WorldWideScience

Sample records for incisive world-class tools

  1. 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....

  2. 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...

  3. 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.

  4. 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.

  5. 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

  6. The bioenergetics of World Class Cycling.

    Science.gov (United States)

    Jeukendrup, A E; Craig, N P; Hawley, J A

    2000-12-01

    Professional cycle racing is one of the most demanding of all sports combining extremes of exercise duration, intensity and frequency. Riders are required to perform on a variety of surfaces (track, road, cross-country, mountain), terrains (level, uphill and downhill) and race situations (criterions, sprints, time trials, mass-start road races) in events ranging in duration from 10 s to 3 wk stage races covering 200 m to 4,000 km. Furthermore, professional road cyclists typically have approximately 100 race d/yr. Because of the diversity of cycle races, there are vastly different physiological demands associated with the various events. Until recently there was little information on the demands of professional cycling during training or competition. However, with the advent of reliable, valid bicycle crank dynanometers, it is now possible to quantify real-time power output, cadence and speed during a variety of track and road cycling races. This article provides novel data on the physiological demands of professional and world-class amateur cyclists and characterises some of the physiological attributes necessary for success in cycling at the élite level.

  7. Strategic Approach for Developing World-Class Universities in Egypt

    Science.gov (United States)

    Ahmed, Hanaa Ouda Khadri

    2015-01-01

    In the past decade, the term "world-class university" "WCU"--also called "globally competitive universities", "world-class", "elite", or "flagship" universities--has become a catch phrase, not simply for improving the quality of learning and research in higher education but also, more…

  8. 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…

  9. 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)

  10. 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.

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

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

    2017-10-26

    Six world-class research teams to investigate overcoming therapeutic resistance in high fatality cancers. October 26, 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 ...

  12. Physique characteristics of world-class African long distance runners

    African Journals Online (AJOL)

    The purposes of the study were to describe the physique characteristics (body composition and somatotypes) of world class African male and female long distance (LD) runners and to determine by means of a discriminant analysis which variables best discriminated among the male and female LD runners. Anthropometric ...

  13. Paths for World-Class Universities in Agricultural Science

    Science.gov (United States)

    Liu, Zhimin; Kipchumba, Simon Kibet; Liu, Lu

    2016-01-01

    The top-ranking world-class universities in agricultural science denote those universities which are globally popular with agriculture-related subjects. The paper synthesizes the results of three different ranking scales (NTU, QS and ARWU) of top 50 universities in agriculture subject in 2013. The overlapped parts have been synchronized to derive…

  14. The Making of a World-Class Elementary School.

    Science.gov (United States)

    Haynes, Richard M.; Chalker, Donald M.

    1998-01-01

    After spending six years studying elementary schools of 10 countries noted for educational excellence (Britain, Canada, France, Germany, Israel, Japan, New Zealand, South Korea, Taiwan, and the United States), the authors reveal world-class standards they have identified for time-on-task, curriculum, assessment, parenting, and student behavior.…

  15. 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 ...

  16. 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…

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Laser Nano-Neurosurgery from gentle manipulation to nano-incision of neuronal cells and scaffolds: an advanced neurotechnology tool.

    Directory of Open Access Journals (Sweden)

    Alessandro eSoloperto

    2016-03-01

    Full Text Available Current optical approaches are progressing far beyond the scope of monitoring the structure and function of living matter, and they are becoming widely recognized as extremely precise, minimally-invasive, contact-free handling tools. Laser manipulation of living tissues, single cells or even single-molecules is becoming a well-established methodology, thus founding the onset of new experimental paradigms and research fields. Indeed, a tightly focused pulsed laser source permits complex tasks such as developing engineered bioscaffolds, applying calibrated forces, transfecting, stimulating or even ablating single cells with subcellular precision, and operating intracellular surgical protocols at the level of single organelles. In the present review, we report the state of the art of laser manipulation in neuroscience, to inspire future applications of light-assisted tools in nano-neurosurgery.

  2. Laser Nano-Neurosurgery from Gentle Manipulation to Nano-Incision of Neuronal Cells and Scaffolds: An Advanced Neurotechnology Tool.

    Science.gov (United States)

    Soloperto, Alessandro; Palazzolo, Gemma; Tsushima, Hanako; Chieregatti, Evelina; Vassalli, Massimo; Difato, Francesco

    2016-01-01

    Current optical approaches are progressing far beyond the scope of monitoring the structure and function of living matter, and they are becoming widely recognized as extremely precise, minimally-invasive, contact-free handling tools. Laser manipulation of living tissues, single cells, or even single-molecules is becoming a well-established methodology, thus founding the onset of new experimental paradigms and research fields. Indeed, a tightly focused pulsed laser source permits complex tasks such as developing engineered bioscaffolds, applying calibrated forces, transfecting, stimulating, or even ablating single cells with subcellular precision, and operating intracellular surgical protocols at the level of single organelles. In the present review, we report the state of the art of laser manipulation in neuroscience, to inspire future applications of light-assisted tools in nano-neurosurgery.

  3. 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...

  4. 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...

  5. 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.

  6. 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.

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

    Science.gov (United States)

    Cremonini, Leon; Westerheijden, Don F.; Benneworth, Paul; 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, especially if definitions of excellence and…

  8. Developing the Vision: Preparing Teachers to Deliver a Digital World-Class Education System

    Science.gov (United States)

    Lane, Jenny M.

    2012-01-01

    In 2008 Australians were promised a "Digital Education Revolution" by the government to dramatically change classroom education and build a "world-class education system". Eight billion dollars have been spent providing computer equipment for upper secondary classrooms, yet there is little evidence that a revolution has…

  9. 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…

  10. Building the World-Class Research Universities: A Case Study of China

    Science.gov (United States)

    Huang, Futao

    2015-01-01

    The purpose of this study is to analyze how China has strived to develop its world-class research universities and what are distinguishing characteristics of China's efforts to form these universities for the last decades. This study begins with a review of literature and research questions. It then touches on the background and rationale of…

  11. Creating a Culture of Innovation: The Challenge in Becoming and Staying a World-Class University

    Science.gov (United States)

    Tierney, William G.

    2014-01-01

    In the 21st century world-class universities will need to be much more focused on innovation, rather than on stability and standardization. An innovative organization is different from a stable one. It requires different skills from its participants, and it functions in a different way from a stable organization. A focus on innovation will…

  12. Following the Leader? Network Models of "World-Class" Universities on Twitter

    Science.gov (United States)

    Shields, Robin

    2016-01-01

    Much research on higher education has discussed the positional competition induced by global rankings and the complementary concept of "world-class" universities. This paper investigates the network of social media communication between globally ranked universities. Specifically, it examines whether universities seek to preserve and…

  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. Alopecia Following Bicoronal Incisions.

    Science.gov (United States)

    Kadakia, Sameep; Badhey, Arvind; Ashai, Sara; Lee, Thomas S; Ducic, Yadranko

    2017-05-01

    Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist comparing alopecia outcomes among bicoronal incision techniques with and without the use of Raney clips. To determine (1) whether postoperative alopecia is more common when bicoronal incisions are performed with monopolar cautery, Colorado microdissection tip cautery, or traditional cold steel and (2) whether this outcome is affected by the use of Raney clips. This retrospective study of postoperative alopecia included 505 patients undergoing bicoronal incisions in a single head and neck surgery practice from 1997 to 2015 with a minimum follow-up of 1 year. Patients with preexisting baldness as well as patients not following up for the minimum period were excluded. All data analysis took place between 1997 and 2015. Maximum alopecia width was measured in the postoperative period and compared among the technique groups both with and without Raney clip use. Raney clip duration as a product of surgery length was also compared. A total of 505 patients (301 male, 204 female) ranging in age from 3 to 97 years were included in the study (median age, 53.9 years). Of these, 236 underwent bicoronal incisions to approach the skull base, 78 to treat chronic frontal sinusitis unresponsive to endoscopic management or frontal sinus mucocele, 143 for trauma, and 48 for craniofacial surgery. For 173 patients, the cold steel technique was used for both skin and subcutaneous incision, 102 of whom needed Raney clips. For 161 patients, cold steel technique was used for skin incisions and monopolar cautery for subcutaneous incision; 81 of these patients required Raney clips. For 171 patients, Colorado tip microdissection cautery was used for both skin and subcutaneous incision, with Raney clips used in 66 of these patients. Incisions made with cold steel for both skin and subcutaneous tissue, regardless of Raney clip use

  17. 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.

  18. 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

  19. World Class Sustainable Supply Chain Management: critical review and further research directions

    OpenAIRE

    Dubey, R; Gunasekaran, A; Childe, SJ; Papadopoulos, T; Fosso Wamba, S

    2017-01-01

    Purpose-Sustainable Supply Chain Management (SSCM) has attracted considerable interest among academics and practitioners. The aim of our article is to present a critical review of the literature, to identify missing links, to argue for the use of world-class SSCM through a framework, and suggest further research directions. Design/methodology/approach-In our article we have undertaken an extensive review of literature and classified articles using a novel classification scheme. Findings-Throu...

  20. The mandibular incisive foramen.

    OpenAIRE

    Serman, N J

    1989-01-01

    An anatomical variant in the region of the mental foramen is discussed. In these cases the inferior alveolar nerve divides into its two terminal branches only after it has exited through the mental foramen. The incisive nerve thus commences outside the mandible, and has a short extra-osseous course before it enters the mandible through a separate foramen on the same horizontal plane. For the distance between these two foramina there is no nerve supply within the mandible. The groove between t...

  1. 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.

  2. 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

  3. 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

  4. Curriculum Initiatives in the United States, Germany and Japan for World-Class Education in the 21st Century.

    Science.gov (United States)

    Bieniawski, Z. T.; Bieniawski, Stefan R.

    1996-01-01

    Summarizes a research study performed to assess curriculum changes in engineering education. Discusses the implications of the various curriculum strategies and initiatives and identifies the necessary socio-technological ingredients for world-class education of engineers. (DDR)

  5. 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 economy (moderate effect, p 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.

  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. 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.

  8. 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

  9. Aplicación del sistema de calidad World Class Manufacturing (WCM)

    OpenAIRE

    Montes Sarnago, Paz

    2010-01-01

    El objeto del siguiente proyecto es implantar un novedoso sistema de gestión de la calidad total en una de las fábricas de la multinacional francesa Saint-Gobain S.A. La fábrica objeto del estudio es Saint-Gobain Abrasivos S.A. y el sistema de gestión de calidad total a implantar es World Class Manufacturing, que representa la agenda integrada, incluyendo los métodos Lean, TPM, Kaizen y Six Sigma. Este método se basa en la sistemática de eliminación de las pérdidas con la parti...

  10. Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters.

    Science.gov (United States)

    Brown, Peter I; Venables, Heather K; Liu, Hymsuen; de-Witt, Julie T; Brown, Michelle R; Faghy, Mark A

    2013-11-01

    Resistance training activates the ventilatory muscles providing a stimulus similar to ventilatory muscle training. We examined the effects of elite powerlifting training upon ventilatory muscle strength, pulmonary function and diaphragm thickness in world-class powerlifters (POWER) and a control group (CON) with no history of endurance or resistance training, matched for age, height and body mass. Body composition was assessed using single-frequency bioelectrical impedance. Maximal static volitional inspiratory (P(I,max)) and expiratory (P(E,max)) mouth pressures, diaphragm thickness (T(di)) derived from ultrasound measurements and pulmonary function from maximal flow volume loops were measured. There were no differences in physical characteristics or pulmonary function between groups. P(I,max) (22 %, P powerlifters improve ventilatory muscle strength and increases diaphragm size. Whole-body resistance training may be an appropriate training mode to attenuate the effects of ventilatory muscle weakness experienced with ageing and some disease states.

  11. 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.

  12. Ventilatory efficiency and breathing pattern in world-class cyclists: A three-year observational study.

    Science.gov (United States)

    Salazar-Martínez, Eduardo; Terrados, Nicolás; Burtscher, Martin; Santalla, Alfredo; Naranjo Orellana, José

    2016-07-15

    The purpose of this three-year observational study was to analyze the ventilatory efficiency and breathing pattern in world-class professional cyclists. Twelve athletes (22.61±3.8years; 177.38±5.5cm; 68.96±5.5kg and VO2max 75.51±3.3mLkg(-1)min(-1)) were analyzed retrospectively. For each subject, respiratory and performance variables were recorded during incremental spiroergometry: oxygen uptake (VO2), carbon dioxide output (VCO2), pulmonary ventilation (VE), tidal volume (Vt), breathing frequency (fR), driving (Vt/Ti), timing (Ti/Ttot), peak power output (PPO) and maximum oxygen uptake (VO2max). Ventilatory efficiency (VE/VCO2 slope) was calculated from the beginning of exercise testing to the second ventilatory threshold (VT2). The VE/VCO2 slope was unaffected during the study period (24.63±3.07; 23.61±2:79; 24:89±2:61) with a low effect size (ES=0.04). The PPO improved significantly in the third year (365±33.74; 386.36±32.33; 415.00±24.15) (p<0.05). The breathing pattern variables, Vt/Ti and Ti/Ttot, did not change significantly over the three year period (ES=0.00; ES=0.03 respectively). These findings suggest that changes in cycling performance in world-class professional cyclists do not modify breathing variables related to the control of ventilatory efficiency. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. 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.

  14. Exploring brain functional plasticity in world class gymnasts: a network analysis.

    Science.gov (United States)

    Wang, Junjing; Lu, Min; Fan, Yuanyuan; Wen, Xue; Zhang, Ruibin; Wang, Bin; Ma, Qing; Song, Zheng; He, Yong; Wang, Jun; Huang, Ruiwang

    2016-09-01

    Long-term motor skill learning can induce plastic structural and functional reorganization of the brain. Our previous studies detected brain structural plasticity related to long-term intensive gymnastic training in world class gymnasts (WCGs). The goal of this study was to investigate brain functional plasticity in WCGs by using network measures of brain functional networks. Specifically, we acquired resting-state fMRI data from 13 WCGs and 14 controls, constructed their brain functional networks, and compared the differences in their network parameters. At the whole brain level, we detected significantly decreased overall functional connectivity (FC) and decreased local and global efficiency in the WCGs compared to the controls. At the modular level, we found intra- and inter-modular reorganization in three modules, the cerebellum, the cingulo-opercular and fronto-parietal networks, in the WCGs. On the nodal level, we revealed significantly decreased nodal strength and efficiency in several non-rich club regions of these three modules in the WCGs. These results suggested that functional plasticity can be detected in the brain functional networks of WCGs, especially in the cerebellum, fronto-parietal network, and cingulo-opercular network. In addition, we found that the FC between the fronto-parietal network and the sensorimotor network was significantly negatively correlated with the number of years of training in the WCGs. These findings may help us to understand the outstanding gymnastic performance of the gymnasts and to reveal the neural mechanisms that distinguish WCGs from controls.

  15. 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.

  16. Different competition approaches in a world-class 50-km racewalker during an Olympic year.

    Science.gov (United States)

    Gomez-Ezeiza, Josu; Granados, Cristina; Santos-Concejero, Jordan

    2016-11-01

    The aim of this case study was to compare the competition approaches for the Race Walking World Cup and the Olympic Games of a world-class 50-km racewalker. Total training volumes, intensity distribution, performance tests, high altitude stages and the evolution of his haematological values during the season were analysed. The last 12 weeks before the Race Walking World Cup (Approach 1) and the Olympic Games (Approach 2) were used for data analysis. Approach 1 was characterized by lower training volumes (791.7±192.8 min vs. 959.0±120.0 min ES=1.0, large effect) and a higher incidence of high intensity training (ES<0.8, large effect), than Approach 2. Approach 1 resulted in lower blood lactate values at set speeds, better haematological values and a better performance in the Race Walking World Cup than in the Olympic Games (3h47'30'' vs. 3h51'30"). According to the results of this analysis, it seems that a training strategy characterised by a higher incidence of high intensity training and lower volume of work may lead to superior training adaptations and performance in 50-km racewalking. This may help elite racewalkers and their coaches to achieve an optimum performance in their major goal competitions.

  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. 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.

  19. 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.

  20. Global Aspirations and Strategising for World-Class Status: New Form of Politics in Higher Education Governance in Hong Kong

    Science.gov (United States)

    Mok, Ka Ho; Cheung, Anthony B. L.

    2011-01-01

    In the era of globalisation, competition has also become global. In higher education, countries worldwide are attaching increasing importance to international ranking exercises and subscribing to the "world-class universities" paradigm, complemented by various strategies to benchmark with leading universities in order to enhance the…

  1. Transforming Higher Education in Whose Image? Exploring the Concept of the "World-Class" University in Europe and Asia

    Science.gov (United States)

    Deem, Rosemary; Mok, Ka Ho; Lucas, Lisa

    2008-01-01

    In order to enhance their global competitiveness, governments in Europe and Asia have started to conduct comprehensive reviews of and implement plans to restructure their higher education systems, with attempts to transform their higher education systems in the image of "world-class" university. With strong intentions to perform well in…

  2. An Analysis of Mobility in Global Rankings: Making Institutional Strategic Plans and Positioning for Building World-Class Universities

    Science.gov (United States)

    Hou, Angela Yung Chi; Morse, Robert; Chiang, Chung-Lin

    2012-01-01

    Since the start of the twenty-first century, university rankings have become internationalized. Global rankings have a variety of uses, levels of popularity and rationales and they are here to stay. An examination of the results of the current global ranking reveals that well-reputed world-class universities are amongst the top ranked ones. A…

  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. 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.

  5. 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.

  6. 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.

  7. Research Data Acquired in World-Class, 60-atm Subsonic Combustion Rig

    Science.gov (United States)

    Lee, Chi-Ming; Wey, Changlie

    1999-01-01

    NASA Lewis Research Center's new, world-class, 60-atmosphere (atm) combustor research facility, the Advanced Subsonic Combustion Rig (ASCR), is in operation and producing highly unique research data. Specifically, data were acquired at high pressures and temperatures representative of future subsonic engines from a fundamental flametube configuration with an advanced fuel injector. The data acquired include exhaust emissions as well as pressure and temperature distributions. Results to date represent an improved understanding of nitrous oxide (NOx) formation at high pressures and temperatures and include an NOx emissions reduction greater than 70 percent with an advanced fuel injector at operating pressures to 800 pounds per square inch absolute (psia). ASCR research is an integral part of the Advanced Subsonic Technology (AST) Propulsion Program. This program is developing critical low-emission combustion technology that will result in the next generation of gas turbine engines producing 50 to 70 percent less NOx emissions in comparison to 1996 International Civil Aviation Organization (ICAO) limits. The results to date indicate that the AST low-emission combustor goals of reducing NOx emissions by 50 to 70 percent are feasible. U.S. gas turbine manufacturers have started testing the low-emissions combustors at the ASCR. This collaborative testing will enable the industry to develop low-emission combustors at the high pressure and temperature conditions of future subsonic engines. The first stage of the flametube testing has been implemented. Four GE Aircraft Engines low-emissions fuel injector concepts, three Pratt & Whitney concepts, and two Allison concepts have been tested at Lewis ASCR facility. Subsequently, the flametube was removed from the test stand, and the sector combustor was installed. The testing of low emissions sector has begun. Low-emission combustors developed as a result of ASCR research will enable U.S. engine manufacturers to compete on a

  8. Endurance and neuromuscular changes in world-class level kayakers during a periodized training cycle.

    Science.gov (United States)

    García-Pallarés, Jesús; Sánchez-Medina, Luis; Carrasco, Luis; Díaz, Arturo; Izquierdo, Mikel

    2009-07-01

    This study was undertaken to analyze changes in selected cardiovascular and neuromuscular variables in a group of elite kayakers across a 12-week periodized cycle of combined strength and endurance training. Eleven world-class level paddlers underwent a battery of tests and were assessed four times during the training cycle (T0, T1, T2, and T3). On each occasion subjects completed an incremental test to exhaustion on the kayak-ergometer to determine maximal oxygen uptake (VO(2max)), second ventilatory threshold (VT2), peak blood lactate, paddling speed at VO(2max) (PS(max)) and at VT2 (PS(VT2)), stroke rate at VO(2max) and at VT2, heart rate at VO(2max) and at VT2. One-repetition maximum (1RM) and mean velocity with 45% 1RM load (V (45%)) were assessed in the bench press (BP) and prone bench pull (PBP) exercises. Anthropometric measurements (skinfold thicknesses and muscle girths) were also obtained. Training volume and exercise intensity were quantified for each of three training phases (P1, P2, and P3). Significant improvements in VO(2max) (9.5%), VO(2) at VT2 (9.4%), PS(max) (6.2%), PS(VT2) (4.4%), 1RM in BP (4.2%) and PBP (5.3%), V (45%) in BP (14.4%) and PBP (10.0%) were observed from T0 to T3. A 12-week periodized strength and endurance program with special emphasis on prioritizing the sequential development of specific physical fitness components in each training phase (i.e. muscle hypertrophy and VT2 in P1, and maximal strength and aerobic power in P2) seems effective for improving both cardiovascular and neuromuscular markers of highly trained top-level athletes.

  9. Performance changes in world-class kayakers following two different training periodization models.

    Science.gov (United States)

    García-Pallarés, Jesús; García-Fernández, Miguel; Sánchez-Medina, Luis; Izquierdo, Mikel

    2010-09-01

    This study was undertaken to compare training-induced changes in selected physiological, body composition and performance variables following two training periodization models: traditional (TP) versus block periodization (BP). Ten world-class kayakers were assessed four times during a training cycle over two consecutive seasons. On each occasion, subjects completed an incremental test to exhaustion on the kayak ergometer to determine peak oxygen uptake (VO(2peak)), VO(2) at second ventilatory threshold (VO(2) VT2), peak blood lactate, paddling speed at VO(2peak) (PS(peak)) and VT2 (PS( VT2)), power output at VO(2peak) (Pw(peak)) and VT2 (Pw( VT2)), stroke rate at VO(2peak) (SR(peak)) and VT2 (SR( VT2)) as well as heart rate at VO(2peak) and VT2. Volume and exercise intensity were quantified for each endurance training session. Both TP and BP cycles resulted in similar gains in VO(2peak) (11 and 8.1%) and VO(2) VT2 (9.8 and 9.4%), even though the TP cycle was 10 weeks and 120 training hours longer than the BP cycle. Following BP paddlers experienced larger gains in PS(peak), Pw(peak) and SR(peak) than those observed with TP. These findings suggest that BP may be more effective than TP for improving the performance of highly trained top-level kayakers. Although both models allowed significant improvements of selected physiological and kayaking performance variables, the BP program achieved similar results with half the endurance training volume used in the TP model. A BP design could be a more useful strategy than TP to maintain the residual training effects as well as to achieve greater improvements in certain variables related to kayaking performance.

  10. Long-term intensive training induced brain structural changes in world class gymnasts.

    Science.gov (United States)

    Huang, Ruiwang; Lu, Min; Song, Zheng; Wang, Jun

    2015-03-01

    Many previous studies suggested that both short-term and long-term motor training can modulate brain structures. However, little evidence exists for such brain anatomical changes in top-level gymnasts. Using diffusion-weighted and structural magnetic resonance images of the human brain, we applied voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) as well as FA-VBA (voxel-based analysis of fractional anisotropy, a VBM-style analysis) methods to quantitatively compare the brain structural differences between the world class gymnasts (WCG) and the non-athlete groups. In order to reduce the rate of false positive findings, we first determined that the clusters defined at a threshold of t > 2.3 and a cluster significance of p brain regions that showed significant differences in a between-group comparison. We then constructed several between-group comparisons based on the repeated diffusion or structural MRI data and created the intersecting regions from multiple between-group comparisons. Thus, we found significantly decreased fractional anisotropy (FA) not only in the white matter of the WCG in areas that included the bilateral superior longitudinal fasciculus, inferior longitudinal fasciculus, and inferior occipito-frontal fascicle, but also in the gray matter of the WCG in areas that included the bilateral middle cingulum, bilateral postcentral gyri, and bilateral motor regions. We also identified significantly increased gray matter density in the WCG, especially in the left inferior frontal gyrus, bilateral inferior and superior parietal lobule, bilateral superior lateral occipital cortex, left cuneus, left angular gyrus, and right postcentral gyrus. We speculate that the brain changes of the WCG may reflect the gymnasts' extraordinary ability to estimate the direction of their movements, their speed of execution, and their identification of their own and surrounding objects' locations. Our findings suggest that our method of constructing

  11. 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)

  12. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair has become ...

  13. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    A. Bhat

    Abstract. Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair.

  14. Incision for pleural tissue biopsy (image)

    Science.gov (United States)

    ... open pleural biopsy, a small piece of the pleural tissue is removed through a surgical incision in the chest. After the sample is obtained, a chest tube is placed and the incision is closed with ...

  15. 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...

  16. The National Shipbuilding Research Program. World Class U.S. Shipbuilding Standards. Task 2: The Management Plan. Part 1: Trip Report to Odense Steel Shipyard, Lindo, Denmark

    National Research Council Canada - National Science Library

    1996-01-01

    .... These report replaces your copy of the Draft Trip Report. The discussions and information provided on your World Class Shipbuilding Standards development and management program was constructive and informative...

  17. 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.

  18. 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.

  19. 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

  20. Three versus four radial keratotomy incisions.

    Science.gov (United States)

    Melles, G R; Go, A T; Beekhuis, W H; van Rij, G; Binder, P S

    1992-01-01

    Radial keratotomy (RK) is currently performed with four or eight semi-radial incisions. To evaluate the effect of a theoretically more stable three-incision RK pattern, centripetal incisions were made in 16 human donor eyes (eight pairs), using a double-edged diamond blade set to 90% of central pachymetry and a 3.5 mm optical clear zone. Intraocular pressure was maintained at 15 mm Hg during surgery and while keratometry readings were made. One randomly selected eye of each pair had three radial incisions made at 12, 4 and 8 o'clock; the other eye had four radial incisions at 12, 3, 6, and 9 o'clock. Corneal flattening was 6.08 diopters (D) with four incisions and 4.84 D with three incisions (P less than .05). Astigmatism increased 0.44 D and 0.69 D, respectively (P greater than .1). Histologically measured mean incision depth (77.4%) did not differ significantly between the groups (P greater than .1). This study shows that 80% of the effect of a four-incision RK pattern can be obtained with a theoretically more stable three-incision pattern.

  1. 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.

  2. 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)

  3. 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)

  4. 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.

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

    OpenAIRE

    Helton Cristian de Paula; Ramon Kael Benassi Bachmann; Joyce Menezes da Fonseca Tonin; Romualdo Douglas Colauto

    2012-01-01

    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 qu...

  6. 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.

  7. 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.

  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. Building a World-Class Front-Line Workforce: The Need for Occupational Skill Standards in State Workforce Preparation Programs. EQW Working Papers.

    Science.gov (United States)

    Sheets, Robert G.

    Establishment of a national-state system of world-class occupational skill standards is a first step in restructuring adult vocational-technical education and job training programs. Occupational skills standards provide the necessary foundation for addressing three major state policy issues: the state's proper role in private work-based training,…

  10. The Variation of Universally Acknowledged World-Class Universities (UAWCUs) between 2010 and 2015: An Empirical Study by the Ranks of THEs, QS and ARWU

    Science.gov (United States)

    Liu, Lu; Liu, Zhimin

    2016-01-01

    Due to certainty recognition in ranking systems, the commonly included top 100 universities are regarded as the Universally Acknowledged World-Class Universities (UAWCUs). From three university rankings-THEs, QS and ARWU from 2010 to 2015, the following conclusions can be drawn from this study: Firstly, 56 universities are commonly ranked in the…

  11. 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,…

  12. 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.

  13. 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.

  14. 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.

  15. 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

    2015-01-01

    Background Little is known about the rate and pattern of injuries in international volleyball competition. Objective 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). Methods 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). Results 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. Conclusions 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. PMID:26194501

  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. 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.

  18. 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.

  19. A small incision technique facilitates pterygium removal

    Directory of Open Access Journals (Sweden)

    Shu Zhang

    2015-09-01

    Full Text Available AIM: To verify the advantages of an improved protocol for pterygium surgery(small incision removalover a conventional protocol of this surgery.METHODS: Totally 40 primary pterygium cases were divided into two groups(n=20 eachaccording to the protocols: small incision removal versus conventional removal. In our small incision removal, group 1, the pterygium body was cut open with a small incision firstly, through which the conjunctiva was separated from the underlying degenerated Tenon's layer; while in the conventional protocol, group 2, the whole head of pterygium was taken down before the separation. Then the head of pterygium was torn down in our protocol using a forceps instead of cutting it down with a blade, which was facilitated by a special corneal epithelial flap formation method. Surgery time, pain score and corneal wound healing were measured to provide objective comparison of outcome between the two protocols. RESULTS: In the group using small incision removal, the average surgery time was 7.72min(or 48.9%shorter than that of the control group using conventional protocol(PPCONCLUSION: The small incision pterygium removal protocol was easier to perform and resulted in a better outcome than the conventional protocol.

  20. Abdominal incisions in General Surgery: a review | Ajao | Annals of ...

    African Journals Online (AJOL)

    There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal ...

  1. Laparoscopic cholecystectomy with two mini cosmetic incisions.

    Science.gov (United States)

    Tavassoli, Alireza; Noorshafiee, Sajad

    2017-12-18

    Minimally invasive surgery gained popularity between general surgeons especially laparoscopic four-port cholecystectomy. By introducing different methods such as NOTES and SILS, the costs elevated with its cosmetics. We aim to study a new technique of laparoscopic cholecystectomy by two incisions with best cosmetics, and same quality and lower cost as conventional four-port laparoscopic cholecystectomy and make a comparison between them. In a double-blind clinical trial from December 2012 to September 2014, patients with cholelithiasis who presented to general surgery clinic and candidate for laparoscopic cholecystectomy were studied. Half of patients underwent double-incision laparoscopic cholecystectomy and other half underwent conventional four-port laparoscopic cholecystectomy. The mean age and BMI were higher in double-incision and four-port group, respectively, but not statistically different. Also male to female ratio was 6:1 in double-incision group and 9:1 in four-port group, and they were not statistically different. The mean operation time was about 2 min more in double-incision group, but it is trivial to consider a significant difference at level of 5%. The mean pain score (0-10) was significantly lower in double incision group in comparison with four-port group (p < 0.0001). Patients in double incision group reported higher satisfaction and were sooner in return to work than in four-port group (p < 0.0001). It seems that DILS for uncomplicated cholelithiasis is safe. By reducing port number, we succeed in reducing the pain and need for analgesics, reducing hospital staying and sooner return to work. By taking into account using conventional CLS instrument and lowering the hospital charges, it could be a good alternative to SILS.

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

    Directory of Open Access Journals (Sweden)

    Nidhi Jauhari

    2014-12-01

    Full Text Available AIM:To determine the surgically induced astigmatism (SIA in Straight, Frown and Inverted V shape (Chevron incisions in manual small incision cataract surgery (SICS.METHODS: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.RESULTS: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.CONCLUSION:Inverted V (Chevron incision gives minimal SIA.

  3. 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.

  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. Comparison of primary total hip replacements performed with a standard incision or a mini-incision.

    Science.gov (United States)

    Woolson, Steven T; Mow, Christopher S; Syquia, Jose Fernando; Lannin, John V; Schurman, David J

    2004-07-01

    Primary total hip replacement performed through an incision that is a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement. A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision. With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036). There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues

  6. Mineralisation footprints and regional timing of the world-class Siguiri orogenic gold district (Guinea, West Africa)

    Science.gov (United States)

    Lebrun, Erwann; Thébaud, Nicolas; Miller, John; Roberts, Malcolm; Evans, Noreen

    2017-04-01

    Siguiri is a world-class orogenic gold district hosted in the weakly metamorphosed Upper Birimian to Lower Tarkwa Group sedimentary rocks of the Siguiri Basin (Guinea). The district is characterised by a protracted deformation history associated with four main deformation events: D1S is a N-S compression; D2S is an E-W compression progressively evolving into an early-D3S transpression and then into a late-D3S NNW-SSE transtension and D4S is a NE-SW compression. Field observations, petrography and geochemistry at three key deposits of the Siguiri district (Bidini, Sintroko PB1 and Kosise) suggest a polyphase hydrothermal history that can be subdivided into four hydrothermal events. The first hydrothermal event was associated with the development of barren bedding-parallel and en-echelon V2S quartz-dominated-(pyrite) veins. The second hydrothermal event is characterised by the development of V3A pyrite-ankerite veins late during D3S. Laser ablation-ICP-MS data show that this vein set contains high gold contents of up to 43.3 ppm, in substitution in pyrite crystal lattice, representing a minor first gold mineralisation event. The third and most prominently developed hydrothermal event is late D3S and represents the second and principal gold mineralisation event. This mineralisation event led to two distinct mineralisation textures. The first texture is best exposed in the Kosise deposit and is characterised by gold-bearing quartz-ankerite-arsenopyrite conjugate V3B veins. Although the bulk of the gold is hosted in native gold grains in V3B veins, LA-ICP-MS analyses show that gold also substitutes in the arsenopyrite crystal lattice (up to 55.5 ppm). The second mineralisation texture is best expressed in the Sanu Tinti deposit and consists of disseminated barren pyrite hosted in a polymict conglomerate. The second and third hydrothermal events are both structurally controlled by a series of early-D3S N-S, NE-SW, WNW-ESE and E-W sub-vertical incipient structures

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

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    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

  8. 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.

  9. DOES TUBULARIZED INCISED PLATE URETHROPLASTY FIT ...

    African Journals Online (AJOL)

    Objective To evaluate prospectively our experience using tubularized incised plate (TIP) urethroplasty in primary and repeat penile shaft hypospadias. Patients and Methods Thirty-two boys with penile shaft hypospadias were selected to undergo TIP procedure. Their age ranged from 22 months to 9 years. Twenty-two cases ...

  10. 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)

  11. 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

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

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    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.

  13. 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.

  14. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome.

    Science.gov (United States)

    Bible, Jesse E; McClure, D Jake; Mir, Hassan R

    2013-11-01

    To analyze the rate of postoperative infection and nonunion after tibial fractures in patients treated for acute compartment syndrome (ACS) using (1) single-incision versus (2) dual-incision fasciotomy technique. Retrospective. Level I trauma center. Review of all adult tibial fractures operatively treated (n = 2756) over a 12-year period identified 175 patients with concurrent ACS requiring fasciotomy. Of 60 patients treated with intramedullary nails, 36 patients had single-incision fasciotomy and 24 had dual-incision fasciotomy. Of 81 patients treated with plate fixation, 59 patients had single-incision fasciotomy and 22 had dual-incision fasciotomy. Tibial fixation with fasciotomy for ACS. Occurrence of postoperative infection and nonunion. Both fasciotomy groups were similar across recorded patient and treatment characteristics. Need for skin graft was similar between fasciotomy groups. For patients treated with intramedullary nail (n = 60), 1 infection (2.8%) occurred in single-incision group versus 2 (8.3%) in dual-incision group (P = 0.558). Seven nonunions (19.4%) occurred in single-incision group versus 3 (12.5%) in dual-incision group (P = 0.726). For plate fixation patients (n = 81), 15 infections (25.4%) occurred with single-incision fasciotomy versus 5 infections (22.7%) with dual-incision fasciotomy (P = 1.000). Seven nonunions (11.9%) occurred with single-incision group versus 4 nonunions (18.2%) with dual-incision group (P = 0.479). This is the first study to compare a single-incision fasciotomy technique to a dual-incision technique in the setting of tibial fractures with ACS, with similar infection and nonunion rates with either technique. The choice of fasciotomy technique can be based on surgeon experience or patient condition as opposed to a suspected elevated infection or nonunion risk with either technique. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  15. Drainage basins and channel incision on Mars

    Science.gov (United States)

    Aharonson, Oded; Zuber, Maria T.; Rothman, Daniel H.; Schorghofer, Norbert; Whipple, Kelin X.

    2002-02-01

    Measurements acquired by the Mars Orbiter Laser Altimeter on board the Mars Global Surveyor indicate that large drainage systems on Mars have geomorphic characteristics inconsistent with prolonged erosion by surface runoff. We find the topography has not evolved to an expected equilibrium terrain form, even in areas where runoff incision has been previously interpreted. By analogy with terrestrial examples, groundwater sapping may have played an important role in the incision. Longitudinally flat floor segments may provide a direct indication of lithologic layers in the bedrock, altering subsurface hydrology. However, it is unlikely that floor levels are entirely due to inherited structures due to their planar cross-cutting relations. These conclusions are based on previously unavailable observations, including extensive piece-wise linear longitudinal profiles, frequent knickpoints, hanging valleys, and small basin concavity exponents.

  16. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

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

    2016-01-01

    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....

  17. Right Kocher’s incision: a feasible and effective incision for right hemicolectomy: a retrospective study

    Directory of Open Access Journals (Sweden)

    Theodosopoulos Theodosios

    2012-06-01

    Full Text Available Abstract Background The choice of surgical incision is determined by access to the surgical field, particularly when an oncological resection is required. Special consideration is also given to other factors, such as postoperative pain and its sequelae, fewer complications in the early postoperative period and a lower occurrence of incisional hernias. The purpose of this study is to compare the right Kocher’s and the midline incision, for patients undergoing right hemicolectomy, by focusing on short- and longterm results. Methods Between 1995 and 2009, hospital records for 213 patients that had undergone a right hemicolectomy for a right- sided adenocarcinoma were retrospectively studied. 113 patients had been operated via a Kocher’s and 100 via a midline incision. Demographic details, operative data (explorative access to the peritoneal cavity, time of operation, recovery parameters (time with IV analgesic medication, time to first oral fluid intake, time to first solid meal, time to discharge, and oncological parameters (lymph node harvest, TNM stage and resection margins were analyzed. Postoperative complications were also recorded. The two groups were retrospectively well matched with respect to demographic parameters and oncological status of the tumor. Results The median length of the midline incision was slightly longer (12 vs. 10 cm, p  Conclusions The Kocher’s incision approach for right- sided colon cancer is technically feasible, safe and overall very well tolerated. It can achieve the same standards of tumor resection and surgical field accessibility as the midline approach, while reducing postoperative recovery.

  18. The left hand second to fourth digit ratio (2D:4D does not discriminate world-class female gymnasts from age matched sedentary girls.

    Directory of Open Access Journals (Sweden)

    Maarten W Peeters

    Full Text Available INTRODUCTION: The second to fourth-digit-ratio (2D:4D, a putative marker of prenatal androgen action and a sexually dimorphic trait, has been suggested to be related with sports performance, although results are not univocal. If this relation exists, it is most likely to be detected by comparing extreme groups on the continuum of sports performance. METHODS: In this study the 2D:4D ratio of world-class elite female artistic gymnasts (n = 129, competing at the 1987 Rotterdam World-Championships was compared to the 2D:4D ratio of sedentary age-matched sedentary girls (n = 129, alongside with other anthropometric characteristics including other sexually dimorphic traits such as an androgyny index (Bayer & Bayley and Heath-Carter somatotype components (endomorphy, mesomorphy, ectomorphy using AN(COVA. 2D:4D was measured on X-rays of the left hand. RESULTS: Left hand 2D:4D digit ratio in world class elite female gymnasts (0.921±0.020 did not differ significantly from 2D:4D in age-matched sedentary girls (0.924±0.018, either with or without inclusion of potentially confounding covariates such as skeletal age, height, weight, somatotype components or androgyny index. Height (161.9±6.4 cm vs 155.4±6.6 cm p0.01, somatotype components (4.0/3.0/2.9 vs 1.7/3.7/3.2 for endomorphy (p<0.01, mesomorphy (p<0.01 and ectomorphy (p<0.05 respectively all differed significantly between sedentary girls and elite gymnasts. As expressed by the androgyny index, gymnasts have, on average, broader shoulders relative to their hips, compared to the reference sample. Correlations between the 2D:4D ratio and chronological age, skeletal age, and the anthropometric characteristics are low and not significant. CONCLUSION: Although other anthropometric characteristics of sexual dimorphism were significantly different between the two samples, the present study cannot discriminate sedentary girls from world-class female gymnasts by means of the left hand 2D:4D ratio.

  19. Small-incision lenticule extraction (SMILE)

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...... 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...

  20. 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.

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

    Science.gov (United States)

    Jeon, Seung Bae; Ahn, Hee Chang; Ahn, Yong Su; Choi, Matthew Seung Suk

    2015-11-01

    Surgical 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. A 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. The 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). Compared 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.

  2. 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 ex...... to be published to confirm its value. An ideal training route for surgeons who are adopting the technique was agreed upon, as was the need for a single, large clinical registry of data....

  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. Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy.

    Science.gov (United States)

    Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad; Sabetkish, Nastaran

    2015-10-01

    To present the feasibility of no skin incision orchiopexy in children with concomitant hypospadias and undescended testis (UDT) by a single subcoronal incision technique. To introduce the creation of subdartos muscle scrotal pouch with no scrotal skin incision. From one thousand and twenty-one children with hypospadias, 61 patients presented with concomitant palpable UDT and hypospadias. In group I (N = 34) single subcoronal incision with no scrotal skin incision was applied. In group II (N = 27), multi-incision technique was applied for classical orchiopexy and hypospadias surgery. For hypospadias reconstruction, all patients had classical subcoronal and para urethral plate incision with penile skin degloving according to the location of urethral meatus. Early and late complications, surgical time, hospital stay, and cosmetic results were recorded. Children with unilateral UDT and hypospadias had one incision in group I and three skin incisions in group II. Patients with bilateral UDT had one incision in group I and five skin incisions in group II. The operation time was significantly shorter in group I (93 ± 11 min) compared with group II (138 ± 17 min) (P = 0.03). Both groups were operated as day care basis; however, the hospital stay was slightly longer in group II (group I = 12 ± 2 h, vs group II = 16 ± 3 h) (P = 0.07). All testes were satisfactorily positioned into the bottom of the scrotum without development of any testicular atrophy. Single subcoronal penile skin incision is a feasible, safe, and cosmetically satisfactory technique in patients with hypospadias and concomitant UDT. Reduced postoperative pain, better objective cosmetic results, shorter operative time and comfortable post-operative period are the most significant advantages of this approach. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  5. Single-Incision Laparoscopic Surgery (SILS Assisted Sigma Resection Via Pfannenstiel Incision for Complicated Diverticulitis

    Directory of Open Access Journals (Sweden)

    Arne Dietrich

    2014-02-01

    Results: The operation time ranged from 89 to 280 min. There were no conversions, and no additional trocars were used. The postoperative hospital stay ranged from 5 to 14 days. All patients were discharged without any intraoperative or postoperative complications. Conclusions: SILS sigma or anterior rectum resection for complicated diverticulitis can be performed via a Pfannenstiel incision. This approach provides direct visualization and access into the pelvis as well as the option to benefit from open surgery devices. The Pfannenstiel incision may generally be recommended for the favorable cosmetic effect and the very low rate of incisional hernias, as reported in the literature. [Arch Clin Exp Surg 2014; 3(1.000: 10-15

  6. Diathermy versus Scalpel incision in elective midline laparotomy: A ...

    African Journals Online (AJOL)

    ... two groups with respect to the mean length of hospital stay (p = 0.834). Conclusion: We conclude that diathermy incision in elective midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and analgesic requirements.

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

    African Journals Online (AJOL)

    Dr. C. Pedro-Egbe

    Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. ABSTRACT. Aim: To compare the visual outcome of a superiorly placed limbal incision ..... Roman SJ, Auclin FX, Chong-Sit DA, Ullern MM. Surgically induced astigmatism with superior and temporal incisions in cases of ...

  8. 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)

  9. 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....

  10. 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 ...

  11. 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

  12. First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique.

    Science.gov (United States)

    Law, Jeffrey; Rowe, Neal; Archambault, Jason; Nastis, Sofia; Sener, Alp; Luke, Patrick P

    2016-01-01

    We compared the outcomes of single-incision, robot-assisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups. Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

  13. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J

    2001-01-01

    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...... postoperative pain and fewer pulmonary complications. Vertical laparotomy, however, is associated with shorter operating time and better possibilities for extension of the incision. The pooled odds ratio for burst abdomen in the vertical incision group was 2.86 (95% confidence interval 1.72 to 4.73, p = 0.......0001), and regarding late incisional hernia the pooled odds ratio was 1.68 (95% confidence interval 1.10 to 2.57. p = 0.02). CONCLUSIONS: Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. They should be recommended, as the early postoperative period is associated...

  14. 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.

  15. 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.

  16. Despite a high prevalence of menstrual disorders, bone health is improved at a weight-bearing bone site in world-class female rhythmic gymnasts.

    Science.gov (United States)

    Maïmoun, Laurent; Coste, Olivier; Georgopoulos, Neoklis A; Roupas, Nikolaos D; Mahadea, Krishna Kunal; Tsouka, Alexandra; Mura, Thibault; Philibert, Pascal; Gaspari, Laura; Mariano-Goulart, Denis; Leglise, Michel; Sultan, Charles

    2013-12-01

    Regular physical activity during puberty improves bone mass acquisition. However, it is unknown whether extreme intense training has the same favorable effect on the skeleton. We evaluated the bone mass acquisition in a unique cohort of world-class rhythmic gymnasts. A total of 133 adolescent girls and young women with a mean age of 18.7 ± 2.7 (14.4-26.7) years participated in this study: 82 elite rhythmic gymnasts (RGs) and 51 controls (CONs). Anthropometric variables and body composition were assessed, and all participants completed questionnaires on their general medical, menstrual, and training histories. Broadband ultrasound attenuation (BUA in decibels per megahertz) was determined by quantitative ultrasound at the heel. RGs presented lower weight (-8.5%, P rhythmic gymnastics appeared to have a beneficial effect on the bone health of a weight-bearing site. This effect was nevertheless modulated by the age of menarche. The high mechanical loading generated by this activity may counterbalance the negative effect of menstrual disorders.

  17. 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

  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. The tectonic setting and evolution of the 2.7 Ga Kalgoorlie-Kurnalpi Rift, a world-class Archean gold province

    Science.gov (United States)

    Witt, Walter K.; Cassidy, Kevin F.; Lu, Yong-Jun; Hagemann, Steffen G.

    2018-01-01

    The Yilgarn Craton results from three major mantle input events (at ca 3.0-2.9, 2.8 and 2.7 Ga) that have interacted with > 3.0 Ga continental crust. Zircon geochronology and Sm-Nd isotopic data subdivide the craton into an older Yilgarn proto-craton and the younger, more primitive Eastern Goldfields Superterrane (EGST). Formation of the Kalgoorlie-Kurnalpi Rift (KKR) within the EGST was associated with the 2.7 Ga event, which exploited weakened crust at the eastern margin of the Yilgarn proto-craton where thick sequences of komatiite and basalt were erupted between ca 2710 and 2690 Ma in the Kalgoorlie Terrane. Calc-alkaline volcanism in the Kurnalpi Terrane began at ca 2730 Ma and continued to ca 2690 Ma, overlapping rifting and plume-related volcanism in the Kalgoorlie Terrane. Deposition of siliciclastic sedimentary rocks within basins at ca 2660 resulted from an intra-orogenic extensional event and coincided with the transition from High-Ca to Low-Ca granite magmatism and peak emplacement of intrusions with a metasomatised mantle source component. Most aspects of the KKR are satisfied by broadly coincident plume-related magmatism in the Kalgoorlie Terrane and westward subduction to the east of the Burtville Terrane. Geochemical characteristics of 2730-2700 Ma calc-alkaline volcanism and 2685-2630 Ma low-SiO2 and alkali-rich intrusions support models for a continental margin subduction zone setting. World-class gold deposits formed in reactivated margins of the KKR, which became flux zones for mantle-derived magmas, hydrothermal fluids and heat during 2675-2620 Ma orogenesis. The orogenic gold mineralisation can be subdivided into proximal intrusion-related and distal-source deposits.

  20. 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.

  1. Cyclic steps incised on experimental bedrock

    Science.gov (United States)

    Yokokawa, M.; Kyogoku, A.; Kotera, A.; Izumi, N.

    2013-12-01

    the step shape has been predicted by the mathematical model (Izumi et al., 2012). Among three cases of sediment supply: 1 g/sec, 3 g/sec, and 6 g/sec with fixed water discharge (52 g/sec), the erosion rate was maximized in the cases of the sediment supply of 3 g/sec both in the cement-sand-water ratios of 2:150:50 and 3:150:50. The erosion rate is higher in the case of the moderate amount of sediment supply rather than in the case of the largest amount of sediment supply in which the alluvial cover effect inhibited erosion. This result is consistent with that observed in previous studies (Sklar & Dietrich, 2004; Johnson & Whipple, 2010). References Izumi, N., Yokokawa, M. & Parker G. 2012. Cyclic step morphology formed on bedrock. Annual Journal of Hydraulic Engineering 68(4) : I_955-I_960. Johnson, J.P.L. & Whipple, K.X. 2010. Evaluating the controls of shear stress, sediment supply, alluvial cover, and channel morphology on experimental bedrock incision rate. Journal of Geophysical Research 115, F02018, doi:10.1029/2009JF001335. Sklar, L.S. & Dietrich, W.E. 2004. A mechanistic model for river incision into bedrock by sultating bedload. Water Resources Re-search 40, W06301, doi:10.1029/2003WR002496.

  2. 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.

  3. 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.

  4. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J

    2001-01-01

    . 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...... with fewer complications (pain, burst abdomen, and pulmonary morbidity) and there is lower incidence of late incisional hernia after transverse compared with vertical laparotomy. A midline incision is still the incision of choice in conditions that require rapid intra-abdominal entry (such as trauma...

  5. 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)

  6. Rectus abdominis atrophy after ventral abdominal incisions: midline versus chevron.

    Science.gov (United States)

    Vigneswaran, Y; Poli, E; Talamonti, M S; Haggerty, S P; Linn, J G; Ujiki, M B

    2017-08-01

    Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions. Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery. At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p 20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon's decision-making process when choosing a transverse over a midline incision.

  7. 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.

  8. Small incision removal of nylon foil orbital implants.

    Science.gov (United States)

    Liu, Catherine Y; Vemuri, Swapna; Tao, Jeremiah P

    2015-01-01

    To describe a small incision technique for the removal of a nylon foil orbital wall implant. The authors retrospectively reviewed the charts of 9 patients who underwent a minimally invasive anterior orbitotomy for nylon foil explantation. Indications for removal and surgical technique, including size of orbitotomy incision and extent of orbital dissection, were recorded. Motility, globe position, strabismus pre- and post procedure, and complications were also assessed. Photographs, videos, and postoperative imaging were included, when available. The indications for removal were adjacent sinusitis (4 cases), undesirable implant position (3), orbital abscess (1), and adjacent orbital emphysema (1). The removal technique was associated with no changes in motility, globe position, or strabismus postprocedure. The average incision size was 1.1 cm, and the procedure was rapid, usually seconds once the anterior aspect of the implant was exposed and grasped with a hemostat. The dissection in all cases was to the anterior aspect of the implant without a need for deep orbital manipulation. The authors demonstrate through video that the implant folds to exit through a small incision. No adverse events were noted. Nasal endoscopy and radiography demonstrated a fibrous capsule that maintained orbital structure and support. Thin nylon foil implant can be explanted safely and efficiently through a very small incision. The orbit maintains structure and configuration postexplantation in this series.

  9. External defibrillation failure due to antimicrobial incise drape.

    Science.gov (United States)

    Barbara, David W; Dietz, Niki M; White, Roger D; Pochettino, Alberto; Nuttall, Gregory A

    2013-09-01

    Antimicrobial incise drapes adhere to a patient's skin during surgery in an attempt to reduce surgical infections. We describe a patient undergoing repeated aortic valve replacement who experienced sudden ventricular fibrillation before median sternotomy. External defibrillation was unsuccessful on multiple attempts using several defibrillators. On removal of the incise drape from the patient's chest, external defibrillation was immediately successful. Increased transthoracic impedance can be caused by multiple factors and may prevent defibrillation. To our knowledge, this is the first reported case of an antimicrobial incise drape preventing defibrillation. If external defibrillation, cardioversion, or pacing is indicated intraoperatively, we recommend prompt removal of the antimicrobial incise drapes before electrode placement if the drapes overlay the intended pad position. Since this case, our institutional practice has now changed to placement of 2 external adhesive defibrillator electrodes onto the patient's skin lateral to the surgical field before incise drape application to allow for defibrillation. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. 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.

  11. Sharp compared with blunt fascial incision at cesarean delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Hare, Kristine J; Krebs, Lone

    2014-01-01

    OBJECTIVE: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control. STUDY DESIGN: Women undergoing primary cesarean delivery (n=34) were randomized...... to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic...... difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725....

  12. The problem of insufficient incisal display: a case presentation.

    Science.gov (United States)

    Castillo, Rodrigo

    2010-01-01

    Enhancement of facial beauty is one of the primary elective goals of patients seeking dental care. Frequently, improvements in natural beauty can be expected to follow restoration of ideal relationships between the denture and the facial soft tissues. A very important feature in a youthful appearance is the incisal tooth display; the amount of maxillary incisal exposure gradually decreases with age, accompanied by a gradual increase in mandibular incisal exposure. However, this problem could be present in young people where the effects of age should not be apparent yet. There are some other factors that could accelerate this process. The present case illustrates the improvement and rejuvenation of an unesthetic young smile through restorative treatment.

  13. Giant Nasolabial Cyst Treated Using Neumann Incision: Case Report

    Directory of Open Access Journals (Sweden)

    Ordones, Alexandre Beraldo

    2013-09-01

    Full Text Available Introduction: A nasolabial cyst is an ectodermal development cyst. It presents as a fullness of canine fossa, nasal ala, or vestibule of the nose. It is rare and usually small. Treatment consists of complete surgical excision or transnasal endoscopic marsupialization. Objective: To describe a giant nasolabial cyst case treated using Neumann incision. Case Report: A 37-year-old man was referred to the otolaryngology department with nasal obstruction and nasal deformity. Computed tomography showed a nasal cystic lesion 4 × 4.5 × 5 cm wide. Surgical excision using Neumann incision was performed. Discussion: Neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment.

  14. Force modeling for incision surgery into tissue with haptic application

    Science.gov (United States)

    Kim, Pyunghwa; Kim, Soomin; Choi, Seung-Hyun; Oh, Jong-Seok; Choi, Seung-Bok

    2015-04-01

    This paper presents a novel force modeling for an incision surgery into tissue and its haptic application for a surgeon. During the robot-assisted incision surgery, it is highly urgent to develop the haptic system for realizing sense of touch in the surgical area because surgeons cannot sense sensations. To achieve this goal, the force modeling related to reaction force of biological tissue is proposed in the perspective on energy. The force model describes reaction force focused on the elastic feature of tissue during the incision surgery. Furthermore, the force is realized using calculated information from the model by haptic device using magnetorheological fluid (MRF). The performance of realized force that is controlled by PID controller with open loop control is evaluated.

  15. 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 .

  16. Single-incision sling operations for urinary incontinence in women.

    Science.gov (United States)

    Nambiar, Arjun; Cody, June D; Jeffery, Stephen T

    2014-06-01

    Urinary incontinence has been shown to affect up to 50% of women. Studies in the United States have shown that up to 80% of these women have an element of stress urinary incontinence. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process; we handsearched journals and conference proceedings (searched 6 February 2013) and searched ClinicalTrials.gov (searched 20 September 2012), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 20 September 2012) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the

  17. Small incision transcutaneous levator aponeurotic repair for blepharoptosis.

    Science.gov (United States)

    Baroody, Michael; Holds, John B; Sakamoto, Douglas K; Vick, Valerie L; Hartstein, Morris E

    2004-06-01

    Patients presenting with blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. A minimally invasive approach directed specifically at the levator aponeurotic anatomic defect may provide benefits to the patient. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. We describe our results with the use of a small incision ptosis repair in select patients. A retrospective chart review between January 2000 and September 2001 included 91 patients and 118 eyelids with blepharoptosis due to aponeurotic disinsertion, corrected by a minimally invasive approach. The small incision technique comprised levator aponeurotic resection and advancement. Pre- and postoperative upper eyelid marginal reflex distances (MRD1), eyelid contour, need for reoperation, and complications (overcorrection, undercorrection, hematoma, and infection) were recorded. The average preoperative MRD1 measured 0.5 +/- 1.1 mm, with a range of -2.0 to 2.5 mm. The average postoperative MRD1 measured 2.6 +/- 0.8 mm, with a range of 1 to 5.5 mm (P < 0.0001). Of the 118 eyelids corrected by a small incision technique, there were 4 overcorrections, 3 undercorrections, 1 failure, 1 postoperative ptosis procedure of the contralateral upper eyelid secondary to Hering's law ptosis, and 4 patients requesting surgical treatment of dermatochalasis. No symptomatic dry eye, exposure keratopathy, or other complication resulted in association with the overcorrections. No contour abnormalities, infections, hematomas, or other complications were noted. Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger-incision

  18. 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....

  19. 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......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...

  20. 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.

  1. 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.

  2. Versatility of tubularized incised plate urethroplasty in the ...

    African Journals Online (AJOL)

    Background: The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the ...

  3. Feasibility of a tubularised incised-plate urethroplasty with double ...

    African Journals Online (AJOL)

    Background: Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias ...

  4. Tubularized Incised Plate (TIP) Urethroplasty: Extended Use in ...

    African Journals Online (AJOL)

    Objective: Recently, tubularized incised plate (TIP) urethroplasty (Snodgrass repair) has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases. Patients and Methods: This study was ...

  5. Combined use of Mathieu and incised plate technique (Snodgrass ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  6. Tubularized incised plate urethroplasty repair in adult hypospadias ...

    African Journals Online (AJOL)

    Objective: Most studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults. Patients and methods: The records of 60 adult patients with primary hypospadias ...

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

    African Journals Online (AJOL)

    Annals of Pediatric Surgery 2012, 8:80–85. Keywords: recurrent hypospadias, salvage hypospadias, tubularized incised plate. aDepartment of Surgery, Division of Pediatric and Plastic Surgery, Faculty of. Medicine, Suez Canal University, Ismailia and bDepartment of Surgery, Faculty of. Medicine, Menoufia University ...

  8. a comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    ... October 2012 to October 2014 for cataract surgery were followed up for 6 weeks after surgery. They were divided into two groups based on the type of surgical procedure opted by the patients. Group A consisted of 50 patients who underwent Manual Small Incision Cataract. Surgery with rigid Polymethyl Methacrylate IOL ...

  9. Anastomosis Procedure through an Inguinal Hernia Incision in ...

    African Journals Online (AJOL)

    was laparoscopically transected by a stapler. A 4 cm skin incision was then made in the left inguinal region and carried down to the peritoneum through the hernia sac [Figure 1]. Bowel resection was performed extracorporeally, and an anvil was placed at the proximal end of the colon, over a purse-string suture. [Figure 2].

  10. rubularised Incised Plate Hypospadias Urethroplasty In A Regional ...

    African Journals Online (AJOL)

    1t the Coast Province General Hospital in Mombasa. Xenya and in some private hospitals, nearby. junction. Artificial erection test is done to check for residual chordee20. Residual penile curvature is corrected by dorsal tunica albuginea plication8. - The glans wings are mobilized laterally. A midline relaxing incision is made ...

  11. Treatment of pharyngocutaneous fistula acquired from incisions and ...

    African Journals Online (AJOL)

    Treatment of pharyngocutaneous fistula acquired from incisions and drainage of deep neck space abscess in a patient with occult third branchial anomaly. ... We did surgical exploration to excise and close the fistula but only succeeded at the second attempt. Conclusion: We conclude that branchial apparatus anomaly ...

  12. 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.

  13. 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

    OBJECTIVE: Compare arthroscopic partial meniscectomy to a true sham intervention. METHODS: Sham-controlled superiority trial performed in three county hospitals in Denmark comparing arthroscopic partial meniscectomy to skin incisions only in patients aged 35-55 years with persistent knee pain and...

  14. Feasibility of reduced port surgery applying Higuchi's transverse incision

    Directory of Open Access Journals (Sweden)

    Kazu Ueda

    2017-02-01

    Conclusion: We reported novel forms of reduced port surgery applying Higuchi's transverse incision. It was suggested that these procedures are relatively simple, but ensure the same safety and efficacy as conventional methods. We intend to increase the number of cases and examine safety, efficacy, and patient satisfaction for these procedures.

  15. Short communication Combined use of Mathieu and incised plate ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  16. Topical‑intracameral anesthesia in manual small incision cataract ...

    African Journals Online (AJOL)

    Background: Cataract remains a leading cause of blindness worldwide. Manual small incision cataract surgery (MSICS) is currently practiced as the technique of choice in Sub‑Saharan Africa to reduce the backlog of cataract blindness. Optimal pain control during surgery remains a challenge to cataract surgeons. Aim: To ...

  17. Visual Outcome after Small Incision Cataract Surgery in ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to determine the visual outcome of patients who had manual small incision cataract surgery in a high volume secondary eye hospital in southwestern Nigeria, and to identify reasons for poor outcome. Methodology: This is an observational descriptive, longitudinal study of consecutive ...

  18. Ankle fusion using a 2-incision, 3-screw technique

    NARCIS (Netherlands)

    Hendrickx, R. P. M.; Kerkhoffs, G. M. M. J.; Stufkens, S. A. S.; van Dijk, C. N.; Marti, R. K.

    2011-01-01

    Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty.

  19. DOES CONJUNCTIVAL INCISION INFLUENCE MEDIAL RECTUS MUSCLE RECESSIONS?

    Directory of Open Access Journals (Sweden)

    Galina G. Dimitrova

    2015-09-01

    Full Text Available Purpose: To evaluate the role of conjunctival incision in medial rectus muscle recessions as surgical treatment of choice in esotropia. Methods: The study included 200 patients (370 eyes, operated on for esotropia in the period of 2000-2014. 170 of them (340 eyes underwent bilateral medial rectus muscle recessions and 30- unilateral medial rectus muscle recession for various forms of alternating/alternated esotropia. We compared the effect (Δ/mm recession of fornix and limbal approach. Diagnostic, surgical and statistical methods were used. Results: Limbal incision was performed on 110 patients (55,3% and fornix approach was done in 89 cases (44,7%. The mean effect corrected prism diopters for each mm of recession (Δ/mm differed significantly in the two groups, being bigger in cases with fornix incision (p<0,001 . Conclusion: The type of conjunctival incision in medial rectus muscle recessions have an influence not only on the cosmetic appearance, but also on the functional result. This is especially true for large recessions.

  20. 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

  1. Functional and aesthetic results of various lip-splitting incisions: A clinical analysis of 60 cases.

    Science.gov (United States)

    Rapidis, A D; Valsamis, S; Anterriotis, D A; Skouteris, C A

    2001-11-01

    This study retrospectively evaluated the functional and aesthetic results of various types of lip-splitting incisions in a group of patients in whom this approach was used to treat intraoral tumors. Between 1992 and 1998, 87 consecutive patients were subjected to either mandibulotomy or mandibulectomy using a lip-splitting incision. During this period, 4 types of incisions were sequentially used: straight midline incision, lateral lip-splitting incision, midline splitting with extension around the contour of the chin, and the chevron chin-contour incision. Sixty patients with a follow-up of at least 6 months were included in the study. The patients were asked to answer a questionnaire regarding the degree of satisfaction with the cosmetic result of the procedure and were clinically assessed for sensory and functional impairment resulting from the incision. The remaining 27 patients were lost to follow-up or had died of their disease. The lateral lip-splitting incision caused the fewest postoperative problems in patients subjected to either mandibulotomy or mandibulectomy. The best overall results were achieved by the chevron-chin contour incision. The incision that followed the contour of the chin and the straight midline incision showed less satisfactory results. The chevron chin-contour incision, along with meticulous soft tissue closure, produces the best aesthetic and functional results. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

  2. Incision of Licus Vallis, Mars, From Multiple Lake Overflow Floods

    Science.gov (United States)

    Goudge, Timothy A.; Fassett, Caleb I.

    2018-02-01

    Licus Vallis is a large valley (>350 km long, >2 km wide, and >150 m deep) that heads at the outlet breach of an 30 km diameter impact crater. We present observations of the geomorphology and topography of this paleolake outlet valley and associated tributary valleys to constrain the history of incision of the Licus Vallis system. Licus Vallis has an abrupt increase in gradient by a factor of approximately 4 along its longitudinal profile, and a knickpoint that drops 200 m over a reach of 2 km approximately 12 km downstream from the valley head. We also describe a set of paired terraces within Licus Vallis, which are continuous for tens of kilometers and define an interior valley >2 km in width. We interpret the geomorphology of Licus Vallis as recording at least two discrete, major episodes of valley incision, both driven by lake overflow floods. The main portion of Licus Vallis formed by overflow flooding from a large ( 103-104 km2) lake contained in an intercrater basin. Subsequently, overflow flooding from a lake within the 30 km diameter impact crater reactivated Licus Vallis, forming a major knickpoint at the valley head and establishing the upstream section of the valley at a lower slope. Farther down the valley, this flood event incised an interior valley bounded by paired terraces. Regional tributary valleys that feed Licus Vallis also have prominent knickpoints, which have retreated farthest for downstream valleys. We conclude that these knickpoints record successive waves of incision that swept up Licus Vallis during lake overflow flooding, with erosion in the main trunk of the valley (from overflow floods) significantly outpacing erosion in the tributary valleys (from regional surface runoff). These observations of Licus Vallis illustrate how lake overflow floods may have provided an important control on the pace of landscape evolution on Mars.

  3. Robot-assisted submandibular gland excision via modified facelift incision

    OpenAIRE

    Jung, Seung Wook; Kim, Young Kwan; Cha, Yong Hoon; Koh, Yoon Woo; Nam, Woong

    2017-01-01

    Background The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar c...

  4. Rehabilitation of anterior teeth with customised incisal guide table.

    Science.gov (United States)

    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya

    2013-05-24

    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabricated accordingly.

  5. Rehabilitation of anterior teeth with customised incisal guide table

    OpenAIRE

    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya

    2013-01-01

    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabr...

  6. Rehabilitation of anterior teeth with customised incisal guide table

    Science.gov (United States)

    Mall, Priyanka; Singh, Kamleshwar; Rao, Jitendra; Kumar, Lakshya

    2013-01-01

    Restoration of anterior guidance is a major challenge to the clinician in planning of all restorative treatments. An accurate anterior guidance is important for proper function, aesthetics, comfort and phonetics. This article describes anterior rehabilitation of a patient who met with a road traffic accident and lost his anterior teeth. Anterior guidance developed in the provisional restorations was accurately recorded in the customised incisal guide table and permanent restorations were fabricated accordingly. PMID:23709546

  7. Mini incision open pyeloplasty - Improvement in patient outcome

    Directory of Open Access Journals (Sweden)

    Vishwajeet Singh

    2015-10-01

    Full Text Available ABSTRACT Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO. Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS. For objective assessment, the improvement in differential renal function (DRF and radio-tracer wash out time (T1/2 on Tc-99m DTPA scan and decrease in hydronephrosis (HDN on renal ultrasound (USG and urography (IVU were assessed. Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124 minutes and 2.5 (2–6 days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001 and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

  8. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery.

    Science.gov (United States)

    Tayar, Claude; Claude, Tayar; Subar, Daren; Daren, Subar; Salloum, Chady; Chady, Salloum; Malek, Alexandre; Alexandre, Malek; Laurent, Alexis; Alexis, Laurent; Azoulay, Daniel; Daniel, Azoulay

    2014-01-01

    Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH). From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.). Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins. SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  9. 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 ...

  10. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery

    Directory of Open Access Journals (Sweden)

    Tayar Claude

    2014-01-01

    Full Text Available Background: Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH. Patients and Methods: From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure TM (Covidien-Valleylab. Boulder. USA, Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.. Results: Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min and the mean estimated blood loss was 57 ml (range: 25-150 ml. The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days. Pathology identified three benign and four malignant liver tumours with clear margins. Conclusion: SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  11. Endoscope-assisted transoral thyroidectomy using a frenotomy incision.

    Science.gov (United States)

    Woo, Seung Hoon

    2014-05-01

    Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) has generated excitement among surgeons as potentially scar-free surgery. We developed this technique while taking into consideration that it could also be applied to transoral thyroid surgery. We report the case of a 35-year-old woman with a 0.5×0.5-cm papillary thyroid microcarcinoma. We implemented a modified approach for the removal of the thyroid by using a frenotomy incision of the mouth, accompanied by an endoscope system. A modified approach for the removal of the thyroid was used on the patient. The total operating time was 120 minutes, and there were no specific complications. The patient continues to be free of any diseases 12 months after the excision. Thyroidectomy can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth. We describe the detailed procedures for an endoscope-assisted transoral thyroidectomy using a frenotomy incision.

  12. 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.

  13. One-incision versus two-incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults.

    Science.gov (United States)

    Rezende, Fernando C; Moraes, Vinícius Y; Franciozi, Carlos Es; Debieux, Pedro; Luzo, Marcus V; Belloti, João Carlos

    2017-12-15

    Anterior cruciate ligament (ACL) tears are serious knee injuries that are frequently treated surgically in the form of arthroscopically assisted reconstruction with grafts from the patella or hamstrings tendons. We reviewed the evidence for the choice of arthroscopically assisted ACL reconstruction technique in terms of whether it should involve one incision (femoral tunnel drilled from inside the knee joint under arthroscopic visualisation) or two incisions (femoral tunnel drilled from outside to inside the knee joint). To assess the effects (benefits and harms) of one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Sciences (LILACS), the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, reference lists, and conference abstracts. The date of the search was 16 August 2017. Randomised and quasi-randomised controlled clinical trials evaluating one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. Two review authors independently searched and selected studies, and extracted data and assessed the risk of bias of the eligible studies. We undertook limited pooling of data using the fixed-effect model. We included five trials (four randomised and one quasi-randomised) evaluating a total of 320 participants who were mainly in their 20s. All participants underwent ACL reconstruction with patella tendon grafts. All five included trials were at a high risk of bias, particularly performance bias. Based on these limitations and the insufficiency of the available data resulting in imprecision of effect estimates, we judged the quality of the evidence as very low for all outcomes. This means that we are uncertain of the findings of the

  14. Pressure Irrigation of Surgical Incisions and Traumatic Wounds.

    Science.gov (United States)

    Fry, Donald E

    Pressure irrigation of surgical incisions and traumatic wounds is commonly used to prevent infections. Commercial pressure irrigation devices have proliferated rapidly, but scientific validation of clinical benefit or appropriate use remains uncertain. The published experimental and clinical investigations of pressure irrigation have been reviewed since the introduction of the Waterpik device in 1967 to identify the evidence for use to prevent soft tissue infections associated with injury wounds or surgical incisions. The published literature favors low pressure irrigation between 5-15 pounds/square inch (psi) for experimental removal of bacteria from contaminated tissues, with pressures higher being associated with soft tissue and bone injury. No experimental or clinical data have demonstrated improved benefit from pulsed over continuous lavage. Clinical studies have been very heterogeneous in patient populations and study design; meta-analysis was not feasible. High-risk abdominal operations may have lower surgical site infection rates with pressure irrigation. Pressure irrigation in fractures and joint replacement surgery has shown mixed results. The largest multi-center randomized trial showed no benefit of pulsed (8-10 psi) lavage over conventional continuous gravity irrigation of open fractures. Experimental studies have shown effective removal of bacteria and contamination, but with a potential risk of tissue injury or displacement of contamination deeper into the soft tissues. Rigorous clinical documentation has not validated the optimum flow or pressure characteristics of pressure lavage in clinical practice. There is need for randomized clinical trials to validate pressure lavage in the prevention of infections in soft tissue injuries or high-risk surgical incisions.

  15. Single transverse extended incision for radical neck dissection

    Directory of Open Access Journals (Sweden)

    José Francisco Sales Chagas

    Full Text Available ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective. Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.

  16. 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.

  17. 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.

  18. A case of endophthalmitis associated with limbal relaxing incision

    Directory of Open Access Journals (Sweden)

    Aravind Haripriya

    2012-01-01

    Full Text Available Limbal relaxing incisions (LRIs are considered a relatively safe procedure with rapid stabilization and absence of infectious complications. Do we need to readdress this last impression? We report a case of nocardia endophthalmitis associated with an exudate at the site of an LRI in a patient who underwent routine cataract surgery. This case, to the best of our knowledge, is the first report of its kind, stressing the need for a cautious approach to the adoption of this method of astigmatic correction.

  19. [Preliminary clinical experience of single incision laparoscopic colorectal surgery].

    Science.gov (United States)

    Wu, S D; Han, J Y

    2016-06-01

    Objective: To discuss the preliminary experience of single incision laparoscopic colorectal surgery. Methods: The clinical data and surgical outcomes of 104 selected patients who underwent single incision laparoscopic colorectal surgery in the 2 nd Department of General Surgery, Shengjing Hospital of China Medical University from January 2010 to September 2015 were retrospectively analyzed. There were 62 male and 42 female patients, aging from 21 to 87 years with a mean of (61±12) years. Eighty-five patients were diagnosed with malignancy while the rest 19 cases were benign diseases. All the procedures were performed by the same surgeon using the rigid laparoscopic instruments. Surgical and oncological outcomes were analyzed in 4 kinds of procedures which are over 5 cases respectively, including low anterior resection, abdominoperineal resection, radical right colon resection and radical sigmoidectomy. Results: Single incision laparoscopic colorectal surgery was performed in 104 selected patients and was successfully managed in 99 cases with a total conversion rate of 4.8%. Radical procedures for malignancy in cases with the number of patients more than 5 were performed for 74 cases. For low anterior resection, 35 cases with an average surgical time of (191±57) minutes, average estimated blood loss of (117±72) ml and average number of harvested lymph nodes of 14.6±1.1. For abdominoperineal resection, 9 cases with an average surgical time of (226±54) minutes, average estimated blood loss of (194±95) ml and average number of harvested lymph nodes of 14.1±1.5. For radical right colon resection, 16 cases with an average surgical time of (222±62) minutes, average estimated blood loss of (142±68) ml and average number of harvested lymph nodes of 15.4±2.4. For radical sigmoidectomy, 14 cases with an average surgical time of (159±32) minutes, average estimated blood loss of (94±33) ml and average number of harvested lymph nodes of 13.9±1.5. The overall

  20. Single Incision Laparoscopic Cholecystectomy vs Conventional Cholecystectomy in Developing Country

    Directory of Open Access Journals (Sweden)

    P B Thapa

    2010-09-01

    Full Text Available INTRODUCTION: Use of laparoscopic surgery has demanded principles of less trauma of access hence less scar and so probably less complications. Hence conventional laparoscopic surgeries were tried with natural orifice transluminal surgery (NOTES and then single incision laparoscopic surgery (SILS. With refinement in instruments and surgeons skills SILS have bridged up between conventional and NOTES in order to quench the desire of less or no scar at all. METHODS: Comparative case control study between conventional laparoscopic cholecystectomy and SILS in public teaching hospital. RESULTS: Total 20 patients underwent SILS cholecystectomy and 20 underwent conventional cholecystectomy and found that no difference between both in terms of post operative pain score, hospital stay and post operative wound infection except significant difference in mean operative time and patient's level of satisfaction was less in patient with SILC if were subjected to pay for instruments in order to maintain cosmesis. CONCLUSIONS: Though SILS have gained rapid acceptance in surgical fraternity, large number of randomized controlled trials are necessary to show its benefit over conventional laparoscopic cholecystectomy. Keywords: cholecystectomy, conventional, laparoscopy, single incision, surgery

  1. Single-incision laparoscopic surgery for diverticulitis in overweight patients.

    Science.gov (United States)

    Rink, Andreas D; Vestweber, Boris; Hahn, Jasmina; Alfes, Angelika; Paul, Claudia; Vestweber, Karl-Heinz

    2015-10-01

    Single-incision laparoscopic surgery (SILS) has been introduced as a new technique for the treatment of various colorectal diseases. Recurrent or complicated diverticulitis of the sigmoid colon is a frequent indication for minimally invasive sigmoid colectomy. The aim of this study was to investigate the impact of obesity on the outcome of SILS sigmoid colectomy. From September 2009 to October 2014, data from 377 patients who had intended SILS sigmoid colectomy for diverticulitis at our institution were collected in a prospective database. The patients were categorized in the following subgroups: group 1 (normal weight, body mass index (BMI)  35 kg/m(2)). The groups were equivalent for sex, age, status of diverticulitis, the presence of acute inflammation in the specimen, and the percentage of teaching operations, but the percentage of patients with accompanying diseases was significantly more frequent in groups 2, 3, and 4 (p = 0.04, 0.008, and 0.018, respectively). As compared to group 1, the conversion rate was significantly increased in groups 2 and 4 (2.3 vs. 9.3% (p = 0.013) and 2.3 vs. 12.5% (p = 0.017), respectively). The duration of surgery, hospitalization, and morbidity did not differ between the four groups. Up to a body mass index of 35 kg/m(2), increased body weight does not significantly reduce the feasibility and outcome of single-incision laparoscopic surgery for diverticulitis.

  2. 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.

  3. Unilateral corneal ectasia following small-incision lenticule extraction.

    Science.gov (United States)

    Sachdev, Gitansha; Sachdev, Mahipal S; Sachdev, Ritika; Gupta, Hemlata

    2015-09-01

    We describe a case of unilateral corneal ectasia in a 26-year-old man following small-incision lenticule extraction. The preoperative corneal topography was normal, with a minimum corneal thickness of 511 μm and 513 μm in the right eye and left eye, respectively. Lenticules of 85 μm and 82 μm were fashioned to offer a refractive correction of -3.75 -1.50 × 180 and -3.50 -1.50 × 165 in the right eye and left eye, respectively. Twelve months after small-incision lenticule extraction, the patient presented with early signs of ectasia in the left eye on corneal topography, which had worsened at the 18-month examination. Intrastromal corneal ring segment implantation with corneal collagen crosslinking was performed to arrest further progression and to improve uncorrected distance visual acuity. On the last examination, the corrected distance visual acuity was 20/20(-2). Dr. Mahipal S. Sachdev receives travel grants from Carl Zeiss Meditec AG. 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.

  4. Endoscopy-assisted cerebral falx incision via unilateral

    Directory of Open Access Journals (Sweden)

    DONG Ji-rong

    2012-04-01

    Full Text Available 【Abstract】Objective: To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treat-ing these patients by minimally invasive surgery. Methods: Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control. Results: Seventeen cases (54.8% in the unilateral operation group survived and were in good condition, 8 (25.8% had moderate disability, 4 (12.9% had severe disability, 1 (3.2% was in vegetative state, and 1 (3.2% died. Compared with the control group, the Glasgow Out-come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans-fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions: Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dis-symmetric bilateral frontal contusion. It can obviously di-minish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation. Key words: Brain injuries; Intracranial hemorrage, traumatic; Endoscopy; Surgically procedures, minimally invasive

  5. 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.

  6. 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

  7. 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.

  8. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery

    OpenAIRE

    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro

    2016-01-01

    Background Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperat...

  9. Autogenic entrenchment patterns and terraces due to coupling with lateral erosion in incising alluvial channels

    Science.gov (United States)

    Malatesta, Luca C.; Prancevic, Jeffrey P.; Avouac, Jean-Philippe

    2017-01-01

    The abandonment of terraces in incising alluvial rivers can be used to infer tectonic and climatic histories. A river incising into alluvium erodes both vertically and laterally as it abandons fill-cut terraces. We argue that the input of sediment from the valley walls during entrenchment can alter the incision dynamics of a stream by promoting vertical incision over lateral erosion. Using a numerical model, we investigate how valley wall feedbacks may affect incision rates and terrace abandonment as the channel becomes progressively more entrenched in its valley. We postulate that erosion of taller valley walls delivers large pulses of sediment to the incising channel, potentially overwhelming the local sediment transport capacity. Based on field observations, we propose that these pulses of sediment can form talus piles that shield the valley wall from subsequent erosion and potentially force progressive channel narrowing. Our model shows that this positive feedback mechanism can enhance vertical incision relative to 1-D predictions that ignore lateral erosion. We find that incision is most significantly enhanced when sediment transport rates are low relative to the typical volume of material collapsed from the valley walls. The model also shows a systematic erosion of the youngest terraces when river incision slows down. The autogenic entrenchment due to lateral feedbacks with valley walls should be taken into account in the interpretation of complex-response terraces.

  10. Safety of cesarean delivery through placental incision in patients with anterior placenta previa.

    Science.gov (United States)

    Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa; Jeong, Eun-Hwan

    2016-03-01

    To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique.

  11. 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.

  12. 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

  13. 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)

  14. 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

  15. 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)

  16. 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.

  17. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G

    2011-01-01

    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  18. 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

  19. 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.

  20. A 1-D morphodynamic model of postglacial valley incision

    Science.gov (United States)

    Tunnicliffe, Jon F.; Church, Michael

    2015-11-01

    Chilliwack River is typical of many Cordilleran valley river systems that have undergone dramatic Holocene degradation of valley fills that built up over the course of Pleistocene glaciation. Downstream controls on base level, mainly blockage of valleys by glaciers, led to aggradation of significant glaciofluvial and glaciolacustrine valley fills and fan deposits, subsequently incised by fluvial action. Models of such large-scale, long-term degradation present a number of important challenges since the evolution of model parameters, such as the rate of bedload transport and grain size characteristics, are governed by the nature of the deposit. Sediment sampling in the Chilliwack Valley reveals a complex sequence of very coarse to fine textural modes. We present a 1-D numerical morphodynamic model for the river-floodplain system tailored to conditions in the valley. The model is adapted to dynamically adjust channel width to optimize sediment transporting capacity and to integrate relict valley fill material as the channel incises through valley deposits. Sensitivity to model parameters is studied using four principal criteria: profile concavity, rate of downstream grain size fining, bed surface sand content, and the timescale to equilibrium. Model results indicate that rates of abrasion and coarsening of the grain size distributions exert the strongest controls on all of the interrelated model performance criteria. While there are a number of difficulties in satisfying all model criteria simultaneously, results indicate that 1-D models of valley bottom sedimentary systems can provide a suitable framework for integrating results from sediment budget studies and chronologies of sediment evacuation established from dating.

  1. 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

    BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for im...

  2. 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...

  3. 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 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.

  4. 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...

  5. 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.

  6. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery.

    Science.gov (United States)

    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro

    2016-07-07

    Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction. The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi. We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was -0.26 ± 0.93 with the temporal incision and -0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was -0.02, with a 95 % CI of -0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was

  7. Transscleral tunnel incision related arterial hemorrhage in 23-gauge Vitrectomy: case report.

    Science.gov (United States)

    Liu, Bingqian; Li, Yonghao; Li, Tao; Lin, Ying; Ma, Wei; Lu, Lin

    2018-01-17

    Transscleral tunnel incisions are commonly made to avoid postoperative leakage in small gauge sutureless vitrectomy. We present an unreported intraoperative complication, tunnel incision related arterial hemorrhage from sclerotomy, in 23-gauge (23G) vitrectomy. Two cases of intraocular arterial hemorrhage from superonasal sclerotomy were observed at the beginning of vitrectomy. The bleeding filled the vitreous cavity quickly and gushed out from the incision port after the involved supronasal cannula was removed. The active bleeding seemed not to stop spontaneously. We controlled the active bleeding by relocating the involved cannula, elevating the intraocular pressure and compressing the sclera wound. Post-operative intraocular hemorrhage from the sclerotomy was not found in any of the two cases. We suggest that the bleeding was from injured ciliary artery when the incision crossed 3 or 9 o'clock accidently. Surgeons might avoid this complication by locating the superior incisions away from the horizontal axis, and should be aware the proper management.

  8. 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.

  9. 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.

  10. Single transverse extended incision for radical neck dissection.

    Science.gov (United States)

    Chagas, José Francisco Sales; Pascoal, Maria Beatriz Nogueira; Aquino, José Luís Braga; Brandi, Luís Antônio; Previtale, Evandro Von Zuben; Trillo, Ana Sofia Pontes; Curioni, Otávio Alberto; Rapoport, Abrão; Dedivitis, Rogério Aparecido

    2016-01-01

    to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio

  11. Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision.

    Science.gov (United States)

    Girbés-Ballester, Paula; Viña-Almunia, Jose; Balaguer-Martí, Jose C; Peñarrocha-Diago, Miguel; Peñarrocha-Oltra, David

    2018-02-16

    To evaluate the effect of incision design in implant surgery on interproximal bone loss of posterior teeth adjacent to interdental single implants, comparing intrasulcular and paramarginal incision. A further aim was to assess the influence of the incision technique on peri-implant bone remodeling. A controlled randomized clinical trial was carried out in a University Clinic. All the patients received an interdental posterior single implant. The incision type was randomly divided into two groups: (a) intrasulcular or (b) paramarginal. Standardized periapical digital radiographs were made with the parallel technique and a silicone index individualized in each patient. Radiographs were made immediately after implant placement, at abutment connection, 6 and 12 months post-loading. Two radiographic reference points were detected at the interproximal aspect of the adjacent teeth: (A) the cementoenamel junction and (B) the most coronal aspect of the bone crest. The interproximal bone loss of the adjacent teeth was calculated as the difference from A to B between the different follow-up periods and baseline. Two different examiners evaluated the radiographic measurements twice. Sixty patients, each with one implant, were included, 30 in each group. A mean interproximal bone loss in teeth of 0.09 mm in the intrasulcular and 0.10 mm in the paramarginal group was found at 12 months post-loading. Mean peri-implant bone remodeling was 0.17 mm in the intrasulcular group and 0.15 mm in the paramarginal group. Differences between incision types were not statistically significant (p > .05). Both incision designs used to place interdental single implants resulted in minimum bone loss at the interproximal aspect of adjacent teeth. The incision design did not significantly influence the radiographically assessed interproximal bone loss nor peri-implant bone remodeling. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. THE EFFECT OF WOUND INCISION CARE USING HONEY AND POVIDONE IODINE 10%

    Directory of Open Access Journals (Sweden)

    M. Zakariya

    2017-07-01

    Full Text Available Introduction : Povidoe iodine often used in incision treatment. This study was aimed to explain the differences between honey and povidone iodine 10% on incision healing, were unknown. Method : This study used a true experiment design with 18 samples of 3 years old-male guinea pigs, divided into three groups. One-control group and 2 treatment groups. This classification was done randomize. The independent variable was used of honey and 10-% povidon iodin and the dependent variable was inflammation phase (squeezing, edema, plasma of incision and proliferation (granulation, incision edge unification, skin structure were assessed in the third and sixth days.  Data were collected by using observation of the signs both of inflammation and proliferation phase and analyzed using Chi Square with level of significance α ≤ 0.05. Result : Results showed that there was no significant difference in the third and sixth days inflammation. In contrast, a significant difference was obtained in the third and sixth days proliferation. Granulation (p< 0,05, incision edge unification (p< 0,05, establishment of skin structures (p< 0,05. Analysis : It can be concluded that the honey usage was proven to be more effective in accelerated incision healing, increasing proliferation and reduce any infection risks. Discussion : For future research there is neeed to conduct a microscopically observation of numerous changes in collagen, PMN-cell (neutrophile and MN-cell (lymphocyte and monocyte, inflammation and proliferation as well as incision healing process.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Reproductive Outcome of Transcervical Uterine Incision in Unicornuate Uterus.

    Science.gov (United States)

    Xia, En-Lan; Li, Tin-Chiu; Choi, Sze-Ngar Sylvia; Zhou, Qiao-Yun

    2017-02-05

    The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision (TCUI) in patients with unicornuate uterus. Thirty-three patients with unicornuate uterus presented to our tertiary center for infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes ( first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth) before and after TCUI were compared by t- test. Among 31 patients who attempted to conceive after TCUI, twenty conceived including one termination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate (t = 4.890; Puterus presenting with infertility or miscarriage.

  16. Small incision lenticule extraction (SMILE) monovision for presbyopia correction.

    Science.gov (United States)

    Luft, Nikolaus; Siedlecki, Jakob; Sekundo, Walter; Wertheimer, Christian; Kreutzer, Thomas C; Mayer, Wolfgang J; Priglinger, Siegfried G; Dirisamer, Martin

    2017-11-04

    To evaluate the outcomes of myopic small incision lenticule extraction (SMILE) monovision in presbyopic patients. This study included 49 presbyopic patients older than 45 years seeking surgical correction of myopia or myopic astigmatism who underwent bilateral SMILE with planned monovision in the SMILE Eyes Clinic Linz, Austria. Target refraction was plano for dominant (distance) eyes and ranged between -1.25 and -0.50 D for nondominant (near) eyes. Best-corrected distance visual acuity, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity, as well as spectacle dependence were assessed after a mean postoperative period of 7.2 ± 4.8 months. Mean age was 49 ± 3 years and female to male ratio was 30:19. Distance eyes achieved a spherical equivalent correction of ±0.50 D from target refraction in 80% of patients and 96% were within ±1.0 D. Binocular UDVA of 20/20 or better was achieved by 90% of patients and all patients achieved 20/25 or better. The proportion of patients with a binocular UDVA of 20/20 or better who could read J2 or better amounted to 84%. Complete spectacle independence was achieved by 84% of patients and independence from reading glasses was achieved in 92% of cases. No patient requested refractive enhancement or monovision reversal. This first evaluation of SMILE monovision endorses the approach as a safe and effective option for the correction of presbyopia in myopic patients seeking refractive surgery.

  17. 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.

  18. Surgical incision can alter capsaicin-induced central sensitization in rat brainstem nociceptive neurons.

    Science.gov (United States)

    Lam, D K; Sessle, B J; Hu, J W

    2008-10-15

    Surgical trauma can affect spinal neuronal excitability, but there have been no studies of the effects of surgical cutaneous injury on central nociceptive processing of deep afferent inputs evoked by noxious stimuli such as capsaicin. Thus our aim was to test the effect of surgical cutaneous incision in influencing central sensitization induced by capsaicin injection into the temporomandibular joint (TMJ). The activity of single nociceptive neurons activated by noxious mechanical stimulation of the TMJ was recorded in the trigeminal subnucleus caudalis/upper cervical cord of halothane-anesthetized rats. The cutaneous mechanoreceptive field (RF), cutaneous mechanical activation threshold (MAT) and TMJ MAT of neurons before and after both surgical cutaneous incision alone and capsaicin injection were compared with results of incision and lidocaine pretreatment of the facial skin overlying the TMJ and capsaicin injection into the TMJ. Incision itself induced a barrage of neuronal spikes and excitability increases reflecting central sensitization (cutaneous RF expansion, cutaneous MAT reduction) in most neurons tested whereas lidocaine pretreatment significantly attenuated the barrage and central sensitization. Capsaicin injection into the TMJ induced cutaneous RF expansion, cutaneous MAT reduction and TMJ MAT reduction following lidocaine pretreatment of the cutaneous incision site whereas capsaicin injection following incision alone not only failed to induce further central sensitization but also decreased the existing incision-induced central sensitization (no cutaneous RF expansion, increased cutaneous MAT and TMJ MAT) in most neurons tested. These findings suggest that central sensitization induced by capsaicin alone or by cutaneous incision alone can readily occur in TMJ-responsive nociceptive neurons and that following incision-induced excitability increases, capsaicin may result in a temporary suppression of nociceptive neuronal changes reflecting central

  19. Incision rate changes in the upper Var River catchment, southern French Alps: from observations to models.

    Science.gov (United States)

    Petit, Carole; Rolland, Yann; Goren, Liran; Bourlès, Didier; Braucher, Régis; Saillard, Marianne; Cassol, Davide

    2017-04-01

    Cosmic Ray Exposure (CRE) dating on river polished surfaces from gorges located in the Var River catchment (Southern French Alps) reveals high incision rate pulses (>10 mm.yr-1) related with climate changes, and in particular with glacial-interglacial transitions. In addition, they show that the onset of the last deglaciation in this area occurred shortly after the Last Glacial Maximum (LGM), i.e. 16-19 ka ago. Extrapolating these results to longer time scales suggests that the post 140 ka history of this landscape was dominated by fluvial incision. Inverse models based on the stream power law are then used to determine uplift rate variations in several small tributaries of this catchment with respect to the main channel. These inverse models show that all tributaries have consistent incision rate histories with alternating high and low values, and a comparison with global temperature curves shows that these variations significantly correlate with quaternary climate changes. We suggest that during warm periods, a wave of regressive erosion propagates in the main channel, while its tributaries deeply incise their substratum to catch up with the falling base-level. We then perform forward models of river incision and simulate the incision of the main channel system over a time span of 600 ka. This model allows us to extract time and space incision rate variations along the Tinée River channel (the largest tributary of the Var River). With a background of a few mm.yr-1, incision rate can increase up to more than 10 mm.yr-1 during short episodes, in agreement with CRE dating. 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 kyr ago.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Evidence for an Early Cretaceous mineralizing event above the basement/sediment unconformity in the intracratonic Paris Basin: paragenetic sequence and Sm-Nd dating of the world-class Pierre-Perthuis stratabound fluorite deposit

    Science.gov (United States)

    Gigoux, Morgane; Delpech, Guillaume; Guerrot, Catherine; Pagel, Maurice; Augé, Thierry; Négrel, Philippe; Brigaud, Benjamin

    2015-04-01

    World-class stratabound fluorite deposits are spatially associated with the basement/sediment unconformity of the intracratonic Paris Basin and the Morvan Massif in Burgundy (France). The reserves are estimated to be about 5.5 Mt of fluorite within six fluorite deposits. In this study, we aim to determine the age of the major fluorite mineralization event of the Pierre-Perthuis deposit (1.4 Mt fluorite) by a combined study of the paragenetic mineral sequence and Sm-Nd dating on fluorite crystals. Fluorite occurs as isolated cubes or filling geodes in a Triassic, silicified, dolomitic formation. Three fluorite stages associated with sphalerite, pyrite, galena, barite, and quartz have been distinguished using optical, cathodoluminescence, and scanning electron microscopes. Seven crystals of the geodic fluorite stage were analyzed for their rare earth element (REE) contents and their 147Sm/144Nd and 143Nd/144Nd isotopic compositions. The normalized REE distribution displays homogeneous bell-shaped patterns for all the geodic fluorite samples with a Mid-REE enrichment over the Light-REE and Heavy-REE. The 147Sm/144Nd varies from 0.3108 to 0.5504 and the 143Nd/144Nd from 0.512313 to 0.512518. A six-point Sm-Nd isochron defines an age of 130 ± 15 Ma (initial 143Nd/144Nd = 0.512054, MSWD = 0.21). This Sm-Nd isochron provides the first age for the stratabound fluorite sediment-hosted deposit, related to an unconformity in the Paris Basin, and highlights a major Early Cretaceous fluid circulation event mainly above the basement/sediment unconformity during a flexural deformation of the Paris Basin, which relates to the rifting of the Bay of Biscay and the formation of the Ligurian Sea in the Western Europe domain.

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

    Directory of Open Access Journals (Sweden)

    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

  5. Early clinical outcomes after small incision lenticule extraction surgery (SMILE).

    Science.gov (United States)

    Recchioni, Alberto; Hartwig, Andreas; Dermott, Jay; Vaswani, Sundeep; Bhatt, Jay; Morris, Robert; O'Donnell, Clare

    2018-02-01

    Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer 'all femtosecond laser' surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK. Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable. The study population consisted of 21 males and 16 females. The mean±standard deviation age was 33±8years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent. This early data from surgeons' first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes. Copyright © 2017. Published by Elsevier Ltd.

  6. Polydioxanone versus polypropylene closure for midline abdominal incisions

    International Nuclear Information System (INIS)

    Naz, S.; Jamali, M.A.

    2017-01-01

    Background: Midline laparotomy is the most common technique of abdominal incisions because it is simple, provides adequate exposure to all four quadrants, and is rapid to open. A major problem after midline laparotomy remains the adequate technique of abdominal fascia closure. This study was conducted to see the role of Polydioxanone and Prolene for midline abdominal closure in terms of postoperative wound infection and wound pain. Methods: This study was carried out at surgical unit II, Federal Government Services Hospital Islamabad. Patients were equally divided in two groups, i.e., A and B. Groups A and B patients undergone midline abdominal closure with Polydioxanone number 1 and Polypropylene number 1 sutures respectively. Results: Total 620 patients were included in this study. Post-operative wound pain score according to Visual analogue scale (VAS) was compared in terms of no pain (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9). In group A (Polydioxanone), the frequency and percentages of no, mild, moderate and severe pain were 101 (32.6%), 95 (30.6%), 81 (26.1%) and 33 (10.6%) respectively, where as in group B (polypropylene) it was 82 (26.5%), 43 (13.9%), 59 (19%) and 126 (40.6%) respectively. Similarly, the frequency and percentages of post-operative wound infection in group A (Polydioxanone) and group B (polypropylene) was 105 (33.9%) and 208 (67.1%) respectively. Conclusion: Polydioxanone results in less wound pain and wound infection when compared to Polypropylene. (author)

  7. Office-based relaxing incision procedure for correction of astigmatism after deep anterior lamellar keratoplasty

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Javadi

    2017-01-01

    Conclusion: Office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after DALK. This approach effectively decreases the need for the more costly alternative in the operating room.

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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

    PURPOSE: Most literature on abdominal incision is based on patients undergoing elective surgery. In a cohort of patients with anastomotic leakage after colonic cancer resection, we analyzed the association between type of incision, fascial dehiscence, and incisional hernia. METHODS: Data were...... extracted from the Danish Colorectal Cancer Group database and merged with information from the Danish National Patient Register. All patients with anastomotic leakage after colonic resection in Denmark from 2001 until 2008 were included and surgical records on re-operations were retrieved. The primary...... 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...

  10. Induced astigmatism in a 6.0 mm no-stitch frown incision.

    Science.gov (United States)

    Sinskey, R M; Stoppel, J O

    1994-07-01

    Fifty-five consecutive patients had cataract extraction with a 6 mm no-stitch frown incision and implantation of a 6 mm optic three-piece posterior chamber lens. Vector analysis calculations of diopters (D) of mean induced keratometric astigmatism for this incision were 0.70 D at one day, 0.76 D at one week, 0.50 D at one month, and 0.50 D at three months. The Naeser's polar value showed a mean with-the-rule astigmatism of +0.42 D at one day and -0.08 D against-the-rule astigmatism at three months. The results suggest that the 6.0 mm no-stitch frown incision induces a low postoperative astigmatism and provides a stable incision.

  11. Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision. Technical note.

    NARCIS (Netherlands)

    Menovsky, T.; Vries, J. de; Wurzer, J.A.; Grotenhuis, J.A.

    2006-01-01

    The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or

  12. Erbium: YAG Laser Incision of Urethral Strictures for Treatment of Urinary Incontinence after Prostate Cancer Surgery

    National Research Council Canada - National Science Library

    Fried, Nathaniel

    2004-01-01

    .... The purpose of this research project is to test a new laser, the Erbium:YAG laser, which is capable of precisely incising the urethral stricture with minimal peripheral damage to adjacent healthy tissue...

  13. Influence of orographic precipitation on the incision within a mountain-piedmont system

    Science.gov (United States)

    Zavala, Valeria; Carretier, Sébastien; Bonnet, Stephane

    2017-04-01

    The geomorphological evolution of a mountain-piedmont system depends both on tectonics and climate, as well as on couplings between the mountain and its piedmont. Although the interactions between climate and tectonics are a fundamental point for understanding the landscape evolution, the erosion of a mountain range and the sediment deposition at the mountain front, or piedmont, have been poorly studied as a coupled system. Here we focus on the conditions driving an incision within such a system. Classically, it is thought that incision results from a change in climate or uplift rates. However, it is not clear which are the specific conditions that favor the occurrence of river incision in the piedmont. In particular, studies have shown that the presence of a piedmont can modify the incision patterns, and even drive autogenic incision, without any change in external forcings. This is a crucial issue in order to interpret natural incisions in terms of uplift or climatic modifications. Such a problem is further complicated by the modification of local precipitations and temperatures during uplift, because the progressive effect of climate change may superimpose to uplift. In this work we explore the hypothesis that a mountain-piedmont coupled system may develop incision in its piedmont as a result of enhanced orographic precipitations during surface uplift. We use a landscape evolution model, Cidre, in order to explore the response of a mountain-piemont system in which the mountain is continuously uplifted but in which precipitation rates depend on elevations. Thus precipitation amounts change during the mountain uplift. We test different peaks and amplitudes of the orographic precipitation pattern, maintaining the other conditions constant. Preliminary results show that elevation-dependent precipitations drive temporary but pronounced incisions of the main rivers within the piedmont, contrary to experiments without orographic precipitations.

  14. Clear corneal incisions in bimanual microincision cataract surgery: long-term wound-healing architecture.

    Science.gov (United States)

    Cavallini, Gian Maria; Campi, Luca; Torlai, Giulio; Forlini, Matteo; Fornasari, Elisa

    2012-10-01

    To evaluate bimanual microincision cataract surgery (MICS) clear corneal incision (CCI) architectural features over the long-term using anterior segment optical coherence tomography (AS-OCT). Case series. Institute of Ophthalmology, University of Modena, Modena, Italy. Patients who had uneventful bimanual MICS in the previous 2 to 16 months were examined using AS-OCT. Images were used to measure corneal thickness, incision length, incision angle, incidence of epithelial or endothelial gaping, misalignment, Descemet membrane detachment, and posterior wound retraction. Fifty-two eyes (33 patients) were enrolled. Mean incision length and incision angle were, respectively, 1427.91 μm and 31.19 degrees for the right hand, 1440.63 μm and 31.54 degrees for the left hand, 1474.13 μm and 31.27 degrees for temporal incisions, and 1394.41 μm and 31.46 degrees for nasal CCIs. Posterior wound retraction was the only architectural feature found. Its prevalence was 7.10% at 2 to 3 months, 31.8% at 4 to 11 months, and 33.3% at 12 months. Fifty-three percent of posterior wound retractions were in 1.8 mm CCIs and 47% in 1.4 mm CCIs. Bimanual MICS was not related to particular morphologic features of CCIs. The enlargement of 1 incision or construction of the incision with the dominant or the nondominant hand did not affect long-term wound architecture. Posterior wound retraction was the only architectural feature; however, its prevalence seems substantially lower than with other surgical techniques. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  15. Spontaneous alignment of crowded inferior incisives after the extractionof temporary canines

    OpenAIRE

    Orellana Manrique, Tomás Oriel; Calderón Cortez, Iván; Orellana Manrique, Martín

    2014-01-01

    This investigation evaluated the behavior of permanent inferior incisives after the primary canine’s extractions. The study was carried out in the Pediatric Clinic of Dental Faculty of San Marcos University. The sample was conformed by 10 patients, male and female children, between 8 and 9 years of age, with good general health, having Class I malocclusion and severe crowding of the inferior incisives. It was taken Cephalometric and Panoramic radiographies, as well as models to make the ortho...

  16. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon

    Science.gov (United States)

    Boone, S. Shaun; Hernandez, Sonia M.; Camus, Alvin C.; Peterson, Douglas C.; Jennings, Cecil A.; Shelton, James L.; Divers, Stephen J.

    2015-01-01

    The visual and microscopic tissue reactions to the absorbable monofilament Monocryl, absorbable monofilament triclosan-coated Monocryl-Plus, absorbable multifilament Vicryl, and nonabsorbable monofilament Prolene were evaluated for their use of surgical closure in Siberian Sturgeon Acipenser baerii. Postoperative assessments were conducted at 1, 2, 8, 12, and 26 and 55 weeks to visually evaluate the surgical incision for suture retention, incision healing, erythema, and swelling. Incisions were also assessed microscopically at 1, 2, and 8 weeks for necrosis, inflammation, hemorrhage, and fibroplasia. The results indicated that incisions closed with either Vicryl or Prolene suture materials were more likely to exhibit more erythema or incomplete healing compared with those closed with Monocryl or Monocryl-Plus. The surgical implantation of a transmitter in the coelomic cavity did not significantly affect the response variables among the four suture materials. Monocryl or Monocryl-Plus were equally effective and superior to other suture materials used for closing surgical incisions in Siberian Sturgeon or closely related species of sturgeon. Furthermore, Monocryl or Monocryl-Plus may decrease the risk of transmitter expulsion through the incision, as surgical wounds appear to heal faster and exhibit less erythema compared with those closed with Vicryl.

  17. 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.

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

    Science.gov (United States)

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

    2009-11-01

    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.

  19. 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

  20. Outcomes of Phacoemulsification Using Different Size of Clear Corneal Incision in Eyes with Previous Radial Keratotomy.

    Directory of Open Access Journals (Sweden)

    Jing Shang Zhang

    Full Text Available To evaluate visual outcomes and complications after phacoemulsification in eyes with cataract and previous radial keratotomy (RK cuts using different sizes of clear corneal incisions.The study was a retrospective study. Thirty eyes with cataract and previous RK underwent phacoemulsification and intraocular lens (IOL implantation. Among them 7 eyes had 8 RK cuts, 13 eyes had 12 RK cuts, and 10 eyes had 16 RK cuts. Phacoemulsification and IOL implantation were performed through a 2.0-3.2 mm clear corneal incision by a single surgeon. In the 8 RK cuts group, 3.2 mm clear corneal incisions were used in 4 eyes, and 3.0 mm clear corneal incisions were used in 3 eyes. In the 12 RK cuts group, 3.2 mm clear corneal incisions were used in 6 eyes, and 2.2 mm clear corneal incisions were used in 7 eyes. In the 16 RK cuts group, 3.2 mm clear corneal incisions were used in 5 eyes, and 2.0 mm clear corneal incisions were used in 5 eyes. Patients were followed up 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively and were examined for the dehiscence of RK cuts during or after the surgery, post-operative best-corrected visual acuity (BCVA, corneal astigmatism, corneal endothelial cell density and complications.Successful phacoemulsification with IOL implantation was performed in all eyes. No wound dehiscence was noted in any eyes with 8 or 12 RK cuts. Wound dehiscence was noted in 2 eyes with 16 RK cuts. The dehiscence of RK cuts was closed successfully by injecting an air bubble with or without viscoelastic agent into the anterior chamber at the end of surgery. During the follow-up, the cuts were well apposed in all eyes, and no new dehiscence of RK cuts was noted. At the last follow-up, mean BCVA (0.2 ± 0.18 logMAR was better than preoperative BCVA(0.45±0.19 logMAR (P < 0.001. There was no significant difference between the long-term preoperative and postoperative mean corneal astigmatism (P = 0.3. However, there was a

  1. Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions

    Directory of Open Access Journals (Sweden)

    Bruce R Kava

    2010-01-01

    Conclusions : Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.

  2. 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.

  3. Neogene unroofing and incision of the Ethiopian Plateau constrained from apatite (U-Th)/He thermochronometry

    Science.gov (United States)

    Gani, N. D.; Van Soest, M. C.; Gani, M. R.; Tadesse, K.; Neupane, P. C.; Falster, A.

    2011-12-01

    Ethiopian Plateau in East Africa, one of the large igneous provinces, has been deeply incised by the Blue Nile River. The plateau has experienced extensive volcanisms at ~30 Ma linked to outpouring of the Afar mantle plume that accumulated average 1 km thick flood basalt. This event, along with later repetitive volcanisms in the region, has complicated (e.g., partial resetting of mineral cooling ages, abnormal geothermal gradients) the application of thermochronological modeling to constrain the Cenozoic unroofing and incision history of the plateau. In this study, we used (U-Th)/He thermochronometry of apatite grains extracted from gneissic and granitic basement rocks and overlying sandstones in a 1.2 km vertical elevation profile within the Blue Nile Canyon to partition incision in geologic time. Our apatite cooling ages are comparatively older than that of previous thermochronological studies of the area. These cooling ages show wide range and random distribution with elevation but positively correlate with effective uranium (eU) concentration of apatite minerals. Thus we chose recently developed RDAAM (Radiation Damage Accumulation and Annealing model) inverse modeling in HeFTy that was demonstrated to be appropriate for regions with complex thermal history and variable eU concentration. Initial results of RDAAM model, guided by reasonable thermal history of the plateau, show gradual cooling and thus slow incision during Early Neogene after the rapid heating of the region linked to the accumulation of thick flood basalt around 30 Ma. Importantly, these simulations predict rapid cooling, thus fast incision, during Late Neogene. This incision history of the Ethiopian Plateau interpreted from apatite thermal modeling is consistent with the previous GIS-and-geochronology-based study that showed increased incision rates around 10 Ma and 6 Ma.

  4. Oblique lateral incision and subpectoral dissection in modified Nuss procedure minimize future breast deformity.

    Science.gov (United States)

    Kimura, Hiroaki; Yasuoka, Tomoyuki; Nagao, Munetomo; Kudoh, Shin; Kobayashi, Seiichiro

    2015-05-01

    We experienced the occurrence of breast deformity in some young female patients who underwent a modified Nuss procedure before breast development. We studied the causes of and preventive measures for this complication. We classified 13 prepubescent female patients who underwent our modified Nuss procedure into three groups according to the direction of the skin incision and the dissection layer for bar insertion. Four patients who underwent transverse lateral thoracic skin incision and bar insertion through a subpectoral dissection were assigned to the T/SP group, five who underwent oblique skin incision along the rib and bar insertion through a suprapectoral dissection were assigned to the O/IP group, and four who underwent oblique skin incision and subpectoral dissection were assigned to the O/SP group. Each patient in the T/SP group underwent the operation by a different surgeon, two of whom were the authors, including the first author; the first author performed all operations in the O/IP and O/SP groups. The first author evaluated the shape of the developed breasts using the frontal- and oblique-view photographs. We also investigated the location of the lateral border of the mammary gland in seven other adolescent and adult female patients using three-dimensional computed tomography images. Lateral depression of the breast occurred in four of eight breasts with a transverse incision, and flattening of the lowermost portion of the inframammary fold occurred in six of 10 breasts with suprapectoral dissection. None of the eight breasts with an oblique incision and subpectoral dissection exhibited deformities. The lateral border of the mammary gland was on the fifth rib in five patients and on the fifth intercostal space in two patients. An oblique lateral thoracic skin incision along the sixth rib and subpectoral dissection may reduce the occurrence of breast deformity. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  5. Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Kai Wu

    2014-01-01

    Full Text Available Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed. Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance. Results: Twenty-one fractures (8.79% involved surgical incision complications, including 8 (3.35% cases of wound dehiscence, 7 (2.93% of flap margin necrosis, 5 (2.09% of hematoma, and 1 (0.42% of osteomyelitis. Five factors were statistically significant : t0 he time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients′ smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference. Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking.

  6. Latest Quaternary rapid river incision across an inactive fold in the northern Chinese Tian Shan foreland

    Science.gov (United States)

    Lu, Honghua; Cheng, Lu; Wang, Zhen; Zhang, Tianqi; Lü, Yanwu; Zhao, Junxiang; Li, Youli; Zheng, Xiangmin

    2018-01-01

    This work focuses on the incision process over the Tuostai anticline, a fold of the proximal structure Belt I in the northern Chinese Tian Shan foreland, where the Sikeshu River has incised deeply into the alluvial gravels and the fold's underlying bedrock strata. Field investigation and geomorphic mapping define five terraces of the Sikeshu River (designated as T1 to T5 from oldest to youngest) preserved within the Tuostai anticline. 10Be surface exposure dating and optically stimulated luminescence dating constrain stabilization of the highest three terrace surfaces at about 80 ka (T1), 16 ka (T2), and 15 ka (T3), respectively. Around 16 ka, the calculated river incision rates significantly increase from 6 mm/yr. Undeformed longitudinal profiles of terraces T2, T3 and T4 over the Tuostai anticline suggest that this structure may have been tectonically inactive since stabilization of these three terraces. We thus think that the observed rapid river incision over the Tuostai anticline has not been largely forced by tectonic uplift. Instead, the progressively warmer and wetter palaeoclimatic condition within the Tian Shan range and its surrounding area during the period of ∼20-10 ka may have enhanced river incision across the Tuostai anticline. A reduced sediment/water ratio might have lowered the gradient of the Sikeshu River.

  7. Dual daughter strand incision is processive and increases the efficiency of DNA mismatch repair.

    Science.gov (United States)

    Hermans, Nicolaas; Laffeber, Charlie; Cristovão, Michele; Artola-Borán, Mariela; Mardenborough, Yannicka; Ikpa, Pauline; Jaddoe, Aruna; Winterwerp, Herrie H K; Wyman, Claire; Jiricny, Josef; Kanaar, Roland; Friedhoff, Peter; Lebbink, Joyce H G

    2016-08-19

    DNA mismatch repair (MMR) is an evolutionarily-conserved process responsible for the repair of replication errors. In Escherichia coli, MMR is initiated by MutS and MutL, which activate MutH to incise transiently-hemimethylated GATC sites. MMR efficiency depends on the distribution of these GATC sites. To understand which molecular events determine repair efficiency, we quantitatively studied the effect of strand incision on unwinding and excision activity. The distance between mismatch and GATC site did not influence the strand incision rate, and an increase in the number of sites enhanced incision only to a minor extent. Two GATC sites were incised by the same activated MMR complex in a processive manner, with MutS, the closed form of MutL and MutH displaying different roles. Unwinding and strand excision were more efficient on a substrate with two nicks flanking the mismatch, as compared to substrates containing a single nick or two nicks on the same side of the mismatch. Introduction of multiple nicks by the human MutLα endonuclease also contributed to increased repair efficiency. Our data support a general model of prokaryotic and eukaryotic MMR in which, despite mechanistic differences, mismatch-activated complexes facilitate efficient repair by creating multiple daughter strand nicks. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. Two hundred seventy-five single-incision laparoscopic gastric band insertions: what have we learnt?

    Science.gov (United States)

    Murgatroyd, Beth; Chakravartty, Saurav; Sarma, Diwakar R; Patel, Ameet G

    2014-07-01

    Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5%), including two conversions to four-port technique (0.7%). Of these patients (n = 15), the majority were male (p rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve.

  11. 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.

  12. 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.

  13. 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.

  14. 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.)

  15. 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.

  16. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile

    Directory of Open Access Journals (Sweden)

    S. C. Blackburn

    2012-01-01

    Full Text Available Background. Single Incision Laparoscopic Surgery (SILS has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel’s diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  17. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile.

    Science.gov (United States)

    Blackburn, S C; Adams, S D; Mahomed, A A

    2012-01-01

    Background. Single Incision Laparoscopic Surgery (SILS) has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel's diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  18. Evaluating single-incision slings in female stress urinary incontinence: the usefulness of the CONSORT statement criteria.

    Science.gov (United States)

    Diallo, Stéphanie; Cour, Florence; Josephson, Anne; Vidart, Adrien; Botto, Henri; Lebret, Thierry; Bonan, Brigitte

    2012-09-01

    To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Inoue, Makoto; Abulon, Dina Joy K; Hirakata, Akito

    2014-01-01

    To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture. 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. 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. 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.

  20. 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.

  1. Influence of Lateral Incision on Inhomogeneous Deformation of a Nickel [001] - Single Cristal at Axial Compression

    Science.gov (United States)

    Lychagin, D. V.; Alfyorova, E. A.; Lychagin, M. V.; Dilun, Czyan

    2016-04-01

    We used the scanning electron microscopy and the electron backscattered diffraction to investigate a deformation relief and a crystallographic disorientation of a nickel [001] single crystal with {100} faces with a lateral incision. We identified that the lateral incision can change the shear domains distribution pattern in the sample by creating additional deformation domains near the incision. The change in the patterns of the misorientation accumulation on the mutually perpendicular faces accompanies this deformation. We established that the orientation alteration occurs toward the increase of the Schmid factor for the slip systems in two of the four (previously equally loaded) slip planes. This method of shear deformation contributes to an optimal mutually consistent deformation in the adjacent areas of the single crystal.

  2. 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.

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

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    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.

  4. Comparison of Fasanella-Servat and Small-Incision Techniques for Involutional Ptosis Repair.

    Science.gov (United States)

    Sohrab, Mahsa A; Lissner, Gary S

    2016-01-01

    To compare the results of the classic Fasanella-Servat internal approach to the newer, small-incision external approach in the repair of involutional ptosis. Retrospective review identified 93 patients (104 surgical procedures) at Northwestern Ophthalmology from June 2005 until October 2011 who underwent either the Fasanella-Servat or the small-incision approaches for involutional ptosis repair. Change in vertical palpebral fissure measurement, change in marginal reflex distance 1 (MRD1) measurement, patient satisfaction, surgical complications, operating time, and postoperative pain were compared between groups. Of the 93 patients, most were female with an average age of 69 years. Of the procedures, 48% were small incision and 52% were Fasanella-Servat approaches. Average postoperative follow up was 34.0 days. Vertical palpebral fissure height increased an average of 3.36 mm (±1.15) in the Fasanella-Servat group and 2.74 mm (±1.18) in the small-incision group (p = 0.003). Preoperative vertical palpebral fissure height was lower in the Fasanella-Servat group, but postoperative vertical palpebral fissure height was similar between the 2 groups (p=0.3). MRD1 increased an average of 3.42 mm (±0.86) in the Fasanella-Servat group and 2.68 mm (±0.93) in the small-incision group (p MRD1 was lower in the Fasanella-Servat group, but postoperative MRD1 was similar between the 2 groups (p = 0.15). Average operating time was 53 minutes (±16) in the small-incision group and 27 minutes (±6) in the Fasanella-Servat group (p MRD1.

  5. 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.

  6. Incision of the Yangtze River at the First Bend Determined by Three-Nuclide Burial Dating

    Science.gov (United States)

    McPhillips, D. F.; Hoke, G. D.; Rood, D. H.; Bierman, P. R.

    2015-12-01

    On the southeast margin of the Tibetan Plateau, the evolution of the Yangtze River and its major tributaries has become an important source of data for investigating geodynamics. In particular, the timing of river incision is frequently interpreted as a proxy for the timing of surface uplift in the absence of structural evidence. We investigate the timing of the incision of the gorge at the First Bend using cosmogenic nuclide burial dating of coarse, quartz sediments from caves. Sediments were deposited when the caves were near river level and subsequently abandoned as the river incised. To resolve burial ages >5 Ma, we measured the radionuclides 10Be and 26Al, and the stable nuclide 21Ne. Results from 4 caves show that 26Al and 10Be concentrations are an order of magnitude lower in abandoned cave samples than in a river-level cave sample where deposition is active (10Be: 1.3x104 and 3.4x105 at/g). In contrast, 26Al/10Be ratios in all caves are ≥6.2 and indistinguishable within error. 21Ne concentrations range from 2.1x106 to 7.8x106 at/g. The results are consistent with an old age for the abandoned cave deposits, such that most of the radionuclides initially present have decayed and the concentrations that we measure today are the result of millions of years of exposure to muons. We solve for burial ages, taking into account in situ muogenic production, and find that the majority of the gorge (1 km) was likely incised between ~12 and 9 Ma. The results also require that the rate of river incision declined after the gorge was cut below the lowest elevation cave at 9 Ma. Inverse modeling of published low-temperature thermochronology (Ouimet et al., 2010) supports our burial age results. River capture near the First Bend, which likely integrated the modern Yangtze, likely occurred prior to the mid-Miocene incision of the gorge. In view of the geographic position of the First Bend—just downslope from the southeast margin of the Plateau—it is difficult to explain

  7. 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.

  8. 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

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

    Directory of Open Access Journals (Sweden)

    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 

  10. Endoscope-assisted intraoral removal of the thyroid isthmus mass using a frenotomy incision.

    Science.gov (United States)

    Woo, Seung Hoon

    2013-09-01

    A thyroid isthmus nodule is a relatively rare condition. A small number of patients will present with thyroid mass isolated at the thyroid isthmus, which can cause discomfort in swallowing and cosmetic problems. Thus, some patients choose to have these nodules excised. The surgical removal of the thyroid isthmus mass is usually accomplished through an external incision of the neck. However, this procedure inevitably results in a neck scar. We report a case of an 18-year-old woman with a thyroid isthmus mass. We implemented a modified approach for the removal of the thyroid isthmus mass by using a frenotomy incision of the mouth, accompanied by an endoscope system. A modified approach for the removal of the thyroid isthmus mass was used on the patient. The total operating time was 70 minutes. The patient continues to be free of any diseases 12 months after the excision. Resection of the thyroid isthmus mass can be performed by an intraoral endoscope-assisted approach through a frenotomy incision of the mouth. We described the detailed procedures for an endoscope-assisted transoral thyroid isthmus mass excision using a frenotomy incision.

  11. Intraoral removal of a thyroglossal duct cyst using a frenotomy incision.

    Science.gov (United States)

    Kim, Jin Pyeong; Park, Jung Je; Lee, Eun Jae; Woo, Seung Hoon

    2011-12-01

    Thyroglossal duct cyst (TGDC) is one of the most common causes of anterior neck swelling close to the midline. Surgical removal of a TGDC is usually accomplished through an external neck incision, including the removal of the middle part of hyoid bone and a block of tissues extending to the foramen cecum. However, this procedure inevitably results in a neck scar. We report the case of a 20-year-old woman with TGDC. We implemented a modified approach to TGDC removal through a frenotomy incision of the mouth using an endoscope system. The patient received a modified approach to TGDC removal. The total operative time was 60 minutes. She remains free of disease 12 months after her surgery. We describe, in a single patient, a procedure in detail for endoscope-assisted transoral TGDC excision using an intraoral frenotomy incision. The advantage of this approach is the avoidance of a neck scar. Our experience with this patient indicates that resection of a TGDC appears to be feasible through a transoral endoscope-assisted approach using a frenotomy incision in the mouth. Further experience with this procedure is required.

  12. 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 hypospadias (p = 0.008), as well as in patients who did (p = 0.0078) and did not undergo intervention (p 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.

  13. 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.

  14. 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.

  15. Two-incision minimally invasive total hip arthroplasty - results and complications

    NARCIS (Netherlands)

    van Oldenrijk, Jakob; Hoogervorst, Paul; Schaap, Gerard R.; van Dijk, C. Niek; Schafroth, Matthias U.

    2011-01-01

    The purpose of this study was to determine the complication rate and functional result after two-incision minimally invasive total hip arthroplasty in a retrospective consecutive case series of the first 45 patients treated by a single surgeon. The mean follow up period was 2.1 years. There were 4

  16. 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.

  17. Forensic aspects of incised wounds and bruises in pigs established post-mortem.

    Science.gov (United States)

    Barington, Kristiane; Jensen, Henrik Elvang

    2017-06-01

    Recognizing post-mortem (PM) changes is of crucial importance in veterinary forensic pathology. In porcine wounds established PM contradicting observations regarding infiltration of leukocytes have been described. In the present study, skin, subcutis and muscle tissue sampled from experimental pigs with PM incised wounds (n=8), PM bruises (n=8) and no lesions, i.e. controls (n=4), were examined for signs of vitality over time. All tissue samples were subjected to gross and histopathological evaluation. Hemorrhages were present along the edges of PM incised wounds but deposits of fibrin were never observed. PM bruise led to hemorrhage in the subcutis visible on cross section of the skin in 3 out of 8 pigs. Histologically, hemorrhages in the subcutaneous tissue and disrupted muscle fibers were observed in PM bruises and could not be differentiated from similar lesions in ante-mortem (AM) bruises. Vital reactions, i.e. infiltrating leukocytes, hyper-leukocytosis and pavement of leukocytes, were absent in all incised wounds and bruises regardless of the time of sampling after traumatization. In conclusion, a vital reaction was not present in PM incised wounds, regardless of the time of sampling. Moreover, it was found that AM bruises free of leukocyte infiltration cannot be distinguished from PM bruises, an observation which is of crucial importance when timing bruises in forensic cases. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Holocene valley-floor deposition and incision in a small drainage basin in western Colorado, USA

    Science.gov (United States)

    Jones, Lawrence S.; Rosenburg, Margaret; Figueroa, Maria del Mar; McKee, Kathleen; Haravitch, Ben; Hunter, Jenna

    2010-09-01

    The valley floor of a 33.9 km 2 watershed in western Colorado experienced gradual sedimentation from before ˜ 6765 to ˜ 500 cal yr BP followed by deep incision, renewed aggradation, and secondary incision. In contrast, at least four terraces and widespread cut-and-fill architecture in the valley floor downstream indicate multiple episodes of incision and deposition occurred during the same time interval. The upper valley fill history is atypical compared to other drainages in the Colorado Plateau. One possible reason for these differences is that a bedrock canyon between the upper and lower valley prevented headward erosion from reaching the upper valley fill. Another possibility is that widespread, sand-rich, clay-poor lithologies in the upper drainage limited surface runoff and generally favored alluviation, whereas more clay-rich lithologies in the lower drainage resulted in increased surface runoff and more frequent incision. Twenty-two dates from valley fill charcoal indicate an approximate forest fire recurrence interval of several hundred years, similar to that from other studies in juniper-piñon woodlands. Results show that closely spaced vertical sampling of alluvium in headwater valleys where linkages between hillslope processes and fluvial activity are relatively direct can provide insight about the role of fires in alluvial chronologies of semi-arid watersheds.

  19. 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.

  20. Carpal tunnel release using the radial sided approach compared with the two-incision approach.

    Science.gov (United States)

    Calleja, Henry; Tsai, Tsu-Min; Kaufman, Christina

    2014-01-01

    We compared carpal tunnel release using a radial sided approach (RCTR) with a two-incision approach with regards to complications, grip strength, and functional outcomes. Retrospective chart review was done and data was collected pre-operatively, and post-operatively at six weeks and three months. A total of 32 and 26 patients were included in the two-incision and RCTR groups respectively. At six weeks, the RCTR group showed an increased grip strength (+32.24%) while the two-incision group was weaker (-6.75%). Both groups showed an increased strength at three months, RCTR at 98.4% while the two-incision group was significantly lower at 38.6% increase. Both techniques provided improvement in outcome scores, with no statistical difference. RCTR was associated with a significantly earlier return of grip strength and had better grip strength at six weeks and three months post-operatively. Both techniques provided symptom relief and good functional outcome.

  1. 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.

  2. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy--a randomised pilot study.

    Science.gov (United States)

    Lakdawala, Muffazal A; Muda, Nor Hisham; Goel, Sunita; Bhasker, Aparna

    2011-11-01

    This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. A prospective comparative analysis was done of 50 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 until April 2010. Both groups were matched for age, gender and BMI and were then randomly assigned to either group. Postoperative pain scoring was done using the visual analogue scale. Postoperative outcomes in terms of pain scores, excess weight loss, resolution of comorbidities and complication rates were compared in both groups, at the end of 6 months. Operating times in both groups were comparable with experience. Intraoperative blood loss was similar in both groups. VAS scoring revealed lesser postoperative pain after the first 8 h in the single-incision group as compared to the laparoscopy group-P < 0.0001. At 6 months, excess weight loss and resolution of comorbidities were comparable in both groups. There were no major complications or mortalities in either group. Single-incision laparoscopic sleeve gastrectomy is a feasible surgical procedure for morbid obesity in selected individuals. When compared to conventional laparoscopic sleeve gastrectomy, it has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little or no visible scarring and reduced postoperative pain.

  3. Quality-of-Life and Visual Function after Manual Small Incision ...

    African Journals Online (AJOL)

    Background: Outcome studies after cataract surgery should focus on functional status and quality of life instead of visual acuity measurement alone. Objective: To assess patients' quality of life (QoL) and overall visual function (VF) after manual small incision cataract surgery (SICS) with intraocular lens (IOL) implantation.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Safety and feasibility of single-incision laparoscopic cholecystectomy in obese patients

    Directory of Open Access Journals (Sweden)

    Masaki Wakasugi

    2017-01-01

    Full Text Available Current literature frequently indicates that experienced laparoscopic surgeons can safely perform single-incision laparoscopic cholecystectomy, but there have been few reports evaluating the feasibility and safety of performing single-incision laparoscopic cholecystectomy for obese patients. Therefore, a large single-center database was retrospectively reviewed to evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy for obese patients by comparing the outcomes of normal-weight and obese patients undergoing single-incision laparoscopic cholecystectomy.A retrospective analysis of 608 patients undergoing SILC between May 2009 and May 2015 at Osaka Police Hospital was performed, and the outcomes of obese [body mass index (BMI ≥ 30 kg/m2] and normal-weight patients (18.5 ≤ BMI < 25 kg/m2 were compared.Thirty-eight obese patients (mean BMI 32.5 kg/m2 were compared to 362 normal-weight patients (mean BMI 22.0 kg/m2. The American Society of Anesthesiologists (ASA scores of the obese patients were significantly higher than those of normal-weight patients. The mean operative times in the normal-weight and the obese groups were 110 min vs. 127 min, respectively (p < 0.05. There were no significant differences in the bleeding volume and the conversion rate to a different operative procedure. Perioperative complications were seen in 6% (23/362 of the patients in the normal-weight group and 8% (3/38 of the patients in the obese group (p = 0.7. The mean postoperative hospital stay was 4.5 days for the normal-weight group and 4.4 days for the obese group (p = 0.8.Single-incision laparoscopic cholecystectomy, which offers good cosmetic outcomes, seems feasible and safe in obese patients.•Single-incision laparoscopic cholecystectomy offers good cosmetic outcomes.•Single-incision laparoscopic cholecystectomy seems feasible and safe in obese patients.

  6. New constraints on the late Cenozoic incision history of the New River, Virginia

    Science.gov (United States)

    Ward, Dylan J.; Spotila, James A.; Hancock, Gregory S.; Galbraith, John M.

    2005-12-01

    The New River crosses three physiogeologic provinces of the ancient, tectonically quiescent Appalachian orogen and is ideally situated to record variability in fluvial erosion rates over the late Cenozoic. Active erosion features on resistant bedrock that floors the river at prominent knickpoints demonstrate that the river is currently incising toward base level. However, thick sequences of alluvial fill and fluvial terraces cut into this fill record an incision history for the river that includes several periods of stalled downcutting and aggradation. We used cosmogenic 10Be exposure dating, aided by mapping and sedimentological examination of terrace deposits, to constrain the timing of events in this history. 10Be concentration depth profiles were used to help account for variables such as cosmogenic inheritance and terrace bioturbation. Fill-cut and strath terraces at elevations 10, 20, and 50 m above the modern river yield model cosmogenic exposure ages of 130, ˜600, and 600-950 ka, respectively, but uncertainties on these ages are not well constrained. These results provide the first direct constraint on the history of alluvial aggradation and incision events recorded by New River terrace deposits. The exposure ages yield a long-term average incision rate of 43 m/my, which is comparable to rates measured elsewhere in the Appalachians. During specific intervals over the last 1 Ma, however, the New River's incision rate reached ˜100 m/my. Modern erosion rates on bedrock at a prominent knickpoint are between ˜28 and ˜87 m/my, in good agreement with rates calculated between terrace abandonment events and significantly faster than ˜2 m/my rates of surface erosion from ancient terrace remnants. Fluctuations between aggradation and rapid incision operate on timescales of 10 4- 10 5 year, similar to those of late Cenozoic climate variations, though uncertainties in model ages preclude direct correlation of these fluctuations to specific climate change events

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

    Science.gov (United States)

    Muysoms, F E; Antoniou, S A; Bury, K; Campanelli, G; Conze, J; Cuccurullo, D; de Beaux, A C; Deerenberg, E B; East, B; Fortelny, R H; Gillion, J-F; Henriksen, N A; Israelsson, L; Jairam, A; Jänes, A; Jeekel, J; López-Cano, M; Miserez, M; Morales-Conde, S; Sanders, D L; Simons, M P; Śmietański, M; Venclauskas, L; Berrevoet, F

    2015-02-01

    The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed 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 instrument. An update of these guidelines is planned for 2017. For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use 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 of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high

  8. Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic Practice and Training.

    Science.gov (United States)

    Troppmann, Christoph; Santhanakrishnan, Chandrasekar; Fananapazir, Ghaneh; Troppmann, Kathrin M; Perez, Richard V

    2017-05-01

    The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown. In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors. Median donor body mass index was 26 kg/m 2 (range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2). Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.

  9. [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.

  10. Mini-incision microdissection testicular sperm extraction: a useful technique for men with cryptozoospermia.

    Science.gov (United States)

    Alrabeeah, K; Witmer, J; Ruiz, S; AlMalki, A; Phillips, S; Zini, A

    2016-03-01

    Microdissection testicular sperm extraction (micro-TESE) was developed to minimize the testicular injury associated with multiple open TESEs. We sought to evaluate a mini-incision micro-TESE in men with cryptozoospermia and non-obstructive azoospermia (NOA). We conducted a retrospective study of 26 consecutive men with NOA and cryptozoospermia who underwent a primary (first) micro-TESE between March 2015 and August 2015. Final assessment of sperm recovery (reported on the day of intra-cytoplasmic sperm injection (ICSI)) was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a mini-incision micro-TESE (with limited unilateral micro-dissection) or standard/extensive (with unilateral or bilateral micro-dissection) was guided by the intra-operative identification of sperm recovery (≥5 spermatozoa) from the first testicle. Overall, sperm recovery was successful in 77% (20/26) of the men. In 37% of the men (8/26), the mini-incision micro-TESE was successful (positive sperm recovery). The remaining 18 men required a standard (extensive) microdissection: 61% (11/18) underwent a unilateral and 39% (7/18) a bilateral micro-TESE. We found that 90% (9/10) of the men with cryptozoospermia and 63% (10/16) of the men with NOA underwent a unilateral (mini or standard micro-TESE). The mini-incision micro-TESE allowed for successful sperm recovery in 60% (6/10) of the men with cryptozoospermia and 13% (2/16) of the men with NOA. The data demonstrate that a mini-incision micro-TESE together with rapid intra-operative assessment and identification of spermatozoa recovery can be useful in men undergoing microTESE, particularly, men with cryptozoospermia. © 2016 American Society of Andrology and European Academy of Andrology.

  11. 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.

  12. From incision to infill: What a Late Quaternary valley system records?

    Science.gov (United States)

    Maselli, V.; Asioli, A.; Trincardi, F.; Ceregato, A.; Rizzetto, F.; Taviani, M.

    2014-12-01

    Erosional sequence boundaries and incised valleys buried in modern continental shelves represent the response of alluvial and coastal systems to Quaternary sea level oscillations. The study of the processes leading to valley incision reveals, at both regional and global scales, the influence of tectonics and eustatism on the evolution of fluvial landforms in coastal plains, while the sedimentary infill of the valley may represents one of the best archives to investigate past environmental changes. Although the time registered in the stratigraphic record represents only a small portion of the geological history, informations about the processes governing the evolution of past landscapes can be quantified by looking to erosional surfaces, where much of the time is condensed. The Manfredonia Incised Valley (southern Adriatic Sea), is a very interesting case of valley as it formed during a single episode of incision related to the last glacial sea level fall and was completely filled during the post-glacial sea level rise. The inverse-funnel shape of the incision, and its confinement toward the mid-inner shelf reveal the impact of the step-wise sea level fall on preexisting coastal morphologies, in particular during the MIS5-4 and MIS3-2 transitions. The 45 m thick sedimentary succession filling the valley recorded the post-glacial sea level rise, as revealed by the upward transition from fluvial to shallow-marine deposits, and the impact of base level and high-frequency climate change on river to coastal systems. The upper 15 m of infill, in particular, consist of multiple bayhead delta progradations occurred synchronously to the formation of sapropel S1, and represent the very-shallow water equivalent of the cm-thick sapropel layers accumulated offshore in the deeper southern Adriatic basin.

  13. Surgical management of stage I and II vulvar cancer:The role of the separated incision

    Directory of Open Access Journals (Sweden)

    Andrijono Andrijono

    2003-06-01

    Full Text Available Vulvar cancer is a gynecological cancer whose incidence rate is relatively low. Patients generally were admitted at advanced stage, and radiation therapy at advanced stage does not provide favorable prognosis. Two main modalities in the treatment of vulvar cancer are surgery and radiation therapy. However, radiation can be performed in early stage vulvar cancer but surgery is thought to have more benefits, such as in side effect on the ovary/ reproductive function disorder, patient's hygiene factor, and the ease in performing therapy if recurrence occurs. There are various techniques of vulvar cancer surgery, such as radical vulvectomy with butterfly incision (RVBI and radical vulvectomy with separated incision (RVSI. The objective of this study was to identify the benefits of radical vulvectomy with separated incision in comparison with radical vulvectomy with butterfly incision in terms of the length of surgery, wound recovery, infection incidence, length of hospital stay. This study was a clinical trial performed during the period of 1990-2000. Fifteen cases of vulvar cancer were found and underwent surgery. Fourteen cases were at stage II and 14 cases were histologically defined as squamous-cell carcinoma and 1 case was adenocarcinoma. The average length of surgery in RVSI was 168 minutes, this was shorter than that in VRBI which reached an average of 275 minutes. The incidence of infection in RVSI group was 3 of 11 cases (27.27%, while in RVBI group all cases had infection in surgical wound. Failure of surgical wound approximation was 1 of 12 cases (9.99%, while in RVBI all cases experienced the failure such that cosmetic surgery was required. Length of postoperative care in RVSI group was 12.3 days, while in RVBI 21.5 days. Thus, complications in VRBI were lower, and length of surgery and length of postoperative care were shorter. (Med J Indones 2003; 12: 103-8 Keywords: vulvar cancer, separated incision

  14. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery.

    Science.gov (United States)

    Liu, Ruoyan; Wang, Yanan; Zhang, Ze; Li, Tingting; Liu, Hao; Zhao, Liying; Deng, Haijun; Li, Guoxin

    2017-06-01

    The advantages of reduced-port laparoscopic surgery (RPLS) for rectosigmoid cancer treatment have been disputed. This study evaluated the outcomes of RPLS compared to conventional laparoscopic surgery (CLS) for rectosigmoid cancer. Data from 211 patients who underwent a selective sigmoidectomy or anterior resection from August 2011 to June 2014 at a single institution were collected and analyzed via propensity score matching. Operative outcomes, inflammatory responses, pain intensity, oncologic outcomes, quality of life, and cosmetic results were compared between groups. After matching, 96 patients (48 CLS and 48 RPLS) were evaluated. Sixteen RPLS cases underwent single-incision laparoscopic surgery (SILS), and 32 underwent single-incision plus one port laparoscopic surgery (SILS + 1). Baseline clinical characteristics were comparable between the RPLS and the CLS groups. Morbidity, pathologic outcomes, and 3-year disease-free survival and overall survival rates were also comparable between the 2 groups. Compared with the CLS group, the RPLS group had a shorter total incision length (p time to liquid diet (p = 0.027), ambulation (p = 0.026), and discharge (p times, C-reactive protein levels at 24 h and 96 h, and interleukin-6 levels at 24 h postoperatively were significantly lower in the SILS + 1 group than those in the CLS and SILS groups (p cosmetic results, and both groups showed better results than the CLS group (p < 0.001). RPLS for rectosigmoid cancer is feasible, with short-term safety and long-term oncological safety comparable to that of CLS. Better cosmesis and accelerated recovery can be expected. SILS + 1 is a better choice than CLS or SILS for rectosigmoid cancer because it minimizes invasiveness and reduces technical difficulties.

  15. Climatic controls on mechanical rock strength and channel incision due to bedrock weathering, Kohala Peninsula, Hawaii

    Science.gov (United States)

    Murphy, B. P.; Johnson, J. P.; Gasparini, N. M.; Sklar, L. S.

    2013-12-01

    Orographic precipitation gradients are prevalent in mountainous terrains, and climate-dependent bedrock weathering may play an important role in the incision of bedrock channels and the evolution of landscapes. Kohala Peninsula on the big island of Hawaii presents a unique natural setting for exploring climate sensitivity of landscape erosion, with over an order of magnitude variation in mean annual precipitation, a landscape composed entirely of weatherable basalt, and systematic variations in fluvial incision and resulting topography across the climate gradient. We hypothesize that increases in local mean annual precipitation will promote long-term channel incision rates due to increases in bedrock weathering, but measurements of rock strength within bedrock channels will be greatly influenced by the efficient removal of weathered rock by fluvial erosion. Mechanical properties of bedrock were measured at a total of 13 sites across two watersheds that vary in local mean annual precipitation from 0.27 - 2.25 m/yr. In situ strength measurements were collected using a Schmidt hammer with a pseudo-random sampling method along transects parallel to stream direction and just above the channel thalweg. Tensile strength and elastic moduli were also measured in the laboratory on cores collected from a subset of the same transects. Long-term channel incision rates were independently constrained from the local valley relief and the ages of mapped basalt units that form the relatively unmodified volcanic shield of Kohala. When strength data comes from sites of low long-term incision, we find strong power-law relationships between both rock strength measurements and local mean annual precipitation. However, for sites with high precipitation rate and variable erosion rates, we find significant variability in the rock strength. We interpret this to reflect the removal of weathered rock by erosion. In order to interpret the influence of climate in our dataset, we made a

  16. 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

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

    Science.gov (United States)

    Genaro, Karina; Fabris, Débora; Arantes, Ana L F; Zuardi, Antônio W; Crippa, José A S; Prado, Wiliam A

    2017-01-01

    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 brain area

  18. 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

  19. Comparative healing of surgical incisions created by the PEAK PlasmaBlade, conventional electrosurgery, and a scalpel.

    Science.gov (United States)

    Loh, Shang A; Carlson, Grace A; Chang, Edward I; Huang, Eric; Palanker, Daniel; Gurtner, Geoffrey C

    2009-12-01

    The PEAK PlasmaBlade is a new electrosurgical device that uses pulsed radiofrequency to generate a plasma-mediated discharge along the exposed rim of an insulated blade, creating an effective cutting edge while the blade stays near body temperature. Full-thickness incisions were made on the dorsums of pigs with the PlasmaBlade, a conventional electrosurgical device, and a scalpel, and blood loss was quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Bleeding was reduced significantly (59 percent) in PlasmaBlade incisions compared with scalpel incisions, and acute thermal damage from the PlasmaBlade (66 +/- 5 microm) was significantly less than both cut and coagulation mode electrosurgical incisions (456 +/- 35 microm and 615 +/- 22 microm, respectively). Histologic scoring for injury and wound strength was equivalent between the PlasmaBlade and scalpel incisions. By 6 weeks, the healed PlasmaBlade and scalpel incisions were approximately three times stronger, and scar cosmetic appearance was significantly better compared with electrosurgical incisions. The PlasmaBlade is a promising new surgical instrument that provides atraumatic, scalpel-like cutting precision and electrosurgical-like hemostasis, resulting in minimal bleeding, tissue injury, and scar formation.

  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. 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

  2. Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice.

    Science.gov (United States)

    Froghi, Farid; Sodergren, Mikael Hans; Darzi, Ara; Paraskeva, Paraskevas

    2010-08-01

    Single-incision laparoscopic surgery (SILS) aims to eliminate multiple port incisions. Although general operative principles of SILS are similar to conventional laparoscopic surgery, operative techniques are not standardized. This review aims to evaluate the current use of SILS published in the literature by examining the types of operations performed, techniques employed, and relevant complications and morbidity. This review considered a total of 94 studies reporting 1889 patients evaluating 17 different general surgical operations. There were 8 different access techniques reported using conventional laparoscopic instruments and specifically designed SILS ports. There is extensive heterogeneity associated with operating methods and in particular ways of overcoming problems with retraction and instrumentation. Published complications, morbidity, and hospital length of stay are comparable to conventional laparoscopy. Although SILS provides excellent cosmetic results and morbidity seems similar to conventional laparoscopy, larger randomized controlled trials are needed to assess the safety and efficacy of this novel technique.

  3. Single-incision laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage.

    Science.gov (United States)

    Igami, Tsuyoshi; Aoba, Taro; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Nagino, Masato

    2015-03-01

    Single-incision laparoscopic cholecystectomy (SILC) has been performed for patients with gallbladder stones but without acute cholecystitis. We report our experience of performing SILC for patients with cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD). We performed SILC via an SILS-Port with additional 5-mm forceps through an umbilical incision in ten patients with cholecystitis requiring PTGBD. All procedures were completed successfully. The mean operative time was 124 min (range 78-169 min) and there were no intraoperative or postoperative complications. The mean postoperative hospital stay was 2.7 days. All patients were satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy (CLC) for patients who fervently demand the cosmetic advantages, despite cholecystitis requiring PTGBD. SILC should be performed carefully to avoid bile duct injury because the only advantage of SILC over CLC is cosmetic.

  4. 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.

  5. Comparison of the loop technique with incision and drainage for soft tissue abscesses: A systematic review and meta-analysis.

    Science.gov (United States)

    Gottlieb, Michael; Peksa, Gary D

    2018-01-01

    Skin and soft tissue infections are a common presentation to the emergency department. Traditional management of abscesses involves a linear incision through the center of the abscess with packing placed. The loop drainage technique (LDT) is an alternate approach that may reduce pain and scarring, as well as decrease the number of follow up visits needed. This systematic review and meta-analysis aimed to compare the efficacy of the LDT with conventional incision and drainage (CID) in the treatment of soft tissue abscesses. PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all retrospective, prospective, or randomized controlled trials comparing the LDT to CID with an outcome of treatment failure, as defined by the individual study. Data were double extracted into a predefined worksheet and quality analysis was performed using the Cochrane Risk of Bias tool. Data were summarized and a meta-analysis was performed with subgroup analyses by adult versus pediatric age groups. This systematic review identified four studies comprising 470 total patients. Overall, the CID technique failed in 25 of 265 cases (9.43%). The LDT failed in 8 of 195 cases (4.10%). There was an odds ratio of 2.63 (95% CI 1.04 to 6.63) in favor of higher failures in the CID group. Funnel plot analysis demonstrated no evidence of publication bias. Subgroups analysis by age group demonstrated improved efficacy of the LDT in pediatric patients, but the adult subgroup did not reach statistical significance. The existing literature suggests that LDT is associated with a lower failure rate than CID. However, the data is limited by small sample sizes and predominantly retrospective study designs. Given the potential for less pain, decreased scarring, and lower associated healthcare costs, this technique should be considered for the treatment of skin and soft tissue abscesses in

  6. 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.

  7. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Directory of Open Access Journals (Sweden)

    Palanivelu Chinnusamy

    2013-01-01

    Full Text Available Introduction: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. Patient and Technique: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. Conclusion: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.

  8. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Science.gov (United States)

    Chinnusamy, Palanivelu; Ahluwalia, Jasmeet Singh; Palanisamy, Senthilnathan; Seshiyer, Rajan Pidigu

    2013-01-01

    INTRODUCTION: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. PATIENT AND TECHNIQUE: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. CONCLUSION: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness. PMID:23741118

  9. A gross anatomic study of distal tibia and fibula for single-incision approach

    OpenAIRE

    Ma, Hui; Zhao, Jie; Yu, Baoqing; Ye, Bin

    2014-01-01

    Objective This study aimed to investigate the feasibility of single incision for plating for the treatment of distal tibia and fibula fractures by a gross anatomic study. Methods The anatomical structures of the anterolateral lower legs were identified. The lower leg length was measured from the top of fibular head to the tip of lateral malleolus. The distances between the extensor digitorum longus and anterior border of distal thirds of the tibia as well as the fibula were also measured. Add...

  10. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes

    OpenAIRE

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.

    2016-01-01

    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the ten...

  11. Comparison of three suture techniques in closure of caprine skin incision: cosmetic and cost considerations

    OpenAIRE

    Adamu Abdul Abubakar; John Bayo Adeyanju; Raphael O. Chukudi Kene; Mohammad Legbo Sonfada; Abubakar Sadiq Yakubu; Umaru Adamu

    2012-01-01

    The cosmetic and economic evaluations of three suture techniques were evaluated in closure of caprine skin incision. Fifteen apparently healthy male and female intact goats, free of any dermatological lesions were used for the investigation. They were randomly grouped into three; A (Subcuticular); B (Ford interlocking) and C (Simple interrupted). Cosmetic appearance of the surgical site was assessed on day 7, 14 and 21 post surgery using standard procedure as described by Sakka et al, 1995...

  12. New constraints on the late Cenozoic incision history of the New River, Virginia

    OpenAIRE

    Ward, Dylan J.

    2004-01-01

    The New River crosses the core of the ancient, tectonically quiescent Appalachian orogen as it follows its course through North Carolina, Virginia, and West Virginia. It is ideally situated to record the changes in geomorphic process rates that occur in the Appalachians as a response to late Cenozoic climate variations. Active erosion features on resistant bedrock that floors the river at prominent knickpoints demonstrate that the river is currently incising toward base level. However, large ...

  13. Single-Incision Laparoscopic Splenectomy and Splenic Autotransplantation for an Enlarged Wandering Spleen with Torsion

    OpenAIRE

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2013-01-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The t...

  14. 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...

  15. 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)

  16. 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.

  17. Endoscope-assisted intraoral removal of ectopic thyroid tissue using a frenotomy incision.

    Science.gov (United States)

    Woo, Seung Hoon; Jeong, Han-Sin; Kim, Jin Pyeong; Park, Jung Je; Baek, Chung-Hwan

    2013-05-01

    Ectopic thyroid tissue is a relatively rare condition and a developmental anomaly characterized by the aggregation of thyroid tissue. Usually, it occurs along the path of descent of the developing thyroid primordium from the foramen caecum, the most common being in the anterior midline of the neck at or below the level of the hyoid bone. Surgical removal of ectopic thyroid tissue is usually accomplished through an external incision in the neck. However, this procedure inevitably results in a neck scar. We report the case of a 30-year-old woman with ectopic thyroid tissue. We implemented a modified approach to ectopic thyroid tissue removal through a frenotomy incision of the mouth using an endoscope system. A modified approach to ectopic thyroid tissue removal was used in this patient. The total operative time was 50 minutes, and the patient remains free of disease 15 months after excision. Resection of ectopic thyroid tissue can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth.

  18. Lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy.

    Science.gov (United States)

    Eshraghi, Bahram; Hashemian, Hesam; Fard, Masoud Aghsaei; Safizadeh, Mona

    2013-10-01

    To evaluate the success of lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy. Interventional consecutive case series conducted in Farabi Eye Hospital between August 2007 and November 2010. Patients with acute dacyocystitis and lacrimal sac empyema underwent incision and drainage, followed by early (less than 4 weeks) external DCR. Data collection included patient demographics, past medical history, procedure technique, culture results, and formation of a persistent cutaneous fistula. A total of 32 patients were included: 87.5% had a positive history of chronic epiphora before dacryocystitis. Of these 32 cases, 55.6% had positive culture. Staphylococcus aureus was the most common organism with 8 isolates (38%). The average number of days between empyema drainage and DCR was 11.44 days. All patients had complete resolution of dacryocystitis, with no recurrence during the follow-up period. Neither of 32 patients treated with early DCR after primary empyema drainage, developed a persistent lacrimal-cutaneous fistula. Incision and drainage of the lacrimal sac empyema followed by early external dacryocystorhinostomy can be an appropriate treatment strategy for acute dacryocystitis.

  19. Sutured clear corneal incision: wound apposition and permeability to bacterial-sized particles.

    Science.gov (United States)

    May, William N; Castro-Combs, Juan; Kashiwabuchi, Renata T; Tattiyakul, Woranart; Qureshi-Said, Saima; Hirai, Flavio; Behrens, Ashley

    2013-03-01

    To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

  20. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial.

    Science.gov (United States)

    Kok, Niels F M; Lind, May Y; Hansson, Birgitta M E; Pilzecker, Desiree; Mertens zur Borg, Ingrid R A M; Knipscheer, Ben C; Hazebroek, Eric J; Dooper, Ine M; Weimar, Willem; Hop, Wim C J; Adang, Eddy M M; van der Wilt, Gert Jan; Bonjer, Hendrik J; van der Vliet, Jordanus A; IJzermans, Jan N M

    2006-07-29

    To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. Single blind, randomised controlled trial. Two university medical centres, the Netherlands. 100 living kidney donors. Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy. The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival. Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy). Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

  1. [Treatment of chalazion with incision and curettage in African patients of the negroid race].

    Science.gov (United States)

    Kaimbo W A Kaimbo, D; Nkidiaka, M C

    2006-01-01

    To evaluate the efficacy of incision and curettage in the treatment of chalazion in black African patients. In a prospective study performed between February 1999 and February 2000, 25 black African patients with chalazion (27 eyes, 30 chalazions), ranging in age from 15 to 51 years (mean age +/-SD, 25.2 years +/-7), were treated with incision and curettage. Measurements of eyebrow height, pretarsal skin height, crease height, inferior eyelid height and the palpebral fissure height were performed before and after treatment. Success was defined as a total disappearance or a decrease in size (less than one millimeter). Success was achieved in all of 25 patients. Recurrence occurred in 3.0% after 5 to 6 weeks. During a mean +/-SD of 4.7 months +/-2.9 of follow-up, fistula (3.0%) was noted as postincision ocular complication. After treatment, a significant decrease of pretarsal skin (P = 0.018) and inferior eyelid height (P=0.004) measurements and an increase in palpebral fissure height measurement (P = 0.025) were noted. Incision and curettage in chalazion treatment appears to be effective in managing chalazion in black African patients as reported in previous studies in Caucasian patients.

  2. A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    I-Hsuan Chen

    2014-01-01

    Full Text Available Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE for female dialysis patients suffering from urothelial carcinoma (UC. Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

  3. Experimental evidence for climatically controlled changes between lateral erosion and incision of actively uplifting folds

    Science.gov (United States)

    Bufe, Aaron; Paola, Chris; Burbank, Douglas; Thompson, Jessica

    2016-04-01

    The understanding of the incision and lateral erosion of rivers provides key data for the interpretation of landscapes as recorders of climatic and tectonic processes. We present results from six physical experiments on the erosion of a simple growing fold by antecedent streams. By varying uplift rates, sediment flux, and the width of alluvial fans upstream of the uplift, we produced a range of morphologies from narrow canyons through the fold to erosion of the entire uplift. The fraction of the uplift that was beveled by the river can be predicted by a dimensionless parameter linking the mobility of channels (strongly dependent on the sediment flux) and the rock-uplift rate. We apply these findings to a series of active folds in the foreland of the Tian Shan in NW China. Whereas the folds are incised today, they preserve uplifted, kilometer-wide beveled platforms. In the light of the experimental results, lateral migration rates required to explain such extensive beveling are similar to the lateral mobility of alluvial streams in areas much wetter than the presently arid northwestern Tarim Basin and suggest that major changes in water and sediment influxes are the probable cause of switches between lateral erosion and incision of active uplifts in the foreland of the Tian Shan. This finding is supported by the clustering of ages of fluvial terrace and alluvial fan deposition in that region.

  4. 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.

  5. Appendectomy and pregnancy: gestational age does not affect the position of the incision.

    Science.gov (United States)

    de Moya, Marc A; Sideris, Antonios C; Choy, Garry; Chang, Yuchiao; Landman, Wendy B; Cropano, Catrina M; Cohn, Stephen M

    2015-03-01

    The position of the base of the appendix during advancing gestational age is based on inadequate data. Therefore, the proper location for an appendectomy incision during pregnancy is highly unclear. This study investigated the location of the appendix during pregnancy to determine the optimal location for an incision in pregnant patients with appendicitis relative to McBurney's point. Magnetic resonance images (MRIs) were reviewed independently by two fellowship-trained abdominal MRI radiologists blinded to the imaging report. The distance of the appendix from anatomic landmarks was measured in a total of 114 pregnant women with an abdominal or pelvic MRI who were admitted between 2001 and 2011 at a Level I trauma center. Patients with a history of appendectomy were excluded. The distance from the base of the appendix to McBurney's point changed over the course of the gestation by only 1.2 cm and which did not amount to a clinically or statistically significant change in position. Our data provide evidence that there is minimal upward or lateral displacement of the appendix during pregnancy, and therefore its distance from the McBurney's point remains essentially unchanged. These findings justify the use of the McBurney's incision for appendectomy during pregnancy regardless of the trimester.

  6. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery.

    Science.gov (United States)

    Verspyck, Eric; Douysset, Xavier; Roman, Horace; Marret, Stephane; Marpeau, Loïc

    2015-01-01

    To compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery. In a retrospective study, records were reviewed for women who had anterior placenta previa and delivered by cesarean after 24 weeks of pregnancy at a tertiary center in Rouen, France. During period A (January 2000 to December 2006), the protocol was to systematically transect the placenta when it was unavoidable. During period B (January 2007 to December 2010), the technique was to avoid incision by circumventing the placenta and passing a hand around its margin. Logistic regression was used to identify independent risk factors associated with maternal transfusion of packed red blood cells. Eighty-four women were included (period A: n=43; period B: n=41). During period B, there was a reduction in frequency of intraoperative hemorrhage (>1000 mL) (P=0.02), intraoperative hemoglobin loss (P=0.005), and frequency of blood transfusion (P=0.02) as compared with period A. In multivariable analysis, period B was associated with a reduced risk of maternal transfusion (odds ratio 0.27; 95% confidence interval 0.09-0.82; P=0.02). Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. 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 .

  8. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis

    Science.gov (United States)

    Liang, Hung-Hua; Hung, Chin-Sheng; Wang, Weu; Tam, Ka-Wai; Chang, Chun-Chao; Liu, Hui-Hsiung; Yen, Ko-Li; Wei, Po-Li

    2014-01-01

    Background Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. Methods We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. Results Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications. PMID:24869622

  9. Gas Hydrate Formation Amid Submarine Canyon Incision: Investigations From New Zealand's Hikurangi Subduction Margin

    Science.gov (United States)

    Crutchley, G. J.; Kroeger, K. F.; Pecher, I. A.; Mountjoy, J. J.; Gorman, A. R.

    2017-12-01

    We investigate gas hydrate system dynamics beneath a submarine canyon on New Zealand's Hikurangi subduction margin using seismic reflection data and petroleum systems modeling. High seismic velocities just above the base of gas hydrate stability (BGHS) indicate that concentrated gas hydrates exist beneath the canyon. Two-dimensional gas hydrate formation modeling shows how the process of canyon incision at this location alters the distribution and concentration of gas hydrate. The key modeling result is that free gas is trapped beneath the gas hydrate layer and then "captured" into a concentrated gas hydrate deposit as a result of a downward-shift in the BGHS driven by canyon incision. Our study thus provides new insight into the functioning of this process. From our data, we also conceptualize two other models to describe how canyons could significantly change gas hydrate distribution and concentration. One scenario is related to deflection of fluid flow pathways from over-pressured regions at the BGHS toward the canyon, and the other is based on relationships between simultaneous seafloor uplift and canyon incision. The relationships and processes described are of global relevance because of considerations of gas hydrate as an energy resource and the influence of both submarine canyons and gas hydrate systems on seafloor biodiversity.

  10. 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.

  11. 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

  12. 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.

  13. [Laparoscopic cholecystectomy with three-port and 25 millimeters long incision.

    Science.gov (United States)

    Gómez Tagle-Morales, Enrique David

    2013-01-01

    Background: three-port and 25 mm total incision laparoscopic cholecystectomy has shown benefits compared to conventional laparoscopy. The aim was to examine the safety and feasibility of this technique. Methods: a three-port laparoscopic cholecystectomy trial was conducted through Cinvestav metasearcher, Seriunam and Rencis. The eligibility criteria were: three port laparoscopic cholecystectomy, 25 mm total incision, and score = 17 on Data Review System. Trials which employed instruments smaller than 5 mm in diameter were excluded. The comparative variables were documented and results obtained in the selected trials were described. Results: four trials were selected, comprising 1767 cases (1329 females and 438 males), average age was 44.3 years. Chronic cholecystitis was documented in 84.3 %, and acute cholecystitis in 14.7 %. Average surgical time was 54.5 minutes. An additional port was required in 4.8 % and 1.4 % was converted to open technique. Bile duct injury was presented in 0.11 %. The success rate was 94.9 %. Conclusions: three port and 25 mm total incision in laparoscopic cholecystectomy is safe and feasible.

  14. Single-incision laparoscopic partial gastrectomy for gastric submucosal tumors without compromising transumbilical stapling.

    Science.gov (United States)

    Takata, Akihiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2014-01-01

    Although SILS has become an increasingly popular type of surgery, its application for gastric submucosal tumors (SMT) has been only sporadically reported. We herein describe 12 recent cases with gastric SMT located in the greater curvature or anterior wall. The aim is to validate technical feasibility and safety of single-incision laparoscopic partial gastrectomy. Thus far, this is one of the largest series of patients with gastric SMT who underwent SILS. From July 2009 to April 2013, single-incision laparoscopic partial gastrectomy was attempted in 12 consecutive patients with gastric SMT. Three trocars were assembled in the umbilical incision, and the lesion was mobilized and staple-resected with endoscopic stapling devices. SILS surgery was successfully completed without any additional trocars. The median operating time was 96.5 min, and median blood loss was 7.5 mL. The median tumor size was 30 mm, with histopathologic diagnosis of gastrointestinal stromal tumor (10) and schwannoma (2). There was no immediate postoperative morbidity. During a median follow-up of 12 months, all patients were on full regular diet without any gastrointestinal symptoms. SILS with transumbilical gastric stapling is a safe and practical alternative to conventional multiport laparoscopy in patients with gastric SMT, except for cases originating in the lesser curvature and close to the cardia/ pylorus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  15. Different air-water spray regulations affect the healing of Er,Cr:YSGG laser incisions.

    Science.gov (United States)

    Sperandio, Felipe Fornias; Meneguzzo, Daiane T; Ferreira, Leila S; da Ana, Patrícia A; Azevedo, Luciane H; de Sousa, Suzana C O M

    2011-03-01

    Surgeries performed with high-intensity laser devices may be improved with accurate protocols, including the air-water spray regulation. Thus, this study sought to investigate the healing process of wounds made on the dorsum of rat tongues using an Er,Cr:YSGG laser device with different air-water spray regulations. The incisions were made on the dorsum of Wistar rat tongues using an Er,Cr:YSGG laser with three different air-water spray regulations (100/0%, 50/50%, 11/7%). Scalpel incisions functioned as controls. The sacrifices occurred between 0 and 14 days after surgery. Morphological, histological, and immunohistochemical (fibronectin and type III collagen) analysis of the wounds were performed. The air-water spray regulation influenced wound healing and the inflammatory response, especially in the earlier stages. Incisions performed using the 100/0% air/water spray regulation had the worst results, expressing a greater amount of fibronectin and type III collagen. The 50/50% air/water spray regulation brought in a non-clear surgical field and poor laser interaction with the tissue. The 11/7% air/water spray regulation showed the best clinical results and less pronounced histological events. According to the results encountered, the air-water spray should be regulated to improve surgery.

  16. A novel locally operated master-slave robot system for single-incision laparoscopic surgery.

    Science.gov (United States)

    Horise, Yuki; Matsumoto, Toshinobu; Ikeda, Hiroki; Nakamura, Yuta; Yamasaki, Makoto; Sawada, Genta; Tsukao, Yukiko; Nakahara, Yujiro; Yamamoto, Masaaki; Takiguchi, Shuji; Doki, Yuichiro; Mori, Masaki; Miyazaki, Fumio; Sekimoto, Mitsugu; Kawai, Toshikazu; Nishikawa, Atsushi

    2014-12-01

    Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.

  17. Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients or two incisions (group 2: 20 patients. The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p 0.05. Group 2 had better results from the pivot-shift maneuver (p < 0.05. CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

  18. Control of port-site bleeding from smaller incisions after laparoscopic cholecystectomy surgery: a new, innovative, and easier technique.

    Science.gov (United States)

    Rastogi, Vijay; Dy, Victor

    2002-08-01

    Laparoscopic cholecystectomy has become the standard of care for patients with acute cholecystitis, symptomatic cholelithiasis, and biliary dyskinesia. Most surgeons now perform this procedure as outpatient surgery. In a standard laparoscopic cholecystectomy procedure, three trocar incisions are made outside the umbilicus. Stopping the bleeding from these port sites can be problematic because of the small size of the incision and the fact that these bleeding points are situated deep in the incision. This is especially true in obese patients and patients taking Asprin or Plavix and undergoing emergency cholecystectomy. In these circumstances, control of the bleeding requires either enlargement of the incision or placement of deep sutures, leading to an ugly scar. We present a simple and innovative technique for controlling port-site bleeding, which involves plugging the port-site hole with Surgicel (Johnson & Johnson Medical, Inc., Arlington, Texas). Our experience with 20 patients to date has shown wound healing to be excellent, with no complications such as hematoma or infection.

  19. Investigation of postoperative intraocular pressure in cases of silicone oil removal using 25-gauge transconjunctival sutureless vitrectomy with oblique incisions.

    Science.gov (United States)

    Takashina, Hirotsugu; Watanabe, Akira; Tsuneoka, Hiroshi

    2015-01-01

    The purpose of this study was to investigate postoperative intraocular pressure (IOP) in cases of silicone oil (SO) removal when using 25-gauge transconjunctival sutureless vitrectomy (TSV) with oblique incisions. We enrolled ten consecutive eyes with SO removal (SO group) and eleven consecutive eyes with idiopathic epiretinal membrane (ERM) as the initial vitrectomy (ERM group) in cases using 25-gauge TSV with oblique incisions. Postoperative IOPs were compared between the two groups at each of the four examination periods. No significant differences were identified in any of the periods examined. The use of 25-gauge TSV with oblique incisions resulted in almost equivalent postoperative IOPs between cases with SO removal and idiopathic ERM as the initial operation. Self-sealing sclerotomy in 25-gauge TSV with oblique incisions may primarily involve the valve architecture, and be complemented by vitreous incarceration.

  20. Surgical site wound infection in relation to antibiotic prophylaxis given before skin incision and after cord clamping during cesarean delivery.

    Science.gov (United States)

    Shrestha, B; Marhatha, R; Giri, A; Jaisi, S; Maskey, U

    2014-12-01

    Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby. This was a prospective, hospital based study, in which hundred cases of cesarean deliveries who received antibiotics prophylaxis one hour before the skin incision were compared with another 100 cases where antibiotic was given after cord clamping following delivery of the baby. Surgical site infection occurred in 3% of women who received antibiotics prophylaxis before skin incision as compared to 6% in whom antibiotic was given after cord clamping. It was statistically not significant (p = 0.465).

  1. 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.

  2. 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

  3. Prime incision: A minimally invasive approach to breast cancer surgical treatment-A 2 cohort retrospective comparison with conventional breast conserving surgery.

    Directory of Open Access Journals (Sweden)

    Silvio Eduardo Bromberg

    Full Text Available The prime incision technique is an oncoplastic surgery aimed to remove both the breast tumor and the sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. We retrospectively evaluated 2 cohorts of 60 consecutive breast cancer patients operated by either conventional breast conservative surgery (N = 26 or one incision surgery (N = 34. There were no recurrence or death events observed in any group. No difference was seen regarding the incidence of surgical complications. In the prime incision group the breast volume removed was significantly lower than in the conventional surgery group as well as was the surgical time and the number of dissected lymph nodes. Aesthetical results were better in the one incision group. Further prospective studies are needed to validate the one incision technique as a surgical option for selected early stage breast cancer patients.

  4. 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.

  5. [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.

  6. A step-by-step oncoplastic breast conservation surgical atlas of reproducible dissection techniques and anatomically ideal incision placement.

    Science.gov (United States)

    Mitchell, Sunny D

    2017-10-01

    To develop an atlas for oncoplastic surgery (OPS) with template dissection techniques via anatomically ideal incisions for breast conservation surgery. The evolution of breast conservation techniques has evolved from placing an incision directly over the lesion to the incorporation of a thoughtful decision making process utilizing oncoplastic surgical (OPS) techniques to combining OPS with incision placement in anatomically advantageous sites. The high survival rates of breast cancer and effect of breast surgery on quality of life reinforce emphasis of optimal oncologic as well as aesthetic outcome. OPS results in greater patient satisfaction, fewer surgeries, and is oncologically safe. Today's breast surgeon is tasked with optimizing both oncologic and aesthetic outcomes. Presentation of reproducible dissection techniques and incision placement strategies to afford surgeons a step-by-step approach of OPS via anatomically ideal incisions in breast conservation surgery. Demonstration of reproducible techniques to facilitate the decision making process of optimal breast conservation surgery, eliminate knowledge gaps for surgeons, optimize outcome for individuals undergoing breast conservation surgery, and decrease disparity of care. Adoption of OPS techniques utilizing an anatomically ideal incision in breast conservation surgery is a feasible and reproducible practice for breast surgeons. Application of these techniques results in maintained optimal shape, size, and contour without the typical overlying skin envelope scars. OPS techniques performed under the skin envelope result in expected OPS oncologic and aesthetic outcomes with the addition of the resulting scar(s) in anatomically discrete position(s).

  7. 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.

  8. Distal biceps brachii tendon repairs: a single-incision technique using a cortical button with interference screw versus a double-incision technique using suture fixation through bone tunnels.

    Science.gov (United States)

    Shields, Edward; Olsen, Joshua R; Williams, Richard B; Rouse, Lucien; Maloney, Michael; Voloshin, Ilya

    2015-05-01

    Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. To perform a clinical comparison of the single-incision CB and double-incision BT techniques. Cohort study; Level of evidence, 3. Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients>1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). Patients in the CB group (n=20) were older (52±9.5 vs 43.7±8.7 years; P=.008), had a shorter interval from surgery to evaluation (17.7±5 vs 30.8±16.5 months; P=.001), and were less likely to smoke (0% vs 28.5%; P=.02) compared with the BT patients (n=21). DASH scores were similar between groups (4.46±4.4 [CB] vs 5.7±7.5 [BT]; P=.65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n=6) experienced a complication compared with those in the BT group (4.8%; n=1) (P=.04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve. © 2015 The Author(s).

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

    Science.gov (United States)

    Santoro, Alberto; Gubbiotti, Francesca; Di Rocco, Giorgio

    2014-01-01

    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. PMID:24605333

  10. Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

    Science.gov (United States)

    Ishii, Takuro; Aoe, Tomohiko; Yu, Wen-Wei; Ebihara, Yuma; Kawahira, Hiroshi; Isono, Shiro; Naya, Yukio

    2016-01-01

    Abstract Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free

  11. 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.

  12. Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap.

    Science.gov (United States)

    Lee, Seokwon; Lee, Jeeyeon; Jung, Younglae; Bae, Youngtae

    2017-10-01

    In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast. Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery. Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner (n = 13, 38.2%) and lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19, 55.9%); good (n = 10, 29.4%); fair (n = 4, 11.8%); poor (n = 1, 2.9%). The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast. © 2015 Royal Australasian College of Surgeons.

  13. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

    Directory of Open Access Journals (Sweden)

    Rajeev Sinha

    2014-01-01

    Full Text Available Introduction: The feasibility of the single incision, multiport transumbilical approach(SILC for the treatment of symptomatic gallbladder calculus disease has been established. Aims: The study examines both short and long term morbidity of the SILC approach. Materials and Methods: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus.Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures.The instruments were those used for standard laparoscopic cholecystectomy(SLC.Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded.Results were compared with those of SLC. Results: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis.The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients.Morrisons pouch drain was left in 3 patients.Injectable analgesics were required in 85% vs 90% (SILC vs SLC on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45% patients.Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ′t′ test. A p value less than 0.05 was considered as significant. Conclusions: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.

  14. Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations.

    Science.gov (United States)

    Dutta, Sanjeev

    2009-09-01

    Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy. A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications. There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome. Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will

  15. Wound temperature profiles of coaxial mini-incision versus sleeveless microincision phacoemulsification.

    Science.gov (United States)

    Belkin, Avner; Abulafia, Adi; Michaeli, Adi; Ofir, Shay; Assia, Ehud I

    2017-04-01

    Temperature profiles at the corneal wound of coaxial mini-incision (2.4 mm) cataract surgery and sleeveless microincision (1.1 mm) cataract surgery were compared. Prospective, controlled, paired-eye clinical trial conducted in a tertiary care hospital. Twenty patients with mild-to-moderate bilateral nuclear sclerotic cataract. Twenty patients underwent bilateral cataract surgery within a 1-month period. One eye was operated on by conventional coaxial mini-incision (2.4 mm) phacoemulsification. The second eye underwent microincision surgery by using a naked phacoemulsification tip and a specialized 19-gauge anterior chamber maintainer as the sole fluid source (three-port microincision cataract surgery technique). Patients had moderate bilateral cataracts with no other anterior segment pathology. Temperature at the corneal wound was constantly recorded by using infrared thermal imaging. Temperatures at the corneal wound. Mean temperatures at the corneal surgical wound were not significantly different between the coaxial and sleeveless groups (31.1 °C ± 2.3 vs. 31.0 °C ± 2. 0; P = 0.89). There was also no difference in maximum temperatures reached during phaco-emulsification. Temperatures did not rise above 40 °C during any surgery, and there were no corneal burns. Final visual acuity and intraoperative and postoperative complication rates were similar between the two groups. The temperature profile at the surgical wound using a microincisional sleeveless phacoemulsification technique is comparable with that of the conventional coaxial mini-incision method. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  16. Geologic constraints on bedrock river incision using the stream power law

    Science.gov (United States)

    Stock, Jonathan D.; Montgomery, David R.

    1999-03-01

    Denudation rate in unextended terranes is limited by the rate of bedrock channel incision, often modeled as work rate on the channel bed by water and sediment, or stream power. The latter can be generalized as KAmSn, where K represents the channel bed's resistance to lowering (whose variation with lithology is unknown), A is drainage area (a surrogate for discharge), S is local slope, and m and n are exponents whose values are debated. We address these uncertainties by simulating the lowering of ancient river profiles using the finite difference method. We vary m, n, and K to match the evolved profile as closely as possible to the corresponding modern river profile over a time period constrained by the age of the mapped paleoprofiles. We find at least two end-member incision laws, KA0.3-0.5S1 for Australian rivers with stable base levels and KfA0.1-0.2Sn for rivers in Kauai subject to abrupt base level change. The long-term lowering rate on the latter expression is a function of the frequency and magnitude of knickpoint erosion, characterized by Kf. Incision patterns from Japan and California could follow either expression. If they follow the first expression with m = 0.4, K varies from 10-7-10-6 m0.2/yr for granite and metamorphic rocks to 10-5-10-4 m0.2/yr for volcaniclastic rocks and 10-4-10-2 m0.2/yr for mudstones. This potentially large variation in K with lithology could drive strong variability in the rate of long-term landscape change, including denudation rate and sediment yield.

  17. 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...

  18. 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

  19. Bilateral Ectasia After Femtosecond Laser-Assisted Small Incision Lenticule Extraction (SMILE).

    Science.gov (United States)

    Mattila, Jaakko S; Holopainen, Juha M

    2016-07-01

    To describe a case of bilateral ectasia after small incision lenticule extraction (SMILE) in a patient with early keratoconus. Case report. Bilateral SMILE was performed on a patient even though preoperative topographies showed changes indicating early keratoconus. The right eye underwent further photorefractive keratectomy enhancement 18 months later. The patient developed a bilateral corneal ectasia. This case underlines the importance of thorough preoperative assessment for possible keratoconus suspect changes with corneal topography to avoid postoperative ectasia. [J Refract Surg. 2016;32(7):497-500.]. Copyright 2016, SLACK Incorporated.

  20. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children.

    Science.gov (United States)

    Tsoraides, Steven S; Pearl, Richard H; Stanfill, Amy B; Wallace, Lizabeth J; Vegunta, Ravindra K

    2010-03-01

    The aim of the study was to evaluate outcomes after a minimally invasive approach to pediatric subcutaneous abscess management as a replacement for wide exposure, debridement, and repetitive packing. A retrospective study was performed of all children who underwent incision and loop drainage for subcutaneous abscesses between January 2002 and October 2007 at our institution. Two mini incisions, 4-5 mm each, were made on the abscess, as far apart as possible. Abscess was probed, and pus was drained. Abscess was irrigated with normal saline; a loop drain was passed through one incision, brought out through the other, and tied to itself. An absorbent dressing was applied over the loop and changed regularly. One hundred fifteen patients underwent drainage procedures as described; 5 patients had multiple abscesses. Mean values (range) are as follows: age, 4.25 years (19 days to 20.5 years); duration of symptoms, 7.8 days (1-42 days); length of hospital stay, 3 days (1-39 days); duration of procedure, 10.8 minutes (4-43 minutes); drain duration, 10.4 days (3-24 days); and number of postoperative visits, 1.8 (1-17). Bacterial culture data were available for 101 patients. Of these, 50% had methicillin-resistant Staphylococcus aureus, 26% had methicillin-sensitive Staphylococcus aureus, and 9% streptococcal species. Of the 115 patients, 5 had pilonidal abscesses, 1 required reoperation for persistent drainage, and 1 had a planned staged excision. Of the remaining 110 patients, 6 (5.5%) required reoperation-4 with loop drains and 2 with incision and packing with complete healing. The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this

  1. Dual-incision approach for repair of peroneal tendon dislocation associated with fractures of the calcaneus.

    Science.gov (United States)

    Mak, May Fong; Tay, Guan Tzu; Stern, Richard; Assal, Mathieu

    2014-02-01

    Dislocation of the peroneal tendons associated with calcaneus fractures should be repaired during fracture fixation to prevent complications. The only documented approach for repair is by proximal extension of the vertical limb of the lateral extensile approach to the calcaneus. However, enlarging the inherently fragile calcaneus flap places it at further risk of damage. Using a separate anterior incision to repair the dislocation, thus avoiding problems caused by excessive flap elevation, seemed intuitive. This approach proved technically effective and reliable in producing favorable outcomes in a series of 14 patients. Copyright 2014, SLACK Incorporated.

  2. An explanation of a groove found on the nasal process of the equine incisive bone.

    Science.gov (United States)

    Pérez, W; Martin, E

    2001-12-01

    Thirteen fresh equine heads were dissected in an attempt to determine the cause of a groove frequently found on the dorsal border and medial side of the nasal process of the incisive bone. This groove appeared on both sides in 40 out of 44 equine skulls. The sulcus seems to be caused by the combined action of the lateralis nasi muscle and the medial accessory cartilage of the nose (cartilago nasalis accessoria medialis). Other sulci found on the nasal process of the bone may be explained as impressions caused by nerves.

  3. 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.

  4. River Incision and Knickpoints on the Flank of the Yellowstone Hotspot — Alpine Canyon of the Snake River, Wyoming

    Science.gov (United States)

    Tuzlak, D.; Pederson, J. L.

    2015-12-01

    Understanding patterns of deformation and testing geophysical models in the dynamic region of the Yellowstone Hotspot requires Quaternary-scale records of incision and uplift, which are currently absent. This study examines fluvial terraces and longitudinal-profile metrics along Alpine Canyon of the Snake River, WY. Because the Snake is the only regional river crossing from the uplifting Yellowstone Plateau and flowing into the subsiding Eastern Snake River Plain, it provides an opportunity to investigate both ends of the phenomenon. Field observations through Alpine Canyon indicate that Pleistocene incision rates in this region are relatively high for the interior western U.S., that the river switches between bedrock and alluvial forms, and that incision/uplift is not uniform. Two endmembers of regional deformation may be tested: 1) the arch of high topography surrounding Yellowstone is uplifting and terraces converge downstream as incision rates decrease towards the Snake River Plain, or 2) baselevel fall originates at the subsiding Snake River Plain and terraces diverge as incision rates increase downstream. Datasets include surficial mapping, rock strength measurements, surveying of the longitudinal profile and terraces using RTK-GPS, optically stimulated luminescence dating of fluvial-terrace deposits, and investigation of drainages through ksn and χ analyses. Initial results indicate that there are four primary terrace deposits along the canyon, three of which are timed with glacial epochs. Considering the relative heights of terrace straths and preliminary ages, incision rates are indeed relatively high. There is a major knickzone covering the last 15 km of the canyon that is also reflected in tributary profiles and is consistent with a wave of incision propagating upstream, favoring the second endmember of active baselevel fall downstream.

  5. Disturbance, stream incision, and channel evolution: The roles of excess transport capacity and boundary materials in controlling channel response

    Science.gov (United States)

    Simon, Andrew; Rinaldi, Massimo

    2006-09-01

    Channel incision is part of denudation, drainage-network development, and landscape evolution. Rejuvenation of fluvial networks by channel incision often leads to further network development and an increase in drainage density as gullies migrate into previously non-incised surfaces. Large, anthropogenic disturbances, similar to large or catastrophic "natural" events, greatly compress time scales for incision and related processes by creating enormous imbalances between upstream sediment delivery and available transporting power. Field examples of channel responses to antrhopogenic and "natural" disturbances are presented for fluvial systems in the mid continent and Pacific Northwest, USA, and central Italy. Responses to different types of disturbances are shown to result in similar spatial and temporal trends of incision for vastly different fluvial systems. Similar disturbances are shown to result in varying relative magnitudes of vertical and lateral (widening) processes, and different channel morphologies as a function of the type of boundary sediments comprising the bed and banks. This apparent contradiction is explained through an analysis of temporal adjustments to flow energy, shear stress, and stream power with time. Numerical simulations of sand-bed channels of varying bank resistance and disturbed by reducing the upstream sediment supply by half, show identical adjustments in flow energy and the rate of energy dissipation. The processes that dominate adjustment and the ultimate stable geometries, however, are vastly different, depending on the cohesion of the channel banks and the supply of hydraulically-controlled sediment (sand) provided by bank erosion. The non-linear asymptotic nature of fluvial adjustment to incision caused by channelization or other causes is borne out in similar temporal trends of sediment loads from disturbed systems. The sediments emanating from incised channels can represent a large proportion of the total sediment yield from a

  6. Two Late Pleistocene climate-driven incision/aggradation rhythms in the middle Dnieper River basin, west-central Russian Plain

    DEFF Research Database (Denmark)

    Panin, Andrei; Adamiec, Grzegorz; Buylaert, Jan-Pieter

    2017-01-01

    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...... 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 warm climate phases - late MIS 3, post-LGM warming including the Bølling-Allerød interstadial. Anomalously large size...... of the preserved river palaeochannels prove that the post-LGM incision phase was induced by a climatically forced large increase of water runoff. Considerable increase of water discharges is considered the most probably cause for the late MIS 4 incision phase also. Therefore river incision seems to have been...

  7. Comparison of two incision designs for surgical removal of impacted mandibular third molar: A randomized comparative clinical study

    Directory of Open Access Journals (Sweden)

    Adarsh Desai

    2014-01-01

    Full Text Available Objective: The objective of this study is to investigate the influence of flap design on visibility and accessibility during removal of impacted third molar and hematoma formation, wound gaping and healing of flap post-operatively. Study Design: The randomized prospective comparative study included 30 patients with impacted mandibular third molars. Two flap designs namely "envelope flap" (Koener′s incision and ′triangular flap′ (Ward′s incision were used. After 7 days, sutures were removed and status of wound, periodontal health, and progress of healing was assessed. Patients were followed through 15 days to judge the incidence of post-operative complications in both groups. Results: No statistical differences were noted between the groups in terms of visibility, accessibility, excessive bleeding during surgery, healing of flap, sensitivity of adjacent teeth, and dry socket. A statistically significant difference was observed in post-operative hematoma, wound gaping, and distal pocket in adjacent tooth, which was significant in Ward′s triangular incision group in comparison to Koeiner′s envelope incision group. Conclusion: The selection of the flap design is dependent on needs of the case and preference of the operating surgeon and does not seem to have a significant influence on the health of tissues. In order to avoid wide area of exposure of bone, the operating surgeon should clinically and radiographically assess the designing of incision and mucoperiosteal flap, the clinical relevance is still debatable.

  8. Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie's disease with erectile dysfunction

    Science.gov (United States)

    Djordjevic, Miroslav L; Kojovic, Vladimir

    2013-01-01

    We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie's disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie's disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months (range 14–82 months), the penis was completely straightened in 59 (95%) patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3–6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie's disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting. PMID:23435473

  9. 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.

  10. 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.

  11. Technique and results after distal braquial biceps tendon reparation, through two anterior mini-incisions

    Science.gov (United States)

    Pascarelli, Luciano; Righi, Lúcio César Silva; Bongiovanni, Roberto Rangel; Imoto, Rogério Sano; Teodoro, Renato Loureiro; Ferro, Hemanoel Fernando dos Anjos

    2013-01-01

    OBJECTIVE: Evaluation of postoperative results of repair of distal biceps brachii ruptures through a two anterior mini-incisions. METHODS: Nine patients with clinical and imaging (MRI) diagnosis of total lesion of the biceps brachii at its insertion were operated with a surgical technique with two mini-incisions between 2008 and 2011. The patients were evaluated after three months of evolution and all of them recovered the fully flexion-extension arch. RESULTS: Two patients (22.2%) presented a limitation of 20 degrees of supination. One patient (11.1%) had radial nerve palsy, but was totally recovered after five months. In one patient (11.1%) the muscle remained retracted, but the insertion was recovered. In three patients (33.3%) adhesion was observed on the proximal scar. There was no clinical or radiographic evidence of radioulnar synostosis after six months of evolution. All patients reported satisfaction with the treatment. CONCLUSIONS: We conclude that the presented method shows good results as well as other techniques, with less risk of adhesion on the flexor fold of the elbow. Level of Evidence IV, Case Series. PMID:24453647

  12. Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach.

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    Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

    2014-08-16

    To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach. We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence. At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.

  13. Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

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    Kyung Soon Park

    2012-01-01

    Full Text Available Background: Minimally invasive (MI total hip arthroplasty (THA is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm ceramic-on-ceramic articulation. Materials and Methods: One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed. Results: Mean Harris hip score (HHS improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation. Conclusions: Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.

  14. The anterolateral incision for pilon fracture surgery: an anatomic study of cutaneous blood supply.

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    Fisher, Brent E; Nathan, Senthil T; Acland, Robert D; Roberts, Craig S

    2011-06-01

    The purpose of this study was to examine the blood supply to the adjacent skin and its vulnerability to anterolateral tibial plating performed with fibular plating through a single surgical incision. Ten lightly embalmed cadaver legs without a history of lower extremity trauma or surgery with a mean age of 71 years (range, 57 to 87 years) were used for this investigation. Each specimen was injected with a commercially available silicone compound through the popliteal artery. The left leg was plated through a modified extensile Böhler approach and the right leg served as the control. Each leg was anatomically dissected. All measurements were taken using a digital caliper by a single investigator. A mean of 93 (range, 4 to 17) perforating arteries were present and in the proximity of the fibula plate. Our findings suggest the potential for iatrogenic soft tissue breakdown along the posterior border of the anterolateral surgical incision in this procedure as a result of compromised blood supply to the skin.

  15. Corneal ectasia 6.5 months after small-incision lenticule extraction.

    Science.gov (United States)

    Wang, Yumeng; Cui, Chuanbo; Li, Zhiwei; Tao, Xiangchen; Zhang, Chunxiao; Zhang, Xiao; Mu, Guoying

    2015-05-01

    Our case involves a 19-year-old patient with forme fruste keratoconus. Small-incision lenticule extraction was performed, and 6.5 months after surgery, corneal ectasia was diagnosed. Preoperatively, the minimum central corneal thickness was 546 μm in the right eye and 542 μm in the left eye; the refractive correction was -6.75 -1.00 × 45 and -6.75 -0.75 × 140, respectively; the lenticular thickness was 137 μm and 135 μm, respectively. At 6.5 months, ectasia was diagnosed based on anterior and posterior surface keratometry of 38.4/39.5 diopters (D) and -6.3/-6.8 D, respectively, in the right eye and 38.6/40.8 D and -7.1/-6.6 D, respectively, in the left eye. The keratometry increased gradually and the corneal thickness decreased after surgery, and these trends continued during the 13-month follow-up. This report documents corneal ectasia as a complication of small-incision lenticule extraction and highlights the importance of preoperative evaluation and the need for long-term follow-up. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. 5-year results of the 1.5cm incision Achilles tendon repair.

    Science.gov (United States)

    Ling, Samuel K K; Slocum, Amanda; Lui, T H

    2017-12-01

    To study a hypothesis that the cost-effective 1.5cm medial incision Achilles tendon repair technique will provide good functional outcomes which are maintained for over 5 years. Prospective study of 12 consecutive cases with a minimal 5-year follow-up were recruited from April 2008 to November 2010. Cases whom were mentally incompetent or those which required concomitant procedures were excluded. Outcomes measures included the numeric pain rating scale, motor power strength, range of motion, functional scoring using the AOFAS hindfoot score and patient's self-assessment using the Foot and Ankle Outcome Score (FAOS). No re-ruptures or sural nerve injured were identified after a minimal 5-year follow-up. Pain was minimal at 0.5/10, calf power was 5/5 and ankle range was good (plantarflexion: 38°/dorsiflexion: 21°). The AOFAS hindfoot score was 97.4 and all 5 sub-categories of the Foot and Ankle Outcome Score (FAOS) were good. The 1.5cm medial incision repair of the Achilles tendon is an economically sound surgical technique, with minimal complications, which gives good medium length functional outcomes. IV. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Structural insights into 5‧ flap DNA unwinding and incision by the human FAN1 dimer

    Science.gov (United States)

    Zhao, Qi; Xue, Xiaoyu; Longerich, Simonne; Sung, Patrick; Xiong, Yong

    2014-12-01

    Human FANCD2-associated nuclease 1 (FAN1) is a DNA structure-specific nuclease involved in the processing of DNA interstrand crosslinks (ICLs). FAN1 maintains genomic stability and prevents tissue decline in multiple organs, yet it confers ICL-induced anti-cancer drug resistance in several cancer subtypes. Here we report three crystal structures of human FAN1 in complex with a 5‧ flap DNA substrate, showing that two FAN1 molecules form a head-to-tail dimer to locate the lesion, orient the DNA and unwind a 5‧ flap for subsequent incision. Biochemical experiments further validate our model for FAN1 action, as structure-informed mutations that disrupt protein dimerization, substrate orientation or flap unwinding impair the structure-specific nuclease activity. Our work elucidates essential aspects of FAN1-DNA lesion recognition and a unique mechanism of incision. These structural insights shed light on the cellular mechanisms underlying organ degeneration protection and cancer drug resistance mediated by FAN1.

  18. [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.

  19. Tissue surface information for intraoperative incision planning and focus adjustment in laser surgery.

    Science.gov (United States)

    Schoob, Andreas; Kundrat, Dennis; Kleingrothe, Lukas; Kahrs, Lüder A; Andreff, Nicolas; Ortmaier, Tobias

    2015-02-01

    Introducing computational methods to laser surgery are an emerging field. Focusing on endoscopic laser interventions, a novel approach is presented to enhance intraoperative incision planning and laser focusing by means of tissue surface information obtained by stereoscopic vision. Tissue surface is estimated with stereo-based methods using nonparametric image transforms. Subsequently, laser-to-camera registration is obtained by ablating a pattern on tissue substitutes and performing a principle component analysis for precise laser axis estimation. Furthermore, a virtual laser view is computed utilizing trifocal transfer. Depth-based laser focus adaptation is integrated into a custom experimental laser setup in order to achieve optimal ablation morphology. Experimental validation is conducted on tissue substitutes and ex vivo animal tissue. Laser-to-camera registration gives an error between planning and ablation of less than 0.2 mm. As a result, the laser workspace can accurately be highlighted within the live views and incision planning can directly be performed. Experiments related to laser focus adaptation demonstrate that ablation geometry can be kept almost uniform within a depth range of 7.9 mm, whereas cutting quality significantly decreases when the laser is defocused. An automatic laser focus adjustment on tissue surfaces based on stereoscopic scene information is feasible and has the potential to become an effective methodology for optimal ablation. Laser-to-camera registration facilitates advanced surgical planning for prospective user interfaces and augmented reality extensions.

  20. Phakic iris-claw intraocular lens implantation for correction of high myopia with clear corneal incision

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    Lin Li

    2014-04-01

    Full Text Available AIM: To investigate the safety and therapeutic effectiveness of phakic iris-claw intraocular lens implantation for correction of high myopia with clear corneal incision. METHODS: Implantation of phakic iris-claw intraocular lens through clear corneal incision was performed on 28 eyes of 20 high myopic patients under topical anaesthesia. Intraoperative and postoperative complications, visual acuity, intraocular pressure, refractive diopter, corneal endothelium, the stable of intraocular lens and the turbid level of lens were observed. RESULTS: All cases were smoothly implanted iris-claw intraocular lens. No complications were found during the operation. The uncorrected visual acuity of post-operation was better than the best corrected visual acuity of pre-operation. The follow-up time lasted for 6mo, and the intraocular lens in all the eyes were basically in the normal position without tilting and obvious deviation. No serious complications such as cataract, uveitis, cystoid macular edema, retinal detachment were seen in all cases. CONCLUSION: On the basis of having adept microsurgery technology, phakic iris-claw intraocular lens implantation is predictable and stable, and post-operation visual acuity is satisfying with few complications. It is a safe and effective way to treat high myopia.

  1. [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.

  2. Endoscopic incision of protruding right ureterocele in a single collecting system: a case report

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    Rinto Hariwibowo

    2017-01-01

    Full Text Available Protruding ureterocele is a very rare case found in the literature. We are reporting a 21 year-old female with an intermittent protruding mass from urethra, accompanied by dysuria, hematuria, and recurrent urinary tract infection. Inspection of the external genitalia revealed a protruding mass from the urethra which could be reduced manually. Excretory urography showed bilateral single collecting systems, grade II hydronephrosis of the right kidney, and a cobra head appearance of the lower right pelvis. The patient was diagnosed with a protruding right ureterocele in a single collecting system, and thus, endoscopic incision of a ureterocele was performed. Ultrasonography which was carried out three weeks after the procedure confirmed no residual hydronephrosis or ureterocele in the bladder. Voiding cystourethrography (VCUG underwent at a three-month-follow up revealed a grade 5 vesico-ureteral reflux (VUR on the right side. Surgical reimplantation was then considered. In conclusion, endoscopic incision was safe and yielded good result for protruding ureteroceles, but the need for secondary surgery in several conditions should be considered.

  3. Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction.

    Science.gov (United States)

    Husseman, J; Szudek, J; Monksfield, P; Power, D; O'Leary, S; Briggs, R

    2013-07-01

    Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach. To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction. Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale. Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures. Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

  4. Management of Ludwig's angina with small neck incisions: 18 years experience.

    Science.gov (United States)

    Bross-Soriano, Daniel; Arrieta-Gómez, José R; Prado-Calleros, Héctor; Schimelmitz-Idi, Jose; Jorba-Basave, Santiago

    2004-06-01

    To review Ludwig's angina medical and surgical approach with small incisions. Retrospective, open, noncomparative, longitudinal. All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000. Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time. Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males). Thirty patients belonged to middle or high socioeconomic status. The primary site of infection was odontogenic in 107 of the patients. All the patients were managed with surgical drainage made within the first 12 hours after hospital admission. The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G. The hospital stay for more than half of patients was 6 days or less. In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina. Forty-six patients had or were diagnosed as having diabetes mellitus. Tracheotomy was required in 34 patients. The airway of the rest of patients was controlled with nasotracheal intubation. Only 33 patients had major complications, such as mediastinitis, sepsis, or death. Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.

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

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    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.

  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. Wound healing activities of different extracts of Centella asiatica in incision and burn wound models: an experimental animal study

    Science.gov (United States)

    2012-01-01

    Background The efficacy of Centella asiatica for incision and burn wounds are not fully understood. Here, we report the wound healing activities of sequential hexane, ethyl acetate, methanol, and water extracts of Centella asiatica in incision and partial-thickness burn wound models in rats. Methods Male Sprague–Dawley rats weighing 250–300 g were randomly divided into incision and burn wound groups. Each group was stratified into seven subgroups: (1) untreated; (2) NSS-; (3) Tween 20®- (vehicle control); (4) hexane extract-; (5) ethyl acetate extract-; (6) methanol extract-; and (7) aqueous extract-treated groups. The test substances were applied topically once daily. The tensile strength of the incision wound was measured on the seventh day after wound infliction. The general appearance and degree of wound healing of the burn wound were assessed on Days 3, 7, 10 and 14 after burn injury and prior to histopathological evaluation. Results On the seventh day after wound infliction, the tensile strength of incision wound in all extract-treated groups was significantly higher than that of the vehicle control (Tween 20®), but comparable to the NSS-treated group. The degrees of healing in the burn wound with the four extracts were significantly higher than that of the control on Days 3, 10 and 14. Histopathological findings on Day 14 after burn injury revealed prominent fibrinoid necrosis and incomplete epithelialization in the control and untreated groups, whereas fully developed epithelialization and keratinization were observed in all extract-treated groups. Analysis by thin layer chromatography demonstrated that the phyto-constituents β-sitosterol, asiatic acid, and asiaticoside and madecassocide were present in the hexane, ethyl acetate and methanol extracts, respectively. Conclusions All extracts of Centella asiatica facilitate the wound healing process in both incision and burn wounds. Asiatic acid in the ethyl acetate extract seemed to be the most active

  9. Wound healing activities of different extracts of Centella asiatica in incision and burn wound models: an experimental animal study

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    Somboonwong Juraiporn

    2012-07-01

    Full Text Available Abstract Background The efficacy of Centella asiatica for incision and burn wounds are not fully understood. Here, we report the wound healing activities of sequential hexane, ethyl acetate, methanol, and water extracts of Centella asiatica in incision and partial-thickness burn wound models in rats. Methods Male Sprague–Dawley rats weighing 250–300 g were randomly divided into incision and burn wound groups. Each group was stratified into seven subgroups: (1 untreated; (2 NSS-; (3 Tween 20®- (vehicle control; (4 hexane extract-; (5 ethyl acetate extract-; (6 methanol extract-; and (7 aqueous extract-treated groups. The test substances were applied topically once daily. The tensile strength of the incision wound was measured on the seventh day after wound infliction. The general appearance and degree of wound healing of the burn wound were assessed on Days 3, 7, 10 and 14 after burn injury and prior to histopathological evaluation. Results On the seventh day after wound infliction, the tensile strength of incision wound in all extract-treated groups was significantly higher than that of the vehicle control (Tween 20®, but comparable to the NSS-treated group. The degrees of healing in the burn wound with the four extracts were significantly higher than that of the control on Days 3, 10 and 14. Histopathological findings on Day 14 after burn injury revealed prominent fibrinoid necrosis and incomplete epithelialization in the control and untreated groups, whereas fully developed epithelialization and keratinization were observed in all extract-treated groups. Analysis by thin layer chromatography demonstrated that the phyto-constituents β-sitosterol, asiatic acid, and asiaticoside and madecassocide were present in the hexane, ethyl acetate and methanol extracts, respectively. Conclusions All extracts of Centella asiatica facilitate the wound healing process in both incision and burn wounds. Asiatic acid in the ethyl acetate extract seemed to

  10. 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

  11. [The cervical dermatoglyphic character of 229 Chinese patients and its application in incision design for the cervical lymph nodes dissection].

    Science.gov (United States)

    Shi, Qian; Chen, Xiaohong

    2013-12-01

    To summarize the cervical dermatoglyphics distribution in 229 participants, and to design dermatoglyphic incision for cervical lymph nodes dissection, including II , III, IV or/and V regions, in accordance with the requirement for cosmetology. To keep the patient's head right forward when the number and locations of the dermatoglyphy were collected by macroscopic observation. Upper Cricoid-Region is defined as the region above the cricoids, and Cricoids-Collarbone-Region is referred to the region below the cricoids. The relationship among the distribution of cervical dermatoglyph, patients' age, gender, and body mass index were analyzed. According to the distribution of cervical dermatoglyph, when performing the regional cervical lymph nodes dissection in patients with laryngocarcinoma and thyroid cancer, cervical dermatoglyphy incision or parallel dermatoglyphy incision were designed, and the operation time, operative complications, and cosmetology effects after surgery were observed. Distribution of cervical dermatoglyphics was statistically correlated to the age, gender, and body mass index (P < 0.05) of patients. The follow-up time were 12 months to 49 months, 19 months on average. Average operating time of unilateral lymph nodes dissection was (46 +/- 12) minutes. Patients undergone the designs of cervical dermatoglyphy incision or parallel dermatoglyphy incision, suffered neither skinflap necrosis nor accessory nerve injury. One patient had lymphatic fistula after surgery, and relieved by conservative treatment. One with T3 N2 M0 laryngocarcinoma got V region lymph nodes recurrence 6-months after surgery. The cervical lymph nodes dissection with dermatoglyphy design is safe with prominent cosmetology effects. It will take a little longer time to perform the neck dissection with the dermatoglyphy incision in the beginning.

  12. Clinical observation on the small incision non phacoemusification cataract surgery performed by China medical team in Africa

    Directory of Open Access Journals (Sweden)

    En-Hui Yi

    2017-02-01

    Full Text Available AIM:To observe the clinical effects of the small incision non phacoemusification cataract surgery in 462 Sudanese cataract cases(536 eyes. METHODS:From September 2013 to August 2015, we analyzed the 462 Sudanese cataract cases(536 eyesperformed cataract surgery by the way of the small incision non phacoemusification with intraocular lens(IOLimplantation and summarized the intraoperative and postoperative complications, the eyesight and intraocular pressure(IOPof the eyes in 1d, 1wk and 1mo after operation. RESULTS: Intraoperative complications: posterior capsular ruptured and vitreous prolapsed in 18 eyes(3.4%, iris prolapsed in 10 eyes(1.9%, suspensory ligament of the lens ruptured in 7 eyes(1.3%, not implanted IOL in 5 eyes(0.9%, descent's membrane detachment in 3 eyes(0.6%, iridodialysis in 1 eye(0.2%. Postoperative complications: corneal edema in 47 eyes(8.8%, anterior chamber inflammatory reaction in 32 eyes(6.0%, pupil oval or slightly upward in 12 eyes(2.2%, the upper iris incarcerated in the tunnel incision in 3 eyes(0.6%,hyphema in 2 eyes(0.4%, infective endophthalmitis in 1 eye(0.2%. Visual acuity: uncorrected visual acuity were ≤0.1 in 52 eyes(9.7%, >0.1-0.1-CONCLUSION:The small incision non phacoemusification cataract surgery with IOL implantation has the advantages of small incision, short operation time, relatively safe, easy to mastered, no-suture, quick visual function recovery and low cost. And, the operation equipments are simple and do not need many expensive medical equipments, supplies and professional staffs. So, the small incision non phacoemusification cataract surgery with IOL implantation is suitable for the anti-blind work of cataract in the foreign aid and remote areas.

  13. [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.

  14. 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.

  15. Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults.

    Science.gov (United States)

    Fu, P-S; Hung, C-C; Hong, J-M; Wang, J-C

    2007-02-01

    The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.

  16. 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.

  17. 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.

  18. World Class Education Ranking: Is It Worth the Effort?

    Science.gov (United States)

    Cheung, Alan; Muse, Ivan

    1998-01-01

    A discussion of why Asian students rank high on international assessment tests in science and mathematics reveals that Asian schools stress rote memorization and test taking to the extent that children don't have the opportunity to be children. The U.S. educational system's encouragement of critical thinking and nonacademic activities contributes…

  19. A World Class Education: Strategic Plan, 2010-2015

    Science.gov (United States)

    New Mexico Public Education Department, 2010

    2010-01-01

    New Mexico's unique demographics and rich intellectual assets, including two of the three largest national engineering and science research laboratories in the country (Sandia and Los Alamos), provide an excellent national setting for educational transformation. With approximately 320,000 K-12 students, New Mexico's demographics are distinctive:…

  20. 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

  1. Building a world class information security governance model

    CSIR Research Space (South Africa)

    Lessing, M

    2008-05-01

    Full Text Available The lack of a fully inclusive guideline document to assist the functioning of sufficient Information Security Governance is common in the business environment. This article focuses on developing such a guideline document, based on a number of best...

  2. 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…

  3. 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

  4. 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

  5. What do world-class companies have in common?

    NARCIS (Netherlands)

    Storbacka, K.E.; Harald, C.

    2007-01-01

    The article discusses the elements of an efficient strategic account management program (SAM). The development of such program entails setting of goals that assist the company's strategy and business case for the program. It suggests that the decisions on establishing a SAM program and its

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

    OpenAIRE

    Inoue, Makoto; Abulon, Dina Joy K; Hirakata, Akito

    2014-01-01

    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 bl...

  8. 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

  9. 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

  10. Tectonic Uplift and Fan Delta Incision along the Conway Coast, NZ

    Science.gov (United States)

    Burtt, D. G.; Bassett, K. N.

    2015-12-01

    The Conway Coast features a unique confluence of fan deltas, terrace uplift, and transpressional faulting. Thrust faults have caused the uplift of the Hawkeswood Range which provides sediment sources for local Gilbert-type fan deltas uplifting to form terraces. Sediments are characterized by steeply dipping foreset beds, horizontal topset beds and tangential bottomset beds. These fan deltas tend to form on steep basin margins often associated with extensional faulting. However, the Conway coast is dominated by thrust faulting. The Rafa terrace, dated between 52.4±4.5 and 79.0±3.5 ka with Optically Stimulated Luminescence, is exposed in cliff faces on the beach. Local creek channels deposited the fan deltas and later incised older deposits to reveal a three-dimensional perspective of the fan delta. This perspective is vital to the recreation of the fan delta position and channel avulsion, leading to a better understanding of the role of uplift superimposed by sea level change in the formation of the terraces. Forty-three photographs were stitched together to form an extensive photomosaic. The types of sediments, significant structures and relationships between adjacent beds were noted and analyzed. Correlations between the sedimentary architecture and sea level change were made using a sea level curve of the South Pacific over the last 140 ka. The incision of mud by gravel producing large flame structures suggests that there was a drop in sea level and a subsequent progradation of the fan delta. Based on the sea level curve, this drop occurred between ~66-79 ka. Higher in the fan delta, a fining-upward sequence points to a rise in sea level. This correlates with a rise on the sea level curve between ~52-63 ka. Upsection there is another coarsening-upward sequence of 5-10 m thick beds suggesting a fall in sea level before the uplift and incision of the terrace and the subsequent formation of the Ngaroma terrace. Due to their lateral extent, the gravels seem to

  11. [History of surgical instruments. 9. Surgical instruments and development of surgical technique of lithotomy incision].

    Science.gov (United States)

    Sachs, M; Peters, J

    1999-01-01

    Lithotomy, i.e. the surgical method of cutting for stone in the bladder, belongs to the oldest and, due to the high risk, most notorious operating techniques. Records of stone-cuttings date as far back as Ancient Greece. The first detailed description of the procedure and instrumentation of lithotomy is to be found by Celsus (1. century AD). The patient in the lithotomy position, the neck of the bladder is approached by a median incision of the perineum. Celsus is also the first to mention special stone-hooking instruments ("uncus") to aid in extracting the bladder-stones. Medico-historical development lead to constant changes in the technique as well as in the instrumentation, since the lack of analgesia and anaesthesia necessitated quick operations of only a few minutes. A key step in the progress of operation was the introduction of so-called path-finders and directing probes in the 16th century. The opening of the bladder from the perineal incision was now accompanied by the simultaneous admission of a metal catheter into the bladder via urethra, thus providing the "Lithotomist", through manual control of the catheter, with an enhanced orientation towards the position of urethra and bladder. At that time, the dissection was conducted bluntly and without direct view of the situation, i.e. without an exact representation of the structures to be separated. Thanks to the improved instrumentation, the instruments could now be guided along a probe directly into the bladder, thus alleviating the tedious search for the opening after changing instruments, all the while with an agitated, pressing patient. Famous names in the development of the lithotomy with an perineal incision are the medical doctor Mariano Santo (around 1488-1564), the barber-surgeon Frère Jacques de Beaulieu (1651-1719) and later Johann Jakob Rau M.D. (1668-1719). Only later, to avoid injury to the perineum, the suprasymphyseal approach ("Sectio alta") was adopted (primarily by Pierre Franco 1556

  12. Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy.

    Science.gov (United States)

    Nagele, Udo; Walcher, Ute; Herrmann, Thomas R W

    2012-10-01

    New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine. From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures. OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29]. SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single

  13. Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

    Directory of Open Access Journals (Sweden)

    Kamil Gulpinar

    2011-01-01

    Full Text Available Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

  14. 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...... lenticule is cut by a femtosecond laser and manually extracted through a peripheral corneal tunnel. The purpose of the prospective quality study is to present our initial clinical experience with ReLEx smile for treatment of moderate and high myopia. Methods: 379 eyes (198 patients) were treated for myopia...... (spherical equivalent (SE) ranging from -13.13 to -1.63 D, mean -7.28 D) with ReLEx smile and followed for 3 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), proportion of eyes within ± 0.5/1.0 D, loss/gain of lines of CDVA, patient...

  15. 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

  16. Single-incision laparoscopic splenectomy and splenic autotransplantation for an enlarged wandering spleen with torsion.

    Science.gov (United States)

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2014-06-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The transplanted splenic tissues could be identified on a spleen scintigram obtained 3 months after the surgery. Howell-Jolly bodies were not observed in blood specimens. This procedure is able to prevent an overwhelming postsplenectomy infection, and leads to satisfactory cosmetic results.

  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. 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

  19. 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.

  20. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty

    DEFF Research Database (Denmark)

    Milandt, Nikolaj; Nymark, Tine; Jørn Kolmos, Hans

    2016-01-01

    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...

  1. 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.

  2. A Hemiclamshell Incision for a Giant Solitary Fibrous Tumor of the Right Hemithorax

    Directory of Open Access Journals (Sweden)

    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.

  3. Effectiveness of negative pressure wound therapy/closed incision management in the prevention of post-surgical wound complications: a systematic review and meta-analysis.

    Science.gov (United States)

    Sandy-Hodgetts, Kylie; Watts, Robin

    2015-01-01

    Statistics Assessment and Review Instrument. Data were extracted from the included papers using a standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. In addition to study results, the data extracted included details of the study population, setting, intervention and author's conclusion. Where appropriate, data were pooled using Comprehensive Meta-Analysis software. Meta-analyses were performed for three outcomes. In cases of heterogeneity between studies a narrative summary of results was undertaken. Eight studies were included in the review. Meta-analyses revealed a statistically significant difference in favor of the use of negative pressure wound therapy as compared to standard surgical dressings was found for surgical site infections. Conflicting results were found for wound dehiscence and seroma. Given the small number of studies, mostly retrospective comparative cohort in design, no definitive conclusions can be reached as to the effectiveness of the use of negative pressure wound therapy in the prevention of surgical wound complications. However, there was a demonstrated association between the use of negative pressure wound therapy and reduction in surgical site infection. Negative pressure wound therapy in preference to standard postoperative dressings, for example dry gauze, may be considered for closed surgical incisions in adults assessed as high-risk for surgical site infections. The focus of further research on this topic should be level one studies (randomized controlled trials) on patients identified as 'at risk' in the preoperative period.

  4. 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.

  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. Influence of ocular features and incision width on surgically induced astigmatism after cataract surgery.

    Science.gov (United States)

    Chang, Shu-Wen; Su, Tai-Yuan; Chen, Yao-Lin

    2015-02-01

    To identify factors associated with surgically induced astigmatism (SIA) following phacoemulsification. Six hundred five eyes underwent phacoemulsification with a 2.2-mm (the 2.2-mm group, n = 248) or 2.75-mm (the 2.75-mm group, n = 357) superior limbal incision. Preoperative axial length, anterior chamber depth, corneal curvature, and intra-ocular pressure were measured. Corneal curvature and intraocular pressure were measured at 1 day, 1 week, and 1, 2, and 3 months postoperatively. SIA, corneal flattening, and torque were calculated using the Alpins method. The effect of preoperative corneal astigmatism meridian on SIA was also examined. Differences in SIA between the 2.2- and 2.75-mm groups were explored, and correlations between SIA and preoperative corneal astigmatism, anterior chamber depth, axial length, age, and intraocular pressure were analyzed. SIA, corneal flattening, and torque were smaller in the 2.2-mm group than in the 2.75-mm group at 1 week (P = .003, .006, and .014, respectively), but not statistically different thereafter. Higher preoperative corneal astigmatism, older age, and shallower anterior chamber depth were associated with greater SIA in both groups. The effect of astigmatism meridian on SIA was more noticeable in the 2.75-mm group. Shorter axial length and lower intraocular pressures were associated with greater SIA in the 2.75-mm group but not in the 2.2-mm group. Reducing limbal incision width and considering patient age, the meridian and magnitude of corneal astigmatism, anterior chamber depth, axial length, and intraocular pressure, and adjusting the flattening component of SIA input for toric intraocular lens power calculation could potentially improve the astigmatism control in refractive lens surgery. Copyright 2015, SLACK Incorporated.

  7. Clinical research of limbal relaxing incision during implantable collamer lens surgery

    Directory of Open Access Journals (Sweden)

    Zhen Li

    2015-02-01

    Full Text Available AIM: To evaluate the efficacy and safety of limbal relaxing incision(LRIfor correcting corneal astigmatism during implantable collamer lens(ICLsurgery.METHODS: A total of 185 eyes of 105 patients with high myopia and corneal keratometric astigmatism were included in the study. ICL surgery with concomitant relaxing incision was performed in 105 eyes of 60 patients in LRIs group(Group A. Eighty eyes of 45 patients only underwent ICL surgery were in control group(Group B. All patients undergone ophthalmic examination that included uncorrected visual acuity(UCVA, best-corrected visual acuity(BCVA, Pentacam analysis system to observe the changes of corneal astigmatism before and 1wk, 1 and 3mo after surgery.RESULTS: Respectively comparing UCVA between two groups in 1 and 3mo postoperatively, the P values were considered statistically significant(PP values were considered no statistically significant(P>0.05. Preoperative corneal astigmatism was 1.52±0.55D in group A and 1.48±0.57D in group B, there was no statistically significant difference(P>0.05. One week postoperatively, the astigmatism was 0.55±0.41D in group A and 1.20±0.48D in group B. One month postoperatively, the astigmatism was 0.60±0.38D in group A and 0.93±0.47D. Three months postoperatively, the astigmatism was 0.51±0.32D in group A and 0.96±0.40D in group B. The difference between the two groups were statistically significant(PPPCONCLUSION: LRIs performed during ICL surgery appeared to be an effective and safer procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality.

  8. 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.

  9. [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.

  10. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique

    Science.gov (United States)

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.

    2016-01-01

    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the tendon edge was complimented by the other strand passing through the central aspect of the distal tendon and advanced to pull the tendon edge down to the bone with appropriate tension. Patients with revision surgery and the use of allograft were excluded. Clinical outcomes included elbow range of motion and grip strength. All patients completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and reported satisfaction level, pain level, and any postoperative complications. Results: Fourteen patients with an average age of 51.3 years (range, 27.8-66.4 years) were included in the study. The dominant arm was injured in 9 cases. At an average of 16.4 months’ follow-up (range, 6.8-34.3 months), all patients had elbow range of motion of 0° to >130°, and grip strength was 101.5% of the uninjured arm (range, 70.6%-121.4%). The Average QuickDASH score was 6.5 (range, 0-36.5). Conclusion: Single incision biceps repair with suture anchor fixation using our hemi-Krackow stitch provided a strong repair allowing easy tensioning of the biceps tendon to bone and showed satisfactory functional outcomes at early follow-up. No patients required revision surgery, and there was only 1 case of transient nerve complaints. PMID:27390570

  11. The limited incision harvest of the rectus femoris flap for complex groin wound management.

    Science.gov (United States)

    Nelson, Jonas A; Fischer, John P; Mackay, Duncan J D; Mirzabeigi, Michael N; Cabiling, David S; Kovach, Stephen J; Serletti, Joseph M; Kanchwala, Suhail

    2014-12-01

    Muscle flaps can be effective in the protocol of complex groin wound management, yet donor-site morbidity remains a continued concern. The purpose of this study was to present a minimally invasive approach to the harvest of the rectus femoris flap (RFF) for groin wound vascularized tissue coverage. A retrospective study examined all patients undergoing RFF coverage and reconstruction of a complex groin wound between July 1, 2010, and December 31, 2011. During the study period, the senior author (S.K.K.) performed all RFF harvests through a minimally invasive approach, whereas all other surgeons performed the RFF harvest through a standard approach. Patients who underwent a minimally invasive RFF approach were compared with those who underwent the standard incision. Forty-three patients underwent RFF coverage procedures, 11 of which were carried out using the minimally invasive technique. The patients in the minimally invasive cohort were older (P = 0.03) but had similar rates of medical comorbidities. Minimally invasive RFF harvests were more commonly performed in the planned, salvage setting (P = 0.03). No difference was found in the vascular surgery procedure type (P = 0.13), presence of exposed prosthetic graft material (0.2), or rate of culture-positive wound (P = 0.67). Importantly, no differences in operative time (184.4 [45.5] minutes vs 169.3 [31.7] minutes, P = 0.45) or postoperative complications were observed, with no graft losses or major limb-related morbidity in either group. The RFF continues to be a workhorse flap for complex groin wounds, most often in the salvage setting. This study demonstrates that a minimally invasive approach can be used for flap harvest with equivalent results to that of the standard longitudinal incision.

  12. [The standard implantation of a total hip prosthesis via two incisions (the Yale Technique)].

    Science.gov (United States)

    Kipping, Robert

    2009-09-01

    Implantation of a total hip endoprosthesis with minimal trauma to the soft tissue. The need for visual aids (e.g., navigation or X-rays) during the procedure is frequently avoided. All kinds of coxarthrosis for every age group, for every variation of bone construction, and even in obese patients. Extremely dysplastic hip joints involving the development of a secondary socket and the necessity of reconstruction of the acetabular socket (e.g., in the Harris method). Using a fixed lateral position, a small entry incision is made between the tensor fasciae latae and the sartorius muscles and the prosthesis socket is put into place. Via a second dorsal incision, after stripping the exterior rotators, the prosthesis stem and ball are implanted and the two parts of the prosthesis are attached. Full weight bearing allowed immediately. A luxation prophylaxis, in the form of a self-developed hip bodice (the so-called Yale bandage), is used until the end of the 4th postoperative week. Discharge from hospital is possible after just a few days. Upon discharge, the patient is sent to a rehabilitation facility, either as a resident or as an outpatient, for approximately 3 weeks. Return to the workplace, with only light physical activity, is possible once the wound has healed completely; this could be as soon as 14 days after the operation. Checkups are made after 4 weeks, 6 months, 1 year and then every year; these checkups include a full examination, X-rays and laboratory tests. Full exposure to sport or heavy manual labor is usually approved after the 6-month checkup. Between October 2004 and April 2006, a total of 221 patients underwent surgery using this new technique (of these 15 patients underwent two-stage bilateral hip joint replacements). Patients were followed up for a minimum of 12 months and a maximum of 30 months. The Harris Hip Score improved from an average of 45.25 preoperatively to 96.4 postoperatively.

  13. Tubularized proximally-incised plate in distal/midshaft hypospadias repair

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

  15. Radiographic and CT Assessment of Reduction of Calcaneus Fractures Using a Limited Sinus Tarsi Incision.

    Science.gov (United States)

    Scott, Aaron T; Pacholke, David A; Hamid, Kamran S

    2016-09-01

    The lateral extensile incision for fixation of displaced intra-articular calcaneus fractures allows for fracture reduction but has been associated with high rates of soft tissue complications. This has prompted a search for less invasive methods of fracture fixation. The purpose of the present study was to determine the adequacy of reduction and rate of complications associated with operative fixation of calcaneal fractures using a limited sinus tarsi approach. A limited sinus tarsi incision with plate fixation was utilized for treatment of 39 displaced intra-articular calcaneal fractures in 35 consecutive patients as part of a single surgeon series. Imaging assessment of previously described fracture displacement measures was undertaken in preoperative and postoperative radiographs and CT. A retrospective chart review was conducted to identify postoperative complications. Mean preoperative Bohler angle measurement was 7.7 (range, -26.0 to 30.0) degrees and the mean final postoperative standing Bohler angle was 25.5 (range, 12.3 to 37.7) degrees. Postoperative CT demonstrated that subtalar articular reduction was within 2 mm of anatomic in 91% of patients. There were 2 instances of superficial wound dehiscence (5.1%) and 1 deep infection (2.6%) that required debridement and complete hardware removal. Visual analog score (VAS) for pain averaged 3 of 10 in the 32 available patients at 1-year follow-up. Eight of these patients (25%) reported no pain (0/10) at final follow-up. Operative fixation of displaced intra-articular calcaneal fractures utilizing the limited sinus tarsi approach resulted in acceptable fracture reduction and a low rate of complications. Level IV, retrospective case series. © The Author(s) 2016.

  16. The Antinociceptive Effect of Light-Emitting Diode Irradiation on Incised Wounds Is Correlated with Changes in Cyclooxygenase 2 Activity, Prostaglandin E2, and Proinflammatory Cytokines

    Directory of Open Access Journals (Sweden)

    Yuan-Yi Chia

    2017-01-01

    Full Text Available Background. Light-emitting diode (LED phototherapy has been reported to relieve pain and enhance tissue repair through several mechanisms. However, the analgesic effect of LED on incised wounds has never been examined. Objectives. We examined the analgesic effect of LED therapy on incision pain and the changes in cyclooxygenase 2 (COX-2, prostaglandin E2 (PGE2, and the proinflammatory cytokines interleukin 6 (IL-6, IL-1β, and tumor necrosis factor α (TNF-α. Methods. Rats received LED therapy on incised skin 6 days before incision (L-I group or 6 days after incision (I-L group or from 3 days before incision to 3 days after incision (L-I-L group. Behavioral tests and analysis of skin tissue were performed after LED therapy. Results. LED therapy attenuated the decrease in thermal withdrawal latency in all the irradiated groups and the decrease in the mechanical withdrawal threshold in the L-I group only. The expression levels of COX-2, PGE2, and IL-6 were significantly decreased in the three LED-treated groups, whereas IL-1β and TNF-α were significantly decreased only in the L-I group compared with their levels in the I groups (p<0.05. Conclusions. LED therapy provides an analgesic effect and modifies the expression of COX-2, PGE2, and proinflammatory cytokines in incised skin.

  17. Clinical and histological comparison of tissue damage and healing following incisions with the CO2-laser and stainless steel surgical blade in dogs.

    Science.gov (United States)

    Durante, E J; Kriek, N P

    1993-09-01

    The tissue damage and subsequent healing of skin, linea alba and intestinal wall incisions made with a CO2-laser and a stainless steel surgical blade were evaluated clinically and histologically in dogs (n = 10). The amount of blood lost in each type of skin incision was measured by taking the pre- and postoperative mass of surgical swabs. The tissues were sutured and the skin incisions examined every day. The animals were subsequently euthanased (Day 12) and all incisions examined histologically. A delay in the healing process was observed in the laser incisions of the skin during the first 4 d, but there was no difference in the healing rate of the intestinal wounds or of the linea alba. The blood loss due to the laser incisions was significantly less than that caused by the surgical blade. It was concluded that the CO2-laser can be used with confidence when incising the skin and intestine and that, due to its precision, the surgical blade is by far a more accurate method to incise the linea alba.

  18. 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.

  19. Impact of adding a second-layer to a single unlocked closure of Cesarean uterine incision: a randomized controlled trial

    DEFF Research Database (Denmark)

    Rudnicki, Martin; Bennich, G; Wilken-Jensen, C

    2016-01-01

    The purpose of the present study was to investigate short- and long term effects on residual myometrial thickness (RMT) by adding a second-layer to a single unlocked closure of caesarean uterine incision. METHOD: he study was a randomized double-blind controlled trial. Healthy nulliparous scheduled...

  20. 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.

  1. Combined use of ultrasound-assisted liposuction and limited-incision platysmaplasty for treatment of the aging neck

    NARCIS (Netherlands)

    Rooijens, P.P.G.M.; Zweep, H.P.; Beekman, W.H.

    2008-01-01

    Background: Many techniques have been introduced for the surgical treatment of the aging neck. In this study the combination therapy of ultrasound-assisted liposuction and limited-incision platysmaplasty for cervicofacial rejuvenation is presented. Methods: Fifteen female patients (age = 43-75

  2. Rapid channel incision of the lower Pearl River (China since the 1990s as a consequence of sediment depletion

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. Diathermy versus scalpel in transverse abdominal incision in women undergoing repeated cesarean section: A randomized controlled trial.

    Science.gov (United States)

    Elbohoty, Ahmed E H; Gomaa, Mostafa F; Abdelaleim, Mohamed; Abd-El-Gawad, Magdi; Elmarakby, Mohamed

    2015-10-01

    The aim of this study was to evaluate the volume of blood loss, wound incision time and wound complication according to use of scalpel or electrosurgery during the creation of transverse abdominal incisions during repeated cesarean section (CS). A randomized controlled trial was carried out at Ain Shams University Maternity Hospital. We recruited 130 women with a history of one previous CS at the time of their planned lower-segment CS. Participants were randomized to anterior abdominal wall opening from subcutaneous tissue till the peritoneum by either the use of scalpel with disposable blade (No. 22) or diathermy using the standard diathermy pen electrode. The main outcome measures were the volume of blood loss from skin incision to the end of the peritoneal incision, the operative time and wound complication. We observed a highly significant difference between the two groups in blood loss (median [interquartile range], 11 [8-15.25] g for the diathermy group vs 20 [18-23] g for the scalpel group, P complications showed no statistical difference. The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time but has no impact on postoperative pain or wound complications. © 2015 Japan Society of Obstetrics and Gynecology.

  5. Influence of groin incision, duration of ischemia, and prostaglandin E1 on ischemia-reperfusion injury of the lower limb

    NARCIS (Netherlands)

    Frässdorf, Jan; Luther, Bernd; Müllenheim, Jost; Otto, Florian; Preckel, Benedikt; Schlack, Wolfgang; Thämer, Volker

    2006-01-01

    OBJECTIVE: The influences of groin incision, duration of ischemia, and the effects of prostaglandin E1 (PGE1) on ischemia-reperfusion (I/R) injury of the hind limb in rabbits were evaluated. DESIGN: A prospective study. SETTING: Laboratory. PARTICIPANTS: In 64 rabbits, bilateral hind limb ischemia

  6. Closed-incision negative-pressure therapy in high-risk general surgery patients following laparotomy: a retrospective study.

    Science.gov (United States)

    Zaidi, A; El-Masry, S

    2017-03-01

    Surgical site infection (SSI) and wound dehiscence are dreaded complications following laparotomy in general surgical patients, and can potentially occur more often in various comorbid states. Negative-pressure wound therapy (NPWT) has a positive effect of on open and complicated wounds and so has been used for at-risk surgical incisions with the aim of redistributing lateral tension and holding incision edges together. The aim of the present study was to compare the rate of wound complications following laparotomy in high-risk general surgical patients with a clean incision treated with closed-incision negative-pressure therapy (ciNPT) with those receiving conventional care. A retrospective review was performed of the hospital medical records of patients who underwent laparotomy between 1 October 2010 and 31 March 2012. Records of 69 patients who received ciNPT and 112 who were managed by adherent gauze dressings were included in the final analysis. Two (2.9%) patients in the ciNPT group and 23 (20.5%) in the non-NPWT group developed a wound complication following laparotomy (P surgery patients considered to have risk of developing wound complications following laparotomy. © 2016 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

  7. 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.

  8. Minimal Incision Scar-Less Open Umbilical Hernia Repair in Adults - Technical Aspects and Short Term Results

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    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

  9. Machine tool

    International Nuclear Information System (INIS)

    Kang, Myeong Sun

    1981-01-01

    This book indicates machine tool, which includes cutting process and processing by cutting process, theory of cutting like tool angle and chip molding, cutting tool such as milling cutter and drill, summary and introduction of following machine ; spindle drive and feed drive, pivot and pivot bearing, frame, guide way and table, drilling machine, boring machine, shaper and planer, milling machine, machine tool for precision finishing like lapping machine and super finishing machine gear cutter.

  10. 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.

  11. Assessment of Location and Anatomical Characteristics of Mental Foramen, Anterior Loop and Mandibular Incisive Canal Using Cone Beam Computed Tomography.

    Science.gov (United States)

    Panjnoush, Mehrdad; Rabiee, Zonnar Sadat; Kheirandish, Yasaman

    2016-03-01

    This study aimed to evaluate the location and characteristics of mental foramen, anterior loop and mandibular incisive canal using cone beam computed tomography (CBCT). This retrospective cross-sectional study evaluated 200 mandibular CBCT scans for the location of mental foramen, anterior loop prevalence and mandibular incisive canal visibility, its mean length and distance to buccal and lingual plates and inferior border of the mandible. The effect of age and gender on these variables was also analyzed (P<0.05). Anterior loop and mandibular incisive canal were seen in 59.5% and 97.5% of the cases, respectively. The mean length of the mandibular incisive canal was 10.48±4.53mm in the right and 10.40±4.52mm in the left side. The mean distance from the endpoints of the canal to buccal plate was 3.63±1.73mm in the right and 3.66±1.45mm in the left side. These distances were 3.89±1.53mm in the right and 4.13±1.48mm in the left side to lingual plate and 9.98±2.07mm in the right and 8.62±1.97mm in the left side to the inferior border of the mandible. The distance from the endpoints of the canal to lingual plate was significantly different in the right and left sides. The distance from the endpoint of the canal to the buccal plate and inferior border of the mandible was significantly shorter in females (P=0.016), and had a weak, significant correlation with age (rsp=0.215, P=0.003). Due to variability in mandibular incisive canal length and high prevalence of anterior loop, CBCT is recommended before surgical manipulation of interforaminal region.

  12. Balancing hydropower production and river bed incision in operating a run-of-river hydropower scheme along the River Po

    Science.gov (United States)

    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

  13. Large-scale single incised valley from a small catchment basin on the western Adriatic margin (central Mediterranean Sea)

    Science.gov (United States)

    Maselli, Vittorio; Trincardi, Fabio

    2013-01-01

    The Manfredonia Incised Valley (MIV) is a huge erosional feature buried below the Apulian shelf, on the western side of the Adriatic margin. The incision extends more than 60 km eastward, from the Tavoliere Plain to the outer shelf, not reaching the shelf edge. High-resolution chirp sonar profiles allow reconstruction of the morphology of the incision and its correlation at regional scale. The MIV records a single episode of incision, induced by the last glacial-interglacial sea level fall that forced the rivers draining the Tavoliere Plain to advance basinward, reaching their maximum extent at the peak of the Last Glacial Maximum. The valley was filled during a relatively short interval of about 10,000 yr during the Late Pleistocene-Holocene sea level rise and almost leveled-off at the time of maximum marine ingression, possibly recording the short-term climatic fluctuations that occurred. The accommodation space generated by the lowstand incision was exploited during the following interval of sea level rise by very high rates of sediment supply that allowed the preservation of up to 45 m of valley fill. High-resolution chirp sonar profiles highlight stratal geometries that are consistent with a typical transgressive valley fill of an estuary environment, including bay-head deltas, central basin and distal barrier-island deposits, organized in a backstepping configuration. The highest complexity of the valley fill is reached in the shallowest and most proximal area, where a kilometric prograding wedge formed during a period dominated by riverine input, possibly connected to high precipitation rates. Based on the depth of the valley margins during this interval, the fill was likely isochronous with the formation of sapropel S1 in the Mediterranean region and may have recorded significant fluctuations within the hydrological cycle.

  14. 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.

  15. 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 ...

  16. 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

  17. A comparison between mass closure and layered closure of midline abdominal incisions

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    Gurjit Singh

    2012-01-01

    Full Text Available Background: Traditionally, a laparotomy wound is closed in layers co-opting the various layers anatomically. A new method of closure, namely single layer closure technique (mass closure technique has come into vogue. Aims: This study aims to evaluate the benefits or otherwise between single layer closure and layered closure after comparing it with studies available in literature. Settings and Design: This study was performed in a teaching institute in patients undergoing laparotomy, either planned or emergency. Materials and Methods: A total of 80 cases were selected at random and the study was carried out over a period of 2 years. The cases were equally divided into two groups of 40. In both groups, vertical midline incision was used. In the first group, abdomen was closed using the single layer closure technique. Continuous suturing with burial of the knots was done in 20 patients and interrupted mass closure was done in another 20 patients. In the other group, the abdomen was closed in layers. The patients were followed up for minimum 6 months. Patients who did not turn up for follow up were asked to notify the development of any wound complication through postal correspondence. Results: The time required for closure was considerably less when continuous suture technique was used. One patient in the mass closure group and four in the layered group developed post-operative wound infections. One patient in the layered closure group developed a stitch sinus. There were two cases of burst abdomen with the layered closure technique. Two patients in the layered closure group developed incisional hernias 6 months post-operatively. Conclusions: Single layer closure technique offers certain definite advantage over the layered closure technique with respect to the time required for closure of the incision, incidence of wound dehiscence and the incidence of incisional hernia. However, the true incidence of wound dehiscence (burst abdomen and incisional

  18. Primary pulley enlargement in zone 2 by incision and repair with an extensor retinaculum graft.

    Science.gov (United States)

    Bunata, Robert E

    2010-05-01

    This retrospective study documents the results of primary enlargement of tendon sheath pulleys by incision and extensor retinaculum graft repair during flexor tendon repairs in zone 2 in 9 fingers. The entire A2 or A4 pulley was enlarged by complete incision and repaired with an interposed extensor retinaculum graft at the time of primary flexor tendon repair in a total of 9 fingers in 7 patients, ages 15 to 54 years. The indication for primary pulley enlargement was failure of the tendon repair to glide smoothly and without snagging through the normally tight-fitting pulley system. In no case was more than one major pulley enlarged, and the entire A1 pulley was never enlarged. The zone 2 tendon repairs were done using a 2-strand modified Kessler 3-0 core suture and a 6-0 nylon running circumferential suture. The follow-up averaged 3.6 years. Interphalangeal total active motion and Strickland-Glogovac grade in patients with adequate follow-up of more than 6 months or obtaining full range of motion were obtained from a retrospective chart review. Interphalangeal total active motion averaged 127 degrees and the scores according to the Strickland-Glogovac system were excellent for 3, good for 2, fair for 2, and poor for 2. There were no tendon ruptures. Two fingers in one patient required a tenolysis and a third finger had secondary skin scar lengthening. Two fingers had visible and palpable bowstringing when seen at long-term follow-up and there was an average flexion contracture of 21 degrees. Primary pulley enlargement using a free graft in zone 2 tendon injuries may achieve the 3 goals of providing a good gliding environment, avoiding triggering, and minimizing bowstringing. These initial clinical outcomes are average for zone 2 tendon repair, but encouraging. Further research and refinement in surgical technique and rehabilitation method are needed to minimize flexion contractures. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc

  19. Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 incisions.

    Science.gov (United States)

    Pérez-Torregrosa, V T; Olate-Pérez, Á; Cerdà-Ibáñez, M; Gargallo-Benedicto, A; Osorio-Alayo, V; Barreiro-Rego, A; Duch-Samper, A

    2016-09-01

    To assess the safety and effectiveness of phacoemulsification combined with XEN45 implant surgery in patients with cataract and open-angle glaucoma, with 12-month follow-up. A prospective study conducted on 30 eyes requiring phacoemulsification with, at least, 2 medications to control intraocular pressure (IOP). Phacoemulsification combined with XEN45 implant surgery was performed within 15minutes of administering subconjunctival mitomycin C. Surgery was performed through 2 temporal incisions, separated by 90°, using the inferior to enter the XEN45 and to implant it in the superior nasal region. A record was made of the best corrected visual acuity, IOP before and 1 day, 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, the number of antiglaucomatous medications, and complications. The best corrected visual acuity was 0.37±0.2 and 0.72±0.15 before and 12 months after surgery, respectively. The pre-operative IOP was 21.2±3.4mmHg, with 3.07 drugs, decreasing by 61.65% on the first day, 37.26% at 1 month, 35.05% at 3 months, 31% at 6 months, 30.6% at 9 months, and 29.34% at 12 months. The number of medications decreased by 94.57%. Complications occurred in 3 eyes, 2 of them were excluded because we could not complete the implantation (280° subconjunctival haemorrhage and XEN extrusion when trying to reposition). In a third case, the bleb was encapsulated at 5 months after surgery. The phacoemulsification combined with XEN45 implant surgery can effectively reduce IOP and the number of drugs in mild-moderate open-angle glaucoma, as they rehabilitate the VA. The use of only 2 micro-invasive incisions makes it simple, quick and safe, with few complications at 12 months follow-up from surgery. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Single-incision trocar-less endoscopic management of giant liver hydatid cyst in children

    Science.gov (United States)

    Acharya, Himanshu; Agrawal, Vikesh; Tiwari, Abhishek; Sharma, Dhananjaya

    2018-01-01

    Introduction: Laparoscopic management of giant hydatid cyst has limitations such as spillage, poor control, difficulties in suctioning the contents through special ports which are not easily available, difficulty in the obliteration of residual cavity and recurrence. We describe single-incision trocar-less endoscopic (SITE) technique which simplifies enucleation and management of residual cavity. Method: Inclusion criteria for these cases were patients having single uncomplicated giant hydatid cyst >5 cm present at the surface of the liver and palpable on clinical examination. The cysts which were <5 cm, multiple, deep-seated and impalpable were excluded from the study. Technique: An incision of 1 cm is marked over the site of the maximum bulge and deepened to open peritoneum, cyst is held with two stay sutures, injection of scolicidal agent and aspiration is done and suction of the cyst content is done. After suction of the contents, 5 mm telescope is inserted, and the cyst cavity is inspected, clearance and cyst procedure is done. Results: In 6 years, 62 cases of giant hydatid cyst fulfilling the inclusion criteria and were taken for SITE technique. SITE was successful in all patients and none needed a conversion. Twenty-nine (46.77%) underwent omentopexy and three (4.83%) underwent SITE capitonnage. There was post-operative biliary leak in one (0.016%) patient who underwent capitonnage, which was managed by prolonged drainage which resolved in 10 days. Mean operative duration was 52 min (30 min to 85 min). Mean follow-up was for 18 months (12–36 months). One (0.016%) patient had cyst recurrence. Discussion: SITE has advantages of endoscopic clearance and does not require special ports which are expensive, technically difficult to use and often unavailable. It allows controlled handling, effective suction and easier management of bile communication. SITE can be a preferred procedure for endoscopic management of giant liver hydatid cysts. Conclusion: SITE

  1. Initiation age and incision rates of inner gorges: Do they record multiple glacial-interglacial cycles?

    Science.gov (United States)

    Delunel, Romain; Casagrande, Jan; Schlunegger, Fritz; Akçar, Naki; Kubik, Peter W.

    2015-04-01

    Inner gorges represent some of the most conspicuous landforms in the European Alps. They form narrow and deep active-channel incisions that link hanging tributaries with trunk valleys in glacially-conditioned environments. Despite abundant research carried out on these objects, both their origin and evolution have remained unclear. In particular, the age of initiation, the rate of incision, and the respective contribution of fluvial and subglacial processes in the evolution of inner gorges have still been a matter of scientific debate. Indeed, answering these questions has been complicated by the lack of appropriate quantitative methods and/or suitable sampling strategies for studying inner gorges. Here, we report 10Be concentrations measured in alluvial sediments that have been collected along the main stream of a ~20-km2-catchment in the Swiss foreland (Central European Alps). This catchment hosts a ca. 100-m-deep and 2-km-long inner gorge that has been cut mainly in glacial till. Catchment wide denudation rates inferred from 10Be analyses (n = 15) vary from ~120 to 650 mm/ka and show a general downstream increasing trend. Additional field observations and GIS analyses reveal that the denudation rates within the catchment increase from the headwaters, characterized by relict glacial/periglacial landscapes, to the downstream end of the basin where the inner gorge has been formed. Using a 10Be-based sediment budget approach and the delineation of topographic domains from a 2-m-resolution LIDAR, we provide an estimate of erosion rates within the gorge that are higher than 2.5 m/ka and can reach up to ~ 7 m/ka. Combining these estimated erosion rates with the reconstruction of eroded volumes within the gorge, we obtain a rough initiation age in the early Holocene, in general agreement with previous studies reporting a postglacial origin for the inner gorges. Our results therefore appear contradictory with recent findings arguing for a gradual formation of inner

  2. Herniotomy in resource-scarce environment: Comparison of incisions and techniques

    Directory of Open Access Journals (Sweden)

    Musa Ibrahim

    2015-01-01

    Full Text Available Background: There are various methods for surgical treatment of hernia and hydrocele in children with variable cost-effectiveness, recovery and cosmetic outcomes. This study analyses our experience with mini-incision/invasive herniotomy in children in resource-limited centre. Materials and Methods: Seven hundred and eighty-four n = 784 patients underwent herniotomy via conventional and mini-invasive methods were assigned into Group A and Group B. Three hundred and seventy-six n = 376 (47.95% in Group A while four hundred and eight n = 408 (52.04% in Group B. Eight hundred and seventeen (817 herniotomy was performed. Demographic data, hernia/hydrocele sides, volume of surgical suture used, surgery duration, and complications analysed. Results: Right side hernia and/or hydrocele were 464 (59.18%. 287 (36.60% had left sided while 33 (4.21% had bilateral hernia and/or hydrocele. There were 14 bilateral hernia repair in Group A and 19 in Group B. The lengths of operation time for unilateral repair ranged from 14 to 54 min in Group A (median, 23 min and 7-44 min in Group B (median, 15 min with a mean surgical duration of 15.48 ± 4.16 min in Group B versus 23.41 ± 5.94 min in Group A (P < 0.001 while the range of the lengths of operation time for bilateral repair in Group A was 20-54 min (median, 36 and 12-30 min (median, 21 in Group B with a mean duration of 36.35 ± 9.89 min in Group A versus 20.42 ± 4.83 min in Group B P = 0.00563. 376 sachets of 45 cm suture material were used in Group A versus 137 in Group B. There were total of 87 (23.13% complications in Group A versus 3 (1.47% in Group B P = 0.000513. Superficial wound infection and abscess were 9 (2.36% and 16 (4.25% in Group A versus none (0 in Group B. Conclusion: Mini-incision/invasive herniotomy in children and adolescents is fast, cost-effective with satisfactory cosmetic outcome and limited complications

  3. Antarctic Subglacial Lake Drainage Via Canals Incised Into Sediment: Progress From Modelling And Observations

    Science.gov (United States)

    Carter, S. P.; Fricker, H. A.; Siegfried, M. R.

    2015-12-01

    Traditional models for the subglacial drainage of ice-dammed lakes in temperate environments invoke a channel eroded into the deformable ice above the bed. In Antarctica, however, modelling studies imply that conditions are more favourable to the drainage of water through channels eroded into the underlying sediments or till, commonly referred to as "canals". We have developed a model for the discharge of "active" subglacial lakes in Antarctica employing drainage through canals and tested its predictions for ice surface drawdown and rate of outflow against satellite- and ground-based observations. Our modeled outflow from a lake begins as a distributed flow, which evolves to incise a channel into the sediment as outflow rates increase. With further erosion, the canal aperture increases and soon quickly become the dominant flow mechanism, pulling water away from the distributed system. Lower pressure within the canal allows the lake to drain to levels below that necessary to initiate outflow, but also allows the sediment to flow into the canal. This deformational closure of the canal typically, ends lake drainage before all water is evacuated. The observed ice speedups associated with lake drainage appear to correlate not with peak total outflow, but with the peak in distributed outflow that before an effective channel is incised. Peak channelized flow reduces water pressure leading to a net slowdown relative to a steady-state distributed drainage. Although sensitivity studies indicate that rate of channel grown and contraction are highly dependent on relatively unconstrained sediment properties (e.g. grain size, porosity), the total drawdown and peak outflow rates for nearly every active lake identified in Antarctica so far all fall within 2 orders of magnitude of one another. The small spread of observations compared to the parameter space of the sensitivity study may indicate either that there is a feedback mechanism for maintaining optimal sediment properties

  4. Highly mutagenic exocyclic DNA adducts are substrates for the human nucleotide incision repair pathway.

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    Paulina Prorok

    Full Text Available BACKGROUND: Oxygen free radicals induce lipid peroxidation (LPO that damages and breaks polyunsaturated fatty acids in cell membranes. LPO-derived aldehydes and hydroxyalkenals react with DNA leading to the formation of etheno(ε-bases including 1,N(6-ethenoadenine (εA and 3,N(4-ethenocytosine (εC. The εA and εC residues are highly mutagenic in mammalian cells and eliminated in the base excision repair (BER pathway and/or by AlkB family proteins in the direct damage reversal process. BER initiated by DNA glycosylases is thought to be the major pathway for the removal of non-bulky endogenous base damage. Alternatively, in the nucleotide incision repair (NIR pathway, the apurinic/apyrimidinic (AP endonucleases can directly incise DNA duplex 5' to a damaged base in a DNA glycosylase-independent manner. METHODOLOGY/PRINCIPAL FINDINGS: Here we have characterized the substrate specificity of human major AP endonuclease 1, APE1, towards εA, εC, thymine glycol (Tg and 7,8-dihydro-8-oxoguanine (8oxoG residues when present in duplex DNA. APE1 cleaves oligonucleotide duplexes containing εA, εC and Tg, but not those containing 8oxoG. Activity depends strongly on sequence context. The apparent kinetic parameters of the reactions suggest that APE1 has a high affinity for DNA containing ε-bases but cleaves DNA duplexes at an extremely slow rate. Consistent with this observation, oligonucleotide duplexes containing an ε-base strongly inhibit AP site nicking activity of APE1 with IC(50 values in the range of 5-10 nM. MALDI-TOF MS analysis of the reaction products demonstrated that APE1-catalyzed cleavage of εA•T and εC•G duplexes generates, as expected, DNA fragments containing 5'-terminal ε-base residue. CONCLUSIONS/SIGNIFICANCE: The fact that ε-bases and Tg in duplex DNA are recognized and cleaved by APE1 in vitro, suggests that NIR may act as a backup pathway to BER to remove a large variety of genotoxic base lesions in human cells.

  5. The evaluation of color and color difference according to the layering placement of Incisal shade composites on the body composites of the indirect resin restoration

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    Su-Jung Park

    2011-01-01

    Full Text Available Objectives The aim of this study was to evaluate the surface color of indirect resin restoration according to the layering placement of different shade of incisal composite. Materials and Methods In this study, CIE L*a*b* value of 16 Body composite of Tescera ATL (Bisco, Schaumburg IL,USA was measured by spectrophotometer (NF999, Nippon Denshuku, Japan, and compared to CIE L*a*b* value of Vitapan shade guide. Nine shade Incisal composite of Tescera ATL were build-up to 1 mm thickness on Body composites inlay block, and CIE L*a*b* value was measured. Incisal composite was ground to 0.5 mm thickness and CIE L*a*b* value was re-measured. Color difference between Body composite and Incisal composites layered on Body composite was calculated as a function of thickness. Results Color difference between corresponding shade of Tescera Body composite and Vitapan shade guide was from 6.88 to 12.80. L* and b*value was decreased as layering thickness of Incisal composite on Body composite was increased. But, a* value did not show specific change tendency. Conclusions Surface color difference between Body composites and Incisal composites layered on Body composite was increased as the layering thickness of Incisal composite increased (p < 0.05.

  6. 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.

  7. 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

  8. OUR EXPERIENCE WITH TUBULARIZED INCISED PLATE URETHROPLASTY FOR DISTAL AND MID-PENILE HYPOSPADIAS

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    Danijela Đerić

    2003-10-01

    Full Text Available Hypospadias does not present an isolated genital anomaly but a complex urological, sex-ual, psychological and psychiatric, reproductive and aesthetic problem. Although there are over 200 operative techniques, this great surgical challenge presently does not have ideal operative solution. Nowadays, the use of urethral plate for urethroplasty, through various surgical tech-niques, presents a revolutionary concept in hypospadias surgery and it is being accepted by an ever-increasing number of hypospadiologists.Tubularized incised plate urethroplasty (TIP -Snodgrass procedure was performed on a total of 22 boys; 16 distal (72.7%, 5 mid-penile (22.7% and 1 proximal hypospadias in period from 1.1.2000 to 30.08.2003, by the same surgical team. The average patient age was 4.5 years (6 mon. to 12 years. All reconstructions have been done as primary urethroplasty while one distal hypospadias had one previous, unsuccessful MAGPI procedure. Complication included small urethrocutaneous fistulas in 4 (18% and meatal stenosis in 1 (4.5% child. Snodgrass pro-cedure is a successful method for reparation of distal hypospadias for it provides an excellent aesthetic result with acceptable complications. In order to evaluate the success of this method in reparation of mid- and proximal hypospadias, as well as the possibility of its application on previously unsuccessful or circumcised patients, it is necessary to gain additional experience al-though the first results are encouraging.

  9. Incised channel fills containing conifers indicate that seasonally dry vegetation dominated Pennsylvanian tropical lowlands

    Science.gov (United States)

    Falcon-Lang, H. J.; Nelson, W.J.; Elrick, S.; Looy, C.V.; Ames, P.R.; DiMichele, W.A.

    2009-01-01

    The idea that the Pennsylvanian tropical lowlands were temporally dominated by rainforest (i.e., the Coal Forest) is deeply ingrained in the literature. Here we challenge two centuries of research by suggesting that this concept is based on a taphonomic artifact, and that seasonally dry vegetation dominated instead. This controversial finding arises from the discovery of a new middle Pennsylvanian (Moscovian) fossil plant assemblage in southeast Illinois, United States. The assemblage, which contains xerophytic walchian conifers, occurs in channels incised into a calcic Vertisol below the Baker Coal. These plants grew on seasonally dry tropical lowlands inferred to have developed during a glacial phase. This xerophytic flora differs markedly from that of the typical clubmoss-dominated Coal Forest developed during deglaciation events. Although preserved only very rarely, we argue that such xerophytic floras were temporally as dominant, and perhaps more dominant, than the iconic Coal Forests, which are overrepresented in the fossil record due to taphonomic megabias. These findings require the iconography of Pennsylvanian tropical lowlands to be redrawn. ?? 2009 Geological Society of America.

  10. 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

  11. Comparison of healing of incised abscess wounds with honey and EUSOL dressing.

    Science.gov (United States)

    Okeniyi, John A O; Olubanjo, Olasunkanmi O; Ogunlesi, Tinuade A; Oyelami, Oyeku A

    2005-06-01

    To clinically compare the healing of abscess wounds dressed with either crude undiluted honey or Edinburgh University solution of lime (EUSOL). A prospective clinical randomized study. The Isolation Children's Ward of the Wesley Guild Hospital, Ilesa, an affiliate of the Obafemi Awolowo University, Ile-Ife, Nigeria. Thirty-two (32) Nigerian children with 43 pyomyositis abcesses. All subjects had fresh surgical incision and drainage of the abcesses and a 21-day course of ampicillin plus cloxacillin (Ampiclox) and gentamicin; the wounds were left to close spontaneously with twice-daily wound dressing with packing of the abscess cavity with either honey- or EUSOL-soaked gauze in two randomized treatment groups. The clinical conditions of the wound sites were documented on days 1, 3, 7, and 21 as either clean or dirty, dry or wet, granulation tissue present or absent, and epithelialization present or absent; the length of hospital stay was also measured. Honey-treated wounds demonstrated quicker healing and the length of hospital stay was significantly shorter in patients with honey-treated wounds than those treated with EUSOL (t = 2.45, p = 0.019). Honey is a superior wound dressing agent to EUSOL. Honey is recommended for the dressing of infected wounds, more so in tropical countries, where it is most readily available.

  12. Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

    Science.gov (United States)

    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.

  13. Topography-guided photorefractive keratectomy for irregular astigmatism after small incision lenticule extraction.

    Science.gov (United States)

    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.

  14. Curative effects of small incision cataract surgery versus phacoemulsification: a Meta-analysis

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    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.

  15. 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.

  16. Factors Influencing Efficacy of Peripheral Corneal Relaxing Incisions during Cataract Surgery

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    Nino Hirnschall

    2015-01-01

    Full Text Available Purpose. To evaluate influencing factors on the residual astigmatism after performing peripheral corneal relaxing incisions (PCRIs during cataract surgery. Methods. This prospective study included patients who were scheduled for cataract surgery with PCRIs. Optical biometry (IOLMaster 500, Carl Zeiss Meditec AG, Germany was taken preoperatively, 1 week, 4 months, and 1 year postoperatively. Additionally, corneal topography (Atlas model 9000, Carl Zeiss Meditec AG, Germany, ORA (Ocular Response Analyzer, Reichert Ophthalmic Instruments, USA, and autorefraction (Autorefractometer RM 8800 Topcon were performed postoperatively. Results. Mean age of the study population n=74 was 73.5 years (±9.3; range: 53 to 90 and mean corneal astigmatism preoperatively was −1.82 D (±0.59; 1.00 to 4.50. Mean corneal astigmatism was reduced to 1.14 D (±0.67; 0.11 to 3.89 4 months postoperatively. A partial least squares regression showed that a high eccentricity of the cornea, a large deviation between keratometry and topography, and a high preoperative astigmatism resulted in a larger postoperative error concerning astigmatism. Conclusions. PCRI causes a reduction of preoperative astigmatism, though the prediction is difficult but several factors were found to be a relevant source of error.

  17. Shifting "Ectasia": Interface Fluid Collection After Small Incision Lenticule Extraction (SMILE).

    Science.gov (United States)

    Bansal, Aashish K; Murthy, Somasheila I; Maaz, Syed M; Sachdev, Mahipal S

    2016-11-01

    To report the first case and a new diagnostic sign of interface fluid collection following small incision lenticule extraction (SMILE). Case report. A 20-year-old man underwent SMILE for correction of compound myopic astigmatism. Postoperative follow-up examination included vision testing, slit-lamp examination, intraocular pressure measurement, corneal topography, and optical coherence tomography (OCT). The patient presented postoperatively with decreased vision in his right eye. Topography revealed an island of corneal steepening, the location of which kept shifting on successive visits. OCT revealed the presence of fluid pockets in the interface. The condition resolved with topical hypertonic saline and the uncorrected visual acuity recovered to 20/20. The intraocular pressure remained normal throughout. This is the first case report of interface fluid collection after SMILE. The report demonstrates shifting corneal "ectasia" (steepening) as a diagnostic sign of interface fluid collection. The authors recommend a new pathogenesis for this condition and suggest the use of topical hypertonic saline to treat this condition. [J Refract Surg. 2016;32(11):773-775.]. Copyright 2016, SLACK Incorporated.

  18. Corneal sensation after corneal refractive surgery with small incision lenticule extraction.

    Science.gov (United States)

    Demirok, Ahmet; Ozgurhan, Engin Bilge; Agca, Alper; Kara, Necip; Bozkurt, Ercument; Cankaya, Kadir Ilker; Yilmaz, Omer Faruk

    2013-10-01

    To compare effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (F-LASIK) on corneal sensation and dry eye parameters. In this prospective, randomized, contralateral-eye study, 28 patients with myopia or myopic astigmatism in both eyes were enrolled. One eye of each patient was treated by SMILE, and the fellow eye was treated by F-LASIK. Mean outcome measures Cochet-Bonnet esthesiometry, Schirmer test with anesthesia, tear breakup time, and tear film osmolarity were evaluated preoperatively as well as 1 week, 1 month, 3 months, and 6 months after surgery. Corneal sensation was reduced after both SMILE and F-LASIK surgeries 1 week, 1 month, and 3 months after surgery (p sensation was significantly lower after F-LASIK than after SMILE at postoperative 1 week, 1 month, and 3 months (p sensation 1 week, 1 month, and 3 months after surgery, they did not affect the dry eye parameters at any point.

  19. Biological corneal inlay for presbyopia derived from small incision lenticule extraction (SMILE).

    Science.gov (United States)

    Liu, Yu-Chi; Teo, Ericia Pei Wen; Ang, Heng Pei; Seah, Xin Yi; Lwin, Nyein Chan; Yam, Gary Hin Fai; Mehta, Jodhbir S

    2018-01-30

    Corneal inlays are a relatively new treatment option for presbyopia. Using biological inlays, derived from lenticules extracted from small incision lenticule extraction, may offer advantages over commercialized synthetic inlays in the aspect of biocompatibility. We conducted a non-human primate study to evaluate the safety, predictability, efficacy and tissue response after autogeneic, decellularized xenogeneic and xenogeneic lenticule implantation. The lenticule implantation effectively resulted in central corneal steepening (simulated keratometric values increased by 1.8-2.3 diopters), central hyper-prolate changes (asphericity Q values changed by -0.26 to -0.36), corneal anterior surface elevation (7.7-9.3 μm) and reasonable effective zone (1.5-1.8 times of the lenticule physical diameter), with no differences among the three groups. Slit lamp microscopy, transmission electron microscopy, confocal microscopy, histology and immunohistochemistry analyses confirmed the biocompatibility of the autogeneic and decellularized lenticules, whereas one eye in the xenogeneic group developed corneal stromal rejection during the study period. Our results showed that lenticule implantation has the potential for the management of presbyopia, and provide the basis for future clinical studies. The decellularization process may increase the potential utilization of lenticules without changing the efficacy.

  20. Multipurpose internal retractor for Single-incision surgery (SIS): single-institution case series.

    Science.gov (United States)

    Galvani, Carlos A; Garza, Ulises; Echeverria, Angela; Kaul, Amit; Samamé, Julia

    2014-04-01

    Single-incision laparoscopic surgery (SIS) is less invasive than standard laparoscopic surgery; however, it is more difficult due to restriction of motion and the impossibility to use assistants. To overcome these obstacles, we developed a self-sustaining multipurpose internal retractor by attaching a Lone Star retractor hook to a laparoscopic bulldog clamp. Herein, we report our SIS experience using our novel retractor. Between October 2008 and April 2011, 104 patients underwent SIS using the internal retractor: 67 bandings (43% simultaneous hiatal hernia repair), 8 sleeve gastrectomies, 27 cholecystectomies, and 2 Nissen fundoplication. Mean age was 40 (range, 21 to 85) and mean body mass index was 40 kg/m (range, 20 to 64 kg/m). No intraoperative complications were observed from the use of the retractor but 2 cases required additional retraction due to liver size. This retractor has been successfully used for different SIS procedures showing to be safe, adaptable, and easy to use, lessening some challenges of SIS.