skin incisions made with electrocautery versus scalpel in terms of their safety, efficacy and post-operative complications. Design: A randomized controlled study. Setting: The study was conducted in Combined Military Hospital (CMH) Kharian, Pakistan airforce (PAF) Hospital Sargodha. Duration of Study: May 2008 to August 2011. Patients and Methods: Ninety seven patients who underwent open cholecystectomy were randomly divided into two groups on the basis of the use of electrocautery versus steel scalpel for making skin incision and sub-cutaneous tissue dissection. Parameters recorded were, time taken from skin incision to full incising of the peritoneum, length of the wound, amount of blood loss during this step of surgery in each group. Post-operative pain scoring using visual analogue scale was done. Wound complications such as infection, haematoma/seroma and dehiscence were noted too. One month of follow up was recorded in each group. Subsequently a comparison of these findings was done. Results: Incision time (sec/cm/sub 2/) was longer in scalpel group than in diathermy group (p = 0.001), whereas, incision blood loss (ml/cm/sub 2/) was significantly less in diathermy group than in scalpel group (p = 0.03). There was no difference in post-operative pain perception as delineated by visual pain analogue scoring system between the two groups (p = 0.57). Post-operative wound complications and the final healing of wound at 01 month of follow-up were almost similar in both groups. Conclusion: Electrocautery may be used safely without any untoward complication in making skin incision and sub-cutaneous tissue dissection with an advantage of reduced incision time and and less blood loss. (author)

  17. The Testing Behind The Test Facility: The Acoustic Design of the NASA Glenn Research Center's World-Class Reverberant Acoustic Test Facility

    Science.gov (United States)

    Hozman, Aron D.; Hughes, William O.; McNelis, Mark E.; McNelis, Anne M.

    2011-01-01

    The National Aeronautics and Space Administration (NASA) Glenn Research Center (GRC) is leading the design and build of the new world-class vibroacoustic test capabilities at the NASA GRC's Plum Brook Station in Sandusky, Ohio, USA. Benham Companies, LLC is currently constructing modal, base-shake sine and reverberant acoustic test facilities to support the future testing needs of NASA's space exploration program. The large Reverberant Acoustic Test Facility (RATF) will be approximately 101,000 cu ft in volume and capable of achieving an empty chamber acoustic overall sound pressure level (OASPL) of 163 dB. This combination of size and acoustic power is unprecedented amongst the world's known active reverberant acoustic test facilities. The key to achieving the expected acoustic test spectra for a range of many NASA space flight environments in the RATF is the knowledge gained from a series of ground acoustic tests. Data was obtained from several NASA-sponsored test programs, including testing performed at the National Research Council of Canada's acoustic test facility in Ottawa, Ontario, Canada, and at the Redstone Technical Test Center acoustic test facility in Huntsville, Alabama, USA. The majority of these tests were performed to characterize the acoustic performance of the modulators (noise generators) and representative horns that would be required to meet the desired spectra, as well as to evaluate possible supplemental gas jet noise sources. The knowledge obtained in each of these test programs enabled the design of the RATF sound generation system to confidently advance to its final acoustic design and subsequent on-going construction.

  18. Landing-related ankle injuries do not occur in plantarflexion as once thought: a systematic video analysis of ankle injuries in world-class volleyball.

    Science.gov (United States)

    Skazalski, Christopher; Kruczynski, Jacek; Bahr, Martin Aase; Bere, Tone; Whiteley, Rod; Bahr, Roald

    2018-01-01

    Ankle injuries are prevalent in elite volleyball and suggested to result from player contact at the net. Traditionally, ankle sprains are thought to happen in a plantarflexed position, but case studies suggest plantarflexion may not be involved. Describe the injury situations and mechanisms of ankle injuries in world-class volleyball based on systematic video analysis of injuries reported through the Fédération Internationale de Volleyball (FIVB) Injury Surveillance System. Videos of 24 injuries from major FIVB tournaments were included for analysis (14 men, 10 women). Five analysts reviewed the videos to determine specific situations and mechanisms leading to injuries. The majority of injuries occurred during two volleyball situations, blocking (n=15) and attacking (n=6). Injuries to blockers were the result of landing on an opponent (n=11) or teammate (n=4). Attacking injuries most frequently occurred when a back-row player landed on a front-row teammate (n=4 of 6). When landing on an opponent under the net, the attacker landed into the opponent's court in 11 of 12 situations but without violating the centre line rule. Injuries mostly resulted from rapid inversion without any substantial plantarflexion. The majority of injuries occur while blocking, often landing on an opponent. The attacker is overwhelmingly to blame for injuries at the net secondary to crossing the centre line. Injuries while attacking often result from a back-row player landing on a front-row teammate. Landing-related injuries mostly result from rapid inversion with the absence of plantarflexion. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Virtual Incision Pattern Planning using Three-Dimensional Images for Optimization of Syndactyly Surgery

    Directory of Open Access Journals (Sweden)

    Inge A. Hoevenaren, MD

    2018-03-01

    Full Text Available Summary:. Syndactyly is a congenital condition characterized by fusion of the fingers. If not treated correctly during infancy, syndactyly may hinder the normal development of hand function. Many surgical techniques have been developed, with the main goal to create a functional hand with the smallest number of operative corrections. Therefore, exact preoperative planning of the reconstructive procedure is essential. An imaging method commonly used for preoperative planning is 3-dimensional (3D surface imaging. The goal of this study was to implement the use of this technique in hand surgery, by designing a virtual planning tool for a desyndactylization procedure based on 3D hand images. A 3D image of a silicon syndactyly model was made on which the incision pattern was virtually designed. A surgical template of this pattern was printed, placed onto the silicon model and delineated. The accuracy of the transfer from the virtual delineation toward the real delineation was calculated, resulting in a mean difference of 0.82 mm. This first step indicates that by using 3D images, a virtual incision pattern can be created and transferred back onto the patient successfully in an easy and accurate way by using a template. Thereafter, 3D hand images of 3 syndactyly patients were made, and individual virtual incision patterns were created. Each pattern was transferred onto the patient by using a 3D printed template. The resulting incision pattern needed minor modifications by the surgeon before the surgery was performed. Further research and validation are necessary to develop the virtual planning of desyndactylization procedures.

  20. Comparison of the Keratometric Corneal Astigmatic Power after Phacoemulsification: Clear Temporal Corneal Incision versus Superior Scleral Tunnel Incision

    Directory of Open Access Journals (Sweden)

    Yongqi He

    2009-01-01

    Full Text Available Objective. This is prospective randomized control trial to compare the mean keratometric corneal astigmatism diopter power (not surgical induced astigmatism among preop and one-month and three-month postop phacoemulcification of either a clear temporal corneal incision or a superior scleral tunnel Incision, using only keratometric astigmatic power reading to evaluate the difference between the two cataract surgery incisions. Methods. 120 patients (134 eyes underwent phacoemulcification were randomly assigned to two groups: Group A, the clear temporal corneal incision group, and Group B, the superior scleral tunnel incision group. SPSS11.5 Software was used for statistical analysis to compare the postsurgical changes of cornea astigmatism on keratometry. Results. The changes of corneal astigmatic diopter in Groups A and B after 3 month postop from keratometric reading were 1.04 + 0.76 and 0.94 + 0.27, respectively (=.84>.05, which showed no statistic significance difference. Conclusion. The incision through either temporal clear cornea or superior scleral tunnel in phacoemulcification shows no statistic difference in astigmatism change on keratometry 3-month postop.

  1. Petrogenesis of volcanic rocks that host the world-class Agsbnd Pb Navidad District, North Patagonian Massif: Comparison with the Jurassic Chon Aike Volcanic Province of Patagonia, Argentina

    Science.gov (United States)

    Bouhier, Verónica E.; Franchini, Marta B.; Caffe, Pablo J.; Maydagán, Laura; Rapela, Carlos W.; Paolini, Marcelo

    2017-05-01

    We present the first study of the volcanic rocks of the Cañadón Asfalto Formation that host the Navidad world-class Ag + Pb epithermal district located in the North Patagonian Massif, Patagonia, Argentina. These volcanic and sedimentary rocks were deposited in a lacustrine environment during an extensional tectonic regime associated with the breakup of Gondwana and represent the mafic to intermediate counterparts of the mainly silicic Jurassic Chon Aike Volcanic Province. Lava flows surrounded by autobrecciated carapace were extruded in subaerial conditions, whereas hyaloclastite and peperite facies suggest contemporaneous subaqueous volcanism and sedimentation. LA-ICPMS Usbnd Pb ages of zircon crystals from the volcanic units yielded Middle Jurassic ages of 173.9 ± 1.9 Ma and 170.8 ± 3 Ma. In the Navidad district, volcanic rocks of the Cañadón Asfalto Formation show arc-like signatures including high-K basaltic-andesite to high-K dacite compositions, Rb, Ba and Th enrichment relative to the less mobile HFS elements (Nb, Ta), enrichment in light rare earth elements (LREE), Ysbnd Ti depletion, and high Zr contents. These characteristics could be explained by assimilation of crustal rocks in the Jurassic magmas, which is also supported by the presence of zircon xenocrysts with Permian and Middle-Upper Triassic ages (281.3 Ma, 246.5, 218.1, and 201.3 Ma) and quartz xenocrysts recognized in these volcanic units. Furthermore, Sr and Nd isotope compositions suggest a contribution of crustal components in these Middle Jurassic magmas. High-K basaltic andesite has initial 87Sr/86Sr ratios of 0.70416-0.70658 and ξNd(t) values of -5.3 and -4. High-K dacite and andesite have initial 87Sr/86Sr compositions of 0.70584-0.70601 and ξNd(t) values of -4,1 and -3,2. The range of Pb isotope values (206Pb/204Pb = 18.28-18.37, 207Pb/204Pb = 15.61-15.62, and 208Pb/204Pb = 38.26-38.43) of Navidad volcanic rocks and ore minerals suggest mixing Pb sources with contributions of

  2. Lateral Erosion Encourages Vertical Incision in a Bimodal Alluvial River

    Science.gov (United States)

    Gran, K. B.

    2015-12-01

    Sand can have a strong impact on gravel transport, increasing gravel transport rates by orders of magnitude as sand content increases. Recent experimental work by others indicates that adding sand to an armored bed can even cause armor to break-up and mobilize. These two elements together help explain observations from a bimodal sand and gravel-bedded river, where lateral migration into sand-rich alluvium breaks up the armor layer, encouraging further incision into the bed. Detailed bedload measurements were coupled with surface and subsurface grain size analyses and cross-sectional surveys in a seasonally-incised channel carved into the upper alluvial fan of the Pasig-Potrero River at Mount Pinatubo, Philippines. Pinatubo erupted in 1991, filling valleys draining the flanks of the volcano with primarily sand-sized pyroclastic flow debris. Twenty years after the eruption, sand-rich sediment inputs are strongly seasonal, with most sediment input to the channel during the rainy season. During the dry season, flow condenses from a wide braided planform to a single-thread channel in most of the upper basin, extending several km onto the alluvial fan. This change in planform creates similar unit discharge ranges in summer and winter. Lower sediment loads in the dry season drive vertical incision until the bed is sufficiently armored. Incision proceeds downstream in a wave, with increasing sediment transport rates and decreasing grain size with distance downstream, eventually reaching a gravel-sand transition and return to a braided planform. Incision depths in the gravel-bedded section exceeded 3 meters in parts of a 4 km-long study reach, a depth too great to be explained by predictions from simple winnowing during incision. Instead, lateral migration into sand-rich alluvium provides sufficient fine sediment to break up the armor surface, allowing incision to start anew and increasing the total depth of the seasonally-incised valley. Lateral migration is recorded in a

  3. Effects of two different incision phacoemulsification on corneal astigmatism

    Directory of Open Access Journals (Sweden)

    Lu Huo

    2014-12-01

    Full Text Available AIM:To compare the effect of different incision in corneal astigmatism after phacoemulsification. METHODS: Totally 88 cases(122 eyeswith pure cataract were randomly divided into two groups. Forty cases(60 eyeswere clarity corneal incision in group A, and 48 cases(62 eyeswere sclera tunnel incision in group B. Mean corneal astigmatism, surgically induced astigmatism(SIA, uncorrected visual acuity(UCVAand best correct vision acuity(BCVAwere observed in pre- and post-operation at 1d; 1wk; 1mo.RESULTS: The mean astigmatism had statistically significant difference between two groups at 1d; 1wk; 1mo after operation(PPP>0.05. UCVA≥0.5 and BCVA≥0.8 had statistically significant difference at 1d; 1wk(PP>0.05.CONCLUSION: Phacoemulsification with scleral tunnel incision remove combined intraocular lens(IOLimplantation has small changes to corneal astigmatism. By selecting personalized corneal incision according to the corneal topography might be more beneficial.

  4. Modification of the Nuss Procedure: The Single-incision Technique

    Directory of Open Access Journals (Sweden)

    Tetsushi Aizawa, MD

    2014-11-01

    Full Text Available Summary: The Nuss procedure is a prevalent minimally invasive surgery for pectus excavatum. Although the Nuss procedure has the advantage of leaving less obtrusive scars, the standard technique requires at least 3 skin incisions to insert several instruments. We experienced 7 cases of the modified Nuss procedure using a single incision during a 7-year period. To facilitate passing of the bar, a traction guide was created according to our unique method. There was no need for a bar stabilizer, and no severe intraoperative complications occurred. All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation. Two patients underwent bar removal via the same single incision without any difficulties.

  5. Minimizing surgical skin incision scars with a latex surgical glove.

    Science.gov (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

    2013-04-01

    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  6. Simulation of channel sandstone architecture in an incised valley

    Energy Technology Data Exchange (ETDEWEB)

    Frykman, P.; Johannessen, P.; Andsbjerg, J.

    1998-12-31

    The present report describes a geostatistical modelling study that is aimed at reflecting the architecture of the channel sandstones in an incised valley fill. The example used for this study is a part of the Middle Jurassic sandy succession of the Bryne Formation in the Danish central Graben. The succession consists mainly of fluvial sediments in the lower part, overlain by tidal influenced sediments, which again is overlain by shallow marine sediments. The modelling study has been performed on a sequence of incised valley sediments in the upper part of the Bryne Formation overlying fluvial sediments. (au) EFP-96. 19 refs.

  7. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai

    2018-01-01

    . In total, nine participants experienced 11 adverse events; six in the surgery group and three in the skin-incisions-only group. CONCLUSION: We found greater improvement from arthroscopic partial meniscectomy compared with skin incisions only at 2 years, with the statistical uncertainty of the between......-group difference including what could be considered clinically relevant. Because of the study being underpowered, nearly half in the sham group being non-blinded and one-third crossing over to surgery, the results cannot be generalised to the greater patient population. TRIAL REGISTRATION NUMBER: NCT01264991....

  8. Meta-analysis of the effectiveness of surgical scalpel or diathermy in making abdominal skin incisions.

    LENUS (Irish Health Repository)

    Ahmad, Nasir Zaheer

    2012-02-01

    BACKGROUND: Surgical scalpels are traditionally used to make skin incisions. Diathermy incisions on contrary are less popular among the surgeons. The aim of this meta-analysis was to compare the effectiveness of both techniques and address the common fallacies about diathermy incisions. METHODS: A literature search of MEDLINE and Cochrane databases was done, using the keywords diathermy, cold scalpel, and incisions. Eleven clinical trials comparing both methods of making skin incisions were selected for meta-analysis. The end points compared included postoperative wound infection, pain in first 24 hours after surgery, time taken to complete the incisions, and incision-related blood loss. RESULTS: Postoperative wound infection rate was comparable in both techniques (P = 0.147, odds ratio = 1.257 and 95% CI = 0.923-1.711). Postoperative pain was significantly less with diathermy incisions in first 24 hours (P = 0.031, weighted mean difference = 0.852 and 95% CI = 0.076-1.628). Similarly, the time taken to complete the incision and incision-related blood loss was significantly less with diathermy incisions (95% CI = 0.245-0.502 and 0.548-1.020, respectively). CONCLUSION: Diathermy incisions are equally prone to get wound infection, as do the incisions made with scalpel. Furthermore, lower incidence of early postoperative pain, swiftness of the technique, and a reduced blood loss are the encouraging facts supporting routine use of diathermy for abdominal skin incisions after taking careful precautions.

  9. Supporting the planning for the evolution of the EOSDIS through an in-depth understanding of user requirements for NASA's world-class Earth science data system

    Science.gov (United States)

    Griffin, V. L.; Behnke, J.; Maiden, M.; Fontaine, K.

    2004-12-01

    commissioned a comprehensive survey to determine user satisfaction using the American Customer Satisfaction Index (ACSI) approach. The results show that, overall, the users are highly satisfied with the EOSDIS systems and services as the EOSDIS ACSI score outperformed both the averages for U.S. companies and for Federal Agencies. Noteworthy was the fact that there was no statistical difference in the quality scores received by the various EOSDIS data centers. The response indicated that customer support provided by the EOSDIS Distributed Active Archive Centers (DAACs) is "world class" and that a very high number of users intend to use EOSDIS in the future (90%) and to recommend it to their colleagues (86%). The survey highlighted areas that, if improved, could lead to increased user satisfaction, including overall product quality, product documentation, and product selection and ordering processes. These results will be factored into NASA's evolution planning.

  10. Minimal incision surgery in strabismus: Modified fornix-based approach.

    Science.gov (United States)

    Pérez-Flores, I

    2016-07-01

    To evaluate the modified fornix-based technique as an approach for minimal incision surgery in strabismus. The medical records of all consecutive patients that underwent strabismus surgery with fornix-based conjunctival incision between 2007 and 2012 were retrospectively reviewed. As a primary variable, an analysis was made of the wound size depending on the number of stitches. A descriptive study was performed on the variables related to patients and to the type of strabismus and surgery. Out of 153patients identified, 138 with 294 surgeries were included. In 200 (68%) interventions, the incision was sutured with one stitch, in 77 (26.2%) with 2, in 13 (4.4%) with 3, and in 4 (1.4%) with 4, with the mean number of stitches being 1.39±0.64. The mean age of the patients was 39years (2-80), and 36 (26.1%) had previous strabismus surgery, with topical anaesthesia being used in 35 (25.4%) cases. At 3months after surgery deviation was ≤10DP in 114 (82.6%) patients. There were no wound-related complications. The modified fornix-based technique is an effective and safe approach for minimal incision surgery in strabismus, in patients at all ages, with previous history of strabismus surgery and with topical anaesthesia. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Phenomenon of mucous retention in the incisive canal.

    Science.gov (United States)

    Keith, D A

    1979-11-01

    Mucous glands are rarely found in the anterior palate but may be observed in the incisive canal. A case history is presented of a lesion that resembled a nasopalatine cyst both clinically and radiographically but which was in fact an intra-bony extravasation phenomenon.

  12. Heterotopic ossification in abdominal incision : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Yoon Sik; Nam, Kung Sook; Hwang, Im Kyung; Kim, Heung Chul [College of Medicine, Hallym Univ., Chuncheon (Korea, Republic of)

    2001-08-01

    Heterotopic ossification in abdominal incision is a rare post-surgical sequala and a subtype of myositis ossificans traumatica. Recognition of this rare condition is important because it may be misinterpreted as a retained foreign body or incisional neoplastic recurrence. We report a case involving a 59-year-old man who presented with a palpable epigastric mass and pronounced fatigability.

  13. Tubularized incised plate technique for recurrent hypospadias: a ...

    African Journals Online (AJOL)

    management of recurrent hypospadias. Summary background ... The potential advantages of tubularized incised plate .... after a mean duration of 4.9 ± 3.1 years from the previous repair (Table 2). .... erection and the risk of infection, especially in patients older than 15 .... However, previous surgery often limits the availability ...

  14. Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis

    DEFF Research Database (Denmark)

    Waaddegaard, P; Miskowiak, J; Stage, P

    1991-01-01

    In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantage...

  15. Single-incision laparoscopic cholecystectomy with needle graspers.

    Science.gov (United States)

    Sumiyoshi, Kinjiro; Sato, Norihiro; Akagawa, Shin; Hirano, Tatsuya; Koikawa, Kazuhiro; Horioka, Kohei; Ozono, Keigo; Fujiwara, Kenji; Tanaka, Masao; Sada, Masayuki

    2012-01-01

    Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure. In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N. SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge. Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.

  16. Single-incision laparoscopic surgery for pyloric stenosis.

    Science.gov (United States)

    Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel

    2012-04-01

    Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

  17. Cost assessment of instruments for single-incision laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob

    2012-01-01

    Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed...

  18. [External periareolar incision for subdermal mastectomy in men with gynecomastia].

    Science.gov (United States)

    Montiel-Jarquín, Alvaro; Reyes-Páramo, Pedro; Ramos-Alvarez, Gloria; López-Colombo, Aurelio; Tinajero-Esquivel, Magdalena; Ruiz-León, Betzabé

    2007-01-01

    Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, symptoms and psychological alterations persist. Subdermal mastectomy is the definitive treatment and can be achieved by different incisions, each with potential complications. We undertook this study to present clinical characteristics of 11 patients with gynecomastia and the results obtained with subdermal mastectomy by means of external periareolar incision. A descriptive cohort study in male patients with gynecomastia was carried out in a third-level medical care hospital. Patients were treated with subdermal mastectomy by means of external periareolar incision. There were 11 male patients with an average age of 19 years (range: 11-60 years), 3 patients (27.2%) with bilateral gynecomastia and 8 patients (72.7%) with unilateral gynecomastia. Average time of evolution was 22 months (range: 16-48 months), 9 patients (81.8%) reported pain, 11 patients (100%) reported psychological alterations with cutaneous alteration, 11 patients (100%) had normal secondary sexual characteristics, 1 patient (9%) had supernumerary nipple development, and 11 patients (100%) had well-defined lesions. According to Simon's classification: seven patients (63.6%) were classified as grade 1, three patients (27.2%) as grade 2 and one patient (9.09%) as grade 3. Each patient had a subdermal mastectomy with external periareolar incision, 11 patients (100%) had a histopathological report of gynecomastia; 1 patient (9.09%) displayed keloid healing and none displayed complications inherent to the surgical procedure. Mastectomy by means of external periareolar incision is useful in the treatment of gynecomastia.

  19. The origin and significance of sinuosity along incising bedrock rivers

    Science.gov (United States)

    Barbour, Jonathan Ross

    Landscapes evolve through processes acting at the earth's surface in response to tectonics and climate. Rivers that cut into bedrock are particularly important since they set the local baselevel and communicate changes in boundary conditions across the landscape through erosion and deposition; the pace of topographic evolution depends on both the rate of change of the boundary conditions and the speed of the bedrock channel network response. Much of the work so far has considered the effects of tectonically-controlled changes in slope and climatically-controlled changes in discharges to the rate of channel bed erosion while considering bank erosion, if active at all, to be of at best secondary importance to landscape evolution. Sprinkled throughout the literature of the past century are studies that have recognized lateral activity along incising rivers, but conflicting interpretations have left many unanswered questions about how to identify and measure horizontal erosion, what drives it, what effect it has on the landscape, and how it responds to climate and tectonics. In this thesis, I begin to answer some of these questions by focusing on bedrock river sinuosity and its evolution through horizontal erosion of the channel banks. An analysis of synoptic scale topography and climatology of the islands of eastern Asia reveals a quantitative signature of storm frequency in a regional measure of mountain river sinuosity. This is partly explained through a study of the hydro- and morphodynamics of a rapidly evolving bedrock river in Taiwan which shows how the erosive forces vary along a river to influence the spatiotemporal distribution of downcutting, sidecutting, and sediment transport. Through these analyses, I also present evidence that suggests that the relative frequency of erosive events is far more important than the absolute magnitude of extreme events in setting the erosion rate, and I show that the horizontal erosion of bedrock rivers is an important

  20. The width of the incisive canal and labial alveolar bone of the incisive canal: an assessment on CT images

    International Nuclear Information System (INIS)

    Roh, Yang Gyun; Jang, Hyun Seon; Kim, Byung Ock; Kim, Jin Soo

    2006-01-01

    To assess the width of the labial alveolar bone of the incisive canal and the width of the incisive canal on spiral computed tomographic images of the anterior portion of the maxilla. Study materials included 38 CT scans taken for preoperative planning of implant placement. Axial cross-sectioned image entirely showing the incisive canal at an orifice to the oral cavity, middle portion, and an orifice to the nasal cavity and the diameter of the incisive canal at the middle portion were determined by two specialist using Digora for Windows 2.1. The statistical analyses were carried out using SPSS 12.0.1. When the maxillary central incisors remained, the mean labial alveolar bone width were 6.81±1.41 mm, 6.46±1.33 mm, and 7.91±1.33 mm. When the maxillary central incisors were missed the mean width were 5.42±2.20 mm, 6.23±2.29 mm, and 7.89±2.13 mm. The labial alveolar bone width at middle portion and an orifice to the nasal cavity were of no statistical significant difference according to presence of the maxillary central incisors (P>0.05). The width between oral cavity and nasal cavity, middle portion and to masal cavity revealed statistically significant difference (P<0.05)

  1. Incisional hernia after upper abdominal surgery: A randomised controlled trial of midline versus transverse incision

    NARCIS (Netherlands)

    J.A. Halm (Jens); H. Lip (Harm); P.I.M. Schmitz (Paul); J. Jeekel (Hans)

    2009-01-01

    textabstractObjectives: To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data: Incisional hernias after midline

  2. Lean tool used in the automotive industry

    Directory of Open Access Journals (Sweden)

    Manuela Ingaldi

    2014-10-01

    Full Text Available In the paper basic concepts of Lean Manufacturing were presented. A company specializing in the development of vehicle dynamics, driver assistance systems, brake systems, seat belt sand electronics technology was characterized. The company is engaged in designing and manufacturing world-class products for the automotive market. The Lean tools used in the production hall, such as Yamazumi chart, machine motion analysis, MTM method and timing, were presented.

  3. Lean tool used in the automotive industry

    OpenAIRE

    Manuela Ingaldi; Marta Jagusiak-Kocik

    2014-01-01

    In the paper basic concepts of Lean Manufacturing were presented. A company specializing in the development of vehicle dynamics, driver assistance systems, brake systems, seat belt sand electronics technology was characterized. The company is engaged in designing and manufacturing world-class products for the automotive market. The Lean tools used in the production hall, such as Yamazumi chart, machine motion analysis, MTM method and timing, were presented.

  4. Channel incision and suspended sediment delivery at Caspar Creek, Mendocino County, California

    Science.gov (United States)

    Nicholas J. Dewey; Thomas E. Lisle; Leslie M. Reid

    2003-01-01

    Tributary and headwater valleys in the Caspar Creek watershed,in coastal Mendocino County, California,show signs of incision along much of their lengths.An episode of incision followed initial-entry logging which took place between 1860 and 1906. Another episode of incision cut into skid-trails created for second-entry logging in the 1970's.

  5. Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

    Science.gov (United States)

    Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

    2012-01-01

    The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

  6. Penetrating and Intrastromal Corneal Arcuate Incisions in Rabbit and Human Cadaver Eyes: Manual Diamond Blade and Femtosecond Laser-Created Incisions.

    Science.gov (United States)

    Gray, Brad; Binder, Perry S; Huang, Ling C; Hill, Jim; Salvador-Silva, Mercedes; Gwon, Arlene

    2016-07-01

    To compare morphologic differences between freehand diamond or femtosecond laser-assisted penetrating and intrastromal arcuate incisions. Freehand diamond blade, corneal arcuate incisions (180° apart, 60° arc lengths) and 150 kHz femtosecond laser (80% scheimpflug pachymetry depth corneal thickness) arcuate incisions were performed in rabbits. Intrastromal arcuate incisions (100 μm above Descemet's membrane, 100 μm below epithelium) were performed in rabbit corneas (energy 1.2 μJ, spot line separation 3 × 3 μm, 90° side cut angle). Eyes were examined by slit lamp and light microscopy up to 47 days post-procedure. Freehand diamond blade penetrating incisions, and femtosecond laser penetrating and intrastromal arcuate incisions (energy 1.8 μJ, spot line separation 2 × 2 μm) were performed in cadaver eyes. Optical coherence tomography was performed immediately after surgery and the corneas were fixed for light scanning and transmission electron microscopy. The rabbit model showed anterior stromal inflammation with epithelial hyperplasia in penetrating blade and laser penetrating wounds. The laser intrastromal and penetrating incisions showed localized constriction of the stromal layers of the cornea near the wound. In cadaver eyes, penetrating wound morphology was similar between blade and laser whereas intrastromal wounds did not affect the cornea above or below incisions. Penetrating femtosecond laser arcuate incisions have more predictable and controlled outcomes shown by less post-operative scarring than incisions performed with a diamond blade. Intrastromal incisions do not affect uncut corneal layers as demonstrated by histopathology. The femtosecond laser has significant advantages in its ability to make intrastromal incisions which are not achievable by traditional freehand or mechanical diamond blades.

  7. Incisive papilla and positions of maxillary anterior teeth among ...

    African Journals Online (AJOL)

    Results: One hundred and twelve maxillary casts generated from participants aged 18-35 years (mean age 22.39±2.00 years), with well aligned arches were studied. The maxillary central incisor exhibited a mean of 14.93±1.52mm from the posterior limit of the incisive papilla while the inter-canine line scored a mean of ...

  8. Manual small incision extracapsular cataract surgery in Australia.

    Science.gov (United States)

    van Zyl, Lourens; Kahawita, Shyalle; Goggin, Michael

    2014-11-01

    Examination of the results and describing the technique of manual small incision extracapsular cataract extraction on patients with advanced cataracts in urban Australia. A descriptive case series. Thirty-eight patients at three public hospitals, one tertiary and two secondary ophthalmic units in urban Australia. Forty eyes with dense mature cataracts with hand movement vision or worse underwent a planned manual small incision extracapsular cataract extraction instead of traditional phaco-emulsification. Postoperative visual aquity, surgically induced astigmatism and complications. Seventy-eight per cent of patients had an uncorrected visual acuity of 6/12 or better on the first postoperative day. Eighty-three per cent of patients had a distance corrected visual acuity of 6/9 or better 3 months postoperatively. One case was complicated by a posterior capsule rupture. No cases of endophthalmitis were reported. The summated vector mean of the surgically induced astigmatism was 0.089D at 93°. Manual small incision extracapsular cataract extraction is an efficacious cataract surgery technique with good visual outcome and is a safe alternative to phaco-emulsification in suitable cases in a first-world setting. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

  9. Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Aram Baram

    2014-02-01

    Full Text Available Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8% that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4. Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months. A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5% and another patient (2.5% presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% (p = .353 and 2.5% (p = .552, respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58% compared to palmar type (14, 35.89% or axillary type (7, 17.94%. Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications.

  10. In vivo architectural analysis of clear corneal incisions using anterior segment optical coherence tomography.

    Science.gov (United States)

    Dupont-Monod, Sylvère; Labbé, Antoine; Fayol, Nicolas; Chassignol, Alexis; Bourges, Jean-Louis; Baudouin, Christophe

    2009-03-01

    To use anterior segment optical coherence tomography (AS-OCT) to analyze the in vivo architecture of clear corneal incisions after phacoemulsification using different techniques. Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France. This prospective observational study analyzed clear corneal incisions used in phacoemulsification. All wounds were evaluated 1 day and 8 days postoperatively by AS-OCT (Visante). Incision architecture and pachymetry at the wound level were analyzed. Thirty-five clear corneal incisions were analyzed. Six eyes had 2.75 mm coaxial phacoemulsification, 19 had 2.20 mm microincision coaxial phacoemulsification, and 10 had 1.30 mm bimanual microincision phacoemulsification. The 1.30 mm incision had a straight-line configuration. The 2.20 mm and 2.75 mm incisions had an arcuate configuration. The angles of incidence of 1.30 mm incisions were greater than those of 2.20 mm incisions (P<.001). All incisions had slight corneal edema limited to the incision area. The edema was slightly greater around 1.30 mm incisions (mean pachymetry 1143 microm +/- 140 [SD]) than around 2.20 mm incisions (mean 1012 +/- 101 microm) (P = .001). Bimanual procedures had satisfactory endothelial apposition in the enlarged areas, where stromal edema was less than that surrounding the unenlarged 1.30 mm incisions. The 3 phacoemulsification techniques induced gaping of the endothelial edge, minor inadequate endothelial apposition, and mild stromal edema in the area of the clear corneal incisions. Bimanual microincision sleeveless phacoemulsification may alter the wound slightly more than coaxial 2.75 mm and microcoaxial 2.20 mm sleeved-tip phacoemulsification.

  11. Signatures of Late Pleistocene fluvial incision in an Alpine landscape

    Science.gov (United States)

    Leith, Kerry; Fox, Matthew; Moore, Jeffrey R.

    2018-02-01

    Uncertainty regarding the relative efficacy of fluvial and glacial erosion has hindered attempts to quantitatively analyse the Pleistocene evolution of alpine landscapes. Here we show that the morphology of major tributaries of the Rhone River, Switzerland, is consistent with that predicted for a landscape shaped primarily by multiple phases of fluvial incision following a period of intense glacial erosion after the mid-Pleistocene transition (∼0.7 Ma). This is despite major ice sheets reoccupying the region during cold intervals since the mid-Pleistocene. We use high-resolution LiDAR data to identify a series of convex reaches within the long-profiles of 18 tributary channels. We propose these reaches represent knickpoints, which developed as regional uplift raised tributary bedrock channels above the local fluvial baselevel during glacial intervals, and migrated upstream as the fluvial system was re-established during interglacial periods. Using a combination of integral long-profile analysis and stream-power modelling, we find that the locations of ∼80% of knickpoints in our study region are consistent with that predicted for a fluvial origin, while the mean residual error over ∼100 km of modelled channels is just 26.3 m. Breaks in cross-valley profiles project toward the elevation of former end-of-interglacial channel elevations, supporting our model results. Calculated long-term uplift rates are within ∼15% of present-day measurements, while modelled rates of bedrock incision range from ∼1 mm/yr for low gradient reaches between knickpoints to ∼6-10 mm/yr close to retreating knickpoints, typical of observed rates in alpine settings. Together, our results reveal approximately 800 m of regional uplift, river incision, and hillslope erosion in the lower half of each tributary catchment since 0.7 Ma.

  12. The extended minimal incision approach to midface rejuvenation.

    Science.gov (United States)

    Pontius, Allison T; Williams, Edwin F

    2005-08-01

    Recent major advancements in comprehensive facial rejuvenation have focused on management of midfacial aging. Multiple techniques have been described to treat the aging midface; the mere nature of so many approaches is evidence that no one technique has prevailed. Although the nasolabial region remains a challenge to correct, the approach described herein provides comprehensive rejuvenation of the midface, lateral brow, and jawline. The technique is performed via a minimal incision brow-lift approach and has been performed (with minor modifications) by the senior author in more than 650 patients over the past 9 years. The technique has proven to be safe, reliable, and effective.

  13. Systematic review and meta-analysis of electrocautery versus scalpel for surgical skin incisions.

    Science.gov (United States)

    Aird, Lisa N F; Brown, Carl J

    2012-08-01

    The creation of surgical skin incisions has historically been performed using a cold scalpel. The use of electrocautery for this purpose has been controversial with respect to patient safety and surgical efficacy. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to compare skin incisions made by electrocautery and a scalpel. A systematic electronic literature search was performed using 2 electronic databases (MEDLINE and PubMed), and the methodological quality of included publications was evaluated. Six RCTs were identified comparing electrocautery (n = 606) and a scalpel (n = 628) for skin incisions. No significant difference in wound infection rates or scar cosmesis was identified between the treatment groups. Electrocautery significantly reduced the incision time and postoperative wound pain. A trend toward less incisional blood loss from skin incisions made with electrocautery was noted. Electrocautery is a safe and effective method for performing surgical skin incisions. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Single incision laparoscopic liver resection (SILL – a systematic review

    Directory of Open Access Journals (Sweden)

    Benzing, Christian

    2015-12-01

    Full Text Available Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL. The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

  15. Magnetic resonance imaging evaluation of incision healing after cesarean sections

    Energy Technology Data Exchange (ETDEWEB)

    Dicle, O. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Kuecuekler, C. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Pirnar, T. [Department of Radiodiagnosis, Dokuz Eyluel University, Izmir (Turkey); Erata, Y. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey); Posaci, C. [Department of Gynecology and Obstetrics, Dokuz Eyluel University, Izmir (Turkey)

    1997-02-01

    The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months. (orig.). With 6 figs.

  16. Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

    Directory of Open Access Journals (Sweden)

    Mihai Dumitrescu

    2017-05-01

    Full Text Available Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.

  17. Magnetic resonance imaging evaluation of incision healing after cesarean sections

    International Nuclear Information System (INIS)

    Dicle, O.; Kuecuekler, C.; Pirnar, T.; Erata, Y.; Posaci, C.

    1997-01-01

    The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months. (orig.). With 6 figs

  18. Discussion on the Relevant Factors of General Surgery Incision Infection and Prevention Methods

    Directory of Open Access Journals (Sweden)

    Jin Baotao

    2017-01-01

    Full Text Available There are many reasons that can lead to incision infection of general surgical patients. The main reasons include weight, age, body albumin level, surgical time, observation ward, etc. This paper analyzes the clinic data of patients with incision infection after general surgery based on clinic practice and study on the reasons that have impact on general surgical incision infection and gives relevant prevention countermeasures.

  19. Long-Term Incisal Relationships After Palatoplasty in Patients With Isolated Cleft Palate.

    Science.gov (United States)

    Odom, Elizabeth B; Woo, Albert S; Mendonca, Derick A; Huebener, Donald V; Nissen, Richard J; Skolnick, Gary B; Patel, Kamlesh B

    2016-06-01

    Various palatoplasty techniques have limited incisions in the hard palate due to concerns that these incisions may limit maxillary growth. There is little convincing long-term evidence to support this. Our purpose is to determine incisal relationships, an indicator for future orthognathic procedure, in patients after repair of an isolated cleft of the secondary palate. Our craniofacial database was used to identify patients aged 10 years or greater with an isolated cleft of the secondary palate who underwent palatoplasty between 1985 and 2002. Data collected included age at palatoplasty and follow-up, cleft type, associated syndrome, Robin sequence, surgeon, repair technique, number of operations, and occlusion. Incisal relationship was determined through clinical observation by a pediatric dentist and orthodontist. Seventy eligible patients operated on by 9 surgeons were identified. Class III incisal relationship was seen in 5 patients (7.1%). Palatoplasty techniques over the hard palate (63 of 70 patients) included 2-flap palatoplasty, VY-pushback, and Von Langenbeck repair. There was an association between class III incisal relationship and syndromic diagnosis (P <0.001). Other study variables were not associated with class III incisal relationships. In patients with an isolated cleft of the secondary palate, there was no association between class III incisal relationship and surgeon, age at repair, cleft type, palatoplasty technique, or number of operations. Increased likelihood of class III incisal relationship was associated primarily with syndromic diagnosis.

  20. Midline versus transverse incision for cesarean delivery in low-income countries

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Aabakke, Anna J M; Secher, Niels J

    2014-01-01

    While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence...... is limited, the literature suggests important advantages of the transverse incision, with lower risk of long-term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change...

  1. Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial.

    Science.gov (United States)

    Shamim, Muhammad

    2009-08-01

    This prospective, double-blind, randomized, controlled trial was designed to compare the outcome of diathermy incisions versus scalpel incisions in general surgery. A total of 369 patients who underwent diathermy incision (group A: 185 patients) or scalpel incision (group B: 184 patients) were analyzed. Variables analyzed were: surgical wound classification, length and depth of incision, incision time, duration of operation, incisional blood loss, postoperative pain, duration of hospital stay, duration of healing, and postoperative complications. The inclusion criteria were all patients who underwent elective or emergency general surgery. The exclusion criteria were only cases with incomplete patients' data and patients who were lost to follow-up. This study was conducted at Fatima Hospital-Baqai Medical University and Shamsi Hospital (Karachi), from January 2006 to December 2007. Incision time was significantly longer for patients in group B (p = 0.001). Incisional blood loss also was more for patients in group B (p = 0.000). Pain perception was found to be markedly reduced during the first 48 h in group A (p = 0.000). Total period of hospital stay (p = 0.129) and time for complete wound healing (p = 0.683) were almost the same for both groups. Postoperative complication rate by wound classification did not differ markedly between the two groups (p = 0.002 vs. p = 0.000). Diathermy incision has significant advantages compared with the scalpel because of reduced incision time, less blood loss, & reduced early postoperative pain.

  2. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery.

    Science.gov (United States)

    Kerver, A L A; Leliveld, M S; den Hartog, D; Verhofstad, M H J; Kleinrensink, G J

    2013-12-04

    Iatrogenic injury to the infrapatellar branch of the saphenous nerve is a common complication of surgical approaches to the anteromedial side of the knee. A detailed description of the relative anatomic course of the nerve is important to define clinical guidelines and minimize iatrogenic damage during anterior knee surgery. In twenty embalmed knees, the infrapatellar branch of the saphenous nerve was dissected. With use of a computer-assisted surgical anatomy mapping tool, safe and risk zones, as well as the location-dependent direction of the nerve, were calculated. The location of the infrapatellar branch of the saphenous nerve is highly variable, and no definite safe zone could be identified. The infrapatellar branch runs in neither a purely horizontal nor a vertical course. The course of the branch is location-dependent. Medially, it runs a nearly vertical course; medial to the patellar tendon, it has a -45° distal-lateral course; and on the patella and patellar tendon, it runs a close to horizontal-lateral course. Three low risk zones for iatrogenic nerve injury were identified: one is on the medial side of the knee, at the level of the tibial tuberosity, where a -45° oblique incision is least prone to damage the nerves, and two zones are located medial to the patellar apex (cranial and caudal), where close to horizontal incisions are least prone to damage the nerves. The infrapatellar branch of the saphenous nerve is at risk for iatrogenic damage in anteromedial knee surgery, especially when longitudinal incisions are made. There are three low risk zones for a safer anterior approach to the knee. The direction of the infrapatellar branch of the saphenous nerve is location-dependent. To minimize iatrogenic damage to the nerve, the direction of incisions should be parallel to the direction of the nerve when technically possible. These findings suggest that iatrogenic damage of the infrapatellar branch of the saphenous nerve can be minimized in anteromedial

  3. Advantages of the modified double ring areolar incision over the traditional areolar incision in multicentric breast fibroadenoma surgery.

    Science.gov (United States)

    Zhang, Mingliang; Shen, Gongjin; Zhang, Song; Cui, Zhen; Qian, Jun

    2017-09-01

    This study was conducted to investigate the clinical advantages of modified double ring areola incision (MDRAI) compared to ordinary areola incision (OAI) in multicentric breast fibroadenoma in women. Sixty cases of multicentric benign breast tumor were recruited from the First Affiliated Hospital of Bengbu Medical College from January to December 2016. The cases were divided into two groups according to surgical approach: MDRAI (n = 20) and OAI (n = 40). The operation duration, intraoperative blood loss, drainage time, and postoperative recurrence rate in the first six months were compared. The mean age and tumor locations were not statistically different between the groups (P > 0.05). However, more lesions and larger tumor diameter were found in the MDRAI group than in the OAI group, with statistical difference (P  0.05). However, the intraoperative blood loss was statistically different between the two groups (P < 0.05). All 60 cases received six months of follow-up. Eight recurrent cases were found in the OAI group, but none in the MDRAI group. The recurrence rate was significantly different (χ 2  = 4.62, P < 0.05). Compared with OAI, MDRAI offers greater advantages in the aspects of blood loss and recurrence for the treatment of breast benign tumor, especially for multicentric larger lesions. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  4. Outcomes of small incision lenticule extraction (SMILE) in low myopia.

    Science.gov (United States)

    Reinstein, Dan Z; Carp, Glenn I; Archer, Timothy J; Gobbe, Marine

    2014-12-01

    To report the visual and refractive outcomes of small incision lenticule extraction for low myopia using the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). A retrospective analysis of 120 consecutive small incision lenticule extraction procedures was performed for low myopia. Inclusion criteria were preoperative spherical equivalent refraction up to -3.50 diopters (D), cylinder up to 1.50 D, and corrected distance visual acuity of 20/20 or better. Outcomes analysis was performed for all eyes with 1-year follow-up according to the Standard Graphs for Reporting Refractive Surgery, and also including mesopic contrast sensitivity. One-year data were available for 110 eyes (92%). Preoperatively, mean spherical equivalent refraction was -2.61 ± 0.54 D (range: -1.03 to -3.50 D) and mean cylinder was 0.55 ± 0.38 D (range: 0.00 to 1.50 D). Postoperatively, mean spherical equivalent refraction was -0.05 ± 0.36 D (range: -0.94 to +1.25 D) and mean cylinder was ± 0.50 D in 84% and ± 1.00 D in 99% of eyes. Uncorrected distance visual acuity was 20/20 or better in 96% of eyes and 20/25 or better in 100% of eyes. One line of corrected distance visual acuity was lost in 9%, but no eyes lost two or more lines. There was an initial overcorrection in mean spherical equivalent refraction on day 1 (+0.37 D) as expected, which regressed to +0.10 D at 1 month and -0.05 D at 3 months, after which stability was reached (mean spherical equivalent refraction was -0.05 D at 1 year). Contrast sensitivity at 1 year was slightly increased at 3, 6, 12, and 18 cycles per degree (P < .05). Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes similar to those previously reported for LASIK. Copyright 2014, SLACK Incorporated.

  5. Mouse preferential incising force orientation changes during jaw closing muscle hyperalgesia and is sex dependent.

    Science.gov (United States)

    Widmer, C G; Morris-Wiman, J

    2016-12-01

    Mouse incising is controlled by a central pattern generator and this activity can change in the presence of pain. The incising frequency and maximum force generation decreases with pain. In this study, we used repetitive acidic injections in the left masseter muscle of male and female mice to determine differences between baseline and jaw muscle pain conditions and the effect of sex on preferential incising direction. A within subject design was used to evaluate data previously acquired using multi-axis force data (X, Y and Z) from the 4th baseline recording day and day 7 post-injection (day of maximal pain response) for each mouse of each sex. A total of 34 female and male (age 3-9months) CD-1 mice were evaluated. After mathematically rotating the X and Y axes to align the Y axis to be parallel to the wire struts of the cage top, data were analyzed to determine incising direction preference during baseline (non-pain) and pain (day 7) conditions and between sex. Radar plots of X-Y, X-Z and Y-Z axes depicted the average direction of incising preference between baseline and pain conditions for each sex. Statistical differences among groups were tested using a mixed model ANOVA. Similar to previous findings, female mice had a more robust difference in incising direction preference when comparing male and female pain conditions and this was most evident in the X-Z axes. The incising frequencies most commonly affected were 5.3, 6.2 and 7.6Hz. Male mice varied little in their incising direction preference between the baseline and pain conditions. In addition, statistical comparison of ratios of the percent of time spent incising in the Z versus X axes for each incising frequency found that the incising preference was not different when comparing 5.3 and 7.6Hz frequencies. Finally, female mice used a novel approach to minimize pain while incising by rotating their head and body nearly 180 degrees while males did not use this strategy as frequently. The preferred incising

  6. Clear corneal incision leakage after phacoemulsification--detection using povidone iodine 5%.

    Science.gov (United States)

    Chee, Soon-Phaik

    2005-01-01

    The purpose of this work was to study the incidence of clear corneal wound leakage at the conclusion of standard co-axial phacoemulsification in a prospective observational series of 100 consecutive cataract cases in a single surgeon's institutional practice. At the conclusion of standard co-axial phacoemulsification using a 2.75 mm temporal single plane clear corneal incision with a 1 mm clear corneal side-port incision, the wounds were hydrated and checked for water-tightness. Povidone iodine 5% (P-I) was then evenly dripped over the cornea and the wounds were inspected visually. Any leakage of aqueous observed was recorded. The amount of leakage was graded as small or large from each wound. Leaky wounds were further hydrated and retested with P-I until sealed. Wound integrity was reassessed on the first postoperative day by use of fluorescein. Of the 100 cases, wound leakage was observed for 31 eyes (31%)-ten main incisions, nineteen side-port incisions, and both incisions in two cases. Wound leakage was easily detected as a ribbon of clear fluid streaming from the incision amid a pool of brown solution. Povidone iodine was not observed within the tract in any incision. All wound leakage was small except for one from the main incision and two from the side-port incision. None of the eyes developed wound leakage the day after surgery and none developed endophthalmitis. In conclusion, leakage from clear corneal incisions at the conclusion of phacoemulsification occurs in almost a third of cases, predominantly from the side incision. It is easily detected by use of the P-I test.

  7. Effects of post-treatment incubation on recombinogenesis in incision-proficient and incision-deficient strains of saccharomyces cerevisiae, 2

    International Nuclear Information System (INIS)

    Saeki, Tetsuya; Machida, Isamu

    1991-01-01

    After the photoaddition of mono- and bifunctional furocoumarins to G1 phase cells, most gene conversion and crossing-over occurred without post-irradiation incubation of these cells in incision-proficient strains. In contrast, incision-deficient cells showed marked induction of both recombinational events only after treated cells had been incubated for several hours before selection. These results indicate that when furocoumarins are photoadded to G1 cells, initiation of recombinational events occurs during the same G1 phase in the incision-proficient cells; whereas, it occurs only after post-irradiation DNA replication in incision-deficient cells. The action of the PSO2 gene product specific for the repair of DNA crosslinks in recombination induction is discussed and compared to the actions of the excision repair genes RAD1 and RAD2. (author)

  8. Median sternotomy - gold standard incision for cardiac surgeons

    Directory of Open Access Journals (Sweden)

    Radu Matache

    2016-05-01

    Full Text Available Sternotomy is the gold standard incision for cardiac surgeons but it is also used in thoracic surgery especially for mediastinal, tracheal and main stem bronchus surgery. The surgical technique is well established and identification of the correct anatomic landmarks, midline tissue preparation, osteotomy and bleeding control are important steps of the procedure. Correct sternal closure is vital for avoiding short- and long-term morbidity and mortality. The two sternal halves have to be well approximated to facilitate healing of the bone and to avoid instability, which is a risk factor for wound infection. New suture materials and techniques would be expected to be developed to further improve the patients evolution, in respect to both immediate postoperative period and long-term morbidity and mortality

  9. Mandibular incisive canal in relation to periapical surgery

    Directory of Open Access Journals (Sweden)

    Kani Bilginaylar

    2016-01-01

    Full Text Available The aim of the present paper is to emphasize the importance of the mandibular interforaminal neurovascular bundle with a case and make a warning to dentists and surgeons during oral and maxillofacial surgeries, such as implant replacement, bone harvesting, genioplasty, open reduction of a mandibular fracture, and cyst enucleations at this region. In this paper, we present a 58-year-old male who referred with pain and a tingling sensation on the left lower lip. After radiographical, extraoral and intraoral examinations, findings indicated the lesion to be a cyst which was related with a periapical lesion of the canine tooth and extracted socket of first premolar tooth. After removal of a cyst, the mandibular incisive nerve was documented which was in relation to cyst cavity.

  10. Incisiones verticales en SARPE Vertical incisions in SARPE

    Directory of Open Access Journals (Sweden)

    J. Gonzalez Lagunas

    2005-06-01

    Full Text Available La expansión rápida de paladar asistida quirúrgicamente (SARPE es una de las opciones terapeuticas de los transtornos transversales del maxilar superior. Presentamos nuestra experiencia inicial con una variante técnica consistente en una corticotomía de la pared lateral del maxilar combinada con una osteotomía palatina media transincisal, y efectuadas a través de tres pequeñas incisiones verticales.Surgically assisted rapid palatal expansion (SARPE is one of the therapeutic options for the correction of transverse maxillary collapse. We present our initial experience with a technique consisting in a lateral corticotomy of the maxilla plus a transincisal midpalatal osteotomy, both performed through minimal vertical incisions.

  11. A case of bifocal endometriosis involving a pfannenstiel incision.

    Science.gov (United States)

    Evsen, Mehmet Sidik; Sak, Muhammet Erdal; Yalinkaya, Ahmet; Firat, Ugur; Caca, Fatma Nur

    2011-01-01

    A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

  12. Performance of fast-absorbable suture and histo-glue in closing incisions in Brown trout

    DEFF Research Database (Denmark)

    Jepsen, Niels; Larsen, Martin Hage; Aarestrup, Kim

    2017-01-01

    , growth, tag expulsion rate and incision healing was compared among three groups of dummy transmitter-tagged wild brown trout Salmo trutta where incisions were closed with two types of suture material (absorbable vs. fast absorbable) and Histo-glue. The tagged fish were kept in semi-natural ponds for 20...

  13. RF front-end world class designs

    CERN Document Server

    Love, Janine

    2009-01-01

    All the design and development inspiration and direction a harware engineer needs in one blockbuster book! Janine Love site editor for RF Design Line,columnist, and author has selected the very best RF design material from the Newnes portfolio and has compiled it into this volume. The result is a book covering the gamut of RF front end design from antenna and filter design fundamentals to optimized layout techniques with a strong pragmatic emphasis. In addition to specific design techniques and practices, this book also discusses various approaches to solving RF front end design problems and h

  14. Teaming. The Key to World Class Manufacturing.

    Science.gov (United States)

    Wright, John R.

    1999-01-01

    Lean manufacturing, a streamlined system of flow and job shop techniques, relies on self-directed work teams. Technology educators can prepare students for work in this environment by using problem-solving teams in the classroom to work on design briefs and other group projects. (SK)

  15. Achieving world class performance step by step.

    Science.gov (United States)

    Kerr, L J

    1992-02-01

    Bridgestone of Japan acquired Firestone, a United States corporation, in early 1988. This article describes the integration process of the two organizations' cultures. There are many lessons in the approach that should apply to a variety of organizations. The Strategic Improvement Process, a rather highly structured approach, harnesses the strengths of both the Japanese and American organizations and starts the manufacturing and technical departments on the road to excellence.

  16. World class BWRs for the 1990s

    International Nuclear Information System (INIS)

    Wilkins, D.; Lowton, R.

    1989-01-01

    The first step in Advanced BWR development took place in 1978. It was the formation in San Jose, California, of an Advanced Engineering Team, consisting of representatives of worldwide BWR suppliers and leading architect engineer firms. The Advanced Engineering Team effort was completed in 1979 and established the basic ABWR concept. During the period 1980-85, ABWR development was focused in Japan. Under the sponsorship of the Tokyo Electric Power Company and Japanese BWR utilities, GE, Hitachi and Toshiba performed design development studies to confirm the technical and economic attractiveness of the ABWR, and also conducted a comprehensive test programme encompassing the new features. In 1987, The Tokyo Electric Power Company announced its decision to proceed with two ABWR units at its Kashiwazaki-Kariwa nuclear power station with commercial operation of the first unit in 1996 and the second in 1998. The company submitted the application for the establishment permit for the two ABWR units in May 1988. The units will be supplied by a joint venture of the three companies who worked on the development studies. This article goes on to describe the ABWR design resulting form this international development effort. (3 figures, 1 table). (Author)

  17. Introduction--World-Class Basic Education

    Science.gov (United States)

    Adams, Don

    2012-01-01

    Borrowing educational institutions and ideas from the past and from other contemporary education systems is a significant part of the educational history of many nations. Many of the current nations continue to probe the past for pleasure or insights, while some nations seek to erase much of their educational past. Further, an increasing number of…

  18. Launching a world-class joint venture.

    Science.gov (United States)

    Bamford, James; Ernst, David; Fubini, David G

    2004-02-01

    More than 5,000 joint ventures, and many more contractual alliances, have been launched worldwide in the past five years. Companies are realizing that JVs and alliances can be lucrative vehicles for developing new products, moving into new markets, and increasing revenues. The problem is, the success rate for JVs and alliances is on a par with that for mergers and acquisitions--which is to say not very good. The authors, all McKinsey consultants, argue that JV success remains elusive for most companies because they don't pay enough attention to launch planning and execution. Most companies are highly disciplined about integrating the companies they target through M&A, but they rarely commit sufficient resources to launching similarly sized joint ventures or alliances. As a result, the parent companies experience strategic conflicts, governance gridlock, and missed operational synergies. Often, they walk away from the deal. The launch phase begins with the parent companies' signing of a memorandum of understanding and continues through the first 100 days of the JV or alliance's operation. During this period, it's critical for the parents to convene a team dedicated to exposing inherent tensions early. Specifically, the launch team must tackle four basic challenges. First, build and maintain strategic alignment across the separate corporate entities, each of which has its own goals, market pressures, and shareholders. Second, create a shared governance system for the two parent companies. Third, manage the economic interdependencies between the corporate parents and the JV. And fourth, build a cohesive, high-performing organization (the JV or alliance)--not a simple task, since most managers come from, will want to return to, and may even hold simultaneous positions in the parent companies. Using real-world examples, the authors offer their suggestions for meeting these challenges.

  19. Adding local flavor to world class imaging.

    Science.gov (United States)

    Kalbhen, Carl L

    2007-01-01

    Chicago, the host city for the annual meeting of the RSNA (Radiological Society of North America), is the quintessential place to obtain certain foods, among them deep dish pizza, the Italian beef sandwich, and the Chicago-style hot dog. Given some appropriate nutritional concerns about these items, it is important to realize that healthier alternatives are grown, produced, and sold regionally. Chicago has also for years been known as one of America's great restaurant towns. However, the French delicacy foie gras cannot be found on the menu of any of its five-star establishments, as the sale of this dish became illegal in 2006. Diagnostic imaging offers a unique perspective on the local Chicago cuisine. (c) RSNA, 2007.

  20. Thermal study of bare tips with various system parameters and incision sizes.

    Science.gov (United States)

    Osher, Robert H; Injev, Valentine P

    2006-05-01

    To identify major and minor surgeon-controlled parameters that affect incision temperature when performing microincision lens removal using the Alcon Infiniti Vision System. In vitro research and development laboratory, Alcon Research, Irvine, California, USA. Phacoemulsification was performed in eye-bank cadaver eyes and the following parameters evaluated: incision, duty cycle, ultrasound (US) power, aspiration flow rate (AFR), vacuum, pulse, bottle height and balanced salt solution temperature, and tip design/size. Each parameter was varied while the others remained constant. The resulting temperature of the incision and US tip was measured using a thermal camera. Major contributors to elevated incision temperature included incision size, US power, duty cycle, AFR, vacuum setting, tip design, and presence of an ophthalmic viscosurgical device (OVD). Minor contributors included pulse frequency, bottle height, and temperature of the infusate. Microincision lens removal can be performed at safe temperatures with the knowledgeable selection of surgeon-controlled parameters.

  1. Single-incision laparoscopic surgery through an ostomy site: a natural approach by an unnatural orifice.

    Science.gov (United States)

    Lopez, Nicole E; Peterson, Carrie Y; Ramamoorthy, Sonia L; McLemore, Elisabeth C; Sedrak, Michael F; Lowy, Andrew M; Horgan, Santiago; Talamini, Mark A; Sicklick, Jason K

    2015-02-01

    Single-incision laparoscopic surgery (SILS) is gaining popularity for a wide variety of surgical operations and capitalizes on the benefits of traditional laparoscopic surgery without incurring multiple incision sites. Traditionally, SILS is performed by a midline periumbilical approach. However, such a minimally invasive approach may be utilized in patients who already have an abdominal incision. Our series retrospectively reviews 7 cases in which we utilized the fascial defect at the time of after ostomy reversal as our SILS incision site. In turn, we performed a variety of concurrent intra-abdominal procedures with excellent technical success and outcomes. Our study is the largest single-institution case series of this novel approach and suggests that utilizing an existing ostomy-site abdominal incision is a safe and effective location for SILS port placement and should be considered in patients undergoing concurrent procedures.

  2. Ex vivo evaluation of femtosecond pulse laser incision of urinary tract tissue in a liquid environment: implications for endoscopic treatment of benign ureteral strictures.

    Science.gov (United States)

    Liang, Jun-Hao; Kang, Jian; Pan, Yu-Long; Zhang, Liang; Qi, Jun

    2011-08-01

    The femtosecond (FS) pulse laser incises soft tissues with minimal peripheral damage and is a promising cutting tool for ureteroscopic endoureterotomy of benign ureteral strictures. To evaluate the feasibility of applying the FS laser to ureteroscopic endoureterotomy. A commercial Ti:Sapphire regenerative amplifier system (Coherent, RegA 9050, USA) was used in this study. Normal saline, 5% glucose solution, 4% mannitol solution, distilled water, and a 1% (v/v) suspension of whole blood with each of these solutions were tested for their attenuation rate (AR) of the FS laser's power. Bladder specimens from Sprague-Dawley (SD) rats were used as a surrogate model. The laser incised slots of 2 mm in length at bladder samples using three power grades (5×, 10×, and 20× the threshold power) combined with five effective pulse rates (40, 20, 10, 5, and 2.5 kHz), both in air and in normal saline. After samples were processed with standard hematoxylin-eosin staining procedures, the incision depth and collateral damage range were determined microscopically. The ARs of blood suspensions with each of the three isosmotic solutions were significantly higher than the other five solutions (P laser's cutting depth and the collateral damage were increased with the laser power or power density but the collateral damages were less than 100 µm. Microbubble formation was detected in the liquid environments tested and influenced the effective laser power. Endoscopic application of the FS laser is feasible. Microbubble formation with the laser incision, however, may influence cutting effects. Proposed methods to address these issues include increasing the irrigation rate, using distilled water as irrigation or using gas insufflation instead of irrigation. It is necessary to evaluate these methods, as well as the long-term biologic response to laser incision, on living animal models in endoscopic settings before use on humans. Copyright © 2011 Wiley-Liss, Inc.

  3. Recent, climate-driven river incision rate fluctuations in the Mercantour crystalline massif, southern French Alps

    Science.gov (United States)

    Petit, C.; Goren, L.; Rolland, Y.; Bourlès, D.; Braucher, R.; Saillard, M.; Cassol, D.

    2017-06-01

    We present a new geomorphological analysis of the Tinée River tributaries in the southern French Alps based on numerical inverse and forward modelling of their longitudinal profiles. We model their relative uplift history with respect to the main channel, hence the incision rate history of this channel. Inverse models show that all tributaries have consistent incision rate histories with alternating high and low values. A comparison with global temperature curves shows that these variations correlate with quaternary climate changes. We suggest that during warm periods, a wave of regressive erosion propagates in the Tinée River, while its tributaries deeply incise their substratum to catch up with the falling base-level. We also show that the post 140 ka history of this landscape evolution is dominated by fluvial incision. We then perform forward models of river incision and simulate the incision of the Tinée River system over a time span of 600 ka. This model allows us to extract time and space incision rate variations of the Tinée River. With a background of a few mm.yr-1, incision rate can increase up to more than 1 cm yr-1 during short periods of time due to climatic oscillations. This result is compatible with published cosmogenic nuclide based dating, which evidenced incision rates from 0.2 to 24 mm yr-1. The part of the channel located between 12 and 20 km downstream from the source has undergone several periods of rapid incision rates, which could explain the steep hillslopes and the triggering of a landslide ∼10 ka ago.

  4. Quaternary river incision in the uplifted Rhenish massif (Ardennes, Belgium) - Insights from 10Be/26Al dating of river terraces

    Science.gov (United States)

    Rixhon, Gilles; Bourlès, Didier; Braucher, Régis; Siame, Lionel; Bovy, Benoît.; Demoulin, Alain

    2010-05-01

    Although it constitutes the main tool to unravel the regional recent tectonics, the chronology of the Pleistocene river incision is still poorly constrained within the uplifted Rhenish-Ardennes massif (Belgium, western Europe). Here, we measure cosmogenic nuclides concentrations (10Be and 26Al) in terrace quartz or quartzite sediments of several Ardennian rivers (Meuse, Ourthe and Amblève) in order to date the so-called Younger Main Terrace (YMT), a key-level in the network evolution. Though these dating methods are successfully used to determine ages of superficial (e.g., glacial) deposits, dating of fluvial terraces remains difficult. Possible predepositional exposures of the sampled material (inherited 10Be and 26Al) may indeed bias the measurements towards higher nuclide concentrations while several postdepositional processes (burial, erosion) may cause a lowering of the 10Be and 26Al concentrations. In an attempt to overcome these difficulties, the selected fluvial deposits (five locations) were sampled using a profiling technique on as thick as possible sections (more than 3 m). We present the first absolute dating of the YMT in the lower Meuse valley (nearby the Dutch boundary), where we obtained an age of 630 ka for a terrace deposit buried beneath 3 m of Weichselian loess. This age is consistent with some previously published estimates based on paleomagnetic data and MIS correlations. However, our ages for the same terrace level within the Ardennes are significantly younger: >400 ka in the lower Ourthe, and only ~220 ka still farther upstream, in the lower Amblève. We thus demonstrate that the post-YMT incision occurred diachronically in NE Ardennes. The ~0.5 Ma timespan needed by the erosion wave to propagate from the lower Meuse towards the Ardennian headwaters contradicts the long-held statement of a climatically driven incision that would have been synchronous throughout the catchment.

  5. STUDY OF VARIOUS MODALITIES IN MANAGEMENT OF INCISION HERNIA REPAIR

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    Raghu Rachha

    2018-03-01

    Full Text Available BACKGROUND Incisional hernias are a major problem following abdominal surgery and their repairs are among the common surgeries done by a general surgeon.1 Besides the preoperative factors such as anaemia, BMI over 25 kg/m2 and smoking which are leading causes contributing to the development of Incisional hernia, laparotomy performed through the abdominal incision doubles the risk of IH.2 In addition, wound infection, increases the risk of IH formation by 1.9 times.3 If left unattended they may attain large size therefore cause discomfort and lead to the complications like Obstruction, Strangulation, Incarceration increasing the risk of morbidity and mortality.4 Treatment of IH involves further major surgery and the results may be poor, with the recurrence rates of up to 49% reported.5 A wide spectrum of surgical techniques have been developed and recommended ranging from sutured techniques to the various types of prosthetic mesh. MATERIALS AND METHODS 30 patients were studied who presented to emergency department with incisional hernias during August 2014 – September 2016 at Gandhi Medical College and Hospital. All patients underwent definitive treatment. RESULTS From our study it is observed that 1. The maximum cases of incisional hernias presenting to the emergency surgical department were found to be in 51-60 years age group. 2. There was female preponderance. 3. Obstruction is the most common presenting symptom found in 60% of cases followed by irreducibility (33.3% and strangulation (6.67%. 4. The onset of incisional hernias is more after 10 years following previous surgery. 5. Among 30 patients, bowel was viable in 18 patients (60% and mesh repair was done in 13 patients. Bowel was gangrenous in 12 patients (40% and anatomical repair was done in 17 patients. 6. Out of 30, women got infected in 11 patients (36.67% wound dehiscence noted in 5 patients (16.67%. 7. The recurrence rate was 6.67% with 6 months follow up. CONCLUSION 1. The mean

  6. De Qeurvian Tenosynovitis: Clinical Outcomes of Surgical Treatment with Longitudinal and Transverse Incision

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    Arefah Dehghani Tafti

    2011-03-01

    Full Text Available AbstractObjectives: De Quervain disease is a mechanical tenosynovitis due to inadequacy volume between abductor pollicis longus, extensor pollicis brevis and their tunnel. Treatment methods include immobilization, steroid injections, and operation. For the first time Fritz De Quervain described surgical treatment of this disease. Since then, various ways of treatment have been reported. The purpose of this study is to compare the clinical outcomes of a longitudinal incision with a transverse incision in De Quervain disease.Methods: This was a randomized controlled clinical trial conducted in three hospitals in Iran, Yazd from March 2003 to September 2008. One hundred-twenty patients with De Quervain disease who did not respond to conservative treatment were operated with two different incisions. The patients were followed for three months to compare the surgical outcomes.Results: During a three month follow-up, a significant difference was shown between the two methods (p=0.03. Results of surgical treatment with longitudinal incision were excellent (only 5 hypertrophic scars, but there were 13 postoperative complaints with transverse incision.Conclusion: According to our findings, longitudinal incision in surgical treatment of De Quervain disease is better than transverse incision.

  7. Nuclear management in manual small incision cataract surgery by snare technique

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    Bhattacharya Debasish

    2009-01-01

    Full Text Available Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber becomes a useful option in these cases. In the snare technique, a stainless steel wire loop when lassoed around the nucleus in the anterior chamber constricts from the equator, easily dividing the hardest of the nuclei into two halves. The wire loop constricts in a controlled way when the second cannula of snare is pulled. The divided halves can easily be brought out by serrated crocodile forceps. This nuclear management can be safely performed through a smaller sclerocorneal flap valve incision where the corneal valve action is retained within the limbus without sutures, and the endothelium or the incision is not disturbed. However, the technique requires space in the anterior chamber to maneuver the wire loop and anterior chamber depth more than 2.5 mm is recommended. Much evidence to this wonderful technique is not available in literature, as its popularity grew through live surgical workshops and small interactive conferences.

  8. Complications of femtosecond laser corneal small incision lenticule extraction

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    Qing-Hong Lin

    2017-07-01

    Full Text Available AIM:To investigate the safety and complications of femtosecond laser corneal small incision lenticule extraction(SMILEprocedure and discuss the prevention and treatment.METHODS: We retrospectively studied the complications of 403 patients(799 eyeswith myopia and myopic astigmatism treated by SMILE.RESULTS: All the patients underwent the operation successfully. Only 1 case(1 eyesuffered from dark spot and changed to femtosecond laser-assisted LASIK(FS-LASIK, 5 cases(5 eyes, 0.6%suffered from the suction loss, 11 cases(17 eyes, 2.1%developed opaque bubble layer. All patients gained perfect uncorrected visual acuity(UCVA(20/20. The best corrected visual acuity(BCVAdid not decrease after operations. The incidence of haze and diffuse lamellar keratitis was low(0.3% and 0.4%, respectivelyand no other complications were observed. There was 9 eyes in 6 patients(1.1%found regression of refraction at 6mo after surgery, while the UCVA of rest patients reached 1.0 at 3mo after surgery.CONCLUSION: The SMILE procedure has high safety for myopia and myopic astigmatism. Effective prevention and management of the complications is the key to achieve the satisfactory visual acuity.

  9. Single-Incision Laparoscopic Sterilization of the Cheetah (Acinonyx jubatus).

    Science.gov (United States)

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schmidt-Küntzel, Anne; Schulman, Martin L; Stander, Jana A; Stegmann, George F; Schoeman, Johan P

    2015-07-01

    To describe laparoscopic ovariectomy and salpingectomy in the cheetah (Acinonyx jubatus) using single-incision laparoscopic surgery (SILS). Prospective cohort. Female cheetahs (Acinonyx jubatus) (n = 21). Cheetahs were randomly divided to receive either ovariectomy (n = 11) or salpingectomy (n = 10). The use and complications of a SILS port was evaluated in all of cheetahs. Surgery duration and insufflation volumes of carbon dioxide (CO2 ) were recorded and compared across procedures. Laparoscopic ovariectomy and salpingectomy were performed without complications using a SILS port. The poorly-developed mesosalpinx and ovarian bursa facilitated access to the uterine tube for salpingectomy in the cheetah. The median surgery duration for ovariectomy was 24 minutes (interquartile range 3) and for salpingectomy was 19.5 minutes (interquartile range 3) (P = .005). The median volume of CO2 used for ovariectomy was 11.25 L (interquartile range 3.08) and for salpingectomy was 4.90 L (interquartile range 2.52), (P = .001) CONCLUSIONS: Laparoscopic ovariectomy and salpingectomy can be performed in the cheetah using SILS without perioperative complications. Salpingectomy is faster than ovariectomy and requires less total CO2 for insufflation. © Copyright 2015 by The American College of Veterinary Surgeons.

  10. Ultrasonographic evaluation of the healing of ventral midline abdominal incisions in the horse.

    Science.gov (United States)

    Wilson, D A; Badertscher, R R; Boero, M J; Baker, G J; Foreman, J H

    1989-06-01

    Ultrasonography was used to evaluate the ventral midline incisions of 21 ponies following exploratory laparotomy. The incisions were evaluated before surgery and at weekly intervals from one to seven weeks after surgery. Both 5.0 and 7.5 MHz linear array and 7.5 MHz sector transducers were used for the evaluations. The incisional complications observed were drainage, oedema, suture sinus formation, suture abscess, superficial dehiscence and incisional hernia. Ultrasonographic imaging of the ventral midline incision was an easy, reliable and objective method for detecting and monitoring the progression of incisional complications in a non-invasive manner.

  11. Towards achieving small-incision cataract surgery 99.8% of the time.

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    Thomas R

    2000-01-01

    Full Text Available A surgical approach designed to reliably attain the modern goal of small incision cataract surgery 99.8% of the time is described. Phacoemulsification as well as a manual small incision technique is utilised to achieve the desired outcome as often as possible and for all types of cataracts. The logic, and required surgical steps are described and illustrated. This surgical technique allows the advantages of small incision surgery to be reliably achieved. The method is flexible and allows decisions and steps to be modified depending on the skill and comfort zone of the individual surgeon.

  12. Techniques for creating inconspicuous face-lift scars: avoiding visible incisions and loss of temporal hair.

    Science.gov (United States)

    Kridel, Russell W H; Liu, Edmund S

    2003-01-01

    Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the price of signs that betray a face-lift, namely, visible incisions. We describe our face-lift incisional planning and the rationale behind specific surgical maneuvers for preventing unwanted sequelae. The telltale signs of poorly placed incisions include temporal hair loss, conspicuous scars, an unnatural appearance to the tragus, and a posterior hairline distorsion. Special considerations are given to the male patient and to the salvage of readily visible incision lines from previous surgery.

  13. Transverse versus Longitudinal Incisions for Femoral Artery Exposure in Treating Patients with Peripheral Vascular Disease.

    Science.gov (United States)

    Parikh, Punam P; Rubio, Gustavo A; Patel, Kunal; Gupta, Kapil; Jones, Keith; Rey, Jorge; Robinson, Handel

    2018-02-01

    This study evaluates differences in wound complication rate when transverse versus longitudinal incision is utilized to expose femoral vessels in managing patients with peripheral vascular disease. A retrospective review from 2013 to 2015 was conducted of 150 patients undergoing 156 lower extremity revascularizations with femoral artery exposure through a groin incision. Patients were stratified into 2 groups, transverse versus longitudinal groin incision. Data were reviewed for 3 surgeons that utilize either transverse or longitudinal groin incision in patients undergoing common or iliofemoral endarterectomies, or where femoral artery was used as inflow and/or outflow vessel for limb revascularization. Each group had a comparative outcomes analysis based on incision type. The primary outcome was wound complication, defined as any wound infection, lymphocele, hematoma, dehiscence, pseudoaneurysm, or necrosis. Other outcomes studied included unplanned return to operating room for wound complication, wound vacuum therapy, and soft-tissue flap closure. Data were analyzed using 2-tailed chi-squared test and Student's t-test. Patients in the transverse (n = 85 cases) versus longitudinal (n = 71 cases) cohorts were similar in relation to demographics and comorbidities. Overall mean follow-up was 220 days. Patients with a transverse as compared to longitudinal incision had a significantly lower overall wound complication rate, 7% vs. 42%, respectively (P transverse incisions were associated with lower incidence of unplanned return to the operating room to manage wound complications than patients with a longitudinal incision (5% vs. 23%, respectively; P Transverse versus longitudinal incisions were also associated with significantly lower need for wound vacuum therapy (6% vs. 15%, respectively; P Transverse groin incisions for femoral artery exposure may offer a lower risk of wound complications for open procedures as compared to a longitudinal incision

  14. A new incision for unilateral cleft lip repair developed using animated simulation of repair on computer

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    Sahay A

    2007-01-01

    Full Text Available Background: Unilateral cleft lip repair continues to leave behind some amount of dissatisfaction, as a scope for further improvement is always felt. Most surgeons do not like to deviate from the standard Millard′s/ triangular techniques, or their minor modifications, as no one likes to experiment on the face for fear of unfavourable outcomes. The computer can be utilized as a useful tool in the analysis and planning of surgery and new methods can be developed and attempted subsequently with greater confidence. Aim: We decided to see if an improved lip repair could be developed with the use of computers. Materials and Methods: Analysis of previous lip repairs was done to determine where an improvement was required. Movement of tissues, by simulating an ideal repair, using image warping software, on digital images of cleft lip was studied in animation sequences. A repair which could reproduce these movements was planned. A new incision emerged, which had combined the principles of Millard′s and Randall / Tennyson repairs, with additional features. The new method was performed on 30 cases. Conclusions: The results were encouraging as the shortcomings of these methods were minimized, and the advantages maximized.

  15. Femtosecond laser effect on the self-sealing properties of the corneal incision of various lengths and profile (experimental trial

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    Yulduz Shavkatovna Nizametdinova

    2015-06-01

    Full Text Available An experimental investigation was carried out to study self-sealing properties of corneal incisions of different profile and length carried out with femtosecond laser Victus (Technolas Perfect Vision/Bausch&Lomb. Using femtosecond laser for this purpose allows creating corneal incisions of high precision and predictability. Reproducibility and standardization of the incision profile and length are an advantage of this technology. Obtained results showed that single-profile incisions are less stable and safe when compared to multi-profile ones. It was noted that incision length increase promotes its self-sealing properties.

  16. Phacoemulsification versus small incision cataract surgery in patients with uveitis

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    Rahul Bhargava

    2015-10-01

    Full Text Available AIM: To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS in patients with uveitic cataract.METHODS:In aprospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI. A P value of <0.05 was considered statistically significant.RESULTS:One hundred and twenty-six of 139 patients (90.6% completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1 or inability implant an intraocular lens (IOL because of insufficient capsular support following posterior capsule rupture (n=5. There was significant improvement in vision after both the procedures (paired t-test; P<0.001. On first postoperative day, uncorrected distance visual acuity (UDVA was 20/63 or better in 31 (47% patients in Phaco group and 26 (43.3% patients in SICS group (P=0.384. The mean surgically induced astigmatism (SIA was 0.86±0.34 dioptres (D in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002. At 6mo, corrected distance visual acuity (CDVA

  17. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

    Institute of Scientific and Technical Information of China (English)

    Hongyi Cui

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

  18. Comparison of Radiofrequency and Electrocautery With Conventional Scalpel Incisions.

    Science.gov (United States)

    Hasar, Zafer Burak; Ozmeric, Nurdan; Ozdemir, Burcu; Gökmenoğlu, Ceren; Baris, Emre; Altan, Gökçen; Kahraman, Sevil

    2016-11-01

    The disadvantages of conventional scalpels, including insufficient control of bleeding, prompted us to search for new alternative methods such as electrosurgery and radiosurgery. In this study, the conventional scalpel was compared with radiosurgery and electrosurgery for wound healing with assessment of lateral heat production, inflammation, and instrument performance. Incisions were made in the palatal mucosa of 42 Wistar rats using a scalpel, electrocautery instrument, or radiofrequency instrument. Postoperative hemostasis, tissue coagulation, and tissue sticking were measured, and pain evaluation through weight loss was recorded. Gingival biopsy specimens from the surgical area were obtained at the time of surgery and 2, 4, 7, and 14 days postoperatively and were evaluated immunohistochemically for inducible nitric oxide synthase and heat shock protein 70. Kruskal-Wallis, 1-way analysis of variance, and Mann-Whitney U tests were used for statistical evaluation. The rats in the electrosurgery and radiosurgery groups had aggressively greater weight loss when compared with the scalpel group in the first 7 days. Hemostasis was better in the electrocautery group, tissue coagulation was greater in the radiofrequency group (P < .001), and tissue sticking was lesser in the scalpel group (P < .001) compared with the other groups. Inducible nitric oxide synthase expression and heat shock protein 70 expression were similar in all 3 groups. Electrosurgery performed better regarding hemostasis, whereas a scalpel was superior in terms of tissue sticking and tissue coagulation. Radiosurgery was superior regarding hemostasis when compared with a conventional scalpel, but it was not as successful as electrosurgery. Copyright © 2016. Published by Elsevier Inc.

  19. Kualitas Pengeringan Kayu Mahoni pada Berbagai Variasi Kerapatan Incising dengan Dua Skedul Pengeringan Suhu tinggi

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    Tomy Listyanto

    2016-11-01

    Full Text Available Tujuan dari penelitian ini adalah untuk mengetahui pengaruh interaksi variasi kerapatan incising dan dua skedul pengeringan terhadap kecepatan dan cacat-cacat pengeringan kayu mahoni, serta mengetahui pengaruh variasi kerapatan incising terhadap kekuatan lengkung statik kayu mahoni yang telah dikeringkan. Tiga pohon mahoni (Swietenia mahagony berdiameter 300-350 mm ditebang dan selanjutnya dibelah dan dibuat menjadi balok dengan ukuran 60 mm × 100 mm dengan panjang 500 mm untuk dijadikan sampel pengeringan. Di antara masing-masing bagian tersebut, dibuat sampel ukuran 20 mm × 20 mm × 25 mm, yang digunakan untuk penentu kadar air awal dan distribusinya. Sampel pengeringan selanjutnya dibagi menjadi 5 variasi kerapatan incising, yaitu 0 lubang/m2 (tanpa incising, 1000 lubang/m2, 2000 lubang/m2, 3000 lubang/m2, dan 4000 lubang/m2. Setiap variasi kerapatan incising selanjutnya akan dikeringkan dengan 2 skedul pengeringan, yaitu suhu pengeringan 100°C sampai tercapai kadar air akhir 12% dan suhu 60°C pada 8 jam pertama dan selanjutnya dilanjutkan 100°C, sampai tercapai kadar air akhir 12%. Paramater yang diamati adalah kecepatan pengeringan, cacat retak permukaan, dan distribusi kadar air akhir. Hasil analisis menunjukkan bahwa kerapatan incising 3000-4000 lubang/m2 memberikan pengaruh yang cukup nyata di dalam mempercepat proses pengeringan dan distribusi kadar air akhir. Skedul pengeringan dan variasi kerapatan incising tidak berpengaruh pada retak permukaan. Pra perlakuan incising sampai batas 4000 lubang/m2 ini dapat diterapkan untuk mempercepat proses pengeringan dengan penurunan nilai modulus elastisitas dan modulus patah yang tidak berbeda nyata. Kata kunci: incising, pengeringan suhu tinggi, mahoni, lengkung statik, skedul pengeringan   Drying Quality of Mahoni Wood in Various Incising Densities and Two High Temperature-Drying Schedules Abstract The aims of this research were to investigate the effects of interaction

  20. Relaxation incisions of venomous snake "Japanese mamushi" bites to the hand

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    Sugamata A

    2011-12-01

    Full Text Available Akira Sugamata, Naoki Yoshizawa, Takahiro OkadaDepartment of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, JapanAbstract: Gloydius blomhoffii, commonly known as Japanese mamushi, is a venomous viper species found widely in Japan. The most frequently bitten regions are the fingers and toes, and severe swelling causes compression of peripheral arteries and/or compartment syndrome of the extremities. We experienced four cases of mamushi bites to the hand, and undertook relaxation incision in the hands of three of these patients. As a result, the patients who underwent relaxation incision did not show any skin necrosis or permanent sensory disturbance in the affected fingers. Relaxation incision can be useful to not only decompress subcutaneous and compartment pressure of the hand, but also to wash out the venom from the bitten region by improving venous and lymphatic drainage.Keywords: mamushi, snakebite, viper, relaxation incision

  1. Treatment for incarcerated indirect hernia with "Cross-Internal Ring" inguinal oblique incision in children.

    Science.gov (United States)

    Yan, Xue-Qiang; Yang, Jun; Zheng, Nan-Nan; Kuang, Hou-Fang; Duan, Xu-Fei; Bian, Hong-Qiang

    2017-01-01

    This study aims to evaluate the utility of the "Cross-Internal Ring" inguinal oblique incision for the surgical treatment of incarcerated indirect hernia (IIH) complicated with severe abdominal distension. Patients of IIH complicated with severe abdominal distension were reviewed retrospectively. All patients received operation through the "Cross-Internal Ring" inguinal oblique incision. There were totally 13 patients were included, male to female ratio was 9-4. The time for patients to resume oral feeding varying from 2 to 5 days after operation, no complications include delayed intestinal perforation, intra-abdominal abscess, and incision infection happened. Average postoperative hospital stay was 5.2 days. All cases were followed up for 6-18 months. No recurrence or iatrogenic cryptorchidism happened. "Cross-Internal Ring" inguinal oblique incision is a simple, safe, and reliable surgical method to treat pediatric IIH complicated with severe abdominal distension.

  2. Treatment for incarcerated indirect hernia with “Cross-Internal Ring” inguinal oblique incision in children

    Directory of Open Access Journals (Sweden)

    Xue-Qiang Yan

    2017-01-01

    Full Text Available Background: This study aims to evaluate the utility of the “Cross-Internal Ring” inguinal oblique incision for the surgical treatment of incarcerated indirect hernia (IIH complicated with severe abdominal distension. Materials and Methods: Patients of IIH complicated with severe abdominal distension were reviewed retrospectively. All patients received operation through the “Cross-Internal Ring” inguinal oblique incision. Results: There were totally 13 patients were included, male to female ratio was 9-4. The time for patients to resume oral feeding varying from 2 to 5 days after operation, no complications include delayed intestinal perforation, intra-abdominal abscess, and incision infection happened. Average postoperative hospital stay was 5.2 days. All cases were followed up for 6–18 months. No recurrence or iatrogenic cryptorchidism happened. Conclusion: “Cross-Internal Ring” inguinal oblique incision is a simple, safe, and reliable surgical method to treat pediatric IIH complicated with severe abdominal distension.

  3. Cochlear implantation with Pulsar Med El: a novel small incision technique.

    Science.gov (United States)

    Cuda, D

    2009-04-01

    Although still widely implanted, Pulsar Med-El is rarely considered for small incision approach. Overall, 30 teen-age and adult patients were operated upon with a novel small incision (4-5 cm). Full insertion of the electrode array was achieved in all cases. No major intra-operative complications occurred. At follow-up, no flap-related complications and no migration of the receiver-stimulator were observed in the "device suture" (14 patients) or "no device suture" groups (16 patients). All patients are full-time users of the device. In conclusion, a small incision for the Pulsar Med-El cochlear implant is feasible, safe and reproducible. Ligature fixation of the device is not critical with this operation. Also with this device, in adult and teen-age patients, it is, therefore, possible to retain several typical advantages of small incision approaches.

  4. Evaluation of a new disposable silicon limbal relaxing incision knife by experienced users

    OpenAIRE

    Parvu Valentin; Dugue Geoffrey; Albanese John; Bajart Ann M; Lee Edwin

    2009-01-01

    Abstract Background Previous research has suggested that the silicon BD Atomic Edge™ knife has superior performance characteristics when compared to a metal knife and performance similar to diamond knife when making various incisions. This study was designed to determine whether a silicon accurate depth knife has equivalent performance characteristics when compared to a diamond limbal relaxing incision (LRI) knife and superior performance characteristics when compared to a steel accurate dept...

  5. Aorta-atria-septum combined incision for aortic valve re-replacement

    Science.gov (United States)

    Xu, Yiwei; Ye, Xiaofeng; Li, Zhaolong

    2018-01-01

    This case report illustrates a patient who underwent supra-annular mechanical aortic valve replacement then suffered from prosthesis dysfunction, increasing pressure gradient with aortic valve. She was successfully underwent aortic valve re-replacement, sub-annular pannus removing and aortic annulus enlargement procedures through combined cardiac incision passing through aortic root, right atrium (RA), and upper atrial septum. This incision provides optimal visual operative field and simplifies dissection. PMID:29850170

  6. Type of incision does not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Oma, Erling; Harling, Henrik

    2017-01-01

    for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type...... not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage....

  7. Laser incising of wood: Impregnation of columns with water-soluble dye

    International Nuclear Information System (INIS)

    Hattori, N.; Ando, K.; Kitayama, S.; Nakamura, Y.

    1994-01-01

    To know whether or not laser incising is a useful pre-treatment technique in impregnating a chemical fluid into lumber, pin holes were made in columns of hinoki (Chamaecyparis obtusa Endl.), sugi (Cryptomeria japonica D. Don), karamatsu (Larix leptolepis Gordon) and douglas-fir (Pseudo-tsuga menziesii Franco) with 1.7 kW CO2 laser, and a water-soluble dye was impregnated into these columns with a local pressure impregnation device. Retentions, and lengths and widths of penetrations from each hole were measured quantitatively. Referring to the results of the preparatory experiment mentioned above, incising patterns for sugi and douglas-fir were designed, and the same water-soluble dye was impregnated into the laser-incised columns as well as into non-incised ones with the vacuum-pressure method to obtain penetrated layers with the target depths completely. As a result, a retention of 200 kg/m3 of dye could be achieved for a column of douglas-fir even if it is a species difficult to impregnate. The penetrated layer also could be formed completely at the depth of the laser incision. Therefore, it is concluded that laser incising can be used for the pre-treatment before impregnation of wood columns. (author)

  8. Evaluation of a new disposable silicon limbal relaxing incision knife by experienced users.

    Science.gov (United States)

    Albanese, John; Dugue, Geoffrey; Parvu, Valentin; Bajart, Ann M; Lee, Edwin

    2009-12-21

    Previous research has suggested that the silicon BD Atomic Edge knife has superior performance characteristics when compared to a metal knife and performance similar to diamond knife when making various incisions. This study was designed to determine whether a silicon accurate depth knife has equivalent performance characteristics when compared to a diamond limbal relaxing incision (LRI) knife and superior performance characteristics when compared to a steel accurate depth knife when creating limbal relaxing incision. Sixty-five ophthalmic surgeons with limbal relaxing incision experience created limbal relaxing incisions in ex-vivo porcine eyes with silicon and steel accurate depth knives and diamond LRI knives. The ophthalmic surgeons rated multiple performance characteristics of the knives on Visual Analog Scales. The observed differences between the silicon knife and diamond knife were found to be insignificant. The mean ratio between the performance of the silicon knife and the diamond knife was shown to be greater than 90% (with 95% confidence). The silicon knife's mean performance was significantly higher than the performance of the steel knife for all characteristics. (p-value knife was found to be equivalent in performance to the diamond LRI knife and superior to the steel accurate depth knife when making limbal relaxing incisions in ex vivo porcine eyes. Disposable silicon LRI knives may be an alternative to diamond LRI knives.

  9. Evaluation of a new disposable silicon limbal relaxing incision knife by experienced users

    Directory of Open Access Journals (Sweden)

    Parvu Valentin

    2009-12-01

    Full Text Available Abstract Background Previous research has suggested that the silicon BD Atomic Edge™ knife has superior performance characteristics when compared to a metal knife and performance similar to diamond knife when making various incisions. This study was designed to determine whether a silicon accurate depth knife has equivalent performance characteristics when compared to a diamond limbal relaxing incision (LRI knife and superior performance characteristics when compared to a steel accurate depth knife when creating limbal relaxing incision. Methods Sixty-five ophthalmic surgeons with limbal relaxing incision experience created limbal relaxing incisions in ex-vivo porcine eyes with silicon and steel accurate depth knives and diamond LRI knives. The ophthalmic surgeons rated multiple performance characteristics of the knives on Visual Analog Scales. Results The observed differences between the silicon knife and diamond knife were found to be insignificant. The mean ratio between the performance of the silicon knife and the diamond knife was shown to be greater than 90% (with 95% confidence. The silicon knife's mean performance was significantly higher than the performance of the steel knife for all characteristics. (p-value Conclusions For experienced users, the silicon accurate depth knife was found to be equivalent in performance to the diamond LRI knife and superior to the steel accurate depth knife when making limbal relaxing incisions in ex vivo porcine eyes. Disposable silicon LRI knives may be an alternative to diamond LRI knives.

  10. In vitro conjunctival incision repair by temperature-controlled laser soldering.

    Science.gov (United States)

    Norman, Galia; Rabi, Yaron; Assia, Ehud; Katzir, Abraham

    2009-01-01

    The common method of closing conjunctival incisions is by suturing, which is associated with several disadvantages. It requires skill to apply and does not always provide a watertight closure, which is required in some operations (e.g., glaucoma filtration). The purpose of the present study was to evaluate laser soldering as an alternative method for closing conjunctival incisions. Conjunctival incisions of 20 ex vivo porcine eyes were laser soldered using a temperature-controlled fiberoptic laser system and an albumin mixed with indocyanine green as a solder. The control group consisted of five repaired incisions by a 10-0 nylon running suture. The leak pressure of the repaired incisions was measured. The mean leak pressure in the laser-soldered group was 132 mm Hg compared to 4 mm Hg in the sutured group. There was no statistically significant difference in both the incision's length and distance from the limbus between the groups, before and after the procedure, indicating that there was no severe thermal damage. These preliminary results clearly demonstrate that laser soldering may be a useful method for achieving an immediate watertight conjunctival wound closure. This procedure is faster and easier to apply than suturing.

  11. Incision extension is the optimal method of difficult gallbladder extraction at laparoscopic cholecystectomy.

    Science.gov (United States)

    Bordelon, B M; Hobday, K A; Hunter, J G

    1992-01-01

    An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5 +/- 63.6 mg in the patients requiring fascial incision extension and 66.3 +/- 79.2 mg in those not requiring fascial incision extension (mean +/- standard deviation). Oral narcotic requirements were 1.1 +/- 1.5 doses vs 1.3 +/- 1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.

  12. Temperature-controlled laser-soldering system and its clinical application for bonding skin incisions

    Science.gov (United States)

    Simhon, David; Gabay, Ilan; Shpolyansky, Gregory; Vasilyev, Tamar; Nur, Israel; Meidler, Roberto; Hatoum, Ossama Abu; Katzir, Abraham; Hashmonai, Moshe; Kopelman, Doron

    2015-12-01

    Laser tissue soldering is a method of repairing incisions. It involves the application of a biological solder to the approximated edges of the incision and heating it with a laser beam. A pilot clinical study was carried out on 10 patients who underwent laparoscopic cholecystectomy. Of the four abdominal incisions in each patient, two were sutured and two were laser soldered. Cicatrization, esthetical appearance, degree of pain, and pruritus in the incisions were examined on postoperative days 1, 7, and 30. The soldered wounds were watertight and healed well, with no discharge from these wounds or infection. The total closure time was equal in both methods, but the net soldering time was much shorter than suturing. There was no difference between the two types of wound closure with respect to the pain and pruritus on a follow-up of one month. Esthetically, the soldered incisions were estimated as good as the sutured ones. The present study confirmed that temperature-controlled laser soldering of human skin incisions is clinically feasible, and the results obtained were at least equivalent to those of standard suturing.

  13. Watershed-scale modeling of streamflow change in incised montane meadows

    Science.gov (United States)

    Essaid, Hedeff I.; Hill, Barry R.

    2014-01-01

    Land use practices have caused stream channel incision and water table decline in many montane meadows of the Western United States. Incision changes the magnitude and timing of streamflow in water supply source watersheds, a concern to resource managers and downstream water users. The hydrology of montane meadows under natural and incised conditions was investigated using watershed simulation for a range of hydrologic conditions. The results illustrate the interdependence between: watershed and meadow hydrology; bedrock and meadow aquifers; and surface and groundwater flow through the meadow for the modeled scenarios. During the wet season, stream incision resulted in less overland flow and interflow and more meadow recharge causing a net decrease in streamflow and increase in groundwater storage relative to natural meadow conditions. During the dry season, incision resulted in less meadow evapotranspiration and more groundwater discharge to the stream causing a net increase in streamflow and a decrease in groundwater storage relative to natural meadow conditions. In general, for a given meadow setting, the magnitude of change in summer streamflow and long-term change in watershed groundwater storage due to incision will depend on the combined effect of: reduced evapotranspiration in the eroded meadow; induced groundwater recharge; replenishment of dry season groundwater storage depletion in meadow and bedrock aquifers by precipitation during wet years; and groundwater storage depletion that is not replenished by precipitation during wet years.

  14. A Precise 6 Ma Start Date for Fluvial Incision of the Northeastern Colorado Plateau Canyonlands

    Science.gov (United States)

    Thomson, S. N.; Soreghan, G. S.; Reiners, P. W.; Peyton, S. L.; Murray, K. E.

    2015-12-01

    Outstanding questions regarding late Cenozoic Colorado Plateau landscape evolution include: (1) the relative roles of isostatic rebound as result Colorado River incision versus longer-term geodynamic processes in driving overall rock uplift of the plateau; and (2) whether incision was triggered by river integration or by a change in deep-seated mantle lithosphere dynamics. A key to answering these questions is to date more precisely the onset of incision to refine previous estimates of between 6 and 10 Ma. We present new low-temperature thermochronologic results from bedrock and deep borehole samples in the northeastern Colorado Plateau to show that rapid river incision began here at 6 Ma (5.93±0.66 Ma) with incision rates increasing from 15-50 m/Myr to 160-200 m/Myr. The onset time is constrained independently by both inverse time-temperature modeling and by the break-in-slope in fission track age-elevation relationships. This new time constraint has several important implications. First, the coincidence in time with 5.97-5.3 Ma integration of the lower Colorado River through the Grand Canyon to the Gulf of California strongly favors downstream river integration triggering carving of the canyonlands of the upper Colorado River system. Second, it implies integration of the entire Colorado River system in less than 2 million years. Third, rock uplift of the plateau driven by the flexural isostatic response to river incision is restricted to just the last 6 Ma, as is associated increased sediment budget. Fourth, incision starting at 6 Ma means that previous estimates of upper Colorado River incision rates based on 10-12 Ma basalt datum levels are too low. This also changes the dependency of measured time interval on incision rate from a non-steady-state negative power-law dependence (exponent of -0.24) to a near steady-state dependence (exponent of 0.07) meaning that long-term upper Colorado river incision rates can provide a reliable proxy for rock uplift rates.

  15. The Laguna Verde Central by it results in maintenance and operation consolidates it position of world class enterprise; La central Laguna Verde por sus resultados en mantenimiento y operacion consolida su posicion de empresa de clase mundial

    Energy Technology Data Exchange (ETDEWEB)

    Rivera C, A. [CFE, Central Laguna Verde, Km. 42.5 Carretera Cardel- Nautla, Veracruz (Mexico)

    2008-07-01

    This work has the objective of showing the results of the Laguna VerdeCentral in the maintenance and the operation that in the short term the generation of electricity in Mexico by nuclear means is a viable option, in virtue of their positioning like Company of World Class, when winning March 25, 2008 the National Prize of Quality with the more high qualification in the history of this prize, same that allows us to be very optimistic in increasing the possibility to that the Nuclear Industry in Mexico grows. The focus of the comparative graphs, with official data of the Comision Federal de Electricidad (CFE), it is so that it is observed that the Laguna Verde Central is above those the other types of generation like they are the Coal power stations, Thermoelectric, Hydroelectric, likewise they can see that we are for up of the Independent Producers of Energy. The information of the electric power generation is presented by reactors nuclear at world level that is growing, in having 31 Generating Units in the construction process that favors the decisions making in the Government federal, likewise contributed data of the increment projected for 2016 in the country of 380,102 GWh that equivalent to 63% of growth, where it exists without place to doubts a good opportunity for the nucleoelectricity. The Investment Works Program of Public Sector (POISE), it shows the information that 6,178 Mwe will be installed settled of a Non-defined Technology in Mexico, information that specifies the opportunity to be a viable option, because the one Plant Factor, the Production of Electric power, and the Variable Cost of Production, the energy generation by nuclear means is the more competitiveness. Finally this work stood out the effort that communitary works are developed to benefit to the society and the environment to be one Viable option not only for their high performance, or competitive for those more low costs, but also to improve the public opinion with the sustainable

  16. Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

    Directory of Open Access Journals (Sweden)

    Je Hwan Yoon

    2013-01-01

    Full Text Available Aims: To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery. Materials and Methods: This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes. The outcome measures were surgically induced astigmatism (SIA and uncorrected visual acuity (UCVA 1 and 3 months, post-operatively. Results: At 1 month, the mean SIA was 0.81 diopter (D for the temporal incisions and 0.92 D for nasal incisions (P = 0.139. At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309. The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively. Conclusion: After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less would be favorable for astigmatism-neutral cataract surgery.

  17. Does pilonidal abscess heal quicker with off-midline incision and drainage?

    Science.gov (United States)

    Webb, P M; Wysocki, A P

    2011-06-01

    No clinical trials have been done to guide the surgeon in the optimal technique of draining a pilonidal abscess. The aim of our study was to investigate whether the location of the incision influences wound healing. Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline vs. lateral) for patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010. These patients were admitted from the Emergency Department with a pilonidal abscess, underwent operative drainage, and returned for follow-up. The main outcome measure was wound healing time. Two hundred and forty-three pilonidal abscesses were drained, 134 with a lateral and 74 with a midline incision. All patients underwent simple longitudinal incision. No patient underwent de-roofing, marsupialisation, or closure. Forty-eight patients with midline drainage who returned for follow-up were matched for gender, age, and microbiology culture results with patients who underwent lateral drainage. Almost all were drained under general anesthesia with a median postoperative stay of 1 day. The overall length of follow-up was the same in both groups (P = 0.13). Abscesses that did not heal were followed-up for the same period of time irrespective of incision type (P = 0.48). Abscesses that healed after midline incision took approximately 3 weeks longer than those drained via a lateral incision (P = 0.02). Our study has limitations since it was a retrospective study that did not capture patients whose abscess drained spontaneously or were drained in the emergency department. Pilonidal abscess should be drained away from the midline.

  18. A study of incisive canal using a cone beam computed tomography

    International Nuclear Information System (INIS)

    Kim, Gyu Tae; Hwang, Eui Hwan; Lee, Sang Rae

    2004-01-01

    To investigate the anatomical structure of the incisive canal radiographically by a cone beam computed tomography. 38 persons (male 26, female 12) were chosen to take images of maxillary anterior region in dental CT mode using a cone beam computed tomography. The tube voltage were 65, 67, and 70 kVp, the tube current was 7 mA, and the exposure time was 13.3 seconds. The FH plane of each person was parallel to the floor. The images were analysed on the CRT display. The mean length of incisive canal was 15.87 mm ± 2.92. The mean diameter at the side of palate and nasal fossa were 3.49 mm ± 0.76 and 3.89 mm ± 1.06, respectively. In the cross-sectional shape of incisive canal, 50% were round, 34.2% were ovoid, and 15.8% were lobulated. 87% of incisive canal at the side of nasal fossa have one canal, 10.4% have two canals, and 2.6% have three canals, but these canals were merged into one canal in the middle portion of palate. The mean angles of the long axis of incisive canal and central incisor to the FH plane were 110.3 ± 6.96 and 117.45 ± 7.41, respectively. The angles of the long axis of incisive canal and central incisor to the FH plane were least correlated (r 0.258). This experiment suggests that a cone beam computed radiography will be helpful in surgery or implantation on the maxillary incisive area.

  19. A study of incisive canal using a cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gyu Tae; Hwang, Eui Hwan; Lee, Sang Rae [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    2004-03-15

    To investigate the anatomical structure of the incisive canal radiographically by a cone beam computed tomography. 38 persons (male 26, female 12) were chosen to take images of maxillary anterior region in dental CT mode using a cone beam computed tomography. The tube voltage were 65, 67, and 70 kVp, the tube current was 7 mA, and the exposure time was 13.3 seconds. The FH plane of each person was parallel to the floor. The images were analysed on the CRT display. The mean length of incisive canal was 15.87 mm {+-} 2.92. The mean diameter at the side of palate and nasal fossa were 3.49 mm {+-} 0.76 and 3.89 mm {+-} 1.06, respectively. In the cross-sectional shape of incisive canal, 50% were round, 34.2% were ovoid, and 15.8% were lobulated. 87% of incisive canal at the side of nasal fossa have one canal, 10.4% have two canals, and 2.6% have three canals, but these canals were merged into one canal in the middle portion of palate. The mean angles of the long axis of incisive canal and central incisor to the FH plane were 110.3 {+-} 6.96 and 117.45 {+-} 7.41, respectively. The angles of the long axis of incisive canal and central incisor to the FH plane were least correlated (r 0.258). This experiment suggests that a cone beam computed radiography will be helpful in surgery or implantation on the maxillary incisive area.

  20. Climate-sensitive feedbacks between hillslope processes and fluvial erosion in sediment-driven incision models

    Science.gov (United States)

    Skov, Daniel S.; Egholm, David L.

    2016-04-01

    Surface erosion and sediment production seem to have accelerated globally as climate cooled in the Late Cenozoic, [Molnar, P. 2004, Herman et al 2013]. Glaciers emerged in many high mountain ranges during the Quaternary, and glaciation therefore represents a likely explanation for faster erosion in such places. Still, observations and measurements point to increases in erosion rates also in landscapes where erosion is driven mainly by fluvial processes [Lease and Ehlers (2013), Reusser (2004)]. Flume experiments and fieldwork have shown that rates of incision are to a large degree controlled by the sediment load of streams [e.g. Sklar and Dietrich (2001), Beer and Turowski (2015)]. This realization led to the formulation of sediment-flux dependent incision models [Sklar and Dietrich (2004)]. The sediment-flux dependence links incision in the channels to hillslope processes that supply sediment to the channels. The rates of weathering and soil transport on the hillslopes are processes that are likely to respond to changing temperatures, e.g. because of vegetation changes or the occurrence of frost. In this study, we perform computational landscape evolution experiments, where the coupling between fluvial incision and hillslope processes is accounted for by coupling a sediment-flux-dependent model for fluvial incision to a climate-dependent model for weathering and hillslope sediment transport. The computational experiments first of all demonstrate a strong positive feedback between channel and hillslope processes. In general, faster weathering leads to higher rates of channel incision, which further increases the weathering rates, mainly because of hillslope steepening. Slower weathering leads to the opposite result. The experiments also demonstrate, however, that the feedbacks vary significantly between different parts of a drainage network. For example, increasing hillslope sediment production may accelerate incision in the upper parts of the catchment, while at

  1. Force modeling for incisions into various tissues with MRF haptic master

    Science.gov (United States)

    Kim, Pyunghwa; Kim, Soomin; Park, Young-Dai; Choi, Seung-Bok

    2016-03-01

    This study proposes a new model to predict the reaction force that occurs in incisions during robot-assisted minimally invasive surgery. The reaction force is fed back to the manipulator by a magneto-rheological fluid (MRF) haptic master, which is featured by a bi-directional clutch actuator. The reaction force feedback provides similar sensations to laparotomy that cannot be provided by a conventional master for surgery. This advantage shortens the training period for robot-assisted minimally invasive surgery and can improve the accuracy of operations. The reaction force modeling of incisions can be utilized in a surgical simulator that provides a virtual reaction force. In this work, in order to model the reaction force during incisions, the energy aspect of the incision process is adopted and analyzed. Each mode of the incision process is classified by the tendency of the energy change, and modeled for realistic real-time application. The reaction force model uses actual reaction force information with three types of actual tissues: hard tissue, medium tissue, and soft tissue. This modeled force is realized by the MRF haptic master through an algorithm based on the position and velocity of a scalpel using two different control methods: an open-loop algorithm and a closed-loop algorithm. The reaction forces obtained from the proposed model are compared with a desired force in time domain.

  2. Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal

    Energy Technology Data Exchange (ETDEWEB)

    De Brito, Ana Caroline Ramos; Nejaim, Yuri; De Freitas, Deborah Queiroz [Dept. of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Sao Paulo (Brazil); De Oliveira Santos, Christiano [Dept. of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo (Brazil)

    2016-09-15

    The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.

  3. Microincision versus small-incision coaxial cataract surgery using different power modes for hard nuclear cataract.

    Science.gov (United States)

    Kim, Eun Chul; Byun, Yong Soo; Kim, Man Soo

    2011-10-01

    To compare the efficacy of microincision and small-incision coaxial phacoemulsification in treating hard cataracts using different ultrasound power modes. Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. Randomized clinical trial. Eyes with hard cataract were randomized to have an initial incision of 1.80 mm, 2.20 mm, or 2.75 mm. The eyes in each group were equally randomized to treatment with burst, pulse, or continuous mode. Ultrasound time (UST), mean cumulative dissipated energy (CDE), corrected distance visual acuity (CDVA), surgically induced corneal astigmatism, incisional and central corneal thickness (CCT), and endothelial cell counts were evaluated. The study enrolled 180 eyes, 60 in each group. Two months postoperatively, there were no statistically significant differences in UST, CDE, CDVA, CCT, or percentage endothelial cell loss between the 3 incision groups. The 2.75 mm incision induced more astigmatism at 2 months and less incisional corneal edema at 1 week than the 1.80 mm or 2.20 mm incision (Phard cataract. The intraoperative energy use and ocular damage was less with the pulse and burst modes than with the continuous mode. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  4. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma.

    Science.gov (United States)

    Barbaros, Umut; Sümer, Aziz; Demirel, Tugrul; Karakullukçu, Nazlı; Batman, Burçin; Içscan, Yalın; Sarıçam, Gülay; Serin, Kürçsat; Loh, Wei-Liang; Dinççağ, Ahmet; Mercan, Selçuk

    2010-01-01

    Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail. A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision. Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases. This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.

  5. Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal

    International Nuclear Information System (INIS)

    De Brito, Ana Caroline Ramos; Nejaim, Yuri; De Freitas, Deborah Queiroz; De Oliveira Santos, Christiano

    2016-01-01

    The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region

  6. Incision and stress regulation in borderline personality disorder: neurobiological mechanisms of self-injurious behaviour.

    Science.gov (United States)

    Reitz, Sarah; Kluetsch, Rosemarie; Niedtfeld, Inga; Knorz, Teresa; Lis, Stefanie; Paret, Christian; Kirsch, Peter; Meyer-Lindenberg, Andreas; Treede, Rolf-Detlef; Baumgärtner, Ulf; Bohus, Martin; Schmahl, Christian

    2015-08-01

    Patients with borderline personality disorder frequently show non-suicidal self-injury (NSSI). In these patients, NSSI often serves to reduce high levels of stress. Investigation of neurobiological mechanisms of NSSI in borderline personality disorder. In total, 21 women with borderline personality disorder and 17 healthy controls underwent a stress induction, followed by either an incision into the forearm or a sham treatment. Afterwards participants underwent resting-state functional magnetic resonance imaging while aversive tension, heart rate and heart rate variability were assessed. We found a significant influence of incision on subjective and objective stress levels with a stronger decrease of aversive tension in the borderline personality disorder group following incision than sham. Amygdala activity decreased more and functional connectivity with superior frontal gyrus normalised after incision in the borderline personality disorder group. Decreased stress levels and amygdala activity after incision support the assumption of an influence of NSSI on emotion regulation in individuals with borderline personality disorder and aids in understanding why these patients use self-inflicted pain to reduce inner tension. © The Royal College of Psychiatrists 2015.

  7. Circumareolar incision-subdermal tunneling dissection for excision of multiple breast fibroadenomata

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    S O Agodirin

    2017-01-01

    Full Text Available Excision of multiple fibroadenomas (MF in separate breast quadrants presents difficulties of number and location of incision(s and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s. The lump(s were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.

  8. Uptake of gallium-67 citrate in clean surgical incisions after colorectal surgery

    International Nuclear Information System (INIS)

    Lin Wanyu; Wang Shyhjen; Tsai Shihchuan; Chao Tehsin

    2001-01-01

    Non-specific accumulation of gallium-67 citrate (gallium) in uncomplicated surgical incisions is not uncommon. It is important to know the normal pattern of gallium uptake at surgical incision sites in order to properly interpret the gallium scan when investigating possible wound infection in patients who have undergone abdominal surgery. We studied 42 patients without wound infection after colorectal surgery and performed gallium scans within 40 days after surgery. Patients were divided into three groups according to the interval between the operation and the scan. In group A (26 patients) gallium scan was performed within 7 days after surgery, in group B (8 patients) between 8 and 14 days after surgery, and in group C (8 patients) between 15 and 40 days after surgery. Our data showed that in group A, 61.5% had gallium accumulation at the surgical incision site. In group B, 50% had accumulation of gallium at the surgical incision site, while in group C only one patient (12.5%) showed gallium uptake. It is concluded that the incidence of increased gallium uptake at clean surgical incision sites is high after colorectal surgery. Nuclear medicine physicians should bear in mind the high incidence of non-specific gallium uptake at such sites during the interpretation of possible wound infection in patients after colorectal surgery. (orig.)

  9. Force modeling for incisions into various tissues with MRF haptic master

    International Nuclear Information System (INIS)

    Kim, Pyunghwa; Kim, Soomin; Park, Young-Dai; Choi, Seung-Bok

    2016-01-01

    This study proposes a new model to predict the reaction force that occurs in incisions during robot-assisted minimally invasive surgery. The reaction force is fed back to the manipulator by a magneto-rheological fluid (MRF) haptic master, which is featured by a bi-directional clutch actuator. The reaction force feedback provides similar sensations to laparotomy that cannot be provided by a conventional master for surgery. This advantage shortens the training period for robot-assisted minimally invasive surgery and can improve the accuracy of operations. The reaction force modeling of incisions can be utilized in a surgical simulator that provides a virtual reaction force. In this work, in order to model the reaction force during incisions, the energy aspect of the incision process is adopted and analyzed. Each mode of the incision process is classified by the tendency of the energy change, and modeled for realistic real-time application. The reaction force model uses actual reaction force information with three types of actual tissues: hard tissue, medium tissue, and soft tissue. This modeled force is realized by the MRF haptic master through an algorithm based on the position and velocity of a scalpel using two different control methods: an open-loop algorithm and a closed-loop algorithm. The reaction forces obtained from the proposed model are compared with a desired force in time domain. (paper)

  10. Steady incision of Grand Canyon at the million year timeframe: a case for mantle-driven differential uplift

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    Crow, Ryan S.; Karl Karlstrom,; Laura Crossey,; Richard Young,; Michael Ort,; Yemane Asmerom,; Victor Polyak,; Andrew Darling,

    2014-01-01

    The Grand Canyon region provides an excellent laboratory to examine the interplay between river incision, magmatism, and the geomorphic and tectonic processes that shape landscapes. Here we apply U-series, Ar–Ar, and cosmogenic burial dating of river terraces to examine spatial variations in incision rates along the 445 km length of the Colorado River through Grand Canyon. We also analyze strath terrace sequences that extend to heights of several hundred meters above the river, and integrate these with speleothem constrained maximum incision rates in several reaches to examine any temporal incision variations at the million-year time frame. This new high-resolution geochronology shows temporally steady long-term incision in any given reach of Grand Canyon but significant variations along its length from 160 m/Ma in the east to 101 m/Ma in the west. Spatial and temporal patterns of incision, and the long timescale of steady incision rule out models where geomorphic controls such as climate oscillations, bedrock strength, sediment load effects, or isostatic response to differential denudation are the first order drivers of canyon incision. The incision pattern is best explained by a model of Neogene and ongoing epeirogenic uplift due to an eastward propagating zone of increased upper mantle buoyancy that we infer from propagation of Neogene basaltic volcanism and a strong lateral gradient in modern upper mantle seismic structure.

  11. Oral subcutaneous midline leiomyomatous hamartoma presenting as congenital incisive papilla overgrowth in a toddler

    Directory of Open Access Journals (Sweden)

    Ashish Loomba

    2017-01-01

    Full Text Available Congenital soft-tissue tumors of oral cavity are mostly hyperplastic and benign in nature. This article presents an unusual case of congenital subcutaneous hamartoma of incisive papilla in a 2-year-old female child causing feeding and breathing difficulty. Total excisional biopsy was done under local anesthesia. Histopathology of tissue in reticulin-stained slide showed the presence of immature muscle fibers whereas Masson's trichrome stain revealed collagen fibers and smooth muscles confirming the diagnosis of oral midline subcutaneous smooth muscle (leiomyomatous hamartoma of incisive papilla. It is important for dental professionals to be aware of this oral lesion present from birth mimicking overgrowth of incisive papilla, by its presentation, differential diagnosis, histopathology, and management.

  12. Incision of the heart during meat inspection of fattening pigs - A risk-profile approach.

    Science.gov (United States)

    Leps, J; Fries, R

    2009-01-01

    Meat inspection in the EU is based on Regulation (EC) 854/2004. Accordingly a risk based meat inspection should be implemented. In this paper, the incision of the heart in pig meat inspection is discussed with respect to efficacy. The incision especially can reveal the presence of endocarditis. Here, Erysipelothrixrhusiopathiae (E. rhusiopathiae) and/or Streptococcussuis (S. suis) are of particular concern. Both agents are regarded to be zoonotic agents. There is some evidence for infection of humans via an alimentary pathway. Hence, the occurrence of E. rhusiopathiae and S. suis is a concern of public health (PH) as well as veterinary public health (VPH). However, other measures, including on-farm disease prevention and diagnosis, seem to be more important for food safety. It is concluded that the incision and inspection of the heart is not justifiable with respect to PH aspects.

  13. First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.

    Science.gov (United States)

    Cingel, Vladimir; Zabojnikova, Lenka; Kurucova, Patricia; Varga, Ivan

    2014-09-01

    Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and

  14. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study.

    Science.gov (United States)

    Sekundo, Walter; Kunert, Kathleen S; Blum, Marcus

    2011-03-01

    This 6 month prospective multi-centre study evaluated the feasibility of performing myopic femtosecond lenticule extraction (FLEx) through a small incision using the small incision lenticule extraction (SMILE) procedure. Prospective, non-randomised clinical trial. PARTICIPANTS; Ninety-one eyes of 48 patients with myopia with and without astigmatism completed the final 6 month follow-up. The patients' mean age was 35.3 years. Their preoperative mean spherical equivalent (SE) was −4.75±1.56 D. A refractive lenticule of intrastromal corneal tissue was cut utilising a prototype of the Carl Zeiss Meditec AG VisuMax femtosecond laser system. Simultaneously two opposite small ‘pocket’ incisions were created by the laser system. Thereafter, the lenticule was manually dissected with a spatula and removed through one of incisions using modified McPherson forceps. Uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity (BSCVA) after 6 months, objective and manifest refraction as well as slit-lamp examination, side effects and a questionnaire. Six months postoperatively the mean SE was −0.01 D±0.49 D. Most treated eyes (95.6%) were within ±1.0 D, and 80.2% were within ±0.5 D of intended correction. Of the eyes treated, 83.5% had an UCVA of 1.0 (20/20) or better, 53% remained unchanged, 32.3% gained one line, 3.3% gained two lines of BSCVA, 8.8% lost one line and 1.1% lost ≥2 lines of BSCVA. When answering a standardised questionnaire, 93.3% of patients were satisfied with the results obtained and would undergo the procedure again. SMILE is a promising new flapless minimally invasive refractive procedure to correct myopia.

  15. Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.

    Science.gov (United States)

    Barkhoudarian, Garni; Cutler, Aaron R; Yost, Sam; Lobo, Bjorn; Eisenberg, Amalia; Kelly, Daniel F

    2015-12-01

    With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis. Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group. Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

  16. Efficiency of soft tissue incision with a novel 445-nm semiconductor laser.

    Science.gov (United States)

    Braun, Andreas; Kettner, Moritz; Berthold, Michael; Wenzler, Johannes-Simon; Heymann, Paul Günther Baptist; Frankenberger, Roland

    2018-01-01

    Using a 445-nm semiconductor laser for tissue incision, an effective cut is expected due to the special absorption properties of blue laser light in soft tissues. The aim of the present study was the histological evaluation of tissue samples after incision with a 445-nm diode laser. Forty soft tissue specimens were obtained from pork oral mucosa and mounted on a motorized linear translation stage. The handpiece of a high-frequency surgery device, a 970-nm semiconductor laser, and a 445-nm semiconductor laser were connected to the slide, allowing a constant linear movement (2 mm/s) and the same distance of the working tip to the soft tissue's surface. Four incisions were made each: (I) 970-nm laser with conditioned fiber tip, contact mode at 3-W cw; (II-III): 445-nm laser with non-conditioned fiber tip, contact mode at 2-W cw, and non-contact mode (1 mm) at 2 W; and (IV): high-frequency surgery device with straight working tip, 90° angulation, contact mode at 50 W. Histological analysis was performed after H&E staining of the embedded specimens at 35-fold magnification. The comparison of the incision depths showed a significant difference depending on the laser wavelength and the selected laser parameters. The highest incision depth was achieved with the 445-nm laser contact mode (median depth 0.61 mm, min 0.26, max 1.17, interquartile range 0.58) (p laser, a higher cutting efficiency can be expected when compared with a 970-nm diode laser and high-frequency surgery. Even the 445-nm laser application in non-contact mode shows clinically acceptable incision depths without signs of extensive soft tissue denaturation.

  17. The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy

    Directory of Open Access Journals (Sweden)

    Affonso H. Camargo

    2006-06-01

    Full Text Available INTRODUCTION: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. MATERIALS AND METHODS: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI, laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. RESULTS: There was no significant difference for operative time between the 2 treatment groups (p = 0.65. Incision related complications occurred in 2 patients (4.4% from the intact specimen group but none in the morcellation group (p = 0.03. Overall narcotic requirement was lower in patients with morcellated (41 mg compared to intact specimen retrieval (66 mg on univariate (p = 0.03 and multivariate analysis (p = 0.049. Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14. CONCLUSION: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

  18. Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis.

    Science.gov (United States)

    Ismail, Ammar; Abushouk, Abdelrahman Ibrahim; Elmaraezy, Ahmed; Menshawy, Amr; Menshawy, Esraa; Ismail, Mahmoud; Samir, Esraa; Khaled, Anas; Zakarya, Hagar; El-Tonoby, Abdelrahman; Ghanem, Esraa

    2017-12-01

    Although cutting electrocautery can be superior to the scalpel in reducing blood loss and incisional time, several reports associated electrocautery with higher rates of wound infection, impaired healing, and worse cosmesis. We performed this systematic review and meta-analysis to compare cutting electrocautery versus scalpel for surgical incisions. We conducted a computerized literature search of five electronic databases and included all published original studies comparing cutting electrocautery and scalpel surgical incisions. Relevant data were extracted from eligible studies and pooled as odds ratios (ORs) or standardized mean difference (SMD) values in a meta-analysis model, using RevMan and Comprehensive Meta-analysis software. Forty-one studies (36 randomized trials, four observational, and one quasirandom study) were included in the pooled analysis (6422 participants). Compared with the scalpel incision, cutting electrocautery resulted in significantly less blood loss (SMD = -1.16, 95% CI [-1.60 to -0.72]), shorter incisional (SMD = -0.63, 95% CI [-0.96 to -0.29]) and operative times (SMD = -0.59, 95% CI [-1.12 to -0.05]), and lower pain scores (SMD = -0.91, 95% CI [-1.27 to -0.55]) with no significant differences in terms of wound infection rates (OR = 0.92, 95% CI [0.74-1.15]) or overall subjective scar score (SMD = -0.49, 95% CI [-1.72 to 0.75]). Surgical incision using electrocautery can be quicker with less blood loss and postoperative pain scores than the scalpel incision. No statistically significant difference was found between both techniques in terms of postoperative wound complications, hospital stay duration, and wound cosmetic characteristics. Therefore, we recommend routine use of cutting electrocautery for surgical incisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Incision of the Jezero Crater Outflow Channel by Fluvial Sediment Transport

    Science.gov (United States)

    Holo, S.; Kite, E. S.

    2017-12-01

    Jezero crater, the top candidate landing site for the Mars 2020 rover, once possessed a lake that over-spilled and eroded a large outflow channel into the Eastern rim. The Western deltaic sediments that would be the primary science target of the rover record a history of lake level, which is modulated by the inflow and outflow channels. While formative discharges for the Western delta exist ( 500 m3/s), little work has been done to see if these flows are the same responsible for outflow channel incision. Other models of the Jezero outflow channel incision assume that a single rapid flood (incision timescales of weeks), with unknown initial hydraulic head and no discharge into the lake (e.g. from the inflow channels or the subsurface), incised an open channel with discharge modulated by flow over a weir. We present an alternate model where, due to an instability at the threshold of sediment motion, the incision of the outflow channel occurs in concert with lake filling. In particular, we assume a simplified lake-channel-valley system geometry and that the channel is hydraulically connected to the filling/draining crater lake. Bed load sediment transport and water discharge through the channel are quantified using the Meyer-Peter and Mueller relation and Manning's law respectively. Mass is conserved for both water and sediment as the lake level rises/falls and the channel incises. This model does not resolve backwater effects or concavity in the alluvial system, but it does capture the non-linear feedbacks between lake draining, erosion rate, channel flow rate, and slope relaxation. We identify controls on incision of the outflow channel and estimate the time scale of outflow channel formation through a simple dynamical model. We find that the observed 300m of channel erosion can be reproduced in decades to centuries of progressive bed load as the delta forming flows fill the lake. This corresponds to time scales on the order of or smaller than the time scale

  20. Fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision.

    Science.gov (United States)

    Yabe, T; Muraoka, M; Motomura, H; Ozawa, T

    2001-11-01

    Four cases of fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision are reported. Because of lack of suitable arteries for anastomosis in the amputated finger, in each case a volar radial vein was anastomosed to the proximal digital artery and external drainage was performed through a transverse tip incision. In 3 cases the replanted fingertip survived completely; partial necrosis occurred in 1 case. Because veins are more superficial and larger than arteries, they are more available for anastomosis. The results indicate that this method is a useful alternative in fingertip replantation.

  1. Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

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    Inoue M

    2014-11-01

    Full Text Available Makoto Inoue,1 Dina Joy K Abulon,2 Akito Hirakata1 1Kyorin Eye Center, School of Medicine, Kyorin University, Tokyo, Japan; 2Alcon Research, Ltd., Irvine, CA, USA Purpose: To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture.Methods: We tested one ridged microvitreoretinal (MVR, one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type. Each blade’s straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design after simulated vitrectomy.Results: Differences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened “M-shaped” with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems.Conclusion: Wound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades. Keywords: entry system, incision closure, leakage, pars plana incision, sclerotomy, trocar blade 

  2. Rapid fluvial incision of a late Holocene lava flow: Insights from LiDAR, alluvial stratigraphy, and numerical modeling

    Science.gov (United States)

    Sweeney, Kristin; Roering, Joshua J.

    2016-01-01

    Volcanic eruptions fundamentally alter landscapes, paving over channels, decimating biota, and emplacing fresh, unweathered material. The fluvial incision of blocky lava flows is a geomorphic puzzle. First, high surface permeability and lack of sediment should preclude geomorphically effective surface runoff and dissection. Furthermore, past work has demonstrated the importance of extreme floods in driving incision via column toppling and plucking in columnar basalt, but it is unclear how incision occurs in systems where surface blocks are readily mobile. We examine rapid fluvial incision of the Collier lava flow, an andesitic Holocene lava flow in the High Cascades of Oregon. Since lava flow emplacement ∼1600 yr ago, White Branch Creek has incised bedrock gorges up to 8 m deep into the coherent core of the lava flow and deposited >0.2 km3 of sediment on the lava flow surface. Field observation points to a bimodal discharge regime in the channel, with evidence for both annual snowmelt runoff and outburst floods from Collier glacier, as well as historical evidence of vigorous glacial meltwater. To determine the range of discharge events capable of incision in White Branch Creek, we used a mechanistic model of fluvial abrasion. We show that the observed incision implies that moderate flows are capable of both initiating channel formation and sustaining incision. Our results have implications for the evolution of volcanic systems worldwide, where glaciation and/or mass wasting may accelerate fluvial processes by providing large amounts of sediment to otherwise porous, sediment-starved landscapes.

  3. Comparison of incision and drainage against needle aspiration for the treatment of breast abscess.

    Science.gov (United States)

    Naeem, Muhammad; Rahimnajjad, Muhammad Kazim; Rahimnajjad, Nasir Ali; Ahmed, Qazi Jalaluddin; Fazel, Pyar Ali; Owais, Muhammad

    2012-11-01

    We aim to compare the incision and drainage against ultrasound-guided aspiration for the treatment of breast abscesses. Sixty-four patients were randomly allocated to Group A (incision and drainage) and Group B (needle aspiration). Incision and drainage was done under general, whereas aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for cultures. Time taken to resolve symptoms including point tenderness, erythema and hyperthermia, recurrence of breast abscess, and healing time was recorded. Patients were followed until 8 weeks. Culture and sensitivity of the pus were done. Data were analyzed in SPSS 16.0. The mean difference of healing time was significant (P = 0.001). A total of 93.3 per cent were healed in Group B and 76.6 per cent in Group A (P = 0.033). Twenty-two samples (34.37%) had no bacterial yield and the remaining 42 samples (65.6%) yielded 11 anaerobic cultures (17.18%) and 31 aerobic cultures (48.4%). Ultrasound-guided aspiration of breast abscesses with the judicious use of antibiotics is a better treatment modality than incision and drainage.

  4. Human FAN1 promotes strand incision in 5'-flapped DNA complexed with RPA.

    Science.gov (United States)

    Takahashi, Daisuke; Sato, Koichi; Hirayama, Emiko; Takata, Minoru; Kurumizaka, Hitoshi

    2015-09-01

    Fanconi anaemia (FA) is a human infantile recessive disorder. Seventeen FA causal proteins cooperatively function in the DNA interstrand crosslink (ICL) repair pathway. Dual DNA strand incisions around the crosslink are critical steps in ICL repair. FA-associated nuclease 1 (FAN1) is a DNA structure-specific endonuclease that is considered to be involved in DNA incision at the stalled replication fork. Replication protein A (RPA) rapidly assembles on the single-stranded DNA region of the stalled fork. However, the effect of RPA on the FAN1-mediated DNA incision has not been determined. In this study, we purified human FAN1, as a bacterially expressed recombinant protein. FAN1 exhibited robust endonuclease activity with 5'-flapped DNA, which is formed at the stalled replication fork. We found that FAN1 efficiently promoted DNA incision at the proper site of RPA-coated 5'-flapped DNA. Therefore, FAN1 possesses the ability to promote the ICL repair of 5'-flapped DNA covered by RPA. © The Authors 2015. Published by Oxford University Press on behalf of the Japanese Biochemical Society. All rights reserved.

  5. The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

    Directory of Open Access Journals (Sweden)

    Noah J. Switzer

    2012-01-01

    Full Text Available Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA. With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA. There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

  6. Effects of Bank Vegetation and Incision on Erosion Rates in an Urban Stream

    Directory of Open Access Journals (Sweden)

    Emily Arnold

    2018-04-01

    Full Text Available Changing land-use associated with urbanization has resulted in shifts in riparian assemblages, stream hydraulics, and sediment dynamics leading to the degradation of waterways. To combat degradation, restoration and management of riparian zones is becoming increasingly common. However, the relationship between flora, especially the influence of invasive species, on sediment dynamics is poorly understood. Bank erosion and turbidity were monitored in the Tookany Creek and its tributary Mill Run in the greater Philadelphia, PA region. To evaluate the influence of the invasive species Reynoutria japonica (Japanese knotweed on erosion, reaches were chosen based on their riparian vegetation and degree of incision. Bank pins and turbidity loggers were used to estimate sediment erosion. Erosion calculations based on bank pins suggest greater erosion in reaches dominated by knotweed than those dominated by trees. For a 9.5-month monitoring period, there was 29 cm more erosion on banks that were also incised, and 9 cm more erosion in banks with little incision. Turbidity responses to storm events were also higher (77 vs. 54 NTU (nephelometric turbidity unit in reaches with knotweed, although this increase was found when the reach dominated by knotweed was also incised. Thus, this study linked knotweed to increased erosion using multiple methods.

  7. Computed tomography contrast media extravasation: treatment algorithm and immediate treatment by squeezing with multiple slit incisions.

    Science.gov (United States)

    Kim, Sue Min; Cook, Kyung Hoon; Lee, Il Jae; Park, Dong Ha; Park, Myong Chul

    2017-04-01

    In our hospital, an adverse event reporting system was initiated that alerts the plastic surgery department immediately after suspecting contrast media extravasation injury. This system is particularly important for a large volume of extravasation during power injector use. Between March 2011 and May 2015, a retrospective chart review was performed on all patients experiencing contrast media extravasation while being treated at our hospital. Immediate treatment by squeezing with multiple slit incisions was conducted for a portion of these patients. Eighty cases of extravasation were reported from approximately 218 000 computed tomography scans. The expected extravasation volume was larger than 50 ml, or severe pressure was felt on the affected limb in 23 patients. They were treated with multiple slit incisions followed by squeezing. Oedema of the affected limb disappeared after 1-2 hours after treatment, and the skin incisions healed within a week. We propose a set of guidelines for the initial management of contrast media extravasation injuries for a timely intervention. For large-volume extravasation cases, immediate management with multiple slit incisions is safe and effective in reducing the swelling quickly, preventing patient discomfort and decreasing skin and soft tissue problems. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  8. Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood.

    Science.gov (United States)

    Andersson, Marie; Doroszkiewicz, Monika; Arfwidsson, Charlotte; Abrahamsson, Kate; Sillén, Ulla; Holmdahl, Gundela

    2015-11-01

    An obstructive urinary flow pattern is frequently seen after tubularized incised plate urethroplasty for hypospadias. However, the significance of this finding has not been determined and long-term results are few. We describe postoperative long-term uroflowmetry results after puberty in males who underwent tubularized incised plate urethroplasty in childhood. A total of 126 boys underwent tubularized incised plate urethroplasty for distal penile to mid shaft hypospadias at Queen Silvia Children's Hospital in Gothenburg between 1999 and 2003. Of the patients 48 were toilet trained at surgery. We report on 40 patients who had data available at 2 and 12 months postoperatively, 7 years postoperatively and at puberty (median age 15.0 years, range 13.7 to 17.1). Of the patients 31 had distal and 9 had mid penile hypospadias. Clinical examination, urinary medical history, uroflowmetry and ultrasound measuring residual urine were performed. Maximum urinary flow was correlated to age and voided volume, using Miskolc nomograms for comparison of percentiles. At 1 year postoperatively 15 boys (37.5%) had normal urinary flow (above 25th percentile), compared to 16 (40%) at 7 years and 38 (95%) at puberty (p puberty for boys with hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Full-Thickness Retinochoroidal Incision in the Management of Central Retinal Vein Occlusion

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    San-Ni Chen

    2015-01-01

    Full Text Available Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA, slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO were included. Functional retinochoroidal venous anastomosis (RCVA was achieved in 48 of the 65 retinochoroidal incisions (73.8%. Central macular thickness (CMT and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%, neovascular glaucoma (7.1%, and preretinal fibrovasular membrane (10.7%, all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement.

  10. Addition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence.

    Science.gov (United States)

    Marwah, Sanjay; Marwah, Nisha; Singh, Mandeep; Kapoor, Ajay; Karwasra, Rajender Kumar

    2005-02-01

    The incidence of fascial dehiscence and incisional hernia after two methods for abdominal wound closure (rectus sheath relaxation incisions and conventional mass closure) was studied in a randomized prospective clinical trial in a consecutive series of 100 patients undergoing midline laparotomy for peritonitis. The two groups were well matched for etiologies of peritonitis, the surgical procedures performed, and the presence of known risk factors for fascial dehiscence. Fifty patients each were randomized either to the conventional continuous mass closure procedure or the rectus sheath relaxation incision technique (designed to increase wound elasticity and decrease tension in the suture line) using identical polypropylene sutures. The incidence of postoperative complications such as duration of ileus, chest infection, and wound infection were not statistically different between the two groups. The intensity of postoperative pain in the rectus sheath relaxation incision group was significantly less. The incidence of wound hematoma was significantly increased in the rectus sheath relaxation incision group. The incidences of fascial dehiscence (16% vs,28%; p cases of peritonitis using the rectus sheath relaxation technique is safe and less painful, provides increased wound elasticity and decreased tension on the suture line, and significantly decreases the incidence of wound dehiscence.

  11. Outcomes of single-stage total arch replacement via clamshell incision

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    Ishizaka Toru

    2011-09-01

    Full Text Available Abstract Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

  12. Seismic evidence of glacial-age river incision into the Tahaa barrier reef, French Polynesia

    Science.gov (United States)

    Toomey, Michael; Woodruff, Jonathan D.; Ashton, Andrew D.; Perron, J. Taylor

    2016-01-01

    Rivers have long been recognized for their ability to shape reef-bound volcanic islands. On the time-scale of glacial–interglacial sea-level cycles, fluvial incision of exposed barrier reef lagoons may compete with constructional coral growth to shape the coastal geomorphology of ocean islands. However, overprinting of Pleistocene landscapes by Holocene erosion or sedimentation has largely obscured the role lowstand river incision may have played in developing the deep lagoons typical of modern barrier reefs. Here we use high-resolution seismic imagery and core stratigraphy to examine how erosion and/or deposition by upland drainage networks has shaped coastal morphology on Tahaa, a barrier reef-bound island located along the Society Islands hotspot chain in French Polynesia. At Tahaa, we find that many channels, incised into the lagoon floor during Pleistocene sea-level lowstands, are located near the mouths of upstream terrestrial drainages. Steeper antecedent topography appears to have enhanced lowstand fluvial erosion along Tahaa's southwestern coast and maintained a deep pass. During highstands, upland drainages appear to contribute little sediment to refilling accommodation space in the lagoon. Rather, the flushing of fine carbonate sediment out of incised fluvial channels by storms and currents appears to have limited lagoonal infilling and further reinforced development of deep barrier reef lagoons during periods of highstand submersion.

  13. Influence of different phacoemulsification incision on postoperative corneal astigmatism for cataract patients

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    Zhao-Rong Zeng

    2014-05-01

    Full Text Available AIM: To compare the effect of different phacoemulsification incision on postoperative corneal astigmatism for cataract patients. METHODS: The cataract patients were selected in our hospital. The patients were divided into control group(corneal limbus opposite curved scleral tunnel incision groupand observation group(above the top of cornea or temporal transparent corneal incision grouprandomly. At 1wk; 1 and 3mo after surgery, the change of corneal astigmatism and vision of the patients in two groups were compared and analyzed. RESULTS:Compared with control group, 1wk; 1 and 3mo after surgery, the average corneal astigmatism and surgically induced corneal astigmatism of the patients in observation group were decreased significantly. The visual acuity and corrected visual acuity were increased significantly. There was statistically significant(PPCONCLUSION: Center distance and small incision corneal phacoemulsification can reduce postoperative astigmatism and improve postoperative visual acuity for cataract patients. It provides guarantee for further strengthen the clinical treated effect for cataract patients.

  14. Laparoscopic surgery for esophageal achalasia: Multiport vs single-incision approach.

    Science.gov (United States)

    Fukuda, Shuichi; Nakajima, Kiyokazu; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2016-02-01

    SILS can potentially improve aesthetic outcomes without adversely affecting treatment outcomes, but these outcomes are uncertain in laparoscopic Heller-Dor surgery. We determined if the degree of patient satisfaction with aesthetic outcomes progressed with the equivalent treatment outcomes after the introduction of a single-incision approach to laparoscopic Heller-Dor surgery. We retrospectively reviewed 20 consecutive esophageal achalasia patients (multiport approach, n = 10; single-incision approach, n = 10) and assessed the treatment outcomes and patient satisfaction with the aesthetic outcomes. In the single-incision approach, thin supportive devices were routinely used to gain exposure to the esophageal hiatus. No statistically significant differences in the operating time (210.2 ± 28.8 vs 223.5 ± 46.3 min; P = 0.4503) or blood loss (14.0 ± 31.7 vs 16.0 ± 17.8 mL; P = 0.8637) were detected between the multiport and single-incision approaches. We experienced no intraoperative complications. Mild dysphagia, which resolved spontaneously, was noted postoperatively in one patient treated with the multiport approach. The reduction rate of the maximum lower esophageal sphincter pressure was 25.1 ± 34.4% for the multiport approach and 21.8 ± 19.2% for the single-incision approach (P = 0.8266). Patient satisfaction with aesthetic outcomes was greater for the single-incision approach than for the multiport approach. When single-incision laparoscopic Heller-Dor surgery was performed adequately and combined with the use of thin supportive devices, patient satisfaction with the aesthetic outcomes was higher and treatment outcomes were equivalent to those of the multiport approach. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  15. Channel Incision Driven by Suburbanization: Impacts to Riparian Groundwater Flow and Overbank Flow Frequency

    Science.gov (United States)

    Bowles, C. J.; Lawrence, R. L.; Noll, C.; Hancock, G. S.

    2005-12-01

    Channel incision is a widely observed response to increased flow in urbanized watersheds, but the effects of channel lowering on riparian water tables is not well documented. In a rapidly incising suburban stream in the Virginia Coastal Plain, we hypothesize that stream incision has lowered floodplain water tables and decreased the overbank flow frequency. The monitored stream is a tributary to the James River draining 1.3 km2 of which 15% is impervious cover. Incision has occurred largely through upstream migration of a one meter high knickpoint at a rate of ~1.5 m/yr, primarily during high flow events. We installed 63 wells in six stream-perpendicular transects as well as a cluster of wells around the knickpoint to assess water table elevations beneath the floodplain adjacent to the incising stream. Two transects are located 30 and 50 m upstream of the knickpoint in the unincised floodplain, and the remainder are 5, 30, 70, and 100 m downstream in the incised floodplain. In one transect above and two below, pressure transducers attached to dataloggers provide a high-resolution record of water table changes. Erosion pins were installed and channel cross-sections surveyed to determine streambed stability. Significant differences are observed in bank morphology and groundwater flow above vs. below the knickpoint. Above the knickpoint, the banks are stable, ~3 m wide, and ~0.3 m deep, and widen and deepen slightly toward the knickpoint. The water table is relatively flat and is 0.2-0.4 m below the floodplain surface, and groundwater contours suggest flow is parallel to the stream direction. The water table responds immediately to precipitation events, and rises to the floodplain surface in significant rainfall events. Immediately downstream of the knickpoint, channel width increases by about a meter, and stream depth increases to ~1.5 meters. The water table immediately below the knickpoint possesses a steep gradient, and is up to one meter below the floodplain

  16. A new technique, combined plication-incision (CPI, for correction of penile curvature

    Directory of Open Access Journals (Sweden)

    Hamed Abdalla Hamed

    Full Text Available ABSTRACT Introduction Penile curvature (PC can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction. Objective To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI. Materials and Methods Two groups (1&2 were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot technique. In each group of 4 dots the superficial layer of tunica albuginea was transversely incised (3-6mm at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot. Results Twelve (57.1 % participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005. Postoperative shortening (5mm of erect penis, encountered in 9 participants, was doubled in group 2 but with insignificant difference (P>0.05. Post-operative recurrence of PC, was encountered in only 1 (4.8% participant in group 2, compared to none in group 1, with insignificant difference (P>0.05. Post-operative erectile rigidity was normally maintained in all participants. Conclusion The new technique was superior to the 16-dot technique for correction of PC.

  17. [Is there a relation between mammaplasties incisions and the final shape of the breast?].

    Science.gov (United States)

    Moufarrège, R; Dionyssopoulos, A; Aymeric, A; Sauvageau, J

    2010-04-01

    The results of reduction mammoplasty and mastopexy demonstrate a great variety of shapes derived from the particularities inherent to each technique. More precisely, it has become apparent to us that the usage of an abnormally long vertical scar leads to a suboptimal final shape of the breast due to the excessive projection compared to its height. Although our clientele continually asks to minimize scars, we have noticed a resurgence in the literature of vertical incision mammoplasty techniques albeit with a scar of an excessive length. The multitude of publications leads to an evident and consistent conclusion: breasts reconstructed with an overly long vertical incision all suffer the same deformity characterized by a banana or squash-shaped breast. We studied the totality of publications on vertical incision technique mammoplasty from the last 15 years and realised they all presented the same problem: an abnormally low height/projection ratio. These numbers have been confronted by the golden ratio established by the first author (2005) [1]. The breast's golden ratio developed by Moufarrège is optimal at a number close to, or superior to 2. Results between 2 and 1.5 are acceptable. All height/projection ratios inferior to 1.5 correspond to suboptimal breast shapes. Furthermore, the totality of results in the vertical scar mammoplasty technique which displayed unsatisfying results had a height/projection ratio inferior to 1.5. Those who promote the vertical incision have the greatest drive to encourage other plastic surgeons to abandon the traditional mutilating boat anchor scar. Nevertheless, they should always remember the deforming effect caused by exaggerated vertical incisions which may be avoided by transforming it into an inverted T with short horizontal branches, a small price to pay to obtain a superior aesthetic result. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  18. Minimal Nasolabial Incision Technique for Nasolabial Fold Modification in Patients With Facial Paralysis.

    Science.gov (United States)

    Faris, Callum; Heiser, Alyssa; Jowett, Nate; Hadlock, Tessa

    2018-03-01

    Creation of symmetrical nasolabial folds (NLFs) is important in the management of the paralyzed face. Established techniques use a linear incision in the NLF, and technical refinements now allow the linear incision to be omitted. This retrospective case series was conducted in a tertiary care setting from February 2, 2017, to June 7, 2017. Participants were all patients (N = 21) with peripheral facial paralysis who underwent NLF modification that used the minimal nasolabial incision technique at the Massachusetts Eye and Ear Infirmary Facial Nerve Center from February 1, 2015, through August 31, 2016. Patient-reported outcome measures using the validated, quality-of-life Facial Clinimetric Evaluation (FaCE) Scale; clinician-reported facial function outcomes using a validated electronic clinician-graded facial paralysis assessment (eFACE); layperson assessment of the overall aesthetic outcome of the NLF; and expert-clinician scar assessment of the NLF. Of the 21 patients who underwent NLF modification that used the minimal nasolabial incision technique, 9 patients (43%) were female and 12 (57%) were male. The mean age was 41 (range, 9-90) years; 17 patients (81%) were adults (≥18 years) and 4 (19%) were children (<18 years). Overall, significant improvements were observed after NLF modification in all outcome measures as graded by both clinicians and patients. The mean (SD) scores for total eFACE were 60.7 (14.9) before the operation and 77.2 (8.9) after the operation (mean difference, 16.5 [95% CI, 8.5-24.2]; P < .001). The mean (SD) static eFACE scores were 61.4 (20.6) before the operation and 82.7 (12.4) after the operation (mean difference, 21.3 [95% CI, 10.7-31.9]; P < .001). The mean (SD) FaCE quality-of-life scores were 51.3 (20.1) before the operation and 70.3 (12.6) after the operation (mean difference, 19.0 [95% CI, 6.5-31.6]; P  =  .001). The layperson self-assessment of the overall aesthetic outcome of the NLF modification was

  19. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats

    Directory of Open Access Journals (Sweden)

    Karina Genaro

    2017-06-01

    Full Text Available Background: Pain involves different brain regions and is critically determined by emotional processing. Among other areas, the rostral anterior cingulate cortex (rACC is implicated in the processing of affective pain. Drugs that interfere with the endocannabinoid system are alternatives for the management of clinical pain. Cannabidiol (CBD, a phytocannabinoid found in Cannabis sativa, has been utilized in preclinical and clinical studies for the treatment of pain. Herein, we evaluate the effects of CBD, injected either systemically or locally into the rACC, on mechanical allodynia in a postoperative pain model and on the negative reinforcement produced by relief of spontaneous incision pain. Additionally, we explored whether CBD underlies the reward of pain relief after systemic or rACC injection.Methods and Results: Male Wistar rats were submitted to a model of incision pain. All rats had mechanical allodynia, which was less intense after intraperitoneal CBD (3 and 10 mg/kg. Conditioned place preference (CPP paradigm was used to assess negative reinforcement. Intraperitoneal CBD (1 and 3 mg/kg inverted the CPP produced by peripheral nerve block even at doses that do not change mechanical allodynia. CBD (10 to 40 nmol/0.25 μL injected into the rACC reduced mechanical allodynia in a dose-dependent manner. CBD (5 nmol/0.25 μL did not change mechanical allodynia, but reduced peripheral nerve block-induced CPP, and the higher doses inverted the CPP. Additionally, CBD injected systemically or into the rACC at doses that did not change the incision pain evoked by mechanical stimulation significantly produced CPP by itself. Therefore, a non-rewarding dose of CBD in sham-incised rats becomes rewarding in incised rats, presumably because of pain relief or reduction of pain aversiveness.Conclusion: The study provides evidence that CBD influences different dimensions of the response of rats to a surgical incision, and the results establish the rACC as a

  20. The "Propeller" incision for transpalatal advancement pharyngoplasty: a new approach to reduce post-operative oronasal fistulae.

    Science.gov (United States)

    Shine, Neville Patrick; Lewis, Richard Hamilton

    2008-09-01

    To present a new soft tissue approach for transpalatal advancement pharyngoplasty (TPA), the propeller incision, and to compare the rates of post-operative oronasal fistula in those undergoing TPA with the traditional "Gothic Arch" incision described by Woodson and those with the propeller incision. A prospectively maintained adult sleep apnoea surgery database was used to identify those patients undergoing TPA, either alone or in combination with other procedures, for obstructive sleep apnoea syndrome (OSAS) between February 2001 and September 2006 in a tertiary referral centre by a single surgeon (RHL). In addition to the incision used during TPA, patient demographic data, previous surgery of the upper airways, smoking history, pre-operative body mass index, respiratory disturbance index, oxygen saturation index and the occurrence of oronasal fistula post-operatively, were recorded. The propeller incision technique is described. A total of 89 patients who underwent TPA were identified. A total of 49 patients had a "Gothic Arch" incision and 40 had a "Propeller" incision. The two groups of patients were comparable in age, sex, previous tonsillar and uvulopalatopharyngoplasty surgery, smoking histories and pre-operative disease severity. In the "Gothic Arch" group, eight patients (16%) developed oronasal fistulae in the post-operative period versus only one patient (2.5%) in the "Propeller" group. The difference between the two groups was statistically significant (P=0.038, Fisher's exact test). Of the total cases with post-operative oronasal fistula (n=9), only one patient (from the Gothic Arch incision group) required operative closure which was performed under local anesthesia and healed without complication. The propeller incision provides an anatomically sensible axial-based flap that provides adequate access to perform TPA. It is associated with a lower incidence of oronasal fistula and is recommended by the authors.

  1. Single-incision video-assisted anatomical segmentectomy with handsewn bronchial closure for endobronchial lipoma.

    Science.gov (United States)

    Galvez, Carlos; Sesma, Julio; Bolufer, Sergio; Lirio, Francisco; Navarro-Martinez, Jose; Galiana, Maria; Baschwitz, Benno; Rivera, Maria Jesus

    2016-08-01

    Endobronchial lipomas are rare benign tumors whose symptoms are usually confused with recurrent infections or even asthma diagnosis, and mostly caused by endobronquial obstructive component which also conditions severity. We report a case of a 60-year-old man with a right-lower lobe upper-segment endobronchial myxoid tumor with uncertain diagnosis. We performed a single incision video-assisted anatomical segmentectomy and wedge bronchoplasty with handsewn closure to achieve complete resection and definitive diagnosis. During the postoperative air leak was not observed and there was no complication, with low pain scores and complete recovery. Final pathological exam showed endobronchial lipoma. Single-incision (SI) anatomical segmentectomies are lung-sparing resections for benign or low-grade malignancies with diagnostic and therapeutic value, and the need for a wedge bronchoplasty is not a necessary indication for conversion to multiport or open thoracotomy.

  2. European Hernia Society guidelines on the closure of abdominal wall incisions

    DEFF Research Database (Denmark)

    Muysoms, F E; Antoniou, S A; Bury, K

    2015-01-01

    using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II...... of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method......, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias....

  3. Can post-sternotomy mediastinitis be prevented by a closed incision management system?

    Directory of Open Access Journals (Sweden)

    Dohmen, Pascal M.

    2014-09-01

    Full Text Available [english] Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today’s golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today’s studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction.

  4. Radiological assessment of 50 cases of incisive or maxillary neoplasia in the dog

    International Nuclear Information System (INIS)

    Frew, D.G.; Dobson, J.M.

    1992-01-01

    This paper reviews the radiological features of 50 canine incisive or maxillary tumours and discusses the value of radiological assessment in the diagnosis and staging of these tumours. The 50 tumours examined included 21 sarcomas, 15 carcinomas, three melanomas and an assortment of benign tumours of the oral cavity. There was not any site specificity for the different histological tumour types within the upper dental arcade, although fibrosarcomas had a tendency to be maxillary whereas the squamous cell carcinomas were equally distributed between the incisive and maxillary regions. Seventy-eight per cent of fibrosarcomas, 82 per cent of squamous cell carcinoma and all three melanomas examined showed radiological evidence of bone involvement. Radiographic changes were also seen in the benign tumours. The pattern of growth of tumours correlated with the radiological changes observed. Malignant tumours showed a tendency to irregular or aggressive bone loss whereas bone production predominated in the benign tumours

  5. Diagnosis and management of maxillary incisors affected by incisal wear: an interdisciplinary case report.

    Science.gov (United States)

    Bernardo, Jussara Karina; Maia, Elaine A Vilela; Cardoso, Antônio Carlos; de Araújo Júnior, Edson Medeiros; Monteiro Júnior, Sylvio

    2002-01-01

    In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented. In some cases of bruxism and/or dental erosion, it is possible to acquire space to recuperate the esthetics and function of maxillary incisors affected by incisal wear through a conservative treatment associated with the control of the etiologic factors.

  6. A STUDY ON EFFICACY OF MANUAL SMALL INCISION CATARACT SURGERY BY TEMPORAL APPROACH

    Directory of Open Access Journals (Sweden)

    Vinodhini Kannan

    2018-01-01

    Full Text Available BACKGROUND Manual Small Incision Cataract Surgery (MSICS is a well-known technique of cataract surgery owing to its advantage of a selfsealing suture less incision with least surgically induced astigmatism at a low cost. It is a safe, simple, consistent, stable and cost-effective technique with various modifications that involve site, size, type of incision and method of nucleus delivery. One such modification is Temporal Incision MSICS, where the cataract surgery is done by a temporal approach, which is equally good compared to the superior incision. This study was done retrospectively to analyse the visual outcome of patients operated by Manual SICS - Temporal Approach, using the WHO criteria and to establish its efficacy as a good surgical technique. MATERIALS AND METHODS Records of patients operated for senile cataract by a single surgeon by Temporal MSICS using a temporal sclerocorneal incision of 6-6.5 mm, during a 1-year period, were analysed retrospectively. Post-operative followup records of POD-1 and subsequent follow-ups at 1 st week and 6 th week were recorded for visual outcome. RESULTS Out of the 83 cases analysed retrospectively, majority of them were found to be between 61-70 years with a female Preponderance. Most of the cases were found to have senile immature cataract (55 patients, with Grade III nuclear sclerosis (52 cases. The pre-operative visual acuity was poor <6/60 in 72 cases (86.7% and borderline in 11 cases (14.5%. 55 cases (66.3% had a 6.5 mm scleral incision and the remaining 28 cases (33.7% had a 6 mm incision. Average duration of surgery noted was 8.35 minutes. Striate Keratopathy was the most common 1 st POD complication followed by corneal oedema. Striate keratopathy was the most common complication at the 1 st week followup followed by pigment dispersion. Majority of cases (76 cases were found to have been complication free at the end of 6 weeks. At the end of 6 weeks post-operatively as per records, 80 cases

  7. Single-incision, laparoscopic-assisted jejunal resection and anastomosis following a gunshot wound.

    Science.gov (United States)

    Rubin, Jacob A; Shigemoto, Reynsen; Reese, David J; Case, J Brad

    2015-01-01

    A 2 yr old castrated male Pomeranian was evaluated for a 6 wk history of chronic vomiting, intermittent anorexia, and lethargy. Physical examination revealed a palpable, nonpainful, soft-tissue mass in the midabdominal area. Abdominal radiographs and ultrasound revealed a focal, eccentric thickening of the jejunal wall with associated jejunal mural foreign body and partial mechanical obstruction. Following diagnosis of a partial intestinal obstruction as the cause of chronic vomiting, the patient underwent general anesthesia for a laparoscopic-assisted, midjejunal resection and anastomosis using a single-incision laparoscopic surgery port. The patient was discharged the day after surgery, and clinical signs abated according to information obtained during a telephone interview conducted 2 and 8 wk postoperatively. The dog described in this report is a unique case of partial intestinal obstruction treated by laparoscopic-assisted resection and anastomosis using a single-incision laparoscopic surgery port.

  8. Early response of local steroid injection versus mini incision technique in treatment of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Awan, A.S.; Khan, A.; Afridi, S.A.; Khan, R.S.

    2015-01-01

    Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post-operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups. Fifty-eight Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8 ± 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant. (author)

  9. Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature

    OpenAIRE

    Bhat, Amilal; Gandhi, Ajay; Saxena, Gajendra; Choudhary, Gautam Ram

    2010-01-01

    Aims : Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature. Materials and Methods : Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plica...

  10. Infilling and flooding of the Mekong River incised valley during deglacial sea-level rise

    Science.gov (United States)

    Tjallingii, Rik; Stattegger, Karl; Wetzel, Andreas; Van Phach, Phung

    2010-06-01

    The abrupt transition from fluvial to marine deposition of incised-valley-fill sediments retrieved from the southeast Vietnamese shelf, accurately records the postglacial transgression after 14 ka before present (BP). Valley-filling sediments consist of fluvial mud, whereas sedimentation after the transgression is characterized by shallow-marine carbonate sands. This change in sediment composition is accurately marked in high-resolution X-ray fluorescence (XRF) core scanning records. Rapid aggradation of fluvial sediments at the river mouth nearly completely filled the Mekong incised valley prior to flooding. However, accumulation rates strongly reduced in the valley after the river-mouth system flooded and stepped back. This also affected the sediment supply to deeper parts of the southeast Vietnamese shelf. Comparison of the Mekong valley-filling with the East Asian sea-level history of sub- and inter-tidal sediment records shows that the transgressive surface preserved in the incised-valley-fill records is a robust sea-level indicator. The valley was nearly completely filled with fluvial sediments between 13.0 and 9.5 ka BP when sea-level rose rather constantly with approximately 10 mm/yr, as indicated by the East Asian sea-level record. At shallower parts of the shelf, significant sediment reworking and the establishment of estuarine conditions at the final stage of infilling complicates accurate dating of the transgressive surface. Nevertheless, incised-valley-fill records and land-based drill sites indicate a vast and rapid flooding of the shelf from the location of the modern Vietnamese coastline to the Cambodian lowlands between 9.5 ka and 8.5 ka BP. Fast flooding of this part of the shelf is related with the low shelf gradient and a strong acceleration of the East Asian sea-level rise from 34 to 9 meter below modern sea level (mbsl) corresponding to the sea-level jump of melt water pulse (MWP) 1C.

  11. Femtosecond laser based small incision lenticule extraction for moderate and high myopia

    DEFF Research Database (Denmark)

    Hjortdal, Jesper Østergaard; Asp, Sven; Ivarsen, Anders

    Femtosecond laser based small incision lenticule extraction for moderate and high myopia. Jesper Hjortdal, Sven Asp, Anders Ivarsen, Anders Vestergaard Department of Ophthalmology, Aarhus University Hospital, Denmark Purpose: ReLEx® smile is a new keratorefractive procedure whereby a stromal lent....... Refractive predictability, safety and patient satisfaction at 3 months seems equal to ReLEx flex and FS-LASIK. Optimizing laser energy settings and surgeon experience is important to minimize initial inferior results....

  12. Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation.

    Science.gov (United States)

    Oji, Tomito; Hayashi, Akiteru; Ogino, Akihiro; Onishi, Kiyoshi

    2018-05-01

    Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.

  13. Lateral Nail Fold Incision Technique for Venous Anastomosis in Fingertip Replantation.

    Science.gov (United States)

    Jeon, Byung-Joon; Yang, Jae-Won; Roh, Si Young; Ki, Sae Hwi; Lee, Dong Chul; Kim, Jin Soo

    2016-01-01

    Successful venous anastomosis is one of the most important factors in fingertip replantation. Volar veins in the fingertip course proximally in a random pattern, which makes it difficult to find out the exact locations. Although dorsal veins in the lateral nail fold have constant location and adequate diameter for anastomosis, they have been known as hard to dissect from the immobile subcutaneous tissue. The authors present a new lateral nail fold incision technique for venous anastomosis in the fingertip amputations. From February 2010 to October 2010, 9 replantations using the new incision and venous anastomosis technique were performed in 9 patients. The levels of amputations were from the nail base to half of the nail bed. After repairing the proper digital arteries, a skin incision was made along the junction between the lateral nail fold and nail bed. Careful dissection was performed to isolate the veins in the lateral nail fold. After evaluation of the suitability of the vessel, venous anastomosis was performed. Seven male and 2 female patients were enrolled in this study. Appropriate dorsal veins for anastomosis could be found in 8 of 9 patients. All the replanted stumps survived without venous congestion and following additional procedures. A sizable volar or dorsal vein could not be found in 1 patient. The salvage technique was required in this patient. Dorsal veins in the lateral nail fold can be found easily because of the constant anatomical location. The new incision on the lateral nail fold provides not only sufficient operative field for anastomosis but also additional opportunity of successful venous anastomosis in the selected cases. The authors, therefore, propose this technique as an effective method for an alternative venous anastomosis in the zone I replantation.

  14. The 'French Fry' VAC technique: hybridisation of traditional open wound NPWT with closed incision NPWT.

    Science.gov (United States)

    Chopra, Karan; Tadisina, Kashyap K; Singh, Devinder P

    2016-04-01

    Surgical site occurrences (SSO), specifically surgical site infections represent a significant burden in the US health care system. It has been hypothesised that postoperative dressing can help drive down SSO. We describe the successful use of a novel technique combining both closed incision and open negative pressure wound therapy in the management of a high-risk wound associated with lymphoedema of obesity. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  15. DNA polymerase. beta. reaction with ultraviolet-irradiated DNA incised by correndonuclease

    Energy Technology Data Exchange (ETDEWEB)

    Nowak, R; Zarebska, Z [Instytut Onkologii, Warsaw (Poland); Zmudzka, B [Polska Akademia Nauk, Warsaw. Inst. Biochemii i Biofizyki

    1980-09-19

    Covalently closed circular Col E1 DNA was ultraviolet-irradiated with a dose of 60 J/m/sup 2/, thus introducing about 3.2 pyrimidine dimers per DNA molecule. Treatment of irradiated Col E1 DNA with Micrococcus luteus correndonuclease resulted, in the vicinity of pyrimidine dimers, in an average of 3.3 incisions per DNA molecule, and converted DNA to the open circular form. Incised Col E1 DNA stimulated no reaction with calf thymus DNA polymerase ..cap alpha.. but was recognized as a template by DNA polymerase ..beta... The latter enzyme incorporated about 1.6 molecules of dTMP (corresponding to 6 molecules of dNMP) per one correndonuclease incision. The length of the DNA polymerase ..beta.. product was comparable to the anticipated length of the DNA region within which the hydrogen bonds were disrupted owing to dimer formation. The enzyme required Mg/sup 2 +/ and four dNTPs for reaction and was resistant to N-ethylmaleimide or p-mercuribenzoate.

  16. The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

    Directory of Open Access Journals (Sweden)

    Xing-long Cheng

    2015-01-01

    Full Text Available Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery.

  17. Characteristics of Bone Injuries Resulting from Knife Wounds Incised with Different Forces.

    Science.gov (United States)

    Humphrey, Caitlin; Kumaratilake, Jaliya; Henneberg, Maciej

    2017-11-01

    The aim of this research was to experimentally determine the characteristics of incised bone wounds, which are commonly found in defense injuries. A specially constructed pivoting arm device was used to inflict wounds with controlled forces and direction. Five knives were selected to inflict the wounds on porcine forelimbs. Eight incised wounds were made per knife per force. A larger knife and a greater force caused longer and wider bone wounds. Comparisons of individual knives at the two forces produced varying results in the bone wounds. A correlation was seen between the force and the length (r = 0.69), width (r = 0.63), and depth (r = 0.57) of bone wounds. Serrated-edge and nonserrated knives can be distinguished from the appearance of the wound. The outcomes may be applicable in forensic investigations to ascertain the forces associated with incised wounds and identify the specific knife used. © 2017 American Academy of Forensic Sciences.

  18. Chemical weathering as a mechanism for the climatic control of bedrock river incision

    Science.gov (United States)

    Murphy, Brendan P.; Johnson, Joel P. L.; Gasparini, Nicole M.; Sklar, Leonard S.

    2016-04-01

    Feedbacks between climate, erosion and tectonics influence the rates of chemical weathering reactions, which can consume atmospheric CO2 and modulate global climate. However, quantitative predictions for the coupling of these feedbacks are limited because the specific mechanisms by which climate controls erosion are poorly understood. Here we show that climate-dependent chemical weathering controls the erodibility of bedrock-floored rivers across a rainfall gradient on the Big Island of Hawai‘i. Field data demonstrate that the physical strength of bedrock in streambeds varies with the degree of chemical weathering, which increases systematically with local rainfall rate. We find that incorporating the quantified relationships between local rainfall and erodibility into a commonly used river incision model is necessary to predict the rates and patterns of downcutting of these rivers. In contrast to using only precipitation-dependent river discharge to explain the climatic control of bedrock river incision, the mechanism of chemical weathering can explain strong coupling between local climate and river incision.

  19. Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis.

    Science.gov (United States)

    Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki

    2017-01-01

    Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.

  20. Smaller incision size leads to higher predictability in microcoaxial cataract surgery.

    Science.gov (United States)

    Klamann, Matthias K J; Gonnermann, Johannes; Maier, Anna-Karina B; Torun, Necip; Bertelmann, Eckart

    2013-01-01

    The aim of the study was to compare the clinical outcomes of a 1.8 mm, 2.2 mm, and 2.75 mm microcoaxial cataract surgery system. METHODS. In this retrospective study, 129 eyes of 129 patients were included. Patients underwent phacoemulsification using a Stellaris system or an Infiniti system. The incision size was 1.8 mm, 2.2 mm, or 2.75 mm, respectively. Subjects were examined before surgery and 4 weeks after. The surgically induced astigmatism (SIA) was examined. The SIA in the 1.8 mm group was statistically lower compared to the 2.2 mm group (p=0.046) and the 2.75 mm group (p=0.017). There was no significant difference between the 2.2 mm group and the 2.75 mm group. With the use of appropriate support systems, 1.8 mm incisions appear to result in less SIA than 2.2 mm and 2.75 mm incisions. Advantages may arise from this, especially in the implantation of aspheric, toric, or multifocal lenses.

  1. Nd:YAG laser incision of the vesical neck in obstructive BPH

    Science.gov (United States)

    Gilbert, Peter T. O.

    2003-06-01

    From February, 1995 through June, 2002, 68 patients underwent laser incision of the prostate at our clinic. By means of a 23 F cytoscope and a 600 micrometer lateral firing quartz fiber the vesical neck was incised at the 5 and 7 o'clock position at 60 W power. Total energy averaged 13648 J. Operative time did not exceed 15 minutes. General anesthesia was employed in all but one patient. 38 patients remained catheter-free whereas 30 patients were catheterized for two hours. Except for three cases, all patients were discharged on the same day, usually after the first micturition. Anti-inflammatory treatment was administered for two weeks, Cotrimoxazole for 5 days. No serious complications were encountered. Minor side effects included urinary retention (1 pat.), urinary infection (3 pat.) and retrograde ejaculation (1 pat.). Considering a mean follow-up of 21 months, the average Qmax improved enormously (25.4 ml/s versus 10.9 ml/s), as did residual urine volume (35 ml versus 95 ml) and IPSS (7.1 versus 20.5). Three patients required TUR-P 2-3 years after laser surgery and one patient underwent radical retropubic prostatectomy for prostate cancer 2 years later. In conclusion, Nd:YAG laser incision of the prostate is a simple, safe, reliable and cost-effective outpatient procedure.

  2. Optical coherence tomography of the effects of stromal hydration on clear corneal incision architecture.

    Science.gov (United States)

    Calladine, Daniel; Tanner, Vaughan

    2009-08-01

    To evaluate the effects of stromal hydration on clear corneal incision (CCI) architecture immediately after surgery using anterior segment optical coherence tomography (AS-OCT). Department of Ophthalmology, Royal Berkshire Hospital, Reading, United Kingdom. Clear corneal incisions in adult eyes were examined using a Visante AS-OCT imaging system within 1 hour of surgery. Half the CCIs had stromal hydration with a balanced salt solution and half did not. Incisions were made with a 2.75 mm steel keratome. Intraocular pressure (IOP) was measured within 90 minutes after surgery. The CCI length and corneal thickness at the CCI site were measured using software built into the AS-OCT system. Thirty CCIs were evaluated. Stromal hydration significantly increased the measured CCI length (Pthe result of a trend toward increased corneal thickness at the CCI site with hydration (PThe mean CCI length was 1.69 mm +/- 0.27 (SD) (range 1.31 to 2.32 mm) with hydration and 1.51 +/- 0.23 mm (range 1.30 to 1.95 mm) without hydration. The mean IOP was 20.9 +/- 8.18 mm Hg and 15.8 +/- 8.20 mm Hg, respectively. The IOP tended to be higher with hydration (Pthe eye with a higher early postoperative IOP, showing the importance of taking stromal hydration into account when designing similar OCT studies of CCI architecture.

  3. No-Drain Single Incision Liposuction Pull-Through Technique for Gynecomastia.

    Science.gov (United States)

    Khalil, Ashraf A; Ibrahim, Amr; Afifi, Ahmed M

    2017-04-01

    Several different methods have been proposed for treatment of gynecomastia, depending on the amount of breast enlargement and skin redundancy. The liposuction pull-through technique has been proposed as an efficacious treatment for many gynecomastia cases. This work aims to study the outcome of this technique when applied as an outpatient procedure, without the use of drains and through a single incision. Fifty-two patients with bilateral gynecomastia without significant skin excess were included in this study. The liposuction pull-through technique was performed through a single incision just above the inframammary fold and without the use of drains. Patients were followed up for 6 months. The proposed technique was able to treat the gynecomastia in all patients, with a revision rate of 1.9% to remove residual glandular tissues. There were no seromas, hematomas, nipple distortion, permanent affection of nipple sensation or wound healing problems. The liposuction pull-through technique is an effective treatment for gynecomastia without significant skin redundancy. It combines the benefits of the direct excision of glandular tissues, with the minimally invasive nature of liposuction. Performing the procedure through a single incision without the use of drains and without general anesthesia is a safe alternative. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  4. Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision.

    Science.gov (United States)

    Lee, Yung Ki; Lee, Jun Hee; Kang, Sang Yoon

    2018-04-01

    Gynecomastia is characterized by the benign proliferation of breast tissue in men. Herein, we present a new method for the treatment of gynecomastia, using ultrasound-assisted liposuction with both conventional and reverse-cutting edge tip cannulas in combination with a pull-through lipectomy technique with pituitary forceps through a single transaxillary incision. Thirty patients were treated with this technique at the author's institution from January 2010 to January 2015. Ten patients were treated with conventional surgical excision of the glandular/fibrous breast tissue combined with liposuction through a periareolar incision before January 2010. Medical records, clinical photographs and linear analog scale scores were analyzed to compare the surgical results and complications. The patients were required to rate their cosmetic outcomes based on the linear analog scale with which they rated their own surgical results; the mean overall average score indicated a good or high level of satisfaction. There were no incidences of skin necrosis, hematoma, infection and scar contracture; however, one case each of seroma and nipple inversion did occur. Operative time was reduced overall using the new technique since it is relatively simple and straightforward. According to the evaluation by the four independent researchers, the patients treated with this new technique showed statistically significant improvements in scar and nipple-areolar complex (NAC) deformity compared to those who were treated using the conventional method. Glandular liposculpture through a single transaxillary incision is an efficient and safe technique that can provide aesthetically satisfying and consistent results.

  5. Distinction of infected and non-infected post-surgical incisions with In-111-WBC scintigraphy

    International Nuclear Information System (INIS)

    Abdel-Nabi, H.; Hinkle, G.H.; Olsen, J.O.

    1985-01-01

    To determine if In-111-WBCs scintigraphy can distinguish between healing and infection in post-surgical wounds, a prospective study was performed in patients with 3-14 day old surgical incisions. Eighteen patients (11 males and 7 females) were scanned 24 hrs after injection of 0.5 mCi of In-111 labeled autologous leukocytes. The scan findings were correlated with blood and/wound cultures results and diagnosis at time of discharge. Incisional uptake of In-111-WBCs was noted in 9 patients with infected surgical wounds and was absent in those 9 patients with non-infected surgical wounds. The results of the authors' study show that In-111-WBCs do not accumulate in non-infected surgical incisions. This confirms their previous findings in rats. The high specificity of In-111 leukocytes imaging makes it a valuable study in the evaluation of post-operative patients with suspected surgical wound infections. In-111 WBCs scintigraphy can distinguish between normal healing and infection at the site of recent (3-14 days) surgical incisions

  6. Disposable skin staplers for closure of linear gastrointestinal incisions in dogs.

    Science.gov (United States)

    Schwartz, Zeev; Coolman, Bradley R

    2018-02-01

    To report the clinical features and outcomes of linear gastrointestinal incisions closed with skin staples in dogs. Historical cohort study. 333 client-owned dogs. Medical records from 1 private referral hospital were searched for dogs that underwent gastrointestinal surgery between November 1999 and October 2015. Cases were included if skin staplers were used to close linear gastrointestinal incisions. Information regarding preoperative, surgical, and postoperative factors was collected. Complications were diagnosed in 8 of 245 (3.27%) dogs, including 3 of 245 (1.22%) dogs that died or were euthanized, 3 of 245 (1.22%) dogs with incisional dehiscence, and 2 of 245 (0.81%) dogs with attachment of a linear foreign body to the staples at the intestinal lumen. Dehiscence was noted at the enterotomy sites in 3 dogs at a mean time of 44 hours after surgery (SD ± 6.93). Two dogs presented with another linear foreign body that was attached to the staples in the intestinal lumen at postoperative days 24 and 42. The risk factors associated with incisional dehiscence included multiple gastrointestinal incisions performed in 1 surgery (χ 2 , P indication for surgical intervention, surgery location in the gastrointestinal tract, or surgeon experience and incisional dehiscence. Skin staplers provide safe and effective closure of gastrotomies, enterotomies, and colonotomies in dogs. This method is reliable, efficient, and affordable in the hands of veterinary surgeons with varying skill levels. © 2017 The American College of Veterinary Surgeons.

  7. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

    Science.gov (United States)

    Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy

    2015-01-01

    The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  8. Cervical and incisal marginal discrepancy in ceramic laminate veneering materials: A SEM analysis

    Directory of Open Access Journals (Sweden)

    Hemalatha Ranganathan

    2017-01-01

    Full Text Available Context: Marginal discrepancy influenced by the choice of processing material used for the ceramic laminate veneers needs to be explored further for better clinical application. Aims: This study aimed to evaluate the amount of cervical and incisal marginal discrepancy associated with different ceramic laminate veneering materials. Settings and Design: This was an experimental, single-blinded, in vitro trial. Subjects and Methods: Ten central incisors were prepared for laminate veneers with 2 mm uniform reduction and heavy chamfer finish line. Ceramic laminate veneers fabricated over the prepared teeth using four different processing materials were categorized into four groups as Group I - aluminous porcelain veneers, Group II - lithium disilicate ceramic veneers, Group III - lithium disilicate-leucite-based veneers, Group IV - zirconia-based ceramic veneers. The cervical and incisal marginal discrepancy was measured using a scanning electron microscope. Statistical Analysis Used: ANOVA and post hoc Tukey honest significant difference (HSD tests were used for statistical analysis. Results: The cervical and incisal marginal discrepancy for four groups was Group I - 114.6 ± 4.3 μm, 132.5 ± 6.5 μm, Group II - 86.1 ± 6.3 μm, 105.4 ± 5.3 μm, Group III - 71.4 ± 4.4 μm, 91.3 ± 4.7 μm, and Group IV - 123.1 ± 4.1 μm, 142.0 ± 5.4 μm. ANOVA and post hoc Tukey HSD tests observed a statistically significant difference between the four test specimens with regard to cervical marginal discrepancy. The cervical and incisal marginal discrepancy scored F = 243.408, P < 0.001 and F = 180.844, P < 0.001, respectively. Conclusion: This study concluded veneers fabricated using leucite reinforced lithium disilicate exhibited the least marginal discrepancy followed by lithium disilicate ceramic, aluminous porcelain, and zirconia-based ceramics. The marginal discrepancy was more in the incisal region than in the cervical region in all the groups.

  9. Incision and Landsliding Lead to Coupled Increase in Sediment Flux and Grain Size Export

    Science.gov (United States)

    Roda-Boluda, D. C.; Brooke, S.; D'Arcy, M. K.; Whittaker, A. C.; Armitage, J. J.

    2017-12-01

    The rates and grain sizes of sediment fluxes modulate the dynamics and timing of landscape response to tectonics, and dictate the depositional patterns of sediment in basins. Over the last decades, we have gained a good quantitative understanding on how sediment flux and grain size may affect incision and basin stratigraphy. However, we comparably still have limited knowledge on how these variables change with varying tectonic rates. To address this question, we have studied 152 catchments along 8 normal fault-bounded ranges in southern Italy, which are affected by varying fault slip rates and experiencing a transient response to tectonics. Using a data set of 38 new and published 10Be erosion rates, we calibrate a sediment flux predictive equation (BQART), in order to estimate catchment sediment fluxes. We demonstrate that long-term sediment flux is governed by fault slip rates and the tectonically-controlled transient incision, and that sediment flux estimates from the BQART, steady-state assumptions, and incised volumes are highly correlated. This is supported by our 10Be erosion rates, which are controlled by fault slip and incision rates, and the associated landsliding. Based on a new landslide inventory, we show that erosion rate differences are likely due to differences in incision-related landslide activity across these catchments, and that landslides are a major component of sediment fluxes. From a data set of >13000 grain size counts on hillslope grain size supply and fluvial sediment at catchment outlets, we observe that landslides deliver material 20-200% coarser than other sediment sources, and that this coarse supply has an impact on the grain size distributions being exported from the catchments. Combining our sediment flux and grain size data sets, we are able to show that for our catchments, and potentially also for any areas that respond to changes in climate or tectonics via enhanced landsliding, sediment flux and grain size export increase

  10. High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study.

    Science.gov (United States)

    Walton, Robert B; Shnaekel, Kelsey L; Ounpraseuth, Songthip T; Napolitano, Peter G; Magann, Everett F

    2017-11-01

    Women having cesarean section have a high risk of wound complications. Our objective was to determine whether high transverse skin incisions are associated with a reduced risk of cesarean wound complications in women with BMI greater than 40. A retrospective cohort study was undertaken of parturients ages 18-45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Temporally matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence, or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included rates of endometritis, number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Analysis of outcomes was performed using two-sample t-test or Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. Thirty-two women had high transverse incisions and were temporally matched with 96 controls (low transverse incisions). The mean BMI was 49 for both groups. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (15.63% versus 27.08%, p = .2379). Those having high transverse skin incisions had lower five minute median Apgar scores (8.0 versus 9.0, p = .0021), but no difference in umbilical artery pH values. The high transverse group also had increased NICU admissions (28.13% versus 5.21%, p = .0011), and early gestational age at delivery (36.8 versus 38.0, p = .0272). High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.

  11. Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography

    International Nuclear Information System (INIS)

    Asaumi, Rieko; Kawai, Taisuke; Sato, Iwao; Yoshida, Shunji; Yosue, Takashi

    2010-01-01

    The shape of the anterior region of the maxilla is critical when planning implant treatment. The purpose of the present study was to assess the typical morphology of the incisive canal and surrounding bone. In total, 70 maxillae of Japanese dry skulls were used after being divided into dentate and edentulous groups. Cone-beam computed tomography (CBCT) images of the maxilla were acquired by using standardized methods. Using the anterior nasal spine as a reference point, the change in position was measured and analyzed statistically. Also, three-dimensional (3-D) images of the incisive canal were classified into five subsets: cylinder, groove, penetration, bifurcation at the superior portion, and bifurcation at the inferior portion. The quantity of alveolar bone in the incisor region was greatly reduced from the alveolar ridge and labial surface. Moreover, the vertical position of the incisive foramen was significantly (P<0.05) superior in the edentulous groups. Regarding the classification of maxillae by the 3-D shape of the incisive canal, many canals were cylindrical. Horizontal bone reduction from the labial side and vertical bone reduction from the alveolar crest were conspicuous; thus, the angle of the anterior alveolar bone changed after the loss of teeth. The incisive canal diameter in the edentulous group was larger than in the dentate group. The nondestructive assessment of the incisive canals and surrounding bone with CBCT showed two typical shapes for the presence or absence of the incisors. These findings indicate the importance of image diagnosis before esthetic restoration. (author)

  12. [EFFECTIVENESS OF ADVANCED SKIN FLAP AND V-SHAPED VENTRAL INCISION ALONG THE ROOT OF PENILE SHAFT FOR CONCEALED PENIS].

    Science.gov (United States)

    Lin, Junshan; Li, Dumiao; Zhang, Jianxing; Wu, Qiang; Xu, Yali; Lin, Li

    2015-09-01

    To investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children. Between July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft. The operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision. A combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.

  13. Stratigraphic architecture of back-filled incised-valley systems: Pennsylvanian-Permian lower Cutler beds, Utah, USA

    Science.gov (United States)

    Wakefield, Oliver J. W.; Mountney, Nigel P.

    2013-12-01

    The Pennsylvanian to Permian lower Cutler beds collectively form the lowermost stratigraphic unit of the Cutler Group in the Paradox Basin, southeast Utah. The lower Cutler beds represent a tripartite succession comprising lithofacies assemblages of aeolian, fluvial and shallow-marine origin, in near equal proportion. The succession results from a series of transgressive-regressive cycles, driven by repeated episodes of climatic variation and linked changes in relative sea-level. Relative sea-level changes created a number of incised-valleys, each forming through fluvial incision during lowered base-level. Aeolian dominance during periods of relative sea-level lowstand aids incised-valley identification as the erosive bounding surface juxtaposes incised-valley infill against stacked aeolian faces. Relative sea-level rises resulted in back-flooding of the incised-valleys and their infill via shallow-marine and estuarine processes. Back-flooded valleys generated marine embayments within which additional local accommodation was exploited. Back-filling is characterised by a distinctive suite of lithofacies arranged into a lowermost, basal fill of fluvial channel and floodplain architectural elements, passing upwards into barform elements with indicators of tidal influence, including inclined heterolithic strata and reactivation surfaces. The incised-valley fills are capped by laterally extensive and continuous marine limestone elements that record the drowning of the valleys and, ultimately, flooding and accumulation across surrounding interfluves (transgressive surface). Limestone elements are characterised by an open-marine fauna and represent the preserved expression of maximum transgression.

  14. Quantification of incisal tooth wear in upper anterior teeth: conventional vs new method using toolmakers microscope and a three-dimensional measuring technique.

    Science.gov (United States)

    Al-Omiri, Mahmoud K; Sghaireen, Mohd G; Alzarea, Bader K; Lynch, Edward

    2013-12-01

    This study aimed to quantify tooth wear in upper anterior teeth using a new CAD-CAM Laser scanning machine, tool maker microscope and conventional tooth wear index. Fifty participants (25 males and 25 females, mean age = 25 ± 4 years) were assessed for incisal tooth wear of upper anterior teeth using Smith and Knight clinical tooth wear index (TWI) on two occasions, the study baseline and 1 year later. Stone dies for each tooth were prepared and scanned using the CAD-CAM Laser Cercon System. Scanned images were printed and examined under a toolmaker microscope to quantify tooth wear and then the dies were directly assessed under the microscope to measure tooth wear. The Wilcoxon Signed Ranks Test was used to analyze the data. TWI scores for incisal edges were 0-3 and were similar at both occasions. Score 4 was not detected. Wear values measured by directly assessing the dies under the toolmaker microscope (range = 113 - 150 μm, mean = 130 ± 20 μm) were significantly more than those measured from Cercon Digital Machine images (range=52-80 μm, mean = 68 ± 23 μm) and both showed significant differences between the two occasions. Wear progression in upper anterior teeth was effectively detected by directly measuring the dies or the images of dies under toolmaker microscope. Measuring the dies of worn dentition directly under tool maker microscope enabled detection of wear progression more accurately than measuring die images obtained with Cercon Digital Machine. Conventional method was the least sensitive for tooth wear quantification and was unable to identify wear progression in most cases. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Water table and overbank flow frequency changes due to suburbanization-induced channel incision, Virginia Coastal Plain, USA

    Science.gov (United States)

    Hancock, G.; Mattell, N.; Christianson, E.; Wacksman, J.

    2004-12-01

    Channel incision is a widely observed response to increased flow in urbanized watersheds, but the effects of channel lowering on riparian water tables is not well documented. In a rapidly incising suburban stream in the Virginia Coastal Plain, we hypothesize that incision has lowered floodplain water tables and decreased the overbank flow frequency, and suggest these changes impact vegetation distribution in a diverse, protected riparian habitat. The monitored stream is a tributary to the James River draining 1.3 km2, of which 15% is impervious cover. Incision has occurred largely through upstream migration of a one m high knickpoint at a rate of 1-2 m/yr, primarily during high flow events. We installed 33 wells in six floodplain transects to assess water table elevations beneath the floodplain adjacent to the incising stream. To document the impacts of incision, two transects are located 30 and 50 m upstream of the knickpoint in unincised floodplain, and the remainder are 5, 30, 70, and 100 m downstream of the knickpoint in incised floodplain. In one transect above and two below, pressure transducers attached to dataloggers provide a high-resolution record of water table response to storm events. Significant differences have been observed in the water table above and below the knickpoint. Above the knickpoint, the water table is relatively flat and is 0.2-0.4 m below the floodplain surface. Water table response to precipitation events is nearly immediate, with the water table rising to the floodplain surface in significant rainfall events. In the transect immediately downstream of the knickpoint, the water table possesses a steep gradient, rising from ~1 m below the floodplain at the stream to 0.3 m below the surface within 20 m. In the most downstream transects, the water table is relatively flat, but is one m below the floodplain surface, equivalent to the depth of incision generated by knickpoint passage. Upstream of the knickpoint, overbank flooding occurs

  16. Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy

    Directory of Open Access Journals (Sweden)

    Alberto Santoro

    2014-01-01

    Full Text Available Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy.

  17. [Antero-medial incision of knee joint for the treatment of intercondylar fracture of femur].

    Science.gov (United States)

    Yin, Zi-Fei; Sun, Bin-Feng; Yang, Xiao-Hai; Wang, Qing; Qian, Ping-Kang; Wu, Xiao-Feng; Xu, Feng

    2017-12-25

    To explore the clinical effect of antero-medial incision of knee joint in treating intercondylar fracture of femur. From September 2012 to March 2015, 24 patients with intercondylar fracture of femur were selected, including 17 males and 7 females, aged from 20 to 65 years old with an average of(38.3±9.5) years old. Among them, 12 cases were caused by traffic accident, 8 cases were caused by falling injury and 4 cases were caused by falling down. All patients were closed fractures. The time from injury to hospital was from 30 min to 8 h with an average of(2.2±0.3) h. According to AO classification, 4 cases were type B1, 3 type B2, 2 type B3, 5 type C1, 6 type C2 and 4 type C3. All patients were treated with antero-medial incision of knee joint. Operative time, blood loss and postoperative complications were observed and recovery of keen function was evaluated by Kolmert scoring. All patients were followed-up from 6 to 12 months with average of (9.0±1.7) months. Operative time ranged from 50 to 90 min with an average of (70.0±8.2) min; blood loss ranged from 90 to 400 ml with an average of (180±36) ml; negative pressure flow was from 30 to 90 ml, with an average of (50.0±7.1) ml. All fracture were healed at stage I without loosening of internal fixator, fracture nonunion, and deep vein thrombosis. According to Kolmert scoring, 16 patients got excellent result, 5 patients good and 3 fair. Antero-medial incision of knee joint in treating intercondylar fracture of femur, which has advantages of good fracture reduction, less injury of soft tissue and simple operation, could obtain good clinical results.

  18. Incisal tooth wear and self-reported TMD pain in children and adolescents.

    Science.gov (United States)

    Hirsch, Christian; John, Mike T; Lobbezoo, Frank; Setz, Juergen M; Schaller, Hans-Guenter

    2004-01-01

    Incisal tooth wear may be a sign of long-term bruxing behavior. Bruxism is purported to be a risk factor for temporomandibular disorders (TMD). The aim of this population-based cross-sectional study was to determine if anterior tooth wear is associated with the self-report of TMD pain in children and adolescents. In a population sample of 1,011 children and adolescents (mean age 13.1 years, range 10 to 18 years; female 52%; response rate 85%), TMD cases were defined as subjects reporting pain in the face, jaw muscles, and temporomandibular joint during the last month according to RDC/TMD. All other subjects were considered controls. Incisal tooth wear was assessed in the clinical examination using a 0 to 2 scale (no wear, enamel wear, dentin wear) for every anterior permanent tooth. The mean wear score for the individuals was categorized into 0, 0.01 to 0.20, 0.21 to 0.40, and 0.41+. A multiple logistic regression analysis, controlling for the effects of age and gender, analyzed the association between the categorized summary wear score and TMD. Specifically, the hypothesis of a trend between higher tooth wear scores and higher risk of TMD was tested. An odds ratio of 1.1 indicated, after adjusting for gender and age, no statistically significantly higher risk of TMD pain with higher tooth wear scores. Incisal tooth wear was not associated with self-reported TMD pain in 10- to 18-year-old subjects.

  19. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

    Directory of Open Access Journals (Sweden)

    Praveenraj Palanivelu

    2015-01-01

    Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  20. Strong feedbacks between hillslope sediment production and channel incision by saltation-abrasion

    Science.gov (United States)

    Lundbek Egholm, David; Faurschou Knudsen, Mads; Sandiford, Mike

    2013-04-01

    While it is well understood that rivers erode mountain ranges by incising the bedrock and by transporting sediments away from the ranges, the basic physical mechanisms that drive long-term bedrock erosion and control the lifespan of mountain ranges remain uncertain. A particularly challenging paradox is reconciling the dichotomy associated with the high incision rates observed in active mountain belts, and the long-term (108 years) preservation of significant topographic reliefs in inactive orogenic belts (e.g. von Blankenburg, 2005). We have performed three-dimensional computational experiments with a landscape evolution model that couples bedrock landslides and sediment flux-dependent river erosion by saltation-abrasion (Sklar & Dietrich, 2004). The coupled model experiments show strong feedbacks between the channel erosion and the hillslope delivery of sediments. The feedbacks point to hillslope sediment production rate as the main control on channel erosion rates where saltation-abrasion dominates over other fluvial erosion processes. Our models results thus highlight the importance of hillslope sediment production controlled by climate and tectonic activity for scaling erosion rates in fluvial systems. Because of variations in landslide frequency, the feedbacks make tectonic activity a primary driver of fluvial erosion and help clarifying the long-standing paradox associated with the persistence of significant relief in old orogenic belts, up to several hundred-million-years after tectonic activity has effectively ceased. References F. von Blankenburg. The control mechanisms of erosion and weathering at basin scale from cosmogenic nuclides in river sediment. Earth Planet. Sci. Lett. 237, 462-479 (2005). L. S. Sklar, W. E. Dietrich. A mechanistic model for river incision into bedrock by saltating bed load. Water Resour. Res. 40, W06301 (2004).

  1. Excision of thymine dimers from specifically incised DNA by extracts of xeroderma pigmentosum cells

    Energy Technology Data Exchange (ETDEWEB)

    Cook, K; Friedberg, E C; Slor, H; Cleaver, J E

    1975-07-17

    DNA repair defects as exhibited in fibroblasts from patients with xeroderma pigmentosa were studied. Five complementation groups for excision-repair defects were examined to test the hypothesis that a defective endonuclease or exonuclease may be the cause. No evidence was found to indicate that the enzyme activity functions in dimer excision. Since ultraviolet irradiated E. coli DNA incised with an endonuclease purified from phage-infected cells were used, it is possible that other factors may be involved in human UV endonuclease action. (JWP)

  2. En bloc resection of huge cemento-ossifying fibroma of mandible: avoiding lower lip split incision.

    Science.gov (United States)

    Ayub, Tahera; Katpar, Shahjahan; Shafique, Salman; Mirza, Talat

    2011-05-01

    Cemento-ossifying Fibroma (COF) is an osteogenic benign neoplasm affecting the jaws and other craniofacial bones. It commonly presents as a progressively slow growing pathology, which can sometimes attain an enormous size, causing facial deformity. A case of a huge cemento-ossifying fibroma, appearing as a mandibular dumbell tumour in a male patient is documented, which caused massive bone destruction and deformity. It was surgically removed by performing en bloc resection of mandible avoiding the splitting of lower lip incision technique, thereby maintaining his normal facial appearance.

  3. Quantifying incision rates since the early Miocene: novelties, potentialities and limitations

    Science.gov (United States)

    Sartégou, A.; Braucher, R.; Blard, P. H.; Bourlès, D. L.; Zimmermann, L.; Tibari, B.; Voinchet, P.; Bahain, J. J.; Sorriaux, P.; Leanni, L.; Team, A.

    2017-12-01

    The rates and chronologies of valley incision are closely modulated by the tectonic uplift of active mountain ranges and were controlled by repeated climate changes during the Quaternary. The Pyrenees are a continental collision between the Iberian and Eurasian plates induced a double vergence orogen, which has been considered as a mature mountain range in spite of significant seismicity and evidence of neotectonics. Nevertheless, recent studies indicate that the range may have never reached a steady state. One option for resolving this controversy is to quantify the incision rates since the Miocene by reconstructing the vertical movement of geometric markers. However, the few available ages from the Pyrenean terrace systems do not exceed the middle Pleistocene. To enlarge the time span of this dataset, we studied alluvium-filled horizontal epiphreatic passages in limestone karstic networks, which represent former valley floors. They record the transient position of former local base levels during the process of valley deepening. We used various suitable geochronological methods (26Al/10Be, 10Be/21Ne, ESR and OSL burial durations on quartz) on intrakarstic alluvial deposits from three valleys of the central and eastern Pyrenees, as well as on a recent analogue. In the Pyrenean context, under particular conditions, these geochronometers allow us to document incision processes since 16-13 Ma, and to study influences of external forcing and eustatism. In comparison with other studies, it appears that incision rates are higher in the central Pyrenees and for the Spanish slope. However, the density of horizontal levels on an altimetric range, the geodynamical and paleoclimatic contexts, the reorganization of the drainage networks can make the filling stories of the networks more complex than expected. Indeed, these radiometric approaches may be limited when some formations are reworked inside and/or outside the karst. The validity of dosimetric methods in a mountainous

  4. Meta-analysis of negative-pressure wound therapy for closed surgical incisions

    DEFF Research Database (Denmark)

    Hyldig, N; Birke-Sorensen, H; Kruse, M

    2016-01-01

    . RESULTS: Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care....... The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence. CONCLUSION: Compared...

  5. Anatomic study on mental canal and incisive nerve canal in interforaminal region in Chinese population.

    Science.gov (United States)

    Xu, Yun; Suo, Ning; Tian, Xiufen; Li, Fei; Zhong, Guangxin; Liu, Xiaoran; Bao, Yongxing; Song, Tao; Tian, Hua

    2015-08-01

    This study was aimed to detect the positions of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region in Chinese population to supply the reference data of the surgical safe zone in chin for clinicians. A total of 80 formalin-fixed semi-mandibles of Chinese adult cadavers were dissected, the positions and courses of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region were measured. The mental foramina were present in all cases (100 %), and most of them were located below 2nd premolar (58.75 %). Accessory mental foramina were observed in 5 %. The anterior end of mandibular canal, extending along the course of 7.37 ± 1.10 mm above the lower border of mandible to interforaminal region about 3.54 ± 0.70 mm medial to the mental foramen, most often ended below between the two premolars (73.75 %), where it continued as the incisive nerve canal (100 %) and the mental canal (96.25 %). Mental canal, with the wall formed by compact bone, being 2.60 ± 0.60 mm in diameter and 4.01 ± 1.20 mm in length, opened into mental foramen. Incisive nerve canal, with the wall formed by thin compact bone and/or partly or completely by spongy bone, being 1.76 ± 0.27 mm in diameter and 24.87 ± 2.23 mm in length, extended to the incisor region along the course of 9.53 ± 1.43 mm above the lower border of mandible, and most often ended below the lateral incisor (70.00 %). This research recommended for chin operations in Chinese population: the surgical safe zone could be set in the region about over 4 mm anterior to the mental foramen, and over 12 mm above inferior border of mandible for anterior alveolar surgery, or within 9 mm above inferior border of mandible for genioplasty.

  6. Wound healing in porcine skin following low-output carbon dioxide laser irradiation of the incision

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, J.K.; Garden, J.M.; Taute, P.M.; Leibovich, S.J.; Lautenschlager, E.P.; Hartz, R.S.

    1987-06-01

    Wound healing of scalpel incisions to the depth of adipose tissue closed with conventional methods was compared with closure by low-output carbon dioxide laser irradiation. In 3 Pitman-Moore minipigs wound healing was evaluated at intervals from 1 to 90 days by the following methods: clinical variables of wound healing; formation of the basement membrane components bullous pemphigoid antigen, laminin, and fibronectin; and histological evaluation of the regeneration of the epidermis, neovascularization, and elastin and collagen formation. There was no significant difference in healing between wounds closed by the various conventional methods and by the low-output carbon dioxide laser.

  7. Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

    Directory of Open Access Journals (Sweden)

    Schelonka LP

    2015-07-01

    Full Text Available Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced salt solution (BSS to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis.Methods: This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 µg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration.Results: A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of postcataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000 in the baseline period to 1/44,863 (rate: 0.022/1,000 during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024. Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015. Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations.Conclusion: We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization

  8. Intra-parotid dermoid cyst: excision through a face lift incision.

    Science.gov (United States)

    Shakeel, M; Keh, S M; Chapman, A; Hussain, A

    2014-11-01

    Intra-parotid dermoid cysts are extremely rare. Clinically, they present like any other parotid lump and pre-operative diagnosis is rarely possible. A 62 years old Caucasian man presented with a painless lump in his right parotid region. The Magnetic Resonance Imaging (MRI) scan revealed a 3 x 3 cm mass in the parotid tail. Cytological examination was unhelpful. The patient underwent successful excision of the cyst through a small face lift incision. No drain was inserted and the patient was discharged home the same day. The patient made an uneventful recovery and was highly satisfied with the aesthetic outcome. The definite histopathological diagnosis was an intra-parotid dermoid cyst.

  9. Infra Patellar Branch of Saphenous Nerve Injury during Hamstring Graft Harvest: Vertical versus Oblique Incisions.

    Science.gov (United States)

    Joshi, A; Kayasth, N; Shrestha, S; Kc, B R

    2016-09-01

    Autologous hamstring grafts are commonly used for anterior cruciate ligament reconstruction. The injury of infrapatellar branch of saphenous nerve is one of the concerns leading to various pattern of sensory loss in the operated leg. An oblique incision to harvest the graft has been reported to be better than the vertical one.The aim of this study was to compare the incidence, recovery of nerve injury and final outcome in patients with hamstring harvest of vertical or oblique incision. A total of 146 patients who underwent hamstring graft harvest for anterior cruciate ligament reconstruction, were included in the study. They were randomized into two (Vertical and Oblique) groups as per the incisions used. The sensory loss along the Infra Patellar Branch of Saphenous Nerve was documented on 3rd day. Recovery of the nerve injury was monitoredat three, six and 12 months follow-ups. At final follow up Tegner Lysholm score and scale was recorded to compare between two groups. The incidence of infrapatellar branch of saphenous nerve injury was 25% in vertical group and 16.36% in oblique group. Recovery of nerve injury started earlier in oblique group compared to vertical group. The mean TegnerLyshom score was not significantly different in both the groups. Oblique incision to harvest hamstring graft has lesser incidence of infrapatellar branch of saphenous nerve injury, recovers earlier and does not have any adverse effect on final outcome compared to the vertical incision.

  10. A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method.

    Science.gov (United States)

    Lee, Hee Chang; Lee, Ji Yeoun; Ryu, Seul Ki; Lim, Jang Mi; Chong, Sangjoon; Phi, Ji Hoon; Kim, Seung-Ki; Wang, Kyu-Chang

    2016-12-01

    The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps. For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps. By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa. This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.

  11. Ultrasound guided aspiration of breast abscess as an alternative to surgical incision and drainage

    International Nuclear Information System (INIS)

    Naper, M.A.; Shaikh, M.S.; Dholia, K.R.

    2017-01-01

    To evaluate the outcome and assess the success rate of ultrasound guided aspiration of breast abscess as an alternative to surgical incision and drainage. Methodology: A prospective descriptive study was carried out at Department of Surgery, Chandka Medical College Hospital, Larkana, Pakistan, from January 2015 to December 2015. A total of 111 patients of breast abscess who underwent ultrasound guided aspiration without anesthesias with oral antibiotic cover were studied. Females with breast abscess within seven days, and the abscess size was <3cm were included in the study. Males, antibioma and inflammatory carcinoma were excluded from the study. Outcome of success or failure was observed within two weeks and recorded. Results: Out of 111 patients, 68.46% were lactating and 31.53% were non-lactating women, with ages ranging from 18 to 60 years (mean 36.5 years). The successful rate with complete resolution after ultrasound guided aspiration was observed in 94.5%. 80.82% responded after single aspiration, 12.38% after two times aspiration, and 6.66% after multiple aspirations, while 5.4% of patients required incision and drainage. Conclusion: Ultrasound guided aspiration of breast abscess is an effective treatment option with a diameter of <3cm, which can be recommended as a routine outpatient procedure. (author)

  12. "Meniscus Sign" to Identify the Lenticule Edge in Small-Incision Lenticule Extraction.

    Science.gov (United States)

    Titiyal, Jeewan S; Kaur, Manpreet; Brar, Anand S; Falera, Ruchita

    2018-06-01

    To describe our technique of lenticule edge identification in small-incision lenticule extraction using the "meniscus sign" to prevent lenticule misdissection. Femtosecond laser application for small-incision lenticule extraction was performed. A "double ring" was visible, signifying the edge of the cap cut (outer ring) and lenticule cut (inner ring). The anterior and posterior lamellar planes were delineated in 2 different directions. During creation of the posterior lamellar channel, the lenticule edge was slightly pushed away from the surgeon to create a gap between the inner ring (diameter of the lenticule cut) and the lenticule edge. The lenticule edge assumed a frilled wavy appearance, and the meniscus sign was observed as a gap between the lenticule edge and the inner ring. The meniscus-shaped gap served as a landmark to identify the lenticule edge, and the relationship between the frilled lenticule edge and surgical instruments further acted as a guide to identify the correct plane of dissection. This technique was successfully undertaken in 50 eyes of 25 patients. The meniscus sign was observed in all cases, and no case had cap lenticular adhesions. The meniscus sign helps to identify the lenticule edge and correct dissection planes and provides a visual landmark during the entire surgical procedure.

  13. Study of modified two incisions silicone oil removal with a 23G transconjunctival sutureless vitrectomy system

    Directory of Open Access Journals (Sweden)

    Hai-Jun Yang

    2015-01-01

    Full Text Available AIM:To evaluate the efficacy and safety of silicone oil removal with a 23G transconjunctival sutureless vitrectomy system linked disposable transfusion tube and self-made suction tip. METHODS: The suction tip was made with a 23G infusion tube be cut from the end of the 5mm. It was used to connect the disposable transfusion tube and 23G puncture cannula. The disposable transfusion tube which was cut from the end of the MaiFei's pipe was connected with the effusion box of the vitreous cutter. Intraocular silicone oil was proactive suction and removed through two incisions on pars plana ciliaris with the vitreous cutter suction system. RESULTS: Only 13 cases(9.8%need suture puncture ports in 132 cases in the operation. Operation time was 7-28min. The average operation time was 15.1± 6.2min. In early postoperative, there were 107 cases(81.1%appeared lower intraocular pressure(CONCLUSION: The surgery that silicone oil is removed through two incisions with a 23G transconjunctival sutureless vitrectomy system linked disposable transfusion tube and self-made suction tip has the advantages of safe, effective, fast, economic, and it is worthy of popularization and application in clinical.

  14. Femtosecond laser refractive surgery: small-incision lenticule extraction vs. femtosecond laser-assisted LASIK.

    Science.gov (United States)

    Lee, Jimmy K; Chuck, Roy S; Park, Choul Yong

    2015-07-01

    Small-incision lenticule extraction (SMILE) is a novel technique devised to correct refractive errors. SMILE circumvents excimer laser photoablation of cornea, as the stromal lenticule cut by femtosecond laser is removed manually. Smaller incisions and preservation of anterior corneal biomechanical strength have been suggested as some of the advantages of SMILE over femtosecond laser-assisted LASIK (FS-LASIK). In this review, we compared previous published results of SMILE and FS-LASIK. The advantage, efficacy and safety of SMILE are compared with FS-LASIK. SMILE achieved similar efficacy, predictability and safety as FS-LASIK. Greater preservations of corneal biomechanical strength and corneal nerves were observed in SMILE when compared with LASIK or PRK. Additionally, the incidence of postoperative dry eye syndrome was found to be less problematic in SMILE than in FS-LASIK. SMILE is a promising new surgery for refractive error correction. Prospective and retrospective studies of SMILE have shown that results of SMILE are similar to FS-LASIK. With advances in femtosecond laser technology, SMILE may gain greater acceptance in the future.

  15. [Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

    Science.gov (United States)

    Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

    2015-01-01

    Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. [Relationship between FoxO1 Expression and Wound Age during Skin Incised Wound Healing].

    Science.gov (United States)

    Chen, Y; Ji, X Y; Fan, Y Y; Yu, L S

    2018-02-01

    To investigate FoxO1 expression and its time-dependent changes during the skin incised wound healing. After the establishment of the skin incised wound model in mice, the FoxO1 expression of skin in different time periods was detected by immunohistochemistry and Western blotting. Immunohistochemistry staining showed that FoxO1 was weakly expressed in a few fibroblasts of epidermis, hair follicles, sebaceous glands, vessel endothelium and dermis in the control group. The FoxO1 expression was enhanced in the epidermis and skin appendages around the wound during 6-12 h after injury, which could be detected in the infiltrating neutrophils and a small number of monocytes. FoxO1 was mainly expressed in monocytes during 1-3 d after injury, and in neovascular endothelial cells and fibroblasts during 5-10 d. On the 14th day after injury, the FoxO1 expression still could be detected in a few fibroblasts. The Western blotting results showed that the FoxO1 expression quantity of the tissue samples in injury group was higher than in control group. The FoxO1 expression peaked at 12 h and 7 d after injury. FoxO1 is time-dependently expressed in skin wound healing, which can be a useful marker for wound age determination. Copyright© by the Editorial Department of Journal of Forensic Medicine.

  17. Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy.

    Science.gov (United States)

    Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew

    2013-01-01

    Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.

  18. Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

    Science.gov (United States)

    Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

    2013-01-01

    Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

  19. Lateral suboccipital retrosigmoid approach with tentorial incision for petroclival meningiomas: technical note.

    Science.gov (United States)

    Yamahata, Hitoshi; Tokimura, Hiroshi; Hirahara, Kazuho; Ishii, Takeshi; Mori, Masanao; Hanaya, Ryosuke; Arita, Kazunori

    2014-08-01

    Introduction The resection of petroclival meningiomas presents great neurosurgical challenges. Although multiple surgical approaches have been developed, the retrosigmoid route tends to be used to address tumors that are predominantly located in the posterior fossa. Our modification of the lateral suboccipital retrosigmoid approach with the placement of a tentorial incision yields good visualization of the supratentorial part of the tumor around the midbrain. Methods We treated four patients, one with primary and three with recurrent petroclival meningioma, by our modified approach. After lateral suboccipital craniotomy, the infratentorial part of the tumor was removed after detaching it from the tentorial surface. The cerebellar tentorium was then carefully incised from the supracerebellar angle, taking care not to damage the superior cerebellar artery and trochlear nerve. Results The operative field surrounding the midbrain was widened by this procedure, and safe dissection of the tumor from the brainstem and other neurovascular structures was performed with direct observation of the interface. Conclusions Our approach is a useful modification of the retrosigmoid approach to petroclival meningiomas. It facilitates the safe resection of the supratentorial part of the tumor in the ambient cistern behind the tentorium.

  20. Treatment of bilateral mammary ptosis and pectus excavatum through the same incision in one surgical stage

    Directory of Open Access Journals (Sweden)

    Fernando Passos Rocha

    Full Text Available CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.

  1. Ultrasound-guided axillary nerve block for ED incision and drainage of deltoid abscess.

    Science.gov (United States)

    Lyons, Claire; Herring, Andrew A

    2017-07-01

    Deltoid abscesses are common and painful, often a consequence of injection drug use and seen frequently in emergency departments (EDs). The required incision and drainage can be completed successfully with effective pain relief using a peripheral nerve block. The brachial plexus nerve block works well, however it is technically complex with a low, but potentially serious, risk of complications such as phrenic nerve paralysis. Selective blockade of the axillary nerve eliminates the risks associated with a brachial plexus block, while providing more specific anesthesia for the deltoid region. Our initial experience suggests that the axillary nerve block (ANB) is a technically simple, safe, and effective way to manage the pain of deltoid abscesses and the necessary incision and drainage (I&D). The block involves using ultrasound guidance to inject a 20mL bolus of local anesthetic into the quadrangular space surrounding the axillary nerve (inferior to the posterolateral aspect of the acromion, near the overlap of the long head of triceps brachii and teres minor). Once injected the local will anesthetize the axillary nerve resulting in analgesia of the cutaneous area of the lateral shoulder and the deeper tissues including the deltoid muscle. Further research will clarify questions about the volume and concentration of local anesthetic, the role of injected adjuncts, and expected duration of analgesia and anesthesia. Herein we present a description of an axillary nerve block successfully used for deltoid abscess I&D in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Behaviour of UV-sensitive mutants of Proteus mirabilis to repair incision breaks

    International Nuclear Information System (INIS)

    Stoerl, K.; Mund, C.

    1977-01-01

    In U.V.-sensitive mutants of P. mirabilis with the phenotype HCR, REC and EXR single-strand breaks appeared immediately after UV-irradiation. The behaviour of REC- and EXR-mutants was similar to the wildtype. The number of incision breaks observed by sedimentation analysis in these strains was very low. They could be joined during the excision repair process. From the ability of REC- and EXR-strains to rejoin most of the induced single-strand breaks it can be concluded that these strains have approximately the same capacity for excision repair as the wildtype. HCR-mutants of P. mirabilis produced single-strand breaks after UV-irradiation in contrast to HCR-mutants of E. coli. Therefore we suggest that HCR-mutants of P. mirabilis are not completely inhibited in the incision step. The single-strand breaks introduced in the DNA at the beginning of the repair process were not rejoined during further incubation. Experiments with toluenized cells led to the same results. The newly synthesized daughter DNA-strands of UV-irradiated HCR-mutants were of low molecular weight in comparison with those from unirradiated control cells during the repair period. This result is in agreement with the incapability of HCR-mutants to remove the pyrimidine dimers from the parental template strand. (author)

  3. Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy

    Science.gov (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

    2014-01-01

    In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331

  4. Correlation between the distance of maxillary central incisors and incisive papilla in different arch form

    Directory of Open Access Journals (Sweden)

    Nur Ateyya Natasha Mohd Zali

    2018-01-01

    Full Text Available In edentulous treatment, relocation of anterior teeth in the preexisting natural position is the utmost importance. It is necessary to refer to the significant anatomical landmarks, one of them is incisive papilla. To make it more efficient both functionally and biologically, the teeth were arranged in particular geometric manner known as a dental arch. The author has chosen to conducted the research among the Malay race represented by the Malay undergraduate students. The purpose of this study was to evaluate the correlation between the distance of maxillary central incisors and incisive papilla (CI-IP in different arch form and gender. Maxillary impressions of 34 dentate individuals were taken, and the measurements were performed using a digital caliper. The results showed the CI-IP distance was ranging between 7.65 to 9.90 mm, with the average of 8.77 mm. There was no significant difference of the CI-IP distance between male and female regardless of their arch forms (p>0.05. Individuals with ovoid and tapered arch form, however, showed a significant difference of the CI-IP distance between male and female (p0.05. It can be concluded that gender factor was irrelevant towards the CI-IP distance regardless of the individual arch form. However, there was a correlation between the CI-IP distance in different arch forms in both male and female sample.

  5. Results of computer assisted mini-incision subvastus approach for total knee arthroplasty.

    Science.gov (United States)

    Turajane, Thana; Larbpaiboonpong, Viroj; Kongtharvonskul, Jatupon; Maungsiri, Samart

    2009-12-01

    Mini-incision subvastus approach is soft tissue preservation of the knee. Advantages of the mini-incision subvastus approach included reduced blood loss, reduced pain, self rehabilitation and faster recovery. However, the improved visualization, component alignment, and more blood preservation have been debatable to achieve the better outcome and preventing early failure of the Total Knee Arthroplasty (TKA). The computer navigation has been introduced to improve alignment and blood loss. The purpose of this study was to evaluate the short term outcomes of the combination of computer assisted mini-incision subvastus approach for Total Knee Arthroplasty (CMS-TKA). A prospective case series of the initial 80 patients who underwent computer assisted mini-incision subvastus approach for CMS-TKA from January 2007 to October 2008 was carried out. The patients' conditions were classified into 2 groups, the simple OA knee (varus deformity was less than 15 degree, BMI was less than 20%, no associated deformities) and the complex deformity (varus deformity was more than 15 degrees, BMI more was than 20%, associated with flexion contractor). There were 59 patients in group 1 and 21 patients in group 2. Of the 80 knees, 38 were on the left and 42 on the right. The results of CMS-TKA [the mean (range)] in group 1: group 2 were respectively shown as the incision length [10.88 (8-13): 11.92 (10-14], the operation time [118 (111.88-125.12): 131 (119.29-143.71) minutes, lateral releases (0 in both groups), postoperative range of motion in flexion [94.5 (90-100): 95.25 (90-105) degree] and extension [1.75 (0-5): 1.5 (0-5) degree] Blood loss in 24 hours [489.09 (414.7-563.48): 520 (503.46-636.54) ml] and blood transfusion [1 (0-1) unit? in both groups], Tibiofemoral angle preoperative [Varus = 4 (varus 0-10): Varus = 17.14 (varus 15.7-18.5) degree, Tibiofemoral angle postoperative [Valgus = 1.38 (Valgus 0-4): Valgus = 2.85 (valgus 2.1-3.5) degree], Tibiofemoral angle outlier (85% both

  6. Comparison of first-intention healing of carbon dioxide laser, 4.0-MHz radiosurgery, and scalpel incisions in ball pythons (Python regius).

    Science.gov (United States)

    Hodshon, Rebecca T; Sura, Patricia A; Schumacher, Juergen P; Odoi, Agricola; Steeil, James C; Newkirk, Kim M

    2013-03-01

    To evaluate first-intention healing of CO(2) laser, 4.0-MHz radiowave radiosurgery (RWRS), and scalpel incisions in ball pythons (Python regius). 6 healthy adult ball pythons. A skin biopsy sample was collected, and 2-cm skin incisions (4/modality) were made in each snake under anesthesia and closed with surgical staples on day 0. Incision sites were grossly evaluated and scored daily. One skin biopsy sample per incision type per snake was obtained on days 2, 7, 14, and 30. Necrotic and fibroplastic tissue was measured in histologic sections; samples were assessed and scored for total inflammation, histologic response (based on the measurement of necrotic and fibroplastic tissues and total inflammation score), and other variables. Frequency distributions of gross and histologic variables associated with wound healing were calculated. Gross wound scores were significantly greater (indicating greater separation of wound edges) for laser incisions than for RWRS and scalpel incisions at all evaluated time points. Necrosis was significantly greater in laser and RWRS incisions than in scalpel incision sites on days 2 and 14 and days 2 and 7, respectively; fibroplasia was significantly greater in laser than in scalpel incision sites on day 30. Histologic response scores were significantly lower for scalpel than for other incision modalities on days 2, 14, and 30. In snakes, skin incisions made with a scalpel generally had less necrotic tissue than did CO(2) laser and RWRS incisions. Comparison of the 3 modalities on the basis of histologic response scores indicated that use of a scalpel was preferable, followed by RWRS and then laser.

  7. S-shaped versus conventional straight skin incision: Impact on primary functional maturation, stenosis and thrombosis of autogenous radiocephalic arteriovenous fistula: Impact of incision on maturation, stenosis & failure of RCAVF. Study design: Prospective observational comparative.

    Science.gov (United States)

    Kordzadeh, Ali; Panayiotopolous, Yiannis

    2017-10-01

    The objective of this study is to test the null hypothesis that an S-shaped surgical incision versus conventional (straight) skin incision in the creation of autogenous radiocephalic arteriovenous fistulas (RCAVFs) have no impact on the primary end-point of primary functional maturation and secondary end points of stenosis and thrombosis. A prospective observational comparative consecutive study with intention-to-treat on individuals undergoing only radiocephalic arteriovenous fistula (RCAVFs) over a period of 12 months was conducted. Variables on patient's demographics, comorbidities, anesthesia type, mean arterial blood pressure, thrill, laterality, cephalic vein and radial artery diameter were collated. The test of probability was assessed through Chi-Square, Kaplan-Meier survival estimator and Log-Rank analysis. Total of n = 83 individuals with median age of 67 years (IQR, 20-89) and male predominance 83% during this period were subjected to RCAVF formation. Total of n = 45 patients in straight skin incision were compared to n = 38 individuals in S-shaped group. Despite equal prevalence of demographics, comorbidities, anesthesia type, mean arterial blood pressure (MAP), thrill, laterality, cephalic vein and radial artery diameter ( p  > 0.05) higher incidence of juxta-anastomotic stenosis was noted in the straight skin incision group ( p  = 0.029) in comparative and survival analysis (Log-Rank, p  = 0.036). The maturation of the entire cohort was 69% (S-shaped 76% vs. straight group 62%) (p > 0.05). The outcome of this study demonstrates that S-shaped surgical skin incision is associated with a lower incidence of stenosis in comparison to straight incision type in RCAVF formation.

  8. Solo Single-Incision Laparoscopic Resectional Roux-en-Y Gastric Bypass for Morbid Obesity with Metabolic Syndrome.

    Science.gov (United States)

    Kang, So Hyun; Lee, Yoontaek; Park, Young Suk; Ahn, Sang-Hoon; Park, Do Joong; Kim, Hyung-Ho

    2017-12-01

    With the advancement of laparoscopic devices and surgical technology, the era of minimal invasive surgery has progressed to reduced-port surgery, and finally to single-incision laparoscopic surgery (SILS). Several reports show successful application of SILS to various types of bariatric surgery. Oftentimes, this requires a skilled and experienced scopist to perform the procedure. To overcome the technical difficulties of single-incision Roux-en-Y gastric bypass, a manual scope holder was used instead of an assistant scopist, greatly stabilizing the field of view. This allows the surgery to be performed at any time without being influenced by the need of a highly experienced scopist. In this report, we describe in detail the world's first solo single-incision laparoscopic resectional Roux-en-Y gastric bypass.

  9. [Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation].

    Science.gov (United States)

    Guan, Ting-Jin; Zheng, Liang-Guo; Sun, Peng; Li, Xing-Xue

    2014-05-01

    To explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation. From July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect. All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months. Preventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.

  10. In vivo architectural analysis of 3.2 mm clear corneal incisions for phacoemulsification using optical coherence tomography.

    Science.gov (United States)

    Torres, Luis F; Saez-Espinola, Fidelia; Colina, Juner M; Retchkiman, Myriam; Patel, Milan R; Agurto, Ricardo; Garcia, Gerardo; Diaz, Jose L; Huang, David; Schanzlin, David J; Chayet, Arturo S

    2006-11-01

    To analyze in vivo the architecture of clear corneal incisions (CCIs) for phacoemulsification using optical coherence tomography (OCT). Anterior Segment Department, Asociacion Para Evitar la Ceguera en Mexico, Hospital Dr Luis Sanchez Bulnes, Mexico. A prospective masked study analyzed 20 unsutured CCIs placed superiorly and created in a uniplanar fashion with a 3.2 mm slit-angled metal keratome. All wounds were evaluated with a retinal OCT model 1, 3, and 30 days postoperatively. Intraocular pressure (IOP) and incision leakage were checked. The architecture was described according to the angle of incidence, apposition of the epithelial and endothelial margins, and wound sealing. No leakage was detected. The angle varied from 33 to 85 degrees; angles greater than 75 degrees were done by a surgeon in training. Wound apposition at the epithelial margin was achieved in all cases. In contrast, imperfect apposition of the endothelial margin was seen in 45% of incisions on day 1 and in 15% on day 30. Incomplete sealing of the wound was seen by OCT in 25% of cases at 24 hours and persisted in 10% of all cases at 1 month. This gaping occurred on the endothelial side and never translated to the epithelial margin. No statistical correlation was found between gaping and the angle of the incision, IOP variations, or surgeon experience. Although in vivo CCIs caused minor anatomic imperfections, they were clinically stable independent of incision angle, IOP variation, and surgeon experience. Incision stability may be related to careful wound construction, epithelial viability, stromal edema, and efficient endothelial pumping.

  11. Local analgesic effect of tramadol is mediated by opioid receptors in late postoperative pain after plantar incision in rats.

    Science.gov (United States)

    de Oliveira Junior, José Oswaldo; de Freitas, Milena Fernandes; Bullara de Andrade, Carolina; Chacur, Marucia; Ashmawi, Hazem Adel

    2016-01-01

    Tramadol is a drug used to treat moderate to severe pain. It is known to present a peripheral effect, but the local mechanisms underlying its actions remain unclear. The role of peripheral opioid receptors in postoperative pain is not well understood. In the present study, we examined the peripheral opioid receptors to determine the local effect of tramadol in a plantar incision pain model. Rats were subjected to plantar incision and divided into four groups on postoperative day (POD) 1: SF_SF, 0.9% NaCl injected into the right hindpaw; SF_TraI, 0.9% NaCl and tramadol injected into the right hindpaw; SF_TraC, 0.9% NaCl and tramadol injected into the contralateral hindpaw; and Nal_Tra, naloxone and tramadol injected into the ipsilateral hindpaw. To determine the animals' nociceptive threshold, mechanical hyperalgesia was measured before incision, on POD1 before treatment and at 15, 30, 45, and 60 minutes after the incision. The same procedure was repeated on the POD2. The expression levels of μ-opioid receptor (MOR) and δ-opioid receptor (DOR) were obtained through immunoblotting assays in the lumbar dorsal root ganglia (L3-L6) in naïve rats and 1, 2, 3, and 7 days after the incision. Our results showed that the plantar incision was able to cause an increase in mechanical hyperalgesia and that tramadol reversed this hyperalgesia on POD1 and POD2. Tramadol injections in the contralateral paw did not affect the animals' nociceptive threshold. Naloxone was able to antagonize the tramadol effect partially on POD1 and completely on POD2. The DOR expression increased on POD2, POD3, and POD7, whereas the MOR expression did not change. Together, our results show that tramadol promoted a local analgesic effect in the postoperative pain model that was antagonized by naloxone in POD2, alongside the increase of DOR expression.

  12. Feasibility of Performing Total Skin-Sparing Mastectomy in Patients With Prior Circumareolar Mastopexy or Reduction Mammoplasty Incisions.

    Science.gov (United States)

    Vaughn, Carolyn J; Peled, Anne Warren; Esserman, Laura J; Foster, Robert D

    2013-06-19

    Total skin-sparing mastectomy (TSSM) techniques with preservation of the nipple-areolar complex (NAC) skin are becoming increasingly popular due to improved cosmesis without compromise in oncologic safety. However, these techniques are not routinely offered to patients who have undergone previous breast surgery involving circumareolar incisions due to concern for NAC viability. We reviewed the outcomes of TSSM in 11 patients who underwent 21 TSSM procedures at our institution between 2008 and 2011. All patients had undergone previous breast surgery including reduction mammaplasty (7 breasts), mastopexy (4 breasts), augmentation (3 breasts), and combined mastopexy-augmentation (7 breasts). Incisions from previous breast surgery included circumareolar (11 cases) and Wise pattern (10 cases) incisions. All patients underwent TSSM through an inframammary incision followed by immediate tissue expander reconstruction and subsequent implant exchange. Patient demographics, previous breast surgery details, tumor and treatment characteristics, and postoperative complications were reviewed. Mean patient age was 43 years (range, 35-53 years) and mean body mass index was 24 kg/m (range, 19-32 kg/m). Mean follow-up was 10.2 months (range, 3-20 months).Indications for TSSM included prophylactic risk reduction in 10 cases, in situ cancer in 2 cases, and invasive cancer in 9 cases. Mean time from previous breast surgery to mastectomy was 6.9 years (range, 6 months-26 years). Major complications requiring operative reintervention included 1 (4.8%) case of cellulitis requiring expander removal and 2 (9.5%) cases of wound breakdown requiring operative closure. There were no complications involving the NAC. Total skin-sparing mastectomy with immediate reconstruction can safely be performed in patients who have undergone previous breast surgery involving circumareolar incisions. Our preferred technique in this group of patients is to perform TSSM through an inframammary incision with 2

  13. Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

    Directory of Open Access Journals (Sweden)

    Sanoop K Zachariah

    2013-01-01

    Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

  14. Anterograde axonal transport and intercellular transfer of WGA-HRP in trigeminal-innervated sensory receptors of rat incisive papilla.

    Science.gov (United States)

    Chan, K Y; Byers, M R

    1985-04-08

    The ultrastructure and identification of WGA-HRP-labeled sensory receptors in the rat incisive papilla (the most anterior part of hard palate) were studied using semiserial thin sections. Various sensory receptors were organized according to three locations: dome region (ventral), chemosensory corpuscle region (medial to orifice of incisive canal), and lateral labium (apposing the incisive canal). In the dome region, the sensory receptors were localized in three sensory zones that were associated with surface ridges (one medial and two lateral). In each of these zones, intraepithelial receptor axons and Merkel receptors occurred in the epithelium, while simple unencapsulated corpuscles, glomerular-Meissner corpuscles, and incisive (encapsulated) corpuscles occurred in the lamina propria. In the chemosensory corpuscle region, chemosensory corpuscles and intraepithelial receptor axons were located in the epithelium, and incisive corpuscles were present in the lamina propria. In the lateral labium, only intraepithelial receptor axons were prominent. In all these sensory receptors, the preterminal axons and axon terminals were labeled with the tracer protein. In addition, some nonneuronal cells closely associated with the axon terminals were selectively labeled, e.g., terminal Schwann cells, lamellar Schwann cells, Merkel cells, corpuscular basal cells and chemosensory cells. Other adjacent cells were not labeled, e.g., unspecialized epithelial cells, capsular cells, corpuscular sustentacular cells, and fibroblasts. In both labeled axons and cells, WGA-HRP was incorporated into vesicles, tubules, and vacuolar organelles. The specific intercellular transfer of tracer protein may indicate trophic interactions between axon terminals and support cells in sensory receptors. The specific organization of multiple sensory receptors in the rat incisive papilla may provide a useful alternative system for studying somatosensory physiology.

  15. Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.

    LENUS (Irish Health Repository)

    Conroy, Eimear

    2010-07-01

    Femoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes\\' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes\\' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter\\'s osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter\\'s osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged

  16. Two kinds of manual chopping methods applied in small incision extracapsular cataract extraction

    Directory of Open Access Journals (Sweden)

    Xia Jiang

    2016-02-01

    Full Text Available AIM:To research clinical effect of two manual chopping methods for small incision extracapsular cataract extraction. METHODS: We observed 143 cases(184 eyeswith grade Ⅳ or higher taken the small incision cataract extraction and intraocular lens implantation. Patients were given randomly knifed chopping with closed hook(92 eyesor double knifed chopping(92 eyes. The intra-operative posterior capsule rupture was observed and compared. At 1d, 1wk and 1mo postoperatively, visual acuity, corneal edema and corneal astigmatism were observed and analyzed. RESULTS:There were 10 eyes in patients accepting knifed chopping with closed hook with intra-operative posterior capsule rupture and 1 eye in patients accepting double knifed chopping. The difference between the two groups was statistically significant. The visual acuity of patients accepting knifed chopping with closed hook(92 eyesat 1d postoperatively was 0.380±0.105, and that of patients accepting double knifed chopping(92 eyeswas 0.420±0.095; the difference between the two groups was statistically significant. The visual acuity of patients accepting knifed chopping with closed hook(84 eyesat 1wk postoperatively was 0.480±0.123, and that of patients accepting double knifed chopping(86 eyeswas 0.520±0.085; the difference between the two groups was statistically significant. The visual acuity of patients accepting knifed chopping with closed hook(60 eyesat 1mo postoperatively was 0.610±0.083, and that of patients accepting double knifed chopping(52 eyeswas 0.643±0.072; the difference between the two groups was not statistically significant. The differences on corneal edema and corneal astigmatism between the two methods at 1d, 1wk and 1mo postoperatively were not statistically significant. CONCLUSION:The application of knifed chopping with closed hook and double knifed chopping in small incision extracapsular cataract extraction and intraocular lens implantation can effectively treat with

  17. Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians.

    Science.gov (United States)

    Ng, Danny Siu-Chun; Chan, Edwin; Yu, Derek Kim-Hun; Ko, Simon Tak-Chuen

    2015-10-01

    To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were

  18. Inhibition by local bupivacaine-releasing microspheres of acute postoperative pain from hairy skin incision.

    Science.gov (United States)

    Ohri, Rachit; Wang, Jeffrey Chi-Fei; Blaskovich, Phillip D; Pham, Lan N; Costa, Daniel S; Nichols, Gary A; Hildebrand, William P; Scarborough, Nelson L; Herman, Clifford J; Strichartz, Gary R

    2013-09-01

    Acute postoperative pain causes physiological deficits and slows recovery. Reduction of such pain by local anesthetics that are delivered for several days postoperatively is a desirable clinical objective, which is approached by a new formulation and applied in animal studies reported here. We subcutaneously injected a new formulation of poly-lactic-co-glycolic acid polymer microspheres, which provides steady drug release for 96+ hours into rats at the dorsal region 2 hours before surgery. A single 1.2-cm-long skin incision was followed by blunt dissection of skin away from the underlying fascia, and closed by 2 sutures, followed by 14 days of testing. Microspheres containing 5, 10, 20, and 40 mg bupivacaine were injected locally 2 hours before surgery; bupivacaine-free microspheres were the vehicle control, and bupivacaine HCl solution (0.5%), the positive control. Mechanical sensitivity was determined by the frequency of local muscle contractions to repeated pokes with nylon monofilaments (von Frey hairs) exerting 4 and 15 g forces, testing, respectively, allodynia and hyperalgesia, and by pinprick. Injection of bupivacaine microspheres (40 mg drug) into intact skin reduced responses to 15 g von Frey hairs for 6 hours and to pinprick for 36 hours. Respective reductions from bupivacaine HCl lasted for 3 and 2 hours. Skin incision and dissection alone caused mechanical allodynia and hyperalgesia for 14 days. Microspheres containing 20 or 40 mg bupivacaine suppressed postoperative hypersensitivity for up to 3 days, reduced integrated allodynia (area under curve of response versus time) over postoperative days 1 to 5 by 51% ± 20% (mean ± SE) and 78% ± 12%, and reduced integrated hyperalgesia by 55% ± 13% and 64% ± 11%, for the respective doses. Five and ten milligrams bupivacaine in microspheres and the 0.5% bupivacaine solution were ineffective in reducing postoperative hypersensitivity, as were 40 mg bupivacaine microspheres injected contralateral to the

  19. Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions.

    Science.gov (United States)

    Li, Shi-Yong; Chen, Gang; Du, Jun-Feng; Chen, Guang; Wei, Xiao-Jun; Cui, Wei; Zuo, Fu-Yi; Yu, Bo; Dong, Xing; Ji, Xi-Qing; Yuan, Qiang

    2015-04-28

    To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions. From March 2010 to June 2014, 30 patients (14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection. The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases. In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0. Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut. Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor. For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum. The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum. For the present cohort of 30 cases, the mean operative time was 178 min, with an average of 13 positive lymph nodes detected. One case of postoperative anastomotic leak was observed, requiring temporary colostomy, which was closed and recovered 3 mo later. The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases. Twelve months after surgery, 94.4% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. The patients were followed up for 1-36 mo, with an average of 23 mo. There was no local recurrence, and 17 patients survived for > 3 years (with a survival rate of 100%). Laparoscopic radical

  20. Holocene Evolution of Incised Coastal Channels on the Isle of Wight, UK: Interpretation via Numerical Simulation.

    Science.gov (United States)

    Leyland, J.; Darby, S. E.

    2006-12-01

    Incised coastal channels are found in numerous locations around the world where the shoreline morphology consists of cliffs. The incised coastal channels found on the Isle of Wight, UK, are known locally as `Chines' and debouche (up to 45m) through the soft cliffs of the south west coast, maintaining steep side walls subject to deep-seated mass wasting. These canyons offer sheltered locations and bare substrate, providing habitat for plant (Philonotis marchica, Anthoceros punctatos) and invertebrate (Psen atratinus, Baris analis, Melitaea cinxi) species of international importance. The base level of the Chines is highly dynamic, with episodes of sea cliff erosion causing the rejuvenation of the channel network. Consequently a key factor in Chine evolution is the relative balance between rates of cliff retreat and headwards incision caused by knickpoint migration. Specifically, there is concern that if contemporary coastal retreat rates are higher than the corresponding rates of knickpoint recession, there will be long-term a reduction in the overall extent of the Chines and their associated habitats. In an attempt to provide a long-term context for these issues, in this poster we explore the Holocene erosional history of the Chines using a numerical landscape evolution model. The model includes a stochastic cliff recession function that controls the position of the outlet boundary. Knickpoint recession rates are simulated using a detachment-limited channel erosion law wherein erosion rate is a power function of drainage area and stream gradient with model parameters defined using empirically- derived data. Simulations are undertaken for a range of imposed boundary conditions representing different scenarios of long-term cliff retreat forced by Holocene sea-level rise, plausible scenarios corresponding to cases where simulated and observed Chine and landscape forms match. The study provides an example of how a landscape evolution model could be used to reconstruct

  1. World Class: USBBY's Outstanding International Books for Young People

    Science.gov (United States)

    Angus, Carolyn

    2009-01-01

    Some of the world's best children's book artists got together to help Amnesty International celebrate the Universal Declaration of Human Rights' 60th anniversary in "We Are All Born Free," one of the 42 titles recommended by the fourth annual United States Board on Books for Young People's (USBBY) Outstanding International Books…

  2. Developing a World-Class Workforce: Transformation, Not Iteration

    Science.gov (United States)

    Mosier, Jerrilee K.; Richey, Michael C.; McPherson, Kenneth B.; Eckhol, John O.; Cox, Frank Z.

    2006-01-01

    This article features a "Triad" partnership of a group of Snohomish County organizations representing education, government and industry. Recognizing the need for a training and workforce development effort to address the aerospace manufacturing employers' needs, Triad views themselves as the pivotal cornerstone for deployment of complex…

  3. Workplace Literacy for World Class Manufacturing. Final Report.

    Science.gov (United States)

    Dowling, William D.; And Others

    The Ohio State University, Inland Fisher Guide Division of General Motors, and United Auto Workers Local 969 formed a collaborative partnership in 1990 to train employees whose inadequate literacy skills made them unable to respond to the requirements of "synchronous manufacturing" (or "just in time" production). One of the goals is to reduce the…

  4. Six world-class research teams to investigate overcoming ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2017-10-26

    Oct 26, 2017 ... Four other teams use advanced genomics and protein engineering techniques to elucidate basic molecular mechanisms associated with tumor ... IDRC is supporting research that studies the most effective ways to empower women, prevent gender-based violence, and make digital platforms work for ...

  5. Building a world class information security governance model

    CSIR Research Space (South Africa)

    Lessing, M

    2008-05-01

    Full Text Available practice documents. The resulting model covers all the relevant aspects on strategic, management and technical level when implemented altogether. This model includes the related aspects of Corporate Governance, Information Technology Governance...

  6. A world-class design for the Chinese Nuclear Program

    International Nuclear Information System (INIS)

    Ruiz, A.; Valero, E.

    1999-01-01

    Under the name Grupo Nuclear SEPI, the companies BWE, ENDESA, ENSA, ENRESA, ENUSA and INITEC, in a partnership in SEPI and with extensive experience in the nuclear sector, have in the last few years been coordinating technical and commercial actions targeted primarily at the Chinese nuclear market. These actions have been carried out under Westinghouse's leadership, for the purpose of providing a 1000 MWe nuclear Power plant design tailored to the local requirements defined by experts and authorities of the People's Republic of China (project CPWR 1000). (Author)

  7. Tactical skills of world-class youth soccer teams

    NARCIS (Netherlands)

    Kannekens, Rianne; Elferink-Gemser, Marije T.; Visscher, Chris

    2009-01-01

    In this study, we examined the relationship between tactical skills and competitive standard of two youth soccer teams by comparing 18 players (age 18-20 years) from the Dutch and 19 players (age 18-23 years) from the Indonesian national youth team. All players completed the declarative and

  8. Enefit technology - world class efficiency in oil shale

    Index Scriptorium Estoniae

    2010-01-01

    Eesti Energia ehitab Narva uut põlevkiviõlitehast Enefit-280. Rajatav õlitehas kasutab senisest keskkonnasõbralikumat Enefit-tehnoloogiat, mis on välja arendatud Eesti Energia ja rahvusvahelise insenerfirma Outotec koostöös. Diagramm. Joonised

  9. Latvian PR people are world class / Ada Parr

    Index Scriptorium Estoniae

    Parr, Ada

    2004-01-01

    Suhtekorraldusfirma Porter Novelli rahvusvahelise partnerluse juht suhtekorralduse osatähtsuse kasvust ettevõtete äritegevuses, suhtekorraldusturu olukorrast ja teenuste kvaliteedi tasemest Baltimaades. Vt. samas: Ada Parr recommends

  10. The Supraorbital Keyhole Craniotomy through an Eyebrow Incision: Its Origins and Evolution

    Directory of Open Access Journals (Sweden)

    D. Ryan Ormond

    2013-01-01

    Full Text Available In the modern era of neurosurgery, the use of the operative microscope, rigid rod-lens endoscope, and neuronavigation has helped to overcome some of the previous limitations of surgery due to poor lighting and anatomic localization available to the surgeon. Over the last thirty years, the supraorbital craniotomy and subfrontal approach through an eyebrow incision have been developed and refined to play a legitimate role in the armamentarium of the modern skull base neurosurgeon. With careful patient selection, the supraorbital “keyhole” approach offers a less invasive but still efficacious approach to a number of lesions along the subfrontal corridor. Well over 1000 cases have been reported in the literature utilizing this approach establishing its safety and efficacy. This paper discusses the nuances of this approach, including the benefits and limitations of its use described through our technique, review of the literature, and case illustration.

  11. Outcomes of Single-Incision Laparoscopic Surgery for Colon Cancer: A Case-Matched Comparative Study

    Directory of Open Access Journals (Sweden)

    Atthaphorn Trakarnsanga

    2016-03-01

    Full Text Available Background: Single-incisionlaparoscopiccolectomy(SILC isanevolvingtechnique withpotentialadvantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purposeof thisstudy wastocomparetheshort-termoutcomesbetweenSILC,hand-assistedlaparoscopiccolectomy (HALC andstandard multi-port laparoscopic colectomy (MLC. Methods: Retrospectiveanalysesofatotalof90patientsbetweenMay2010and December2011, whounderwent SILC for coloncancer surgery, wereperformedin30patients. Clinicopathologicalparameters were matched1:1 withpatients whounderwent HALC (n=30andMLC (n=30.Short-term outcomes werecollectedandanalyzed. Results: Operativetime wassignificantlyshorter inSILC comparedto HALC andMLC (p<0.001,as wellasless estimatedbloodloss (p=0.02. There werenosignificantdifferences inconversionrateandnumberofharvested lymphnodes.SILChadtheadvantageofless24-hrpostoperativepainscorecomparedtoHALCandMLC(p<0.001, whereas length of stayandtime to full diet werenotdifferent. Conclusion: Inselectedpatients,SILC canbesuccessfullyandsafelyperformed withshorteroperativetime, less estimated blood loss andless postoperativepainscore.

  12. Subcuticular Suture Technique: Alternative to Frost Suture to Prevent Ectropion After Transcutaneous Incision of Lower Eyelid.

    Science.gov (United States)

    Kudva, Adarsh; Kamath, Abhay; Cariappa, K M; Gadicherla, Srikanth; Dhara, B Vasantha

    2017-12-01

    An ectropion is a complication that can arise from reconstruction in the infraorbital region. Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Various transcutaneous approaches to orbit skeleton have investigated in view of complication arising from them. A subtarsal approach with a postoperative Frost suture gives an advantage to reduce the occurrence of ectropion especially after treatment of orbital floor fractures. This case describes a method of subcuticular suturing technique for subtarsal incision of lower lid which can be used to support the lid during healing period, thus decreasing the rate of ectropion. The technique described here is an alterative method for frost suturing with certain advantages.

  13. Effect of dried sunflower seeds on incisal edge abrasion: A rare case report.

    Science.gov (United States)

    Rath, Avita; Ramamurthy, Priyadarshini H; Fernandes, Bennete Aloysius; Sidhu, Preena

    2017-01-01

    Tooth surface loss (TSL) is a complex phenomenon characterized by the loss of hard tooth structure at various locations of the teeth, usually due to more than one factor. TSL due to abrasion can be significant in patients consuming coarse, abrasive diet. The present case reports an interesting incisal edge abrasion in a female patient, attributed to a particular dietary behavior of long-term consumption of sunflower seeds. All her family members and most of the people from her native place were also reported to have similar lesions by the patient. Larger epidemiological studies to assess the prevalence and severity of such abrasive lesions in geographic areas with this particular dietary habit need to be carried out so that people may be made aware and educated about alternative ways of eating sunflower seeds that will not cause any form of tooth wear.

  14. Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

    Science.gov (United States)

    Goel, Ruchi; Kamal, Saurabh; Kumar, Sushil; Kishore, Jugal; Malik, K. P. S.; Angmo Bodh, Sonam; Bansal, Smriti; Singh, Madhu

    2012-01-01

    Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS. PMID:22523646

  15. Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

    Directory of Open Access Journals (Sweden)

    Ruchi Goel

    2012-01-01

    Full Text Available Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS. Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (=0.16. Both groups, achieved similar best corrected visual acuity (=0.73, although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

  16. MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ramkumar Reddy

    2015-09-01

    Full Text Available Distal fibular fractures are usually communitted and most of the times osteoporotic especially if they are occurring in females and in geriatric age group. These fractures are usu ally associated with other fractures, which necessitates them to be fixed accurately. Owing to the fact that distal fragment is subcutaneous with scanty soft tissue over bone, which pose these fracture fixations become difficult by open methods in view of wound healing. A prospective study of 26 patients with distal fibular fractures were treated with MIPPO with hook plate were healed with less complications and better outcome. With this background we suggest a minimally invasive incision over proximal frag ment where sufficient soft tissue cover is present. From there pushing the special hook plate subperiosteally to distal fragment, hooking the tip of fibula and fixing the proximal fragment after reduction gives a simple and effective stable fixation

  17. Rehabilitation of an Incised Stream Using Plant Materials: the Dominance of Geomorphic Processes

    Directory of Open Access Journals (Sweden)

    F. Douglas. Shields, Jr.

    2008-12-01

    Full Text Available The restoration of potentially species-rich stream ecosystems in physically unstable environments is challenging, and few attempts have been evaluated scientifically. Restoration approaches that involve living and dead native vegetation are attractive economically and from an ecological standpoint. A 2-km reach of an incised, sand-bed stream in northern Mississippi was treated with large wood structures and willow plantings to trigger responses that would result in increasing similarity with a lightly degraded reference stream. Experimental approaches for stream bank and gully stabilization were also examined. Although the project was initially successful in producing improved aquatic habitat, after 4 yr it had failed to effectively address issues related to flashy watershed hydrology and physical instability manifest by erosion and sedimentation. The success of ecosystem rehabilitation was thus governed by landscape-scale hydrological and geomorphological processes.

  18. A Hemiclamshell Incision for a Giant Solitary Fibrous Tumor of the Right Hemithorax

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    Nilgün Kanlıoğlu Kuman

    2012-01-01

    Full Text Available A 41-year-old female was admitted with respiratory distress. Chest radiographs showed opacity in the right hemithorax with mediastinal shift. Computed tomography (CT scan showed a pleural mass with a 22 cm diameter occupying the whole right hemithorax and causing atelectasis. Magnetic resonance imaging (MRI showed lower position of the right hemidiaphragm and the liver. Superior vena cava and heart were shifted to left. Presence of infiltration to the adjacent tissues could not be clearly evaluated because of pressure effect. Transthoracic needle biopsy specimen was reported to be benign. Because of the size and location of the mass, a hemiclamshell incision was chosen, which allowed excellent visualization and complete dissection of the giant tumor. The histopathology of the resected specimen confirmed solitary fibrous tumor. The patient was stabilized by careful observation and treatment. No complication except pneumonia in the postoperative first month occurred during the 22-month follow-up period.

  19. Hybrid Single-Incision Laparoscopic Colon Cancer Surgery Using One Additional 5 mm Trocar.

    Science.gov (United States)

    Kim, Hyung Ook; Choi, Dae Jin; Lee, Donghyoun; Lee, Sung Ryol; Jung, Kyung Uk; Kim, Hungdai; Chun, Ho-Kyung

    2018-02-01

    Single-incision laparoscopic surgery (SILS) is a feasible and safe procedure for colorectal cancer. However, SILS has some technical limitations such as collision between instruments and inadequate countertraction. We present a hybrid single-incision laparoscopic surgery (hybrid SILS) technique for colon cancer that involves use of one additional 5 mm trocar. Hybrid SILS for colon cancer was attempted in 70 consecutive patients by a single surgeon between August 2014 and July 2016 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Using prospectively collected data, an observational study was performed on an intention-to-treat basis. Hybrid SILS was technically completed in 66 patients, with a failure rate of 5.7% (4/70). One patient was converted to open surgery for para-aortic lymph node dissection. Another was converted to open surgery due to severe peritoneal adhesion. An additional trocar was inserted for adhesiolysis in the other two cases. Median lengths of proximal and distal margins were 12.8 cm (interquartile range [IQR], 10.0-18.6), and 8.2 cm (IQR, 5.5-18.3), respectively. Median total number of lymph nodes harvested was 24 (IQR, 18-33). Overall rate of postoperative morbidity was 12.9%, but there were no Clavien-Dindo grade III or IV complications. There was no postoperative mortality or reoperation. Median postoperative hospital stay was 6 days (IQR, 5-7). Hybrid SILS using one additional 5 mm trocar is a safe and effective minimally invasive surgical technique for colon cancer. Experienced laparoscopic surgeons can perform hybrid SILS without a learning curve based on the formulaic surgical techniques presented in this article.

  20. Dating of river terraces along Lefthand Creek, western High Plains, Colorado, reveals punctuated incision

    Science.gov (United States)

    Foster, Melissa A.; Anderson, Robert S.; Gray, Harrison J.; Mahan, Shannon A.

    2017-10-01

    The response of erosional landscapes to Quaternary climate oscillations is recorded in fluvial terraces whose quantitative interpretation requires numerical ages. We investigate gravel-capped strath terraces along the western edge of Colorado's High Plains to constrain the incision history of this shale-dominated landscape. We use 10Be and 26Al cosmogenic radionuclides (CRNs), optically stimulated luminescence (OSL), and thermally transferred OSL (TT-OSL) to date three strath terraces, all beveled in shale bedrock and then deposited upon by Lefthand Creek, which drains the crystalline core of the Front Range. Our study reveals: (i) a long history (hundreds of thousands of years) of fluvial occupation of the second highest terrace, T2 (Table Mountain), with fluvial abandonment at 92 ± 3 ka; (ii) a brief occupation of a narrow and spatially confined terrace, T3, at 98 ± 7 ka; and (iii) a 10-25 thousand year period of cutting and fluvial occupation of a lower terrace, T4, marked by the deposition of a lower alluvial unit between 59 and 68 ka, followed by deposition of an upper alluvial package at 40 ± 3 ka. In conjunction with other recent CRN studies of strath terraces along the Colorado Front Range (Riihimaki et al., 2006; Dühnforth et al., 2012), our data reveal that long periods of lateral planation and fluvial occupation of strath terraces, sometimes lasting several glacial-interglacial cycles, are punctuated by brief episodes of rapid vertical bedrock incision. These data call into question what a singular terrace age represents, as the strath may be cut at one time (its cutting-age) and the terrace surface may be abandoned at a much later time (its abandonment age), and challenge models of strath terraces that appeal to simple pacing by the glacial-interglacial cycles.

  1. A Simple Method for Closure of Urethrocutaneous Fistula after Tubularized Incised Plate Repair: Preliminary Results.

    Science.gov (United States)

    Shirazi, Mehdi; Ariafar, Ali; Babaei, Amir Hossein; Ashrafzadeh, Abdosamad; Adib, Ali

    2016-11-01

    Urethrocutaneous fistula (UCF) is the most prevalent complication after hypospadias repair surgery. Many methods have been developed for UCF correction, and the best technique for UCF repair is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin. In this study, we introduced and evaluated a simple method for UCF correction after tubularized incised plate (TIP) repair. This clinical study was conducted on children with UCFs ≤ 4 mm that developed after TIP surgery for hypospadias repair. The skin was incised around the fistula and the tract was released from the surrounding tissues and the dartos fascia, then ligated with 5 - 0 polydioxanone (PDS) sutures. The dartos fascia, as the second layer, was covered on the fistula tract with PDS thread (gauge 5 - 0) by the continuous suture method. The skin was closed with 6 - 0 Vicryl sutures. After six months of follow-up, surgical outcomes were evaluated based on fistula relapse and other complications. After six months, relapse occurred in only one patient, a six-year-old boy with a single 4-mm distal opening, who had undergone no previous fistula repairs. Therefore, in 97.5% of the cases, relapse was non-existent. Other complications, such as urethral stenosis, intraurethral obstruction, and epidermal inclusion cysts, were not seen in the other patients during the six-month follow-up period. This repair method, which is simple, rapid, and easily learned, is highly applicable, with a high success rate for the closure of UCFs measuring up to 4 mm in any location.

  2. [Expression of cannabinoid receptor I during mice skin incised wound healing course].

    Science.gov (United States)

    Zhao, Zhen-bin; Guan, Da-wei; Liu, Wei-wei; Wang, Tao; Fan, Yan-yan; Cheng, Zi-hui; Zheng, Ji-long; Hu, Geng-yi

    2010-08-01

    To investigate the expression of cannabinoid receptor I (CB1R) during mice skin incised wound healing course and time-dependent changes of CB1R in wound age determination. The changes of CBIR expression in skin incised wound were detected by immunohistochemistry and Western blotting. The control group showed a low expression of CB1R detected mainly in epidermis, hair follicles, sebaceous gland and dermomuscular layer. CB1R expression was undetectable in neutrophils in the wound specimens from 6h to 12h post-injury. CB1R positive cells were mostly mononuclear cells (MNCs) and fibroblastic cells (FBCs) from 1 d to 5 d post-injury. CB1R positive cells were mostly FBCs from 7 d to 14d post-injury. The ratio of the CB1R positive cells increased gradually in the wound specimens from 6 h to 3 d post-injury, reached peak level at 5 d, and then decreased gradually from 7d to 14 d post-injury. The positive bands of CB1R were observed in all time points of the wound healing course by Western blotting. The expression peak showed at 5 d post-injury. CB1R is activated during the wound healing course. The expression of CB1R is found in mononuclear cells, which could be involved in inflammation reaction. CBIR is observed in fibroblastic cells, which could participate in the wound healing. CB1R may be a potentially useful marker for determination of wound healing age.

  3. Surgical treatment of gynecomastia with severe ptosis: periareolar incision and dermal double areolar pedicle technique.

    Science.gov (United States)

    Cannistra, Claudio; Piedimonte, Andrea; Albonico, Fiorella

    2009-11-01

    Gynecomastia is a morphostructural impairment of the mammary region in men caused by parenchymal hypertrophy or a cutaneous distortion of breast skin covering or both. The clinical classification introduced by Simon et al. in 1973 ranks gynecomastia in three degrees. Each subtype can be treated with a specific technique. This article describes an alternative surgical procedure for treating gynecomastia with severe ptosis(type III and type IIIb of Simon's classification). Fifty-eight patients were treated for gynecomastia in our Plastic Surgery Unit from 1996 to 2004. The cutaneous excess of periareolar skin is evaluated by a pinching test. A circular periareolar mark is traced corresponding to the cutaneous excess that has to be removed.Initially, liposuction of adipous tissue on the periphery of the mammary region is performed through two cutaneous 3-mm incisions at the 3 o'clock and 9 o'clock positions around the areola. After this, the liposuction incisions are enlarged from 10 o'clock to 8 o'clock and from 2 o'clockto 4 o'clock to create access for the mastectomy. This dissection creates a double dermal areolar pedicle. The new areolar position is fixed with a Benelli round block suture. A resolution of the morphologic deformity without evident scars after hair growth and a correction of the breast deformity has been observed in the 6-month follow-ups conducted for all the patients. We observed that the vascular-nervous net under the areola at 12 o'clock and 6 o'clock is very important, more so than the lateral pedicle, and the conservation of a double vascular-nervous pedicle reduces significantly the risk of areolar necrosis, especially in cases of gynecomastia type III and in cases where there is a high degree of breast malformation such as the tuberous breast.

  4. Tubularized proximally-incised plate in distal/midshaft hypospadias repair

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    Antonio Marte

    2017-06-01

    Full Text Available The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass procedure, 23 were selected between January 2013 and January 2016 (19.1%. This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2. No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

  5. Single incision laparoscopic-assisted intestinal surgery (SILAIS) in 7 dogs and 1 cat.

    Science.gov (United States)

    Case, J Brad; Ellison, Gary

    2013-06-01

    To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. Prospective case series. Dogs (n = 7) and cat (n = 1). An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82-148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease. © Copyright 2013 by The American College of Veterinary Surgeons.

  6. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients

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    Omer Bayrak

    2015-08-01

    Full Text Available ABSTRACTPurpose:To compare transobturator midurethral sling (TOS and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2 female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL.Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05. ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively. In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190.Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.

  7. Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report.

    Science.gov (United States)

    Hwang, Seong Bae; Choi, Byung Seo; Byun, Geon Young; Koo, Bum Hwan; Lee, Sung Ryul

    2017-02-01

    Accessory breasts have received little attention in the surgical fields, although the condition is quite common in the female population, with 2-6% of women suffering from it. Its convexity and cyclic pain make women feel embarrassed and uncomfortable, so patients often desire surgical excision to improve their appearances and to remove the pain. A total of 967 patients who had been treated by an excision of accessory breast tissue with liposuction using minimal incision from September 2013 to Dec 2015 at the Damsoyu Hospital were analyzed for clinical factors retrospectively. All 967 patients were female. There were 514 (53.2%) unmarried patients and 453 (46.8%) married patients. The major clinical manifestation was the problem in the appearance with cyclic pain in both unmarried and married groups (82.7 vs. 87.9%). Three types of accessory breasts were observed: 779 (80.6%) breast tissue only in axillae, 182 (18.8%) breast tissue with accessory nipple, and 6 (0.6%) breast tissue with accessory nipple-areolar complex. The mean operation time was 58 min. All cyclic axillar pain in our cases was resolved after the operation. Postoperative complications developed in 160 patients (16.55%). Among them, seroma after operation was the most common (11.27%). In our study, 95.65% of the patients were satisfied with the cosmetic outcomes. The surgical excision of accessory breasts with liposuction through the minimal incision is a safe and effective method to make women feel comfortable in clinical manifestations and be satisfied with their cosmetic axillar line. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  8. The Problem of the Pannus: Physician Preference Survey and a Review of the Literature on Cesarean Skin Incision in Morbidly Obese Women.

    Science.gov (United States)

    Smid, Marcela C; Smiley, Sarah G; Schulkin, Jay; Stamilio, David M; Edwards, Rodney K; Stuebe, Alison M

    2016-04-01

    This study aims to determine preferences of a nationally representative sample of obstetrician/gynecologists (OB/GYNs) regarding cesarean delivery (CD) incision practices for women with morbid obesity (body mass index ≥ 40 kg/m(2)). We conducted an online survey using the American College of Obstetricians and Gynecologists database. We compared physician demographics, practice characteristics, and CD incision type preference. After exclusion of ineligible participants, 247 OB/GYNs completed the survey (42% response rate). In nonemergency CD of morbidly obese women, 84% of physicians preferred a Pfannenstiel skin incision (67% preferring taping the pannus; 17% without taping the pannus). In emergency CD, 66% preferred a Pfannenstiel incision (46% without taping the pannus; 20% with taping the pannus) and 20% a vertical incision. For both emergency and nonemergency CD, there was no difference in incision type preferences by provider years in practice, practice scope, or number of CD performed each year. Given the preference of a Pfannenstiel incision with taping the pannus during CD of morbidly obese women, further investigation is needed to assess the risks and benefits of this incision and the practice of elevating the pannus. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence

    NARCIS (Netherlands)

    Schellart, René P.; Zwolsman, Sandra E.; Lucot, Jean-Philippe; de Ridder, Dirk J. M. K.; Dijkgraaf, Marcel G. W.; Roovers, Jan-Paul W. R.

    2018-01-01

    Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial

  10. Repair of a submucous cleft palate by W-pushback and levator repositioning without incision to the nasal mucosa.

    Science.gov (United States)

    Hwang, Kun

    2012-03-01

    The author created an innovative method of W-pushback and levator repositioning without having to make an incision to the nasal mucosa for submucous cleft palate repair.The W-shaped mucoperiosteal flap is outlined where the 2 peaks of W are the alveolar processes of both canine teeth and the midpoint of W is the anterior limit of the cleft notch of the hard palate. A short incision, medial to and behind the maxillary tuberosity and curved forward onto the palate and extended forward just medial to the alveolar process, is joined by a second incision from the apex of the cleft to the region of the canine tooth. The W-shaped mucoperiosteal flap is raised until the midline notch of the hard palate is exposed. The nasal mucosa and abnormally inserted levator veli palatini muscle to the posterior border of the hard palate bone are detached. By leaving the nasal mucosa intact, the detached levator veli palatini muscle is approximated at the midline and so the zona pellucida is obliterated. The cleft uvulas are cut in half and closed. The approximated W-flap is joined to the small anterior flap by 1 or more sutures (the W-pushback).Three patients were operated on with this technique without serious complications.The author believes that this method can make the levator sling and increase the length of the soft palate without making an incision to the nasal mucosa.

  11. Rapid channel incision of the lower Pearl River (China since the 1990s as a consequence of sediment depletion

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    X. X. Lu

    2007-12-01

    Full Text Available This paper reported a dramatic channel incision (>10 m in the deepest cut during the past 10 y or so in the lower Pearl River, the second largest river in terms of water discharge in China. The channel incision had caused changes both in the channel geometry as well as in the river hydraulics. Also, the water exchange between the two major tributaries of the Pearl River, the Xijiang and Beijiang, had been significantly changed due to the channel incision. The rapid channel incision was principally the result of extensive sand mining in the lower Pearl River and the delta region due to the booming economy in the Pearl Delta region. Slight increase of water discharge and significant decrease of sediment load since the early 1990s in both the Xijiang and Beijiang also likely contributed to the observed dramatic river bed downcutting to some extent. This has important implications for river management, as the large Chinese rivers have seen a dramatic depletion of sediment fluxes due to the combined effects of declining rainfall, dam constructions, water diversion, reforestation and afforestation, and sediment mining over the recent decades.

  12. Maternal infection rates after cesarean delivery by Pfannenstiel or Joel-Cohen incision: a multicenter surveillance study.

    Science.gov (United States)

    Dumas, Anne Marie; Girard, Raphaële; Ayzac, Louis; Caillat-Vallet, Emmanuelle; Tissot-Guerraz, Françoise; Vincent-Bouletreau, Agnès; Berland, Michel

    2009-12-01

    Our purpose was to evaluate maternal nosocomial infection rates according to the incision technique used for caesarean delivery, in a routine surveillance study. This was a prospective study of 5123 cesarean deliveries (43.2% Joel-Cohen, 56.8% Pfannenstiel incisions) in 35 maternity units (Mater Sud Est network). Data on routine surveillance variables, operative duration, and three additional variables (manual removal of the placenta, uterine exteriorization, and/or cleaning of the parieto-colic gutter) were collected. Multiple logistic regression analysis was used to identify independent risk factors for infection. The overall nosocomial infection and endometritis rates were higher for the Joel-Cohen than Pfannenstiel incision (4.5% vs. 3.3%, 0.8% vs. 0.3%, respectively). The higher rate of nosocomial infections with the Joel-Cohen incision was due to a greater proportion of patients presenting risk factors (i.e., emergency delivery, primary cesarean, blood loss > or =800 mL, no manual removal of the placenta and no uterine exteriorization). However, the Joel-Cohen technique was an independent risk factor for endometritis. The Joel-Cohen technique is faster than the Pfannenstiel technique but is associated with a higher incidence of endometritis.

  13. Enhancing dissemination of Beauveria bassiana with host plant base incision trapfor the management of the banana weevil Cosmopolites sordidus

    NARCIS (Netherlands)

    Tinzaara, W.; Emudong, P.; Nankinga, C.; Tushemereirwe, W.; Kagezi, G.H.; Gold, C.S.; Dicke, M.; Huis, van A.; Karamura, E.

    2015-01-01

    The banana weevil, Cosmopolites sordidus (Germar) (Coleoptera: Curculionidae) is an important pest of highland banana in East and central Africa. It causes yield loss of up to 100% in heavily infested fields. Studies were carried out in Uganda to evaluate the efficacy of the the plant base incision

  14. The transverse colon cancer with the reversed rotation of the midgut treated with single incision laparoscopic colectomy.

    Science.gov (United States)

    Hirano, Yasumitsu; Hattori, Masakazu; Fujita, Manami; Nishida, Youji; Douden, Kenji; Hashizume, Yasuo

    2013-06-01

    Reversed rotation of the midgut is a rare type of intestinal malrotation. Moreover, synchronous colon cancer has rarely been reported. Preliminary experience with single-incision laparoscopic colectomy (SILC) for colon cancer with reversed rotation of the midgut is reported. An 82-year-old woman was admitted because of a fecal occult blood. A colonoscopy revealed transverse colon cancer. An air-barium contrast enema showed the right-sided sigmoid colon and the left-sided cecum. A computed tomography revealed that the duodenum and the transverse colon were situated at the ventral side of the superior mesenteric artery, and a preoperative diagnosis of suspicion of reversed rotation of the midgut was made. First, a lap protector was inserted through a 4.0 cm transumbilical incision. Four 5 mm ports were placed in the lap protector. On the observation of laparoscopy, the cecum and the ascending colon were not fixed with the retroperitoneum and situated on the left, and the sigmoid colon was situated on the right. We successfully mobilized the transverse colon using a single-incision laparoscopic approach. Resection was achieved following extracorporealization, and the anastomosis was performed extracorporeally using staplers. The patient was discharged on the thirteenth postoperative day. Postoperative follow-up did not reveal any umbilical wound complications. SILC for colon cancer associated with malrotation of the midgut is feasible and a promising alternative method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

  15. CO2 temperature-controlled laser soldering of pig trachea incisions in vitro using flexible albumin bands

    Science.gov (United States)

    Sharvit, Dan; Vasilyev, Tamar; Vasserman, Irena; Simhon, David; Kariv, Naam; DeRowe, Ari; Katzir, Abraham

    2005-04-01

    Resection of a segment of the trachea is a procedure applied for the removal of cervical tumors invading the trachea, or for the treatment of severe tracheal stenosis. The current method of anastomosis is based on multiple sutures. The main drawbacks of this method are: 1) A long procedure time, 2) An air leakage, and 3) An inflammatory response to the sutures. In this study we evaluated the feasibility and effectiveness of the use of temperature controlled CO2 laser soldering of incisions in pig tracheas in vitro. A transverse incision was made in a separated pig trachea. A flexible albumin band was prepared and was laser soldered with albumin solder to the outer surface of the trachea, covering the incision. The soldered trachea ends were sealed and the burst pressure was measured. In a series of in vitro experiments, the mean burst pressure was found to be 230 mm Hg. These preliminary results demonstrated that laser soldering using a flexible albumin band may be a useful method for sealing an incision in the trachea.

  16. Middel Pleistocene to Holocene fluvial terrace development and uplift-driven valley incision in the SE Carpathians, Romania

    NARCIS (Netherlands)

    Necea, D.; Fielitz, W.; Andriessen, P.A.M.; Dinu, C.

    2013-01-01

    This study reveals that in the SE Carpathians terrace development and fluvial incision during the Middle Pleistocene-Holocene are predominantly controlled by tectonic uplift as shown by terrace distributions and uplift amounts and rates. The work focuses on a transect from the internal nappes and

  17. Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

    Science.gov (United States)

    Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

    2015-01-01

    We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

  18. Modeling Long-Term Fluvial Incision : Shall we Care for the Details of Short-Term Fluvial Dynamics?

    Science.gov (United States)

    Lague, D.; Davy, P.

    2008-12-01

    Fluvial incision laws used in numerical models of coupled climate, erosion and tectonics systems are mainly based on the family of stream power laws for which the rate of local erosion E is a power function of the topographic slope S and the local mean discharge Q : E = K Qm Sn. The exponents m and n are generally taken as (0.35, 0.7) or (0.5, 1), and K is chosen such that the predicted topographic elevation given the prevailing rates of precipitation and tectonics stay within realistic values. The resulting topographies are reasonably realistic, and the coupled system dynamics behaves somehow as expected : more precipitation induces increased erosion and localization of the deformation. Yet, if we now focus on smaller scale fluvial dynamics (the reach scale), recent advances have suggested that discharge variability, channel width dynamics or sediment flux effects may play a significant role in controlling incision rates. These are not factored in the simple stream power law model. In this work, we study how these short- term details propagate into long-term incision dynamics within the framework of surface/tectonics coupled numerical models. To upscale the short term dynamics to geological timescales, we use a numerical model of a trapezoidal river in which vertical and lateral incision processes are computed from fluid shear stress at a daily timescale, sediment transport and protection effects are factored in, as well as a variable discharge. We show that the stream power law model might still be a valid model but that as soon as realistic effects are included such as a threshold for sediment transport, variable discharge and dynamic width the resulting exponents m and n can be as high as 2 and 4. This high non-linearity has a profound consequence on the sensitivity of fluvial relief to incision rate. We also show that additional complexity does not systematically translates into more non-linear behaviour. For instance, considering only a dynamical width

  19. Minimal Incision Scar-Less Open Umbilical Hernia Repair in Adults - Technical Aspects and Short Term Results

    Directory of Open Access Journals (Sweden)

    Sanoop Koshy Zachariah

    2014-09-01

    Full Text Available Background: There is no gold standard technique for umbilical hernia repair .Conventional open umbilical hernia repair often produces an undesirable scar. Laparoscopic umbilical hernia repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open umbilical hernia repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short term results. Methods: This is a retrospective analysis of the first 20 patients who underwent minimal incision scar-less open umbilical hernia repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects upto 2cm.Larger defects were repaired using an onlay mesh. In patients with a BMI of 30 kg/m2 or greater, onlay mesh hernioplasty was performed irrespective of the defect size.Results: A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29 - 82 years. Mean BMI was 26.27 (range 20. -33.1 kg/m2. Average size of the incision was 1.96 range (1.5 to 2.5 cm. Mesh hernioplasty was done in 9 patients. 11 patients underwent primary suture repair alone. There were no postoperative complications associated with his technique. Average post operative length of hospital stay was 3.9 (range 2-10 days. Mean follow-up was 29.94 months, (2 weeks to 2.78 years. On follow up there was no externally visible scar in any of the patients. There were no recurrences on final follow up. Conclusion: This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform safe, offers good cosmesis, does not require incisions beyond the umbilicus and cost effective, with encouraging results on short term follow up. Further research is needed to assess the true potential of the

  20. Tool-effect: Controls on Landscape Persistence

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    Willenbring, J. K.; Brocard, G. Y.; Salles, T.; Harrison, E. J.

    2017-12-01

    The ability of rivers to cut through rock and to remove former land surfaces sets the pace of landscape response to mountain uplift. Because of associations between tectonism, river incision, erosion, carbon burial and silicate weathering, high rates of rock uplift are thought to initiate a cascade of processes that are linked to sequestration of CO2 over geologic timescales. However, even in some cases of landscapes experiencing rapid uplift, some portions of landscapes remain unchanged or `relict' for long periods and the fluxes of chemical weathering and physical erosion do not reflect the new tectonic regime-sometimes for millions of years following uplift. These relict portions of the landscape are often composed of subdued topography with thick soils. River incision is achieved by various processes, but one of the main contributors is bedrock abrasion by bedload. Here, we show how the presence of flat, relict landscapes in headwaters can lead to reduced incision rates and low erosion fluxes. We use a known pulse of uplift in Puerto Rico and track the river response to the uplift over time to illustrate a how landscapes in hot, humid climates can persist for millions of years even after rapid mountain uplift. We run experiments on simplified topography using numerical landscape evolution models. Typically, numerical landscape evolution models apply a standard stream power law model, whereby river incision is proportional to basal shear stress or unit stream power, and is not affected by gravel flux. We implement a formulation of the tool and cover effect model, and then we added a reinforcing effect of weathering on this process, by implementing a gravel production function. This function simulates the effect of the residence time of rocks in soil, which is expected to affect the grain-size distribution of the particles in the soil, with lower erosion rates, and longer residence time further decreasing the proportion of gravel delivered to the streams. We find

  1. Effects of entonox in comparison of lidocaine on pain severity during episiotomy incision in nulliparous women: A randomized control trial

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    Azam Honarmandpour

    2017-01-01

    Full Text Available Background & Aim: Episiotomy is one of the most common surgical procedures in obstetrics, which requires analgesia. Entonox gas is known to have analgesic and sedative properties. However, no studies have been found on the analgesic effects of Entonox on episiotomy incision. Therefore, this study aimed to compare the effects of Entonox and lidocaine on pain intensity during episiotomy incision in nulliparous women. Materials and Methods: This randomized controlled trial was conducted on 120 term nulliparous women, who met the inclusion criteria. Subjects were selected by randomized sampling and equally divided into two groups of intervention and control (n=60. In the intervention group, Entonox gas was applied two minutes before episiotomy incision until the end of the procedure. On the other hand, the control group received 5 ml of lidocaine 2% as routine care before episiotomy incision. Data were collected using visual analogue scale to compare the study groups in terms of pain intensity. In addition, patient satisfaction with pain management technique during episiotomy and side effects of Entonox were assessed. Data analysis was performed in SPSS version 22 using Mann-Whitney U and Chi-square tests, and P value of less than 0.05 was considered statistically significant. Results: In this study, no significant difference was observed between the intervention and control groups regarding pain intensity (P=0.52. Moreover, no significant difference was observed in the satisfaction level of the two groups (P=0.70. Conclusion: According to the results of this study, Entonox could be used as an effective and noninvasive alternative to lidocaine to reduce pain during episiotomy incision without significant side effects.

  2. Balancing hydropower production and river bed incision in operating a run-of-river hydropower scheme along the River Po

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    Denaro, Simona; Dinh, Quang; Bizzi, Simone; Bernardi, Dario; Pavan, Sara; Castelletti, Andrea; Schippa, Leonardo; Soncini-Sessa, Rodolfo

    2013-04-01

    Water management through dams and reservoirs is worldwide necessary to support key human-related activities ranging from hydropower production to water allocation, and flood risk mitigation. Reservoir operations are commonly planned in order to maximize these objectives. However reservoirs strongly influence river geomorphic processes causing sediment deficit downstream, altering the flow regime, leading, often, to process of river bed incision: for instance the variations of river cross sections over few years can notably affect hydropower production, flood mitigation, water supply strategies and eco-hydrological processes of the freshwater ecosystem. The river Po (a major Italian river) has experienced severe bed incision in the last decades. For this reason infrastructure stability has been negatively affected, and capacity to derive water decreased, navigation, fishing and tourism are suffering economic damages, not to mention the impact on the environment. Our case study analyzes the management of Isola Serafini hydropower plant located on the main Po river course. The plant has a major impact to the geomorphic river processes downstream, affecting sediment supply, connectivity (stopping sediment upstream the dam) and transport capacity (altering the flow regime). Current operation policy aims at maximizing hydropower production neglecting the effects in term of geomorphic processes. A new improved policy should also consider controlling downstream river bed incision. The aim of this research is to find suitable modeling framework to identify an operating policy for Isola Serafini reservoir able to provide an optimal trade-off between these two conflicting objectives: hydropower production and river bed incision downstream. A multi-objective simulation-based optimization framework is adopted. The operating policy is parameterized as a piecewise linear function and the parameters optimized using an interactive response surface approach. Global and local

  3. Impact of two telemetry transmitter implantation incision suturing methods on the physiological state and condition of perch (Perca fluviatilis

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    Rożyński Maciej

    2017-06-01

    Full Text Available The aim of this work was to determine the impact on European perch, Perca fluviatilis L. (mean body weight – 78.33 g of the intraperitoneal implantation of telemetry transmitters using different suturing methods. In the first experiment silk sutures were used (experiment I – group ST, while in the second tissue adhesive was used (experiment II – group GT. Following the procedure, the fish were kept for 42 days in a recirculating system. Differences in growth and condition parameters were only noted in the first week of the experiment. Specimens from group GT had lower values for DGR (daily growth rate and SGR (specific growth rate, but a higher value for FCR (feed conversion ratio values. For the hematological parameters, lower values of MCV (mean corpuscular volume and PLT (blood platelets were noted in group GT, while for the biochemical parameters, lowered ALP (alkaline phosphatase activity and Mg (magnesium concentrations were noted in group ST. In group ST, 33.3% of the specimens loss their tags, while in group GT 77.8% did so. Differences in incision healing were only noted in the second week, when specimens in group ST were observed to have fully closed incisions, while in group GT 50% of the incisions were open. Despite the high percentage of implantation incision healing in both groups, because of the high values of tag loss rate, neither method can be recommended for perch. It might be more effective to use tag with external antennae in this species. The method use for closing implantation incisions also must be improved to eliminate tag shedding.

  4. Quantitative analysis of the relationship between maxillary incisors and the incisive canal by cone-beam computed tomography in an adult Japanese population

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    Tomonari Matsumura

    2017-08-01

    Full Text Available Abstract Background In setting goals for orthodontic treatment, determining the morphologies of the alveolar bone and maxillary incisor root is important for avoiding root resorption, dehiscence, and fenestration. This study aimed to analyze the configurational relationships among maxillary incisors, the alveolar border, and the incisive canal by cone-beam computed tomography (CBCT. Methods Cone-beam CT images of 93 orthodontic patients were evaluated for length of the incisive canal (L; angles between the palatal plane and the maxillary alveolar border (θ1, the incisive canal (θ2, and maxillary incisor (θ3; distance from the left maxillary incisor to the incisive canal (D; and cross-sectional areas of the incisive canal (CSAs at three vertical levels. Comparison of variables between male and female patients was performed with the two-sample t test. Correlations between parameters were examined by Pearson’s correlation analysis and Bonferroni correction for multiple comparisons. Results Male patients exhibited significantly greater values of L than female patients. There were significant positive correlations between θ1 and θ2, θ2 and θ3, and θ3 and θ1. While the value of D was the lowest at the oral opening, that of the cross-sectional area of the incisive canal (CSA was the greatest at the incisal root apex. Conclusions This study demonstrated that the incisive canal had large inter-individual variability, and the proximity between the incisive canal and the incisal root could not be precisely predicted by the conventional cephalograms. Therefore, pre-treatment CBCT examination should be recommended when a large amount of maxillary anterior retraction and/or intrusion is planned in orthodontic diagnosis.

  5. Corneal tissue welding with infrared laser irradiation after clear corneal incision.

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    Rasier, Rfat; Ozeren, Mediha; Artunay, Ozgür; Bahçecioğlu, Halil; Seçkin, Ismail; Kalaycoğlu, Hamit; Kurt, Adnan; Sennaroğlu, Alphan; Gülsoy, Murat

    2010-09-01

    The aim of this study was to investigate the potential of infrared lasers for corneal welding to seal corneal cuts done in an experimental animal model. Full-thickness corneal cuts on freshly enucleated bovine eyes were irradiated with infrared (809-nm diode, 980-nm diode, 1070-nm YLF, and 1980-nm Tm:YAP) lasers to get immediate laser welding. An 809-nm laser was used with the topical application of indocyanine green to enhance the photothermal interaction at the weld site. In total, 60 bovine eyes were used in this study; 40 eyes were used in the first part of the study for the determination of optimal welding parameters (15 eyes were excluded because of macroscopic carbonization, opacification, or corneal shrinkage; 2 eyes were used for control), and 20 eyes were used for further investigation of more promising lasers (YLF and Tm:YAP). Laser wavelength, irradiating power, exposure time, and spot size were the dose parameters, and optimal dose for immediate closure with minimal thermal damage was estimated through histological examination of welded samples. In the first part of the study, results showed that none of the applications was satisfactory. Full-thickness success rates were 28% (2 of 7) for 809-nm and for 980-nm diode lasers and 67% (2 of 3) for 1070-nm YLF and (4 of 6) for 1980-nm Tm:YAP lasers. In the second part of the study, YLF and Tm:YAP lasers were investigated with bigger sample size. Results were not conclusive but promising again. Five corneal incisions were full-thickness welded out of 10 corneas with 1070-nm laser, and 4 corneal incisions were partially welded out of 10 corneas with 1980-nm laser in the second part of the study. Results showed that noteworthy corneal welding could be obtained with 1070-nm YLF laser and 1980-nm Tm:YAP laser wavelengths. Furthermore, in vitro and in vivo studies will shed light on the potential usage of corneal laser welding technique.

  6. The analgesic efficacy of subcostal transversus abdominis plane block with Mercedes incision.

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    Guo, Jian-Guo; Li, Hui-Ling; Pei, Qing-Qing; Feng, Zhi-Ying

    2018-04-10

    Conventional perioperative analgesic modalities (e.g. opioids, epidural analgesia) have their own drawbacks, which limit their clinical application. This study investigated the opioid-sparing effectsof the oblique subcostal transversus abdominis plane (OSTAP) blockade with ropivacaine for the patients undergoing open liver resection with a Mercedes incision. 126 patients who were scheduled for open liver resection were enrolled in this study. Patients were randomly assigned to receive bilateral ultrasound-guided OSTAPblocks with either 0.375% ropivacaine (groupT) or 0.9% isotonic saline (group C). Both groups also received intravenous patient-controlled analgesia and intravenous 40 mg parecoxib every 12 h for a total of 3 days. Preoperative and intraoperative parameters, plus intraoperative and postoperative cumulative sufentanil consumption, were recorded. 70 patients were enrolled in the study finally. There were no significant differences between the two groups with respect to preoperative parameters, and surgical and anesthetic characteristics. The intraoperative sufentanil use, cumulative sufentanil consumption at 5 min after extubation, 2 h, 4 h,12 h and 24 h after operation in group T was significantly less than that in group C (P = 0.001, 0.001, 0.000, 0.000, 0.001 and 0.044, respectively). Compared with group C, postoperative NRS pain scores at rest were significantly lower at 2 h and 4 h postoperatively in group T (P = 0.04and 0.02, respectively); NRS scores at the time of coughing were also significantly lower in group T than in group C at all time points except 5 min after extubation (all P < 0.001). Furthermore, compared with group C, the number of intraoperative vasodilator use, the extubation time and the incidence of nausea was reduced in group T. Ultrasound-guided OSTAP block with ropivacaine can significantly decrease the perioperative cumulative dosage of analgesics and improve analgesic effect without obvious side

  7. Ectasia following small-incision lenticule extraction (SMILE: a review of the literature

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    Moshirfar M

    2017-09-01

    Full Text Available Majid Moshirfar,1,2 Julio C Albarracin,3 Jordan D Desautels,1,4 Orry C Birdsong,1 Steven H Linn,1 Phillip C Hoopes Sr1 1HDR Research Center, Hoopes Vision, Draper, 2John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 3Department of Ophthalmology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 4Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA Purpose: Four cases of corneal ectasia after small-incision lenticule extraction (SMILE have been reported. In this review, we provide an overview of the published literature on corneal ectasia after SMILE and risk factors associated with this complication.Methods: Case reports were identified by a search of seven electronic databases for pertinent heading terms between 2011 and July 2017. We identified patient characteristics and surgical details including preoperative topography, central corneal thickness, and anterior keratometry (Km. Residual stromal bed (RSB values not reported were computed using VisuMax ReLEx SMILE software Version 2.10.10. Preoperative ectasia risk was measured using the Randleman Ectasia Risk Score System (ERSS. Percent tissue alteration was calculated for each patient as described by Santhiago et al.Results: Seven eyes of four patients developed corneal ectasia post SMILE. Two patients had abnormal topography in both eyes. One patient had abnormal topography in one eye. Only one patient was noted to have normal topography in both eyes and later developed ectasia in one eye in the absence of any known risk factors. The mean Randleman ectasia risk score was 4±3 (range: 1–8. The mean calculated percent tissue altered (PTA was 38%±6% (range: 30%–47%.Conclusion: A majority of reported ectasia cases occurred in patients with subclinical keratoconus. These conditions may be exacerbated by SMILE and should be

  8. Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction

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    Marcos Laube Leite

    Full Text Available ABSTRACT OBJECTIVE: To compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. METHODS: Thirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2-14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. RESULTS: The total rate of dysesthesia was 42% (14 patients. Five patients (26% on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients. On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%. No statistical differences between both groups were observed regarding patients' weight, age, and height¸ as well as skin incision length. CONCLUSION: Patients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.

  9. Topography-guided photorefractive keratectomy for irregular astigmatism after small incision lenticule extraction.

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    Ivarsen, Anders; Hjortdal, Jesper Ø

    2014-06-01

    To report the outcome of topography-guided photorefractive keratectomy (PRK) after complicated small incision lenticule extraction (SMILE). Retrospective case series of 5 eyes with irregular topography and ghost images after complicated SMILE. All eyes received transepithelial topography-guided PRK. Two eyes were treated with 0.02% mitomycin C. Patients were examined after a minimum of 3 months with evaluation of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, Pentacam tomography (Oculus Optikgeräte, Wetzlar, Germany), and whole-eye aberrometry. In 3 eyes, subjective symptoms were diminished and UDVA, CDVA, topography, and corneal wavefront aberrations were improved. The remaining 2 eyes developed significant haze with worsened topography and wavefront aberrations. One eye experienced a two-line reduction in CDVA. Eyes with haze development had not been treated with mitomycin C. Transepithelial topography-guided PRK may reduce visual symptoms after complicated SMILE if postoperative haze can be controlled. To reduce the risk of haze development, application of mitomycin C may be considered. Copyright 2014, SLACK Incorporated.

  10. Analysis on incidence and management of complications after femtosecond laser-assisted small incision lenticule extraction

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    Cai-Hong Li

    2018-04-01

    Full Text Available AIM: To evaluate the safety and postoperative complications of femtosecond laser-assisted small incision lenticule extraction(SMILE. METHODS: Retrospective case series. A total of 1127 patients(2 236 eyeswho were treated with SMILE for myopia or myopia astigmatism between June 2016 and May 2017 were enrolled in this study. Eyes that developed postoperative complications were noted and identified. The incidence, risk factors, management and prognosis were analyzed. The follow-up was 6mo.RESULTS: The rate of postoperative complications was 8.05%, included diffuse lamellar keratitis(3.31%, delayed visual acuity(2.59%, minor interface residue(0.63%, and ghost images(1.52%. These complications had an impact on best corrected visual acuity(BCVAat 3mo in only 1 eye with decentered ablation and was re-treated with topography-guided laser-assisted subepithelial keratomileusis(LASEK. Good visual outcomes were achieved in all eyes finally. CONCLUSION: Although few eyes suffered postoperative complications, SMILE is an acceptable safe surgery. Careful surgical skill, appropriate surgical parameter, and rational postoperative medication can decrease the risk of complication.

  11. Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

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    Nikolić Živorad S.

    2016-01-01

    Full Text Available Introduction. No consensus has been reached yet on the surgical approach for treatment of condylar fractures. Objective. The aim of this study was to present modified Risdon approach (without facial nerve identification in the treatment of subcondylar mandibular fractures. Method. This is a retrospective study of a period 2005-2012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (19-68 years old were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. Results. No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8% patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. Conclusion. In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result - due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure. [Projekat Ministarstva nauke Republike Srbije, br. 175075

  12. SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

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    Chee Wei Tay

    2013-01-01

    Full Text Available Objectives. We report the single-incision laparoscopic cholecystectomy (SILC learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04 after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004. Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC.

  13. Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

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    Galvez, Carlos; Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

    2017-01-01

    Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.

  14. Small-incision cataract extraction combined trabeculectomy for primary angle-closure glaucoma with cataract

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    Yu-Feng Wu

    2014-09-01

    Full Text Available AIM: To observe the curative effect of treating small-incision cataract extraction by intraocular lens implantation combined with trabeculectomy for primary angle-closure glaucoma with cataract. METHODS: Totally 44 cases(52 eyesof primary angle-closure glaucoma combined with cataract were selected to undergo the combined surgery, in order to observe the patients' pre- and postoperative eyesights, intraocular pressures and the postoperative complications.RESULTS: The postoperative eyesight was improved significantly as compared with the preoperative eyesight. The intraocular pressure was declined dramatically. The result was of statistical significance(P0.05. All the 52 cases' surgeries were performed by the same surgeon. The surgeries were processed smoothly, with 6 postoperative eyes of anterior chamber inflammation cell response, 3 eyes of anterior chamber fibrinoid exudate, 2 eyes of shallow anterior chamber through mydriasis and treatment with glucocorticoids and non-steroidal eyedrops before absorption, and no complications like malignant glaucoma, cyclodialysis, etc. were reported through mydriasis and pressure bandaging before recovery.CONCLUSION: Treating the primary angle-closure glaucoma combined with cataract through the combined surgery has high reliability and desirable curative effect. The surgical method is simple to learn and applicable for promotion on the basic level.

  15. Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study.

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    Kwag, Seung-Jin; Kim, Jun-Gi; Oh, Seong-Taek; Kang, Won-Kyung

    2013-09-01

    The purpose of the study was to evaluate the safety and effects of single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer by comparing it with conventional laparoscopic anterior resection (CLAR). Twenty-four patients who underwent SILAR between April 2010 and July 2011 were case matched 1:2 with patients who underwent CLAR, with respect to age, sex, body mass index, tumor location, and history of abdominal surgery. Two patients in the SILAR group and 1 patient in the CLAR group experienced anastomotic leakage. The operative time was longer in the SILAR group than in the CLAR group (251 ± 50 vs 237 ± 49 minutes; P = .253). The number of harvested lymph nodes (19.6 ± 10.7 vs 20.8 ± 7.7; P = .630) was not different. The postoperative hospital stay was shorter in the SILAR group (7.1 ± 3.4 days) than in the CLAR group (8.1 ± 3.5 days) (P = .234). On the basis of the early outcomes, we conclude that SILAR is feasible and safe. Moreover, the adequate lymph node harvest and free margins support the use of this procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Small incision lenticule extraction (SMILE) and femtosecond laser LASIK: comparison of corneal wound healing and inflammation

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    Dong, Zixian; Zhou, Xingtao; Wu, Jihong; Zhang, Zhehuan; Li, Tao; Zhou, Zimei; Zhang, Shenghai; Li, Gang

    2014-01-01

    Aim To evaluate and compare early corneal wound healing and inflammatory responses after small incision lenticule extraction (SMILE) versus femtosecond laser laser in situ keratomileusis (LASIK). Methods Thirty-six eyes of 36 rabbits underwent SMILE, while another 36 eyes of 36 rabbits were treated with femtosecond laser LASIK. All the eyes were subjected to the same refractive correction of −6.00 DS/−1.00 DC. Twelve eyes that had no surgery were included for control. After euthanisation, corneal tissue sections were evaluated with terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labelling (TUNEL) assay to detect apoptosis at postoperative 4 and 24 h, immunocytochemistry for Ki67 to detect keratocyte proliferation at postoperative day 3, week 1 and month 1, and immunocytochemistry for CD11b to detect inflammation at postoperative day 1, day 3 and week 1, respectively. Results No adverse effects were noted after SMILE or LASIK. Corneal healing postoperatively was uneventful in all cases. There were significantly fewer TUNEL-positive corneal stromal cells after the SMILE procedure at 4 and 24 h postoperatively (pLASIK procedure. In addition, immunocytochemistry showed significantly fewer Ki67-positive cells in the SMILE group than those in the femtosecond laser LASIK group at day 3 and week 1 postoperatively (pLASIK. PMID:24227802

  17. APE1 incision activity at abasic sites in tandem repeat sequences.

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    Li, Mengxia; Völker, Jens; Breslauer, Kenneth J; Wilson, David M

    2014-05-29

    Repetitive DNA sequences, such as those present in microsatellites and minisatellites, telomeres, and trinucleotide repeats (linked to fragile X syndrome, Huntington disease, etc.), account for nearly 30% of the human genome. These domains exhibit enhanced susceptibility to oxidative attack to yield base modifications, strand breaks, and abasic sites; have a propensity to adopt non-canonical DNA forms modulated by the positions of the lesions; and, when not properly processed, can contribute to genome instability that underlies aging and disease development. Knowledge on the repair efficiencies of DNA damage within such repetitive sequences is therefore crucial for understanding the impact of such domains on genomic integrity. In the present study, using strategically designed oligonucleotide substrates, we determined the ability of human apurinic/apyrimidinic endonuclease 1 (APE1) to cleave at apurinic/apyrimidinic (AP) sites in a collection of tandem DNA repeat landscapes involving telomeric and CAG/CTG repeat sequences. Our studies reveal the differential influence of domain sequence, conformation, and AP site location/relative positioning on the efficiency of APE1 binding and strand incision. Intriguingly, our data demonstrate that APE1 endonuclease efficiency correlates with the thermodynamic stability of the DNA substrate. We discuss how these results have both predictive and mechanistic consequences for understanding the success and failure of repair protein activity associated with such oxidatively sensitive, conformationally plastic/dynamic repetitive DNA domains. Published by Elsevier Ltd.

  18. Combined use of ultrasonic-assisted liposuction and semicircular periareolar incision for the treatment of gynecomastia.

    Science.gov (United States)

    Esme, Danielle L; Beekman, Werner H; Hage, J Joris; Nipshagen, Martine D

    2007-12-01

    Of the wide range of excisional and liposuction techniques used to correct gynecomastia, so far, no single one was suitable for all grades of gynecomastia. We introduce ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision as the standard surgical technique for all such grades. Twenty-eight men (aged 17 to 80 years) were consecutively treated from March 2004 through April 2006 for grade Ia (n = 3), Ib (n = 2), IIa (n = 6), IIb (n = 6), III (n = 8), or IV (n = 3) gynecomastia. Their characteristics and the outcome of surgery were retrospectively assessed. A mean of 848 mL (range, 300 to 1400 mL) of liquefied breast tissue was aspirated, and 31 g (range, 3 to 180 g) of fibroglandular tissue were excised per breast. No immediate or delayed adjuvant skin reduction was needed in any of the patients. Moderate postoperative ecchymosis was observed in 2 patients, but no complications were encountered in this series. The cosmetic outcome was good to excellent in all. UAL in combination with gland resection through a minimal caudal semicircular periareolar incision and conventional liposuction effectively corrects all grades of gynecomastia. This combination has little morbidity, requires no skin excision, and leads to uniformly good esthetic results.

  19. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty.

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    Milandt, Nikolaj; Nymark, Tine; Jørn Kolmos, Hans; Emmeluth, Claus; Overgaard, Søren

    2016-08-01

    Background and purpose - Iodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA). Methods - 20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation-75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions. Results - We found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees. Interpretation - The use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk.

  20. Raman spectroscopy of normal oral buccal mucosa tissues: study on intact and incised biopsies

    Science.gov (United States)

    Deshmukh, Atul; Singh, S. P.; Chaturvedi, Pankaj; Krishna, C. Murali

    2011-12-01

    Oral squamous cell carcinoma is one of among the top 10 malignancies. Optical spectroscopy, including Raman, is being actively pursued as alternative/adjunct for cancer diagnosis. Earlier studies have demonstrated the feasibility of classifying normal, premalignant, and malignant oral ex vivo tissues. Spectral features showed predominance of lipids and proteins in normal and cancer conditions, respectively, which were attributed to membrane lipids and surface proteins. In view of recent developments in deep tissue Raman spectroscopy, we have recorded Raman spectra from superior and inferior surfaces of 10 normal oral tissues on intact, as well as incised, biopsies after separation of epithelium from connective tissue. Spectral variations and similarities among different groups were explored by unsupervised (principal component analysis) and supervised (linear discriminant analysis, factorial discriminant analysis) methodologies. Clusters of spectra from superior and inferior surfaces of intact tissues show a high overlap; whereas spectra from separated epithelium and connective tissue sections yielded clear clusters, though they also overlap on clusters of intact tissues. Spectra of all four groups of normal tissues gave exclusive clusters when tested against malignant spectra. Thus, this study demonstrates that spectra recorded from the superior surface of an intact tissue may have contributions from deeper layers but has no bearing from the classification of a malignant tissues point of view.

  1. Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

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    Rodrigo Pedraza

    2013-01-01

    Full Text Available Introduction. Single-incision laparoscopic colectomy (SILC is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies ( and anterior resections (. There were no significant differences in operative time (127.9 versus 126.7 min, conversions (0 versus 1, complications (14% versus 8%, length of stay (4.5 versus 4.0 days, readmissions (2% versus 2%, and reoperations (2% versus 2%. Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

  2. Long-term Results of Small-incision Lenticule Extraction in High Myopia

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    Yusuf Yıldırım

    2016-10-01

    Full Text Available Objectives: To evaluate two-year results of small-incision lenticule extraction (SMILE for correction of high myopia. Materials and Methods: Forty-five eyes of 35 patients with mean spherical equivalent (SE of -7.10±0.95 D who underwent routine SMILE by a single surgeon and were followed for at least 2 years were analyzed by retrospective chart review. SMILE was performed with a Visumax femtosecond laser (Carl Zeiss Meditec, Jena, Germany. Follow-up intervals were at 1, 6, 12, and 24 months after surgery. Uncorrected and best corrected distance visual acuity (CDVA, corneal wavefront measurements, and all complications were recorded. Results: After 2 years, 86% of eyes with plano target had an uncorrected distant visual acuity (VA of 20/20 or better. Two percent of eyes lost 1 line of CDVA, while 32% gained 1 line. The mean SE after 2 years was -0.30±0.50 D. Corneal total high-order aberrations (HOA increased from 0.43 to 0.92 μm at postoperative 12 months. There were metallic foreign bodies at the corneal interface in 1 eye of 1 patient which caused no decrease in VA. Conclusion: SMILE for high myopia seems safe and effective in light of two-year follow-up results. The procedure caused a moderate increase in HOA.

  3. Effects of intraoperative irradiation on gastric and urinary bladder incisions in the dog

    International Nuclear Information System (INIS)

    Craig, J.A.; Sigler, R.; Walker, M.

    1985-01-01

    Fourteen adult dogs of mixed breeding were given intraoperative irradiation (25 Gy) after surgical incisions were made into the greater curvature of the stomach and the ventral surface of the urinary bladder. Sequential biopsy samples were obtained 10 days to 180 days after surgical operation. All irradiated stomachs developed gastritis and persistent ulceration of the irradiated field. Microscopic changes induced by irradiation of both the bladder and stomach progressed from severe submucosal edema to severe submucosal fibrosis. A parallel progression of fibrinoid degeneration of the small blood vessels was seen in both organs. Severe gastric ulceration persisted up to 180 days after irradiation, although a degree of mucous neck cell and gastric gland regeneration did occur. Pathologic changes were less severe in the bladder than in the stomach. The bladder had greater resiliency and capability for healing and, in contrast to the stomach, showed a capability to reepithelialize the radiation-induced ulcers. Conclusions of this study are as follows: (a) the canine urinary bladder tolerated intraoperative radiation therapy after tissue resection better than did the canine stomach, (b) the combination of surgical operation and irradiation resulted in a more prolonged and complicated healing pattern than did either procedure alone, and (c) the introduction of a surgical procedure upon irradiated tissue within an undetermined time span relative to irradiation resulted in a similar pattern of disturbed healing

  4. Tenon’s Cyst Presenting as a Long-Term Complication following Incision Cataract Surgery

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    Prabhakar Srinivasapuram Krishnacharya

    2013-01-01

    Full Text Available Context. Tenon’s cyst or conjunctival cyst formation is not uncommon late complication of traditional extracapsular cataract surgery; however, few reports are available in the literature. Aims. Large cystic swellings were clinically diagnosed as filtering blebs at the cataract incision site in two patients. The purpose of the case presentation is to discuss the factors leading to cyst formation, visual loss and cyst recurrence after its excision. Patients and Methods. Case 1. Sixty-one-year-old male patient presented with a bleb at superior limbal region in the right eye, two years after cataract surgery. Case 2. A giant bleb was found at the same region in the right eye of a 65-year-old male patient, eight years after cataract surgery. Results. Complete excision of the cyst was performed with conjunctival autograft in the first patient and followed up for two years. No recurrence of the cyst was observed. Internal wound gaping was seen on gonioscopy in the second patient. Conclusions. Unstable scleral tunnel could explain bleb formation in both the patients. Complete bleb excision with conjunctival auto-graft resulted in closure of the defect with no bleb recurrence during two-year follow-up. Over-filtration causing hypotonic maculopathy was the reason for decreased vision in the second case.

  5. Single-incision laparoscopic appendectomy using homemade glove port at low cost

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    Sang Myoung Lee

    2016-01-01

    Full Text Available Purpose: The aim of this study was to report homemade glove port technique for single-incision laparoscopic appendectomy (SILA. Materials and Methods: Our homemade glove port was composed of a size 6 latex sterile surgical glove, a sterilized plastic bangle, and three pieces of silicon tube (5 cm in length that were used as the suction tube. Clinical data were retrospectively collected from those patients who underwent SILA at Bucheon St. Mary's Hospital, Bucheon, Gyeonggi-do, South Korea between February 2014 and June 2014, including patient demographics, and operative and postoperative outcomes. To compare the outcomes, a retrospective review was performed for those patients who underwent conventional laparoscopic appendectomy (CLA between October 2013 and January 2014. Both SILA and CLA were performed by the same surgical team. Results: The SILA and CLA groups included 37 and 57 patients, respectively. The mean age, weight, body mass index (BMI, operation time, and pathologic diagnosis of gangrenous appendicitis were not significantly different between the two groups. However, the mean hospital stay in the CLA group was significantly (P = 0.018 longer than that in the SILA group (4.2 days vs 3.5 days. There was no conversion to open surgery in both the groups. Of the cases who underwent SILA, 10 (27.0% needed insertion of additional port and drain. There was one (3.2% complication of umbilical surgical site infection. Conclusion: In this study, SILA, with homemade glove port, was technically feasible and safe at low cost.

  6. Intrauterine endometrial cyst after low uterine incision: A case report with literature review.

    Science.gov (United States)

    Yin, Weiyao; Zhang, Jiawen; Xu, Liangzhi; Luo, Li

    2018-04-01

    During the surgical procedure, endometrial cells can be seeded into the wound edge of the uterine wall, developing into scar endometriosis. Due to the extremely low incidence, estimation of its prevalence is still unavailable. Even rarer might be the scar endometriosis in uterine cavity, to our best knowledge, a situation has not been reported yet. A 37-year-old woman complained of heavier and prolonged menstruation as well as pelvic pain during menses for more than 4 months. An endometrial cyst in diameter of 6 cm in uterine cavity was revealed by transvaginal ultrasound. Her surgical history was significant for 1 caesarean section and 1 abdominal myomectomy through transverse incision of lower uterine segment. Space-occupying lesions in uterine cavity, moderate anemia and scar uterus. The hysteroscopy was performed and a multilocular cyst full of chocolate-like fluid was removed. Pathological examination confirmed endometrial glands in the removed cyst tissue. During the follow-up visits at 1 and 6 months after surgery, the patient denied any special discomfort. Her postoperative transvaginal ultrasound showed an enlarged uterus with no lesion in uterine cavity. To achieve a better surveillance, a 3-year period of follow-up after surgery at a 6-month interval was suggested. Intrauterine endometriosis should be considered in patients of pelvic surgery history with pelvic pain, menstrual disorder, and intrauterine cystic mass.

  7. Risk factors for incomplete healing of the uterine incision after cesarean section.

    Science.gov (United States)

    Chen, Yan; Han, Ping; Wang, Yi-Jia; Li, Yan-Xia

    2017-08-01

    To analyze related risk factors of post-cesarean scar defects (PCSDs). A retrospective study of full-term women delivered by cesarean with singleton infants at our hospital from April 2014 to December 2015 was performed. 69 cases of diagnosed PCSDs and 107 cases with no PCSD who accepted cesarean were recruited for analysis. Individual medical case and operative report review were retrieved for maternal clinical characteristics analysis. There was no difference in age, gestational age, BMI and baby's weight between the two groups. PCSD group has more cases of anemia, higher neutrophil percentage and more cases of elected cesarean and emergency cesarean than controls (all p cesarean, there were more cases with cervix dilated larger than 3 cm in operation and more cases received cesarean at least one time before. In addition, women with cesarean interval of at least 5 years, women with ultrasonic measured echo longer than 3 cm, women with poor healing in uterine incision, women with retroposition of uterus and women who had intrauterine separation are more prone to develop PCSDs. The occurrence of a defective uterine scar after cesarean section is primarily a by-product of the combination of multiple factors: age ≥30 years, BMI ≥27.30, premature rupture of membranes, elective cesarean section, post-operative anemia, WBC count ≥12.5 × 10 9  g/L and retroposition of uterus. These are high risk factors of PCSDs.

  8. Curative effects of small incision cataract surgery versus phacoemulsification: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Chang-Jian Yang

    2013-08-01

    Full Text Available AIM: To evaluate the curative efficacy of small incision cataract surgery(SICSversus phacoemulsification(Phaco.METHODS: A computerized literature search was carried out in Chinese Biomedical Database(CBM, Wanfang Data, VIP and Chinese National Knowledge Infrastructure(CNKIto collect articles published between 1989-2013 concerning the curative efficacy of SICS versus Phaco. The studies were assessed in terms of clinical case-control criteria. Meta-analysis were performed to assess the visual acuity, the complications rates between SICS and Phaco 90 days after surgery. Treatment effects were measured as risk difference(RDbetween SICS and Phaco. Fixed and random effect models were employed to combine results after a heterogeneity test. RESULTS:A total of 8 studies were included in our Meta-analysis. At 90 days postoperative time, there were no significant differences between the two groups at the visual acuity >0.5(P=0.14; and no significant differences on the complications rates of corneal astigmatism, corneal edema, posterior capsular rupture and anterior iris reaction(P>0.05.CONCLUSION: These results suggest that there is no different on the curative effects of SICS and Phaco for cataract.

  9. High-power diode laser in the circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a prospective case series study.

    Science.gov (United States)

    Jaeger, Filipe; Chiavaioli, Gustavo Marques; de Toledo, Guilherme Lacerda; Freire-Maia, Belini; Amaral, Marcio Bruno Figueiredo; Mesquita, Ricardo Alves

    2018-01-01

    The incisions during orthognathic surgery are classically performed with conventional scalpel or electrocautery. Considering that the high-power diode laser surgery may provide advantages when compared to conventional incision techniques, the current study aimed to present a prospective case series of patients submitted to circumvestibular incision for Le Fort I osteotomy. Ten patients with dentofacial deformities who underwent to rapid assisted maxillary expansion or bimaxillary orthognathic surgery were enrolled in the study. All incisions were performed by a single surgeon using an 808-nm diode laser, with an optical fiber of 600 μm, at a power of 2.5 W, in a continuous-wave mode. The performance of the incision was evaluated by incision velocity, bleeding, edema, secondary infection, clinical healing, and pain. The velocity of the incision ranged from 0.10 to 0.20 mm/s (mean 0.13 ± 0.03 mm/s). Considering bleeding during the soft tissue incision, all surgeries were classified as absent bleeding. All patients presented a clinical healing of the surgical wound in a period that range from 3 to 5 weeks and experienced swelling during the follow-up period. On average, approximately 50% of the swelling had resolved after the third postoperative week, and 28.8% of swelling remained after 2 months after the surgery. The pain decreased after 2 and 3 days, and 90.0% of the patients reported no pain after 7 postoperative days. High-power diode laser is effective and safety during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgery decreasing bleeding, surgery time, pain, and edema after orthognathic surgery.

  10. Histomorphological and immunofluorescence evaluation of clear corneal incisions after microcoaxial phacoemulsification with 2.2 mm and 1.8 mm systems.

    Science.gov (United States)

    Vasavada, Abhay R; Johar, Kaid; Praveen, Mamidipudi R; Vasavada, Viraj A; Arora, Anshul I

    2013-04-01

    To compare changes in the incision's histomorphology and denaturation of collagen I in rabbit eyes having microcoaxial phacoemulsification through 2.2 mm and 1.8 mm incision-compatible systems. Randomized experimental trial. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Thirty rabbit eyes were randomized into Group 1 (microcoaxial phacoemulsification through 2.2 mm incisions using Infiniti system [torsional ultrasound]) and Group 2 (microcoaxial phacoemulsification through 1.8 mm incisions using Stellaris system [longitudinal ultrasound]). Each group was then divided into 3 subgroups of 5 eyes each based on 1 of the 3 intervention options: phacoemulsification only, intraocular lens (IOL) insertion only, and phacoemulsification with IOL insertion. Left eyes were randomized for microcoaxial phacoemulsification, and right eyes were treated as controls. After phacoemulsification, eyes in Group 1 showed loss of epithelium at the roof of the incisions and Descemet membrane detachment at the floor of the incisions. These findings did not change after IOL insertion. After phacoemulsification, eyes in Group 2 showed loss of epithelium, but Descemet membrane remained attached. There was a longitudinal split in the incision's stroma in the direction of internal entry. The stromal damage increased after IOL implantation. Immunofluorescence studies showed no obvious irregularities in the arrangement of collagen I in either group. A dot blot analysis showed significant denaturation of collagen I in Group 2. The histomorphology of the 2.2 mm system incision showed localized Descemet membrane detachment and endothelial cell loss. The 1.8 mm system incision showed exaggerated stromal damage after IOL insertion. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  11. [One-stage Operation through the Same Skin Incision for Synchronous Double Primary Breast and Lung Cancer;Report of a Case].

    Science.gov (United States)

    Takahashi, Noriyuki; Kuga, Yoko; Uno, Satoko; Saito, Keita

    2018-02-01

    A 75-year-old woman noticed a small mass in the right side breast and consulted our hospital. The results of the detailed examination indicated the synchronous double primary right breast cancer and the same side lung cancer (rS5). One-stage operation from the same skin incision was scheduled. Volume rendering (VR) of computed tomography (CT)-scan was very useful in deciding the position and the length of the skin incision. The breast tumor resection and the right middle lobe resection were successfully performed through 6.5 cm skin incision.

  12. Simulation tools

    CERN Document Server

    Jenni, F

    2006-01-01

    In the last two decades, simulation tools made a significant contribution to the great progress in development of power electronics. Time to market was shortened and development costs were reduced drastically. Falling costs, as well as improved speed and precision, opened new fields of application. Today, continuous and switched circuits can be mixed. A comfortable number of powerful simulation tools is available. The users have to choose the best suitable for their application. Here a simple rule applies: The best available simulation tool is the tool the user is already used to (provided, it can solve the task). Abilities, speed, user friendliness and other features are continuously being improved—even though they are already powerful and comfortable. This paper aims at giving the reader an insight into the simulation of power electronics. Starting with a short description of the fundamentals of a simulation tool as well as properties of tools, several tools are presented. Starting with simplified models ...

  13. Histological Study of Induced Incisions on Rabbits’ Tongues with Three Diode Lasers with Different Wavelengths in Continuous Mode

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    Salwa Yammine

    2018-01-01

    Full Text Available Objective. Diode lasers have multiple indications in everyday dental practice. They allow carrying out incisions, coagulation of soft tissue, and Low-Level Laser Therapy. The goal of this study is to compare histologically the tissue interaction zones and edges of an induced laser incision on rabbits’ tongues with three different wavelengths of 810, 940, and 980 nm in continuous mode. Methods. Fourteen male rabbits were divided into six groups. Each animal underwent three incisions of 10 mm length on the right ventral face of the tongue, carried out in continuous mode with three diode lasers with different wavelengths of 810, 940, and 980 nm. Rabbits were sacrificed at 0, 1, 2, 6, and 15 hours and 14 days. Five rabbits were sacrificed at 0 hours and 2 hours and one rabbit was sacrificed at 1, 6, and 15 hours and at 14 days. The appearance of neutrophils marked the onset time of the inflammatory reaction. Histological study of the incisions was chosen to evaluate the edges and to measure the depth and width of carbonization and necrotic and inflammatory zones. Healing was evaluated at 14 days. Friedman test was used to assess statistical differences between groups. Results. In the experimental adopted conditions, the carbonization zone was marked by degradation of vacuoles and an elongation of nuclei and was observed on the edges of incisions. Carbonization and necrotic and inflammatory zones were measured for rabbits sacrificed at 0, 1, 2, 6, and 15 hours but the onset of inflammation zone marked by the infiltration of neutrophils did not appear before 6 hours. The neutrophils infiltration was higher at 15 hours than at 6 hours. Complete healing was shown at 14 days. According to the time for the regularity of the edges, the interpretation was qualitative without a statistical test. The statistical analysis of the three different diode lasers in this study showed nonsignificant difference between the different groups for the depth (p=0

  14. [Management of moderate to severe pediatric concealed penis in children by Devine's technique via incision between the penis and scrotum].

    Science.gov (United States)

    Zhang, Xin-Sheng; Liu, Shi-Xiong; Xiang, Xue-Yan; Zhang, Wen-Gang; Tang, Da-Xing

    2014-04-01

    To search for a simple and effective surgical approach to the management of moderate to severe pediatric concealed penis in children. We used Devine's technique via incision between the penis and scrotum in the treatment of 68 cases of moderate to severe pediatric concealed penis. The patients were aged 3 -13 (mean 6.5) years, 30 with moderate and 38 with severe pediatric concealed penis. This strategy achieved good near- and long-term effects and satisfactory appearance of the penis, which was similar to that of circumcision. At 3 months after surgery, the penile length was 3 - 5.2 cm, averaging (2.35 +/- 0.35) cm. Devine's technique via incision between the penis and scrotum is a simple and effective surgical option for moderate to severe pediatric concealed penis in children.

  15. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

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    Fujioka Hiroyuki

    2012-12-01

    Full Text Available Abstract The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  16. Objective and subjective outcome in 42 patients after treatment of sialolithiasis by transoral incision of Warthon's duct

    DEFF Research Database (Denmark)

    Juul, Marie Louise; Wagner, Niels

    2014-01-01

    In this retrospective follow-up study, we present the middle-term results of transoral removal of submandibular calculi by incision in the floor of the mouth together with a patient satisfaction survey. These results will be compared with those of international studies. This is an individual...... retrospective cohort follow-up study. Forty-two patients had salivary calculi removed by incision in the mouth in the period from August 2009 to July 2012 at the Ear-nose-throat department of the North Zealand Hospital, Hillerød, Denmark. A retrospective study was carried out, focusing on the effects...... of the surgery and on patient satisfaction. The patients completed a questionnaire and underwent an objective physical exam. We found a high success rate (93 %), high patient satisfaction (94 %) and a high number of patients with no symptoms (92 %). In 94 % of the patients the gland was preserved, and there were...

  17. Sonographic Appearance of Abdominal Wall at the Left Flank of Laparotomy Incision Site in Ettawah Grade Does

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    M. F. Ulum

    2014-12-01

    Full Text Available The aim of this study was to describe the sonographic appearance of abdominal wall at the left flank of laparotomy incision site in 11 mated Ettawah grade does. Brightness-mode ultrasound examination by using transducer with frequency of 5.0-6.0 MHz was conducted to grouping the does based on their pregnancy statuses. The incision site of the abdominal wall at left flank laparotomy was transcutaneous-scanned as long as 8 cm vertically. The sonographic appearance of the laparotomy wall thickness showed that in all groups of does were similar and not different statistically. The thickness of oblique external and oblique internal abdominal muscles increased in the pregnant does as compared to non-pregnant does (P<0.05.

  18. [Treatment of gynecomastia by a combined method of liposuction and semicircular periareolar incision glandular organ partial resection].

    Science.gov (United States)

    Liu, Su; Kuang, Ruixia; Chen, Zhenyu; Li, Huichao; Zhang, Weina; Wang, Zhiguo; Miao, Yuanxin; Chen, Lu

    2008-12-01

    To evaluate the effect of the combined method of liposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia. From June 2004 to June 2006, 40 patients, aged 11-41 years old, were treated, with no-nodule (n = 10), nodule (n = 22) and female-breast-like with nodules (n = 8). Three patients were unilateral and 37 ones were bilateral. The levels of serum prolactin, luteinizing hormone, follicle stimulating hormone, estradiol, testosterone and cortisol were normal in 38 patients, while in the other 2 patients, the levels of serum prolactin, luteinizing hormone, follicle stimulating hormone and estradiol were higher than normal, and the testosterone level was lower. Liposuction alone was performed in 10 no-nodule patients (lipo-type), and combined liposuction and semicircular periareolar incision glandular organ partial resection were conducted in the other 30 patients (lipo-glandular type). RESULTS; Except for 2 cases in which hematoma and a small amount of effusion were found on the first and second day postoperatively and then obtained healing by first intention right after hematoma removal in time, all the other patients incisions obtained healing by first intention. Nipple numbness occurred in 3 cases on the first day postoperatively and no special treatment was conducted. There was still nipple hypesthesia in these 3 cases after 6-month follow-up. There were no complications such as hematoma, effusion, nipple and mammary areola necrosis, and nipple hypesthesia in other patients. All the 40 patients were followed up for 6-24 months (13 months on average). They were satisfied with their chest figures and no recurrence was observed. The combined method of liposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia has many advantages, such as safe, micro-scars, natural and beautiflhl male breast figures as well as high patients' satisfaction.

  19. Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement

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    Cooper R. Benson

    Full Text Available ABSTRACT Purpose We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP. Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. Materials and Methods We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. Results The mean patient age was 61 (SD, 7.5 years with mean body mass index of 31 (SD, 5.9. The average pre-operative pad usage was 7.7 (SD 1.63 pads per day. The mean follow-up was 13.9 months (SD 9.45. Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. Conclusions We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

  20. Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

    Science.gov (United States)

    Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

    2018-05-18

    To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

  1. Removable thermoplastic appliances modified by incisal cuts show altered biomechanical properties during tipping of a maxillary central incisor.

    Science.gov (United States)

    Brockmeyer, Phillipp; Kramer, Katharina; Böhrnsen, Florian; Gruber, Rudolf Matthias; Batschkus, Sarah; Rödig, Tina; Hahn, Wolfram

    2017-08-28

    The present study aimed to evaluate the force delivery of removable thermoplastic appliances (RTAs), modified by different sized incisal cuts, during tipping of a maxillary central incisor in palatal and vestibular direction. Forty-five RTAs from three different materials (Biolon®, Erkodur®, Ideal Clear®) of the same thickness (1 mm) were used. Analysis was performed on a separated maxillary central incisor which was part of a resin model with a complete dentition. In 15 RTAs, of different material, a cut was inserted at the incisal edge of tooth 11. In 15 other appliances, the cut was extended to teeth 12 and 21. Fifteen aligners remained uncut. The experimental tooth was tipped starting from the zero position in 0.05° steps to a maximal deflection of ± 0.42° of the incisal edge in vestibular and palatal direction, after positioning the RTA onto the model. The horizontal (Fx) and the vertical (Fz) force components were decreased by approximately half with increasing cut size. Fz values changed during palatal tipping from a weak intrusive force, for aligners without cut, to an extrusive force with increasing cut size. Compared to both other materials used (Erkodur® and Ideal Clear®), the Biolon® aligners showed significantly higher Fx and Fz values (p < 0.0001, respectively). RTAs modified by different sized incisal cuts show altered biomechanical properties and an inversion of the vertical force component, during tipping of a maxillary central incisor.

  2. Removable thermoplastic appliances modified by incisal cuts show altered biomechanical properties during tipping of a maxillary central incisor

    Directory of Open Access Journals (Sweden)

    Phillipp Brockmeyer

    2017-08-01

    Full Text Available Abstract Background The present study aimed to evaluate the force delivery of removable thermoplastic appliances (RTAs, modified by different sized incisal cuts, during tipping of a maxillary central incisor in palatal and vestibular direction. Methods Forty-five RTAs from three different materials (Biolon®, Erkodur®, Ideal Clear® of the same thickness (1 mm were used. Analysis was performed on a separated maxillary central incisor which was part of a resin model with a complete dentition. In 15 RTAs, of different material, a cut was inserted at the incisal edge of tooth 11. In 15 other appliances, the cut was extended to teeth 12 and 21. Fifteen aligners remained uncut. The experimental tooth was tipped starting from the zero position in 0.05° steps to a maximal deflection of ± 0.42° of the incisal edge in vestibular and palatal direction, after positioning the RTA onto the model. Results The horizontal (Fx and the vertical (Fz force components were decreased by approximately half with increasing cut size. Fz values changed during palatal tipping from a weak intrusive force, for aligners without cut, to an extrusive force with increasing cut size. Compared to both other materials used (Erkodur® and Ideal Clear®, the Biolon® aligners showed significantly higher Fx and Fz values (p < 0.0001, respectively. Conclusions RTAs modified by different sized incisal cuts show altered biomechanical properties and an inversion of the vertical force component, during tipping of a maxillary central incisor.

  3. Application on small incision extracapsular cataract extraction in large-scale vision recovery action in Shaanxi Province

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    Juan Zhang

    2014-09-01

    Full Text Available AIM: To investigate the characteristics of scale cataract operations and the effects and experiences of small incision extracapsular cataract extraction with intraocular lens(IOLimplantation in large-scale vision recovery action. METHODS: Four thousand eight hundred ninety-two cases(4 892 eyesof cataract were treated by small incision non-phacoemulcification cataract extraction from March 2010 to November 2011 in our hospital(Fuming No.1 surgery car of Shaanxi Provincewhich were retrospectively analyzed. Visual acuity, intraoperative and postoperative complications, the recovery of postoperative inflammation were observed. RESULTS: Visual acuity reached 0.3 or more in 4 521 eyes(92.42%at 1d after the operation, at 3d after the operation in 4 571 eyes(93.44%, there were 4 887 eyes with IOL implantation, implantation rate was 99.90%. All the cases had lesser intraoperative and postoperative complications, and the postoperative inflammation recovered quickly. CONCLUSION: Small incision extracapsular cataract extraction with IOL implantation is simple, effective, economical, safe and adapting for large-scale vision recovery action.

  4. 10Be and 26Al dating of river terraces and quaternary incision rates in the Ardenne massif (eastern Belgium)

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    Rixhon, G.; Braucher, R.; Siame, L.; Bourlès, D.; Demoulin, A.

    2009-04-01

    Because of the lack of reliable chronological data, the Quaternary evolution of the hydrographic network of the Ardennes (western continuation of the Rhenish shield, western Europe) remains still poorly known. Therefore, we measured the cosmogenic nuclides content (10Be and 26Al) of terrace sediments of Ardennian rivers (Meuse, Ourthe & Amblève) in order to date several terrace levels and to better constrain the Quaternary incision of the network. Though these dating methods are successfully used to determine ages of superficial (e.g., glacial) deposits, dating of fluvial terraces remains difficult. Possible predepositional exposures of the sampled material (inherited 10Be and 26Al) may indeed bias the measurements towards higher nuclide concentrations while several postdepositional processes (burial, erosion) may cause a lowering of the 10Be and 26Al concentrations. In an attempt to overcome these difficulties, the selected fluvial deposits (six locations) were sampled using a profiling technique on as thick as possible sections (more than 3 m). While previous studies assigned an early middle Pleistocene age (around 800 ka) to the main terrace level in the Rhine-Meuse system, our 10Be dates for the same terrace level (according to geometrical correlation) in the Amblève River, a Meuse subtributary, are much younger (upper Pleistocene). To explain this age discrepancy, we suggest that the incision was strongly diachronous from the Meuse valley towards its Ardennian headwaters, as a result of a delayed upstream propagation of the incision wave when it passes tributary junctions.

  5. Short-term pre- and post-operative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception.

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    Cao, Jing; Wang, Po-Kai; Tiwari, Vinod; Liang, Lingli; Lutz, Brianna Marie; Shieh, Kun-Ruey; Zang, Wei-Dong; Kaufman, Andrew G; Bekker, Alex; Gao, Xiao-Qun; Tao, Yuan-Xiang

    2015-12-02

    Chronic stress has been reported to increase basal pain sensitivity and/or exacerbate existing persistent pain. However, most surgical patients have normal physiological and psychological health status such as normal pain perception before surgery although they do experience short-term stress during pre- and post-operative periods. Whether or not this short-term stress affects persistent postsurgical pain is unclear. In this study, we showed that pre- or post-surgical exposure to immobilization 6 h daily for three consecutive days did not change basal responses to mechanical, thermal, or cold stimuli or peak levels of incision-induced hypersensitivity to these stimuli; however, immobilization did prolong the duration of incision-induced hypersensitivity in both male and female rats. These phenomena were also observed in post-surgical exposure to forced swimming 25 min daily for 3 consecutive days. Short-term stress induced by immobilization was demonstrated by an elevation in the level of serum corticosterone, an increase in swim immobility, and a decrease in sucrose consumption. Blocking this short-term stress via intrathecal administration of a selective glucocorticoid receptor antagonist, RU38486, or bilateral adrenalectomy significantly attenuated the prolongation of incision-induced hypersensitivity to mechanical, thermal, and cold stimuli. Our results indicate that short-term stress during the pre- or post-operative period delays postoperative pain recovery although it does not affect basal pain perception. Prevention of short-term stress may facilitate patients' recovery from postoperative pain.

  6. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment.

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    Mohr, Stefan; Siegenthaler, Franziska; Imboden, Sara; Kuhn, Annette; Mueller, Michael D

    To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." Explanatory video demonstrating the technique and intraoperative findings. University hospital. The 68-year-old patient was referred with a vaginal mesh erosion that resulted in abscess formation at the vaginal apex. The patient was symptomatic with an increasingly foul-smelling vaginal discharge for about 1 year. She had a laparoscopic sacrocolpopexy in a remote hospital 22 months before the current operation and had a total abdominal hysterectomy 15 years ago. The, patient's history was uneventful without dyspareunia, incontinence or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. The local institutional review board granted exemption for this publication. Frequently, pelvic organ prolapse can only be effectively treated if the surgical procedure comprises support of the central compartment. Laparoscopic sacrocolpopexy shows superior outcomes for this indication, with success rates of up to 96%. However, a rare side effect of laparoscopic sacrocolpopexy is mesh erosion, occurring in up to 2.4% [1]. These erosions are usually treated laparoscopically [2]. In this video we show an alternative route for excision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess irrigation and mesh excision with minimally invasive instruments. For treatment of the abscess and removal of the exposed mesh, the SILS trocar was placed vaginally, and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Because no mesh material was exposed after excision, the vagina was not closed to avoid creating a cavity with the risk of promoting reabscess formation, and secondary wound healing was anticipated. Laparoscopy was used to confirm that no intra-abdominal lesion coexisted or occurred. There were

  7. Effect of smile index and incisal edge position on perception of attractiveness in different age groups.

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    Chou, J-C; Nelson, A; Katwal, D; Elathamna, E N; Durski, M T

    2016-11-01

    Changes in occlusal vertical dimension (OVD) and age have been found to affect Smile Index (SI, width/height of smile). Limited information is available regarding the aesthetic effects of these changes. The objective of this study was to evaluate the attractiveness of digitally manipulated smile images with differences in SI and incisal edge position (IEP) judged by respondents in different age groups. A total of 12 smile images were generated with varying SI (3·5, 5·3, 7·2, 9·0) and IEP (High, Medium, Low). Fifty respondents each in four age groups (15-24, 25-39, 40-54, 55+) evaluated the attractiveness of the 12 images using a 0-10 visual analog scale (VAS, 10 being most attractive). A repeated-measures three-factorial mixed model assessed differences. SI, IEP and age of respondents were found to significantly influence attractiveness score (P age groups combined, SI = 7·2/IEP = Medium was most attractive (VAS = 7·22), followed by SI = 9·0/IEP = Medium, and SI = 5·3/IEP = Medium (VAS = 6·53 and 6·48, respectively). SI = 3·5/IEP = High and SI = 3·5/IEP = Low were least attractive (VAS = 1·99 and VAS = 2·58, respectively). Age group significantly influenced aesthetic perception, with younger respondents more critical in differences in SI and IEP. SI and IEP significantly influenced attractiveness of the smile in all respondent age groups. Low SI (i.e. 3·5) combined with high or low IEP was unattractive. Medium SI to high SI (i.e. 5·3-9·0) combined with medium IEP were considered attractive. © 2016 John Wiley & Sons Ltd.

  8. Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

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    Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim

    2015-06-01

    The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.

  9. Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature.

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    Bhat, Amilal; Gandhi, Ajay; Saxena, Gajendra; Choudhary, Gautam Ram

    2010-10-01

    Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature. Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plication was added according to the severity of curvature. Feasibility of preputial reconstruction was assessed by applying 3 stay sutures-the first to fix the skin at the corona, the second at the junction of the inner and outer preputial skin for pulling up the skin over the glans, and the third stay on penile skin at the level of the corona for retracting the skin. Preputial reconstruction consisted of a standard 3 layered re-approximation of the margins of the dorsal hood. Age of the patients varied from 10 months to 21 years with an average of 6 years and 4 months. Ventral curvature (mild 10, moderate 13, and severe 4 cases) was corrected by the mobilization of the urethral plate and spongiosum in 14 patients, 11 cases had mobilization of the proximal urethra in addition and 2 patients required single stitch dorsal plication with the above-mentioned steps. Two patients developed urethral fistula and 1 had preputial dehiscence. Preputioplasty with TIP is feasible in proximal hypospadias with curvature without increasing the complication rate. Postoperative phimosis can be prevented by on-table testing of the adequacy of preputial skin by 3 stay sutures.

  10. Single-incision laparoscopic surgery in a survival animal model using a transabdominal magnetic anchoring system.

    Science.gov (United States)

    Cho, Yong Beom; Park, Chan Ho; Kim, Hee Cheol; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho-Kyung

    2011-12-01

    Though single-incision laparoscopic surgery (SILS) can reduce operative scarring and facilitates postoperative recovery, it does have some limitations, such as reduction in instrument working, difficulty in triangulation, and collision of instruments. To overcome these limitations, development of new instruments is needed. The aim of this study is to evaluate the feasibility and safety of a magnetic anchoring system in performing SILS ileocecectomy. Experiments were performed in a living dog model. Five dogs (26.3-29.2 kg) underwent ileocecectomy using a multichannel single port (OCTO port; Darim, Seoul, Korea). The port was inserted at the umbilicus and maintained a CO(2) pneumoperitoneum. Two magnet-fixated vascular clips were attached to the colon using an endoclip applicator, and it was held together across the abdominal wall by using an external handheld magnet. The cecum was then retracted in an upward direction by moving the external handheld magnet, and the mesocolon was dissected with Ultracision(®). Extracorporeal functional end-to-end anastomosis was done using a linear stapler. All animals survived during the observational period of 2 weeks, and then re-exploration was performed under general anesthesia for evaluation of intra-abdominal healing and complications. Mean operation time was 70 min (range 55-100 min), with each subsequent case taking less time. The magnetic anchoring system was effective in achieving adequate exposure in all cases. All animals survived and convalesced normally without evidence of clinical complication during the observation period. At re-exploration, all anastomoses were completely healed and there were no complications such as abscess, bleeding or organ injury. SILS ileocecectomy using a magnetic anchoring system was safe and effective in a dog model. The development of magnetic anchoring systems may be beneficial for overcoming the limitations of SILS.

  11. Comparison of Changes in Corneal Biomechanical Properties after Photorefractive Keratectomy and Small Incision Lenticule Extraction

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    Yusuf Yıldırım

    2016-04-01

    Full Text Available Objectives: To compare the postoperative biomechanical properties of the cornea after photorefractive keratectomy (PRK and small incision lenticule extraction (SMILE in eyes with low and moderate myopia. Materials and Methods: We retrospectively examined 42 eyes of 23 patients undergoing PRK and 42 eyes of 22 patients undergoing SMILE for the correction of low and moderate myopia. Corneal hysteresis (CH and corneal resistance factor (CRF were measured with an Ocular Response Analyzer before and 6 months after surgery. We also investigated the relationship between these biomechanical changes and the amount of myopic correction. Results: In the PRK group, CH was 10.4±1.3 mmHg preoperatively and significantly decreased to 8.5±1.3 mmHg postoperatively. In the SMILE group, CH was 10.9±1.7 mmHg preoperatively and decreased to 8.4±1.5 mmHg postoperatively. CRF was significantly decreased from 10.8±1.1 mmHg to 7.4±1.5 mmHg in the PRK group whereas it was decreased from 11.1±1.5 mmHg to 7.9±1.6 mmHg in the SMILE group postoperatively. There was a significant correlation between the amount of myopic correction and changes in biomechanical properties after PRK (r=-0.29, p=0.045 for CH; r=-0.07, p=0.05 for CRF and SMILE (r=-0.25, p=0.048 for CH; r=-0.37, p=0.011 for CRF. Conclusion: Both PRK and SMILE can affect the biomechanical strength of the cornea. SMILE resulted in larger biomechanical changes than PRK

  12. Regional anesthesia for small incision cataract surgery: Comparison of subtenon and peribulbar block

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    Oyebola Olubodun Adekola

    2018-01-01

    Full Text Available Background and Objective: The recent trend in cataract surgery is the use of regional ophthalmic nerve blocks or topical anesthesia. We determined and compared the effect of peribulbar and subtenon block on pain and patients' satisfaction, following small incision cataract surgery (SICS. Methods: This was age-sex-matched comparative study involving 462 ASA I-III patients, aged 18 years and above scheduled for SICS. They were assigned to receive either peribulbar block (Group P or subtenon (Group ST. The pain score and patients' satisfaction with the anesthetic experiences were recorded by a study-masked anesthesiologist during surgery and postoperatively at 30 min and 1, 2, 4, and 24 h. Results: The median numeric rating score was significantly lower in the subtenon group than the peribulbar group: During surgery, Group ST 1 (1 versus group P 1.5 (2.25, P < 0.001. At 30 min after surgery, Group ST 0 (1 versus Group P 1 (2.5 versus P < 0.001, and at 1 h after surgery, Group ST 0 (1 versus group P 1 (2, P = 0.002. Ten patients had akinesia in the peribulbar group compared with one in the subtenon group. Chemosis was significantly higher in the subtenon group 10 (3.2% than in the peribulbar group 0 (0%, P = 0.035. Similarly, a significant difference was not with subconjuctival hemorrhage; subtenon 14 (4.5% versus peribulbar 2 (1.3%, P = 0.105. Conclusion: The use of subtenon block resulted in lower pain scores and higher patient's satisfaction than peribulbar block. However, subconjuctival hemorrhage and chemosis were more common with subtenon block.

  13. Safety assessment of a new single-use small-incision injector for intraocular lens implantation.

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    Satanovsky, Alexandra; Ben-Eliahu, Shmuel; Apple, David J; Kleinmann, Guy

    2011-07-01

    To evaluate the safety of a new injector, the Raysert R-INJ-04/18, for implantation of the C-flex intraocular lens (IOL). Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel. Experimental study. Sixty IOLs were subdivided into 2 equally sized groups. Group A IOLs were injected using the established R-INJ-04 injector, and those in Group B were injected with the new injector. The IOLs were injected into a Petri dish. Subsequently, all IOLs and injectors were evaluated macroscopically and microscopically and then photographed under light microscopy (LM). Two IOLs in each group were randomly chosen and sent for evaluation by scanning electron microscopy (SEM) and energy dispersive analysis of x-ray. All remaining IOLs were sent for power and modulation transfer function (MTF) analysis. All Group B IOLs were successfully injected without evident signs of scratching, cracks, or deposits on LM and SEM examination. In Group A, findings were confined to a singular incidence of a small deposit detected on the periphery of the posterior optical surface of the IOL, with corresponding findings detected on the injector nozzle. No signs of scratching, cracks, or deposits were found in the rest of the IOLs or injectors. The power and MTF analyses were within the normal range for all IOLs. The new 1.8 mm external diameter soft-tipped injector for 2.4 to 2.2 mm incisions was shown to be safe for the implantation of the C-flex 21.0 diopter IOL. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  14. COMPLICATION AND VISUAL OUTCOME OF SMALL INCISION CATARACT SURGERY IN REACH IN CAMP CASES

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    Rajendra Kumar Behera

    2018-01-01

    Full Text Available BACKGROUND Cataract is the principal cause of blindness in India accounting for 62.6%. This problem can be tackled, and the backlog of cataract blind can be reduced by large scale cataract operations in reach in camps at Base Hospital approach for good visual outcome with lesser complications. MATERIALS AND METHODS In this retrospective study, 2400 cataract patients with vision less than 6/60 underwent uncomplicated sutureless small incision cataract surgery with intraocular lens implantation. Postoperative complication and visual acuity was recorded. RESULTS The most common operative complications were Descemet detachment (0.75%, posterior capsule rent with IOL implant (0.58% and premature entry (0.25%. Immediate postoperative complications were mainly corneal oedema (1.16%, severe iritis (1.5% and hyphema (0.5%. Late postoperative complications were iritis (0.69%, persistent corneal oedema (0.43% and papillary capture (0.17%. Majority (48.71% had visual acuity 6/9 on first followup in 45th day followed by visual acuity of 6/12 on 38.44% of cases. 71.23% of cases had astigmatism below -1.5 D cylinder at 90 degrees. CONCLUSION The overall vision-threatening complications after cataract surgery in the Base Hospital are low. Our study reflects the efficacy of Base Hospital approach in terms of visual and surgical outcome as an important aspect from the public health point of view, which can help in clearing the cataract backlog in developing countries like India.

  15. The effect of gabapentin and pregabalin on intestinal incision wound healing in rabbits

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    M. Korkmaz

    2015-03-01

    Full Text Available Aim: To evaluate the macroscopic and histologic effects of pregabalin (PG gabapentin (GB on longitudinal intestinal wound healing in New Zealand rabbits. Materials and Methods: The animals were divided into three groups randomly; the control group (n=6, PG group (n=6 and GB group (n=6. All animals were premedicated with xylazine HCI, 5 mg/kg i.m. and general anaesthesia was performed by ketamine HCI 50 mg/kg i.m injection. A 4 cm incision in the caecum through median laparotomy was achieved under aseptic surgery. Intestinal wound was closed with double-sutured. All animals were received parenteral antibiotic treatment for 5 days. PG and GB groups were treated by PG (30 mg/kg, oral, daily and GB (30 mg/kg, oral, daily for 10 days respectively. Control group did not receive any treatment. The animals were euthanized on day 10 and the caecum was examined by laparotomy. Adhesion formation was observed, and tissue samples were taken from suture lines for histologic examination. Cellular infiltration (polymorphonuclear white blood cells and mononuclear cells, accumulation of connective tissue, vascularization and extent of necrosis were evaluated and scored separately for each of mucosal, submucosal, muscular and serosal layers of caecum. Results: Adhesions were more severe in the GB group compared to other groups. No statistically significant differences were detected among the three groups about the wound healing. Conclusion: It was suggested that the use of gabapentinoids had no significant effect on wound healing in patients undergoing gastrointestinal surgery and further studies with treatment periods longer than 10 days are needed.

  16. Small intestinal submucosa for patch grafting after plaque incision in the treatment of Peyronie's disease

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    Eugene W. Lee

    2008-03-01

    Full Text Available OBJECTIVE: Report the results using porcine small intestinal submucosa (SIS as a graft material in the surgical management of Peyronie's disease (PD. MATERIALS AND METHODS: We performed a retrospective chart review of men with PD who underwent surgical correction of the curvature by plaque “H” incision and patch grafting with 4-ply SIS (Cook, Bloomington, IN by a single surgeon at our institution. Degree and direction of curvature, sexual function, and co-morbidities were assessed pre- and postoperatively. RESULTS: Thirteen patients were identified. Mean age was 57 ± 8, range 42-70 years. Median follow-up was 14 months, range 3-89 months. At presentation, all reported penile curvature. Also reported were difficulty with vaginal penetration (determined by question number 2 of the sexual encounter profile questionnaire - SEP2, palpable plaque, hourglass deformity, difficulty with firmness, and difficulty with sustaining erection (determined by SEP3 in77%, 69%, 77%, 62%, and 46% of patients, respectively. Mean and median degrees of curvature of the primary deformity were 71 and 67.5 degrees, respectively. Three patients had secondary curves of less than 30 degrees in a different direction. Mean and median plaque size were 3.5 and 2.7 cm², respectively. Seven patients had one graft and six patients had two grafts placed with a mean size of 15 ± 0 cm². CONCLUSIONS: For the patient with PD, SIS grafting can achieve a functionally straight erection with durable results yet with relatively high rates of erectile dysfunction. SIS is a viable graft material for use in the surgical treatment of PD.

  17. Enhancement After Myopic Small Incision Lenticule Extraction (SMILE) Using Surface Ablation.

    Science.gov (United States)

    Siedlecki, Jakob; Luft, Nikolaus; Kook, Daniel; Wertheimer, Christian; Mayer, Wolfgang J; Bechmann, Martin; Wiltfang, Rainer; Priglinger, Siegfried G; Sekundo, Walter; Dirisamer, Martin

    2017-08-01

    To report the feasibility and outcomes of surface ablation after small incision lenticule extraction (SMILE). In this retrospective evaluation of 1,963 SMILE procedures, 43 eyes (2.2%) were re-treated at three separate clinics. Of these, 40 eyes of 28 patients with a follow-up of at least 3 months were included in the analysis. During surface ablation, mitomycin C was applied for haze prevention. Spherical equivalent was -6.35 ± 1.31 diopters (D) before SMILE and -0.86 ± 0.43 D before surface ablation. Surface ablation was performed after a mean of 9.82 ± 5.27 months and resulted in a spherical equivalent of 0.03 ± 0.57 D at 3 months (P line. Corrected distance visual acuity (CDVA) remained unchanged with 0.01 ± 0.07 logMAR before versus -0.01 ± 0.05 logMAR after re-treatment (P = .99). Six eyes (15.0%) lost one line of CDVA, but final CDVA was 0.00 logMAR in four and 0.10 logMAR in two of these cases. The safety and efficacy indices were 1.06 and 0.90 at 3 months, respectively. Three of the four surface ablation profiles (Triple-A, tissue-saving algorithm, and topography-guided) resulted in equally good results, whereas enhancement with the aspherically optimized profile (ASA), used in two eyes, resulted in overcorrection (+1.38 and +1.75 D). Combined with the intraoperative application of mitomycin C, surface ablation seems to be a safe and effective method of secondary enhancement after SMILE. Due to the usually low residual myopia, the ASA profile is not recommended in these cases. [J Refract Surg. 2017;33(8):513-518.]. Copyright 2017, SLACK Incorporated.

  18. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish

    2016-10-01

    Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

  19. HYDROGEOMORPHIC SETTING, CHARACTERISTICS, AND RESPONSE TO STREAM INCISION OF MONTANA RIPARIAN MEADOWS IN THE CENTRAL GREAT BASIN--IMPLICATIONS FOR RESTORATION

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    Riparian wet meadow complexes in the mountains of the central Great Basin are scarce, ecologically important systems that are threatened by stream incision. An interdisciplinary group has investigated 1) the origin, characteristics, and controls on the evolution of these riparian...

  20. Resveratrol engages AMPK to attenuate ERK and mTOR signaling in sensory neurons and inhibits incision-induced acute and chronic pain

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    Tillu Dipti V

    2012-01-01

    Full Text Available Abstract Background Despite advances in our understanding of basic mechanisms driving post-surgical pain, treating incision-induced pain remains a major clinical challenge. Moreover, surgery has been implicated as a major cause of chronic pain conditions. Hence, more efficacious treatments are needed to inhibit incision-induced pain and prevent the transition to chronic pain following surgery. We reasoned that activators of AMP-activated protein kinase (AMPK may represent a novel treatment avenue for the local treatment of incision-induced pain because AMPK activators inhibit ERK and mTOR signaling, two important pathways involved in the sensitization of peripheral nociceptors. Results To test this hypothesis we used a potent and efficacious activator of AMPK, resveratrol. Our results demonstrate that resveratrol profoundly inhibits ERK and mTOR signaling in sensory neurons in a time- and concentration-dependent fashion and that these effects are mediated by AMPK activation and independent of sirtuin activity. Interleukin-6 (IL-6 is thought to play an important role in incision-induced pain and resveratrol potently inhibited IL-6-mediated signaling to ERK in sensory neurons and blocked IL-6-mediated allodynia in vivo through a local mechanism of action. Using a model of incision-induced allodynia in mice, we further demonstrate that local injection of resveratrol around the surgical wound strongly attenuates incision-induced allodynia. Intraplantar IL-6 injection and plantar incision induces persistent nociceptive sensitization to PGE2 injection into the affected paw after the resolution of allodynia to the initial stimulus. We further show that resveratrol treatment at the time of IL-6 injection or plantar incision completely blocks the development of persistent nociceptive sensitization consistent with the blockade of a transition to a chronic pain state by resveratrol treatment. Conclusions These results highlight the importance of signaling

  1. Plantar Fascia Release Through a Single Lateral Incision in the Operative Management of a Cavovarus Foot: A Cadaver Model Analysis of the Operative Technique.

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    Kiskaddon, Eric M; Meeks, Brett D; Roberts, Joseph G; Laughlin, Richard T

    2018-04-04

    Plantar fascia release and calcaneal slide osteotomy are often components of the surgical management for cavovarus deformities of the foot. In this setting, plantar fascia release has traditionally been performed through an incision over the medial calcaneal tuberosity, and the calcaneal osteotomy through a lateral incision. Two separate incisions can potentially increase the operative time and morbidity. The purpose of the present study was threefold: to describe the operative technique, use cadaveric dissection to analyze whether a full release of the plantar fascia was possible through the lateral incision, and examine the proximity of the medial neurovascular structures to both the plantar fascia release and calcaneal slide osteotomy when performed together. In our cadaveric dissections, we found that full release of the plantar fascia is possible through the lateral incision with no obvious damage to the medial neurovascular structures. We also found that the calcaneal branch of the tibial nerve reliably crossed the osteotomy in all specimens. We have concluded that both the plantar fascia release and the calcaneal osteotomy can be safely performed through a lateral incision, if care is taken when completing the calcaneal osteotomy to ensure that the medial neurovascular structures remain uninjured. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

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    Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

    2016-02-01

    The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

  3. Early Postoperative Nociceptive Threshold and Production of Brain-Derived Neurotrophic Factor Induced by Plantar Incision Are Not Influenced with Minocycline in a Rat: Role of Spinal Microglia

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    Eiji Masaki

    2016-03-01

    Full Text Available Background: Brain-derived neurotrophic factor (BDNF from spinal microglia is crucial for aberrant nociceptive signaling in several pathological pain conditions, including postoperative pain. We assess the contribution of spinal microglial activation and associated BDNF overexpression to the early post-incisional nociceptive threshold. Methods: Male Sprague-Dawley rats were implanted with an intrathecal catheter. A postoperative pain model was established by plantar incision. Thermal and mechanical nociceptive responses were assessed by infrared radiant heat and von Frey filaments before and after plantar incision. Rats were injected intrathecally the microglial activation inhibitor minocycline before incision, 24 h after incision, or both. Other groups were subjected to the same treatments and the L4-L5 spinal cord segment removed for immunohistochemical analysis of microglia activation and BNDF expression. Results: Plantar incision reduced both thermal latency and mechanical threshold, indicating thermal hypersensitivity and mechanical allodynia. Minocycline temporally reduced thermal withdrawal latency but had no effect on mechanical withdrawal threshold, spinal microglial activity, or dorsal horn BDNF overexpression during the early post-incision period. Conclusion: These results suggest that spinal microglia does not contribute substantially to post-incisional nociceptive threshold. The BDNF overexpression response that may contribute to postoperative hyperalgesia and allodynia is likely derived from other sources.

  4. Transversal incision of the vagina favors the remaining of the tape in the middle-third urethra compared to longitudinal incision during transobturator sling procedures for stress urinary incontinence.

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    Pirtea, L; Sas, I; Ilina, Razvan; Grigoraș, D; Mazilu, O

    2015-07-17

    To describe a new type of incision of the vagina during transobturator sling procedure and to evaluate by ultrasound the tape position at 3, 6 and 12 months after surgery. We conducted a prospective study including 51 patients with urinary stress incontinence who underwent sling procedure using the transversal vaginal incision. Tape position was evaluated by ultrasound at 3, 6 and 12 months after surgery and expressed as a percentage of the urethral length (the proximal third of the urethral length 0-39 %, the middle third 40-60 %, and the distal third 60-100 %). Informed consent was obtained from all patients prior to their inclusion in the study. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of "Victor Babeş" University of Medicine and Pharmacy Timisoara before the beginning of the study (no 7/17.04.2012). At 3 months after surgery, 3.92 % of the slings were located in the proximal third of the urethra, 88.23 % in the middle third of the urethra and 7.84 % in the distal third. At 6 and 12 months after surgery we obtained similar results: 9.81 % of the slings were located in the proximal third of the urethra, 82.35 % in the middle third and 7.84 % in the distal third of the urethra. The transversal incision of the vagina offers a minimal dissection along the long axis of the urethra favoring the remaining of the tape in the middle third of the urethra.

  5. Long-term outcomes of limbal relaxing incisions during cataract surgery: aberrometric analysis

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    Monaco G

    2015-08-01

    Full Text Available Gaspare Monaco, Antonio ScialdoneDepartment of Ophthalmology, Ospedale Fatebenefratelli e Oftalmico, Milan, ItalyPurpose: To compare the final changes in corneal wavefront aberration by limbal relaxing incisions (LRIs after cataract surgery.Methods: This prospective cumulative interventional nonrandomized case study included cataract and astigmatic patients undergoing LRIs and phaco with intraocular lens implantation. LRIs were planned using Donnenfeld nomogram. The root mean square of corneal wave aberration for total Z(n,i(1≤n≤8, astigmatism Z(2,±1, coma Z(3–5–7,±1, trefoil Z(3–5–7,±2, spherical Z(4–6–8,0, and higher-order aberration (HOA Z(3≤n≤8 was examined before and 3 years after surgery (optical path difference-Scan II [OPD-Scan II]. Uncorrected distance visual acuity and best-corrected distance visual acuity (CDVA for distance, keratometric cylinder, and variations in average corneal power were also analyzed.Results: Sixty-four eyes of 48 patients were included in the study. Age ranged from 42 to 92 years (70.6±8.4 years. After LRIs, uncorrected distance visual acuity and best-corrected distance visual acuity improved statistically (P<0.01. The keratometric cylinder value decreased by 40.1%, but analysis of KP90 and KP135 polar values did not show any decrease that could be statistically confirmed (P=0.22 and P=0.24. No significant changes were detected in root mean square of total (P=0.61 and HOAs (P=0.13 aberrations. LRIs did not induce alteration in central corneal power confirming a 1:1 coupling ratio.Conclusion: LRIs determined a nonsignificant alteration of corneal HOA. Therefore, LRIs can be still considered a qualitatively viable mean in those cases where toric intraocular lenses are contraindicated or not available. Yet, the authors raise the question of nonpersonalized nomograms, as in the present study, LRIs did not reach the preset target cylinder. Keywords: astigmatism, ocular wavefront, intraocular

  6. Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes.

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    Vellei, Samatha; Borri, Alessandro

    2017-08-01

    To compare the outcome of patients who had undergone single-incision laparoscopic appendectomy (SILA) with others who had undergone three-port laparoscopic appendectomy (3-PORT). Data from all adults with uncomplicated appendicitis treated by laparoscopic appendectomy between June 2012 and December 2015 were prospectively collected. Patients with chronic pain, appendix malignancy, at least two previous laparotomies, and those undergoing concomitant surgery for different condition were excluded from analysis. Postoperative pain was assessed by a visual analog scale (VAS). Patients were reviewed postoperatively at 7 days and 1 month in the outpatient clinic. Late complications were assessed with a telephonic interview. A total of 91 patients were included (46 SILA; 45 3-PORT). There were 16 males and 30 females in the SILA group (mean age = 26.76 ± 10.58 years) and 18 males and 27 females in the 3-PORT group (mean age = 26.84 ± 10.79 years). The mean operative time for SILA was 48.54 ± 12.80 min, for the 3-PORT group the mean operative time was 46.33 ± 15.54 min (P = 0.46). No case required conversion. Mean postoperative hospital length of stay was 1.87 ± 0.69 days for SILA and 2.38 ± 1.11 days for 3-PORT (P = 0.01). VAS value of 3.91 ± 1.96 and mean ketorolac usage of 0.38 ± 0.65 in 3-PORT group and SILA patients reported 3.70 ± 1.58 and 0.39 ± 0.58, respectively (P = 0.91). Our mean follow-up in SILA group was 25.75 ± 10.82 months, for 3-PORT group the mean follow-up was 26.9 ± 11.8 months. Eleven patients missed long-term follow-up. No incisional hernia was found. There is a statistically significant difference in cosmetic evaluation in favor of SILA (P PORT laparoscopic appendectomy, but after SILA procedure discharge was quicker and long-term cosmetic satisfaction was superior.

  7. Tidal Simulations of an Incised-Valley Fluvial System with a Physics-Based Geologic Model

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    Ghayour, K.; Sun, T.

    2012-12-01

    Physics-based geologic modeling approaches use fluid flow in conjunction with sediment transport and deposition models to devise evolutionary geologic models that focus on underlying physical processes and attempt to resolve them at pertinent spatial and temporal scales. Physics-based models are particularly useful when the evolution of a depositional system is driven by the interplay of autogenic processes and their response to allogenic controls. This interplay can potentially create complex reservoir architectures with high permeability sedimentary bodies bounded by a hierarchy of shales that can effectively impede flow in the subsurface. The complex stratigraphy of tide-influenced fluvial systems is an example of such co-existing and interacting environments of deposition. The focus of this talk is a novel formulation of boundary conditions for hydrodynamics-driven models of sedimentary systems. In tidal simulations, a time-accurate boundary treatment is essential for proper imposition of tidal forcing and fluvial inlet conditions where the flow may be reversed at times within a tidal cycle. As such, the boundary treatment at the inlet has to accommodate for a smooth transition from inflow to outflow and vice-versa without creating numerical artifacts. Our numerical experimentations showed that boundary condition treatments based on a local (frozen) one-dimensional approach along the boundary normal which does not account for the variation of flow quantities in the tangential direction often lead to unsatisfactory results corrupted by numerical artifacts. In this talk, we propose a new boundary treatment that retains all spatial and temporal terms in the model and as such is capable to account for nonlinearities and sharp variations of model variables near boundaries. The proposed approach borrows heavily from the idea set forth by J. Sesterhenn1 for compressible Navier-Stokes equations. The methodology is successfully applied to a tide-influenced incised

  8. [Phacoemulsification versus manual small incision cataract surgery: Anatomic and functional results].

    Science.gov (United States)

    Ammous, I; Bouayed, E; Mabrouk, S; Boukari, M; Erraies, K; Zhioua, R

    2017-06-01

    Prospective randomised study to compare the impact of phacoemusification (PHACO) and small incision cataract surgery (SICS) on endothelial structure (cell density and morphology) and refractive results (visual acuity, induced astigmatism). Prospective study of 57 patients (63 eyes) over 20 months (May 2012-January 2014) undergoing surgery by 2 experienced surgeons. We included patients with senile or presenile cataracts, LOCS III class 2, 3 and 4. Patients were randomized into 2 groups based on their birth month (group 1: PHACO [33]; group 2: SICS [30]). All pre- intra- and postoperative data were collected prospectively. The minimum follow-up was 6 months. We used the SPSS 18.0 for statistical analysis. Statistical tests used included the test-t Student, the Anova test, the Mann-Witney non-parametric test and the Khi 2 test. A threshold of significance was set at 0.05. The mean preoperative endothelial cell density was 2447.5±225 c/mm 2 with no significant difference between the two groups (P=0.207). The mean percentage of hexagonality was 55.5±8.2% in groups 1 and 2. The most significant cell loss was during the first immediate postoperative period for both groups. At Day 15 postoperative, the decrease in cell loss was significant (P<0.001) with a mean loss of 312.9±208.9 c/mm 2 (P<10 -2 ). Postoperatively, the mean best-corrected visual acuity was 0.057 log MAR for all of our patients (P=0.170); no patient had an acuity ≤1/10. The mean astigmatism at the conclusion of follow-up was 1.08±0.42 D in group 1 and 1.51±0.55 D in group 2, with a significant difference (P=0.001). Both SICS and PHACO give excellent results, both anatomical and refractive. However, SICS appears to be more advantageous than PHACO in terms of speed, cost, and independence from technology, and appears to be better suited to dense cataracts and mass surgery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Two Late Pleistocene climate-driven incision/aggradation rhythms in the middle Dnieper River basin, west-central Russian Plain

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    Panin, Andrei; Adamiec, Grzegorz; Buylaert, Jan-Pieter; Matlakhova, Ekaterina; Moska, Piotr; Novenko, Elena

    2017-06-01

    In valleys of the River Seim and its tributaries in the middle Dnieper basin (west-central Russian Plain), two low terraces (T1, 10-16 m, and T0, 5-7 m above the river) and a floodplain (2-4 m) with characteristic large and small palaeochannels exist. A range of field and laboratory techniques was applied and ∼30 new numerical ages (OSL and 14C dates) were obtained to establish a chronology of incision and aggradation events that resulted in the current valley morphology. Two full incision/aggradation rhythms and one additional aggradation phase from the previous rhythm were recognized in the Late Pleistocene - Holocene climate cycle. The following events were detected. (1) Late MIS 5 - early MIS 4: aggradation of Terrace T1 following the deep incision at the end of MIS 6. (2) Late MIS 4 (40-30 ka): incision into Terrace T1 below the present-day river, formation of the main scarp in the bottom of the valley between Terrace T1 and Terrace T0/Floodplain levels. (3) MIS 2: aggradation of Terrace T0, lateral migrations of a shallow braided channel located few meters above the present-day river since ∼25 ka through the LGM. (4) 18-13 ka: incision into Terrace T0 below the modern river. Multiple-thread channels concentrated in a single flow that at some places formed large meanders. In the period 15-13 ka, high floods that rose above the present-day floods left large levees and overbank loams on Terrace T0. (5) Younger Dryas - Holocene transition: aggradation up to the modern channel level, transformation of large Late Glacial to small Holocene meanders. The established incision/aggradation rhythms are believed to be manifested over the Central Russian Plain outside the influence of ice sheets in the north and base level changes in the south. The two-phase deepening of the valley occurred in the last quarter of the last glacial epoch but can not be attributed directly to the glacial-interglacial transition. Both the detected incision events correspond to relatively

  10. Response of the Apodi-Mossoró estuary-incised valley system (NE Brazil to sea-level fluctuations

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    Helenice Vital

    2010-01-01

    Full Text Available This study focuses on the Quaternary sea level changes in the Apodi-Mossoró Estuary and adjacent shelf, Northeastern Brazil, based on the analysis of high-resolution seismic profiles, integrated with echosounder, SRTM and satellite image data. We use these data to develop a relative stratigraphy. An incised-valley extending from the Apodi-Mossoró Estuary onto the shelf dominates the investigated area. In very shallow waters (down to 10 m depth the channel lies mainly in a NW-SE direction, changing to NE-SW in waters below10 m, in the form of a J-shaped valley. The southern flank of the shallow channel presents an abrupt morphology, probably determined by a residual scarp due to neotectonic reactivation of a pre-existing fault. This incised-valley can be correlated with a former river valley formed during the late Pleistocene fall in sea-level. The base-level change related to this drop in sea level can be regionally expressed on seismic lines as a laterally-continuous stratigraphic surface named Horizon I, interpreted as representing the sub-aerial exposure of the continental shelf. Many incised valleys were excavated on this exposed shelf, including that of the Apodi-Mossoró Estuary and its incised valley system. This incised valley has lain buried since the Holocene transgression. The Holocene sediments present sub-horizontal layers, or they have filled the incised valley with oblique features.Este estudo utiliza a integração de dados sísmicos de alta resolução, batimétricos, SRTM e imagens de satélite para desenvolvimento da estratigrafia relativa visando entender as variações do nível do mar durante o Quaternário no estuário do rio Apodi-Mossoró e plataforma adjacente, nordeste do Brasil. A principal feição identificada foi um canal submerso, na plataforma interna, parcialmente preenchido, provavelmente relacionado com o sistema de vales incisos formado durante o rebaixamento do nível do mar no Pleistoceno. O canal

  11. The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision.

    Science.gov (United States)

    Smith, C; McEwan, A I; Jhaveri, R; Wilkinson, M; Goodman, D; Smith, L R; Canada, A T; Glass, P S

    1994-10-01

    We have previously demonstrated that the minimum alveolar concentration of isoflurane at 1 atm that is required to prevent movement in 50% of patients or animals exposed to a maximal noxious stimulus is markedly reduced by increasing fentanyl concentrations. Total intravenous anesthesia with propofol is increasing in popularity, yet the propofol concentrations required for total intravenous anesthesia or the interaction between propofol and fentanyl have not yet been defined. Propofol and fentanyl were administered via computer-assisted continuous infusion to provide pseudo-steady-state concentrations and allow equilibration between plasma-blood concentration and their biophase concentration. For the induction of anesthesia patients were randomly allocated to receive propofol only or propofol plus fentanyl 0.2, 0.8, 1.5, 3.0, and 4.5 ng/ml. In each group patients were randomized to target propofol concentrations of 1.5-10 micrograms/ml. At 7 and 10 min arterial blood samples were taken for subsequent measurement of propofol and fentanyl concentrations. At 10 min loss of consciousness was assessed by the patients' ability to respond to a simple verbal command. Thereafter a new target concentration of propofol was entered to ensure loss of consciousness, and succinylcholine was administered to facilitate tracheal intubation. Patients were rerandomized to a new target concentration of propofol (1-19 micrograms/ml) until skin incision. Before skin incision and 1 min after skin incision, arterial blood samples were again obtained for subsequent measurement of fentanyl and propofol concentrations. At skin incision and for 1 min the patient was observed for purposeful movement. Only samples in which the pre- and poststimulus drug concentrations were within 35% of each other were included. The propofol blood concentration at which 50% or 95% of patients did not respond to verbal command (Cp50s and Cp95s, respectively) and to skin incision (Cp50i and Cp95i, respectively

  12. Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study

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    Savas Yildiray

    2009-06-01

    Full Text Available Abstract Background Treatment modalities in Chiari malformation type 1(CMI accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid. Methods Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 × 3 cm area with C1–C2 (partial laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions. Results Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely. Conclusion Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has

  13. Intratarsal fixation at the same level as the skin incision to reduce asymmetric double eyelids: evaluation of symmetry using photogrammetry.

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    Han, Kihwan; Yeo, Hyeonjung; Choi, Tae Hyun; Son, Daegu; Kim, Jun Hyung

    2010-03-01

    One of the most common complications of double eyelid operations is asymmetry. To reduce asymmetry, we fixed the dermis to the tarsal plate at the same level as the skin incision, and objectively evaluated the symmetry of the height using photogrammetry.Of 30 patients who had double eyelid operations by the intratarsal fixation technique, 15 patients completed a minimum follow-up of 6 months. After the skin incision and removal of the orbicularis oculi muscle and the orbital fat, the pretarsal fat pad was excised to expose the superior portion of the tarsal plate. The 3 fixation points were marked on the tarsal plate at the same level with the skin incision using a spreading caliper. The dermis was fixed to the marked points of the tarsal plate and the skin was closed.The height of the double eyelid was measured by clinical photography at 4 points when the eyes were opened and at 3 points when the eyes were closed. The height proportional index at each point was obtained by dividing the height of the left double eyelid by that of the right double eyelid. We compared each height proportional index with "1" to evaluate the symmetry of both double eyelids using a paired t test.The follow-up period was an average of 9.0 months. The mean height proportional indices were 0.97 (a), 0.96 (b), 0.98 (c), 1.08 (d), 0.97 (e), 1.02 (f), and 1.13 (g). According to a paired t test, the height of the left double eyelid was not different from that of the right double eyelid.Intratarsal fixation, along with other previously known methods, decreases asymmetric double eyelids.

  14. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery.

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    Peleg, David; Ahmad, Ronan Said; Warsof, Steven L; Marcus-Braun, Naama; Sciaky-Tamir, Yael; Ben Shachar, Inbar

    2018-03-01

    Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Parallel pocket incision: Less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining.

    Science.gov (United States)

    Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hayashi, Akitatsu; Koshima, Isao

    2015-10-01

    The treatment of deep pressure ulcer with a wide wound edge undermining (pocket) is challenging, especially when conservative treatments are ineffective. As most patients with a pressure ulcer suffer from systemic comorbidities, invasive surgery cannot be performed on all patients, and less invasive treatment is required. Less invasive surgical intervention to a deep pressure ulcer, parallel pocket incision (PPI), was performed on 10 patients with intractable pressure ulcers with a pocket formation. In PPI procedures, two parallel skin incisions were made to open up the deepest fold of the pocket and to preserve the skin overlying the pocket lesion; through the created incisions, the necrotic tissues around the deepest fold of the undermining could be easily removed, which facilitated spontaneous wound healing. Postoperative results and complications were evaluated. All PPI procedures were safely performed under local infiltration anesthesia without major postoperative complication; minor bleeding was seen intraoperatively in three patients, which could be easily controlled with electric cautery coagulation. Nine of 10 ulcers were cured after PPI, and one could not be followed up due to the patient's death non-related to the pressure ulcer. For the nine cured patients, the average time for cure was 14.9 weeks, and no recurrence was observed at postoperative 6 months. PPI is a simple, technically easy, and less invasive surgical intervention to an intractable pressure ulcer with a pocket, which can be safely performed under local infiltration anesthesia even on a patient with severe systemic comorbidities. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Postoperative ocular higher-order aberrations and contrast sensitivity: femtosecond lenticule extraction versus pseudo small-incision lenticule extraction.

    Science.gov (United States)

    Tan, Deborah K L; Tay, Wan Ting; Chan, Cordelia; Tan, Donald T H; Mehta, Jodhbir S

    2015-03-01

    To evaluate and compare changes in contrast sensitivity and ocular higher-order aberrations (HOAs) after femtosecond lenticule extraction (FLEx) and pseudo small-incision lenticule extraction (SMILE). Singapore National Eye Centre, Singapore. Retrospective case series. Patients had femtosecond lenticule extraction (Group 1) or pseudo small-incision lenticule extraction (Group 2) between March 2010 and December 2011. The main outcome measures were manifest refraction, HOAs, and contrast sensitivity 1, 3, 6, and 12 months postoperatively. Fifty-two consecutive patients (102 eyes) were recruited, 21 patients (42 eyes) in Group 1 and the 31 patients (60 eyes) in Group 2. The uncorrected and corrected distance visual acuities were significantly better in Group 2 than in Group 1 at 12 months (P = .032). There was no significant increase in 3rd- or 4th-order aberrations at 1 year and no significant difference between the 2 groups preoperatively or postoperatively. At 1 year, there was a significant increase in mesopic contrast sensitivity in Group 2 at 1.5 cycles per degree (cpd) (P = .008) that was not found in Group 1, and photopic contrast sensitivity at 6.0 cpd was higher in Group 2 (P = .027). These results indicate that refractive lenticule extraction is safe and effective with no significant induction of HOAs or deterioration in contrast sensitivity at 1 year. Induction of HOAs was not significantly different between both variants of refractive lenticule extraction. However, there was significant improvement in photopic contrast sensitivity after pseudo small-incision lenticule extraction, which persisted through 1 year. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  17. The clinical research of off-pump coronary artery bypass grafting by small incision at the left chest.

    Science.gov (United States)

    Xiao, L-B; Zhang, Y-H; Zhou, J-W; Yang, M; Ling, Y-P; Gao, Z-S; Wang, Y-S

    2016-01-01

    To explore the clinical value of off-pump coronary artery bypass grafting by small incision at the left chest, and develop a better surgical regimen for coronary heart disease patients. 201 coronary heart disease patients who need coronary artery bypass grafting were required and randomly divided into 2 groups including a control group and an observation group. There were 107 cases in the control group who received coronary bypass grafting by extracorporeal circulation; there were 103 cases in the observation group who received off-pump coronary bypass grafting by small incision at the left chest. The duration of the mechanism ventilation, length of stay in ICU, hospitalization time, postoperative drainage volume, and the occurrence rate of complications were recorded and compared. The duration of mechanism ventilation, length of stay in ICU, hospitalization time and postoperative drainage volume in the control group were (19.21 ± 1.33) hours, (5.08 ± 0.57) days, (21.20 ± 2.34) days and (997.68 ± 96.35) mL, which were (7.73 ± 0.74) hours, (2.83 ± 0.16) days, (15.67 ± 1.18) days and (901.53 ± 89.32) mL in the observation group respectively, with statistical difference between the two groups (pdisease, pulmonary infection, perioperative cardiac infarction and mortality did not display a significant difference between the two groups (p > 0.05). Off-pump coronary artery bypass grafting by small incision at the left chest is a surgical method with less injury and fast recovery, which can be used as the preferred therapeutical method for the coronary heart disease patients who need coronary artery bypass grafting.

  18. Treatment of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision: experience with 31 cases.

    Directory of Open Access Journals (Sweden)

    Jun Shi

    Full Text Available Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm. No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes.

  19. A COMPARATIVE STUDY OF THE AMOUNT OF ASTIGMATISM FOLLOWING CONVENTIONAL EXTRACAPSULAR CATARACT EXTRACTION AND MANUAL SMALL INCISION CATARACT SURGERY

    Directory of Open Access Journals (Sweden)

    Rajkumari Bigyabati

    2016-06-01

    Full Text Available BACKGROUND Cataract is the principal cause of avoidable blindness in India and throughout the world. Surgical removal of the cataractous lens remains the only effective treatment for management of cataract blindness. The success of cataract surgery is determined by best and earliest visual recovery. But the occurrence of postoperative astigmatism has become a major hurdle in achieving this goal. AIMS The study was designed to compare the amount of astigmatism following conventional extracapsular cataract extraction (ECCE and manual small incision cataract surgery (SICS. MATERIALS AND METHODS The study was carried out in 100 eyes of 75 patients aged between 50 and 80 years admitted for cataract surgery. Out of these, 50 eyes were operated by conventional extracapsular cataract extraction and 50 eyes by manual small incision cataract surgery. The patients were followed up at 2 nd , 4 th , 6 th and 8 th weeks. At each follow-up visual acuity, refraction and acceptance and keratometry were recorded and the findings analysed for astigmatism. RESULTS In the current study, the mean (SD astigmatism developed at the end of the 2 nd , 4 th and 6 th of follow-up was significantly lower in the SICS group as compared to the ECCE group (P<0.000. At the end of 8 weeks of follow-up, the mean (SD astigmatism of the SICS group was 0.64±0.56 D as compared to the mean (SD of the ECCE group of 1.39±86 D and the difference was found to be significant (p<0.014. CONCLUSION The current study concludes that manual small incision cataract surgery is a better technique to control postoperative astigmatism than conventional extracapsular cataract extraction.

  20. Analysis of Relative Parallelism Between Hamular-Incisive-Papilla Plane and Campers Plane in Edentulous Subjects: A Comparative Study.

    Science.gov (United States)

    Tambake, Deepti; Shetty, Shilpa; Satish Babu, C L; Fulari, Sangamesh G

    2014-12-01

    The study was undertaken to evaluate the parallelism between hamular-incisive-papilla plane (HIP) and the Campers plane. And to determine which part of the posterior reference of the tragus i.e., the superior, middle or the inferior of the Camper's plane is parallel to HIP using digital lateral cephalograms. Fifty edentulous subjects with well formed ridges were selected for the study. The master casts were obtained using the standard selective pressure impression procedure. On the deepest point of the hamular notches and the centre of the incisive papilla stainless steel spherical bearings were glued to the cast at the marked points. The study templates were fabricated with autopolymerizing acrylic resin. The subjects were prepared for the lateral cephalograms. Stainless steel spherical bearings were adhered to the superior, middle, inferior points of the tragus of the ear and inferior border of the ala of the nose using surgical adhesive tape. The subjects with study templates were subjected to lateral cephalograms. Cephalometric tracings were done using Autocad 2010 software. Lines were drawn connecting the incisive papilla and hamular notch and the stainless steel spherical bearings placed on the superior, middle and inferior points on the tragus and the ala of the nose i.e., the Campers line S, Campers line M, Campers line I. The angles between the three Camper's line and the HIP were measured and recorded. Higher mean angulation was recorded in Campers line S -HIP (8.03) followed by Campers line M-HIP (4.60). Campers line I-HIP recorded the least angulation (3.80). The HIP is parallel to the Camper's plane. The Camper's plane formed with the posterior reference point as inferior point of the tragus is relatively parallel to the HIP.

  1. Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

    Directory of Open Access Journals (Sweden)

    Hye Mi Yoo

    2015-05-01

    Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

  2. Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

    Science.gov (United States)

    Stiles, Mandy; Case, J Brad; Coisman, James

    2016-08-01

    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

  3. Sequential treatment with intradermal incision (intracision) and 2,940-nm Er:YAG laser for chicken pox scars.

    Science.gov (United States)

    Lee, Sang Ju; Kim, Young Koo; Choi, Sun Young; Park, Kui Young; Seo, Seong Jun

    2014-01-01

    Boxcar scars, such as chicken pox scars, are round to oval depressions with sharply defined vertical edges. Subcision is a simple and safe procedure for treatment of atrophic and depressed scars, but boxcar scars are generally not eliminated by subcision. Intradermal incision technique (intracision) can treat chicken pox scars by untethering fibrotic strands, raising collagen synthesis, and having additional intradermal blood pocket formation. We have found that chicken pox scars further improve when intracision is followed by laser skin resurfacing. © 2013 Wiley Periodicals, Inc.

  4. Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision.

    Science.gov (United States)

    Assaf, Ahmed; Roshdy, Maged Maher

    2013-01-01

    This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. This study includes 139 consecutive cataractous eyes (nuclear color 2-4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature(®) system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti(®) system with the OZil(®) Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm(2) vs 2315.6 ± 83.1 cell/mm(2), P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm(2) vs 2270.3 ± 89.9 cell/mm(2), P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Ellips™ FX transversal and OZil(®) IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes.

  5. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  6. Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision

    Directory of Open Access Journals (Sweden)

    Assaf A

    2013-01-01

    Full Text Available Ahmed Assaf, Maged Maher RoshdyOphthalmology Department, Ain Shams University, Cairo, EgyptPurpose: This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification.Patients and methods: This study includes 139 consecutive cataractous eyes (nuclear color 2–4, according to the Lens Opacities Classification System III [LOCSIII] of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature® system with the Ellips™ FX transversal continuous ultrasound (US mode for group I (mean age: 65.33 ± 6.97 years, and we used the Infiniti® system with the OZil® Intelligent Phaco (IP torsional US mode for group II (mean age: 64.02 ± 7.55 years. The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated.Results: All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75. In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm2 vs 2315.6 ± 83.1 cell/mm2, P = 0.80 nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm2 vs 2270.3 ± 89.9 cell/mm2, P = 0.98 differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in gr