WorldWideScience

Sample records for surgical technique utilized

  1. Survey on Robot-Assisted Surgical Techniques Utilization in US Pediatric Surgery Fellowships.

    Science.gov (United States)

    Maizlin, Ilan I; Shroyer, Michelle C; Yu, David C; Martin, Colin A; Chen, Mike K; Russell, Robert T

    2017-02-01

    Robotic technology has transformed both practice and education in many adult surgical specialties; no standardized training guidelines in pediatric surgery currently exist. The purpose of our study was to assess the prevalence of robotic procedures and extent of robotic surgery education in US pediatric surgery fellowships. A deidentified survey measured utilization of the robot, perception on the utility of the robot, and its incorporation in training among the program directors of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellowships in the United States. Forty-one of the 47 fellowship programs (87%) responded to the survey. While 67% of respondents indicated the presence of a robot in their facility, only 26% reported its utilizing in their surgical practice. Among programs not utilizing the robot, most common reasons provided were lack of clear supportive evidence, increased intraoperative time, and incompatibility of instrument size to pediatric patients. While 58% of program directors believe that there is a future role for robotic surgery in children, only 18% indicated that robotic training should play a part in pediatric surgery education. Consequently, while over 66% of survey respondents received training in robot-assisted surgical technique, only 29% of fellows receive robot-assisted training during their fellowship. A majority of fellowships have access to a robot, but few utilize the technology in their current practice or as part of training. Further investigation is required into both the technology's potential benefits in the pediatric population and its role in pediatric surgery training.

  2. The utilization of six sigma and statistical process control techniques in surgical quality improvement.

    Science.gov (United States)

    Sedlack, Jeffrey D

    2010-01-01

    Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.

  3. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  4. Surgical skin-marking techniques.

    Science.gov (United States)

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.

  5. Stereotactic limbic leucotomy: surgical technique

    Science.gov (United States)

    Richardson, Alan

    1973-01-01

    The requirements for modern psychosurgery are safety and accuracy. Stereotactic techniques give the geometric accuracy and stimulation gives physiological information, which is important in determining lesion sites or at least lesion symmetry. The process whereby focal brain destruction is produced is ideally by a freezing probe, but equally effectively by coagulation. A number of small lesions is thus required. This at present is unavoidable if side effects are to be obviated. Careful continuing assessment of results is necessary to validate any surgical procedure. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:4618905

  6. Minimally invasive surgical technique for tethered surgical drains

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    Shane R Hess

    2017-01-01

    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  7. A New Surgical Technique for Ingrown Toenail

    OpenAIRE

    Seyed Reza Mousavi; Jaledin Khoshnevice

    2012-01-01

    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin o...

  8. Comparison of surgical procedures for vascular and airway anastomoses that utilize a modified non-suture external cuff technique for experimental lung transplantation in rats.

    Science.gov (United States)

    Mizobuchi, Teruaki; Sekine, Yasuo; Yasufuku, Kazuhiro; Fujisawa, Takehiko; Wilkes, David S

    2004-07-01

    Lung transplantation in rats is technically difficult and results may vary. The non-suture cuff technique (non-suture [NS]), which involves using a cuff for anastomoses of vessels and airways, is commonly utilized to perform transplant procedures. However, the standard bronchial cuff may occlude the lumen, resulting in diminished graft survival. In contrast, the non-suture cuff technique for vascular anastomoses with bronchial suturing (bronchial suture [BS]), although more technically difficult, is known to have prolonged bronchial patency. We developed a "modified" NS technique that uses a larger and longer cuff for anastomoses and compared the efficacy of this procedure to the BS technique for lung transplantation. The BS procedure was performed in 146 transplant procedures. The modified NS procedure, which uses a larger cuff than the standard NS procedure, was performed in 113 procedures. Although total ischemic times were comparable, the total operation time in the NS group was significantly shorter than in the BS group (p technique is widely acknowledged to provide prolonged patency of bronchial anastomosis, graft survival in the NS group was observed up 17 months post-transplant. These data show that the NS technique, which is less technically difficult, results in shorter operative times compared with the BS procedure, and results in durable anastomoses of lung grafts.

  9. Changes in urological surgical techniques

    Directory of Open Access Journals (Sweden)

    Oktay Üçer

    2010-06-01

    Full Text Available Recently, laparoscopic and afterwards robotic techniques have constituted most of urologic surgery procedures. Open surgery may give place to robotic surgery due to possible widespread use of robots in the future. Studies, that compare these two techniques are usually designed about radical prostatectomy, since it is the most common operation performed by using these techniques. In literature,robotic surgery seems more advantageous than other techniques but the most important disadvantage of this technique is cost-effective problems. In present review,history of open, laparoscopic and robotic surgery, and comparison of advantages, disadvantages and cost of these techniques have been discussed with literature.

  10. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

    Science.gov (United States)

    Vilá y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-01-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores. PMID:27073783

  11. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique.

    Science.gov (United States)

    Vilá Y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-02-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores.

  12. Surgical techniques: past, present and future

    Directory of Open Access Journals (Sweden)

    Karim Qayumi

    2012-04-01

    Full Text Available The aim of this paper is to provide an analytical survey of the information available on the development of past and present surgical techniques, and to make projections for the future. For the purposes of this paper, the Past starts in the Neolithic period and ends in the 1800s. In this context, I have divided the Past into Prehistoric, Ancient and Middle Ages, and this period ends in the second half of the 19th century when the major obstacles to the further development of surgery, such as overcoming pain and infection, were removed. We will discuss the development of surgical techniques, and the obstacles and opportunities prevalent in these periods. In the context of this paper, the Present begins in 1867, when Louis Pasteur discovered microorganisms, and ends in the present day. There have been many important changes in the development of surgical techniques during this period, such as the transfer of surgery from the unsterile operating room to the modern hospital operating theater, the development of advanced and specialized surgical practices, such as transplants and laparoscopy, and minimally invasive surgical methods, robotic and Natural Orifice Transluminal Endoscopic Surgery. It is very difficult to foresee how surgical techniques will develop in the Future because of the unpredictable nature of technological progress. Therefore, in this paper, the forecast for the Future is limited to the next 50- 100 years and is a realistic calculation based on already existing technologies. In this context, the Future is divided into the development of surgical techniques that will develop in the near and distant future. It is anticipated that this overview will shed light on the historical perspective of surgical techniques and stimulate interest in their further development.

  13. A new surgical technique for ingrown toenail.

    Science.gov (United States)

    Mousavi, Seyed Reza; Khoshnevice, Jaledin

    2012-01-01

    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin on the toe we have done one-bite suture by Nylon 3/0 that was removed after 3 weeks. Results. All patients were operated on by our new technique and the outcome was excellent; recurrence and failure of the technique were very low. Discussion. Because with this simple technique we excise the granulation tissue and elevate margin of nail over the skin, we will have higher cure rate, shorter postoperative pain, lower risk of postoperative infection, and remarkable cosmetic result without deformity; hence this technique should be considered as an alternative method of treatment.

  14. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

    Science.gov (United States)

    Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh

    2017-01-01

    ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017

  15. [Idiopathic Progressive Subglottic Stenosis: Surgical Techniques].

    Science.gov (United States)

    Hoetzenecker, K; Schweiger, T; Klepetko, W

    2016-09-01

    Idiopathic subglottic stenosis is a disease characterized by slow, progressive scarring and constriction of the subglottic airway. It almost always occurs in females between the 3rd and 5th decade of life. Symptoms are frequently misinterpreted as asthma and patients are referred for endoscopic evaluation only when asthma medications fail to alleviate their symptoms. Treatment options can be divided into endoscopic and open surgical techniques. Microlaryngoscopic scar reduction by laser followed by balloon dilation usually delivers good short-term results. However, the majority of patients will experience restenosis within a short period of time. Open surgical correction techniques are based on a complete removal of the affected airway segment. This must be combined with various extended resection techniques in patients with advanced stenosis. Depending on the extent and severity of the stenosis the following surgical techniques are required: standard cricotracheal resection (Grillo's technique), cricoplasty with dorsal and lateral mucosaplasty, or a combination of resection and enlargement techniques using rib cartilage grafts. In experienced centres, success rates of over 95 % are reported with good functional outcome of voice and deglutition.

  16. Rhinoplasty: surface aesthetics and surgical techniques.

    Science.gov (United States)

    Çakir, Bariş; Doğan, Teoman; Öreroğlu, Ali Riza; Daniel, Rollin K

    2013-03-01

    Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights, with specific proportions and breakpoints. Our evaluation of the nasal surface aesthetics is achieved using the concept of geometric polygons as aesthetic subunits, both to define the existing deformity and the aesthetic goals. Surgical techniques have been developed and modified to achieve the desired surface appearance, and those are detailed in this article. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operative plan to achieve specific goals, and to select the appropriate operative technique. These aesthetic concepts and surgical techniques were used in 257 consecutive rhinoplasties performed in the past 3 years by the principal author (B.Ç.).

  17. [Inguinofemoral hernia: multicenter study of surgical techniques].

    Science.gov (United States)

    Porrero, José L; Sánchez-Cabezudo, Carlos; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuánbenito, Alfonso; Hidalgo, Manuel

    2005-07-01

    The present study was performed by the Spanish Association of surgeons through its abdominal wall and sutures section. The aim was to determine the current situation of inguinofemoral hernias in Spain and was based on an anonymous multicenter study with the participation of various national hospitals. Fifty general surgery departments in distinct surgical centers throughout Spain responded to an anonymous survey in 2000. The survey gathered data on anesthetic features, surgical techniques and complications in the treatment of inguinofemoral hernias. Sixty-six percent of hospital centers had a specific abdominal wall unit and 24% performed laparoscopic hernia surgery. Prosthetic techniques (especially Lichtenstein) were the most frequently used in the treatment of primary inguinal hernia (72%) and recurrent hernia (100%). The most frequently used prosthetic material was polypropylene mesh (76%). Only 28% of the departments surveyed performed anatomic techniques in the repair of primary inguinal hernia (Shouldice and Bassini). The most frequent treatment for femoral hernia was the Lichtenstein "plug" (78%). Sixty-eight percent of the centers surveyed performed regional anesthesia, 18% used general anesthesia and only 14% used local anesthesia with sedation. Severe complications were found in 20% of departments. Clinical postoperative follow-up was performed in 96% of the centers and telephone follow-up was used in 4%. The recurrence rate was 1.2% for primary inguinal hernia, 2.7% for recurrent inguinal hernia and 0.3% for femoral hernia. In Spain the most commonly used surgical technique in the treatment of inguinal hernia is Lichtenstein hernioplasty under spinal anesthesia and with polypropylene prosthesis. The Lichtenstein plug is the most commonly used technique in the treatment of femoral hernia.

  18. Drilling: medical indications and surgical technique

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    Cristina Kallás Hueb

    2015-12-01

    Full Text Available SUMMARY Introduction: anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation. Objective: to identify the current indications of laparoscopic ovarian drilling and the best surgical technique. Method: a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling. Results: we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling. Conclusion: laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

  19. [Pancoast tumors ; modified surgical approaches and techniques].

    Science.gov (United States)

    Tsunezuka, Yoshio; Yachi, T; Waseda, R; Yamamoto, D

    2010-01-01

    The surgical treatment of Pancoast tumors is associated with difficulties related to its anatomical locations. Different surgical approaches have been reported but every approaches have some advantages and disadvantages. We report 2 Pancoast tumors cases with unique surgical approaches and our techniques. Case 1 : A 38-year-old man complained of face edema. The chest computed tomography (CT) revealed an right anterior apical tumor with direct invasion of the 1st and 2nd rib. Preoperative chemotherapy with 2 courses of carboplatin [area under the blood concentration-time curve (AUC) 6, day 1] and paclitaxel (80 mg/m2, day1, 8, 15) and concurrent extracorporeal radiation (70 Gy) was used to treat the adenocarcinoma. The skin incision was performed according to Masaoka's anterior approach, and a proximal median sternotomy communicated with an incision in the 4th intercostal space. The clavicula was freed by the L-shaped incision on the manubrium and the 1st cartilage section according to Grunenwald method to retract the section. Case 2 : A 65-year-old man complained back pain. The chest CT revealed an right superior sulcus tumor, displaced bronchus (B1+B3 tracheal bronchus, B2) and pulmonary arteries anomalies. Combined Shaw-Paulson incision and 4 intercostal lateral thoracotomy was performed to right upper lobectomy and systematic lymph nodes dissection.

  20. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

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    Mladenović Marko

    2015-01-01

    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  1. Endoscopic quadricepsplasty: A new surgical technique.

    Science.gov (United States)

    Blanco, C E; Leon, H O; Guthrie, T B

    2001-05-01

    We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.

  2. Sternoclavicular dislocation: case report and surgical technique.

    Science.gov (United States)

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of

  3. Sternoclavicular dislocation: case report and surgical technique

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    2015-08-01

    Full Text Available Abstract Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our

  4. Amygdalohippocampotomy: surgical technique and clinical results.

    Science.gov (United States)

    Gonçalves-Ferreira, Antonio; Campos, Alexandre Rainha; Herculano-Carvalho, Manuel; Pimentel, Jose; Bentes, Carla; Peralta, Ana Rita; Morgado, Carlos

    2013-05-01

    The removal of mesial temporal structures, namely amygdalohippocampectomy, is the most efficient surgical procedure for the treatment of epilepsy. However, disconnection of the epileptogenic zones, as in temporal lobotomy or, for different purposes, hemispherotomy, have shown equivalent results with less morbidity. Thus, authors of the present study began performing selective amygdalohippocampotomy in cases of refractory mesial temporal lobe epilepsy (TLE) to treat mesial temporal lobe sclerosis (MTLS). The authors conducted a retrospective analysis of all cases of amygdalohippocampotomy collected in a database between November 2007 and March 2011. Since 2007, 21 patients (14 males and 7 females), ages 20-58 years (mean 41 years), all with TLE due to MTLS, were treated with selective ablation of the lateral amygdala plus perihippocampal disconnection (anterior one-half to two-thirds in dominant hemisphere), the left side in 11 cases and the right in 10. In 20 patients the follow-up was 2 or more years (range 24-44 months, average 32 months). Clinical outcome for epilepsy 2 years after surgery (20 patients) was good/very good in 19 patients (95%) with an Engel Class I (15 patients [75%]) or II outcome (4 patients [20%]) and bad in 1 patient (5%) with an Engel Class IV outcome (extratemporal focus and later reoperation). Surgical morbidity included hemiparesis (capsular hypertensive hemorrhage 24 hours after surgery, 1 patient), verbal memory worsening (2 patients), and quadrantanopia (permanent in 2 patients, transient in 1). Late psychiatric depression developed in 3 cases. Operative time was reduced by about 30 minutes (15%) on average with this technique. Amygdalohippocampotomy is as effective as amygdalohippocampectomy to treat MTLS and is a potentially safer, time-saving procedure.

  5. Current status of adult-to-adult living donor liver transplantation: surgical techniques and innovations

    Institute of Scientific and Technical Information of China (English)

    YAN Lü-nan; WU Hong; CHEN Zhe-yu; LIN Yi-xin

    2009-01-01

    @@ In response to critical organ shortage, transplant surgeons have utilized living donors in an attempt to decrease the mortality rate associated with waiting on the liver transplant list. Although the surgical techniques were first utilized clinically 15 years ago, the application of living donor liver transplantation (LDLT) has been somewhat limited by the steep learning curve associated with developing a program.

  6. Evidence-based surgical techniques for caesarean section

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Secher, Niels Jørgen; Krebs, Lone

    2014-01-01

    Caesarean section (CS) is a common surgical procedure, and in Denmark 21% of deliveries is by CS. There is an increasing amount of scientific evidence to support the different surgical techniques used at CS. This article reviews the literature regarding CS techniques. There is still a lack...

  7. Premature Ejaculation and Utilization of Cognitive Techniques

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    Serkan AKKOYUNLU

    2013-03-01

    Full Text Available Introduction: Premature ejaculation is the most common male sexual dysfunction leading to distress in many couples. Master and Johnson emphasized the concept of early learned experiences and Kaplan emphasized lack of sensory awareness. For treatment sex therapists mainly utilize start-stop and squeeze techniques as homework. Couples enter sex therapy with some cognitive distortions and beliefs about sex and sexuality. These beliefs are also named sexual myths. For some couples using techniques to challenge cognitive distortions and maladaptive beliefs about sex and sexuality can be used. In this paper by presenting a case we discussed how cognitive techniques can be used along with behaviour techniques with couples. Case: Presenting clients are five years married couple who are thirty and twenty nine years old respectively. They attended to the outpatient clinic with the request of the female client. Their main complaint was premature ejaculation. They were diagnosed premature ejaculation using clinical interview. In treatment besides start and stop technique, cognitive techniques were utilized to address dysfunctional beliefs about sexuality. Discussion: Premature ejaculation is a male sexual dysfunction that causes distress and intimacy problems between couples. Stop start and squeeze techniques were accepted as the choice of treatment but their effectiveness is questioned recently. Also cognitive distortions and maladaptive beliefs may hamper therapy progress. Besides that, behavioral techniques utilizing cognitive techniques to lessen the degree of dysfunctional beliefs about sex and sexuality may help the couple to overcome premature ejaculation and enhance sexual satisfaction and intimacy.

  8. Survey of Cataract Surgical Techniques in Nigeria

    African Journals Online (AJOL)

    PROF SABE NWOSU

    Objective: To determine the techniques of cataract surgery as currently being ... include phacoemulsification, manual small incision sutureless. 3 cataract surgery (SICS) ... technology automated small incision phacoemulsification technique.5.

  9. Computer-Assisted Technique for Surgical Tooth Extraction.

    Science.gov (United States)

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  10. Computer-Assisted Technique for Surgical Tooth Extraction

    Directory of Open Access Journals (Sweden)

    Hosamuddin Hamza

    2016-01-01

    Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  11. Intraretinal Foreign Bodies: Surgical Techniques and Outcomes

    Directory of Open Access Journals (Sweden)

    Mostafa Feghhi

    2013-01-01

    Full Text Available Purpose: To report the clinical features of eyes with intraretinal foreign bodies (IRFBs and to evaluate the results of surgical management in these eyes. Methods: Hospital records of 34 eyes of 33 patients with IRFBs were reviewed. All eyes underwent pars plana vitrectomy to remove the foreign bodies using intraocular forceps or by magnetic extraction. Results: All patients were male with mean age of 28΁12.3 years and were followed for a mean period of 24.5΁2.3 months. The IRFBs were ferromagnetic in 29 (85.3% cases and were removed using an external magnet in 13 eyes (38.4% or intraocular forceps in 21 eyes (61.6%. Laser photocoagulation was performed around the IRFB prior to surgery in 7 (20.6% eyes. Macular pucker and scars developed in 8 (23.5% eyes and retinal breaks posterior to the sclerotomy were formed in 12 eyes (35.3% postoperatively. Final visual acuity was 20/40 or better in 12 (35.3% eyes and 20/200 or better in 23 (67.7% eyes. Final visual acuity of 20/200 or better had no significant relationship with the site, size, or type of the IRFB or with the interval from trauma to surgery. Conclusion: Despite the complexity of surgical management of IRFBs, anatomic and visual outcomes of vitreoretinal surgery in these cases are generally good. The appropriate route of removal may be determined by the type, size, and site of the IRFB. Removal of magnetic IRFBs using external magnets versus intraocular forceps seems to entail comparable results.

  12. Minimally invasive surgical techniques in periodontal regeneration.

    Science.gov (United States)

    Cortellini, Pierpaolo

    2012-09-01

    A review of the current scientific literature was undertaken to evaluate the efficacy of minimally invasive periodontal regenerative surgery in the treatment of periodontal defects. The impact on clinical outcomes, surgical chair-time, side effects and patient morbidity were evaluated. An electronic search of PUBMED database from January 1987 to December 2011 was undertaken on dental journals using the key-word "minimally invasive surgery". Cohort studies, retrospective studies and randomized controlled clinical trials referring to treatment of periodontal defects with at least 6 months of follow-up were selected. Quality assessment of the selected studies was done through the Strength of Recommendation Taxonomy Grading (SORT) System. Ten studies (1 retrospective, 5 cohorts and 4 RCTs) were included. All the studies consistently support the efficacy of minimally invasive surgery in the treatment of periodontal defects in terms of clinical attachment level gain, probing pocket depth reduction and minimal gingival recession. Six studies reporting on side effects and patient morbidity consistently indicate very low levels of pain and discomfort during and after surgery resulting in a reduced intake of pain-killers and very limited interference with daily activities in the post-operative period. Minimally invasive surgery might be considered a true reality in the field of periodontal regeneration. The observed clinical improvements are consistently associated with very limited morbidity to the patient during the surgical procedure as well as in the post-operative period. Minimally invasive surgery, however, cannot be applied at all cases. A stepwise decisional algorithm should support clinicians in choosing the treatment approach.

  13. Advances in pediatric colorectal surgical techniques.

    NARCIS (Netherlands)

    Rangel, S.J.; Blaauw, I. de

    2010-01-01

    The operative management of pediatric colorectal diseases has improved significantly in recent years through the development of innovative approaches for operative exposure and a better understanding of colorectal anatomy. Advances in transanal and minimal access techniques have formed the

  14. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy

    2013-01-01

    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  15. Surgical techniques for lumbo-sacral fusion.

    Science.gov (United States)

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice.

  16. Invasive and minimally invasive surgical techniques for back pain conditions.

    Science.gov (United States)

    Lavelle, William; Carl, Allen; Lavelle, Elizabeth Demers

    2007-12-01

    This article summarizes current issues related to invasive and minimally invasive surgical techniques for back pain conditions. It describes pain generators and explains theories about how discs fail. The article discusses techniques for treating painful sciatica, painful motion segments, and spinal stenosis. Problems related to current imaging are also presented. The article concludes with a discussion about physical therapy.

  17. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures

    OpenAIRE

    Zelle, Boris A.; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction ...

  18. Surgical technique refinements in head and neck oncologic surgery.

    Science.gov (United States)

    Liu, Jeffrey C; Shah, Jatin P

    2010-06-15

    The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression, and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction.

  19. Surgical Technique Refinements in Head and Neck Oncologic Surgery

    OpenAIRE

    Liu, Jeffrey C.; Shah, Jatin P.

    2010-01-01

    The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of ...

  20. Three different surgical techniques of crown lengthening: A comparative study

    OpenAIRE

    Ramya Nethravathy; Santhana Krishnan Vinoth; Ashwin Varghese Thomas

    2013-01-01

    Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinical...

  1. Surgical Treatment of Epiphrenic Diverticulum: Technique and Controversies.

    Science.gov (United States)

    Andolfi, Ciro; Wiesel, Ory; Fisichella, P Marco

    2016-11-01

    The goal of this article is to illustrate the current minimal invasive approaches to patients with epiphrenic diverticulum in terms of preoperative evaluation, surgical technique, and outcomes. Two techniques will be presented: a laparoscopic and a video-assisted thoracic repair. Indications for each technique will be discussed as well as proper patient selection and management. Current controversies in the treatment of patients with this rare disease will be addressed.

  2. Ahmed glaucoma valve implant: surgical technique and complications

    Directory of Open Access Journals (Sweden)

    Riva I

    2017-02-01

    Full Text Available Ivano Riva,1 Gloria Roberti,1 Francesco Oddone,1 Anastasios GP Konstas,2 Luciano Quaranta3 1IRCCS “Fondazione GB Bietti per l’Oftalmologia”, Rome, Italy; 21st University Department of Ophthalmology, Glaucoma Unit, AHEPA Hospital, Thessaloniki, Greece; 3Department of Medical and Surgical Specialties, Section of Ophthalmology, University of Brescia, Brescia, Italy Abstract: Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications. Keywords: glaucoma, surgical technique, glaucoma drainage devices, Ahmed glaucoma valve, complications

  3. Some Observations on Veterinary Undergraduate Training in Surgical Techniques.

    Science.gov (United States)

    Whittick, William G.

    1978-01-01

    The undergraduate surgery course of the Faculty of Veterinary Medicine and Animal Science, Universiti Pertanian Malaysia, is described with focus on its experential method of teaching surgical techniques. Also discussed are the benefits of veterinary school cooperation with a large city Society for the Prevention of Cruelty to Animals (SPCA). (JMD)

  4. Erosive Burning Study Utilizing Ultrasonic Measurement Techniques

    Science.gov (United States)

    Furfaro, James A.

    2003-01-01

    A 6-segment subscale motor was developed to generate a range of internal environments from which multiple propellants could be characterized for erosive burning. The motor test bed was designed to provide a high Mach number, high mass flux environment. Propellant regression rates were monitored for each segment utilizing ultrasonic measurement techniques. These data were obtained for three propellants RSRM, ETM- 03, and Castor@ IVA, which span two propellant types, PBAN (polybutadiene acrylonitrile) and HTPB (hydroxyl terminated polybutadiene). The characterization of these propellants indicates a remarkably similar erosive burning response to the induced flow environment. Propellant burnrates for each type had a conventional response with respect to pressure up to a bulk flow velocity threshold. Each propellant, however, had a unique threshold at which it would experience an increase in observed propellant burn rate. Above the observed threshold each propellant again demonstrated a similar enhanced burn rate response corresponding to the local flow environment.

  5. Overview of waste heat utilization techniques

    Energy Technology Data Exchange (ETDEWEB)

    Olszewski, M.

    1979-04-01

    Power plants annually reject about 11 x 10/sup 9/ GJ (11 x 10/sup 15/ Btu) of low-grade heat to the atmosphere. Typically, this heat is found in the large quantities of cooling water necessary to condense the steam in the power-generating cycle. Such cooling water is generally discharged in the range of 15 to 43/sup 0/C (60 to 110/sup 0/F) depending on the temperature of the available inlet water, quantity circulated, plant load, and heat-rejection system used. A number of possible uses have been suggested for this low-grade heat, including: greenhouse horticulture; soil heating (both open field and in greenhouses); spray irrigation for frost protection; organic waste treatment (particularly for algae or biomass production); and aquaculture/mariculture. To date greenhouse and aquaculture/mariculture systems have received the most attention and have, therefore, progressed farthest. This paper describes several innovative techniques that utilize power-plant reject heat for these applications. Schematic descriptions are given for these techniqes and a brief review of the project status is provided. The major efforts to utilize reject heat for agricultural purposes are described not only for the U.S., but efforts in Canada, France, West Germany, and the USSR are noted.

  6. Surgical treatment of idiopathic syringomyelia: Silastic wedge syringosubarachnoid shunting technique

    Directory of Open Access Journals (Sweden)

    Teck M Soo

    2014-01-01

    Conclusions: Shunting procedures for the syringomyelia disease spectrum have been criticized due to the inconsistent long-term outcomes. This surgical technique used to treat symptomatic idiopathic syringomyelia has been devised based on our intraoperative experience, surgical outcomes, and evaluation of the literature. The purpose of the wedges is to preserve patency of the communication between the syrinx cavity and the expanded subarachnoid space by preventing healing of the myelotomy edges and by maintaining an artificial conduit between the syrinx cavity and the subarachnoid space. Although short-term results are promising, continued long-term follow up is needed to determine the ultimate success of the silastic wedge shunting procedure.

  7. Nonpenetrating glaucoma surgery with goniosynechiolysis ab interno: a surgical technique.

    Science.gov (United States)

    Mirshahi, A; Scharioth, G B

    2009-01-01

    To present a surgical technique for treatment of peripheral anterior synechiae (PAS or goniosynechiae) at the operative field during nonpenetrating glaucoma surgery. After usual preparation of a superficial and a deep scleral flap with externalization of the Schlemm's canal and peeling the juxtacanalicular trabecular meshwork, the goniosynechia is transected by a spatula introduced to the anterior chamber through a paracentesis. A Descemet's window provides full visual control at the peripheral cornea at the basis of the superficial scleral flap. With this surgical technique, selective treatment of goniosynechiae is possible exactly at the area where creation of low outflow resistance is intended by the surgeon during nonpenetrating glaucoma surgery. This technique enables the surgeon to perform nonpenetrating glaucoma surgery even in the presence of peripheral anterior synechiae.

  8. Review of Surgical Techniques of Experimental Renal Transplantation in Rats.

    Science.gov (United States)

    Shrestha, Badri; Haylor, John

    2017-08-01

    Microvascular surgical techniques of renal transplant in rats have evolved over the past 5 decades to achieve successful rat renal transplant; these modifications have included surgical techniques to address the anatomic variations in the renal blood vessels and those to reduce ischemic and operation durations. Here, we review the surgical techniques of renal transplant in rats and evaluate the advantages and disadvantages of individual techniques of vascular and ureteric anastomoses. For this review, we performed a systematic literature search using relevant medical subject heading terms and included appropriate publications in the review. Since the first description of a rat model of renal transplant by Bernard Fisher and his colleagues in 1965, which used end-to-side anastomosis between the renal vein and renal artery to the recipient inferior vena cava and aorta, several vascular and ureteric anastomosis techniques have been modified. Vascular anastomosis techniques now include end-to-end anastomosis, use of donor aortic and inferior vena cava conduits, sleeve and cuff anastomoses, and application of fibrin glue. Likewise, restoration of the urinary tract can now be achieved by direct anastomosis of the donor ureter to the recipient bladder, end-to-end anastomosis between the donor and recipient ureters, and donor bladder cuff to the recipient bladder. There are advantages and disadvantages attributable to individual techniques. The range of vascular and ureteric anastomosis techniques that has emerged reflects the need for mastering more than one technique to suit the vascular anatomy of individual animals and to reduce operating time for achieving successful outcomes after renal transplant.

  9. Halstedian technique revisited. Innovations in teaching surgical skills.

    Science.gov (United States)

    Barnes, R W; Lang, N P; Whiteside, M F

    1989-07-01

    This paper reviews the laboratory models used to teach fundamental surgical skills in our general surgery residency. The laboratory modules allow supervision and self-instruction, practice, and videotape monitoring of the following techniques: skin incision, suturing, knot tying, hemostasis, vascular anastomosis, and intestinal anastomosis. Pigs' feet simulate human skin for exercises in skin incision, lesion excision, suturing, and basic plastic surgical techniques. Latex tubing and penrose drains allow experience in suturing, knot tying, and hemostasis. Polytetrafluoroethylene vascular prostheses permit quantification of the precision of needle passage and suturing by measurement of leakage of water through a vascular anastomosis. Reconstituted, lyophilized, irradiated bovine arteries and ileum provide models of biologic tissue for creating handsewn vascular anastomoses and sutured or stapled gastrointestinal anastomoses. A headlamp videocamera allows unobstructive recording of the resident's technical performance and provides subsequent visual feedback for self-improvement when compared to reference instructional videotapes. We feel that these innovations may enhance surgical dexterity of residents without the need for animal sacrifice. Our goal is to foreshorten the learning curve for basic surgical skills and improve performance in the clinical operating room.

  10. Modification of the technique of osteotomy for surgical maxillary expansion

    Directory of Open Access Journals (Sweden)

    João Luis Carlini

    2015-10-01

    Full Text Available Surgically assisted maxillary expansion is a technique used to correct transverse maxillary deficiency, which is a dentofacial anomaly related to the decrease of the upper arch over the lower arch. It is applied to patients in their late teens and adults due to skeletal maturity, causing obliteration of the intermaxillary suture, which requires orthodontic procedure, associated with surgery. The purpose of this study is to report the clinical case of a patient admitted for surgical maxillary expansion through the modified technique and point out the possible advantages, such as aesthetics maintenence, long-term stability, faster return to orthodontic treatment, and improved bone healing. However, there are some contraindications when the patient presents severe crowding, roots of the canine and lateral incisor are converging and in patients who will undergo to protraction with facial mask.

  11. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  12. Hemorrhage after tonsillectomy: does the surgical technique really matter?

    Science.gov (United States)

    Gysin, Claudine; Dulguerov, Pavel

    2013-01-01

    A thorough review of the publications on surgical techniques used for tonsillectomy is provided, emphasizing randomized studies and meta-analysis. In the assessment of the data it is important to clearly define and categorize the types of posttonsillectomy bleeding (PTB), as well as the various factors that have been associated with increased PTB. In recent audits of a large number of tonsillectomies, the PTB rates seem to concur: 1% early and 2.5% delayed PTB; 10% anamnestic, 2% objective, and 2% re-operation PTB. Objective PTB rates beyond 10% should require an audit. The bipolar technique seems associated with the least early PTB, while the cold technique is associated with the least delayed PTB. Because of the lack of large well-conducted randomized trials, it is difficult to conclude which technique is the best. With electrocautery techniques, the current power should be adjusted to the minimal level providing hemostasis. Surgical techniques for tonsillectomy that should probably be abandoned include monopolar electrocautery, Coblation, various lasers, and the harmonic scalpel. Vessel-sealing systems might hold promise and deserve further evaluation. Tonsillotomy might be associated with less postoperative pain, but the hemorrhagic advantage in randomized studies is not obvious. Tonsil regrowth rates and efficacy to treat obstruction need also further evaluation.

  13. Surgical technique for allogeneic uterus transplantation in macaques

    OpenAIRE

    Hideaki Obara; Iori Kisu; Yojiro Kato; Yohei Yamada; Kentaro Matsubara; Katsura Emoto; Masataka Adachi; Yusuke Matoba; Kiyoko Umene; Yuya Nogami; Kouji Banno; Hideaki Tsuchiya; Iori Itagaki; Ikuo Kawamoto; Takahiro Nakagawa

    2016-01-01

    No study has reported an animal model of uterus transplantation (UTx) using cynomolgus macaques. We aimed to establish a surgical technique of allogeneic UTx assuming the recovery of a uterus from a deceased donor in cynomolgus macaques. Four allogeneic UTxs were performed in female cynomolgus macaques. Donor surgeries comprised en bloc recovery of organs with iliac vessels on both sides, and/or abdominal aorta/vena cava after sufficient perfusion from one femoral artery or external iliac art...

  14. Permanent facial paralysis: surgical correction with Labbe’s technique

    OpenAIRE

    Yangali, Rubén; Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello. Hospital Central de la Fuerza Aérea del Perú. Lima, Perú.; Neme, Alex; Servicio de Urgencias. Hospital La Mancha Centro. Ciudad Real, España.; Moreno, Kattia; Research Assistant Otolaryngology and Head and Neck Surgery. University Of Cincinnati. Ohio, USA.; Cuadros, Jerson; Centro de Terapia Física y Rehabilitación (CETEFI). Arequipa, Perú

    2013-01-01

    Facial paralysis causes a large aesthetic and functional defect. Different surgical techniques may be used to repair this defect. Some of them have focused in structural and physiological aspects. We consider that temporalis lengthening myoplasty is currently the most important technique for permanent facial paralysis repair. La parálisis facial genera un gran déficit estético y funcional. Las diversas técnicas quirúrgicas han ido evolucionando, a fin de corregir este defecto de la forma m...

  15. Tactical and surgical techniques issues in the surgical treatment of incisional hernias

    OpenAIRE

    2014-01-01

    Abstract Within five years, between 2006 and 2011, a total of 368 incisional hernias have been operated in the Surgery Clinic 1, University Emergency Hospital Bucharest. The study followed the morphological and biological parameters, associated pathology, tactics and surgical technique used and postoperative morbidity. The average age of patients was 61.75 years, female sex was predominant (81.25%), and incisional hernias were large and giant in a percentage of 73.37%. Locations were predomin...

  16. Surgical technique for allogeneic uterus transplantation in macaques

    Science.gov (United States)

    Obara, Hideaki; Kisu, Iori; Kato, Yojiro; Yamada, Yohei; Matsubara, Kentaro; Emoto, Katsura; Adachi, Masataka; Matoba, Yusuke; Umene, Kiyoko; Nogami, Yuya; Banno, Kouji; Tsuchiya, Hideaki; Itagaki, Iori; Kawamoto, Ikuo; Nakagawa, Takahiro; Ishigaki, Hirohito; Itoh, Yasushi; Ogasawara, Kazumasa; Saiki, Yoko; Sato, Shin-ichi; Nakagawa, Kenshi; Shiina, Takashi; Aoki, Daisuke; Kitagawa, Yuko

    2016-01-01

    No study has reported an animal model of uterus transplantation (UTx) using cynomolgus macaques. We aimed to establish a surgical technique of allogeneic UTx assuming the recovery of a uterus from a deceased donor in cynomolgus macaques. Four allogeneic UTxs were performed in female cynomolgus macaques. Donor surgeries comprised en bloc recovery of organs with iliac vessels on both sides, and/or abdominal aorta/vena cava after sufficient perfusion from one femoral artery or external iliac artery. Before perfusion, 150 mL of whole blood was obtained from the donor for subsequent blood transfusion to the recipient. Four uterine grafts were orthotopically transplanted to recipients. End-to-side anastomosis was performed to the iliac vessels on one side in case 1 and iliac vessels on both sides in case 2; aorto-aorto/cavo-caval anastomosis was performed in cases 3 and 4. Arterial blood flow of the uterine grafts was determined by intraoperative indocyanine green (ICG) angiography. ICG angiography results showed sufficient blood flow to all uterine grafts, and anaemia did not progress. Under appropriate immune suppression, all recipients survived for more than 90 days post-transplantation, without any surgical complications. We describe a surgical technique for allogeneic UTx in cynomolgus macaques. PMID:27786258

  17. Surgical technique for treatment of recalcitrant adductor longus tendinopathy.

    Science.gov (United States)

    Gill, Thomas J; Carroll, Kaitlin M; Makani, Amun; Wall, Andrew J; Dumont, Guillaume D; Cohn, Randy M

    2014-04-01

    Chronic groin pain in the athlete can be a difficult problem to manage. Adductor dysfunction is the most common cause of groin pain in athletes, with the adductor longus being the tendon most commonly involved. The most reproducible finding for adductor longus tendinopathy is tenderness along the tendon with passive abduction and resisted hip adduction in extension. Magnetic resonance imaging and injection of a corticosteroid and anesthetic into the proximal muscle-tendon junction are both helpful in confirming the diagnosis. Nonoperative treatment may consist of protected weight bearing, ice application, ultrasonography, electrical stimulation, and gentle stretching with progressive strengthening. However, nonoperative management is not always successful. In these instances, surgical treatment can be quite effective. We present the indications, surgical technique, and rehabilitation protocol of adductor tenotomy for chronic tendinopathy. This can prove a useful tool for the treatment of recalcitrant groin pain attributable to the adductor longus.

  18. Surgical Repair of Leaking Filtering Blebs Using Two Different Techniques

    Directory of Open Access Journals (Sweden)

    António B Melo

    2012-01-01

    Full Text Available Purpose: To report the outcomes of two different surgical techniques for the repair of late onset bleb leakage following trabeculectomy. Methods: This retrospective study includes 21 eyes of 20 patients with prior trabeculectomy and late-onset bleb leaks; 14 eyes underwent excision of the filtering bleb together with conjunctival advancement while in the other 7 eyes the bleb was retained but de-epithelialized before conjunctival advancement. Success was defined as resolution of leakage with no need for additional glaucoma surgery together with intraocular pressure (IOP of 5-21 mmHg. Complete and qualified success was considered when the above mentioned was achieved without or with glaucoma medications, respectively. Results: Mean duration of follow-up was 20.3΁14.4 months. No significant difference was observed between the two groups in terms of complete, qualified and overall success rates (P>0.05, however more antiglaucoma medications were necessary in the bleb excision group (P=0.02. Conclusions: Both surgical techniques of bleb repair were comparably effective, however the bleb de-epithelialization technique was associated with less need for glaucoma medications after the procedure.

  19. Surgical correction of acquired unilateral diaphragmatic paralysis by plication technique

    Directory of Open Access Journals (Sweden)

    Christos F. Kampolis

    2013-06-01

    Full Text Available Summary: Acquired diaphragmatic paralysis may compromise lung mechanics and cause dyspnoea and/or lead to respiratory failure in the long term. A 76 year-old female patient presented with progressive worsening of dyspnoea and spirometric indices, and imaging studies revealed elevation of the left hemidiaphragm. Surgical correction was carried out by diaphragmatic plication technique, through a mini-thoracotomy approach. Immediate alleviation (within days of her symptoms was observed, while improvement of radiological and pulmonary function tests occurred some weeks later. Pneumon 2013,26(2

  20. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique

    Directory of Open Access Journals (Sweden)

    Ioannis D. Kyriazanos

    2015-01-01

    Full Text Available Wound dehiscence is a serious postoperative complication, with an incidence of 0.5–3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of “intentional open abdomen” was described and both clinical entities share common pathophysiological and clinical pathways (“postoperative open abdominal wall”. Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as “frozen abdomen,” where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the “Coliseum technique” for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of “malignant” frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  1. Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?

    Science.gov (United States)

    Friedman, James M; Hagander, Lars; Hughes, Christopher D; Nash, Katherine A; Linden, Allison F; Blossom, Jeff; Meara, John G

    2013-01-01

    An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. The highest annual surgical utilization rate was 184 operations/100,000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright © 2012 John Wiley & Sons, Ltd.

  2. [Wound microbial sampling methods in surgical practice, imprint techniques].

    Science.gov (United States)

    Chovanec, Z; Veverková, L; Votava, M; Svoboda, J; Peštál, A; Doležel, J; Jedlička, V; Veselý, M; Wechsler, J; Čapov, I

    2012-12-01

    The wound is a damage of tissue. The process of healing is influenced by many systemic and local factors. The most crucial and the most discussed local factor of wound healing is infection. Surgical site infection in the wound is caused by micro-organisms. This information is known for many years, however the conditions leading to an infection occurrence have not been sufficiently described yet. Correct sampling technique, correct storage, transportation, evaluation, and valid interpretation of these data are very important in clinical practice. There are many methods for microbiological sampling, but the best one has not been yet identified and validated. We aim to discuss the problem with the focus on the imprint technique.

  3. Social costs of two cataract surgical techniques in Brazil.

    Science.gov (United States)

    Kara-Junior, Newton; Parede, Tais Renata Ribeira; Santhiago, Marcony Rodrigues; Santiago, Marcony Rodrigues; Espindola, Rodrigo França; Mazurek, Maysa Godoy Gomes; Carvalho, Regina de Souza

    2010-10-01

    To compare postoperative social costs of two cataract surgical techniques, phacoemulsification (PHACO) and extracapsular extraction (ECCE). Prospective randomized intervention study including 205 patients, of which 101 underwent PHACO and 104 ECCE in the public service, in the city of São Paulo, Southeastern Brazil, in 2002. The socioeconomic impact of these surgical procedures was assessed based on postoperative costs for patients, employers and social security. Comparisons between the two groups studied were performed using the chi-square test or Mann-Whitney test, when appropriate. A 5% significance level was set. Hospital and eyeglasses costs for PHACO were lower than for ECCE patients, with a mean difference of US$ 16.74. Costs to employers related to medical leave for the first 15 days of absence and costs of caregivers in the form of absence from work to attend postoperative follow-up visits were on average US$ 0.18 lower in PHACO compared to ECCE group. The estimated Social Security expenditure per patient undergoing surgery was US$ 6.57 and US$ 51.15 in PHACO and ECCE groups, respectively. The average saving with PHACO compared to ECCE technique was US$ 61.50 for employers, patients, caregivers and Social Security.

  4. A new plastic surgical technique for adult congenital webbed penis

    Institute of Scientific and Technical Information of China (English)

    Yue-bing CHEN; Xian-fan DING; Chong LUO; Shi-cheng YU; Yan-lan YU; Bi-de CHEN; Zhi-gen ZHANG; Gong-hui LI

    2012-01-01

    Objective:To introduce a novel surgical technique for correction of adult congenital webbed penis.Methods:From March 2010 to December 2011,12patients (age range:14-23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us.Results:All cases were treated successfully without severe complication.The operation time ranged from 20 min to 1 h.The average bleeding volume was less than 50 ml.All patients achieved satisfactory cosmetic results after surgery.The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up.Conclusions:Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery.Good corrective surgery should expose the glans and coronal sulcus,match the penile skin length to the penile shaft length dorsally and ventrally,and provide a normal penoscrotal junction.Our new technique is a safe and effective method for the correction of adult webbed penis,which produces satisfactory results.

  5. Leak detection utilizing analog binaural (VLSI) techniques

    Science.gov (United States)

    Hartley, Frank T. (Inventor)

    1995-01-01

    A detection method and system utilizing silicon models of the traveling wave structure of the human cochlea to spatially and temporally locate a specific sound source in the presence of high noise pandemonium. The detection system combines two-dimensional stereausis representations, which are output by at least three VLSI binaural hearing chips, to generate a three-dimensional stereausis representation including both binaural and spectral information which is then used to locate the sound source.

  6. Surgical technique: Retroperitoneoscopic approach for adrenal masses in children.

    Science.gov (United States)

    Yankovic, F; Undre, S; Mushtaq, I

    2014-04-01

    Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of adrenal masses. The transperitoneal laparoscopic and retroperitoneoscopic approaches are described. Both are safe and as effective as open adrenalectomy, with the added benefit of the minimally invasive approach. It can be utilized for patients requiring surgery for a phaeochromocytoma, adrenal adenoma, adrenal adenocarcinoma, Cushing's syndrome, neuroblastoma, and an incidentaloma. Relative contraindications include previous surgery of the liver or kidney, large tumours (>8-10 cm in diameter) or coagulation disorders. Although the transperitoneal route is used more widely, the retroperitoneal approach provides direct access to the adrenal gland and easy visualization of the adrenal vein. It avoids also colonic mobilization, minimizes the risk of injury to hollow viscera, and the potential risk of adhesion formation. However, the reversed orientation of the kidney and hilum, combined with a significantly smaller working space, may make this approach difficult to master.

  7. Fluorescence lifetime technique for surgical imaging, guidance and augmented reality (Conference Presentation)

    Science.gov (United States)

    Marcu, Laura

    2017-02-01

    The surgeon's limited ability to accurately delineate the tumor margin during surgical interventions is one key challenge in clinical management of cancer. New methods for guiding tumor resection decisions are needed. Numerous studies have shown that tissue autofluorescence properties have the potential to asses biochemical features associates with distinct pathologies in tissue and to distinguish various cancers from normal tissues. However, despite these promising reports, autofluorescence techniques were sparsely adopted in clinical settings. Moreover, when adopted they were primarily used for pre-operative diagnosis rather than guiding interventions. To address this need, we have researched and engineered instrumentation that utilizes label-free fluorescence lifetime contrast to characterize tissue biochemical features in vivo in patients and methodologies conducive to real-time (few seconds) diagnosis of tissue pathologies during surgical procedures. This presentation overviews clinically-compatible multispectral fluorescence lifetime imaging techniques developed in our laboratory and their ability to operate as stand-alone tools, integrated in a biopsy needle and in conjunction with the da Vinci surgical robot. We present pre-clinical and clinical studies in patients that demonstrate the potential of these techniques for intraoperative assessment of brain tumors and head and neck cancer. Current results demonstrate that intrinsic fluorescence signals can provide useful contrast for delineation distinct types of tissues including tumors intraoperatively. Challenges and solutions in the clinical implementation of these techniques are discussed.

  8. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. A new technique in the surgical treatment of Hangman's fractures: Neurospinal Academy (NSA) technique

    OpenAIRE

    Sedat Dalbayrak; Onur Yaman; Mesut Yilmaz

    2013-01-01

    Context: Treatment of Hangman′s fractures is still controversial. Hangman′s fractures Type II and IIA are usually treated with surgical procedures. Aim: This study aims at describing the Neurospinal Academy (NSA) technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. Settings and Design: NSA technique both pars or pedicle screws are placed bicortically to ensure that ant...

  10. Orthodontic microsurgery: a new surgically guided technique for dental movement.

    Science.gov (United States)

    Vercellotti, Tomaso; Podesta, Andrea

    2007-08-01

    Eight patients with malocclusions were treated with a new orthodontic-surgical technique that reduces the duration of treatment compared to conventional techniques. The monocortical tooth dislocation and ligament distraction (MTDLD) technique combines two different dental movements that work separately but simultaneously on opposite root surfaces. On the root surface corresponding to the direction of movement, vertical and horizontal microsurgical corticotomies are performed around each tooth root with a piezosurgical microsaw to eliminate cortical bone resistance. The immediate application of strong biomechanical forces produces rapid dislocation of the root and the cortical bone together. On the root surface opposite the direction of movement, the force of dislocation produces rapid distraction of ligament fibers. During the osteogenic process that follows, application of normal orthodontic biomechanics achieves the final tooth movement. All eight patients underwent periodontal and radiologic examinations for more than 1 year after treatment. No periodontal defects were observed in any of the patients, including one with a severe malocclusion and a thin periodontal tissue biotype. Compared to traditional orthodontic therapy, the average treatment time with the MTDLD technique in the mandible and maxilla was reduced by 60% and 70%, respectively.

  11. Surgical treatment of scoliosis: a review of techniques currently applied

    Directory of Open Access Journals (Sweden)

    Maruyama Toru

    2008-04-01

    Full Text Available Abstract In this review, basic knowledge and recent innovation of surgical treatment for scoliosis will be described. Surgical treatment for scoliosis is indicated, in general, for the curve exceeding 45 or 50 degrees by the Cobb's method on the ground that: 1 Curves larger than 50 degrees progress even after skeletal maturity. 2 Curves of greater magnitude cause loss of pulmonary function, and much larger curves cause respiratory failure. 3 Larger the curve progress, more difficult to treat with surgery. Posterior fusion with instrumentation has been a standard of the surgical treatment for scoliosis. In modern instrumentation systems, more anchors are used to connect the rod and the spine, resulting in better correction and less frequent implant failures. Segmental pedicle screw constructs or hybrid constructs using pedicle screws, hooks, and wires are the trend of today. Anterior instrumentation surgery had been a choice of treatment for the thoracolumbar and lumbar scoliosis because better correction can be obtained with shorter fusion levels. Recently, superiority of anterior surgery for the thoracolumbar and lumbar scoliosis has been lost. Initial enthusiasm for anterior instrumentation for the thoracic curve using video assisted thoracoscopic surgery technique has faded out. Various attempts are being made with use of fusionless surgery. To control growth, epiphysiodesis on the convex side of the deformity with or without instrumentation is a technique to provide gradual progressive correction and to arrest the deterioration of the curves. To avoid fusion for skeletally immature children with spinal cord injury or myelodysplasia, vertebral wedge ostetomies are performed for the treatment of progressive paralytic scoliosis. For right thoracic curve with idiopathic scoliosis, multiple vertebral wedge osteotomies without fusion are performed. To provide correction and maintain it during the growing years while allowing spinal growth for

  12. Policy Analysis of Surgical Utilization at Blanchfield Army Community Hospital

    Science.gov (United States)

    2009-04-09

    Utilization 12 anterior /posterior cruciate ligament (ACL/PCL) reconstruction surgery may take 2-3 hours and a cataract surgery may only take 10-20 minutes...equipment, or secondary services like an ICU or physical therapy . Larger, more in depth cases could be performed at Gateway, thus allowing for an...Fort Campbell’s Post Office is on the Kentucky side which, ultimately, provides the post with a Kentucky mailing address. The physical facility of BACH

  13. Psoas over the brim lengthenings. Anatomic investigation and surgical technique.

    Science.gov (United States)

    Skaggs, D L; Kaminsky, C K; Eskander-Rickards, E; Reynolds, R A; Tolo, V T; Bassett, G S

    1997-06-01

    Lengthening of the psoas tendon commonly is performed for various conditions of the hip including developmental dysplasia and neuromuscular contractures and instability. Anecdotal reports of injury to surrounding neurovascular structures suggest an investigation of the local anatomy is warranted. Using magnetic resonance images from 54 children younger than 10 years, the authors examined the anatomic relationship between major neurovascular structures (femoral artery and vein, external iliac artery and vein, femoral nerve) and the psoas tendon. The mean distance between the neurovascular structures and the psoas tendon in the over the brim position is 1 cm, although it may be as close as 4 mm in a child. The mean distance is 3.1 cm at the tendon's insertion at the lesser trochanter. Surgeons performing psoas over the brim lengthenings should be aware that major neurovascular structures may be only 4 mm from the psoas tendon. The recommended surgical technique is presented.

  14. Use of surgical techniques in the rat pancreas transplantation model

    Institute of Scientific and Technical Information of China (English)

    Yi Ma; Zhi-Yong Guo

    2008-01-01

    BACKGROUND:Pancreas transplantation is currently considered to be the most reliable and effective treatment for insulin-dependent diabetes mellitus (also called type 1 diabetes). With the improvement of microsurgical techniques, pancreas transplantation in rats has been the major model for physiological and immunological experimental studies in the past 20 years. We investigated the surgical techniques of pancreas transplantation in rats by analysing the difference between cervical segmental pancreas transplantation and abdominal pancreaticoduodenal transplantation. METHODS:Two hundred and forty male adult Wistar rats weighing 200-300 g were used, 120 as donors and 120 as recipients. Sixty cervical segmental pancreas transplants and 60 abdominal pancreaticoduodenal transplants were carried out and vessel anastomoses were made with microsurgical techniques. RESULTS:The time of donor pancreas harvesting in the cervical and abdominal groups was 31±6 and 37.6±3.8 min, respectively, and the lengths of recipient operations were 49.2±5.6 and 60.6±7.8 min. The time for donor operation was not signiifcantly different (P>0.05), but the recipient operation time in the abdominal group was longer than that in the cervical group (P0.05). CONCLUSIONS:Both pancreas transplantation methods are stable models for immunological and physiological studies in pancreas transplantation. Since each has its own advantages and disadvantages, the designer can choose the appropriate method according to the requirements of the study.

  15. Chordee repair utilizing a novel technique ensuring neurovascular bundle preservation.

    Science.gov (United States)

    Dean, G E; Burno, D K; Zaontz, M R

    2000-03-01

    Penile chordee, with and without hypospadias, is amenable to surgical correction. The Nesbit technique of dorsal plication of the ventral tunica albuginea is effective in correcting most cases of corporal disproportion. A hazard with this approach is the potential inclusion of the dorsal neurovascular bundle, with resultant erectile and sensory dysfunction. We developed a simple technique using the Freer elevator to isolate the neurovascular bundle prior to plication. This ensures that no injury occurs to the neurovascular bundle during plication. Since 1994, 37 boys with chordee have been repaired using this approach. Their ages at the time of operation ranged from 5 months to 28 years (mean 9 months). Following standard degloving of the penis, an incision through Buck's fascia is made lateral and parallel to the neurovascular bundle at the maximum level of the chordee. A similar incision is carried out on the contralateral side. A 4-mm-wide Freer elevator is positioned under Buck's fascia while hugging the tunica albuginea. The Freer elevator slides across the midline to the contralateral side, separating Buck's fascia and underlying layers from the tunica albuginea. Following isolation of the bundle, each corporal body is plicated by creating a longitudinal incision through the tunica albuginea, which then is closed transversely with a 5-0 polydioxanone suture. Buck's fascia subsequently is closed with an absorbable suture following confirmation of chordee correction. No complications have been encountered during a mean follow-up of 21 months (range 5-51 months). No patients have required reoperation for persistent chordee. We developed a technique that elevates the neurovascular bundle prior to plication, thereby ensuring no injury to this structure. We have successfully used this modified Nesbit technique since 1994 and have had no complications. Utilization of the Freer elevator adds an estimated 5 minutes to chordee correction compared to a standard

  16. Vascular Z-shaped ligation technique in surgical treatmentof haemorrhoid

    Institute of Scientific and Technical Information of China (English)

    KazIm Gemici; Ahmet Okus; Serden Ay

    2015-01-01

    AIM To present the effectiveness of minimal invasivevascular zet ligation in the surgical treatment ofhaemorrhoidal disease (HD).METHODS: Among 138 patients with 2nd-4th gradeinternal HD having several complaints and operatedat our hospital between 2003-2013; 116 patients whoregularly attended 1-year control were included in thestudy. Operation times, postoperative early period pain,satisfaction score, complications and relapse detailswere obtained from computer records retrospectively.Visual Analogous Scale (VAS) scores were used forpatient satisfaction on the 3rd, 7th and 21st days.Technique; fixed suture which is constituted by thefirst leg of the Z-shaped suture (to pass by the mucosaand muscular layer) was put in the pile root in order toensure vascular ligation and fixation. The second legof the Z-shaped suture is constituted by mobile sutureand it passes by the pile mucosa and submucosa whichprolapses 5-10 mm below the first suture.RESULTS: Seventy-five of the patients (65%) weremale, 41 of them (35%) were female and their ageaverage was 41. The mean operation time was 12 ±4.8 min. VAS/satisfaction score was found as 2.2/4.3,1.8/4.0, 1.2/4.4 respectively on the 3rd, 7th, and 21stdays. Four of the patient (3.5%) had relapse.CONCLUSION: This technique is an easily applicable,cost efficient way of operation which increases patientsatisfaction.

  17. Through Knee Amputation: Technique Modifications and Surgical Outcomes

    Directory of Open Access Journals (Sweden)

    Frank P Albino

    2014-09-01

    Full Text Available BackgroundKnee disarticulations (KD are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center.MethodsA retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A. between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified.ResultsBetween 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%, arterial thrombosis (35%, and trauma (9%. Postoperative complications included superficial cellulitis (13%, soft tissue infection (4%, and flap ischemia (4% necessitating one case of surgical debridement (4% and four trans-femoral amputations (9%. 9 (22% patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01.ConclusionsKnee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

  18. Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique

    OpenAIRE

    Toossi, Nader; Amin, Nirav Hasmukh; Cerynik, Douglas L.; Jones, Morgan H.

    2014-01-01

    Objectives: Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear. Methods: A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, a...

  19. Surgical technique of orthotopic liver transplantation in rats: the Kamada technique and a new splint technique for hepatic artery reconstruction.

    Science.gov (United States)

    Ishii, Eiichi; Shimizu, Akira; Takahashi, Mikiko; Terasaki, Mika; Kunugi, Shinobu; Nagasaka, Shinya; Terasaki, Yasuhiro; Ohashi, Ryuji; Masuda, Yukinari; Fukuda, Yuh

    2013-01-01

    Orthotopic liver transplantation (OLT) in rats is technically feasible and useful for the assessment of clinical liver transplantation and analysis of inflammatory liver diseases. OLT in rats was pioneered by Lee et al. in 1973 using hand-suture techniques of all vessels. This model has not been widely used due to the long operative time and technical demand. The cuff method was introduced by Kamada in 1979, and today, the Kamada technique is the one most commonly used worldwide. However, this technique does not include hepatic artery reconstruction, although this procedure is routinely performed in clinical transplantation. Nevertheless, several techniques for hepatic artery reconstruction in rat OLT have been reported recently, and our group also developed a simple splint technique from recipient right renal artery to donor celiac axis bearing the hepatic artery. In the present article, we describe the Kamada technique, as a standard surgical method for rat OLT. In addition, we also describe our splint technique for hepatic artery reconstruction. Then, we compare the features of Kamada technique and our splint technique for hepatic artery reconstruction and all other surgical techniques currently in use for rat OLT. The widespread use of the rat OLT model should help to provide full assessment of transplant immunology and the mechanism and treatment of inflammatory liver diseases.

  20. Utilization of the NASA Robonaut as a Surgical Avatar in Telemedicine

    Science.gov (United States)

    Dean, Marc; Diftler, Myron

    2015-01-01

    The concept of teleoperated robotic surgery is not new; however, most of the work to date has utilized specialized robots designed for specific set of surgeries. This activity explores the use of a humanoid robot to perform surgical procedures using the same hand held instruments that a human surgeon employs. For this effort, the tele-operated Robonaut (R2) was selected due to its dexterity, its ability to perform a wide range of tasks, and its adaptability to changing environments. To evaluate this concept, a series of challenges was designed with the goal of assessing the feasibility of utilizing Robonaut as a telemedicine based surgical avatar.

  1. Role of recipient-site preparation techniques and post-operative wound dressing in the surgical management of vitiligo

    Directory of Open Access Journals (Sweden)

    Nour Al-Hadidi

    2015-01-01

    Full Text Available Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below.

  2. Lumbar hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2009-03-01

    Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.

  3. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    Science.gov (United States)

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

  4. Utility of an intraoperabive gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

    NARCIS (Netherlands)

    Jorna, Francisca H.; Jager, Pieter L.; Lemstra, Clara; Wiggers, Theo; Stegeman, Coen A.; Plukker, John T. M.

    2008-01-01

    BACKGROUND: In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism. METHODS: The value of the probe in guiding resection o

  5. Evaluation of PO2 and PCO2 changes during surgical removal of third molars utilizing enflurane anesthesia.

    Science.gov (United States)

    Kraut, R A; Rubal, B; Bush, B

    1985-01-01

    This study investigated the changes in partial pressure of oxygen during surgical removal of wisdom teeth utilizing a spontaneous ventilation general anesthesia technique with enflurane. Simultaneous transcutaneous and arterial blood gas determination confirmed the presence of two oxygen patterns. Normal preoperative pulmonary function tests, coupled with the stability of the Paco(2) between surgery and extubation, indicates that the 23±10 mmHg increase in transcutaneous oxygen (Ptco(2)) reported in 14 of 27 patients evaluated, was due to ventilation perfusion defects, since 13 of the 27 patients showed a 149±22 mmHg increase in Ptco(2) during the same time period.

  6. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap

    OpenAIRE

    Han, Dong-Seok; Jang, Hoon; Youn, Chang-Shik; Yuk, Seung-Mo

    2015-01-01

    Background Until recently, no single, universally accepted surgical method has existed for all types of concealed penis repairs. We describe a new surgical technique for repairing concealed penis by using an advanced musculocutaneous scrotal flap. Methods From January 2010 to June 2014, we evaluated 12 patients (12–40 years old) with concealed penises who were surgically treated with an advanced musculocutaneous scrotal flap technique after degloving through a ventral approach. All the patien...

  7. Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.

    Science.gov (United States)

    Tejwani, Rohit; Young, Brian J; Wang, Hsin-Hsiao S; Wolf, Steven; Purves, J Todd; Wiener, John S; Routh, Jonathan C

    2017-06-01

    Minimally invasive surgery (MIS) techniques are anecdotally reported to be increasingly used, but little objective data supports this. Our objective was to assess trends in MIS utilization across various procedures in pediatric urology and to compare postoperative complication rates between MIS and open procedures. We analyzed the 1998-2012 Nationwide Inpatient Sample. We identified children (<18 years old) undergoing open and MIS inpatient procedures and any in-hospital post-operative complications that occurred during that postoperative hospitalization. We utilized propensity score matching and multivariable logistic regression to adjust for confounding factors. We identified 163,838 weighted encounters in the "overall cohort," 70,273 of which were at centers performing more than five MIS procedures over the years studied. Use of MIS techniques increased significantly over time for several procedures, most prominently for nephrectomy (Fig.). The overall rate of complications was lower in patients undergoing MIS compared with open surgery (6% vs. 11%, p < 0.001). Specialized centers had a significantly lower overall rate of complications than unspecialized centers (9% vs. 12%, p < 0.001). Within specialized centers, MIS had lower complication rates than open procedures (7% vs. 9%, p < 0.001); this finding was consistent even after adjusting for other factors (OR 0.71, p = 0.02). Limitations include that these data may not be generalizable to encounters not in the sample pool. As a large, retrospective, administrative database, NIS may be affected by miscoding bias - rendering our analysis sensitive to the accuracy of procedure coding in NIS. Although the accuracy level of NIS is high for an administrative database, it is possible at least some portion of our cohort may be incorrectly coded. Further, the NSQIP complications we identified may represent associated comorbidities and not true postoperative complications, as NIS does not provide temporal

  8. Time Trade-off Utility Analysis for Surgical Intervention in Comitant Strabismus, Glaucoma, and Cataract

    Directory of Open Access Journals (Sweden)

    Kishimoto,Fumiko

    2012-06-01

    Full Text Available The utility value was compared among 3 surgical interventions, and the validity of the time trade-off (TTO method was evaluated by analyzing the correlations of the utility value with the results of the Visual Function Questionnaire-14 (VF-14 and other variables. The subjects were 127 patients aged 40-85 years who were surgically treated between January 2008 and March 2010, including 26 patients with glaucoma, 50 with cataracts, and 51 with comitant strabismus. The scores on VF-14 and utility values determined using TTO were calculated retrospectively. The mean value (SD of the utility gain was 0.096 (0.105 for glaucoma, 0.101 (0.105 for comitant strabismus, and 0.167 (0.237 for unilateral and 0.245 (0.167 for bilateral cataracts, indicating significant postoperative improvements in the utility value. A significant correlation was observed between the utility value and the postoperative VF-14 scores of the bilateral cataracts, and the postoperative visual acuity of the better eye of the unilateral cataract. The mean value of the quality-adjusted life years was 2.181 for bilateral and 1.424 for unilateral cataracts, 1.132 for strabismus, and 0.870 for glaucoma with an annual discount rate of 3%. The gain of utility value was highest in bilateral cataracts, and lowest in glaucoma, and thus the TTO analysis was considered to be highly valid for cataract surgery.

  9. A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique

    Science.gov (United States)

    Mutaf, Mehmet; Temel, Metin; Koç, Mustafa Nihat

    2017-01-01

    Background We present a clinical experience with a new local flap procedure, namely the triangular closure technique, for reconstruction of sacrococcygeal skin defects resulting from excision of the pilonidal sinus. Material/Methods In this technique, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The size of the defect ranged between 3.5 cm and 12 cm in dimension. Results A tension-free defect closure was obtained in all patients. All flaps except one healed with no complications. A mean follow-up of 3.62±1.77 months revealed aesthetically and functionally acceptable results with the obliteration of the natal cleft in all patients. No recurrence was observed in the follow-up period. Conclusions The triangular closure technique was found to be a useful technique for the treatment of pilonidal sinus with favorable results regarding the time before return to work. PMID:28238003

  10. Creating new middle breeding materials by utilizing new techniques

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@ A new breeding program" Creating new middle breeding materials by utilizing new techniques", cooperated by China National Rice Research Institute (CNRRI) and Japan International Research Center for Agricultural Science (JIRCAS)", started in Hangzhou, China in 1999.The study led by Dr Kunihiro Y. (Japan) and Dr QIAN Qian (China) now advances smoothly.

  11. A standardized surgical technique for rat superior cervical ganglionectomy

    DEFF Research Database (Denmark)

    Savastano, Luis Emilio; Castro, Analía Elizabeth; Fitt, Marcos René

    2010-01-01

    injury. Despite having several experimental applications in the rat, a thorough description of a standardized procedure has never been published. Here, we provide a brief review of the principal features and experimental uses of the SCGx, the surgical anatomy of the neck and sympathetic cervical chain......, and a step-by-step description of how to consistently remove the superior cervical ganglia through the omohyoid muscle or the carotid triangle. Furthermore, we suggest procedures and precautions to be taken during and after surgery to optimize results and describe tools to validate surgical success. We...

  12. A new technique in the surgical treatment of Hangman′s fractures: Neurospinal Academy (NSA technique

    Directory of Open Access Journals (Sweden)

    Sedat Dalbayrak

    2013-01-01

    Full Text Available Context: Treatment of Hangman′s fractures is still controversial. Hangman′s fractures Type II and IIA are usually treated with surgical procedures. Aim: This study aims at describing the Neurospinal Academy (NSA technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. Settings and Design: NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Materials and Methods: Hangman II and IIA patient are treated with NSA technique. Result: Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. Conclusions: In Hangman′s fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.

  13. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    Directory of Open Access Journals (Sweden)

    Roy Varghese

    2016-01-01

    Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  14. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

    Science.gov (United States)

    Colling, Kristin P; Glover, James K; Statz, Catherine A; Geller, Melissa A; Beilman, Greg J

    2015-10-01

    Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; physterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (pobesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

  15. Hindfoot endoscopy for posterior ankle impingement. Surgical technique

    NARCIS (Netherlands)

    van Dijk, C.N.; de Leeuw, P.A.J.; Scholten, P.E.

    2009-01-01

    BACKGROUND: The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less mo

  16. Comparison of surgical techniques in the treatment of laryngeal polypoid degeneration.

    Science.gov (United States)

    Lumpkin, S M; Bishop, S G; Bennett, S

    1987-01-01

    Surgical excision has been the accepted treatment of laryngeal polypoid degeneration, or chronic polypoid corditis. We report on 29 women with polypoid degeneration who received one of three surgical treatments: vocal fold stripping, carbon dioxide laser obliteration, or the Hirano technique. The duration of postoperative dysphonia was longest with the laser removal and shortest with the Hirano technique. A combination of vocal hygiene management and the Hirano technique of removal provided the most efficacious treatment.

  17. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-28

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  18. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  19. Intraoperative technique as a factor in the prevention of surgical site infection.

    Science.gov (United States)

    McHugh, S M; Hill, A D K; Humphreys, H

    2011-05-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. [Late results of the "simplified technique" in the surgical management of a thoracoabdominal aortic aneurysm, ten years later - clinical report].

    Science.gov (United States)

    Dinis da Gama, A

    2007-01-01

    The authors report the clinical case of a dissecting thoracoabdominal aortic aneurysm, in a 49-years old female, with the diagnosis of Marfan's syndrome, who underwent surgical treatment utilizing the "simplified technique", introduced by ourselves in 1983, for the management of this most demanding situation. Reviewed ten years later, having reassumed her social and professional life, a control angio-CT disclosed the procedure of aortic reconstruction and the revascularization of the digestive and renal arteries working in excellent condition. The unique and singular reconstructive procedure here utilized and its excellent long term result, justify its presentation and divulgation.

  1. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.

    Science.gov (United States)

    Van Houdenhoven, Mark; van Oostrum, Jeroen M; Hans, Erwin W; Wullink, Gerhard; Kazemier, Geert

    2007-09-01

    An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques. We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization. Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time. Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.

  2. Equine maxilar molar exodontia by repulsion: description of two different surgical techniques

    OpenAIRE

    Montero, Javier; Estrada, Juan; Estrada, Ricardo; Vargas, Jose; Somarriba, Miguel; Harrington, Stephanie; Segura, Carlos; Estrada, Manuel

    2013-01-01

    Two modifications of the technique for molar exodontia by repulsion are described. Each clinical case had the first maxilar molar on the left side (tooth number 209) extracted using one of the two modifications. Each surgical procedure was performed by a different veterinary surgeon. Both procedures, although similar, differed in equipment used, surgical approach and postoperative care. The surgical procedure in both patients was performed with the horse in the standing position under the eff...

  3. Equine maxilar molar exodontia by repulsion: description of two different surgical techniques

    OpenAIRE

    Montero, Javier; Estrada, Juan; Estrada, Ricardo; Vargas, Jose; Somarriba, Miguel; Harrington, Stephanie; Segura, Carlos; Estrada, Manuel

    2013-01-01

    Two modifications of the technique for molar exodontia by repulsion are described. Each clinical case had the first maxilar molar on the left side (tooth number 209) extracted using one of the two modifications. Each surgical procedure was performed by a different veterinary surgeon. Both procedures, although similar, differed in equipment used, surgical approach and postoperative care. The surgical procedure in both patients was performed with the horse in the standing position under the eff...

  4. Surgical techniques for the management of male infertility

    Institute of Scientific and Technical Information of China (English)

    Natalya A Lopushnyan; Thomas J Walsh

    2012-01-01

    Evaluation and surgical treatment of male infertility has evolved and expanded,now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success.Surgeries for male infertility are divided into four major categories:(i)diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitrofertilization and intracytoplasmic sperm injection (IVF-ICSI).While today we are more successful than ever in treating male infertility,pregnancy is still not always achieved likely due to factors that remain poorly understood.Clinicians treating infertility should advocate for couple-based therapy,and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies.

  5. Sacroiliac screw fixation: A mini review of surgical technique

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2014-01-01

    Full Text Available The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.

  6. Sacroiliac screw fixation: A mini review of surgical technique

    Science.gov (United States)

    Alvis-Miranda, Hernando Raphael; Farid-Escorcia, Hector; Alcalá-Cerra, Gabriel; Castellar-Leones, Sandra Milena; Moscote-Salazar, Luis Rafael

    2014-01-01

    The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique. PMID:25336831

  7. A Novel Surgical Pre-suturing Technique for the Management of ...

    African Journals Online (AJOL)

    Journal of Surgical Technique and Case Report | Jul-Dec 2014 | Vol-6 | Issue-2. 49. A Novel Surgical ... 1Department Periodontology, Rural Dental College, Loni,. Maharashtra, India ... used for local infiltration anesthesia. 0.5‑1 ml of solution.

  8. [Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries].

    Science.gov (United States)

    Rejas Ugena, E; Trinidad Ruiz, G; Alvarez Domínguez, J; Carrasco Claver, F; Pino Rivero, V; Blasco Huelva, A

    2006-05-01

    To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.

  9. Application and evaluation of improved surgical aseptic technique curriculum in specialty nurse training in Henan Province

    Directory of Open Access Journals (Sweden)

    Bing Bai

    2016-09-01

    Conclusion: Novel surgical aseptic technique and application in the curriculum design of training for OR nurses should be developed to enhance their mastery of theoretical and practical skills and to modify their behaviors.

  10. Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach.

    Science.gov (United States)

    Rodriguez, Joseph F; Packiam, Vignesh T; Boysen, William R; Johnson, Scott C; Smith, Zachary L; Smith, Norm D; Shalhav, Arieh L; Steinberg, Gary D

    2017-07-01

    To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data. Using the National Cancer Database, we identified patients who underwent nephroureterectomy for localized upper tract urothelial carcinoma between 2010 and 2013. Demographic and clinicopathologic characteristics were compared among the three operative approaches. Multivariate regression analyses were used to determine the impact of approach on performance of lymphadenectomy (LND), positive surgical margins (PSM), and overall survival (OS). In total, there were 9401 cases identified for analysis, including 3199 ONU (34%), 2098 RNU (22%), and 4104 LNU (44%). From 2010 to 2013, utilization of RNU increased from 14% to 30%. On multivariate analysis, LND was more likely in RNU (odds ratio [OR] 1.52; p ONU. RNU was associated with decreased PSM compared with ONU (OR = 0.73; p = 0.04). After adjusting for other factors, OS was not significantly associated with surgical approach. RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

  11. TECHNIQUE AND SURGICAL OUTCOMES OF ANATOMICAL LIVER RESECTIONS FOR COLORECTAL CANCER LIVER METASTASES

    Directory of Open Access Journals (Sweden)

    D. V. Sidorov

    2013-01-01

    Full Text Available Technique and surgical outcomes of anatomical liver resections using ERBEJET2® water-jet dissector were described. Overall 98 patients with colorectal cancer liver metastases were included in this study. In 43 patients resections were performed using water-jet dissection technique. Water-jet dissection seems to be safe and effective technique for anatomical liver resections.

  12. A standardized surgical technique for rat superior cervical ganglionectomy.

    Science.gov (United States)

    Savastano, Luis Emilio; Castro, Analía Elizabeth; Fitt, Marcos René; Rath, Martin Fredensborg; Romeo, Horacio Eduardo; Muñoz, Estela Maris

    2010-09-30

    Superior cervical ganglionectomy (SCGx) is a valuable microsurgical model to study the role of the sympathetic nervous system in a vast array of physiological and pathological processes, including homeostatic regulation, circadian biology and the dynamics of neuronal dysfunction and recovery after injury. Despite having several experimental applications in the rat, a thorough description of a standardized procedure has never been published. Here, we provide a brief review of the principal features and experimental uses of the SCGx, the surgical anatomy of the neck and sympathetic cervical chain, and a step-by-step description of how to consistently remove the superior cervical ganglia through the omohyoid muscle or the carotid triangle. Furthermore, we suggest procedures and precautions to be taken during and after surgery to optimize results and describe tools to validate surgical success. We expect that the following standardized and optimized protocol will allow researchers to organize knowledge into a cohesive framework in those areas where the SCGx is applied. Copyright 2010 Elsevier B.V. All rights reserved.

  13. CORONIS - International study of caesarean section surgical techniques: the follow-up study

    OpenAIRE

    Abalos, E; Oyarzun, E; Addo, V.; Sharma, JB; Matthews, J; Oyieke, J; Masood, SN; El Sheikh, MA; Brocklehurst, P.; Farrell, B; Gray, S; Hardy, P.; Jamieson, N; Juszczak, E.; Spark, P

    2013-01-01

    BACKGROUND: The CORONIS Trial was a 2×2×2×2×2 non-regular, fractional, factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes, the primary outcome being a composite of maternal death or infectious morbidity. The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies. Such outcomes include those related to subsequent pregnancy: mode of delivery; abnormal placentation (e....

  14. Application of minimally invasive technique in surgical treatment of pancreatic diseases

    Directory of Open Access Journals (Sweden)

    ZHANG Yixi

    2015-05-01

    Full Text Available In recent years, with the rapid development of minimally invasive concept, from laparoscopic operation to three-dimension laparoscopic technique and to robotic surgical system, treatment modalities have changed a lot. Pancreatic diseases, including multiple lesions, have different prognoses. An appropriate surgical procedure should be selected while ensuring the radical treatment of disease, so as to minimize the injury to patients and the impairment of organ function. Minimally invasive technique is of great significance in the surgical treatment of pancreatic diseases.

  15. Extended trochanteric osteotomy: planning, surgical technique, and pitfalls.

    Science.gov (United States)

    Meek, R M; Greidanus, Nelson V; Garbuz, Donald S; Masri, Bassam A; Duncan, Clive P

    2004-01-01

    The extended trochanteric osteotomy is appropriate for a number of surgical indications. It facilitates removal of well-fixed cement mantles with a loose or well-fixed stem and of extensively porous-coated or tapered cementless stems. This exposure is particularly valuable in the presence of varus remodeling of the proximal femur, permitting correction of proximal femoral deformity and reducing the risk of fracture of the greater trochanter. It is also indicated in the removal of a well-fixed cemented stem that is complicated by infection, where it is vital to extract all foreign material for successful eradication of the infection. In addition, when the osteotomy is required for femoral exposure, it enhances acetabular exposure to allow even the most complex reconstruction. Also, as the soft-tissue attachments to the bone fragment are preserved in this approach, abductor muscle tension can be adjusted.

  16. Use of surgical techniques in the rat pancreas transplantation model

    National Research Council Canada - National Science Library

    Ma, Yi; Guo, Zhi-Yong

    2008-01-01

    ... (also called type 1 diabetes). With the improvement of microsurgical techniques, pancreas transplantation in rats has been the major model for physiological and immunological experimental studies in the past 20 years...

  17. PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION

    Science.gov (United States)

    NISHIMI, ALEXANDRE YUKIO; ARBEX, DEMETRIO SIMÃO; MARTINS, DIOGO LUCAS CAMPOS; GUSMÃO, CARLOS VINICIUS BUARQUE DE; BONGIOVANNI, ROBERTO RANGEL; PASCARELLI, LUCIANO

    2016-01-01

    ABSTRACT Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion. PMID:28149190

  18. An effective visualization technique for depth perception in augmented reality-based surgical navigation.

    Science.gov (United States)

    Choi, Hyunseok; Cho, Byunghyun; Masamune, Ken; Hashizume, Makoto; Hong, Jaesung

    2016-03-01

    Depth perception is a major issue in augmented reality (AR)-based surgical navigation. We propose an AR and virtual reality (VR) switchable visualization system with distance information, and evaluate its performance in a surgical navigation set-up. To improve depth perception, seamless switching from AR to VR was implemented. In addition, the minimum distance between the tip of the surgical tool and the nearest organ was provided in real time. To evaluate the proposed techniques, five physicians and 20 non-medical volunteers participated in experiments. Targeting error, time taken, and numbers of collisions were measured in simulation experiments. There was a statistically significant difference between a simple AR technique and the proposed technique. We confirmed that depth perception in AR could be improved by the proposed seamless switching between AR and VR, and providing an indication of the minimum distance also facilitated the surgical tasks. Copyright © 2015 John Wiley & Sons, Ltd.

  19. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

    Science.gov (United States)

    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours.

  20. Frenectomy: a review with the reports of surgical techniques.

    Science.gov (United States)

    Devishree; Gujjari, Sheela Kumar; Shubhashini, P V

    2012-11-01

    The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy.The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller's technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported.

  1. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery*

    Science.gov (United States)

    Suzuki, Heliane Sanae; Serafini, Sérgio Zuñeda; Sato, Maurício Shigueru

    2014-01-01

    BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique. PMID:24626646

  2. Perineal hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2010-05-01

    Perineal hernia is the protrusion into the perineum of intraperitoneal or extraperitoneal contents through a congenital or acquired defect of the pelvic diaphragm. The first case was reported by de Garangeot in 1743. Perineal hernias may occur anteriorly or posteriorly to the superficial transverse perineal muscles. Congenital perineal hernia is a rare entity. Failure of regression of the peritoneal cul de sac of the embryo is considered a predisposing factor for hernia formation. Acquired perineal hernias are primary or secondary. Primarily acquired perineal hernias are caused by factors associated with increased intra-abdominal pressure. They are more common in females as a result of the broader female pelvis and the attenuation of the pelvic floor during pregnancy and childbirth. Secondarily acquired perineal hernias are incisional hernias associated with extensive pelvic operations such as abdominoperineal resection of the anorectum and pelvic exenteration. Pain in the perineal area, intestinal obstruction, topical skin erosion, and difficulty with urination necessitate the surgical repair of a perineal hernia. This can be accomplished through transabdominal, perineal, or combined abdominoperineal approaches. The defect in the muscles of the pelvic diaphragm may be closed either with direct suturing or by using autogenous tissues or synthetic mesh.

  3. Comparison of two surgical techniques in large incisional hernias

    Directory of Open Access Journals (Sweden)

    Mustafa Sit

    2014-03-01

    Full Text Available Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report. Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011. Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus,which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get. Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall. J Clin Exp Invest 2014; 5 (1: 36-39

  4. Subtalar joint arthrodesis: open and arthroscopic indications and surgical techniques.

    Science.gov (United States)

    Roster, Brent; Kreulen, Christopher; Giza, Eric

    2015-06-01

    Arthrodesis of the subtalar joint can be performed via both open and arthroscopic techniques. Both groups of procedures have their own relative indications and contraindications, as well as complications. Good results have been reported for both general procedures, although some studies suggest superiority with arthroscopic subtalar arthrodesis. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. 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

    2017-06-28

    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).

  6. Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease.

    Science.gov (United States)

    Hatzichristodoulou, Georgios; Osmonov, Daniar; Kübler, Hubert; Hellstrom, Wayne J G; Yafi, Faysal A

    2017-02-28

    Peyronie's disease (PD) is a benign fibrotic disorder of the tunica albuginea of the penis, which can cause penile pain, curvature, shortening, erectile dysfunction, and psychological distress. Surgery is indicated when penile curvature prevents satisfactory sexual intercourse. Plaque incision or excision with grafting has been suggested as an option in patients with a penile curvature greater than 60°, a shortened penis, and/or an hourglass or complex deformity. To provide an overview of recent studies reporting outcomes of grafting techniques and to report advances in the development of new grafting materials for PD surgery. A literature review was performed through PubMed from 2011 through 2016 regarding grafting techniques for PD. Key words used for the search were grafting techniques, grafts, graft materials, Peyronie's disease, surgical outcomes, and surgical therapy. To report on novel and promising graft materials for PD and to discuss surgical techniques, outcomes, and limitations. Discussed outcomes include postoperative penile straightening, shortening, erectile function, glans sensation, and patient satisfaction. Various surgical techniques and grafting materials can be used for the coverage of the tunica albuginea defect after partial plaque excision or incision. Autologous and non-autologous grafts have been used in this setting. A major advantage of the available "off-the-shelf" grafts is that they do not require donor site harvesting, thus decreasing morbidity and operative time. Tissue-engineered grafts represent the future, but more research is needed to further improve surgical handling and postoperative outcomes. Patients opting for grafting techniques should have sufficient erectile rigidity preoperatively. Surgeon experience, careful patient selection, patient preference, and type of penile deformity affect the choice of graft and surgical approach used. Hatzichristodoulou G, Osmonov D, Kübler H, et al. Contemporary Review of Grafting

  7. Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures.

    Science.gov (United States)

    Wu, Chi-Chuan

    2010-01-01

    Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.

  8. SURGICAL REMOVAL OF THE EPIDERMAL INCLUSION CYSTS WITH SQUEEZE TECHNIQUE: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Mehmet Eren Yuksel

    2015-12-01

    Full Text Available Epidermal inclusion cysts are common benign cutaneous cysts which arise from hair follicles. These cysts usually present as asymptomatic, small, smooth, firm, round, slow growing swellings on hair bearing areas such as scalp, face, neck and trunk. Epidermal inclusion cysts are easily diagnosed by their clinical features. However, trichilemmal cyst, dermoid cyst, neurofibroma, hemangioma, lipoma and liposarcoma should also be kept in mind in differential diagnosis of cutaneous cystic lesions. As malignant transformation of epidermal inclusion cysts has been reported, histopathological evaluation of epidermal inclusion cysts is mandatory in order to rule out malignancy. Moreover, giant epidermal inclusion cysts with ulceration, rapid growth, resistance to treatment, recurrence and fistula drainage may have malignant potential. Therefore, epidermal cysts should be surgically removed. There are several different types of surgical techniques to remove cutaneous cysts. A proper surgical technique should facilitate the complete removal of the cyst wall to prevent recurrence. In addition, it should provide minimal scarring and a low wound infection rate. Epidermal inclusion cysts can be easily removed surgically with squeeze technique. In this technique, the cyst is squeezed out through a small incision using both index fingers. Thus, the cyst is not ruptured. The squeeze technique allows the cyst capsule to remain intact. Therefore, the risk of wound infection, recurrence and scar formation is minimized. Hereby, we present a 48-year-old male with multiple epidermal inclusion cysts on the scalp treated surgically with squeeze technique

  9. Spigelian hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-01-01

    Spigelian hernia (1-2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the "spigelian hernia belt," a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.

  10. Surgical techniques of cataract surgery and subsequent postoperative endophthalmitis.

    Science.gov (United States)

    Trinavarat, Adisak; Atchaneeyasakul, La-ongsri

    2005-11-01

    To compare the incidence and characteristics of patients with endophthalmitis after extracapsular cataract extraction (ECCE) to those after phacoemulsification Records of patients receiving intravitreal antibiotic injection to treat endophthalmitis after cataract surgery between Jan 2001 and Dec 2004 were reviewed. Demographic data and other characteristics including associated diseases, details of cataract surgical procedure and intraoperative complication, onset of endophthalmitis after cataract surgery, presenting symptoms and signs of endophthalmitis, how endophthalmitis was managed, causative organisms, duration of hospitalization and results of treatment were collected. This information was compared between those of endophthalmitis patients after ECCE and those after phacoemulsification. There were 5 cases who developed endophthalmitis after ECCE and 31 cases after phacoemulsification. The incidence was 0.365% after ECCE and 0.279% after phacoemulsification (p = 0.589). Visual acuity (VA) before cataract surgery in ECCE group was worse than the phacoemulsification group (median VA: counting fingers vs 6/36, p = 0.001). Median onset of endophthalmitis was 8 days after ECCE and 6 days after phacoemulsification. Presenting symptoms and signs were similar. Causative agents were identified in 4 (80%) and 14 (45%) cases in the ECCE and phacoemulsification groups respectively. Gram-positive bacteria were the major cause of infection in both groups. Endophthalmitis caused by citrobacter sp. in ECCE group and enterococcus or streptococcus sps. the phacoemulsification in the group ended up with enucleation or no light perception. The present study has not demonstrated an apparent difference between endophthalmitis after ECCE and those after phacoemulsification. Endophthalmitis after either procedure can be managed as the same condition.

  11. Surgical technique for minimally invasive fibula fracture fixation.

    Science.gov (United States)

    Carlile, G S; Giles, N C L

    2011-09-01

    This paper describes a minimally invasive percutaneous technique for reduction and fixation of distal fibula fractures using plate osteosynthesis. We believe this technique benefits patients with poor quality soft tissue envelopes. So far a total of 25 patients have undergone percutaneous fixation, 22 females and 3 males. At no stage yet has a minimally invasive procedure been abandoned intra-operatively in favour of conversion to an open procedure. The mean age was 61.6 years (range 25-80 years). The mean time to surgery was 2.00 days (range 0-5) and mean time to discharge was 4.20 days (range 1-9). At a minimum of over 1 year's follow-up all fractures have healed, with no delayed unions or complications so far experienced.

  12. Surgical technique for lung retransplantation in the mouse

    OpenAIRE

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.; Kreisel, Daniel

    2013-01-01

    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation,...

  13. [Orthotopic liver transplant in rats. Surgical technique, complications and treatment].

    Science.gov (United States)

    Lausada, Natalia R; Gondolesi, G E; Ortiz, E; Dreizzen, E; Raimondi, J C

    2002-01-01

    The orthotopic rat liver transplant model is a widely used technique in transplantation research. It has many advantages over other animal transplant models because of its availability and low cost. However, it must be emphasized that success with the rat model requires thorough training. The aim of this paper is to describe the microsurgical technique involved in 60 rat liver transplants and to discuss the complications and their treatments. Forty-nine liver transplants were performed at the Experimental Laboratory of the University Hospital, Ontario, Canada (ELUH) and 11 were performed at the Laboratorio de Trasplante de Organos de la Facultad de Ciencias Médicas de La Plata, Buenos Aires. Argentina (LTO). Among the transplants performed at the ELUH, the observed complications were haemorrhage (n = 4), pneumothorax (n = 1), anastomotic failure (n = 15), bile leak (n = 3), and bile duct necrosis (n = 9). The remaining 17 rats at the ELUH were healthy at day 7 after surgery. Animal survival immediately postop, at 24 hours postop and at 7 days postop was achieved with the 9th, 20th and 21st transplants respectively. At the LTO, 3 rats died as a result of anaesthetic complications. Seven-day animal survival was achieved with the 11th transplant. We beleive that the description of the orthotopic rat liver transplantation technique, as well as the discussion regarding complications and their management, can be useful for researchers interested in performing liver transplantation in rats.

  14. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    Science.gov (United States)

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  15. Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique

    Directory of Open Access Journals (Sweden)

    Gabriele Antonini

    2016-01-01

    Full Text Available Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner’s sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result.

  16. Surgical technique for lung retransplantation in the mouse

    Science.gov (United States)

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.

    2013-01-01

    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation, with a success rate exceeding 95%. The mouse lung retransplantation model represents a novel and powerful tool to examine how cells that reside in or infiltrate pulmonary grafts shape immune responses. PMID:23825768

  17. Innovation in surgical technology and techniques: Challenges and ethical issues.

    Science.gov (United States)

    Geiger, James D; Hirschl, Ronald B

    2015-06-01

    The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation.

  18. Activity analysis: measurement of the effectiveness of surgical training and operative technique.

    OpenAIRE

    Shepherd, J P; Brickley, M.

    1992-01-01

    All surgical procedures are characterised by a sequence of steps and instrument changes. Although surgical efficiency and training in operative technique closely relate to this process, few studies have attempted to analyse it quantitatively. Because efficiency is particularly important in day surgery and lower third molar removal is a high-volume procedure, the need for which is responsible for particularly long waiting-lists in almost all UK health regions, this operation was selected for e...

  19. Surgical management of Gorlin syndrome: a 4-decade experience using local excision technique.

    Science.gov (United States)

    Griner, Devan; Sutphin, Daniel; Sargent, Larry A

    2015-04-01

    Basal cell nevus syndrome (aka Gorlin syndrome, Gorlin-Goltz syndrome, nevoid basal cell carcinoma syndrome, and fifth phacomatosis) is a rare but well-described autosomal dominant condition with variable penetrance. We present a female patient who has been successfully treated using local surgical excision and diligent skin surveillance for more than 4 decades, demonstrating that simple local incision is an efficacious and reasonable surgical alternative that may circumvent the specialization and expense of Mohs technique.

  20. Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

    Full Text Available Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.

  1. Influence of surgical technique, implant shape and diameter on the primary stability in cancellous bone.

    Science.gov (United States)

    Bilhan, H; Geckili, O; Mumcu, E; Bozdag, E; Sünbüloğlu, E; Kutay, O

    2010-12-01

    Achievement of primary stability during surgical placement of dental implants is one of the most important factors for successful osseointegration depending on various anatomical, surgical and implant-related factors. Resonance frequency analysis (RFA) has been shown as a non-invasive and objective technique for measuring the stability of implants. The aim of this study was to evaluate the effect of some surgical and implant-related factors in enhancing primary stability and to estimate a correlation between RFA and insertion torque (IT) in proximal regions of cow ribs representing cancellous bone. Fifteen implant beds were prepared in the most proximal region of six fresh cow ribs. Ninety implants with three different shapes and two different diameters were placed with two different surgical techniques, and the primary stability was compared using RFA and IT. Significantly higher RFA and IT values were achieved when under-dimensioned drilling was used as the surgical method (Pconical Astra Tech implants showed the highest IT values (Pconical implants with a wide diameter to be placed with the modified surgical technique proposed appear to be useful in enhancing the primary stability in cancellous bone.

  2. Richter hernia: surgical anatomy and technique of repair.

    Science.gov (United States)

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-02-01

    Richter hernia (partial enterocele) is the protrusion and/or strangulation of only part of the circumference of the intestine's antimesenteric border through a rigid small defect of the abdominal wall. The first case was reported in 1606 by Fabricius Hildanus. The first definition of partial enterocele was given by August Gottlieb Richter in 1785. Sir Frederick Treves discriminated it from Littre hernia (hernia of the Meckel diverticulum). More often these hernias are diagnosed in the sixth and seventh decades of life. They comprise 10 per cent of strangulated hernias. Their common sites are the femoral ring, inguinal ring, and at incisional trauma. The most-often entrapped part of the bowel is the distal ileum, but any part of the intestinal tube may be incarcerated. These hernias progress more rapidly to gangrene than other strangulated hernias, and obstruction is less frequent. The gold standard technique for repair is the preperitoneal approach, followed by laparotomy and resection if perforation is suspected.

  3. Surgical techniques for quantitative nutrient digestion and absorbtion studies in the pig

    DEFF Research Database (Denmark)

    Jørgensen, Henry; Serena, Anja; Theil, Peter Kappel;

    2010-01-01

    Surgical techniques allow quantitative measurement of nutrient digestion and absorption in pigs. The present paper presents our updated techniques for anaesthesia and surgery. The surgery technique of catheterization of the portal vein, mesenteric vein and mesenteric artery, as well as the fittin...... of a flow probe for continuous portal blood flow measurements in sows is described. Further, the cannulation of the terminal ileum with a dirigible bi-directional T-cannula for the total collection of ileal digesta is described...

  4. Blood Conservation Strategies and Liver Transplantation Transfusion-Free Techniques Derived from Jehovah's Witness Surgical Cohorts.

    Science.gov (United States)

    Sheth, Mansi; Kulkarni, Sujit; Dhanireddy, Kiran; Perez, Alexander; Selby, Rick

    2015-01-01

    Red blood cell and component transfusions are a frequent and widely accepted accompaniment of surgical procedures. Although the risk of specific disease transmission via allogeneic blood transfusions (ABT) is very low, the occurrence of transfusion related immune modulation (TRIM) still remains a ubiquitous concern. Recent studies have shown that ABT are linked to increased morbidity and mortality across various specialties, with negative outcomes directly correlated to number of transfusions. Blood conservation methods are therefore necessary to reduce ABT. Acute normo-volemic hemodilution (ANH) along with pre-operative blood augmentation and intraoperative cell salvage are blood conservation techniques utilized in tertiary and even quaternary (transplantation) surgery in Jehovah's Witnesses with excellent outcomes. The many hematologic complications such as anemia, thrombocytopenia and coagulopathies that occur with liver transplantation present a significant barrier when trying to avoid ABT. Despite this, living donor liver transplantation (LDLT) has been successfully performed in a transfusion-free environment, providing valuable insight into the possibilities of limiting ABT and its associated risks in all patients.

  5. Gene therapy during cardiac surgery: role of surgical technique to minimize collateral organ gene expression.

    Science.gov (United States)

    Katz, Michael G; Swain, JaBaris D; Fargnoli, Anthony S; Bridges, Charles R

    2010-12-01

    Effective gene therapy for heart failure has not yet been achieved clinically. The aim of this study is to quantitatively assess the cardiac isolation efficiency of the molecular cardiac surgery with recirculating delivery (MCARD™) and to evaluate its efficacy as a means to limit collateral organ gene expression. 10(14) genome copies (GC) of recombinant adeno-associated viral vector 6 encoding green fluorescent protein under control of the cytomegalovirus promoter was delivered to the nine arrested sheep hearts. Blood samples were assessed using real-time quantitative polymerase chain reaction (RT QPCR). Collateral organ gene expression was assessed at four-weeks using immunohistochemical staining. The blood vector GC concentration in the cardiac circuit during complete isolation trended from 9.59±0.73 to 9.05±0.65 (log GC/cm(3)), and no GC were detectable in the systemic circuit (P800-fold (P99% isolation efficiency. Conversely, incomplete isolation resulted in equalization of vector GC concentration in the circuits, leading to robust collateral organ gene expression. MCARD™ is an efficient, clinically translatable myocardial delivery platform for cardiac specific gene therapy. The cardiac surgical techniques utilized are critically important to limit collateral organ gene expression.

  6. Umbilical hernia repair in conjunction with abdominoplasty: a surgical technique to maintain umbilical blood supply.

    Science.gov (United States)

    Bruner, Terrence W; Salazar-Reyes, Hector; Friedman, Jeffrey D

    2009-01-01

    Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. Traditional surgical techniques for abdominoplasty and umbilical hernia repair, when performed simultaneously, can potentially compromise the vascular supply to the umbilicus. The authors describe a simplified surgical technique for the correction of umbilical hernias in conjunction with abdominoplasty. This procedure avoids any fascial incisions immediately adjacent to the umbilicus, thereby maintaining a maximal blood supply to the umbilical stalk. Over a six-year period, 17 patients underwent the described procedure. None have had a recurrence of their hernia or umbilical necrosis, and the aesthetics of the umbilicus have been improved.

  7. An innovative surgical technique for treating penile incarceration injury caused by heavy metallic ring

    Directory of Open Access Journals (Sweden)

    S J Baruah

    2009-01-01

    Full Text Available Penile incarceration injury by heavy metallic ring is a rare genital injury. A man may place metal object for erotic or autoerotic purposes, for masturbation or increasing erection, and due to psychiatric disturbances are some of the reasons for a penile incarceration injury. The incarcerating injury results in reduced blood flow distal to the injury, leading to edema, ischemia, and sometimes gangrene. These injuries are divided into five grades and their treatment options are divided into four groups. Surgical techniques are reserved for the advanced grades (Grades IV and V. We describe an innovative surgical technique, which can be adopted in Grades II and III injuries.

  8. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review.

    Science.gov (United States)

    Donaldson, L H; Gill, A J; Hibbert, M

    2016-11-01

    There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates. A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%. In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high. © 2016 Royal Australasian College of Physicians.

  9. Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma

    Directory of Open Access Journals (Sweden)

    Jonathan J Morrison

    2012-01-01

    Full Text Available Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT. Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts′ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH and those not requiring immediate surgery (non-LTTH. Statistical Analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher′s exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP, pulse pressure, shock index (SI=heart rate/SBP and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.

  10. A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

    Directory of Open Access Journals (Sweden)

    Patrick Holweg

    2017-01-01

    Full Text Available Various surgical techniques have been described for the fixation of acromioclavicular (AC dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points, SPADI (0 points, and QuickDASH score (0 points. The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

  11. Consistent evaluation of an ultrasound-guided surgical navigation system by utilizing an active validation platform

    Science.gov (United States)

    Kim, Younsu; Kim, Sungmin; Boctor, Emad M.

    2017-03-01

    An ultrasound image-guided needle tracking systems have been widely used due to their cost-effectiveness and nonionizing radiation properties. Various surgical navigation systems have been developed by utilizing state-of-the-art sensor technologies. However, ultrasound transmission beam thickness causes unfair initial evaluation conditions due to inconsistent placement of the target with respect to the ultrasound probe. This inconsistency also brings high uncertainty and results in large standard deviations for each measurement when we compare accuracy with and without the guidance. To resolve this problem, we designed a complete evaluation platform by utilizing our mid-plane detection and time of flight measurement systems. The evaluating system uses a PZT element target and an ultrasound transmitting needle. In this paper, we evaluated an optical tracker-based surgical ultrasound-guided navigation system whereby the optical tracker tracks marker frames attached on the ultrasound probe and the needle. We performed ten needle trials of guidance experiment with a mid-plane adjustment algorithm and with a B-mode segmentation method. With the midplane adjustment, the result showed a mean error of 1.62+/-0.72mm. The mean error increased to 3.58+/-2.07mm without the mid-plane adjustment. Our evaluation system can reduce the effect of the beam-thickness problem, and measure ultrasound image-guided technologies consistently with a minimal standard deviation. Using our novel evaluation system, ultrasound image-guided technologies can be compared under equal initial conditions. Therefore, the error can be evaluated more accurately, and the system provides better analysis on the error sources such as ultrasound beam thickness.

  12. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hollingsworth, Caroline L. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States); Rice, Henry E. [Duke University Medical Center, Department of Surgery, Durham, NC (United States)

    2010-07-15

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  13. Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique.

    Science.gov (United States)

    Rubin, Guy; Orbach, Hagay; Chezar, Avi; Rozen, Nimrod

    2017-01-01

    Distal radial physeal fractures with volar displacement are rare. Several methods of operative treatment include volar plate without inserting distal screws, percutaneous technique using two anterior skin incisions and reversed Kapandji technique with pins introduced through a posterior approach and locked at the anterior cortex of the fracture. We report three cases along with a literature review of the surgical techniques described in the past and a novel surgical technique for this uncommon fracture termed "Volar Kapandji". All patients had anatomic reduction at the last follow-up radiography, and all patients had a full range of motion and VAS 0 at the last follow-up. No complications were recorded. This case study presents the minimally invasive option for treating rare cases of physeal distal radius fractures with volar displacement. V.

  14. Posterior Segment Intraocular Foreign Body: Extraction Surgical Techniques, Timing, and Indications for Vitrectomy

    Directory of Open Access Journals (Sweden)

    Dante A. Guevara-Villarreal

    2016-01-01

    Full Text Available Ocular penetrating injury with Intraocular Foreign Body (IOFB is a common form of ocular injury. Several techniques to remove IOFB have been reported by different authors. The aim of this publication is to review different timing and surgical techniques related to the extraction of IOFB. Material and Methods. A PubMed search on “Extraction of Intraocular Foreign Body,” “Timing for Surgery Intraocular Foreign Body,” and “Surgical Technique Intraocular Foreign Body” was made. Results. Potential advantages of immediate and delayed IOFB removal have been reported with different results. Several techniques to remove IOFB have been reported by different authors with good results. Conclusion. The most important factor at the time to perform IOFB extraction is the experience of the surgeon.

  15. SURGICAL TECHNIQUE

    African Journals Online (AJOL)

    We describe a simple form of posterior spinal surgery for patients ... The pain completely resolved in two patients while the third one had a ... Preoperative magnetic resonance imaging (MRI) T2 .... treatment; or for spinal cord or nerve root.

  16. Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws.

    Science.gov (United States)

    Mamede, João; Castro Adeodato, Sandro; Aquino Leal, Rafael

    2017-04-01

    Four-corner fusion has been shown to be a reliable option of treatment of wrist arthritis, but there is no consensus about which implant and surgical procedure should be used in the arthrodesis. The present study aimed to describe a surgical technique using 2 crossed screws as implants, inserted in a retrograde manner, and to demonstrate preliminary results of the use of the technique. A retrospective study was conducted using medical records and imaging tests (radiographs and computed tomography) of all 15 patients who underwent a standardized 4-corner fusion technique, between December 2011 and July 2015, in the Department of Hand Surgery of Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, Brazil. We collected data on the following variables: fusion rate, time to fusion, and percentage of patients who had any complications or needed another surgical procedure on the same wrist. All but one patient achieved fusion of arthrodesis. The average time to union was 5.54 months (SD = 3.84). Only the patient who developed nonunion of the 4-corner fusion required another surgery on the same wrist. The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.

  17. [Forum on tissue expansion. Expansion of the scalp. Surgical techniques and clinical applications].

    Science.gov (United States)

    Foyatier, J L; Delay, E; Comparin, J P; Latarjet, J; Masson, C L

    1993-02-01

    Repair of all forms of alopecia is one of the principal applications of scalp expansion. The authors have inserted 400 expansion prostheses, including 20 in the scalp. The surgical technique, choice of material and various types of flaps are described and illustrated by clinical cases of extensive alopecia.

  18. The evolution of surgical techniques in clinical liver transplantation. A review

    NARCIS (Netherlands)

    Polak, Wojciech G.; Peeters, Paul M. J. G.; Slooff, Maarten J. H.

    2009-01-01

    Currently, liver transplantation (LT) is an accepted method of treatment of end-stage liver disease, metabolic diseases with their primary defect in the liver and unresectable primary liver tumors. Surgical techniques in LT have evolved considerably over the past 40 yr. The developments have led to

  19. Neovascularisation after surgery for recurrent saphenofemoral incompetence: Does surgical dissection technique matter?

    NARCIS (Netherlands)

    J.W. Mouton (Johan); M.M. Marklewitz (M.); S. Friedli (S.); T. Zehnder (T.); H.E. Wagner (H.); D. Heim (D.); M.G.R. de Maeseneer (Marianne)

    2011-01-01

    textabstractBackground: The effect of the type of surgery on neovascularisation in the groin is unknown. The aim of the present study was to compare three different surgical techniques used for recurrent saphenofemoral incompetence in view of their effect on neovascularisation in the groin at short-

  20. Clinical evaluation of techniques used in the surgical treatment of progressive hemifacial atrophy

    NARCIS (Netherlands)

    R. Roddi (Roberto); E. Riggio (Egidio); P.M. Gilbert (Philip); S.E.R. Hovius (Steven); J. Michiel Vaandrager (J.); J.C.H.M. van der Meulen (Jacques)

    1994-01-01

    textabstractWe critically review 13 patients with progressive hemifacial atrophy treated with three basic surgical procedures (free flap transplantation, alloplastic implants, micro-fat injections ‘lipofilling’) and further ancillary techniques. In spite of the satisfactory results achieved with the

  1. Primary cerebral echinoccocosis in a child: Case report - Surgical technique, technical pitfalls, and video atlas

    Directory of Open Access Journals (Sweden)

    Ahmed M. A. Altibi

    2016-01-01

    Conclusion: Intracranial hydatid cyst is very rare. Nevertheless, it should always be considered as a differential diagnosis in cerebral cystic lesions, especially in children. The surgical technique used to remove the cyst appears to be safe. However, several precautions must be applied intraoperatively to avoid the catastrophe of cyst rupture.

  2. Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy.

    Science.gov (United States)

    Kim, Jeong Sook; Lee, In Ok; Eoh, Kyung Jin; Chung, Young Shin; Lee, Inha; Lee, Jung-Yun; Nam, Eun Ji; Kim, Sunghoon; Kim, Young Tae; Kim, Sang Wun

    2017-03-01

    This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy. Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm(2)-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; Phuge ovarian tumors.

  3. Programmable rate modem utilizing digital signal processing techniques

    Science.gov (United States)

    Bunya, George K.; Wallace, Robert L.

    1989-01-01

    The engineering development study to follow was written to address the need for a Programmable Rate Digital Satellite Modem capable of supporting both burst and continuous transmission modes with either binary phase shift keying (BPSK) or quadrature phase shift keying (QPSK) modulation. The preferred implementation technique is an all digital one which utilizes as much digital signal processing (DSP) as possible. Here design tradeoffs in each portion of the modulator and demodulator subsystem are outlined, and viable circuit approaches which are easily repeatable, have low implementation losses and have low production costs are identified. The research involved for this study was divided into nine technical papers, each addressing a significant region of concern in a variable rate modem design. Trivial portions and basic support logic designs surrounding the nine major modem blocks were omitted. In brief, the nine topic areas were: (1) Transmit Data Filtering; (2) Transmit Clock Generation; (3) Carrier Synthesizer; (4) Receive AGC; (5) Receive Data Filtering; (6) RF Oscillator Phase Noise; (7) Receive Carrier Selectivity; (8) Carrier Recovery; and (9) Timing Recovery.

  4. Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique

    Science.gov (United States)

    Jordana, M Isabel Canut; Formigó, Daniel Pérez; González, Rodrigo Abreu; Reus, Jeroni Nadal

    2010-01-01

    Aims We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact. Methods Complete ophthalmologic examination and optical coherence tomography (OCT) of the anterior segment were performed. Results Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control. Conclusion Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively. PMID:21151331

  5. Low Profile Mesh Plating for Patella Fractures: Video of a Novel Surgical Technique.

    Science.gov (United States)

    Verbeek, Diederik O; Hickerson, Lindsay E; Warner, Stephen J; Helfet, David L; Lorich, Dean G

    2016-08-01

    Patella fractures can be challenging to treat particularly in the presence of inferior pole comminution. In this video we present a novel surgical technique for the treatment of patella fractures using a small fragment low profile mesh plate. Key points are the surgical exposure with direct visualization of the articular reduction, the preparation of the mesh plate to accommodate patellar anatomy and the augmentation of the construct using Krackow sutures to address inferior pole comminution. Low profile mesh plating allows for multiplanar fixation of patella fractures while avoiding implant and fixation problems related to tension band fixation. Our early experience with this technique is encouraging and it appears that this technique is useful for the treatment of the majority of patella fractures.

  6. Association between Fellowship Training, Surgical Volume, and Laparoscopic Suturing Techniques among Members of the American Association of Gynecologic Laparoscopists

    Directory of Open Access Journals (Sweden)

    Emad Mikhail

    2016-01-01

    Full Text Available Study Objective. To compare surgical volume and techniques including laparoscopic suturing among members of the American Association of Gynecologic Laparoscopists (AAGL according to fellowship training status. Design. A web-based survey was designed using Qualtrics and sent to AAGL members. Results. Minimally invasive gynecologic surgery (FMIGS trained surgeons were more likely to perform more than 8 major conventional laparoscopic cases per month (63% versus 38%, P<0.001, OR [95% CI] = 2.78 [1.54–5.06] and were more likely to perform laparoscopic suturing during these cases (32% versus 16%, P<0.004, OR [95% CI] = 2.44 [1.25–4.71]. The non-fellowship trained (NFT surgeons in private practice were less likely to perform over 8 conventional laparoscopic cases (34% versus 51%, P=0.03, OR [95% CI] = 0.50 [0.25–0.99] and laparoscopic suturing during these cases (13% versus 27%, P=0.01, OR [95% CI] = 0.39 [0.17–0.92] compared to NFT surgeons in academic practice. Conclusion. The surgical volume and utilization of laparoscopic suturing of FMIGS trained surgeons are significantly increased compared to NFT surgeons. Academic practice setting had a positive impact on surgical volume of NFT surgeons but not on FMIGS trained surgeons.

  7. Association between Fellowship Training, Surgical Volume, and Laparoscopic Suturing Techniques among Members of the American Association of Gynecologic Laparoscopists.

    Science.gov (United States)

    Mikhail, Emad; Scott, Lauren; Miladinovic, Branko; Imudia, Anthony N; Hart, Stuart

    2016-01-01

    Study Objective. To compare surgical volume and techniques including laparoscopic suturing among members of the American Association of Gynecologic Laparoscopists (AAGL) according to fellowship training status. Design. A web-based survey was designed using Qualtrics and sent to AAGL members. Results. Minimally invasive gynecologic surgery (FMIGS) trained surgeons were more likely to perform more than 8 major conventional laparoscopic cases per month (63% versus 38%, P < 0.001, OR [95% CI] = 2.78 [1.54-5.06]) and were more likely to perform laparoscopic suturing during these cases (32% versus 16%, P < 0.004, OR [95% CI] = 2.44 [1.25-4.71]). The non-fellowship trained (NFT) surgeons in private practice were less likely to perform over 8 conventional laparoscopic cases (34% versus 51%, P = 0.03, OR [95% CI] = 0.50 [0.25-0.99]) and laparoscopic suturing during these cases (13% versus 27%, P = 0.01, OR [95% CI] = 0.39 [0.17-0.92]) compared to NFT surgeons in academic practice. Conclusion. The surgical volume and utilization of laparoscopic suturing of FMIGS trained surgeons are significantly increased compared to NFT surgeons. Academic practice setting had a positive impact on surgical volume of NFT surgeons but not on FMIGS trained surgeons.

  8. Learning curve of a complex surgical technique: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

    Science.gov (United States)

    Lee, Kong Hwee; Yeo, William; Soeharno, Henry; Yue, Wai Mun

    2014-10-01

    Prospective cohort study. This study aimed to evaluate the learning curve of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Very few studies have evaluated the learning curve of this technically demanding surgery. We intend to evaluate the learning curve of MIS TLIF with a larger sample size and assess surgical competence based not only on operative time but with perioperative variables, clinical and radiologic outcomes, incidence of complications, and patient satisfaction. From 2005 to 2009, the first 90 single-level MIS TLIF, which utilized a consistent technique and spinal instrumentation, performed by a single surgeon at our tertiary institution were studied. Variables studied included operative time, perioperative variables, clinical (Visual Analogue Scores for back and leg pain, Oswestry Disability Index, North American Spine Society Scores for neurogenic symptoms) and radiologic outcomes, incidence of complications and patient rating of expectation met, and the overall result of surgery. The asymptote of the surgeon's learning curve for MIS TLIF was achieved at the 44th case. Comparing the early group of 44 patients to the latter 46, the demographics were similar. For operative parameters, only 3 variables showed differences between the 2 groups: mean operative duration, fluoroscopy duration, and usage of patient-controlled analgesia. At the final follow-up, for clinical outcome parameters, the 2 groups were different in 3 parameters: VAS scores for back, leg pain, and neurogenic symptom scores. For radiologic outcome, both groups showed similar good fusion rates. For complications, none of the MIS TLIF cases were converted to open TLIF intraoperatively. In the early group, there were 3 complications: 1 incidental durotomy and 2 asymptomatic cage migrations; and in the latter group, there was 1 asymptomatic cage migration. In our study, technical proficiency in MIS TLIF was achieved after 44 surgeries, and the latter patients benefited

  9. Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

    NARCIS (Netherlands)

    Houdenhoven, van Mark; Oostrum, van Jeroen M.; Wullink, Gerhard; Hans, Erwin; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert

    2008-01-01

    Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes ope

  10. Priority of surgical treatment techniques of full cartilage defects of knee joint

    Directory of Open Access Journals (Sweden)

    Андрій Вікторович Літовченко

    2015-10-01

    Full Text Available Aim. Surgical treatment of chondromalacia of knee joint cartilage is an actual problem of the modern orthopedics because the means of conservative therapy can be realized at an initial stage only and almost exhausted at the further ones. Imperfections of palliative surgical techniques are the short-term clinical effect and pathogenetic baselessness because surgical procedure is not directed on reparation of cartilaginous tissue. For today there are a lot of transplantation techniques that are used for biological renewal of articular surface with formation of hyaline or at least hyaline-like cartilage. The deep forage of cartilage defect bottom to the medullary canal is a perspective and priority technique.Methods. The results of treatment of 61 patients with chondromalacia of knee joint of 3-4 degree according to R. Outerbridge are the base of the work. 20 patients of every group underwent microfracturization of cartilage defect bottom and subchondral forage of defect zone. 21 patients underwent the deep forage of defect zone of knee joint according to an offered technique.Result. The results of treatment with microfracturization, subchondral forage and deep forage of defect zone indicate the more strong clinical effect especially in the last clinical group where good and satisfactory results ratios in the term of observation 18 and 24 month remain stable.Conclusions. Deep forage of cartilage defects zone is the most adequate reparative technique of the surgical treatment of local knee joint cartilage defects. Owing to this procedure the number of cells of reparative chondrogenesis predecessors is realized

  11. [Surgical techniques in mitral valve diseases. Reconstruction and/or replacement].

    Science.gov (United States)

    Noack, T; Mohr, F-W

    2016-02-01

    Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.

  12. A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

    Science.gov (United States)

    Johnson, S M; Garnett, G M; Woo, R K

    2017-01-01

    Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited

  13. Surgical extrusion technique for clinical crown lengthening: report of three cases.

    Science.gov (United States)

    Kim, Chang-Sung; Choi, Seong-Ho; Chai, Jung-Kiu; Kim, Chong-Kwan; Cho, Kyoo-Sung

    2004-10-01

    Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

  14. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    Science.gov (United States)

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].

    Science.gov (United States)

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

    2006-04-01

    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique.

  16. Improvements in self-administration studies based on changes in skin button type and surgical technique.

    Science.gov (United States)

    Gilbert, Lindsey M; Sgro, Mario P; Modlin, Deah L; Wheat, Nathaniel J; Kallman, Mary J

    2015-01-01

    These studies, ranging in duration from 3 to 8months, evaluated the patency and longevity of the intravenous (IV) self-administration surgical model in male Sprague Dawley rats. Surgeries were categorized and assessed based on the number of catheter and/or skin button repairs required per animal across four separate self-administration studies. Design improvements in skin button types and changes in surgical procedures were chronologically tracked and assessed. Animals were evaluated under a self-administration paradigm in which they were trained to respond for a food reward under a fixed ratio schedule (FR5 or FR10). Animals were then surgically prepared with a femoral catheter and skin button port. Following recovery, animals were returned to food-maintained responding for at least 5 sessions and subsequently trained to respond for injections of a reinforcing drug. Once drug training criteria was established, the effects of vehicle or varying doses of test articles were evaluated. Animals were tested in operant chambers one hour each day 5days a week and the length of each study was recorded. Differences in the number of repairs per study as well as the total number of repairs were tabulated. Study length was directly correlated to the mean number of repairs occurring per study, with study length increasing as the total number of repairs increased. The majority of repairs were skin button-related issues. Multiple combinations of skin button types and surgical techniques were implemented across time to evaluate model efficiency and decrease overall cycle time per study. Initial combinations produced a greater number of repairs on a per study basis. However, the skin button type and surgical technique combination that resulted in the fewest number of total repairs used a lateral incision with a dorsal biopsy punch. The combination of improvements in skin button type and surgical techniques drastically decreased the number of surgical repairs required per study

  17. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    Science.gov (United States)

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch.

    Science.gov (United States)

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles

    2016-07-15

    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    Science.gov (United States)

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

  20. Choice of a General Anesthesia Technique in the Surgical Treatment of Postinfarct Left Ventricular Aneurysms

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    N. A. Karpun

    2005-01-01

    Full Text Available Objective. To choose the optimum technique of general anesthesia in the surgical treatment of patients with postinfarct left ventricular aneurysms (PLVA.Materials and methods. Fifty-four patients operated on for PLVA were examined. They were divided into 4 groups according to the basic technique of general anesthesia: 1 intravenous anesthesia based on propofol and fentanyl; 2 inhalation sevoflurane anesthesia with fentanyl enhancement of the analgesic component; 3 inhalation isoflurane anesthesia with fentanyl enhancement of the analgesic component; 4 general anesthesia in combination with epidural blockade. Central hemodynamics was investigated by the thermodilution technique and the perioperative period was also studied.Results and discussion. None of the general anesthesia techniques affected the development of perioperative complications. However, with decreased myocardial reserves, high thoracic epidural anesthesia should be applied with caution as it causes a significant desympathization, which may lead to impairments of the autoregulatory mechanisms of coronary blood flow and aggravate existing contractile disorders. Intravenous and inhalation anesthesia techniques provide a fair hemodynamic stability at all stages of surgical treatment. Inhalation anesthesia has a number of advantages: less cost and the possibility of rapid activation of patients in the early postoperative period.

  1. Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

    Science.gov (United States)

    Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P

    2017-06-01

    Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX(®), Meshlab(®), Netfabb(®) and Blender(®). Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Surgical techniques for the treatment of ankyloglossia in children: a case series.

    Science.gov (United States)

    Junqueira, Marina Azevedo; Cunha, Nayara Nery Oliveira; Costa e Silva, Lidiane Lucas; Araújo, Leandro Borges; Moretti, Ana Beatriz Silveira; Couto Filho, Carlos Eduardo Gomes; Sakai, Vivien Thiemy

    2014-06-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  3. Surgical techniques for the treatment of ankyloglossia in children: a case series

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    Marina Azevedo JUNQUEIRA

    2014-06-01

    Full Text Available This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  4. Surgical Removal of Neglected Soft Tissue Foreign Bodies by Needle-Guided Technique

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    Ali Ebrahimi

    2012-12-01

    Full Text Available Introduction: The phenomenon of neglected foreign bodies is a significant cause of morbidity in soft tissue injuries and may present to dermatologists as delayed wound healing, localized cellulitis and inflammation, abscess formation, or foreign body sensation. Localization and removal of neglected soft tissue foreign bodies (STFBs is complex due to possible inflammation, indurations, granulated tissue, and fibrotic scar. This paper describes a simple method for the quick localization and (surgical removal of neglected STFBs using two 23-gauge needles without ultrasonographic or fluoroscopic guidance.  Materials and Methods: A technique based on the use of two 23-gauge needles was used in 41 neglected STFBs in order to achieve proper localization and fixation of foreign bodies during surgery.  Results:    Surgical removal was successful in 38 of 41 neglected STFBs (ranging from 2–13mm in diameter.  Conclusion: The cross-needle-guided technique is an office-based procedure that allows the successful surgical removal of STFBs using minimal soft tissue exploration and dissection via proper localization, fixation, and propulsion of the foreign body toward the surface of the skin.

  5. Minimally invasive selective osteotomy of the knee: A new surgical technique.

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    Leon, H O; Blanco, C E; Guthrie, T B

    2001-05-01

    We present a simple surgical technique created by the authors to address degenerative chondral lesions of the knee and its application in a limited prospective case series. The technique assumes the concept of beneficial epiphyseal changes caused by disruption of the subchondral bone in improving symptoms, as with drilling, microfracture, periarticular osteotomy, and other invasive procedures. Minimally invasive selective osteotomy (MISO) is an expansion of the arthroscopic treatment of the knee, specifically targeting symptomatic lesions with minimal additional trauma and cost, while avoiding disruption of the articular surface of the subchondral bone. The technique involves a mimimal access approach with selective saw cuts placed with a 1-cm oscillating blade parallel to the joint surface 1 to 1.5 cm deep to identified lesions. The technique does not address malalignment but can address lesions not addressed by classic osteotomies and, as such, may be combined with other corrective alignment procedures as necessary. We present the results of MISO of the knee in a case series of 62 outpatients carried out at the Orthopaedic Division of the Clinical and Surgical Hermanos Ameijeiras Hospital in Havana, Cuba. At 2-year follow-up, there was improvement of symptoms without significant complications.

  6. A Novel Surgical Technique for Augmented Corticotomy-Assisted Orthodontics: Bone Grafting With Periosteum.

    Science.gov (United States)

    Ma, Zhi-Gui; Yang, Chi; Xie, Qian-Yang; Xi, Qian-Yang; Ye, Zhou-Xi; Ye, Zhou-Xie; Zhang, Shan-Yong; Abdelrehem, Ahmed

    2016-01-01

    To introduce grafting fixed with the periosteum (dumpling technique) as an alternative surgical technique for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. Eleven patients (9 women, 2 men; mean age, 21.4 yr) with a thin alveolus or alveolar defect in the lower anterior region by clinical and radiographic examination underwent an augmented corticotomy using the new dumpling technique. Cone-beam computerized tomography was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0) and 1 week (T1) and 6 months (T2) after the bone-augmentation procedure. Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare variables at each time point. No severe postsurgical complications occurred in any patient. The mean alveolar bone thickness of the labial plate increased from T0 to T1 (P .05). No significant differences were found in root length of the lower anterior teeth at these 3 time points (P > .05). In this preliminary study, the dumpling technique for augmented corticotomy-assisted surgical orthodontics showed alveolar bone augmentation by increasing the vertical alveolar height and the horizontal bone thickness in the labial aspect of the anterior mandibular area. However, long-term follow-up is necessary. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  7. All Optical Signal-Processing Techniques Utilizing Four Wave Mixing

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    Refat Kibria

    2015-02-01

    Full Text Available Four Wave Mixing (FWM based optical signal-processing techniques are reviewed. The use of FWM in arithmetical operation like subtraction, wavelength conversion and pattern recognition are three key parts discussed in this paper after a brief introduction on FWM and its comparison with other nonlinear mixings. Two different approaches to achieve correlation are discussed, as well as a novel technique to realize all optical subtraction of two optical signals.

  8. Surgical techniques and curative effect of carotid endarterectomy for carotid artery stenosis

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    Min HAN

    2014-02-01

    Full Text Available Objective To investigate the surgical techniques of carotid endarterectomy (CEA for treating carotid artery stenosis, in order to improve the surgical efficacy and reduce intraoperative adverse events and complications after operation. Methods Retrospective analysis was carried out on surgical data of 53 cases who were performed CEA from October 2010 to October 2013 in Department of Neurosurgery in Tianjin Huanhu Hospital. There were 39 males and 14 females, aged from 40 to 78 years old and mean age (60.34 ± 8.92 years old; the course of disease was from 2 d to 4 years. Twenty-six cases were diagnosed as right carotid stenosis, 15 cases left carotid stenosis and 12 cases double-sided carotid stenosis. Among all of those cases, 35 cases were diagnosed as moderate stenosis (30%-69%, 16 cases severe stenosis (70%-99% , and 2 cases complete occlusion. Results Among 53 patients, 50 patients underwent CEA; 2 cases underwent CEA and aneurysm clipping; one case underwent stent removal surgery and CEA because restenosis was found after carotid artery stenting (CAS. Postoperative neck CTA and fMRI showed good morphology of carotid artery, fluent blood flow and improved cerebral perfusion after operation. All of those patients were followed up for 3 to 24 months. One case died of myocardial infarction; 2 cases appeared skin numbness on the operating side of the neck, and the symptom disappeared 3 months later; one case appeared hoarseness after operation; 3 cases experienced mild transient ischemic attack (TIA and the symptom disappeared 2 months later. No case of stroke was found. Conclusions CEA is a safe and effective surgical approach to treat carotid stenosis. Correct and reasonable choices of the surgical indications and skilled surgical technique are the key to ensure the success of operation and to improve efficacy of the therapy. doi:10.3969/j.issn.1672-6731.2014.02.006Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v14n2a6

  9. Endoscopic Surgical Treatment of Lumbar Synovial Cyst: Detailed Account of Surgical Technique and Report of 11 Consecutive Patients.

    Science.gov (United States)

    Oertel, Joachim M; Burkhardt, Benedikt W

    2017-07-01

    Lumbar synovial cysts (LSCs) are an uncommon cause of radiculopathy and back pain. Open surgical treatment is associated with extensive bone resection and muscle trauma. The endoscopic tubular-assisted LSC resection has not been described in detail. Here the authors assessed the effectiveness of this technique for LSC resection. Eleven patients (4 female and 7 male patients) were operated on via an ipsilateral approach for resection of LSC using an endoscopic tubular retractor system. Preoperative magnetic resonance imaging was evaluated for signs of degeneration and instability. At follow-up a standardized questionnaire including the Oswestry Disability Index and functional outcome according to MacNab criteria was conducted. Additionally, a personal examination with particular reference to back and leg pain was performed. The mean follow-up was 10.5 months. Preoperatively, spondylolisthesis grade 1 was noted in 4 patients (36.4%). Ten patients had bilateral facet joint effusion (90.9%). At follow-up 10 patients reported being free of leg pain (90.9%), eight patients reported no back pain (72.7%), ten patients had full motor strength (90.9%), and 9 patients had no sensory deficit (81.8%). Nine patients reported an excellent or a good clinical outcome (81.8%). The mean Oswestry Disability Index was 4.7%. None of the patients developed new mechanical low back pain or required subsequent fusion procedure. The endoscopic tubular-assisted procedure is a safe way to treat LSC. It offers complete resection of LSC and achieves good clinical outcome by preserving muscle and ligamentous and bony structures, which prevents delayed instability. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Technique of wheat breeding for efficiently utilizing soil nutrient elements

    Institute of Scientific and Technical Information of China (English)

    李继云; 刘秀娣; 周伟; 孙建华; 童依平; 刘文杰; 李振声; 王培田; 姚树江

    1995-01-01

    500 wheat varieties were grown and screened,and 18 of them with better characters identified inthe low phosphorus,low zinc,low boron soil and in contrast with the control(appilied with N,P,Zn andB).A few varieties showed able to efficiently utilize P,Zn or B in soil,and it has been demonstrated by theanalysis that their roots can secrete more organic acids making the soil pH around the roots decrease.Six or-ganic acids in the roots of four representative varieties were analysed,their contents were of difference amongthe varieties and had a positive correlation with the yield of the varieties in low nutrition soil.All theabove-mentioned provided the scientific basis of crop breeding for efficient utilization of soil nutritions.

  11. Computer Processing of Visual Evoked Potentials Utilizing Digital Filtering Techniques

    OpenAIRE

    Vigorito, A.; Stephens, G.; Louis, H; Cinotti, A.; Michelson, L.; E. Stephens

    1981-01-01

    Recording of the VER (Visual Evoked Response) and the ERG (ElectroRetinoGram) in our laboratory is done with stimulation, using a fixed checkerboard pattern or a reversible checkerboard pattern. Questionable data frames are eliminated from the signal averaging process by means of a semiautomatic electronic analyzer or by means of a computer program. This special computer software, with flexible format constraints, is utilized on an off-line basis to remove residual artifacts and noise from av...

  12. Removal of Supernumerary Teeth Utilizing a Computer-Aided Design/Computer-Aided Manufacturing Surgical Guide.

    Science.gov (United States)

    Jo, Chanwoo; Bae, Doohwan; Choi, Byungho; Kim, Jihun

    2017-05-01

    Supernumerary teeth need to be removed because they can cause various complications. Caution is needed because their removal can cause damage to permanent teeth or tooth germs in the local vicinity. Surgical guides have recently been used in maxillofacial surgery. Because surgical guides are designed through preoperative analysis by computer-aided design software and fabricated using a 3-dimensional printer applying computer-aided manufacturing technology, they increase the accuracy and predictability of surgery. This report describes 2 cases of removal of a mesiodens-1 from a child and 1 from an adolescent-using a surgical guide; these would have been difficult to remove with conventional surgical methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis.

    Science.gov (United States)

    Rubino, M; Civani, A; Pagani, D; Sansone, V

    2013-10-01

    We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

  14. Chondroblastoma of the femoral head disrupting the articular cartilage. Description of a novel surgical technique.

    Science.gov (United States)

    Givissis, Panagiotis; Agathangelidis, Filon; Christodoulou, Evangelos; Christodoulou, Anastasios

    2012-06-01

    Chondroblastoma is a rare benign tumour. Involvement of the femoral head may often lead to a delayed diagnosis. We present the case of a 15-year-old patient with right hip pain which was first attributed to adductor tendinitis. Following aggravation of the symptoms, thorough investigation including a CT-guided biopsy, revealed the diagnosis of chondroblastoma of the femoral head. Removal of the lesion based on the techniques described in literature was not possible, mainly because the articular cartilage was breached. A novel surgical technique was used in order to address the rare location and behaviour of the tumour. This technique offered the patient pain relief and return to his previous every day and sports activities. No recurrence was seen at two years follow-up.

  15. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

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    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  16. Surgical approach to right colon cancer: From open technique to robot. State of art.

    Science.gov (United States)

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  17. Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique

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    M Isabel Canut Jordana

    2010-11-01

    Full Text Available M Isabel Canut Jordana1, Daniel Pérez Formigó1, Rodrigo Abreu González2, Jeroni Nadal Reus11Barraquer Ophthalmology Centre, Barcelona, Spain; 2University Hospital of La Candelaria, Tenerife, SpainAims: We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact.Methods: Complete ophthalmologic examination and optical coherence tomography (OCT of the anterior segment were performed.Results: Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control.Conclusion: Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively.Keywords: pigmentary glaucoma, intraocular lens, optical coherence tomography, laser

  18. Liver hydatidosis: reasoned indications of surgical treatment. Comparison between conservative and radical techniques Retrospective study.

    Science.gov (United States)

    Salamone, Giuseppe; Tutino, Roberta; Atzeni, Jenny; Licari, Leo; Falco, Nicola; Orlando, Giuseppina; Gulotta, Gaspare

    2014-01-01

    Liver hydatidosis is a focal benign parasitic disease that still cause high rate of morbidity particularly in the Mediterranean area. A retrospective study comparing conservative and radical techniques in a General and Urgent Surgery operative unit was carried out in order to find signs of its surgical treatment. A total of 50 patients, 24 men and 26 women, who experienced a surgical treatment from 2000 to 2011, participated, and through the Fisher's Exact Test characteristics of the cysts, post-operative complications and relapse were compared. As a result, 29 patients undertook conservative surgery, while 21 radical surgery. There was a relationship between characteristics of the cysts and the technique chosen, (pcase (p<0.14). In conclusion, in a non hepato-bilio-pancreatic center a radical surgery including liver resection is suggested for left lobe's cysts, while a conservative technique tends to be more effective for right lobe's cysts mainly if complex. Consequently, patients with complicated presentation could explain why conservative treatment causes higher rate of morbidity.

  19. A modified minimally invasive technique for the surgical management of large trichobezoars

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    Amit Javed

    2013-01-01

    Full Text Available Background: Trichobezoar which were traditionally managed by open surgical retrieval are now often managed by minimally invasive surgical approach. Removal of a large trichobezoar by laparoscopy, however, needs an incision (usually 4-5 cm in size for specimen removal and has the risk of intra-peritoneal spillage of hair and inspissated secretions. Materials and Methods : The present paper describes a modified laparoscopy-assisted technique with temporary gastrocutaneopexy for the effective removal of a large trichobezoar using a camera port and a 4-5 cm incision (which is similar to that needed for specimen removal during laparoscopy. Results: Three patients with large trichobezoar were managed with the described technique. The average duration of surgery was 45 (30-60 min and the intraoperative blood loss was minimal. There was no peritoneal spillage and the trichobezoar could be retrieved through a 4-5 cm incision in all patients. All had an uneventful recovery and at a median followup of 6 months had excellent cosmetic and functional results. Conclusion: The described technique is a minimally invasive alternative for trichobezoar removal. There is no risk of peritoneal contamination and the technical ease and short operative time in addition to an incision limited to size required for the specimen removal, makes it an attractive option.

  20. Natural resource inventory for urban planning utilizing remote sensing techniques

    Science.gov (United States)

    Foster, K. E.; Mackey, P. F.; Bonham, C. D.

    1972-01-01

    Remote sensing techniques were applied to the lower Pantano Wash area to acquire data for planning an ecological balance between the expanding Tucson metropolitan area and its environment. The types and distribution of vegetation are discussed along with the hydrologic aspects of the Wash.

  1. Conduction Disorders in Continuous Versus Interrupted Suturing Technique in Ventricular Septal Defect Surgical Repair

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    Gholampour-Dehaki

    2016-01-01

    Full Text Available Background Ventricular septal defects (VSD is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery. Objectives This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair. Patients and Methods Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6% and interrupted suturing technique in group B patients (n = 68, 29.4%. Results The most common concomitant congenital anomaly was Tetralogy of Fallot (27.3%. Twenty-four (10.4% patients had intraoperative cardiac arrhythmia, including 19 (8.2% transient and 5 (2.2 % permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7% and 5 patients (2.2%, respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB, complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%, 42 (18.2%, 29 (12.6%, and 5 patients (2.2%, respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001, while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06. Conclusions In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure.

  2. Advanced characterization of microscopic kidney biopsies utilizing image analysis techniques.

    Science.gov (United States)

    Goudas, Theodosios; Doukas, Charalampos; Chatziioannou, Aristotle; Maglogiannis, Ilias

    2012-01-01

    Correct annotation and identification of salient regions in Kidney biopsy images can provide an estimation of pathogenesis in obstructive nephropathy. This paper presents a tool for the automatic or manual segmentation of such regions along with methodology for their characterization in terms of the exhibited pathology. The proposed implementation is based on custom code written in Java and the utilization of open source tools (i.e. RapidMiner, ImageJ). The corresponding implementation details along with the initial evaluation of the proposed integrated system are also presented in the paper.

  3. Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation.

    Science.gov (United States)

    Anchieta, M V M; Salles, F A; Cassaro, B D; Quaresma, M M; Santos, B F O

    2016-10-01

    Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time. The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics-Materialise (Belgium)-software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press. The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material's exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon's discretion. This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.

  4. Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques.

    Science.gov (United States)

    Garg, A K; Morales, M J

    1998-01-01

    In the event of moderate to severe mandibular bone resorption posterior to the mental foramen, repositioning of the inferior alveolar nerve provides a greater amount of available bone for implant placement and reduces the risk of nerve injury. While neural paresthesia may initially occur, this altered sensation generally resolves spontaneously. Alveolar nerve repositioning may be possible in cases in which other procedures cannot be performed due to the extent of atrophy of the posterior mandibular alveolar crest. This article presents the surgical technique to achieve this objective.

  5. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls.

    Science.gov (United States)

    Barg, Alexej; Knupp, Markus; Henninger, Heath B; Zwicky, Lukas; Hintermann, Beat

    2012-12-01

    Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.

  6. A Case of Microstomia Subsequent to Toxic Epidermal Necrolysis Surgically Treated by Simple Technique

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    Takanobu Mashiko, MD

    2013-06-01

    Full Text Available Summary: Toxic epidermal necrolysis (TEN is a rare but severe adverse dermatitis that is an autoimmune reaction to drugs such as nonsteroidal anti-inflammatory drugs. TEN most severely affects the mucous membranes including the mouth and could develop into microstomia; however, microstomia in relation to TEN has rarely been reported in the literature. We describe an adult female patient who developed microstomia due to scar contracture of the bilateral oral commissures subsequent to TEN and was successfully treated by a simple surgical technique consisting solely of transverse incision of the commissure and longitudinal closure.

  7. A novel computer-assisted surgical technique for revision total knee arthroplasty.

    Science.gov (United States)

    Marcacci, Maurilio; Nofrini, Laura; Iacono, Francesco; Di Martino, Alessandro; Bignozzi, Simone; Lo Presti, Mirco

    2007-12-01

    Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the intervention, and provides the surgeon with tools to analyse and modify the proposed plan and to accurately reproduce it on the patient. Although we performed few cases with this navigated procedure, early results obtained demonstrated to be very promising.

  8. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique.

    Science.gov (United States)

    Koulouvaris, Panagiotis; Stafylas, Kosmas; Sculco, Thomas; Xenakis, Theodore

    2008-10-01

    Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.

  9. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development.

    Science.gov (United States)

    Deprés-Tremblay, Gabrielle; Chevrier, Anik; Snow, Martyn; Hurtig, Mark B; Rodeo, Scott; Buschmann, Michael D

    2016-12-01

    Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Minor modification of Millard's surgical technique for correction of complete unilateral cleft lip

    Directory of Open Access Journals (Sweden)

    Coen Pramono D

    2010-12-01

    Full Text Available Background: A surgical technique for correction of complete unilateral cleft lip was done using a minor modification of Millard’s surgical technique. The purpose of this modification is to achieve a good anatomical form of columelia, nostril cill and the position of nasal tip. Purpose: This article presents the correction of the complete cleft lip which was done initially by correction of the slanted columella followed by correction of the nostril sill which was done before the sequence of closing the lip crevice. Case: Correction of a case with complete unilateral cleft lip on a fifteen year old girl using modification of Millard’s surgical technique is presented. Case Management: Rotation incision in the philtrum region was made as introduced by Millard to make a triangular flap. The triangular flap was contralaterally rotated and pulled into the direction of cleft to achieve a normal position of the columella and nasal tip. The lateral side of the ala was incised in circular form down to the alar base and straight through to the direction of cleft formed an alar flap which consisted of ala, clefted and slanted nasal base tissue. The tip of the triangular flap was trimmed and approximated to the alar flap to form a new the nostril sill. Adjustment of the size of the nostrill sill size was achieved during the approximation of those two flaps. The nasal base was built during approximation of the lateral and the medial segment flap or philtrum region and the base of new nostril sill. Surgical correction of the complete unilateral cleft lip including correction of the nostrill sill using approximation of triangular flap and the alar flap was achieved. Conclusion: This surgical technique with minor modification of Millard’s surgical technique can be used for correction of the complete unilateral cleft lip with extremely slanted columella and nasal tip to form thenostril sill.Latar belakang: Koreksi celah bibir komplit satu sisi telah

  11. Organism Isolation in Corneal Ulcer- Utility of Different Techniques

    OpenAIRE

    M Thapa; A.K. Sharma; D.N. Shah; S KC; Shrestha, S.

    2012-01-01

    Introduction: Various techniques are available for isolation of microorganism in cases of microbial keratitis including conventional methods of scraping, re-scraping inoculation in different media and corneal biopsy. Methods: This was a cross sectional descriptive study conducted from February 2002 to July 2003. A total of 161 eyes of corneal ulcers were evaluated with scraping inoculation. Re-scraping and corneal biopsy were performed in those cases which did not grow any organism in t...

  12. Waste printed circuit board recycling techniques and product utilization

    Energy Technology Data Exchange (ETDEWEB)

    Hadi, Pejman; Xu, Meng [Chemical and Biomolecular Engineering Department, Hong Kong University of Science and Technology, Clear Water Bay Road, Hong Kong Special Administrative Region (Hong Kong); Lin, Carol S.K. [School of Energy and Environment, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong Special Administrative Region (Hong Kong); Hui, Chi-Wai [Chemical and Biomolecular Engineering Department, Hong Kong University of Science and Technology, Clear Water Bay Road, Hong Kong Special Administrative Region (Hong Kong); McKay, Gordon, E-mail: kemckayg@ust.hk [Chemical and Biomolecular Engineering Department, Hong Kong University of Science and Technology, Clear Water Bay Road, Hong Kong Special Administrative Region (Hong Kong); Division of Sustainable Development, College of Science, Engineering and Technology, Hamad Bin Khalifa University, Qatar Foundation, Doha (Qatar)

    2015-02-11

    Highlights: • There is a major environmental issue about the printed circuit boards throughout the world. • Different physical and chemical recycling techniques have been reviewed. • Nonmetallic fraction of PCBs is the unwanted face of this waste stream. • Several applications of the nonmetallic fraction of waste PCBs have been introduced. - Abstract: E-waste, in particular waste PCBs, represents a rapidly growing disposal problem worldwide. The vast diversity of highly toxic materials for landfill disposal and the potential of heavy metal vapors and brominated dioxin emissions in the case of incineration render these two waste management technologies inappropriate. Also, the shipment of these toxic wastes to certain areas of the world for eco-unfriendly “recycling” has recently generated a major public outcry. Consequently, waste PCB recycling should be adopted by the environmental communities as an ultimate goal. This article reviews the recent trends and developments in PCB waste recycling techniques, including both physical and chemical recycling. It is concluded that the physical recycling techniques, which efficiently separate the metallic and nonmetallic fractions of waste PCBs, offer the most promising gateways for the environmentally-benign recycling of this waste. Moreover, although the reclaimed metallic fraction has gained more attention due to its high value, the application of the nonmetallic fraction has been neglected in most cases. Hence, several proposed applications of this fraction have been comprehensively examined.

  13. Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

    Science.gov (United States)

    Woo, Russell K; Skarsgard, Erik D

    2015-06-01

    Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. [Medical resource utilization and allocation in Japan--evaluation of surgical expenditures].

    Science.gov (United States)

    Hiki, Yoshiki

    2004-05-01

    We evaluated the appropriateness of medical cost allocation in Japan from the global aspect especially the percentage of the national budget for medical cost to gross national product (GDP). Base on OECD-Health Data in 2002, Japan was ranked high in the world in terms of medical services but was ranked the second lowest in terms of the percentage of medical cost to GDP (7.6%) among G7 advanced countries. In addition, at surgical departments, allocated medical cost is mostly used for surgical supplies and instruments, and only negligibly for doctor's fee. Unless this situation is improved, the surgical department in Japan will decline. Improvement measures should be taken without delay.

  15. Three axis vector atomic magnetometer utilizing polarimetric technique.

    Science.gov (United States)

    Pradhan, Swarupananda

    2016-09-01

    The three axis vector magnetic field measurement based on the interaction of a single elliptically polarized light beam with an atomic system is described. The magnetic field direction dependent atomic responses are extracted by the polarimetric detection in combination with laser frequency modulation and magnetic field modulation techniques. The magnetometer geometry offers additional critical requirements like compact size and large dynamic range for space application. Further, the three axis magnetic field is measured using only the reflected signal (one polarization component) from the polarimeter and thus can be easily expanded to make spatial array of detectors and/or high sensitivity field gradient measurement as required for biomedical application.

  16. Three axis vector atomic magnetometer utilizing polarimetric technique

    CERN Document Server

    Pradhan, Swarupananda

    2016-01-01

    The three axis magnetic field measurement based on the interaction of a single elliptically polarized light beam with an atomic system is described. The magnetic field direction dependent atomic responses are extracted by the polarimetric detection in combination with laser frequency modulation and magnetic field modulation techniques. The magnetometer offers additional critical requirements like compact size and large dynamic range for space application. Further, the three axis magnetic field is measured using only reflected signal from the polarimeter, thus can be easily expanded to make spatial array of detectors or / and high sensitivity field gradient measurement as required for biomedical application.

  17. Three axis vector atomic magnetometer utilizing polarimetric technique

    Energy Technology Data Exchange (ETDEWEB)

    Pradhan, Swarupananda, E-mail: spradhan@barc.gov.in, E-mail: pradhans75@gmail.com [Laser and Plasma Technology Division, Bhabha Atomic Research Centre, Mumbai 400085, India and Homi Bhabha National Institute, Department of Atomic Energy, Mumbai 400094 (India)

    2016-09-15

    The three axis vector magnetic field measurement based on the interaction of a single elliptically polarized light beam with an atomic system is described. The magnetic field direction dependent atomic responses are extracted by the polarimetric detection in combination with laser frequency modulation and magnetic field modulation techniques. The magnetometer geometry offers additional critical requirements like compact size and large dynamic range for space application. Further, the three axis magnetic field is measured using only the reflected signal (one polarization component) from the polarimeter and thus can be easily expanded to make spatial array of detectors and/or high sensitivity field gradient measurement as required for biomedical application.

  18. Activity analysis: measurement of the effectiveness of surgical training and operative technique.

    Science.gov (United States)

    Shepherd, J P; Brickley, M

    1992-11-01

    All surgical procedures are characterised by a sequence of steps and instrument changes. Although surgical efficiency and training in operative technique closely relate to this process, few studies have attempted to analyse it quantitatively. Because efficiency is particularly important in day surgery and lower third molar removal is a high-volume procedure, the need for which is responsible for particularly long waiting-lists in almost all UK health regions, this operation was selected for evaluation. A series of 80 consecutive procedures, carried out for 43 day-stay patients under general anaesthesia by seven junior staff (senior house officers and registrars: 39 procedures) and four senior staff (senior registrars and consultants: 41 procedures) were analysed. Median operating time for procedures which required retraction of periosteum was 9.5 min (range 2.7-23.3 min). Where these steps were necessary, median time for incision was 25 s (range 10-90 s); for retraction of periosteum, 79 s (range 5-340 s); for bone removal, 118 s (range 10-380 s); for tooth excision, 131 s (range 10-900 s); for debridement, 74 s (range 5-270 s); and for suture, 144 s (range 25-320 s). Junior surgeons could be differentiated from senior surgeons on the basis of omission, repetition and duration of these steps. Juniors omitted retraction of periosteum in 10% of procedures (seniors 23%) and suture in 13% (seniors 32%). Juniors repeated steps in 47% of operations; seniors, 14%. Junior surgeons took significantly more time than senior surgeons for incision, bone removal and tooth excision. No significant differences between junior and senior surgeons were found in relation to the incidence of altered lingual and labial sensation at 7 days. It was concluded that activity analysis may be a useful measure of the effectiveness of surgical training and the efficiency of operative technique.

  19. New surgical technique to correct urovagina improves the fertility of dairy cows.

    Science.gov (United States)

    González-Martín, J V; Astiz, S; Elvira, L; López-Gatius, F

    2008-02-01

    Several surgical techniques have been proposed for the treatment of urovagina as a major cause of infertility in cows. However, so far no technique seems to be successful in all cases. Given that an incompetent or damaged constrictor vestibuli muscle is a feature of cows with urovagina, we hypothesized that surgical correction of urovagina by cerclage of the vestibulovaginal junction under the vaginal wall cranial to the urethral opening would prevent cranial flow of urine and improve fertility. Our study was performed on 39 non-pregnant lactating Holstein-Friesian cows suffering urovagina, with a vaginal content of urine exceeding 100mL and with evident incompetence of the constrictor vestibuli muscle. Cows were randomly assigned to a Control (untreated cows, n=20) or Experimental (n=19) group. An encircling polydioxanone suture was placed in the vaginal wall at the vestibulovaginal junction to create a vestibulovaginal cerclage in the Experimental cows. Surgery was observed to resolve urovagina in 17 (89.5%) of the 19 treated cows. Pregnancy was recorded in 7/20 (35%) and 14/19 (74%) cows in the Control and Experimental groups, respectively. Using logistic regression procedures and based on the odds ratio, we determined that cows undergoing surgical correction of urovagina were 5.2 times more likely to become pregnant than untreated cows (P=0.015). Our results suggest that vestibulovaginal junction cerclage prevents the cranial flow of urine and improves the function of the constrictor vestibuli muscle in cows suffering urovagina. They also indicate that, under these conditions, urovagina correction may dramatically increase fertility.

  20. Waste printed circuit board recycling techniques and product utilization.

    Science.gov (United States)

    Hadi, Pejman; Xu, Meng; Lin, Carol S K; Hui, Chi-Wai; McKay, Gordon

    2015-01-01

    E-waste, in particular waste PCBs, represents a rapidly growing disposal problem worldwide. The vast diversity of highly toxic materials for landfill disposal and the potential of heavy metal vapors and brominated dioxin emissions in the case of incineration render these two waste management technologies inappropriate. Also, the shipment of these toxic wastes to certain areas of the world for eco-unfriendly "recycling" has recently generated a major public outcry. Consequently, waste PCB recycling should be adopted by the environmental communities as an ultimate goal. This article reviews the recent trends and developments in PCB waste recycling techniques, including both physical and chemical recycling. It is concluded that the physical recycling techniques, which efficiently separate the metallic and nonmetallic fractions of waste PCBs, offer the most promising gateways for the environmentally-benign recycling of this waste. Moreover, although the reclaimed metallic fraction has gained more attention due to its high value, the application of the nonmetallic fraction has been neglected in most cases. Hence, several proposed applications of this fraction have been comprehensively examined. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results

    Directory of Open Access Journals (Sweden)

    Tova Lifshitz

    2012-01-01

    Full Text Available We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

  2. Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results

    Science.gov (United States)

    Lifshitz, Tova; Levy, Jaime; Kratz, Assaf; Belfair, Nadav; Tsumi, Erez

    2012-01-01

    We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up. PMID:23202402

  3. Animal models in bariatric surgery--a review of the surgical techniques and postsurgical physiology.

    Science.gov (United States)

    Rao, Raghavendra S; Rao, Venkatesh; Kini, Subhash

    2010-09-01

    Bariatric surgery is considered the most effective current treatment for morbid obesity. Since the first publication of an article by Kremen, Linner, and Nelson, many experiments have been performed using animal models. The initial experiments used only malabsorptive procedures like intestinal bypass which have largely been abandoned now. These experimental models have been used to assess feasibility and safety as well as to refine techniques particular to each procedure. We will discuss the surgical techniques and the postsurgical physiology of the four major current bariatric procedures (namely, Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, and biliopancreatic diversion). We have also reviewed the anatomy and physiology of animal models. We have reviewed the literature and presented it such that it would be a reference to an investigator interested in animal experiments in bariatric surgery. Experimental animal models are further divided into two categories: large mammals that include dogs, cats, rabbits, and pig and small mammals that include rats and mice.

  4. Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices.

    Science.gov (United States)

    Torricelli, Fabio C; Marchini, Giovanni S; Pedro, Renato N; Monga, Manoj

    2016-12-01

    The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

  5. The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study

    Science.gov (United States)

    Severino, Marco; Rastelli, Claudio; Bernardi, Sara; Caruso, Silvia; Galli, Massimo; Lamazza, Luca; Di Paolo, Carlo

    2017-01-01

    Background The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. Material and Methods 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. Results The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. Conclusions In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized. Key words:Implant primary stability, resonance frequency analysis, implant site preparation. PMID:28160577

  6. Surgical treatment of iliotibial band friction syndrome with the mesh technique.

    Science.gov (United States)

    Sangkaew, Chanchit

    2007-05-01

    Iliotibial band friction syndrome is an overuse injury caused by repetitive friction of the iliotibial band across the lateral femoral epicondyle. It has been reported to afflict long-distance runners, cyclists and military personnel. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a corticosteroid injection. If the conservative treatment is unsuccessful, surgery has been advocated. This report describes a new surgical technique to release the pressure on the lateral femoral epicondyle in a patient who failed the nonoperative efforts. The surgery was performed with the knee held in 30 degrees of flexion and consisted of multiple 2 mm long incisions across the fiber of the iliotibial band covering the lateral femoral epicondyle. There were six incisions, each of which was 4 mm apart. The incisions were spontaneously enlarged and changed to several punctured wounds (mesh appearance) by the tension of iliotibial band, resulted in relaxing the tight iliotibial band over the lateral femoral epicondyle. At the final follow-up 2 years after surgery the patient was pain free and could resume his previous occupational activities. The surgical result of the present technique is encouraging.

  7. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-09-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  8. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-01-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  9. Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience.

    Science.gov (United States)

    ShanYong, Zhang; Liu, Huan; Yang, Chi; Zhang, XiaoHu; Abdelrehem, Ahmed; Zheng, JiSi; Jiao, ZiXian; Chen, MinJie; Qiu, YaTing

    2015-07-01

    To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  10. Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique?

    Science.gov (United States)

    Siminelakis, Stavros; Kakourou, Alexandra; Batistatou, Alexandra; Sismanidis, Stelios; Ntoulia, Alexandra; Tsakiridis, Kosmas; Syminelaki, Theodora; Apostolakis, Eleftherios; Tsiouda, Theodora; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Dryllis, Georgios; Machairiotis, Nikolaos; Mpakas, Andreas; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Background Cardiac myxoma is a benign neoplasm that represents the most prevalent primary tumor of the heart. If not treated with the right surgical technique recurrence occurs. Aim of our study is to present our surgical approach and the histology of the tumors resected. Methods All patients, except for one, underwent extracorporeal circulation and mild hypothermia, right atrial or both atrial incision and excision of the fossa ovalis, followed by prosthetic patch suturing. All specimens were submitted for microscopic evaluation (haematoxylin-eosin). We contacted personally each patient and asked them to complete a standardized questionnaire, concerning their peri-operative characteristics. Results Six cases were “active” myxomas, 3 were “mildly active” and 3 were “inactive”. “Normal differentiation” was seen in 6, “medium” in 1 and “poor” in 5 cases. In our series there were no recurrences recorded during the follow-up period. Conclusions The ideal approach, according to our experience is right atrial or both atrial incision as described by Shumacker and King, with excision of the fossa ovalis and the surrounding tissues and closure with a pericardial patch. Such a technique provides an excellent long-term survival in these patients. PMID:24672697

  11. Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique.

    Science.gov (United States)

    Dayer, Romain; Ceroni, Dimitri; Lascombes, Pierre

    2014-07-01

    Untreated growing patients with congenital scoliosis and fused ribs will develop finally thoracic insufficiency syndrome. The technique of expansion thoracoplasty with implantation of a vertical expandable prosthetic titanium rib (VEPTR) was introduced initially to treat these children. This article attempts to provide an overview of the surgical technique of opening-wedge thoracostomy and VEPTR instrumentation in children with congenital thoracic scoliosis and fused ribs. Our modification of the surgical approach using a posterior midline incision rather than the modified thoracotomy incision initially described could potentially help to diminish wound dehiscence and secondary infection, while preserving a more acceptable esthetic appearance of the back. Vertical expandable prosthetic titanium rib-based treatments should be undertaken only with a good knowledge of its numerous specific complications. Every aspect of the treatment should be oriented to minimize these complications. At the same time it should be kept in mind that the ultimate step of this long-term fusionless treatment strategy will be a technically demanding spine fusion.

  12. Laparoscopic vasectomy in African savannah elephant (Loxodonta africana); surgical technique and results.

    Science.gov (United States)

    Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine

    2013-12-01

    Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications.

  13. A new surgical technique for perfusion of the epididymal fat pad in situ in rats.

    Science.gov (United States)

    Dauchy, Robert T; Blask, David E; Sauer, Leonard A

    2003-05-01

    We developed a new surgical technique for preparing the epididymal fat pad in rats for perfusion that maintains continuous blood flow. Epididymal fat pads can be perfused in situ using donor blood from either fed or fasted (24 h) animals. During the course of all perfusions, arterial and venous blood pH and gases were monitored and recorded. Total fatty acid (TFA) uptake and release by the epididymal fat depot was measured for the control and treatment perfusions; glycerol release was measured in all control perfusions. After addition of 14C-glucose to the donor-blood perfusate, all radioactivity appeared in the fat pad effluent blood; none appeared in the host systemic blood, and this finding indicated that the epididymal fat pad was separated from the host vasculature during perfusion in situ. The results presented here demonstrate excellent tissue function and metabolism, as a result of the perfusion technique. Our new surgical method for in vivo investigation of the epididymal fat pad, an important white adipose tissue, likely will have many applications in the study of lipid transport and metabolism, hyperlipidemia, obesity, and cancer cachexia.

  14. Laparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success.

    Science.gov (United States)

    Scheib, Stacey A; Tanner, Edward; Green, Isabel C; Fader, Amanda N

    2014-01-01

    The objectives of this review were to analyze the literature describing the benefits of minimally invasive gynecologic surgery in obese women, to examine the physiologic considerations associated with obesity, and to describe surgical techniques that will enable surgeons to perform laparoscopy and robotic surgery successfully in obese patients. The Medline database was reviewed for all articles published in the English language between 1993 and 2013 containing the search terms "gynecologic laparoscopy" "laparoscopy," "minimally invasive surgery and obesity," "obesity," and "robotic surgery." The incidence of obesity is increasing in the United States, and in particular morbid obesity in women. Obesity is associated with a wide range of comorbid conditions that may affect perioperative outcomes including hypertension, atherosclerosis, angina, obstructive sleep apnea, and diabetes mellitus. In obese patients, laparoscopy or robotic surgery, compared with laparotomy, is associated with a shorter hospital stay, less postoperative pain, and fewer wound complications. Specific intra-abdominal access and trocar positioning techniques, as well as anesthetic maneuvers, improve the likelihood of success of laparoscopy in women with central adiposity. Performing gynecologic laparoscopy in the morbidly obese is no longer rare. Increases in the heaviest weight categories involve changes in clinical practice patterns. With comprehensive and thoughtful preoperative and surgical planning, minimally invasive gynecologic surgery may be performed safely and is of particular benefit in obese patients. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  15. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period.

    Science.gov (United States)

    Pippi Salle, J L; Sayed, S; Salle, A; Bagli, D; Farhat, W; Koyle, M; Lorenzo, A J

    2016-02-01

    The optimal treatment of proximal hypospadias remains controversial. Several techniques have been described, but the best approach remains unsettled. To evaluate and compare the complication rates of proximal hypospadias with and without ventral curvature (VC), according to three different surgical techniques: tubularized incised plate (TIP) uretroplasty, dorsal inlay graft TIP (DIG), and staged preputial repair (SR). It was hypothesized that SR performs better than TIP and DIG for proximal hypospadias. Single-center, retrospective chart review of all patients with primary proximal hypospadias reconstructed between 2003 and 2013. The DIG was selectively employed in cases with narrow urethral plate (UP) and deficient spongiosum. Extensive urethral plate (UP) mobilization (UPM), dorsal plication (DP) and/or deep transverse incisions of tunica albuginea (DTITA) were selectively performed when attempting to spare transecting the UP. Division of UP and SR was favored in cases with severe VC (>50°), which was often concurrently managed with DTITA if intrinsic curvature was present. For SR, tubularization of the graft was performed 6 months later. A total of 140 patients were included. Tubularized incised plate (TIP), DIG, and SR techniques were performed in 57, 23, and 60 patients, respectively. The TIP and DIG techniques achieved similar success rates, although DIG was performed in cases of narrow and spongiosum-deficient plates. Reoperation rates with TIP and DIG techniques was 52.6% and 52.1% (NS). Urethro-cutaneous fistulas were seen in 31.5% and 13% of TIP and DIG techniques, respectively. Staged repair accomplished better results than both TIP and DIG techniques, despite being performed in the most unfavorable cases (reoperation rate 28%). After technical modifications, the DIG technique achieved similar outcomes of SR. Proximal hypospadias remains challenging, regardless of the technique utilized for its repair. Urethro-cutaneous fistulas were more commonly seen

  16. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002.

    Science.gov (United States)

    Babalola, Ebenezer O; Bharucha, Adil E; Melton, L Joseph; Schleck, Cathy D; Zinsmeister, Alan R; Klingele, Christopher J; Gebhart, John B

    2008-09-01

    To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

  17. Single-Incision Laparoscopic Cholecystectomy - can we Afford that? Cost Comparison of Different Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Matyja Maciej

    2014-04-01

    Full Text Available One of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision laparoscopic cholecystectomy, SILC and ‘no -port’ SILC. Material and methods. We conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20, SILC (n=20 and no-port SILC (n=20. These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The ‘no- port’ SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated port Results. The average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groups Conclusions. Currently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single

  18. A description of two surgical and anesthetic management techniques used for a patient with fibrodysplasia ossificans progressiva.

    Science.gov (United States)

    Wadenya, Rose; Fulcher, Megan; Grunwald, Tal; Nussbaum, Burton; Grunwald, Zvi

    2010-01-01

    Fibrodysplasia ossificans progressiva (FOP) is a rare and debilitating genetic disorder of skeletal malformations and progressive heterotopic ossification. Flare-ups are episodic, with bone formation in skeletal muscle and connective tissue leading to ankylosis of major joints of the axial and appendicular skeleton. This report outlines the management of a patient with FOP who had ankylosis of the temporomandibular joint and progressive ossification of the neck structures. The patient underwent two different surgical and anesthetic procedures within a 10-year period to manage his oral pain. The authors compare the surgical techniques, osteotomy versus the more conservative buccal approach, anesthesia techniques, and conventional intubation versus sedated fiberoptic intubation. This report emphasizes the importance of a less invasive surgical technique and an appropriate anesthetic management that reduces the risks, cost, and morbidity associated with routine surgical management of patients with FOP.

  19. Surgical treatment for scoliosis extending to main thoracic spine by key-vertebral-screws technique (KVST)

    Institute of Scientific and Technical Information of China (English)

    LI Ming; ZHU Xiao-dong; Cheung KM; Luk KD

    2007-01-01

    Objective:To introduce a key-vertebral-screws technique(KVST) in the surgical treatment of scoliosis extending to main thoracic levels,and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique.Methods:Seventeen consecutive patients with scoliosis extending to main thoracic spine,who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility,surgical correction rate,fulcrum bending correction index (FBCI) in main thoracic curves.Universal Spine System (USS) instrumentation was used in 15 cases,Monarch in another 2 cases.The severity of the curves was measured by Cobb's method using RadWork 6.0 software.Preoperative standing AP radiographs,preoperative fulcrum bending anterioposterior (AP) radiographs,postoperative standing AP radiographs,and most recent follow-up standing AP radiographs for spine were measured and recorded.All the data were analyzed with two-sample paired t-test by Origin 7.0 software.Results:Infection and neurological complications were not noted.No major complications were found.Just one case had some axial back pain,which got a full recovery from physiotherapy for 2 weeks.In the X-ray,there was an average correction of 71.5% of the fused main thoracic curves,which had no significant lose of correction in final follow-up.For the whole fused main thoracic curves,the fulcrum bending flexibility were lower to operation correction rate (P=0.013).The average FBCI was 123%.From the data,the more rigid curves (especially fulcrum bending flexibility<50%),the more correction rate operation could get,compared with fulcrum bending flexibility.Conclusion:(1) KVST is a good method in the surgical treatment of thoracic scoliosis,which can get satisfying result with lower medical cost.(2) Fulcrum bending flexibility is lower than operative correction rate by KVST in main thoracic curves (P<0.05).In

  20. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

    OpenAIRE

    Evdokia Chasioti; Mohammed Sayed; Howard Drew

    2015-01-01

    The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sin...

  1. A modified surgical technique in the management of eyelid burns: a case series

    Directory of Open Access Journals (Sweden)

    Sun Shudong

    2011-08-01

    Full Text Available Abstract Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.

  2. Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    Shou-sen WANG

    2012-05-01

    Full Text Available Objective  To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods  A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results  VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions  The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.

  3. The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients.

    Science.gov (United States)

    Benis, Szabolcs; Goubau, Jean F; Mermuys, Koen; Van Hoonacker, Petrus; Berghs, Bart; Kerckhove, Diederick; Vanmierlo, Bert

    2017-02-01

    Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

  4. Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation.

    Science.gov (United States)

    Vass, Gabor; Mohos, Gabor; Bere, Zsofia; Ivan, Laszlo; Varga, Janos; Piffko, Jozsef; Rovo, Laszlo

    2016-12-01

    Nasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique-as much as the uniqueness of each case allowed it-based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire. Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test. Based on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4-6 months, compared with the preoperative scores. In our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

  5. Sleeve Gastrectomy Postoperative Hemorrhage is Linked to Type-2 Diabetes and Not to Surgical Technique.

    Science.gov (United States)

    Spivak, Hadar; Azran, Carmil; Spectre, Galia; Lidermann, Galina; Blumenfeld, Orit

    2017-05-18

    The degree, prevalence, and risk factors linked to sleeve gastrectomy (SG) postoperative hemorrhage (POH) have not been fully defined. An analysis was conducted on a prospectively collected database of 394 consecutive primary SGs performed in a single practice from January 2014 to December 2015. (1) acute POH, defined by red blood cell (RBC) transfusion and/or re-exploration; (2) subclinical POH, defined by postoperative hemoglobin drop (HgbD) >one standard deviation above mean. Variables tested included three surgical techniques: normal stapling (n = 137), "tight" stapling, (n = 142) and oversewing, (n = 115); age; gender; body mass index (BMI); co-morbidities; and elevated postoperative systolic blood pressure. Acute POH occurred in 11/394 patients (2.8%) and subclinical POH (HgbD > 2.2 g/dL) was detected in 27/312 (7.7%) of patients with available HgbD data. Acute POH patients had a mean HgbD of 5.43 ± 1.40 g/dl (p < 0.001) reflecting approximately 38.6% ± 10.0% of total blood volume. No difference in prevalence of POH was observed for the different surgical techniques. Compared with non-bleeders (n = 312), acute and subclinical POH patients (n = 38) had 52.6 vs. 27.2% prevalence type-2 diabetes (T2D) and 60.5 vs. 40.1% prevalence of dyslipidemia and higher mean preoperative hemoglobin 14.3 ± 11 vs.13.5 ± 1.2 (p < 0.05 for all). On regression analysis, only T2D (OR 2.6; 95% CI 1.2-5.6) and higher level of preoperative hemoglobin (OR 1.7; 95% CI 1.3-2.4) were independent risk factors for POH. In this study, acute and subclinical POH were primarily linked to T2D and not to surgical techniques. Special consideration is recommended for patients with T2D undergoing SG.

  6. Technical note: A new surgical technique for ovariohysterectomy during early pregnancy in beef heifers.

    Science.gov (United States)

    McLean, K J; Dahlen, C R; Borowicz, P P; Reynolds, L P; Crosswhite, M R; Neville, B W; Walden, S D; Caton, J S

    2016-12-01

    We hypothesized that a standing flank ovariohysterectomy procedure could be developed in beef heifers that would provide high quality tissues for addressing critical questions during early pregnancy, while concomitantly keeping livestock stewardship a high priority. To test the hypothesis, we: 1) developed a standing flank ovariohysterectomy procedure for use in beef heifers, and 2) implemented this procedure in a cohort of heifers up to d 50 of pregnancy for tissue collections, documentation of post-surgical recovery, and assessment of feedlot finishing performance. Ovariectomy and cesarean section protocols are well established in research and veterinary medicine and were used as starting points for procedural development. Crossbred Angus heifers ( = 46; ∼ 15 mo of age; BW = 362.3 ± 34.7 kg) were used to develop this new surgical tissue collection technique. Heifers were subjected to the 5-d CO-Synch + CIDR estrous synchronization protocol so ovariohysterectomy occurred at d 16, 22, 28, 34, 40, and 50 of gestation. Key aspects of the standing flank ovariohysterectomy technique included 1) use of local anesthetic for a standing flank incision, 2) locate the uterine and ovarian arteries via blind palpation and ligate them through the broad ligament via an improved clinch knot, 3) cut the ovaries and uterus free from the broad ligament, 4) ligate the cervix and uterine branch of the vaginal artery, and 5) cut through the cervix and remove the reproductive tract. Surgical times, from skin incision to placement of the last suture, were influenced ( = 0.04) by stage of gestation. In pregnant heifers, time decreased from d 22 (120.0 ± 12.0 min) of gestation to d 40 (79.5 ± 12.0 min) of gestation; then increased at d 50 (90.5 ± 14.7 min) of gestation. Using this procedure, we obtained uterine, placental, and embryo/fetal tissues that had experienced limited hypoxia, little or no trauma, and thus were excellent quality for scientific study. All heifers recovered

  7. Esophagogastric pathology in morbid obese patient: preoperative diagnosis and influence in the selection of surgical technique

    Directory of Open Access Journals (Sweden)

    Sergio Estévez-Fernández

    2015-07-01

    Full Text Available Introduction: Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy. The influence of the fibrogastroscopy (FGS findings in the therapeutic approach is analyzed. Patients and methods: A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy. Results: Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky's ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients. The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases. The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87 and the body mass index > 50 kg/m² (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4. Conclusions: The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery.

  8. A comparison of two anesthesia methods for the surgical removal of maxillary third molars: PSA nerve block technique vs. local infiltration technique

    OpenAIRE

    Al-Delayme, Ra´ed MA.

    2014-01-01

    Objectives: The purpose of this study was to compare the effect of PSA block injection with infiltration technique regarding local anesthesia for surgical extraction of upper third molar. Material and Methods: A prospective, intra individual, single-blind randomized controlled trial was designed to study the severity of pain during injection and after surgical extraction of the bilaterally and symmetrically similar upper third molar in a total of 53 patients, in addition to evaluating the nee...

  9. Ex-vivo partial nephrectomy after living donor nephrectomy: Surgical technique for expanding kidney donor pool

    Directory of Open Access Journals (Sweden)

    Yaw A Nyame

    2017-01-01

    Full Text Available Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature.

  10. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    Science.gov (United States)

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  11. Various techniques for the surgical treatment of common bile duct stones: a meta review.

    Science.gov (United States)

    Shojaiefard, Abolfazl; Esmaeilzadeh, Majid; Ghafouri, Ali; Mehrabi, Arianeb

    2009-01-01

    Common bile duct stones (CBDSs) may occur in up to 3%-14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal), or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure) are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.

  12. Various Techniques for the Surgical Treatment of Common Bile Duct Stones: A Meta Review

    Directory of Open Access Journals (Sweden)

    Abolfazl Shojaiefard

    2009-01-01

    Full Text Available Common bile duct stones (CBDSs may occur in up to 3%–14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal, or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.

  13. A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

    Directory of Open Access Journals (Sweden)

    Rohit Singh

    2015-12-01

    Full Text Available Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  14. [Surgical Techniques for Patella Replacement in Cases of Deficient Bone Stock in Revision TKA].

    Science.gov (United States)

    Ritschl, P; Machacek, F; Strehn, L; Kloiber, J

    2015-06-01

    The patella replacement in revision surgery is a challenge especially in cases of unsufficient bone stock. Depending on the extent of the bone defect, the following videos demonstrate different approaches: Video 1: bone sparing removal of the patella implant: onlay-type patella implants. Video 2: complete cortical bone rim of the patella, residual thickness between 6 to 10 mm: biconvex patella implant. Video 3 and 4: small defects of the cortical bone rim of the patella, residual thickness 1 to 5 mm (patella shell): gull-wing osteotomy, patella bone grafting techniques. Video 5: partial necrosis/defect of the patella shell with incomplete cortical bone rim: porous tantalum patella prosthesis. On account of the various surgical options for different bone defects of the patella, patellectomy and pure patelloplasty should be avoided to prevent functional shortcomings. Georg Thieme Verlag KG Stuttgart · New York.

  15. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Directory of Open Access Journals (Sweden)

    Miettinen Simo

    2012-09-01

    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  16. Minimally invasive cardiac surgery in the adult: surgical instruments, equipment, and techniques.

    Science.gov (United States)

    Kitamura, M; Uwabe, K; Hirota, J; Kawai, A; Endo, M; Koyanagi, H

    1998-09-01

    To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.

  17. Evaluation of a modified surgical technique to correct urine pooling in cows.

    Science.gov (United States)

    Prado, T M; Schumacher, J; Hayden, S S; Donnell, R L; Rohrbach, B W

    2007-06-01

    Various surgical techniques to correct urovagina in cows describe creating a mucosal extension from the urethral orifice to the labia; however, a fistula often forms in the mucosal extension. The objective of the present study was to determine if the incidence of fistula formation could be decreased by covering transposed submucosal tissue on the dorsal aspect of the urethral extension with a mucosal graft. Cows in both the control group (19) and the experimental group (19) received a modified McKinnon technique of urethral extension; cows in the experimental group also had a sheet of mucosa, obtained from the dorsal aspect of the vestibule, grafted to submucosa exposed during creation of the urethral extension. During histological examination of the biopsy of the graft and its recipient site (harvested 1 week after surgery), neither inosculation nor revascularization of the graft was evident in any sample. Fourteen of 19 (74%) cows in the control group and 10 of 19 (53%) cows in the experimental group developed a fistula in the extension (P=0.18). We concluded that application of a mucosal graft to the subcutaneous tissue exposed to the vestibule using the McKinnon technique of creating a urethral extension was of little or no benefit in preventing the formation of a fistula in the extension. Furthermore, during evaluation of the extensions, digital palpation alone was often insufficient for detection of a fistula.

  18. Surgical technique, fusion rates, and planovalgus foot deformity correction with naviculocuneiform fusion.

    Science.gov (United States)

    Ajis, Adam; Geary, Nicholas

    2014-03-01

    Arthrodesis of the naviculocuneiform (NC) joints is not a common procedure, as it is perceived by many to be less reliable or less predictable than arthrodesis of proximal or distal joints in the medial column. There is a subset of patients with planovalgus feet, cavovarus feet, and degenerative arthritis who also have an apex of deformity at the NC joints in whom fusion is indicated. The surgical technique, fusion rates, and deformity correction data for NC fusion in planovalgus feet are evaluated in this report. Twenty-eight patients (33 feet) who underwent surgery between October 2008 and November 2012 were identified who had NC fusion as their only arthrodesis procedure. Medical records and radiographs were reviewed, and time to union was calculated. Twenty patients from that group underwent NC fusion for symptomatic planovalgus feet, and their preoperative and last postoperative weight-bearing radiographs were reviewed and compared for deformity correction. All patients were operated on by the senior author or a senior foot and ankle trainee during fellowship using the same surgical technique, and all patients followed a standardized postoperative rehabilitation protocol. Mean time to union for all 33 NC fusions was 21.7 ± 2 weeks (mean ± SEM). One patient underwent revision for nonunion, resulting in an arthrodesis rate of 97%. For NC fusions in those with planovalgus feet, an improvement in mean lateral talus-first metatarsal angle (Meary's line) from 12.3 ± 1.3 degrees to 5.2 ± 1.2 degrees (P treatment for their condition. NC fusion was a safe and predictable procedure for any of its indications, with a fusion rate similar to that of other joints in the foot albeit with a longer time to union. For patients with symptomatic and flexible planovalgus feet, NC fusion resulted in deformity correction in multiple planes and good symptomatic relief. Level IV, retrospective case series.

  19. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

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    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  20. Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rola Muhammed Shadid

    2014-01-01

    Full Text Available Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability.

  1. Utility of melatonin to treat surgical stress after major vascular surgery--a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    registered. Blood samples were collected preoperatively and at 5 min, 6 hr and 24 hr after clamp removal or after re-circulation of the first leg and the samples were analyzed for malondialdehyde (MDA), ascorbic acid (AA), dehydroascorbic acid (DHA), and interleukin-6 (IL-6). Troponin I (TpI) and C...... with melatonin intravenously up to 60 mg in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical...

  2. Surgical Correction of Rigid Equinovarus Contracture Utilizing Extensive Soft Tissue Release.

    Science.gov (United States)

    Reeves, Christopher L; Shane, Amber M; Zappasodi, Francesca; Payne, Trevor

    2016-01-01

    Although deforming contractures of the lower extremities after acute cerebrovascular events are well documented in the literature, there is limited literature regarding specific surgical considerations for the correction of these deformities, which are nonosseus in nature. The equinovarus foot, regardless of its origin, is a challenging pathologic condition for the foot and ankle surgeon. It is critical to have a firm understanding of the cause and symptoms behind an equinovarus deformity before treatment. The clinical presentation is discussed with special attention to deformities in adults with rigid equinovarus deformities after cerebrovascular-related accidents or peripheral ischemic events. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Surgical Rehabilitation Techniques in Children with Poor Prognosis Short Bowel Syndrome.

    Science.gov (United States)

    Dore, Mariela; Junco, Paloma Triana; Andres, Ane M; Sánchez-Galán, Alba; Amesty, Maria Virginia; Ramos, Esther; Prieto, Gerardo; Hernandez, Francisco; Lopez Santamaria, Manuel

    2016-02-01

    Intestinal failure (IF) requires a multidisciplinary management based on nutritional support, surgical and medical rehabilitation, and transplantation. The aim of this study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty, Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel syndrome (SBS) and poor prognosis due to complex abdominal pathology. We performed a single-center retrospective study of patients with IF evaluated for intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an SRT. Nonparametric tests were used for statistical analysis.A total of 205 patients (107 males/98 females) with mean age of 25 ± 7 months were assessed for IF. A total of 433 laparotomies were performed on 130 patients including intestinal resection, enteroplasties, adhesiolysis, and transit reconstruction. SRT were performed in 22 patients: 12 enteroplasties, 8 STEPs, and 4 Bianchi procedures. All patients were parenteral nutrition (PN) dependent with different stages of liver disease: mild (13), moderate (5), and severe (4). The adaptation rate for patients who underwent enteroplasty, STEP, and Bianchi were 70, 63, and 25%, respectively, although the techniques are not comparable. Overall, intestinal adaptation was achieved in nine (41%) patients, and four (18%) patients showed significant reduction of PN needs. One child did not respond to SRT and did not meet transplantation criteria. The remaining eight (36%) patients were included on the waiting list for transplant: four were transplanted, two are still on the waiting list, and two died. Better outcomes were observed in milder cases of liver disease (mild 77%, moderate 40%, severe 25%) (p bowel (p > 0.05). One patient required reoperation after a Bianchi procedure due to intestinal ischemia and six needed further re-STEP or adhesiolysis procedure several months later. The median follow-up was 62 (3-135) months. Overall mortality was

  4. The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis

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    Ozlem Ural

    2016-01-01

    Full Text Available Aims: To evaluate the utility of margin-reflex distance (MRD as an alternative to levator function (LF in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male, levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.

  5. The Utilization of the Monte Carlo Technique for Rational Drug Discovery.

    Science.gov (United States)

    Toropova, Mariya A; Raška, Ivan; Toropov, Andrey A; Rašková, Mária

    2016-01-01

    Quantitative structure - activity relationships (QSARs) are built up for three endpoints (i) blood-brain barrier permeability; (ii) butyrylcholinesterase (BChE) inhibitory activity; and (iii) for biological effect of antibacterial drugs. The models are based on utilization of the Monte Carlo technique. The CORAL software available on the Internet has been utilized for the calculations. The principles of validation of models together with principles of selection of potential therapeutic agents are suggested. An original version of the definition for the domain of applicability as well as the mechanistic interpretation of model calculated with the Monte Carlo technique are described. Advantages and disadvantages of the utilized approach are discussed.

  6. J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

    Science.gov (United States)

    Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

    2014-11-01

    Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

  7. Brain Tumor Interface Dissection Technique with Surgical Blade from Laboratory to Neurosurgical Operating Room.

    Science.gov (United States)

    Rai, Survendra Kumar R; Mancarella, Cristina; Goel, Atul H

    2017-04-01

    Ideal tumor resection requires brain/spinal cord tumor interface separation in perfect and precise surgical planes within a few micrometers for radical tumor resection and maximum normal tissue preservation. Despite the availability of several dissection techniques, the search for additional alternatives and an ideal technique continues. We evaluated the feasibility and advantages of dissection using a No. 15-blade scalpel in special brain tumor surgery situations. We developed a leaf model wherein its outer layer is progressively dissected from its inner skeleton using a scalpel. An additional model used was a tomato wherein its skin was peeled off its pulp using the same technique. We developed an inexpensive leaf model. A scalpel knife was used in a microneurosurgical setting, and the leaf's outer layer is peeled off. The technique is then used in an operating room setup where surgery on extra-axial tumors like meningiomas and intra-axial brain and spinal cord tumors is done. A No. 15 scalpel was used for dissection between the layers of the Peltophorum pterocarpum leaf model. This dissection method was compared with other neurosurgical dissecting tools. We dissected 120-μm thick leaves into 2 layers with removal of an 18- to 55-μm thick layer. Leaving behind a transparent layer was possible using a No. 15 blade scalpel. Similarly, it was possible to preserve a 35- to 40-μm thick arachnoid layer that separated a meningioma from the underlying brain parenchyma. A scalpel with a sharp edge could be used to perform precise and fine dissection. The scalpel deserves to occupy a place of pride as a dissecting tool in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

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    Ana K. Islam

    2016-01-01

    Full Text Available Background. Acceptance of dual kidney transplantation (DKT has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001. For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2% and acute rejection (20.7 versus 22.4% were equivalent (p = ns. A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p<0.01 was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns. Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  9. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique.

    Science.gov (United States)

    Islam, Ana K; Knight, Richard J; Mayer, Wesley A; Hollander, Adam B; Patel, Samir; Teeter, Larry D; Graviss, Edward A; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H; Gaber, A Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p < 0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  10. CT enterography: Principles, technique and utility in Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Huprich, James E. [Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (United States)], E-mail: huprich@mayo.edu; Fletcher, J.G. [Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (United States)], E-mail: fletcher.joel@mayo.edu

    2009-03-15

    CT enterography is a modification of conventional CT technique optimized for the evaluation of small bowel. This technique utilizes multidetector scanners with high spatial and temporal resolution; multiplanar reconstructions; and large volumes of enteric contrast to provide bowel distension. This article discusses the essential principles of the exam and its use in the evaluation of Crohn's disease of the small bowel.

  11. Does the standard vs piggyback surgical technique affect the development of early acute renal failure after orthotopic liver transplantation?

    Science.gov (United States)

    Cabezuelo, J B; Ramirez, P; Acosta, F; Torres, D; Sansano, T; Pons, J A; Bru, M; Montoya, M; Rios, A; Sánchez Bueno, F; Robles, R; Parrilla, P

    2003-08-01

    The objective of this study was to evaluate the effect of the surgical technique on postoperative renal function during the first week after liver transplantation (OLT). We performed a retrospective study of 184 consecutive OLT. Criteria for acute renal failure were: serum creatinine >1.5 mg/dL, an increase by 50% in the baseline serum creatinine, or oliguria requiring renal replacement therapy. The distribution of patients according to the surgical technique was: standard (n=84), venovenous bypass (n=20), and piggyback (n=80). Other variables analyzed were: intraoperative requirement for blood products, treatment with adrenergic agonists, intraoperative complications, and postreperfusion syndrome. Univariate analysis showed the following parameters to be significantly related to postoperative renal failure: intraoperative fresh frozen plasma and cryoprecipitate requirements, intraoperative complications, postreperfusion syndrome, need for noradrenaline or dobutamine, standard surgical technique versus piggyback (39% vs 18%, P20 U cryoprecipitate requirement (OR=1.04, P=.01). In conclusion, compared with the piggyback technique, the standard surgical technique appears to be an independent risk factor for postoperative acute renal failure. When venovenous bypass is used in patients who do not tolerate trial clamping of inferior vena cava, it does not reduce the incidence of postoperative renal failure. Finally, the piggyback technique significantly reduces the probability of acute renal failure after liver transplantation.

  12. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc......Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose...... in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical situations....

  13. Metatarsal Reconstruction with a Fibular Osteocutaneous Flap: A Novel Approach Utilizing Virtual Surgical Planning

    Directory of Open Access Journals (Sweden)

    Hugo St. Hilaire, MD, DDS

    2014-11-01

    Full Text Available Summary: Craniofacial reconstruction remains the main application for virtual surgical planning (VSP. We present a case in which this technology was applied to reconstruct a bony defect of the first metatarsal bone from a gunshot injury. VSP was used to facilitate a 1-stage reconstruction with a fibular osteocutaneous flap. A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone. Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators. Successful reconstruction of the metatarsal bone was achieved with excellent functional outcomes. We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

  14. "Bird-Wing" abdominal phalloplasty: A novel surgical technique for penile reconstruction

    Directory of Open Access Journals (Sweden)

    Minu Bajpai

    2013-01-01

    Full Text Available Aim: To describe a technique of phalloplasty that is devoid of donor site scarring and suitable for urethral inlay and penile prosthesis in subsequent stages in cases of aphallia. Materials and Methods: Four patients with various disorders of sex development with 46 XY and severe penile deficiency, including one with complete androgen insensitivity syndrome who was initially raised as female, have been operated using a "Bird Wing" lower abdominal skin crease incision. Results: The patients′ age ranged from 6 to 17 years with preoperative stretched penile lengths between 1 and 2.5 cm. Phallic sizes between 7.5 and 12.5 cm was achieved leaving the donor site unremarkable with lower abdominal skin crease linear scar and excellent postoperative recovery. Conclusions: This phalloplasty technique can be utilized as a definitive procedure in many situations of penile insufficiency. Subsequent stages of urethral repair and insertion of penile prosthesis can be easily added.

  15. Percutaneous elastic intramedullary nailing of metacarpal fractures: Surgical technique and clinical results study

    Directory of Open Access Journals (Sweden)

    Farook Mohamed Z

    2011-07-01

    Full Text Available Abstract Background We reviewed our results and complications of using a pre-bent 1.6 mm Kirschner wire (K-wire for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity. Methods A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimeters and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5 mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. Results We studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days. All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks. At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. Conclusions With this simple and minimally invasive technique performed as day-case surgery, all patients were able to start mobilisation immediately. The general outcome was good hand function with few complications.

  16. [Improvised surgical technique for elderly women with advanced breast cancer accompanied by extensive skin invasion].

    Science.gov (United States)

    Hayashi, Keiko; Kosaka, Yoshimasa; Sengoku, Norihiko; Enomoto, Takumo; Kajita, Sabine; Kuranami, Masaru; Watanabe, Masahiko

    2012-11-01

    Patient 1 was a 63-year-old woman whose chief complaint was a mass in the left breast. Physical examination revealed an inverted left nipple, a very large mass on the anterior aspect of the sternum, and erythema. Because the tumor had directly invaded the sternum, T4cN3M0, stage IIIC breast cancer was diagnosed. The patient preoperatively received chemotherapy with 6 courses of FEC100 (5-fluorouracil, epirubicin, and cyclophosphamide) and 5 courses of nanoparticle albumin -bound paclitaxel (260 mg/m2), which enabled a partial response. Patient 2 was an 83-year-old woman whose chief complaint was a mass in the upper internal and external quadrants of the right breast measuring 20×15 cm and erythema. The mass was accompanied by enlarged right axillary lymph nodes(T4bN1M0, stage IIIB breast cancer). Both patients underwent core needle biopsy of the skin and breast masses. They were both diagnosed with invasive, lobular, triple-negative breast cancer (estrogen receptor negative, progesterone receptor negative, human epidermal growth factor receptor 2 negative). The surgical resection line was drawn to include the extensive skin invasion, and mastectomy and axillary dissection were performed. Skin grafting was scheduled but the retromammary space on the healthy side was dissected to the anterior border of the latissimus dorsi muscle, and the skin of the healthy side was used to cover the defect on the affected side. Consequently, the pendulous breast on the healthy side was elevated. This surgical technique provided an excellent aesthetic outcome without any skin problems, because autologous skin was used to fill the defect. Radiotherapy could subsequently be administered as scheduled. This procedure may be useful for elderly patients.

  17. Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

    Directory of Open Access Journals (Sweden)

    Amit Mishra

    2016-02-01

    Full Text Available Abstract Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years. Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3. Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730. Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium.

  18. Comparison of two surgical techniques for creating an acute myocardial infarct in rats

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    Luiz Guilherme Achcar Capriglione

    2014-12-01

    Full Text Available Objective: To perform a comparative assessment of two surgical techniques that are used creating an acute myocardial infarc by occluding the left anterior descending coronary artery in order to generate rats with a left ventricular ejection fraction of less than 40%. Methods: The study was completely randomized and comprised 89 halothane-anaesthetised rats, which were divided into three groups. The control group (SHAM comprised fourteen rats, whose left anterior descending coronary artery was not occluded. Group 1 (G1: comprised by 35 endotracheally intubated and mechanically ventilated rats, whose left anterior descending coronary artery was occluded. Group 2 (G2: comprised 40 rats being manually ventilated using a nasal respirator whose left anterior descending coronary artery was occluded. Other differences between the two techniques include the method of performing the thoracotomy and removing the pericardium in order to expose the heart, and the use of different methods and suture types for closing the thorax. Seven days after surgery, the cardiac function of all surviving rats was determined by echocardiography. Results: No rats SHAM group had progressed to death or had left ventricular ejection fraction less than 40%. Nine of the 16 surviving G1 rats (56.3% and six of the 20 surviving G2 rats (30% had a left ventricular ejection fraction of less than 40%. Conclusion: The results indicate a tendency of the technique used in G1 to be better than in G2. This improvement is probably due to the greater duration of the open thorax, which reduces the pressure over time from the surgeon, allowing occlusion of left anterior descending coronary artery with higher accuracy.

  19. Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

    Science.gov (United States)

    Mishra, Amit; Jain, Anil; Hinduja, Manish; Wadhawa, Vivek; Patel, Ramesh; Vaidhya, Nikunj; Rodricks, Dayesh; Patel, Hardik

    2016-01-01

    Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium. PMID:27074270

  20. Surgical treatment of varicose vein using the tumescent technique of local anesthesia

    Directory of Open Access Journals (Sweden)

    Bjelanović Zoran

    2011-01-01

    Full Text Available Background/Aim. Tumescent local anesthesia (TLA is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein. Methods. Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%. Results. Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days. Conclusion. Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component

  1. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF).

    Science.gov (United States)

    Jerosch, Jörg; Schunck, Jochem; Liebsch, Dietrich; Filler, Tim

    2004-09-01

    The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch

  2. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity.

    Science.gov (United States)

    Giordano, Flavio; Zicca, Anna; Barba, Carmen; Guerrini, Renzo; Genitori, Lorenzo

    2017-04-01

    Indications for vagus nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)-related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50-60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The vagus nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0-2.0 mA; 500 μs pulse width; 20-30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the vagus nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3-8%), and vagus nerve injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late injury of the nerve. Late complications due to nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal nerve. A true late paralysis of the left vocal cord

  3. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement

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    Weill, A.; Kobaiter, H.; Chiras, J. [Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France)

    1998-02-01

    The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief. (orig.) With 6 figs., 2 tabs., 20 refs.

  4. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis.

    Science.gov (United States)

    Pretell, Juan; Ortega, Javier; García-Rayo, Ramón; Resines, Carlos

    2009-10-01

    This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15-84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48-77) to 91 (range 76-95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60-99) to 13 (range 0-70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal "Z" lengthening of the fascia lata appears to be a good alternative for treatment of this condition.

  5. The endoscopic endonasal approach to the Meckel's cave tumors: surgical technique and indications.

    Science.gov (United States)

    Jouanneau, Emmanuel; Simon, Emile; Jacquesson, Timothée; Sindou, Marc; Tringali, Stéphane; Messerer, Mahmoud; Berhouma, Moncef

    2014-12-01

    Many benign and malignant tumors as well as other inflammatory or vascular diseases may be located in the areas of Meckel's cave or the cavernous sinus. Except for typical features such as for meningiomas, imaging may not by itself be sufficient to choose the best therapeutic option. Thus, even though modern therapy (chemotherapy, radiotherapy, or radiosurgery) dramatically reduces the field of surgery in this challenging location, there is still some place for surgical biopsy or tumor removal in selected cases. Until recently, the microscopic subtemporal extradural approach with or without orbitozygomatic removal was classically used to approach Meckel's cave but with a non-negligible morbidity. Percutaneous biopsy using the Hartel technique has been developed for biopsy of such tumors but may fail in the case of firm tumors, and additionally it is not appropriate for anterior parasellar tumors. With the development of endoscopy, the endonasal route now represents an interesting alternative approach to Meckel's cave as well as the cavernous sinus. Through our experience, we describe the modus operandi and discuss what should be the appropriate indication of the use of the endonasal endoscopic approach for Meckel's cave disease in the armamentarium of the skull base surgeon.

  6. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis

    Science.gov (United States)

    Ortega, Javier; García-Rayo, Ramón; Resines, Carlos

    2009-01-01

    This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15–84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48–77) to 91 (range 76–95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60–99) to 13 (range 0–70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal “Z” lengthening of the fascia lata appears to be a good alternative for treatment of this condition. PMID:19214507

  7. Objective assessment of surgical technique in rotation and nasal projection variation

    Directory of Open Access Journals (Sweden)

    Marina Serrato Coelho Fagundes

    2016-02-01

    Full Text Available ABSTRACT INTRODUCTION: In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE: To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS: A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip. Rotation and nasal projection were measured from photographs obtained preoperatively and after 12 months. RESULTS: All 27 patients completed the study. The mean age was 27.1 years. There was a mean increase of 8.4° in the rotation - a statistically significant value. There was no significant change in the projection. CONCLUSION: The medial intercrural and nasal tip rotation sutures are effective in increasing nasal rotation in Caucasian patients undergoing rhinoplasty.

  8. Different surgical techniques and L-carnitine supplementation in an experimental varicocele model.

    Science.gov (United States)

    Akdemir, S; Gurocak, S; Konac, E; Ure, I; Onen, H I; Gonul, I I; Sozen, S; Menevse, A

    2014-10-01

    We aimed to investigate the impact of various varicocelectomy techniques and/or L-carnitine as an adjunct treatment, following the emergence of oxidative stress, on the expression levels of SCF/c-kit signalling pathways in spermatogenesis. Forty-two rats were divided into seven groups: group 1 (G1) control; group 2 (G2) sham; group 3 (G3) varicocele; group 4 (G4) varicocele + varicocelectomy with testicular nonartery sparing; group 5 (G5) same as G4 but with artery sparing; group 6 (G6) same as G4 but with L-carnitine and group 7 (G7) same as G5 with L-carnitine. mRNA expression levels of SCF and c-kit were measured quantitatively using real-time polymerase chain reaction. CASP-3 activity at protein level was determined, and histological evaluation was performed. mRNA expression level of SCF increased in G6 as compared to control group (3.52-folds change; P = 0.035), whereas mRNA expression level of c-kit gene remained the same. We found that in the left testis of G6 group, mRNA expression level of SCF increased 2.2-folds in comparison with the right testis (P carnitine may be considered as supportive treatment regimes in addition to conventional surgical treatments.

  9. Peritoneal inflammatory response to surgical correction of left displaced abomasum using different techniques.

    Science.gov (United States)

    Wittek, T; Fürll, M; Grosche, A

    2012-12-08

    The objective of this study was to compare the inflammatory response within the abdominal cavity between three surgical methods. The study comprised 45 cows with left displacement of the abomasum, which were allocated into three groups (n = 15). Right flank laparotomy and omentopexy (group R), left flank laparotomy and omentopexy (group L), and laparoscopic abomasopexy (group J) have been applied. Laparoscopic abomasopexy was the only technique that requires perforation of the abomasal wall. Blood and peritoneal fluid (PF) samples were obtained before, and on days 1, 2 and 3 after surgery. Macroscopic and microscopic evaluation of PF were performed. Cytological and biochemical parameters were analysed in blood and PF. No bacteria were present in PF after surgery. The number of PF leukocytes increased in all groups on day 1 after surgery with the highest value after laparoscopy (median, 1st quartile, 3rd quartile, R: 13.1, 6.4, 16.0; L: 13.6, 9.9, 17.4; J: 33.7, 21.1, 46.9 G/l). Laparotomy resulted in an increase of blood and PF CK on day 1 after surgery, whereas, laparoscopy caused an increased PF CK only. All groups had elevated PF D-dimer concentrations before surgery, with further increase in groups R and L on day 1 after surgery.

  10. Arthroscopic grafting of scaphoid nonunion - surgical technique and preliminary findings from 23 cases.

    Science.gov (United States)

    Cognet, J-M; Louis, P; Martinache, X; Schernberg, F

    2017-02-01

    We report our experience with the arthroscopic treatment of 23 cases of scaphoid nonunion. We explain the surgical technique and describe the different steps needed to achieve bone union. We report our initial clinical and radiological results. This was a prospective non-randomized study. Inclusion criteria were a scaphoid nonunion without radiocarpal arthritis, without any time limit and without any selection as to nonunion location. Before the operation, patients underwent an X-Ray and CT scan or MRI. Schernberg's classification was used to evaluate the location of the nonunion. Internal fixation was performed with a screw or K-wires. Bone grafts were taken from the dorsal side of the distal radius using a T-Lok™ bone marrow biopsy needle (Argon Medical Devices, Plano, TX, USA). A CT scan was performed 3 months after the operation to determine whether union was achieved. Pain, strength and range of motion were evaluated before and after the operation. The patients' smoking habits were also documented. The average follow-up was 17.3 months (4-41). There were 20 men and 3 women with an average age of 26 years (17-63). The average duration of nonunion before the operation was 17 months (6-60). Based on Schernberg's classification, there was one type I, 12 type II and 10 type III nonunions. Wrist strength increased from 32 to 41kg. Union was obtained in all patients after an average of 4 months (3-12). Numerous treatments have been described for treating scaphoid nonunion: Matti-Russe, Fisk-Fernadez bone graft, vascularized bone graft, bone substitutes, etc. The success rate varies depending on the technique and study design. We have described an arthroscopic technique for treating scaphoid nonunion with very promising preliminary results. Arthroscopic debridement is needed to ensure good quality bone at the graft site, while preserving extrinsic vascularization. Traction is used during the operation to restore the scaphoid height, once debridement has been

  11. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial

    Directory of Open Access Journals (Sweden)

    2007-10-01

    Full Text Available Abstract Background Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision. Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are: • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum (pelvic and parietal • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis or further operative procedures; or blood transfusion. The sample size required is 15,000 women in total; at least 7,586 women

  12. [Study on surgical techniques for cervical ectopic renal transplantation in rat].

    Science.gov (United States)

    Zhu, Liang; Gong, Dezheng; Zou, Yuan; Li, Yousheng; Wu, Yunhong; Yuan, Bo; Guan, Lili; Wu, Qiong; Li, Hongyu; Liu, Jing

    2008-07-01

    To establish a simple and stable cervical ectopic renal transplantation rat model that increase surgical successful rate. A total of 208 male inbred Wistar rats (weighing 220-260 g) were randomly served as donors and recipients. The graft consisting of kidney, renal vein (RV) and renal artery (RA) was obtained, and perfused in situ. The donor RA was end-to-end anastomosed to the recipient left common carotid artery (CCA) by using of "sleeve" anastomosis, and the donor RV to the recipient right external jugular vein by using of "cuff" technique. The distal end of the ureter was brought out to form cervical cutaneous stomas. A total of 104 ectopic renal transplantations were performed in rats, including stages of the pre-experiment (62 operations) and experiment (42 operations). The success rates of the two stages were 80.6% and 95.2%, respectively. The causes of failure in the pre-experimental stage were anesthesia accidents, thrombosis of the arterial anastomosis, massive hemorrhage, air embolism and phlebemphraxis. In the experimental stage, 2 rats died due to late anastomotic hemorrhage and thrombosis. The remaining 40 transplanted kidney survived more than 6 months. The time for surgery was (40 +/- 6) minutes, the average time for donor surgery was (20 +/- 5) minutes, the preparation time for the graft was (8 +/- 2) minutes, the operative time for the recipient was (18 +/- 3) minutes, including the time for the arterial anastomosis (5 +/- 2) minutes and venous anastomosis (2 +/- 1) minutes, the cold ischemia time of graft was (15 +/- 3) minutes. The cervical ectopic renal transplantation technique has the advantages of easy-and fast-to-perform, shorter operation and cold ischemia time, higher successful rate.

  13. Improved surgical technique for laparoscopic Roux-en-Y gastric bypass reduces complications at the gastrojejunostomy.

    Science.gov (United States)

    Suter, Michel; Donadini, Andrea; Calmes, Jean-Marie; Romy, Sébastien

    2010-07-01

    Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric procedures for morbidly obese patients. It is associated with effective long-term weight loss, but can lead to significant complications, especially at the gastrojejunostomy (GJS). All the patients undergoing laparoscopic RYGBP at one of our two institutions were included in this study. The prospectively collected data were reviewed retrospectively for the purpose of this study, in which we compared two different techniques for the construction of the GJS and their effects on the incidence of complications. In group A, anastomosis was performed on the posterior aspect of the gastric pouch. In group B, it was performed across the staple line used to form the gastric pouch. A 21-mm circular stapler was used in all patients. A total of 1,128 patients were included between June 1999 and September 2009-639 in group A and 488 in group B. Sixty patients developed a total of 65 complications at the GJS, with 14 (1.2%) leaks, 42 (3.7%) strictures, and 9 (0.8%) marginal ulcers. Leaks (0.2% versus 2%, p = 0.005) and strictures (0.8% versus 5.9%, p < 0.0001) were significantly fewer in group B than in group A. Improved surgical technique, as we propose, with the GJS across the staple line used to form the gastric pouch, significantly reduces the rate of anastomotic complications at the GJS. A circular 21-mm stapler can be used with a low complication rate, and especially a low stricture rate. Additional methods to limit complications at the GJS are probably not routinely warranted.

  14. Retrospective review of grafting techniques utilized in conjunction with endosseous implant placement.

    Science.gov (United States)

    Meraw, S J; Eckert, S E; Yacyshyn, C E; Wollan, P C

    1999-01-01

    Bone resorptive patterns may prevent the ideal placement of endosseous implants. Numerous techniques have been described to create a more favorable surgical site for implant placement. This retrospective review was conducted to determine the frequency of need for implant site preparation in an outpatient clinical setting. In addition, different techniques of surgical site preparation were evaluated to determine their frequency of use and surgical outcome. A history review was conducted of all consecutively treated partially edentulous patients between January 1993 and December 1997. This review evaluated the number of implants placed, the age and gender of patient, the type of graft used, and the status of the implant. In all, 542 patients were seen in this time interval, with a total of 1,313 implants placed. Implant site preparation was needed in 4.4% of the patients, with the requirement for grafts occurring more frequently in the maxilla. Implant site preparation is a relatively infrequent requirement in the general population. Grafts are required more frequently in the maxilla than in the mandible. Complications following grafting were relatively infrequent and were not severe.

  15. An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap technique

    Directory of Open Access Journals (Sweden)

    W L Adeyemo

    2013-01-01

    Full Text Available Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390 of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision surgery. The most common surgical technique employed was modified Fork flap (Millard technique, which was employed in 37 (95% cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

  16. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    Science.gov (United States)

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

  17. Influence of Surgical Technique, Performance Status, and Peritonitis Exposure on Surgical Site Infection in Acute Complicated Diverticulitis: A Matched Case-Control Study.

    Science.gov (United States)

    Zonta, Sandro; De Martino, Michela; Podetta, Michele; Viganò, Jacopo; Dominioni, Tommaso; Picheo, Roberto; Cobianchi, Lorenzo; Alessiani, Mario; Dionigi, Paolo

    2015-10-01

    Acute generalized peritonitis secondary to complicated diverticulitis is a life-threatening condition; the standard treatment is surgery. Despite advances in peri-operative care, this condition is accompanied by a high peri-operative complication rate (22%-25%). No definitive evidence is available to recommend a preferred surgical technique in patients with Hinchey stage III/IV disease. A matched case-control study enrolling patients from four surgical units at Italian university hospital was planned to assess the most appropriate surgical treatment on the basis of patient performance status and peritonitis exposure, with the aim of minimizing the surgical site infection (SSI). A series of 1,175 patients undergoing surgery for Hinchey III/IV peritonitis in 2003-2013 were analyzed. Cases (n=145) were selected from among those patients who developed an SSI. control ratio was 1:3. Cases and control groups were matched by age, gender, body mass index, and Hinchey grade. We considered three surgical techniques: T1=Hartman's procedure; T2=sigmoid resection, anastomosis, and ileostomy; and T3=sigmoid resection and anastomosis. Six scoring systems were analyzed to assess performance status; subsequently, patients were divided into low, mild, and high risk (LR, MR, HR) according to the system producing the highest area under the curve. We classified peritonitis exposition as P1=24 h. Univariable and multivariable analyses were performed. The Apgar scoring system defined the risk groups according to performance status. Lowest SSI risk was expected when applying T3 in P1 (OR=0.22), P2 (OR=0.5) for LR and in P1 (OR=0.63) for MR; T2 in P2 (OR=0.5) in LR and in P1 (OR=0.61) in MR; T1 in P3 (OR=0.56) in LR; in P2 (OR=0.63) and P3 (OR=0.54) in MR patients, and in each P subgroup (OR=0.93;0.97;1.01) in HR. Pre-operative assessment based on Apgar scoring system integrated with peritonitis exposure in complicated diverticulitis may offer a ready-to-use tool for reducing SSI

  18. Combating Fraud in Medical Research: Research Validation Standards Utilized by the Journal of Surgical Radiology

    Directory of Open Access Journals (Sweden)

    Bhavin Patel

    2013-11-01

    Full Text Available Fraud in medical publishing has risen to the national spotlight as manufactured and suspect data have led to retractions of papers in prominent journals. Moral turpitude in medical research has led to the loss of National Institute of Health (NIH grants, directly affected patient care, and has led to severe legal ramifications for some authors. While there are multiple checks and balances in medical research to prevent fraud, the final enforcement lies with journal editors and publishers. There is an ethical and legal obligation to make careful and critical examinations of the medical research published in their journals. Failure to follow the highest standards in medical publishing can lead to legal liability and destroy a journal’s integrity. More significant, however, is the protection of the medical profession’s trust with their colleagues and the public they serve. This article discusses various techniques and tools available to editors and publishers that can help curtail fraud in medical publishing.

  19. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    Science.gov (United States)

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

  20. Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

    Science.gov (United States)

    Malagelada, Francesc; Coll Rivas, Moisès; Jiménez Obach, Albert; Auleda, Jaume; Guirao, Lluis; Pleguezuelos, Eulogio

    2013-03-01

    In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

  1. Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

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    Satoshi Koizumi

    2017-04-01

    Full Text Available The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

  2. The vascular anatomy of the human temporalis muscle: implications for surgical splitting techniques.

    Science.gov (United States)

    Cheung, L K

    1996-12-01

    Despite the wide application of the temporalis muscle flap and its modifications, understanding of the vascular pattern and territories within the muscle remains poor. This study aimed to evaluate the vascular architecture in the human temporalis muscle for surgical application. The material comprised 15 fresh cadavers (30 muscle specimens), which were divided into three groups for vascular infusion by either Indian ink solution, lead oxide solution, or methylmethacrylate resin. The vascular network in the temporalis muscle was analyzed by stereomicroscopy, radiography, and scanning electron microscopy. The human temporalis muscle was found to have vascular supply from three primary arteries: the anterior deep temporal artery (ADTA), the posterior deep temporal artery (PDTA), and the middle temporal artery (MTA). Each primary artery branched into the secondary arterioles and then the terminal arterioles. The venous network accompanied the arteries, and double veins pairing one artery was a common finding. The capillaries formed a dense, interlacing network with orientation along the muscle fibres. Arteriovenous anastomosis was absent. In the coronal plane, the vessels were located mainly on the lateral and medial aspects of the muscle with a significantly lower vascular density in the midline. Morphometric analysis of the arterial network showed that the PDTA was larger in size at primary and secondary branching levels than the ADTA and the MTA, whereas no differences were present at the terminal arteriolar levels. The distribution of the arterial territories was as follows: the ADTA occupied 21% anteriorly, the PDTA occupied 41% in the middle region, and the MTA occupied 38% in the posterior region. This improved understanding of the vascular architecture within the temporalis muscle complements the anatomic basis of the flap-splitting technique and increases the safety of its application.

  3. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

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    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  4. Prospective study of percutaneous tracheostomy: Role of bronchoscopy and surgical technique.

    Science.gov (United States)

    Laisaar, Tanel; Jakobson, Eero; Sarana, Bruno; Sarapuu, Silver; Vahtramäe, Jüri; Raag, Mait

    2016-01-01

    Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques. During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study. A total of 111 subjects (77 males) with median age 64 (range, 18-86) years and body mass index 25.4 (range, 15.9-50.7) were included. In unit A, tracheal wall was directly exposed; in unit B, limited dissection to enable tracheal palpation was made. In both units, bronchoscopy was used to check the location of an already inserted guiding needle; needle position required correction in 8% and 12% of cases, respectively. In unit C, in tracheostomies without pretracheal tissue dissection, bronchoscopy was used to guide needle insertion; needle position required correction in 66% of cases. Median duration of operations performed by thoracic surgeons and residents was 10 (range, 3-37) min and by intensive care doctors and residents was 16.5 (range, 3-63) min (p < 0.001). Time from the beginning of preparations for tracheostomy until the end of the whole procedure was median 32 min for bedside tracheostomies and 64 min for operations in the operating theatre (p < 0.001). Limited pretracheal tissue dissection enabled proper guiding needle insertion and bronchoscopy was rarely needed. Percutaneous tracheostomies performed by thoracic surgeons took less time, and duration of the whole procedure was remarkably shorter when performed at bedside.

  5. Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results.

    Science.gov (United States)

    van der Wijk, Jacobien; Goubau, Jean F; Mermuys, Koen; van Hoonacker, Petrus; Vanmierlo, Bert; Kerckhove, Diederick; Berghs, Bart

    2015-08-01

    Background Simple decompression of the first extensor compartment is commonly used for treating de Quervain disease, with the possible complication of subluxation of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) over the radial styloid. To prevent this painful subluxation of the tendons, several methods of reconstructing the pulley have been proposed. Questions/Purposes The purpose of our study was to evaluate a new technique for reconstructing the first extensor compartment following a release for de Quervain disease. Patients and Methods A retrospective study (mean length 40.4 months) was performed in 45 patients. The outcome assessment involved two different questionnaires and ultrasound evaluation of any tendon subluxation. Results None of the patients required reoperation for tendon instability or incomplete decompression of the first extensor compartment. Two patients experienced clicking around the radial styloid after surgery. This was not related to the amount of volar migration of the tendons. Conclusions We believe the reconstruction proposed here is an effective method of preventing painful subluxation of the APL and EPB following a release of the first extensor compartment.

  6. The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy.

    Science.gov (United States)

    Sivarajan, Ganesh; Borofsky, Michael S; Shah, Ojas; Lingeman, James E; Lepor, Herbert

    2015-01-01

    Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH.

  7. A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices

    NARCIS (Netherlands)

    Verheij, Emmy; Bezdjian, Aren; Grolman, Wilko; Thomeer, Hans

    OBJECTIVE:: To investigate skin-related postoperative complications from tissue preservation approaches in percutaneous bone conduction device (BCD) implantations. DATA SOURCES:: PubMed, Embase, and Cochrane Library. STUDY SELECTION:: We identified studies on BCDs including the opted surgical

  8. Comprehensive and innovative techniques for livertransplantation in rats: A surgical guide

    Institute of Scientific and Technical Information of China (English)

    Tomohide; Hori; Justin; H; Nguyen; Yasuhiro; Ogura; Toshiyuki; Hata; Shintaro; Yagi; Ann-Marie; T; Baine; Norifumi; Ohashi; Christopher; B; Eckman; Aimee; R; Herdt; Hiroto; Egawa; Yasutsugu; Takada; Fumitaka; Oike; Seisuke; Saka-moto; Mureo; Kasahara; Kohei; Ogawa; Koichiro; Hata; Taku; Iida; Yukihide; Yonekawa; Lena; Sibulesky; Kagemasa; Kuribayashi; Takuma; Kato; Kanako; Saito; Mie; Torii; Naruhiko; Sahara; Naoko; Kamo; Tomoko; Sahara; Motohiko; Yasutomi; Shinji; Uemoto

    2010-01-01

    AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful surgeries.RESULTS: Learning curve data indicated that 50 cases were required for operator tr...

  9. Surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation with insulin systemic circulation reflux and enteric drainage

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    Ming CAI

    2011-12-01

    Full Text Available Objective The present paper aims to summarize the surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation(SPKT with insulin systemic circulation reflux and enteric drainage to reduce surgical risks and complications and improve the long-term survival of transplanted organs.Methods The present paper retrospectively analyzes the clinical data,surgical techniques,and prevention of surgery-related complications from five cases that received SPKT with insulin systemic circulation reflux and enteric drainage.These five patients suffered from Type 1 diabetes mellitus and diabetic nephropathy resulting in uremia.They were admitted to the Organ Transplant Center of the 309th Hospital of PLA from 2003 to 2010.Results Of the five successful SPKT cases,three patients had normally functioning graft pancreas and kidneys and were able to stop their insulin and hypoglycemic drug medications and dialysis.Two cases had delayed kidney graft functions.One suffered perioperative death due to infection and multiple organ failure,and the other received graft pancreas resection due to a leaky gut caused by donor duodenal segment necrosis.The graft kidney,however,retained normal function.The insulin medication was stopped after an average time of 15 days,and blood creatinine returned to its normal level after 10 days.The graft survival was checked after 12 months to 96 months(by July of 2011,and the graft procedure was found to be successful.Conclusions SPKT with insulin systemic circulation reflux and enteric drainage is the preferred surgical technique for pancreas transplantation.Enhanced surgical skills and effective perioperative management can help reduce,and even eliminate,postoperative complications and improve graft survival.

  10. [The utilization of the "simplified technique" in the simultaneous management of independent thoracic and abdominal aortic aneurysms. A clinical report].

    Science.gov (United States)

    da Gama, A Dinis; Perdigão, João; Ministro, Augusto; Evangelista, Ana; Damião, Angélica; Alves, A Garcia

    2009-01-01

    The coexistence of independent aneurysms of the thoracic and abdominal aorta in a single individual, with operative indication has been regarded, since ever, as an enormous challenge to the vascular surgeons and is a source of controversy, regarding the hierarchy, priorities and methods of expeditious management. The authors report the clinical case of a 65 years old male, with a descending thoracic aortic aneurysm, extended to the abdominal visceral vessels, having 6.5 cm of maximum size, together with an infrarenal aortic aneurysm, with 4.5 cm of major diameter. The patient underwent the surgical treatment of both aneurysms, in the same operation, utilizing the "simplified technique", introduced by ourselves in 1984, for the management of thoracoabdominal aortic aneurysms. The efficacy, safety and excellency of the procedure as well as of the clinical result, assessed by angio-CT scans, allow us to enhance one more indication for the "simplified technique" in the management of complex aortic pathology, thus justifying its presentation and divulgation.

  11. Work Measurement Techniques Utilized by The Building Industry in The Midlands Province Of Zimbabwe

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    Tirivavi Moyo

    2014-07-01

    Full Text Available The Zimbabwean construction industry, both in the private and public sector, is characterized by cost and time overruns. Whilst the causes are innumerable, labour productivity control, through use of effective work measurement techniques, is paramount as labour constitutes a considerable portion of any construction project. It is therefore expedient that an investigation of the work measurement techniques utilized by the industry be undertaken. Focus was made on the Midlands province, it being resident to a considerable number of mining entities undergoing building construction growth momentum on the back of significant investments since 2009. The survey was undertaken through use of interview administered questionnaires on Construction Industry Federation of Zimbabwe registered companies that are resident in the province and on those that have undertaken or are undertaking construction projects within the same province. Construction companies in the Midlands province have overwhelmingly, albeit inappropriately, used the estimating technique as alluded to by 95% of the respondents. The outputs generated from use of this technique are significantly different from the actual outputs directly causing time overruns on the project sites. The other methods of time study at 33%, work sampling at 10% and synthesis at 5% have been sparingly utilized. The results from the use of time study and work sampling in combination with the estimating technique are within the allowable limits and hence these projects have no time overrun concerns emanating from the use of these techniques.

  12. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

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    Evdokia Chasioti

    2015-01-01

    Full Text Available The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis.

  13. Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series

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    Mayra Elena Hernández Carrazco

    2014-07-01

    Full Text Available Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications

  14. Influence of implant shape, surface morphology, surgical technique and bone quality on the primary stability of dental implants.

    Science.gov (United States)

    Elias, Carlos Nelson; Rocha, Felipe Assis; Nascimento, Ana Lucia; Coelho, Paulo Guilherme

    2012-12-01

    The primary stability of dental implants has been investigated before, but a study of the influence of implant shape, size and surface morphology (machined, acid etched or anodized), surgical technique (press-fit or undersized) and substrate (natural or simulated bone) on the primary stability of dental implants has not been reported. The present work intends to fill this gap. In this work, six different dental implants were inserted into and removed from synthetic and natural bone while measuring the torque. A total of 255 dental implants with three shapes, four sizes and three surface topographies were inserted into pig rib, PTFE and polyurethane. The implant sites were prepared using straight and tapered drills. The primary stability was estimated from the maximum insertion torque. Comparisons between samples were based on the maximum insertion torque (MIT), the maximum removal torque (MRT) and the torque ratio (TR=MRT/MIT). The insertion torque into pig ribs showed larger dispersion. All parameters (shape, size and surface morphology of the implant, surgical technique and substrate type) were found to have a significant influence on primary stability. The insertion of a tapered implant requires a higher torque than the insertion of a straight implant. Surface treatments improve the primary stability. The influence of the surgical technique is smaller than that of implant size and shape. The highest insertion torque was that of anodized tapered implants inserted into undersized sites. Finally, the primary stability of dental implants is highly dependent on implant design, surgical technique and substrate type. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. A new surgical technique of uterine auto-transplantation in cynomolgus monkey: preliminary report about two cases

    OpenAIRE

    KISU, IORI; Mihara, Makoto; BANNO, KOUJI; Hara, Hisako; Yamamoto, Takumi; Araki, Jun; Iida, Takuya; Hayashi, Yohei; Moriguchi, Hisashi; Aoki, Daisuke

    2011-01-01

    Objective Uterine transplantation experiments have been performed in various animal species for future clinical applications of uterine transplantation for permanent uterine factor infertility in humans. The aim of this study was to confirm the feasibility of uterine auto-transplantation in cynomolgus monkeys by developing new surgical techniques. Methods Two female cynomolgus monkeys underwent surgery under general anesthesia. The uterus with vascular grafts and the vaginal wall was removed,...

  16. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques.

    Science.gov (United States)

    Jayakar, Prasanna; Gotman, Jean; Harvey, A Simon; Palmini, André; Tassi, Laura; Schomer, Donald; Dubeau, Francois; Bartolomei, Fabrice; Yu, Alice; Kršek, Pavel; Velis, Demetrios; Kahane, Philippe

    2016-11-01

    Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  17. Development of an adhesive surgical ward round checklist: a technique to improve patient safety.

    LENUS (Irish Health Repository)

    Dhillon, P

    2012-02-01

    Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

  18. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

    Directory of Open Access Journals (Sweden)

    Suresh K Sankhla

    2015-01-01

    Full Text Available Objective: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas. Methods: Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors. Results: A gross total or near total excision was achieved in 10 (66.7% patients, subtotal resection in 4 (26.7%, and partial removal in 1 (6.7% patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20% developed postoperative CSF leaks which were managed conservatively. Three (20% patients with diabetes insipidus and 2 (13.3% with panhypopituitarism required long-term hormonal replacement therapy. Conclusions: Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks.

  19. Surgical pneumatization through maxillary sinus wall and the schneiderian membrane: A new technique to facilitate augmentation of the maxillary sinus

    Directory of Open Access Journals (Sweden)

    Anders-Petter Carlsson

    2017-01-01

    Full Text Available A minimum subantral bone height in the posterior maxilla may require a bone augmentation where a sinus lift procedure is the most commonly used technique, either preceding or simultaneously with the implant installation. While elevating the Schneiderian membrane ruptures are common, possibly resulting in less bone formation. In this paper, we propose the surgical pneumatization of the Schneiderian membrane as a new technique to minimize the risk of such complications. This can be achieved mainly by creating a hole for the immediate and increased passage of air through the Schneiderian membrane and the maxillary sinus wall above the region of augmentation.

  20. A review of olive mill solid wastes to energy utilization techniques.

    Science.gov (United States)

    Christoforou, Elias; Fokaides, Paris A

    2016-03-01

    In recent years, the utilization of olive industry by-products for energy purposes has gained significant research interest and many studies have been conducted focused on the exploitation of olive mill solid waste (OMSW) derived from the discontinuous or continuous processing of olive fruits. In this review study, the primary characteristics of OMSW and the techniques used to define their thermal performance are described. The theoretical background of the main waste-to-energy conversion pathways of solid olive mill wastes, as well as the basic pre-treatment techniques for upgrading solid fuels, are presented. The study aims to present the main findings and major conclusions of previously published works undertaken in the last two decades focused on the characterization of olive mill solid wastes and the utilization of different types of solid olive mill residues for energy purposes. The study also aims to highlight the research challenges in this field.

  1. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane--bone substitute sandwich technique.

    Science.gov (United States)

    Ogunsalu, C

    2005-09-01

    This paper describes a new technique for the closure of oro-antral fistula/communication, in which both hard tissue (bone) and soft tissue closure is achieved. The sandwich technique utilizes a suitable bone grafting material sandwiched between two sheaths of Biogide (a resorbable membrane) for the hard tissue closure of oro-antral communication post traumatic exodontia. The bone grafting material utilized for this case was Bio-oss. The result obtained was excellent with regeneration of sufficient bony tissue to allow placement of an endosseous implant. This sandwich technique is a simple and excellent technique for the closure of oro-antral communication, especially when subsequent placement of endosseous implant is considered without the need of donor site surgery for bone grafting. The otorhinolaryngologists and oral and maxillofacial surgeons should find this technique very useful in the closure of oro-antral fistulae.

  2. A Cross Layer Based Scalable Channel Slot Re-Utilization Technique for Wireless Mesh Network

    Directory of Open Access Journals (Sweden)

    Asha C N

    2016-04-01

    Full Text Available Due to tremendous growth of the wireless based appl ication services are increasing the demand for wireless communication techniques that use band width more effectively. Channel slot re- utilization in multi-radio wireless mesh networks i s a very challenging problem. WMNs have been adopted as back haul to connect various networ ks such as Wi-Fi (802.11, WI-MAX (802.16e etc. to the internet. The slot re-utiliza tion technique proposed so far suffer due to high collision due to improper channel slot usage approx imation error. To overcome this here the author propose the cross layer optimization techniq ue by designing a device classification based channel slot re-utilization routing strategy which considers the channel slot and node information from various layers and use some of the se parameters to approximate the risk involve in channel slot re-utilization in order to improve the QoS of the network. The simulation and analytical results show the effectiveness of ou r proposed approach in term of channel slot re-utilization efficiency and thus helps in reducin g latency for data transmission and reduce channel slot collision.

  3. A surgical technique for implantation of the vibrant soundbridge middle ear implant in dogs

    NARCIS (Netherlands)

    Haar, G. Ter; Mulder, J.J.S.; Venker-van Haagen, A.J.; Sluijs, F.J. van; Smoorenburg, G.F.

    2011-01-01

    OBJECTIVE: To report a surgical implantation of the Vibrant Soundbridge (VSB) middle ear implant in dogs. STUDY DESIGN: Pilot study. ANIMALS: Dogs (n=3). METHODS: A lateral approach to the tympanic bulla was used to insert the floating mass transducer of the VSB into the tympanic bulla. Using

  4. A surgical technique for implantation of the vibrant soundbridge middle ear implant in dogs

    NARCIS (Netherlands)

    Haar, G. Ter; Mulder, J.J.S.; Venker-van Haagen, A.J.; Sluijs, F.J. van; Smoorenburg, G.F.

    2011-01-01

    OBJECTIVE: To report a surgical implantation of the Vibrant Soundbridge (VSB) middle ear implant in dogs. STUDY DESIGN: Pilot study. ANIMALS: Dogs (n=3). METHODS: A lateral approach to the tympanic bulla was used to insert the floating mass transducer of the VSB into the tympanic bulla. Using micros

  5. New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma

    NARCIS (Netherlands)

    Cobben, DCP; Koopal, S; Tiebosch, ATMG; Jager, PL; Elsinga, PH; Wobbes, T; Hoekstra, HJ

    2002-01-01

    The emphasis of the research on the surgical treatment of melanoma has been on the resection margins, the role of elective lymph node dissection. in high risk patients and the value of adjuvant regional treatment with hyperthermic isolated lymph perfusion with melphalan. Parallel to this research,

  6. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Boris Abayev

    2015-03-01

    Full Text Available Objectives: The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN repositioning with a minimum 6 months of follow-up. Results: A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions: Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

  7. Evaluation of coblation lingual tonsil removal technique for obstructive sleep apnea in Asians: preliminary results of surgical morbidity and prognosticators.

    Science.gov (United States)

    Wee, Jee Hye; Tan, Kenglu; Lee, Woo-Hyun; Rhee, Chae-Seo; Kim, Jeong-Whun

    2015-09-01

    Retroglossal obstruction is one of the etiologies causing obstructive sleep apnea (OSA) and can be addressed by removing some tissues of the tongue base. However, because of its deep-seated location, its surgical removal is still challenging. Although coblation technique has been introduced, its efficacy and morbidity need further evaluation, particularly in Asians. This study aimed to assess its safety and effectiveness and to identify outcome prognosticators. Forty-seven OSA patients who underwent coblation lingual tonsil removal were included. Retroglossal obstruction was confirmed by drug-induced sleep videofluoroscopy. Attended full-night polysomnography was performed twice; before and 6 months after surgery in 27 patients. The tongue base was fully exposed with three deep-seated traction sutures, visualized with a 30° or 70° endoscope, and ablated using a coblator. Surgical success was defined with postoperative apnea hypopnea index (AHI) 50 %. Postoperative morbidities were evaluated. Demographic and polysomnographic parameters between success and failure groups were compared. None of the patients had immediate postoperative hemorrhage. Postoperatively, one patient had delayed hemorrhage and one patient severe respiratory difficulty. Taste loss, tongue dysmotility, dental injury or severe oropharyngeal stricture were absent. A mean AHI decreased from 37.7 ± 18.6 to 18.7 ± 14.8/h (P Coblation lingual tonsil removal technique showed minimal morbidity and favorable outcome in Koreans. The surgical outcome might be associated with the severity of single respiratory events.

  8. Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques.

    Science.gov (United States)

    Abayev, Boris; Juodzbalys, Gintaras

    2015-01-01

    The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

  9. Surgical treatment of adult moyamoya disease with combined STA-MCA bypass and EDAS: demonstration of technique in video presentation.

    Science.gov (United States)

    Li, Yiping; Cikla, Ulas; Baggott, Christopher; Yilmaz, Tevfik; Chao, Clifford; Baskaya, Mustafa K

    2015-01-01

    The natural history of Moyamoya disease (MD) is variable. Moyamoya disease in children mostly presents with progressive ischemic complications and in adulthood it tends to present with hemorrhage. Surgical strategies depend on augmenting cerebral blood flow to the anterior cerebral circulation. Revascularization is the mainstay treatment for MD. We introduce a 31 year old female with a history of MD and leftsided revascularization as a child, who presented with headache, confusion, and worsening left sided weakness. Cranial computed tomography (CT) showed a right sided putaminal hemorrhage. Cerebral angiogram with selective external runs revealed MD, hypoplastic parietal branch of the superficial temporal artery (STA) on the right side and previous revascularization on the left side. Thus, our decision was made to perform a bypass with the frontal branch of the STA to an M3-M4 segment of the middle cerebral artery and an encephaloduroarteriomyosynangiosis with the parietal branch of the STA. The patient's postoperative course was uneventful. Postoperative CT angiogram confirmed patency of bypass. This technique provides immediate revascularization and seems to provide risk reduction for ischemic and hemorrhagic stroke. We review the natural history and surgical treatment of MD along with a case presentation in which surgical technique is demonstrated in video.

  10. The importance of drug-induced sedation endoscopy (D.I.S.E.) techniques in surgical decision making: conventional versus target controlled infusion techniques-a prospective randomized controlled study and a retrospective surgical outcomes analysis.

    Science.gov (United States)

    De Vito, Andrea; Agnoletti, Vanni; Zani, Gianluca; Corso, Ruggero Massimo; D'Agostino, Giovanni; Firinu, Elisabetta; Marchi, Chiara; Hsu, Ying-Shuo; Maitan, Stefano; Vicini, Claudio

    2017-02-17

    Drug-Induced Sedation Endoscopy (DISE) consists of the direct observation of the upper airways during sedative-induced sleep, allowing the identification of the sites of pharyngeal collapse, which is the main pathological event in Obstructive Sleep Apnea (OSA). The Authors have compared Target Controlled Infusion (TCI) sedation endoscopy (TCI-DISE) technique to conventional DISE (CDISE), performed by a manual bolus injection of sedative agent, to recreate accurately and safely snoring and apnea patterns comparable to natural sleep. The authors conducted a prospective, randomized, long-term study and a retrospective analysis of surgical outcomes. The apnea-event observation and its correlation with pharyngeal collapse patterns is the primary endpoint; secondary endpoints are defined as stability and safety of sedation plan of DISE-TCI technique. From January 2009 to January 2011, OSA patients were included in the study and randomly allocated into two groups: the bolus injection conventional DISE group and the TCI-DISE group. Third endpoint is to compare the surgical outcomes enrolling OSA patients from January 2009 to June 2015. We recorded the complete apnea-event at oropharynx and hypopharynx levels in 15/50 pts in conventional DISE group (30%) and in 99/123 pts in TCI-DISE group (81%) (p DISE group because a severe desaturation occurred during the first bolus of propofol (1 mg/kg) (p = 0.4872 ns). We recorded instability of the sedation plan in 13 patients of conventional DISE group (65%) and 1 patient of the TCI-DISE group (5%) (p = 0.0001). In 37 TCI-DISE group surgical patients we reported a significant reduction of postoperative AHI (from 42.7 ± 20.2 to 11.4 ± 10.3) in comparison with postoperative AHI in 15 C-DISE group surgical patients (from 41.3 ± 23.4 to 20.4 ± 15.5) (p = 0.05). Our results suggest the DISE-TCI technique as first choice in performing sleep-endoscopy because of its increased accuracy, stability and

  11. Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

    Directory of Open Access Journals (Sweden)

    Jose M. Cabello

    2009-04-01

    Full Text Available INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

  12. Cartilage repair: A review of stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques

    Directory of Open Access Journals (Sweden)

    Vijayan S

    2010-01-01

    Full Text Available Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.

  13. Lingual split versus surgical bur technique in the extraction of impacted mandibular third molars: a systematic review.

    Science.gov (United States)

    Steel, Ben

    2012-09-01

    The relative merits of different surgical techniques to extract impacted mandibular third molars have been debated for many years. A simple classification is those using a bur and those using a chisel. This article seeks to identify any differences in postoperative outcomes between the surgical bur and lingual split techniques. Using inclusion criteria allowing randomized controlled trials only, 5 studies are identified of which 4 are used in the analysis. The following outcomes are investigated: pain, swelling, trismus, bleeding, delayed healing/infection, and disturbance to lingual and inferior alveolar nerve function. The limited analysis allowed by the number and size of the studies leads to tentative conclusions of no difference between postoperative pain and swelling, and some evidence of less trismus for the lingual split technique. There is some weak evidence of a similar incidence of neurological sequelae between the 2 techniques, but this is not a strong conclusion owing to the small size of the included studies. There are inadequate data regarding bleeding and delayed healing/infection for analysis. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Guided tissue regeneration-based root coverage utilizing collagen membranes: technique and case reports.

    Science.gov (United States)

    Wang, Hom-Lay; Al-Shammari, Khalaf F

    2002-01-01

    Gingival recession defects have traditionally been treated with various grafting procedures. Recently, guided tissue regeneration with collagen membranes has shown promising results. This article reviews the rationale, indications, contraindications, and clinical methods for the use of bioabsorbable collagen membrane barriers. Several properties make collagen membranes attractive candidates for use as barriers in guided tissue regeneration-based root coverage procedures. These include the inhibition of epithelial migration and promotion of new connective tissue attachment; the ability to aggregate platelets, thereby facilitating wound stabilization and maturation; the promotion of cellular migration and wound closure; the elimination of the need for reentry surgery; and the ability to augment tissue thickness. Cases are presented to illustrate the surgical principles and techniques.

  15. Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience.

    Science.gov (United States)

    Ceccarelli, Graziano; Codacci-Pisanelli, Massimo; Patriti, Alberto; Ceribelli, Cecilia; Biancafarina, Alessia; Casciola, Luciano

    2013-09-01

    Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique

  16. The management of thoracic inlet syndrome associated with Hurler's syndrome: a novel surgical technique.

    LENUS (Irish Health Repository)

    Ahsan, Rauf M

    2012-02-01

    A 21-year-old male developed significant swelling of his tongue after a respiratory arrest. The patient had a history of Hurler\\'s syndrome. Magnetic resonance imaging (MRI) angiogram delineated that the swelling was due to compression of his internal jugular veins at the level of the first rib, resulting in thoracic inlet obstruction. The standard surgical treatment of thoracic inlet obstruction was not suitable in this patient\\'s case due to his short thick neck and his characteristic Hurler\\'s syndrome body habitus. Therefore, a novel surgical strategy was used to decompress his head and neck vessels. The manubrium was widened using an iliac crest bone graft, stabilised using internal fixation plates and reconstructed with a pectoral muscle flap.

  17. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications.

    Science.gov (United States)

    Keiner, Doerthe; Gaab, Michael R; Backhaus, Vanessa; Piek, Juergen; Oertel, Joachim

    2010-12-01

    Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.

  18. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    Science.gov (United States)

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  19. Microsurgical open mini uniskin incision technique in the surgical treatment of carpal tunnel syndrome

    OpenAIRE

    Keramettin Aydin; Cengiz Cokluk; Nilgun Cengiz; Ayhan Bilgici

    2006-01-01

    Background: Patients who undergo carpal tunnel surgery sometimes complain of the restriction of the grip and pinch function, palmar tenderness, cosmetic problems, and scar formation at the site of the incision. Aims: We used a modified mini uni-skin incision with appropriate hand position for microscopic view in the surgical treatment of carpal tunnel syndrome to prevent cosmetic problems related with scar formation after surgery. Settings and Design: In this study we used two different ...

  20. Surgical hand antisepsis in veterinary practice: evaluation of soap scrubs and alcohol based rub techniques.

    Science.gov (United States)

    Verwilghen, Denis R; Mainil, Jacques; Mastrocicco, Emilie; Hamaide, Annick; Detilleux, Johann; van Galen, Gaby; Serteyn, Didier; Grulke, Sigrid

    2011-12-01

    Recent studies have shown that hydro-alcoholic solutions are more efficient than traditional medicated soaps in the pre-surgical hand antisepsis of human surgeons but there is little veterinary literature on the subject. The aim of this study was to compare the efficiency of medicated soaps and a hydro-alcoholic solution prior to surgery using an in-use testing method in a veterinary setting. A preliminary trial was performed that compared the mean log(10) number of bacterial colony forming units (CFU) and the reduction factors (RF) between two 5-min hand-scrubbing sessions using different soaps, namely, povidone iodine (PVP) and chlorhexidine gluconate (CHX), and the 1.5-min application of a hydro-alcoholic rub. A clinical in-use trial was then used to compare the hydro-alcoholic rub and CHX in a surgical setting. Sampling was performed using finger printing on agar plates. The hydro-alcoholic rub and CHX had a similar immediate effect, although the sustained effect was significantly better for the hydro-alcoholic rub, while PVP had a significantly lower immediate and sustained effect. The hydro-alcoholic rub showed good efficiency in the clinical trial and could be considered as a useful alternative method for veterinary surgical hand antisepsis.

  1. Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques.

    Science.gov (United States)

    Alzahrani, Tariq

    2017-01-01

    Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.

  2. Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques

    Directory of Open Access Journals (Sweden)

    Tariq Alzahrani

    2017-01-01

    Full Text Available Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.

  3. Alveolar Antral Artery: Review of Surgical Techniques Involving this Anatomic Structure

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2014-04-01

    Full Text Available Introduction: The horizontal bony canal in the lateral maxillary wall is the site of anastomosis between the arterial branches from the posterior superior alveolar artery (PSAa and the infraorbital artery. This anatomic structure is known as the ‘alveolar antral artery’.   Materials and Methods: We performed a literature review. The anatomic location of the alveolar antral artery in the lateral maxillary sinus wall was researched and its importance in surgical procedures routinely performed on this bony wall discussed.   Results: This artery can be accidentally involved during surgical procedures on the lateral maxillary sinus wall, such as open sinus lift surgery, horizontal osteotomy of the maxilla, Le Fort I fracture treatment, and Caldwell-Luc surgeries.   Conclusion: The alveolar antral artery is an important anatomic structure in the lateral maxillary sinus wall. A preoperative cone beam computed tomography (CBCT scan can be used as a good diagnostic procedure to reduce surgical complications in suspected cases as well as conditions that may involve this artery. 

  4. An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing.

    Science.gov (United States)

    Carro, C; Camilleri, L; Traore, O; Badrikian, L; Legault, B; Azarnoush, K; Dualé, C; De Riberolles, C

    2007-09-01

    Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.

  5. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.

    Science.gov (United States)

    Witt, Bryan L; Hyer, Christopher F

    2012-01-01

    Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge(®) (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire(®) (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire(®) provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years' duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients' average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0

  6. Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

    OpenAIRE

    Herrera,Silvia Rejane Fontoura; Leme,Ricardo José de Almeida; Valente, Paulo Roberto [UNIFESP; Caldini,Élia Garcia; Saldiva, Paulo Hilário Nascimento; Pedreira, Denise Araujo Lapa

    2012-01-01

    OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a ne...

  7. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery.

    Science.gov (United States)

    Gabrić Pandurić, Dragana; Blašković, Marko; Brozović, Juraj; Sušić, Mato

    2014-02-01

    Excessive gingival display (EGD) is a condition in which an overexposure of the maxillary gingiva (>3 mm) is present during smiling. The proper diagnosis and determination of its etiology are essential for the selection of the right treatment modality. Different techniques have been used in cases of hyperactive upper lip: botulinum toxin injections, lip elongations with rhinoplasties, lip muscle detachments, myotomies, and lip repositions. This report presents a case of a young woman with an EGD larger than 10 mm during smiling caused by altered passive eruption, vertical maxillary excess, and a hyperactive upper lip that was treated with a modified lip repositioning technique and laser gingivectomy because she strongly refused orthognathic surgical treatment. A novel addition to the technique is proposed, a reversible trial accomplished just by applying sutures on the borders of the future split-thickness flap, marked using diode laser, before starting the flap incision.

  8. Analyzing the barriers affecting the effective utilization of quality tools and techniques using Integrated ISM approach

    Directory of Open Access Journals (Sweden)

    Vivek Sharma

    2017-08-01

    Full Text Available The aim of this study is to recognize and scrutinize the barriers affecting the utilization of quality tools and techniques (QT&T in manufacturing organizations. For this purpose, twelve barriers af-fecting the execution of QT&T in manufacturing organizations have been identified from literature analysis and experts’ opinion (academicians and industrial. Questionnaire-based survey has been utilized for the validation of identified barriers. Afterwards, an integrated model of QT&T has been developed by using interpretive structural Modelling (ISM and Matriced Impacts Croisés Multi-plication Appliquée á un Classement (MICMAC approach. This research gives an apparent depic-tion to identify and handle the barriers by computing the effectiveness of each barrier. Barriers like accessibility of time and space, inability to change organizational culture and inadequate coordina-tion and teamwork are found to be the key barriers for utilization of QT&T in manufacturing organ-ization. The developed model will help the manufacturing organizations effectively utilize QT&T.

  9. Optical birefringence and molecular orientation of crazed fibres utilizing the phase shifting interferometric technique

    Science.gov (United States)

    Sokkar, T. Z. N.; El-Farahaty, K. A.; El-Bakary, M. A.; Omar, E. Z.; Hamza, A. A.

    2017-09-01

    In this article, the features of the phase shifting interferometric technique were utilized to investigate the effect of the presence of crazes in both outer and inner layers on optical birefringence and molecular orientation of polypropylene fibres. The Pluta polarizing interference microscope was used as a phase shifting technique. This method includes adding a stepper motor with a control unit to the micrometer screw of the Pluta microscope. This optical system was calibrated to be used as a phase shifting interferometric technique. The advantage of this technique is that it can detect the crazes in both inner and outer layers of the sample under test. Via this method, the relation between the presence of the crazes (in both inner and outer layers) and the optical molecular orientation of polypropylene (PP) fibres was demonstrated. To clarify the role of this method, the spatial carrier frequency technique was used to show the effect of the presence of the crazes only in the outer layers on the phase distribution values and hence the structural properties of PP fibres.

  10. Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects.

    Science.gov (United States)

    Aslan, Serhat; Buduneli, Nurcan; Cortellini, Pierpaolo

    Primary wound closure and uneventful early wound stability over the biomaterials are the most critical elements of successful periodontal regeneration. Yet the surgical elevation of the interdental papilla to access deep and wide intrabony defects entails an impairment of the papillary blood supply that can result in difficult healing due to a lack of primary closure in the early healing period. This negative event might complicate the healing process, favoring bacterial contamination. A novel modified tunnel surgical technique designed to maintain the integrity of the interdental papilla is presented in this article, with the aim of providing an optimal environment for wound healing in regenerative procedures. Entire papilla preservation is described and applied in three different cases, in association with the use of a combination of bone substitutes and enamel matrix derivative for periodontal regeneration. The entire papilla preservation technique was successfully applied to the three selected cases, resulting in an uneventful postsurgical period and a substantial defect fill over the 8-month follow-up. This tunnel-like technique can be recommended for further research to support the success identified in this case series.

  11. Evaluation of three suture techniques based on surgical wound assessment in Caprine

    Directory of Open Access Journals (Sweden)

    John Bayo Adeyanju

    2012-11-01

    Full Text Available Subcuticular, simple interrupted and ford interlocking suture patterns were used in closing skin incision at paralumbar fossa in fifteen apparently healthy male and female adult goats. The goats were randomly divided into three groups: A (Subcuticular; B(Ford interlocking and C(Simple interrupted. Clinical appearance of the surgical wound was scored twice post surgery at 18-24 hours and 10-14 days using swelling, erythema, dehiscence and discharge as the parameters. There were no statistical difference (P

  12. Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

    DEFF Research Database (Denmark)

    Appelt, Ane L.; Jakobsen, Anders

    2015-01-01

    , particularly in cases with small tumours and limited local disease. This report discusses several radiotherapy techniques for tumour boosting, focusing on technical challenges and clinical experiences with each technique. Specifically, external beam radiotherapy, brachytherapy and contact X-ray treatment...... for dose escalation are considered. Ultimately, no technique provides definitive advantage over others, and the choice in clinical practice will have to depend on the patient population treated as well as the technical capabilities of the treating department....

  13. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Luis Gustavo Vilá Mollinedo

    2016-08-01

    Full Text Available Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta.

  14. About the parametrizations utilized to perform magnetic moments measurements using the transient field technique

    Science.gov (United States)

    Gómez, A. M.; Torres, D. A.

    2016-07-01

    The experimental study of nuclear magnetic moments, using the Transient Field technique, makes use of spin-orbit hyperfine interactions to generate strong magnetic fields, above the kilo-Tesla regime, capable to create a precession of the nuclear spin. A theoretical description of such magnetic fields is still under theoretical research, and the use of parametrizations is still a common way to address the lack of theoretical information. In this contribution, a review of the main parametrizations utilized in the measurements of Nuclear Magnetic Moments will be presented, the challenges to create a theoretical description from first principles will be discussed.

  15. Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole

    Directory of Open Access Journals (Sweden)

    Prabhushanker Mahalingam

    2013-01-01

    Full Text Available We are presenting the initial results of inverted internal limiting membrane (ILM flap technique for large macular hole. Five eyes of five patients with large diameter macular hole (>700 μm were selected. All patients underwent inverted ILM flap technique for macular hole. Anatomical closure and functional success were achieved in all patients. There was no loss of best-corrected visual acuity in any of the patients. Inverted ILM flap technique in macular hole surgery seems to have a better hole closure rates, especially in large diameter macular holes. Larger case series is required to assess the efficacy and safety of this technique.

  16. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.

    Science.gov (United States)

    Geppert, Barbara; Lönnerfors, Celine; Persson, Jan

    2011-11-01

    Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. University hospital. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, plaparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. A surgical rat model of sleeve gastrectomy with staple technique: long-term weight loss results.

    Science.gov (United States)

    Patrikakos, Panagiotis; Toutouzas, Konstantinos G; Perrea, Despoina; Menenakos, Evangelos; Pantopoulou, Alkistis; Thomopoulos, Theodore; Papadopoulos, Stefanos; Bramis, John I

    2009-11-01

    Sleeve gastrectomy (SG) is one of the surgical procedures applied for treating morbid obesity consisting of removing the gastric fundus and transforming the stomach into a narrow gastric tube. The aim of this experimental study is to create a functional model of SG and to present the long-term weight loss results. Twenty adult Wistar rats were fed with high fat diet for 12 weeks before being divided randomly in two groups of ten rats each. One group underwent SG performed with the use of staples, and the other group underwent a sham operation (control group). The animals' weight was evaluated weekly for 15 weeks after the operation. All animals survived throughout the experiment. After the operation both groups started to lose weight with maximum weight loss on the seventh postoperative day (POD) for the sham-operated group and on the 15th POD for the SG group. Thereafter, both groups started to regain weight but with different rates. By the fourth postoperative week (POW), the average weight of the sham group did not differ statistically significantly compared to the preoperative weight, while after the eighth POW, rats' average weight was statistically significantly increased compared to the preoperative value. On the other hand, average weight of the SG group was lower postoperatively until the end of the study compared to the preoperative average weight. We have created a surgical rat model of experimental SG model, enabling the further study of biochemical and hormonal parameters.

  18. Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Luis Marchi

    2012-01-01

    Full Text Available Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3% stand-alone levels experienced cage subsidence. Pain (VAS and disability (ODI improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months.

  19. Changing Indications and Surgical Techniques for Corneal Transplantation Between 2004 and 2009 at a Tertiary Referral Center

    Science.gov (United States)

    Zare, Mohammad; Javadi, Mohammad A.; Einollahi, Bahram; Karimian, Farid; Rafie, Ali R. B.; Feizi, Sepehr; Azimzadeh, Ahmad

    2012-01-01

    Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4%) followed by aphakic/pseudophakic bullous keratopathy (11.7%), previous failed grafts (10.6%), infectious corneal ulcers (10.1%), non-herpetic corneal scars (7.6%), trachoma keratopathy (4.7%), stromal corneal dystrophies (4.6%), post-herpetic corneal scar (3.7%), Fuchs’ endothelial dystrophy (0.8%), and congenital hereditary endothelial dystrophy (0.4%). Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%), deep anterior lamellar keratoplasty (DALK; 20.1%), conventional lamellar keratoplasty (LKP; 4.4%), and Descemet's stripping automated endothelial keratoplasty (DSAEK; 2.3%). Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications and

  20. Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Mohammad Zare

    2012-01-01

    Full Text Available Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4% followed by aphakic/pseudophakic bullous keratopathy (11.7%, previous failed grafts (10.6%, infectious corneal ulcers (10.1%, non-herpetic corneal scars (7.6%, trachoma keratopathy (4.7%, stromal corneal dystrophies (4.6%, post-herpetic corneal scar (3.7%, Fuchs′ endothelial dystrophy (0.8%, and congenital hereditary endothelial dystrophy (0.4%. Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%, deep anterior lamellar keratoplasty (DALK; 20.1%, conventional lamellar keratoplasty (LKP; 4.4%, and Descemet′s stripping automated endothelial keratoplasty (DSAEK; 2.3%. Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications

  1. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M

    2013-12-01

    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery.

  2. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.

    Science.gov (United States)

    Smith, Gabriel A; Kochar, Arshneel S; Manjila, Sunil; Onwuzulike, Kaine; Geertman, Robert T; Anderson, James S; Steinmetz, Michael P

    2014-08-01

    Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.

  3. Top-level modeling of an als system utilizing object-oriented techniques

    Science.gov (United States)

    Rodriguez, L. F.; Kang, S.; Ting, K. C.

    The possible configuration of an Advanced Life Support (ALS) System capable of supporting human life for long-term space missions continues to evolve as researchers investigate potential technologies and configurations. To facilitate the decision process the development of acceptable, flexible, and dynamic mathematical computer modeling tools capable of system level analysis is desirable. Object-oriented techniques have been adopted to develop a dynamic top-level model of an ALS system.This approach has several advantages; among these, object-oriented abstractions of systems are inherently modular in architecture. Thus, models can initially be somewhat simplistic, while allowing for adjustments and improvements. In addition, by coding the model in Java, the model can be implemented via the World Wide Web, greatly encouraging the utilization of the model. Systems analysis is further enabled with the utilization of a readily available backend database containing information supporting the model. The subsystem models of the ALS system model include Crew, Biomass Production, Waste Processing and Resource Recovery, Food Processing and Nutrition, and the Interconnecting Space. Each subsystem model and an overall model have been developed. Presented here is the procedure utilized to develop the modeling tool, the vision of the modeling tool, and the current focus for each of the subsystem models.

  4. Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs

    Science.gov (United States)

    Benoit, Laurent; Cheynel, Nicolas; Ortega-Deballon, Pablo; Giacomo, Giovanni Di; Chauffert, Bruno; Rat, Patrick

    2008-01-01

    Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. In closed-abdomen HIPEC operating room staffs are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. In open-abdomen HIPEC, the opposite is true. Even though the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs. We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of “glove-box”. The cutaneous edges of the laparotomy are stapled to a latex «wall expander». The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a « hand-access » port like those used in laparoscopic surgery is fixed inside the frame. In 10 patients, this device proved to be hermetic both for liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43°C during most of the procedure. The whole abdominal cavity was accessible to the surgeon allowing optimal exposure of all peritoneal surfaces. This technique allows optimal HIPEC while limiting the potential toxic effects for the surgical, medical and paramedical teams. PMID:17929098

  5. Central tendon splitting combined with SutureBridge double-row technique as a surgical treatment for insertional Achilles tendinopathy

    Institute of Scientific and Technical Information of China (English)

    LIN Yuan; WANG Zhi-wei; ZHANG Bo; PAN Jiang; QU Tie-bing; HAI Yong

    2013-01-01

    Background Surgical treatment of insertional Achilles tendinopathy should be considered when a variety of conservative measures fail.To achieve a satisfactory outcome,thorough debridement of the Achilles tendon is critical,besides excision of the bursitis and the calcaneal exostosis.Central tendon-splitting provides straightforward access to the calcified or degenerative tissue within the Achilles tendon.For Achilles tendon reconstruction if detachment is present,several surgical techniques have been reported.Controversy surrounds the technique can provide maximum security for reattachment of the Achilles tendon.The SutureBridge double-row construct,initially used in rotator cuff repair,is probably a good choice.Methods Ten consecutive patients with insertional Achilles tendinopathy underwent tendon reattachment using the SutureBridge technique through a central tendon-splitting approach.We retrospectively evaluated the surgical outcomes,which included pre-and postoperative visual analog scale (VAS),postoperative Maryland Foot Score (MFS),postoperative range of motion of the affected ankle,and related complications.Follow-up was performed in the outpatient department.Results One patient was lost to follow-up.Nine patients (two male and seven female; 12 feet) were reviewed with a minimum follow-up of six months (range 6-30 months).The postoperative VAS pain scores were markedly lower than the preoperative scores.Postoperative MFS was 92.1±8.0 (range 74-100).No intra-or postoperative complications were found,except for one case of delayed healing incision.At last follow-up,all affected ankles achieved their normal range of motion,and patients were able to resume daily activities without any assistive device.Conclusions Although a randomized control trial with a larger sample may be necessary to compare the central tendonsplitting combined with the SutureBridge technique with other techniques,our results confirmed that it was a promising alternative for treatment of

  6. Robotic Surgery in Women With Ovarian Cancer: Surgical Technique and Evidence of Clinical Outcomes.

    Science.gov (United States)

    Minig, Lucas; Padilla Iserte, Pablo; Zorrero, Cristina; Zanagnolo, Vanna

    2016-01-01

    Robotic surgery is a new technology that has been progressively implemented to treat endometrial and cervical cancer. However, the use of robotic surgery for ovarian cancer is limited to a few series of cases and comparative studies with laparoscopy or laparotomy. The technical issues concerning robotic surgery, as well as clinical evidence, are described in this review. Robotic surgery in early stage, advanced stage, and relapsed ovarian cancer is discussed separately. In conclusion, evidence regarding the use of robotic-assisted surgical treatment for women with ovarian cancer is still scarce, but its use is progressively growing. Robotic-assisted staging in selected patients with early stage disease has an important role in referral institutions when well-trained gynecologists perform surgeries. However, minimally invasive surgery in patients with advanced stage or relapsed ovarian cancer requires further investigation, even in selected cases.

  7. Swine (Sus scrofa) as a Model of Postinfarction Mitral Regurgitation and Techniques to Accommodate Its Effects during Surgical Repair.

    Science.gov (United States)

    Sarin, Eric L; Shi, Weiwei; Duara, Rajnish; Melone, Todd A; Kalra, Kanika; Strong, Ashley; Girish, Apoorva; McIver, Bryant V; Thourani, Vinod H; Guyton, Robert A; Padala, Muralidhar

    2016-01-01

    Mitral regurgitation (MR) is a common heart-valve lesion after myocardial infarction in humans. Because it is considered a risk factor for accelerated heart failure and death, various surgical approaches and catheter-based devices to correct it are in development. Lack of a reproducible animal model of MR after myocardial infarction and reliable techniques to perform open-heart surgery in these diseased models led to the use of healthy animals to test new devices. Thus, most devices that are deemed safe in healthy animals have shown poor results in human efficacy studies, hampering progress in this area of research. Here we report our experience with a swine model of postinfarction MR, describe techniques to induce regurgitation and perform open-heart surgery in these diseased animals, and discuss our outcomes, complications, and solutions.

  8. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

  9. Semitendinosus and gracilis free muscle-tendon graft for repair of massive rotator cuff tears: surgical technique.

    Science.gov (United States)

    Gigante, Antonio; Bottegoni, Carlo; Milano, Giuseppe; Riccio, Michele; Dei Giudici, Luca

    2016-01-01

    Massive rotator cuff tears are difficult to treat surgically due to retraction, degeneration and fraying of the ends of torn tendons, severe fatty infiltration and atrophy of the respective muscles. Procedures developed to close the gap between the rotator cuff and the greater tuberosity of the humerus, such as soft tissue release may be inadequate for large tears. Human or porcine dermal allografts still have uncertain benefits, and tendon transfers seem to be associated with poor outcomes, donor site morbidity and altered mechanics. Reverse total shoulder arthroplasty has limited durability and is not indicated in young patients with high functional demands. We developed a new technique for repairing massive rotator cuff tears by semitendinosus and gracilis myotendinous grafting. This novel therapeutic option allows massive rotator cuff tears to be repaired using autologous material that is adequate and adaptable, making it possible to cover any width of defect. The technique is low-invasive and not technically demanding, with minimal donor site morbidity.

  10. Reconstruction of a deficient patella in revision total knee arthroplasty: results of a new surgical technique using transcortical wiring.

    Science.gov (United States)

    Seo, Jai-Gon; Moon, Young-Wan; Lee, Byung-Hoon; Kim, Sang-Min

    2015-02-01

    This study aimed to report the results of a novel surgical technique for the reconstruction of a deficient patella during revision total knee arthroplasty (TKA). Twenty-eight patients (30 knees) with a deficient patella were treated with an onlay-type prosthesis and bone-augmenting procedure, using acrylic bone cement and transcortical wiring. The technique was indicated when the thickness of remnant patella was less than 8mm with variable amounts of the peripheral rim. Mean follow-up period was 36.6months (range, 24 to 55months).The respective mean Knee Society scores for knee and function improved from 34.2 and 23 points, preoperatively to 73.5 and 61 points, at final follow-up. One patient experienced patellar fracture 1week after surgery. There were no complications associated with implanted hardware. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques.

    Science.gov (United States)

    Estupiñán-Jiménez, J C; Castro-Rincón, J M; González, O; Lora, D; López, E; Pérez-Cerdà, F

    2015-04-01

    To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. The influence of surgical technique on early posttransplant atrial fibrillation – comparison of biatrial, bicaval, and total orthotopic heart transplantation

    Science.gov (United States)

    Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Erbel, Christian; Gleissner, Christian A; Darche, Fabrice F; Thomas, Dierk; Bruckner, Tom; Katus, Hugo A; Doesch, Andreas O

    2017-01-01

    Purpose Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. Patients and methods This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. Results A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (Pvalvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. Conclusion Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012). PMID:28331331

  13. A case of mediastinal goiter treated surgically using a clavicle-lifting technique

    Directory of Open Access Journals (Sweden)

    Eisaku Ito

    2015-01-01

    Conclusion: Although further study is necessary, it appears that a transcervical approach using the clavicle-lifting technique may be an acceptable treatment for mediastinal goiters that extend to the aortic arch.

  14. Unilateral orchidectomy in donkey (Equus asinus: Evaluation of different surgical techniques, histological and morphological changes on remaining testis

    Directory of Open Access Journals (Sweden)

    Haroon Ali Yousef Hussein

    2013-03-01

    Full Text Available Unilateral orchidectomy (UO is required when further breeding potential is important. It is sometimes necessary to remove a single testis in a matured stallion for therapeutic reasons. In this study, twelve donkeys were used to evaluate three techniques of unilateral castration, histological and morphological changes on the remaining testis. Results of the study showed that each of the surgical techniques used had its advantages and disadvantages in comparison with the other two techniques. Therefore the selection among the three techniques depends on the surgeon preferences and the environment in which the unilateral orchidectomy is performed. The volume of the remaining testis recorded at the end of the study was significantly greater than that estimated at the start of the study (p < 0.05. The percentage of sperm motility obtained from the remaining testis was significantly decreased (p < 0.05. Histological examination of the testis in open surgery (group I (where the scrotum was left opened revealed severe hemorrhages, edema and fibrosis. The testis showed degenerative changes in the seminiferous tubules and interstitial orchitis. Histological examination of the testes removed using a closed technique, (in groups II and III where the scrotum wound was sutured, revealed hyperplasia of spermatogenic series and Leydig cells. In conclusion, unilateral orchidectomy had compensatory effects on the weight and volume of remaining testis. Adverse effects on sperm motility and viability can affect the fertility of the animal.

  15. Submucosal anoderm-preserving hemorrhoidectomy revisited: a modified technique for the surgical management of hemorrhoidal crisis.

    Science.gov (United States)

    Theodoropoulos, George E; Michalopoulos, Nikolaos V; Linardoutsos, Dimitrios; Flessas, Ioannis; Tsamis, Dimitrios; Zografos, George

    2013-11-01

    Submucosal hemorrhoidectomy (Parks' procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction.

  16. Surgical pearl: the temporary assistant.

    Science.gov (United States)

    Jacobs, Aleda A; Orengo, Ida F

    2008-04-15

    A simple maneuver is presented which simultaneously facilitates both adequate surgical site exposure and sufficient traction. A single suture with high tensile strength can be utilized to this end. This technique is especially helpful when the cutaneous surgeon is operating alone.

  17. A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax

    Directory of Open Access Journals (Sweden)

    Michal Brichacek, MD

    2017-07-01

    Full Text Available Background:. This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix. Methods:. The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed. Results:. Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD. Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling. Conclusions:. The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.

  18. Team Training (Training at Own Facility) versus Individual Surgeon’s Training (Training at Trainer’s Facility) When Implementing a New Surgical Technique:

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Andresen, Kristoffer; Laursen, Jannie

    2014-01-01

    Background. When implementing a new surgical technique, the best method for didactic learning has not been settled. There are basically two scenarios: the trainee goes to the teacher's clinic and learns the new technique hands-on, or the teacher goes to the trainee's clinic and performs the teach......Background. When implementing a new surgical technique, the best method for didactic learning has not been settled. There are basically two scenarios: the trainee goes to the teacher's clinic and learns the new technique hands-on, or the teacher goes to the trainee's clinic and performs...... these issues on a discussion of barriers for adoption of the new ONSTEP technique for inguinal hernia repair after initial training. Results and Conclusions. The optimal training method would include moving the teacher to the trainee's department to obtain team-training effects simultaneous with surgical...

  19. Block bone graft fixation (onlay): a modification of the surgical technique.

    Science.gov (United States)

    Gealh, Walter Cristiano; dos Santos, Pâmela Letícia; Pereira, Cassiano Costa Silva; Okamoto, Tetuo; Antoniali, Cristina; Okamoto, Roberta

    2014-03-01

    Several reconstructive methods of the alveolar ridge have been reported to make possible future rehabilitations with implants. Many of these methods come from studies done in animals, mainly rats. With this clinical practice based on scientific evidence, any experimental procedure that can be undertaken in real life is fundamental. Thus, any research that emulates as closely as possible those techniques used in humans are important. This study describes the modification of the technique for block bone graft fixation (onlay) in rats using the "lag screw"-type technique, normally used in clinical procedures for grafts in humans. The conclusion was that the execution of the described procedures minimizes interference of blood flow in the area because of the maintenance of the muscle insertion in the buckle aspect of the most anterior region of the mandible, providing better stability to the graft and better contact interface of the graft and receptor bed.

  20. Surgical technique: The intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions.

    Science.gov (United States)

    Darcy, Catharine M; Smit, Jeroen M; Audolfsson, Thorir; Acosta, Rafael

    2011-01-01

    The internal mammary vessels are one of the most frequently used recipient sites for microsurgical free-flap breast reconstruction, and an accepted technique to expose these vessels involves removal of a segment of costal cartilage of the rib. However, in some patients, cartilage removal may result in a visible medial chest-wall depression that requires corrective procedures. We, therefore, use an intercostal space approach to the internal mammary vessels, as there is minimal disturbance of the costal cartilage with this technique. We have developed and performed our technique over an 8-year period in 463 microvascular breast reconstructions, and present it here as it contains modifications not previously described that may be of interest to other surgeons. There was no serious morbidity associated with the intercostal space approach, the internal mammary vessels were reliably and safely exposed in all these cases and the flap success rate was 95.8%. Copyright © 2010. Published by Elsevier Ltd.

  1. Utilization of advanced calibration techniques in stochastic rock fall analysis of quarry slopes

    Science.gov (United States)

    Preh, Alexander; Ahmadabadi, Morteza; Kolenprat, Bernd

    2016-04-01

    In order to study rock fall dynamics, a research project was conducted by the Vienna University of Technology and the Austrian Central Labour Inspectorate (Federal Ministry of Labour, Social Affairs and Consumer Protection). A part of this project included 277 full-scale drop tests at three different quarries in Austria and recording key parameters of the rock fall trajectories. The tests involved a total of 277 boulders ranging from 0.18 to 1.8 m in diameter and from 0.009 to 8.1 Mg in mass. The geology of these sites included strong rock belonging to igneous, metamorphic and volcanic types. In this paper the results of the tests are used for calibration and validation a new stochastic computer model. It is demonstrated that the error of the model (i.e. the difference between observed and simulated results) has a lognormal distribution. Selecting two parameters, advanced calibration techniques including Markov Chain Monte Carlo Technique, Maximum Likelihood and Root Mean Square Error (RMSE) are utilized to minimize the error. Validation of the model based on the cross validation technique reveals that in general, reasonable stochastic approximations of the rock fall trajectories are obtained in all dimensions, including runout, bounce heights and velocities. The approximations are compared to the measured data in terms of median, 95% and maximum values. The results of the comparisons indicate that approximate first-order predictions, using a single set of input parameters, are possible and can be used to aid practical hazard and risk assessment.

  2. [The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

    Science.gov (United States)

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

    2006-02-01

    The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide

  3. Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty.

    Science.gov (United States)

    Schirm, Andreas C; Jeffcote, Benjamin O; Nicholls, Rochelle L; Jakob, Hilaire; Kuster, Markus S

    2011-06-01

    Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs. Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2mm and the force measurements repeated. Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90° of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs. The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.

  4. Obturator hernia revisited: surgical anatomy, embryology, diagnosis, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, Lee J; Zoras, Odysseas; Mirilas, Petros

    2011-09-01

    Obturator hernia is the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator canal. The first case was published by de Ronsil in 1724. Obturator hernia is more common in older malnourished women due to loss of supporting connective tissue and the wider female pelvis. The hernia sac usually contains small bowel, especially ileum. It may follow the anterior or posterior division of the obturator nerve. In most cases, obturator hernia presents with intestinal obstruction of unknown cause. It may present with obturator neuralgia, as a palpable mass or, in cases of bowel necrosis, as ecchymosis of the thigh. A correct diagnosis is made in 20 to 30 per cent of cases. CT scan is considered the gold standard for diagnosis, whereas ultrasonography, contrast studies, herniography and plain films are less specific. Surgery is the only treatment option for obturator hernia. Hesitancy to intervene surgically for chronically ill patients results in high mortality. Transabdominal approach is indicated in cases of complete bowel obstruction or suspected peritonitis. The extra-abdominal approach is used in preoperatively diagnosed cases and in absence of bowel strangulation. The laparoscopic approach is minimally invasive and effectively reduces morbidity. The defect is closed using sutures, tissue flaps, or prosthetic mesh.

  5. Awareness and Utilization of Classroom Assessment Techniques in Higher Education: The Case of a State College in Bicol

    Directory of Open Access Journals (Sweden)

    Seth B. Barandon

    2016-05-01

    Full Text Available Assessment plays a crucial role in the delivery of quality education. In the triad of education, assessment is considered one of the key areas aside from curriculum and instruction; thus, educators need to give premium to classroom assessment techniques. This descriptive study determined the level of awareness and extent of utilization of classroom assessment techniques by faculty of a state college in Bicol. Respondents were seventy-six (76 randomly chosen permanent and Contract of Service faculty provided the data by answering a questionnaire. Findings show that the faculties were moderately aware of formative assessment technique and summative assessment technique. Likewise, the faculty moderately utilized both the formative assessment and summative assessment techniques. Pearson product-moment correlation test results show that there is a significant relationship between the level of awareness and the extent of utilization of assessment techniques. Over-all, it is concluded that the higher the level of awareness of the faculty, the higher is their extent of utilization of classroom assessment techniques. Among the proposed measures to enhance utilization of classroom assessment technique are training in classroom assessment by external experts, intensive follow-up activity after the training, and classroom observation.

  6. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    Houdenhoven, van M.; Oostrum, van J.M.; Hans, E.W.; Wullink, G.; Kazemier, G.

    2013-01-01

    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  7. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    van Houdenhoven, M.; van Oostrum, J.M.; Hans, Elias W.; Wullink, Gerhard; Kazemier, G.

    2013-01-01

    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  8. Surgical technique: establishing a pre-clinical large animal model to test aortic valve leaflet substitute

    Science.gov (United States)

    Knirsch, Walter; Cesarovic, Niko; Krüger, Bernard; Schmiady, Martin; Frauenfelder, Thomas; Frese, Laura; Dave, Hitendu; Hoerstrup, Simon Philipp; Hübler, Michael

    2016-01-01

    To overcome current limitations of valve substitutes and tissue substitutes the technology of tissue engineering (TE) continues to offer new perspectives in congenital cardiac surgery. We report our experiences and results implanting a decellularized TE patch in nine sheep in orthotropic position as aortic valve leaflet substitute. Establishing the animal model, feasibility, cardiopulmonary bypass issues and operative technique are highlighted. PMID:28149571

  9. Repositioning template for mandibular reconstruction with fibular free flaps: an alternative technique to pre-plating and virtual surgical planning.

    Science.gov (United States)

    Berrone, M; Crosetti, E; Succo, G

    2014-08-01

    Oral malignancies involving the mandibular bone require a complex reconstructive plan. Mandibular reconstruction with a fibular free flap is currently considered the best choice for functional and aesthetic rehabilitation after oncological surgery. This flap can be modelled with multiple osteotomies and can provide bone, muscle and skin for composite reconstruction. One of the most delicate aspects of mandibular reconstruction is the technique of bone modelling; the risk of prolonging the period of ischaemia and not restoring the correct maxillomandibular and occlusal relationships can ultimately lead to a higher rate of complications as well as poor aesthetic and functional results. Recently, there has been rising interest in virtual surgical planning and computer-assisted mandibular reconstruction in pre-operative planning; however, this is not always possible because of the costs involved and the set-up time for the entire procedure. In this paper, we present a simple and inexpensive technique for fibular free flap modelling and repositioning after segmental resection of the mandible; the technique entails the pre-operative preparation of a resin repositioning template on a stereolithographic model. This technique has been successfully applied in four cases: two cases underwent resection involving only the mandibular body, one case involving the mandibular body and symphysis and one case in which a ramus to ramus resection was performed. In this preliminary report, we show that the resin repositioning template is an easy, safe and useful tool for mandibular reconstruction with a fibular free flap.

  10. Utilization of induced mutation techniques in rice improvement in the Philippines

    Energy Technology Data Exchange (ETDEWEB)

    Asencion, A.B.; Santos, I.S.; Barrida, A.C.; Medina, F.I.S. III [Philippine Nuclear Research Institute, Atomic Research Center (Philippines)

    2001-03-01

    Rice is one of the most important food crops in the Philippines, as such, efforts have been made consistently to improve the varieties released to the farmers for planting. Both conventional and induced mutation techniques were utilized to solve some of the problems. Varieties with improved qualities, resistance to pests and diseases, reduced height, early maturity and non-photoperiod sensitive were developed using either physical or chemical mutagen. Other methods were also tried to enhance variability like combination of gamma irradiation and biotechnology. Irradiation of F1 seeds was also initiated including the use of mutants in crosses to transfer their improved mutated characters. Promising selections were already tested and six lines from the F1 irradiation out-yielded both C4-63G and IR 1561-288-3, their parents. (author)

  11. Development of a novel nanoindentation technique by utilizing a dual-probe AFM system.

    Science.gov (United States)

    Cinar, Eyup; Sahin, Ferat; Yablon, Dalia

    2015-01-01

    A novel instrumentation approach to nanoindentation is described that exhibits improved resolution and depth sensing. The approach is based on a multi-probe scanning probe microscopy (SPM) tool that utilizes tuning-fork based probes for both indentation and depth sensing. Unlike nanoindentation experiments performed with conventional AFM systems using beam-bounce technology, this technique incorporates a second probe system with an ultra-high resolution for depth sensing. The additional second probe measures only the vertical movement of the straight indenter attached to a tuning-fork probe with a high spring constant and it can also be used for AFM scanning to obtain an accurate profiling. Nanoindentation results are demonstrated on silicon, fused silica, and Corning Eagle Glass. The results show that this new approach is viable in terms of accurately characterizing mechanical properties of materials through nanoindentation with high accuracy, and it opens doors to many other exciting applications in the field of nanomechanical characterization.

  12. Development of a novel nanoindentation technique by utilizing a dual-probe AFM system

    Directory of Open Access Journals (Sweden)

    Eyup Cinar

    2015-10-01

    Full Text Available A novel instrumentation approach to nanoindentation is described that exhibits improved resolution and depth sensing. The approach is based on a multi-probe scanning probe microscopy (SPM tool that utilizes tuning-fork based probes for both indentation and depth sensing. Unlike nanoindentation experiments performed with conventional AFM systems using beam-bounce technology, this technique incorporates a second probe system with an ultra-high resolution for depth sensing. The additional second probe measures only the vertical movement of the straight indenter attached to a tuning-fork probe with a high spring constant and it can also be used for AFM scanning to obtain an accurate profiling. Nanoindentation results are demonstrated on silicon, fused silica, and Corning Eagle Glass. The results show that this new approach is viable in terms of accurately characterizing mechanical properties of materials through nanoindentation with high accuracy, and it opens doors to many other exciting applications in the field of nanomechanical characterization.

  13. Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

    Science.gov (United States)

    Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

    2017-01-01

    Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Laparoscopic loop colostomy using an esophageal retractor and a penrose drain: surgical technique.

    Science.gov (United States)

    Sabbagh, Raja; Rafiq, Amil; Familua, Oluwamayowa; Donaldson, Brian

    2013-10-01

    Laparoscopic Loop colostomy has been described in the literature as a safe and useful minimally invasive technique. It is indicated in patients with large perineal wounds requiring fecal diversion, obstructing lesions of the distal colon or rectum. The purpose of this article is to describe a modified version of this procedure which was used by 1 surgeon in our institution on a series of 5 patients. In this method, an esophageal retractor and Penrose drain are used to tent up and exteriorize the desired segment of colon to be used for the colostomy site. Results were that all 5 were completed laparoscopically and there were no complications. In conclusion, this variation in the technique has been useful in our institution and others may find it worthwhile to consider.

  15. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    Science.gov (United States)

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. PMID:26703927

  16. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    OpenAIRE

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creatin...

  17. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    OpenAIRE

    MEROLLA, GIOVANNI; Nastrucci, Guglielmo; Porcellini, Giuseppe

    2013-01-01

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid compon...

  18. Cartilage repair: surgical techniques and tissue engineering using polysaccharide- and collagen-based biomaterials.

    Science.gov (United States)

    Galois, L; Freyria, A M; Grossin, L; Hubert, P; Mainard, D; Herbage, D; Stoltz, J F; Netter, P; Dellacherie, E; Payan, E

    2004-01-01

    Lesions of articular cartilage have a large variety of causes among which traumatic damage, osteoarthritis and osteochondritis dissecans are the most frequent. Replacement of articular defects in joints has assumed greater importance in recent years. This interest results in large part because cartilage defects cannot adequately heal themselves. Many techniques have been suggested over the last 30 years, but none allows the regeneration of the damaged cartilage, i.e. its replacement by a strictly identical tissue. In the first generation of techniques, relief of pain was the main concern, which could be provided by techniques in which cartilage was replaced by fibrocartilage. Disappointing results led investigators to focus on more appropriate bioregenerative approaches using transplantation of autologous cells into the lesion. Unfortunately, none of these approaches has provided a perfect final solution to the problem. The latest generation of techniques, currently in the developmental or preclinical stages, involve biomaterials for the repair of chondral or osteochondral lesions. Many of these scaffolds are designed to be seeded with chondrocytes or progenitor cells. Among natural and synthetic polymers, collagen- and polysaccharide-based biomaterials have been extensively used. For both these supports, studies have shown that chondrocytes maintain their phenotype when cultured in three dimensions. In both types of culture, a glycosaminoglycan-rich deposit is formed on the surface and in the inner region of the cultured cartilage, and type II collagen synthesis is also observed. Dynamic conditions can also improve the composition of such three-dimensional constructs. Many improvements are still required, however, in a number of key aspects that so far have received only scant attention. These aspects include: adhesion/integration of the graft with the adjacent native cartilage, cell-seeding with genetically-modified cell populations, biomaterials that can be

  19. “Bird-Wing” abdominal phalloplasty: A novel surgical technique for penile reconstruction

    OpenAIRE

    Minu Bajpai

    2013-01-01

    Aim: To describe a technique of phalloplasty that is devoid of donor site scarring and suitable for urethral inlay and penile prosthesis in subsequent stages in cases of aphallia. Materials and Methods: Four patients with various disorders of sex development with 46 XY and severe penile deficiency, including one with complete androgen insensitivity syndrome who was initially raised as female, have been operated using a "Bird Wing" lower abdominal skin crease incision. Results: The patients′ a...

  20. Comparison of Mandibular Surgical Techniques for Accessing Cranial Base Vascular Lesions

    OpenAIRE

    Devlin, Michael A.; Hoffmann, Keith D.; Johnson, Walter D.

    2003-01-01

    This study compared mandibular distraction and vertical ramus osteotomy in terms of their effectiveness at increasing access to the cranial base and distal internal carotid artery. Five fresh–frozen cadavers were used to obtain a total of ten cranial base exposures. The following two techniques were evaluated on each of the ten exposures: (1) anterior distraction of the mandible without violation of the temporomandibular joint capsule, and (2) vertical ramus osteotomy of the mandible with dis...

  1. An Alternative Technique for Surgical Management of Poststernotomy Osteomyelitis and Reconstruction of the Sternal Defect

    Directory of Open Access Journals (Sweden)

    Petros Konofaos

    2013-01-01

    Full Text Available Introduction. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. Case presentation. A 70-year-old man with the diagnosis of poststernotomy osteomyelitis underwent reconstruction of his sternal defect with the use of bilateral pectoralis major muscle flaps. The patient had an uneventful recovery, and the physical examination revealed a normal range of motion for both upper limbs and sternal stability. Conclusion. The proposed technique incorporates a simple mobilization of the two pectoralis major muscles to be used as flaps to fill the sternal defect without the need for humeral detachment or a second cutaneous incision. Using this technique, a muscular implant is made that seals the dead space, which has no tension due to the presence of a second layer. Postoperative results are excellent, not only regarding infection and functionality but also from an aesthetic point of view.

  2. Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

    Directory of Open Access Journals (Sweden)

    Elias Jarade

    2017-04-01

    Full Text Available Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.

  3. 肘关节置换术操作技术的进展%The progress of the surgical technique of total elbow replacement

    Institute of Scientific and Technical Information of China (English)

    查晔军; 蒋协远

    2016-01-01

    Total elbow replacement is designed for the elbow joint articular surface damage and degenerative joint changes, but in recent years, it is widely used in the treatment of the distal humeral articular comminuted fracture in elderly patients. The purpose is to provide a stable, painless elbow joint with good functions. Total elbow replacement is a dififcult operation with its special surgical indications, requiring rich surgical experience. Even if the surgical technique is mature, there are still a lot of controversies in the surgical indication, prosthesis selection, surgical approach, condylar management and the disposal of the ulnar nerve. Based on the literature reviewed and the author’s experience, this paper analyzes some disputes. Although many scholars have conducted many prospective controlled studies, there are still some authors with different views, requiring prospective randomized controlled studies with a greater number of cases to clarify.

  4. Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review

    Directory of Open Access Journals (Sweden)

    Daberechi K Adiele

    2014-01-01

    Full Text Available Background: Atrial septal defect (ASD is a congenital heart defect that leads to shunting of blood between left and right atria. It may be asymptomatic and sometimes may present with heart failure. Surgical repair is definitive, but currently non-surgical procedure is used to close the defect. Materials and Methods: It is a retrospective study of patients who underwent transcatheter closure of ASD at Innova Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3 and 6 months after the procedure to assess complications. The morphological characteristics of the ASD, including its diameter, location, shape and the width of surrounding septal margins, were also evaluated. Results: From April 2007 to June 2011, 69 consecutive children (29 males, 40 females with a median age of 9.0 years (range = 3.2-19 years registered with diagnosis of ASD. The median weight was 31.5 kg (range = 7.5-39.0 kg. Five patients (7.2% were young children aged 3-5 years. Forty-four (63.8% of these children presented with symptoms of heart failure, whereas 47 (68.1% of the cases repaired with device were large-sized ASD. The most common interventional procedures done were Searcare Heart® and Amplatzer® technique with a highest success rate obtained in 2010. Conclusions: ASD is a common congenital heart disease with a high success rate for those who undergo intervention.

  5. The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

    Science.gov (United States)

    Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G

    2017-02-01

    Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Comparison of quality of life based on surgical technique in patients with breast cancer.

    Science.gov (United States)

    Sun, Young; Kim, Sung-Won; Heo, Chan Yeong; Kim, Dongwon; Hwang, Yoonsun; Yom, Cha Kyong; Kang, Eunyoung

    2014-01-01

    More than 80% of women with breast cancer survive for more than 5 years; quality of life is an important issue in these patients. The aim of this study was to assess differences in quality of life among patients who have undergone breast-conserving surgery, total mastectomy and immediate reconstruction after total mastectomy. A cross-sectional study was conducted during follow-up visits. Women who underwent surgical treatment at least 2 years prior were eligible if they were aged 20-70 years and had a diagnosis of breast cancer (Stages 0-III). Quality of life was evaluated based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire breast cancer-specific module, Rosenberg Self-esteem Scale, Beck Depression Index, Body Image Scale and sexual scale of the Cancer Rehabilitation Evaluation System. A total of 407 patients completed the questionnaires; 254 were treated with breast-conserving surgery, 122 with total mastectomy and 31 with reconstruction after total mastectomy. The mean period between surgery and the survey was 49 months. Women in the breast-conserving surgery group showed better outcomes than women in the total mastectomy and reconstruction after total mastectomy groups with respect to emotional-social function, nausea/vomiting, financial difficulty, body image, arm symptoms and self-esteem. Patients in the reconstruction after total mastectomy group had significantly better outcomes on the sexual scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire breast cancer-specific module and arm symptoms than the total mastectomy group. Quality of life was better in the breast-conserving surgery group than in the total mastectomy or reconstruction after total mastectomy groups, and the total mastectomy and reconstruction after total mastectomy groups had similar quality of

  7. Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2015-04-01

    Full Text Available AbstractObjective:Report initial experience with the Frozen Elephant Trunk technique.Methods:From July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ±11 years. They had type A aortic dissection (acute 9.6%, chronic 57.3%, type B (14.3%, all chronic and complex aneurysms (19%. It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft. Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months.Results:In-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152±24min, myocardial ischemia (115±31min and selective cerebral perfusion (60±15min. Main complications were bleeding (14.2%, spinal cord injury (9.5%, stroke (4.7%, prolonged mechanical ventilation (4.7% and acute renal failure (4.7%. The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%.Conclusion:Frozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.

  8. Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer (CLBC).

    Science.gov (United States)

    Moustafa, A; Fakhr, I

    2014-12-01

    Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance between good cosmetic outcome and limited risk of locoregional recurrence, by enabling proper resection margins. To present multiple techniques of partial breast reconstruction following the resection of centrally located breast cancer (CLBC) resection. From January 2011 to August 2014, 21 patients underwent central quadrantectomy for carcinoma of the central region of the breast. Excisions included the nipple/areola complex, in most of the cases, down to the pectoralis fascia with a wide safety margin, and proper axillary management. Oncoplastic approaches included latissimus dorsi flap, inferior pedicle flap, Melon slice, Grisotti and round block techniques. Mean age of patients was 49.5±10.61 years. Tumor size ranged from 1.5 to 4.5 cm. Postoperative pathology revealed a tumor mean safety margin of 2.5±0.83 cm, with positive axillary lymph nodes in 15 (75.0%) patients. Nineteen (95.0%) patients received postoperative breast radiotherapy, while 9/20 (45.0%) and 3/20 (15.0%) received adjuvant chemotherapy or hormonal therapy, respectively, and only 8/20 (40.0%) patients received both therapies. During a median follow-up period of 14.89 months, neither local nor distant metastasis, were detected. The postoperative cosmetic result evaluated by the patients was excellent in 6/20 patients (30.0%), good in 11/20 patients (55.0%), fair in 3/20 (15.0%) with neither poor nor bad results, with an overall mean of 4.0±0.5 equivalent to 80% satisfaction. Multiple oncoplastic breast surgery techniques can be used for the resection of CLBC with satisfying cosmetic outcomes. Copyright © 2014. Production and hosting by Elsevier B.V.

  9. Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis.

    Science.gov (United States)

    DiBartola, Alex C; Everhart, Joshua S; Magnussen, Robert A; Carey, James L; Brophy, Robert H; Schmitt, Laura C; Flanigan, David C

    2016-06-01

    Compare histological outcomes after microfracture (MF), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS). Literature review using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library. Inclusion criteria limited to English language studies International Cartilage Repair Society (ICRS) grading criteria for cartilage analysis after ACI (autologous chondrocyte implantation), MF (microfracture), or OATS (osteochondral autografting) repair techniques. Thirty-three studies investigating 1511 patients were identified. Thirty evaluated ACI or one of its subtypes, six evaluated MF, and seven evaluated OATS. There was no evidence of publication bias (Begg's p=0.48). No statistically significant correlation was found between percent change in clinical outcome and percent biopsies showing ICRS Excellent scores (R(2)=0.05, p=0.38). Percent change in clinical outcome and percent of biopsies showing only hyaline cartilage were significantly associated (R(2)=0.24, p=0.024). Mean lesion size and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Most common lesion location and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Microfracture has poorer histologic outcomes than other cartilage repair techniques. OATS repairs primarily are comprised of hyaline cartilage, followed closely by cell-based techniques, but no significant difference was found cartilage quality using ICRS grading criteria among OATS, ACI-C, MACI, and ACI-P. IV, meta-analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Surgical technique for heart transplantation: a strategy for congenital heart disease.

    Science.gov (United States)

    Hosseinpour, Amir-Reza; González-Calle, Antonio; Adsuar-Gómez, Alejandro; Cuerpo, Gregorio; Greco, Rubén; Borrego-Domínguez, José Miguel; Ordoñez, Antonio; Wallwork, John

    2013-10-01

    The standard techniques for orthotopic heart transplantation often require certain adjustments when the procedure is carried out for complex congenital heart disease. This is because of both the unusual anatomy and possible distortions caused by previous surgery. Such technical adjustments have been described in various published reports over the years. Those reports, when combined, do cover the full spectrum of the technical difficulties that may be encountered, whether the defects are in their original form or altered by surgery, such that no cardiac malformation or distortion would prohibit transplantation. However, those reports are comprehensive only when combined. None of the individual reports addresses all the possible technical challenges. Consequently, the available information is somewhat fragmented. In addition, the generic aspect of the described technical strategies is not always given the emphasis that it deserves. Indeed, occasionally a technique may be presented as a specific solution for a specific malformation, without necessarily pointing out that the same technique may be applied to other hearts with different overall pathologies but which share that specific malformation. The aim of this review article was to combine all the available published information in one article in a manner that constructs a simple but comprehensive and generic system of decision-making that may be applied to any heart in order to determine the exact technical adjustments needed for transplantation in each case. Such a strategy is possible for two reasons. First, only a few anatomical sites are technically significant, namely the points of anastomosis between the donor's organ and the recipient. The rest of the intracardiac morphology does not affect the operation and may be ignored. Second, each of those anatomical sites can present difficulties in only a few ways, and each of those few difficulties has a well-described and published solution already. Therefore, the

  11. Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

    Science.gov (United States)

    Gore, Sinclair M.; Wishart, Gordon C.; Malata, Charles M.

    2012-01-01

    Objective: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. Methods: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Results: Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. Conclusions: This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease. PMID:22893784

  12. Improvements of Surgical Technique in Establishment of Rat Orthotopic Pulmonary Transplantation Model Using Cuffs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    In order to establish more simple and effective rat orthotopic lung transplantation models, 20 rats were divided into donor and recipient groups. Rat lung transplantation models were established by using improved cuff technique. All the 10 operations were accomplished successfully.The mean operative time of recipients was 45±4 min. The survival time was over 30 days after lung transplantation. The checks of X-ray were almost ncrmal. There was no significant difference in the blood gas analysis before and after clipping the right hilum (P>. 05). This method is more simple,applicable and requires less time.

  13. Surgical techniques and adjuvants for the management of primary and recurrent pterygia.

    Science.gov (United States)

    Hovanesian, John A; Starr, Christopher E; Vroman, David T; Mah, Francis S; Gomes, Jose A P; Farid, Marjan; Shamie, Neda; Davidson, Richard S; John, Thomas; Holland, Edward J; Kim, Terry

    2017-03-01

    The removal and rate of recurrence of pterygium have been discussed for years. The disorder is highly associated with environmental factors, and recurrence rates can be unacceptably high and cannot be successfully predicted. New techniques and graft preparations and postoperative management strategies are helping to reduce the recurrence rates and provide an ocular surface that is near ideal for future cataract or refractive surgery. This review discusses the advantages and disadvantages of various treatment strategies. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  14. [Surgical technique of saphenous vein harvesting using a Cusco vaginal speculum].

    Science.gov (United States)

    Kikuchi, Keita; Suzuki, Kotaro; Endo, Yoshiki; Matsuyama, Takayoshi; Osaka, Shin-ichi; Kurata, Atsushi

    2014-11-01

    We used Cusco vaginal speculum in harvesting saphenous vein graft (SVG) as an assist device for making a skin tunnel. After making 2 incisions of 3 to 4 cm, the SVG was dissected in a usual procedure. Then Cusco vaginal speculum was inserted into the skin tunnel between the 2 incisions. The SVG was dissected in a usual fashion under direct vision with the speculum. This procedure requires only small incisions, short learning curve and low cost. The new technique using Cusco vaginal speculum can be a reliable option for harvesting SVG.

  15. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Science.gov (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H

    2016-04-01

    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  16. Improving Double Docking for Robot-assisted Para-aortic Lymphadenectomy in Endometrial Cancer Staging: Technique and Surgical Outcomes.

    Science.gov (United States)

    Ekdahl, Linnea; Salehi, Sahar; Falconer, Henrik

    2016-01-01

    Robot-assisted para-aortic lymphadenectomy (PALND) may prove to be a challenging procedure, and the ability to reach the planned anatomic landmarks is critical. In this retrospective study between 2012 and 2015, we present surgical data using a modified technique to perform infrarenal PALND for endometrial cancer using double side docking. All women with high-risk endometrial cancer scheduled for complete robotic staging including infrarenal PALND were included in the analysis. During the study period, a total of 76 women were identified. Three patients had disseminated disease and were treated with palliative hysterectomy only. The remaining 73 women underwent surgery with the intention to perform infrarenal PALND. In 7 cases, PALND was aborted because of technical inability to reach the left renal vein (10%). A median of 36 lymph nodes were harvested (pelvic n = 20, para-aortic n = 16). The median operating time (skin to skin) for patients with completed infrarenal PALND was 228 minutes (range, 181-371 minutes). Among all 76 patients, postoperative complications according to the Clavien-Dindo nomenclature were observed in 27 (36%) patients, with 6 (8%) having grade III complications. No patient died within 30 days from surgery. Our technique of double docking for robot-assisted PALND was associated with a success rate of 90%. The described technique seems to be a useful strategy to maximize the likelihood of completing the planned procedure.

  17. Comparison of ischaemic preconditioning with surgical delay technique to increase the viability of single pedicle island venous flaps: an experimental study.

    Science.gov (United States)

    Ceylan, Refika; Kaya, Burak; Çaydere, Muzaffer; Terzioğlu, Ahmet; Aslan, Gürcan

    2014-12-01

    The aim of the present study was to investigate the effect of ischaemic preconditioning compared with the surgical delay procedure in an effort to increase the survival rate of single pedicle island venous flaps. Eighteen male Wistar albino rats (250-350 g) were included. A 3 × 4 cm flap was planned at the right lower abdomen of the rat. Superficial epigastric vein constituted the pedicle of the flap. The rats were divided into three groups, each consisting of six rats. In the control group, a single pedicle venous island flap was elevated on each rat and no other surgical procedure was performed. In the ischaemic preconditioning group, ischaemic preconditioning was performed and, in the surgical delay procedure group, the surgical delay technique was performed before flap elevation. The mean necrosis areas were 56.85 ± 14.60%, 28.73 ± 15.60%, and 12.08 ± 3.65% in the control, ischaemic preconditioning, and surgical delay procedure groups, respectively. The necrosis areas were significantly smaller in the ischaemic preconditioning group and surgical delay procedure groups compared to the control group (p = 0.004 and p surgical delay procedure groups. Histopathological parameters including necrosis, abscess formation, and skin ulceration scores were significantly lower in the ischaemic preconditioning group than in the control group, whereas the study groups were similar. In conclusion, ischaemic preconditioning may serve as an adjuvant technique in increasing venous island flap viability.

  18. Taking label-free optical spectroscopy techniques into the operating theatre: biopsy needles and surgical guidance probes (Conference Presentation)

    Science.gov (United States)

    Leblond, Frédéric

    2017-02-01

    Recent advances will be described relating to the development and clinical translation of optical spectroscopy techniques designed to guide surgical interventions in brain and prostate oncology applications. The use of molecular imaging guidance systems can enable true intra-operative tissue identification, increasing the effectiveness of cancer surgery and potentially positively impacting patient survival. Surgical resection is a fundamental cancer treatment, but its effectiveness is reduced by the inability to rapidly and accurately identify cancer margins. We will introduce a portable intraoperative label-free multimodal optical spectroscopy system combining intrinsic fluorescence, diffuse reflectance, and Raman spectroscopy that can identify cancer in situ during surgery. We will show that this on-line guidance system can detect primary cancer such as glioma as well as metastatic melanoma and cancer of the lung and colon with an accuracy, sensitivity, and specificity of 97%, 100%, and 93% respectively. Moreover, a method will be presented, along with preliminary tissue classification results, based on the interrogation of whole human prostates from prostatectomies. The development and in vivo validation of an optical brain needle biopsy instrument will be presented demonstrating its ability to detect bulk tumor using Raman spectroscopy with the goal of reducing the number of non-diagnostic samples during a procedure. The extraction of tissue can cause life-threatening hemorrhage because of significant blood vessel injury during the procedure. We will demonstrate that a sub-diffuse optical tomography technique integrated with a commercial biopsy needle can detect the presence of blood vessels to limit the hemorrhage risk.

  19. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications

    OpenAIRE

    Mavrodi, Alexandra; Ohanyan, Ani; Kechagias, Nikos; Antonis TSEKOS; Konstantinos VAHTSEVANOS

    2015-01-01

    Background Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Material and Methods Patients of the first group unde...

  20. Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique.

    Science.gov (United States)

    Miller, Elizabeth A; Cobb, Anna L; Cobb, Tyson K

    2017-09-01

    Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

  1. Outcomes of Four Different Surgical Techniques in the Treatment of Geriatric Intertrochanteric Femur Fractures

    Directory of Open Access Journals (Sweden)

    Altuğ Duramaz

    2014-12-01

    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: One hundred eighty-two patients operated due to intertrochanteric femur fracture in our clinic were divided into four groups: hemiarthroplasty (HA, proximal femoral nail (PFN, sliding hip screw (SHC, and external fixator (EF groups. Time to surgery, comorbidities, anesthesia techniques, postoperative ambulation time, mortality rates and daily activity levels were compared. The patients were evaluated via outpatient follow-up and telephone interview. The Barthel index of activities of daily living was used for evaluation. Results: Patient distribution was: HA: 17 patients, PFN: 26 patients, SHC: 71 patients, and EF: 68 patients. The gender distribution (F/M and the mean age were: HA: 11/6, 83.4 years, PFN: 18/8, 81.2 years, SHC: 48/23, 82.1 years, and EF: 44/24, 84.5 years. There was no statistically significant difference between the groups in gender, comorbidities, anesthesia techniques, mean follow-up period, and Barthel index scores. In HA group, walking with double support duration was shorter (p=0.028. Conclusion: Elderly intertrochanteric femur fractures should be operated as soon as possible in order to prevent eventual complications preferably by regional anesthesia and internal fixation.

  2. A new treatment strategy for severe arthrofibrosis of the knee. Surgical technique.

    Science.gov (United States)

    Wang, Jian-Hua; Zhao, Jin-Zhong; He, Yao-Hua

    2007-03-01

    To reduce the morbidity of traditional quadricepsplasty for the treatment of severe arthrofibrosis of the knee, we instituted a treatment regimen consisting of an initial extra-articular mini-invasive quadricepsplasty and subsequent intra-articular arthroscopic lysis of adhesions during the same anesthesia session. The purpose of the present study was to determine the results of this technique. From 1998 to 2001, twenty-two patients with severely arthrofibrotic knees were managed with this operative technique. The mean age of the patients at the time of the operation was thirty-seven years. After a mean duration of follow-up of forty-four months (minimum, twenty-four months), all patients were evaluated according to the criteria of Judet and The Hospital for Special Surgery knee-rating system. The average maximum degree of flexion increased from 27 degrees preoperatively to 115 degrees at the time of the most recent follow-up (p < 0.001). According to the criteria of Judet, the result was excellent for sixteen knees, good for five, and fair for one. The average Hospital for Special Surgery knee score improved from 74 points preoperatively to 94 points at the time of the most recent follow-up (p < 0.001). A superficial wound infection occurred in one patient. Only one patient had a persistent 15 degrees extension lag. This mini-invasive operation for the severely arthrofibrotic knee can be used to increase the range of motion and enhance functional outcome.

  3. Performance evaluation of preprocessing techniques utilizing expert information in multivariate calibration.

    Science.gov (United States)

    Sharma, Sandeep; Goodarzi, Mohammad; Ramon, Herman; Saeys, Wouter

    2014-04-01

    Partial Least Squares (PLS) regression is one of the most used methods for extracting chemical information from Near Infrared (NIR) spectroscopic measurements. The success of a PLS calibration relies largely on the representativeness of the calibration data set. This is not trivial, because not only the expected variation in the analyte of interest, but also the variation of other contributing factors (interferents) should be included in the calibration data. This also implies that changes in interferent concentrations not covered in the calibration step can deteriorate the prediction ability of the calibration model. Several researchers have suggested that PLS models can be robustified against changes in the interferent structure by incorporating expert knowledge in the preprocessing step with the aim to efficiently filter out the spectral influence of the spectral interferents. However, these methods have not yet been compared against each other. Therefore, in the present study, various preprocessing techniques exploiting expert knowledge were compared on two experimental data sets. In both data sets, the calibration and test set were designed to have a different interferent concentration range. The performance of these techniques was compared to that of preprocessing techniques which do not use any expert knowledge. Using expert knowledge was found to improve the prediction performance for both data sets. For data set-1, the prediction error improved nearly 32% when pure component spectra of the analyte and the interferents were used in the Extended Multiplicative Signal Correction framework. Similarly, for data set-2, nearly 63% improvement in the prediction error was observed when the interferent information was utilized in Spectral Interferent Subtraction preprocessing.

  4. UTILIZATION OF FORMALIN EMBALMED SPECIMENS UNDER ECO-FRIENDLY CONDITIONS BY ADVANCED PLASTINATION TECHNIQUE

    Directory of Open Access Journals (Sweden)

    R. Menaka

    2015-06-01

    Full Text Available Preparation of anatomical models and teaching aids is a challenging task in the medical, veterinary and paramedical sciences as like as life form. The successful preservation of conventional methods by embalmed cadavers/ corpse’s are routinely practiced for educational/research purposes. The existing form of preservation technique is not promising to meet the current challenges in the teaching and learning of human/veterinary anatomy. The embalming fluid causes potential health hazards with continuous exposure of formalin fumes. The study was conducted on dissected cadaverous embalmed specimens by using advanced plastination technique. The 10% formalin fixed and preserved specimens of buffalo head and horse limb were subjected to dehydration, impregnation and hardening with clearing, dehydrating and curing agents. Plastination methodology consists of slowly replacing tissue fluids, lipids with a dehydrating agent and replaced with polymer under force impregnation. In these processes, water and lipids in biological tissues are replaced by curable polymers. The yielded specimens are pleasant to handle, non toxic, pliable, dried and don’t smell or decay. These plastinates are well utilized in routine practical demonstrations of gross anatomical observations in institutional teaching as well as learning. The plastinated specimens are today’s milestone in medical education and become an ideal teaching tool not only in anatomy but also in pathology, obstetrics, radiology and surgery. Hence, any methodology or technique that would decrease the level of exposure to formaldehyde should be explored. Plastinates offer this excellent alternative as it lowers the risk of undue exposure to formaldehyde with higher health and safety regulations in our country.

  5. Transplantation of infant kidneys - the surgical technique en bloc and transplant position variation: A case report

    Directory of Open Access Journals (Sweden)

    Popović Vladan

    2015-01-01

    Full Text Available Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called “marginal donors” group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

  6. Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

    Directory of Open Access Journals (Sweden)

    Barz Thomas

    2008-06-01

    Full Text Available Abstract Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc. and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc. modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost

  7. Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

    Directory of Open Access Journals (Sweden)

    Guilherme de Almeida Santos

    2012-09-01

    Full Text Available The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases, Ferguson (341 cases and mixed (310 cases in 11,043 patients with hemorrhoidal disease (HD allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8% than men (46.2%, and more accepted by women (26.5% than men (24.8%. Hemorrhoidectomy was more common in patients of the fourth (27.7%, fifth (21.9% and third (21.0% decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%, eighth (35.9% and ninth (34.5% decades of age. The overall incidence of surgical complications was 3.0% (87 cases: anal stenosis (1.8%, bleeding (0.8%, worsening of anal hypotonia (0.2%, sepsis (0.1% and systemic complications (0.1%, with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0% - stenosis (1.9%, bleeding (1.9%, worsening of anal hypotonia (0.2% and systemic complications (0.04%. The incidence of surgical complications by Ferguson's technique was 3.5% - stenosis (1.7%, bleeding (0.6%, worsening of anal hypotonia (0.6% and sepsis (0.6%. And the incidence of surgical complications by mixed techniques was 2.5% - stenosis (1.0%, bleeding (0.3%, worsening of anal hypotonia (0.3%, sepsis (0.3% and systemic complications (0.3%. The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0% and hemorrhage in men (1.1%. Surgical complications were more observed in the eighth (5.1% and seventh (3.8% decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%, with annular stenosis as the most common anatomical shape (70.0%. Anal stenosis was more common among women (2.0% presenting mean age of 38.2 years, with no

  8. Micrometeorological Technique for Monitoring of Geological Carbon Capture, Utilization and Storage: Methodology, Workflow and Resources

    Science.gov (United States)

    Burba, G. G.; Madsen, R.; Feese, K.

    2013-12-01

    The eddy covariance (EC) method is a micrometeorological technique for direct high-speed measurements of the transport of gases and energy between land or water surfaces and the atmosphere [1]. This method allows for observations of gas transport scales from 20-40 times per second to multiple years, represents gas exchange integrated over a large area, from hundreds of square meters to tens of square kilometres, and corresponds to gas exchange from the entire surface, including canopy, and soil or water layers. Gas fluxes, emission and exchange rates are characterized from single-point in situ measurements using permanent or mobile towers, or moving platforms such as automobiles, helicopters, airplanes, etc. Presently, over 600 eddy covariance stations are in operation in over 120 countries [1]. EC is now recognized as an effective method in regulatory and industrial applications, including CCUS [2-10]. Emerging projects utilize EC to continuously monitor large areas before and after the injections, to locate and quantify leakages where CO2 may escape from the subsurface, to improve storage efficiency, and for other CCUS characterizations [5-10]. Although EC is one of the most direct and defensible micrometeorological techniques measuring gas emission and transport, and complete automated stations and processing are readily available, the method is mathematically complex, and requires careful setup and execution specific to the site and project. With this in mind, step-by-step instructions were created in [1] to introduce a novice to the EC method, and to assist in further understanding of the method through more advanced references. In this presentation we provide brief highlights of the eddy covariance method, its application to geological carbon capture, utilization and storage, key requirements, instrumentation and software, and review educational resources particularly useful for carbon sequestration research. References: [1] Burba G. Eddy Covariance Method

  9. Bipolar Button Transurethral Enucleation of Prostate in Benign Prostate Hypertrophy Treatment: A New Surgical Technique.

    Science.gov (United States)

    Giulianelli, Roberto; Gentile, Barbara; Albanesi, Luca; Tariciotti, Paola; Mirabile, Gabriella

    2015-08-01

    To evaluate the safety and efficacy of transurethral bipolar enucleation with a button electrode (B-TUEP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia. Between July 2011 and March 2012, a single surgeon performed 50 B-TUEP. Preoperative and postoperative assessments included prostate-specific antigen, International Prostate Symptoms Score (IPSS), International Index of Erectile Function-5 (IIEF-5), quality of life (QoL) index, uroflowmetry with postvoiding residual (PVR) urinary volume, and prostate volume measured by transrectal ultrasonography. Intraoperatively, we evaluated B-TUEP time (enucleation and resection time). Perioperatively, we evaluated hemoglobin dosage, bladder irrigation time, catheterization time, acute urinary retention events, length of stay, patient readmission, and any endoscopic retreatments. Three months after surgery, 82% of the patients presented a significant improvement in maximum urine flow (Qmax; P prostate. B-TUEP using the Gyrus PK system is a rapid and safety technique with optimal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Lumbar extracavitary corpectomy with a single stage circumferential arthrodesis: surgical technique and clinical series.

    Science.gov (United States)

    Singh, Kern; Park, Daniel K

    2012-07-01

    Circumferential arthrodesis and reconstruction is necessary after a lumbar corpectomy in the setting of malignancy and infection. The advent of expandable cage technology now allows for safe anterior column reconstruction via a posterior approach with no transection and minimal retraction of the lumbar spinal nerve roots. Fifteen patients underwent a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach. Posterior segmental pedicle screw fixation and iliac crest bone graft was used in all cases. Fifteen lumbar extracavitary corpectomy nerve root-sparing procedures have been performed to date, with at least 1-year follow-up (12 tumors/3 infections). No patient suffered any neurological complications. One patient suffered from a postoperative myocardial infarction 10 days after the procedure. Two patients had medical complications that were treated without sequelae. We present a technical description and case series of patients undergoing a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach with at least 1-year follow-up. The technique is safe, technically feasible, and obviates an anterior approach in this oftentimes critically ill patient population.

  11. Anterograde excision of a sublingual gland: new surgical technique for the treatment of ranulas.

    Science.gov (United States)

    Liu, Zhigang; Wang, Bin

    2016-02-01

    Wharton's duct is dissected in a retrograde direction from the orifice of the duct to the hilum of the submandibular gland when the gland is being excised conventionally. Here we describe an anterograde technique, in which Wharton's duct is dissected in an anterograde direction from the hilum of the submandibular gland to the orifice of the duct. This prospective clinical study included 50 consecutive patients with ranulas who had anterograde excision of the sublingual gland between May 2012 and January 2015. The intraoral incision was similar to that for conventional excision. Wharton's duct and other important anatomical structures located in the space behind the sublingual gland were all identified at the beginning of the procedure, followed by anterograde dissection of Wharton's duct. After the glandular tissue lateral to the duct had been incised completely, the duct was exposed and the gland cut into two parts. Finally, the two parts were removed, and the ranula ruptured. The patients were followed up from 6 months-2 years. There were no complications. Anterograde excision of the sublingual gland is based on the anatomy, and this reduces the risk of complications after removal of a ranula.

  12. A NEW AND SAFER SURGICAL TECHNIQUE FIGURE OF EIGHT STITCH FOR MANAGEMENT OF PERFORATED PEPTIC ULCER

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    Lalit

    2014-05-01

    Full Text Available There are many methods for closing the perforated peptic ulcer. The technique of closure of perforation by figure of 8 stitch method has been found to be very effective in managing patients with this common problem. MATERIAL AND METHOD: The present study was conducted in Unit III of Department of General Surgery, Government Medical College and Dr. Susheela Tiwari Government Hospital Haldwani, from January 2012 to December 2013 on the cases of peptic ulcer perforation peritonitis. All patients with clinical and radiological features and intraoperative findings suggestive of perforated peptic ulcer were included in the study. RESULTS: A total of 153 patients were included in the study. Out of these, 128 patients (84% were males and 25 patients (16% were females. In 120 patients (78% there was duodenal perforation and in 33 patients (22 % gastric perforation was present. Out of these 33 patients, 6 patients had posterior gastric perforation. 140 patients were managed with midline laparotomy and 13 with laparoscopic method, with one converted to open due to presence of posterior gastric perforation. The average time of patient reporting to the emergency was3-4 days, with earliest reporting time of 2-3 hours and late reporting up to 7-8 days. Age ranged from 15 years to 90 years (average 35 - 45 years. In the postoperative period, 3 patients had leakage from repair site, 7 patients died, rest showed good outcome. CONCLUSION: Figure of 8 stitch method showed very good and acceptable result. Therefore, in our opinion this method should be promoted for surgery of perforated peptic ulcer

  13. Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

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    Randy Mascarenhas

    2014-01-01

    Full Text Available Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter. All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST and American Shoulder and Elbow Surgeons (ASES evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI forms. 10 patients (9 males, 1 female were followed for an average of 16 months (4-36 months and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%. ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.

  14. Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

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    Uwe Wollina

    2014-01-01

    Full Text Available Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182, morpheic (79, and micronodular (20, Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%. All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs guarantee a high rate of complete tumour removal and a very low risk of recurrence.

  15. Contrast-enhanced MR angiography utilizing parallel acquisition techniques in renal artery stenosis detection

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    Slanina, Martin, E-mail: slaninajicin@seznam.c [Department of Radiology, Charles University Prague, Medical Faculty and Teaching Hospital in Hradec Kralove, Sokolska 581, Hradec Kralove 500 05 (Czech Republic); Zizka, Jan; Klzo, Ludovit; Lojik, Miroslav [Department of Radiology, Charles University Prague, Medical Faculty and Teaching Hospital in Hradec Kralove, Sokolska 581, Hradec Kralove 500 05 (Czech Republic)

    2010-07-15

    Significant renal artery stenosis (RAS) is a potentially curable cause of renovascular hypertension and/or renal impairment. It is caused by either atherosclerosis or fibromuscular dysplasia. Correct and timely diagnosis remains a diagnostic challenge. MR angiography (MRA) as a minimally invasive method seems to be suitable for RAS detection, however, its diagnostic value widely differs in the literature (sensitivity 62-100% and specificity 75-100%). The aim of our prospective study was to compare the diagnostic value of contrast-enhanced MRA utilizing parallel acquisition techniques in the detection of significant RAS with digital subtraction angiography (DSA). A total of 78 hypertensive subjects with suspected renal artery stenosis were examined on a 1.5 Tesla MR system using a body array coil. Bolus tracking was used to monitor the arrival of contrast agent to the abdominal aorta. The MRA sequence parameters were as follows: TR 3.7 ms; TE 1.2 ms; flip angle 25{sup o}; acquisition time 18 s; voxel size 1.1 mm x 1.0 mm x 1.1 mm; centric k-space sampling; parallel acquisition technique with acceleration factor of 2 (GRAPPA). Renal artery stenosis of 60% and more was considered hemodynamically significant. The results of MRA were compared to digital subtraction angiography serving as a standard of reference. Sensitivity and specificity of MRA in the detection of hemodynamically significant renal artery stenosis were 90% and 96%, respectively. Prevalence of RAS was 39% in our study population. Contrast-enhanced MRA with high spatial resolution offers sufficient sensitivity and specificity for screening of RAS.

  16. Reducing post-surgical adhesions utilizing a drug-enhanced device: sodium carboxymethylcellulose aqueous gel/poly(p-dioxanone) and Tranilast.

    Science.gov (United States)

    Cui, Helen; Gensini, Michel; Kataria, Ram; Twaddle, Tricia; Zhang, John; Wadsworth, Scott; Petrilli, Janel; Rodgers, Kathleen; diZerega, Gere; Cooper, Kevin

    2009-02-01

    Post-surgical adhesion formation has numerous deleterious side effects in a wide variety of surgical settings. Physical barriers used together with laparoscopy were developed to reduce tissue trauma seen with open procedures. However, despite surgeons' meticulous techniques and the use of such barriers, adhesion formation remains a serious clinical problem, creating complications that cost the health care system over $1 billion annually. Our laboratories have combined a previously marketed drug, Tranilast, with a sodium carboxymethylcellulose (NaCMC) gel in a sustained release formulation using poly(p-dioxanone) (PDO) to provide a locally delivered medicated device that significantly reduces adhesions. This paper describes the preparation of the gel and the sustained release formulation, its key physical properties, and its sustained release kinetics. Pre-clinical data on inhibition of adhesion formation by the sustained release poly(p-dioxanone)/sodium carboxymethylcellulose/Tranilast drug enhanced device are also presented.

  17. The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature.

    Science.gov (United States)

    Cornelius, Carl-Peter; Ehrenfeld, Michael

    2010-06-01

    Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines.

  18. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications

    Directory of Open Access Journals (Sweden)

    Timothy J Kovanda

    2014-01-01

    Full Text Available Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA, which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.

  19. The relative risk of neurosensory deficit following removal of mandibular third molar teeth: the influence of radiography and surgical technique.

    Science.gov (United States)

    Smith, W P

    2013-01-01

    The aim of this study was to identify the relative risk of damage to the inferior dental (ID) and lingual nerves in patients undergoing lower third molar removal. A single surgeon reviewed 1,000 patients. Temporary ID neurosensory deficit was highest (11%) when root apices were intimate to the ID nerve and lowest (0.9%) when close or distant from the nerve. Permanent ID neurosensory deficit was 0.4% per tooth but only when intimate to the canal. Bone removal, tooth division, and lingual split technique increase the risk of excessive hemorrhage which appears to be linked to the highest risk of temporary ID neurosensory deficit (20%). Permanent lingual nerve injury was rare (0.06%) and not related to lingual retraction. Preoperative warning for lower third molar removal can be individually tailored depending on the intimacy of the ID canal to the root apices and the anticipated surgical technique. Crown Copyright © 2013. Published by Mosby, Inc. All rights reserved.

  20. Long-term results of the surgical treatment of Peyronie's disease with Egydio's technique: a European multicentre study

    Institute of Scientific and Technical Information of China (English)

    Salvatore Sansalone; Giulio Garaffa; Rados Djinovic; Stefano Pecoraro; Mauro Silvanis; Guido Barbagli; Alessandro Zucchi; Giuseppe Vespasiani; Carla Loreto8

    2011-01-01

    The long-term outcomes of 157 patients affected by Peyronie's disease (PD) who underwent penile straightening with Egydio's technique between January 2004 and December 2008 are reported.Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study.Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 (11EF-5) questionnaire.Stretched penile length was recorded pre-and postoperatively.Surgical complications,cosmesis and sexual function,patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months,i year and 2 years,respectively.After a median follow-up period of 20 months (range:12-24 months),we found that mild residual curvature (12%) and glans hypoesthesia (3%) were the only causes of partial dissatisfaction.No rejection of the graft was observed.All patients recovered their ability to penetrate with no difficulty.In addition,an intraoperative average increase of 2.5 cm (range:1.7-4.1 cm) in stretched penile length was recorded,with all patients engaging in penetrative sexual intercourse.In conclusion,this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.

  1. A Modular Approach Utilizing Decision Tree in Teaching Integration Techniques in Calculus

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    Edrian E. Gonzales

    2015-08-01

    Full Text Available This study was conducted to test the effectiveness of modular approach using decision tree in teaching integration techniques in Calculus. It sought answer to the question: Is there a significant difference between the mean scores of two groups of students in their quizzes on (1 integration by parts and (2 integration by trigonometric transformation? Twenty-eight second year B.S. Computer Science students at City College of Calamba who were enrolled in Mathematical Analysis II for the second semester of school year 2013-2014 were purposively chosen as respondents. The study made use of the non-equivalent control group posttest-only design of quasi-experimental research. The experimental group was taught using modular approach while the comparison group was exposed to traditional instruction. The research instruments used were two twenty-item multiple-choice-type quizzes. Statistical treatment used the mean, standard deviation, Shapiro-Wilk test for normality, twotailed t-test for independent samples, and Mann-Whitney U-test. The findings led to the conclusion that both modular and traditional instructions were equally effective in facilitating the learning of integration by parts. The other result revealed that the use of modular approach utilizing decision tree in teaching integration by trigonometric transformation was more effective than the traditional method.

  2. Utilization of Data Mining Techniques for Prediction and Diagnosis of Tuberculosis Disease Survivability

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    K.R.Lakshmi

    2013-10-01

    Full Text Available The prediction and diagnosis of Tuberculosis survivability has been a challenging research problem for many researchers. Since the early dates of the related research, much advancement has been recorded in several related fields. For instance, thanks to innovative biomedical technologies, better explanatory prognostic factors are being measured and recorded; thanks to low cost computer hardware and software technologies, high volume better quality data is being collected and stored automatically; and finally thanks to better analytical methods, those voluminous data is being processed effectively and efficiently. Tuberculosis is one of the leading diseases for all people in developed countries including India. It is the most common cause of death in human being. The high incidence of Tuberculosis in all people has increased significantly in the last years. In this paper we have discussed various data mining approaches that have been utilized for Tuberculosis diagnosis and prognosis. This study paper summarizes various review and technical articles on Tuberculosis diagnosis and prognosis also we focus on current research being carried out using the data mining techniques to enhance the Tuberculosis diagnosis and prognosis. Here, we took advantage of those available technological advancements to develop the best prediction model for Tuberculosis survivability.

  3. Direct Data Domain Sparsity-Based STAP Utilizing Subaperture Smoothing Techniques

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    Zhaocheng Yang

    2015-01-01

    Full Text Available We propose a novel direct data domain (D3 sparsity-based space-time adaptive processing (STAP algorithm utilizing subaperture smoothing techniques for airborne radar applications. Different from either normal sparsity-based STAP or D3 sparsity-based STAP, the proposed algorithm firstly uses only the snapshot in the cell under test (CUT to generate multiple subsnapshots by exploiting the space-time structure of the steering vector and the uncorrelated nature of the components of the interference covariance matrix. Since the interference spectrum is sparse in the whole angle-Doppler plane, by employing a sparse regularization, the generated multiple subsnapshots are jointly used to recover the interference spectrum. The interference covariance matrix is then estimated from the interference spectrum, followed by the space-time filtering and the target detection. Simulation results illustrate that the proposed algorithm outperforms the generalized forward/backward method, the conventional D3 least squares STAP algorithm, and the existing D3 sparsity-based STAP algorithm. Furthermore, compared with the normal sparsity-based STAP algorithm using multiple snapshots, the proposed algorithm can also avoid the performance degradation caused by discrete interferers merely appearing in the CUT.

  4. Comparison of Surgical Blade and Cryosurgery with Liquid Nitrogen Techniques in Treatment of Physiologic Gingival Pigmentation: Short Term Results

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    Saeed Rahmati

    2014-12-01

    Full Text Available Statement of the Problem: Melanin pigmentation of the gingiva is a crucial esthetic problem. A variety of methods have been used for gingival depigmentation. Purpose: The purpose of this study was to compare the results of two treatment modalities: scalpel technique and cryotherapy with liquid nitrogen in treatment of gingival pigmentation. Materials and Method: Twenty patients with chief complaint of gingival pigmentation participated in our study. 10 patients were treated with cryotherapy and remaining 10 participants were undergone the scalpel technique surgery. We evaluated acquiescence and comfort of the patients, degree of depigmentation, based on the area of pigmentation shown by gridlines option in Microsoft Paint software, and the presence or absence of gingival recession before and one month after treatment. Data was analyzed using Mann-Whitney and Chi-Square tests. A significance level of p≤ 0.05 was adopted. Results: Mean value and standard deviation of depigmentation for group A and group B was 96.17±2.51 and 95±2.48, respectively. The difference was not statistically significant (p= 0.225. There was no association between the treatment modality and the gingival recession (p= 0.303 or the treatment modality and the patient satisfaction (p= 0.346. No significant difference was found between gingival recession measures before and after the operation in the two treatment modalities. Conclusion: Surgical blade and cryosurgery with liquid nitrogen had no significant difference in treatment of physiologic gingival pigmentation. Both Techniques are acceptable in the treatment of gingival pigmentation.

  5. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases

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    Uchiyama Yoshiyasu

    2011-09-01

    Full Text Available Abstract Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33 and 28.8 months (range, 24-36. A rectangular bone trough (about 1 × 4 cm was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM, outcome of treatment, and isometric power were measured at final follow-up. Results There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases or good (1/5. In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. Conclusions Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon.

  6. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

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    Berger, Cezar Augusto Sarraf

    2014-12-01

    Full Text Available Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©. The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%. The most common dorsum technique was hump removal (33.33%, and the predominance of sutures (24.76% was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%. Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures.

  7. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

    Science.gov (United States)

    Berger, Cezar Augusto Sarraf; Freitas, Renato da Silva; Malafaia, Osvaldo; Pinto, José Simão de Paula; Macedo Filho, Evaldo Dacheux; Mocellin, Marcos; Fagundes, Marina Serrato Coelho

    2014-01-01

    Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures. PMID:25992149

  8. Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele

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    Matheus Fernandes de Oliveira

    2015-12-01

    Full Text Available ABSTRACT Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS. This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.

  9. Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap.

    Science.gov (United States)

    Carnio, João; Camargo, Paulo M; Pirih, Paulo Q

    2015-01-01

    The attached gingiva is a desirable anatomical element for the maintenance of gingival health. The free gingival graft (FGG) and the modified apically repositioned flap (MARF) are predictable surgical techniques often employed to increase the zone of attached gingiva. This randomized study compared the FGG and the MARF in increasing the zone of attached gingiva in contralateral sides of 15 patients 1 year posttreatment. There was an increase in keratinized tissue and attached gingiva in both groups. Gingival recession did not significantly change between pre- and posttreatment levels in either group. The MARF surgical time was approximately half as long as that of the FGG. The authors conclude that both techniques are viable; however, the main advantages of the MARF were decreased surgical time and less postoperative discomfort.

  10. Utilization of spray drying technique for improvement of dissolution and anti-inflammatory effect of Meloxicam.

    Science.gov (United States)

    Shazly, Gamal; Badran, Mohamed; Zoheir, Khairy; Alomrani, Abdullah

    2015-01-01

    Meloxicam (MLX) is a poorly water-soluble non steroidal anti-inflammatory drug (NSAID). The main objective of the present work was to enhance the dissolution of MLX and thus its bioavailability by the aid of additives. The novelty of this work rises from the utilization of spray drying technology to produce micro particulates solid dispersion systems containing MLX in the presence of small amount of additives. Differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR), and Scan Electron Microscope (SEM) were used for studying the physico-chemical and morphological properties of MLX samples. The dissolution of MLX samples was investigated in two different pH media. The morphology of MLX solid dispersion micro-particles was spherical in shape according to SEM. FT-IR profiles indicated that a complex was formed between MLX and the additives. DSC patterns of the MLX micro-particles suggested a reduction in the crystallinity of MLX and probability of presence of an interaction between MLX and the additives. The rate of dissolution of the spray-dried MLX enhanced as compared with the unprocessed MLX in both acidic and neutral media. It was found that 100% of the added MLX released within 5 min in phosphate buffer dissolution medium (pH 7.4) compared to that of the unprocessed MLX (15% in 60 min). Such increase rate in the dissolution of the spray dried MLX could be attributed to the increase in wettability of MLX particles and the hydrophilic nature of the additives. The anti-inflammatory effect of the spray dried MLX was explored using formalin induced rat paw edema model. The spray-dried samples showed an increase in the anti-inflammatory activity of MLX as compared to the unprocessed MLX. This work reveals that the spray drying technique is suitable for preparation of micro-particles with improved dissolution and anti-inflammatory effect of MLX.

  11. Awareness and Utilization of Classroom Assessment Techniques in Higher Education: The Case of a State College in Bicol

    OpenAIRE

    Seth B. Barandon; Dulce F. Atian

    2016-01-01

    Assessment plays a crucial role in the delivery of quality education. In the triad of education, assessment is considered one of the key areas aside from curriculum and instruction; thus, educators need to give premium to classroom assessment techniques. This descriptive study determined the level of awareness and extent of utilization of classroom assessment techniques by faculty of a state college in Bicol. Respondents were seventy-six (76) randomly chosen permanent and Contract...

  12. Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques.

    Science.gov (United States)

    Akusoba, Ikemefuna; Birriel, T Javier; El Chaar, Maher

    2016-01-01

    There are no clinical guidelines or published studies addressing excessive weight loss and protein calorie malnutrition following a standard Roux-en-Y gastric bypass (RYGB) to guide nutritional management and treatment strategies. This study demonstrates the presentation, clinical algorithm, surgical technique, and outcomes of patients afflicted and successfully treated with excessive weight loss following a standard RYGB. Three patients were successfully reversed to normal anatomy after evaluation, management, and treatment by multidisciplinary team. Lowest BMI (kg/m(2)) was 18.9, 17.9, and 14.2, respectively. Twelve-month post-operative BMI (kg/m(2)) was 28.9, 22.8, and 26.1, respectively. Lowest weight (lbs) was 117, 128, and 79, respectively. Twelve-month post-operative weight (lbs) was 179, 161, and 145, respectively. Pre-reversal gastrostomy tube was inserted into the remnant stomach to demonstrate weight gain and improve nutritional status prior to reversal to original anatomy. We propose a practical clinical algorithm for the work-up and management of patients with excessive weight loss and protein calorie malnutrition after standard RYGB including reversal to normal anatomy.

  13. [Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases].

    Science.gov (United States)

    Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A

    2010-01-01

    Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

  14. Epineural Sheath Jacket as a New Surgical Technique for Neuroma Prevention in the Rat Sciatic Nerve Model.

    Science.gov (United States)

    Siemionow, Maria; Bobkiewicz, Adam; Cwykiel, Joanna; Uygur, Safak; Francuzik, Wojciech

    2017-10-01

    Terminal neuromas resulting from severe nerve injuries and traumatic or surgical limb amputations can become a source of pain, and significantly impair patients' quality of life. Recently, the number of patients with peripheral nerve injuries increased due to modern war conflicts, natural disasters, and traffic accidents. This study investigated the efficacy of the epineural sheath jacket (ESJ) as a novel technique for neuroma prevention in the rat sciatic nerve model. A 20-mm segment of the right sciatic nerve was excised in 18 Lewis rats, and the animals were divided into 3 experimental groups (n = 6/group): group I-control, nerve stump without protection; group II-muscle burying group, nerve stump buried in the muscle; group III-ESJ group, nerve stump protected by ESJ. The ESJ was created from the excised sciatic nerve and applied as a "cap" over the proximal nerve stump. The presence of neuropathic pain was assessed weekly by pinprick test and Tinel sign, up to 24 weeks postsurgery. At 24 weeks, assessments, such as macroscopic evaluation, retrograde neuronal labeling analysis, histomorphometry, and neural/connective tissue ratio were performed. Epineural sheath jacket significantly reduced neuroma formation, which was associated with decreased Tinel sign (16.7%, P < 0.05) response compared with the nerve stump control. Moreover, ESJ reduced axonal sprouting, bulb-shaped nerve ending formation and perineural adhesions, as confirmed by macroscopic evaluation. Histological evaluation confirmed that nerve stumps protected with the ESJ showed less fibrosis and presented well-organized axonal structure. Neural/connective tissue ratio and retrograde neuronal labeling analysis revealed significantly improved results in the ESJ group compared to the control nerve stump group (P = 0.032 and P = 0.042, respectively). The protective effect of the ESJ against neuroma formation was confirmed by behavioral and histological analyses, showing outcomes comparable to the muscle

  15. Current status of full-endoscopic techniques in the surgical treatment of disk herniations and spinal canal stenosis

    Institute of Scientific and Technical Information of China (English)

    Ruetten S; Komp M; Oezdemir S

    2014-01-01

    Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony, disk, capsular or ligament structures. The most frequent causes are disk herniations and spinal stenoses. The lumbar and cervical spine is the most prominent cause. After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical or microscopically-assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region, while in the cervical spine, microsurgical or microscopically-assisted anterior decompression and fusion are standard. Both procedures demonstrate good clinical results but present problems associated with the operation. Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection. Taking this into account, completely new endoscopes and instrument sets has been developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior, contralateral and anterior approaches for the cervical spine. The possibilities and results of comparable and established standard procedures have been used as a benchmark in the course of clinical validation. The development of surgically created approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria. The clinical results of standard procedures are achieved, which must be regarded as a minimum criterion for the

  16. The Effect of the SCAMPER Technique in Raising Awareness Regarding the Collection and Utilization of Solid Waste

    Science.gov (United States)

    Çelikler, Dilek; Harman, Gonca

    2015-01-01

    The aim of this study was to determine the effect of the SCAMPER technique in raising awareness among science students regarding the collection and utilization of solid waste. The participants included a total of 65 third-year students. According to the study results, the science students described schools and visual media as their main source of…

  17. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Directory of Open Access Journals (Sweden)

    Sucandy Iswanto

    2014-01-01

    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  18. Techniques of analyzing the impacts of certain electric-utility ratemaking and regulatory-policy concepts. Bibliography

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-08-01

    This bibliography provides documentation for use by state public utility commissions and major nonregulated utilities in evaluating the applicability of a wide range of electric utility rate design and regulatory concepts in light of certain regulatory objectives. Part I, Utility Regulatory Objectives, contains 2084 citations on conservation of energy and capital; efficient use of facilities and resources; and equitable rates to electricity consumers. Part II, Rate Design Concepts, contains 1238 citations on time-of-day rates; seasonally-varying rates; cost-of-service rates; interruptible rates (including the accompanying use of load management techniques); declining block rates; and lifeline rates. Part III, Regulatory Concepts, contains 1282 references on restrictions on master metering; procedures for review of automatic adjustment clauses; prohibitions of rate or regulatory discrimination against solar, wind, or other small energy systems; treatment of advertising expenses; and procedures to protect ratepayers from abrupt termination of service.

  19. Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease.

    Science.gov (United States)

    Sheth, Jamie S; Belperio, John A; Fishbein, Michael C; Kazerooni, Ella A; Lagstein, Amir; Murray, Susan; Myers, Jeff L; Simon, Richard H; Sisson, Thomas H; Sundaram, Baskaran; White, Eric S; Xia, Meng; Zisman, David; Flaherty, Kevin R

    2017-02-01

    Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung disease (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high-resolution CT (HRCT) data leads to a confident diagnosis congruent to SLB and therefore avoids the need for SLB in some patients. We evaluated 33 patients being investigated for suspected ILD who underwent HRCT, TBB, and SLB. First, clinicians, radiologists, and a pathologist reviewed the clinical information and HRCT and TBB findings. Clinicians were asked to provide a diagnosis and were also asked if SLB was needed for a more confident diagnosis. Subsequently, the clinical, HRCT, and SLB data were reviewed, and the same participants were asked to provide a final diagnosis. Clinician consensus and overall agreement between TBB- and SLB-based diagnoses were calculated. Four patients had definite usual interstitial pneumonia (UIP) on HRCT and would not be considered for biopsy using current guidelines. Of the 29 patients without a definitive HRCT diagnosis, the clinicians felt confident of the diagnosis (ie, would not recommend SLB) in six cases. In these cases, there was 100% agreement between TBB and SLB diagnoses. UIP was the most common diagnosis (n = 3) and was associated with an HRCT diagnosis of possible UIP/nonspecific interstitial pneumonia-like. Agreement was poor (33%) between TBB and SLB diagnoses when confidence in the TBB diagnosis was low. Information from TBB, when combined with clinical and HRCT data, may provide enough information to make a confident and accurate diagnosis in approximately 20% to 30% of patients with ILD. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  20. Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Edward McPherson

    2014-06-01

    Full Text Available This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA procedures utilizing a technique to optimize knee flexion. The main features include: (1the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2 patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4incorporation of a rapid recovery protocol with features to promote knee flexion. Results were categorized into three groups: low pre-op flexion (90 degrees and below, regular pre-op flexion (91-125 degrees, and high pre-op flexion (126 degrees and above. Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years. In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years. Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years. In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.

  1. Comparison of subtemporal versus presigmoidal approaches for exposing petrous apex utilizing virtual reality technique

    Directory of Open Access Journals (Sweden)

    Ke TANG

    2016-08-01

    Full Text Available Objective To perform quantitative comparison of microanatomical features between subtemporal and presigmoidal minimally invasive approaches for exposing petrous apex on the basis of virtual reality image model.  Methods CT and MRI were performed on 15 adult cadaver heads (30 sides to establish virtual reality three-dimensional anatomical model of petrous apex. The superior edge of the root of temporal bone zygomatic process and the mastoidale on the calvaria were selected as landmark points of craniotomy through subtempral and presigmoidal approaches. Petrous apex was selected as exposure landmark point on the skull base. The lines between craniotomy and exposure landmark points were used as axis to outline a cylinder simulating surgical routes of subtemporal and presigmoidal approaches. Anatomical exposures in two surgical routes were observed and measured. Statistical comparison was launched by paired t test.  Results Surgical route of subtemporal approach passed through middle skull base and temporal lobe, and then reached petrous apex. Petrous bone drilling was performed to expose internal acoustic meatus, facial nerve and labyrinth. Then, trigeminal nerve, superior petrous sinus and cavernous sinus were exposed. Surgical route of presigmoidal approach was performed by drilling petrous bone through mastoid and passing vertical segment of facial nerve. Then, glomus jugulare, the lower cranial nerves, ossicular chain, labyrinth and internal carotid artery (ICA were exposed in turn. Reaching internal acoustic meatus, the route exposed anterior inferior cerebellar artery (AICA and facial-acoustic nerve complex. Reaching petrous apex, the route involved superior cerebellar artery, superior petrous sinus, inferior petrous sinus, cavernous sinus, trigeminal nerve and partial temporal lobe. The volumes of route, osseous structures, facial-acoustic complex, labyrinth and vein involved in presigmoidal approach were more than those in subtemporal

  2. Efficient Power Utilization Techniques for Wireless Sensor Networks – A Survey

    Directory of Open Access Journals (Sweden)

    Mr. Sharad Saxena,

    2011-02-01

    Full Text Available Micro-sensor networks are widely deployed sensor network in typical geographical areas where human intervention is almost impossible. A WSN is a collection of several small energy limited sensors. These devices are autonomous devices performs the job of data collection and forwarding it to the central node called sink node. The observed data can travel through multiple paths to reach sink node. Sink nodeperforms the task of data fusion to determine a meaningful output. The micro sensors use battery power supply to achieve this goal. The considerable part here is to utilize that limited power supply for a longer time period. Although latest developments in the area of electronics has enabled the development of lowcost and low power sensor networks, still researchers are developing protocols by ifferent approaches to optimize power utilization for such tiny micro-sensors. This paper studies various approaches used by researchers to enhance power utilization.

  3. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.METHODS: Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint.RESULTS: We achieved fracture consolidation in 90%. Fourteen cases (21% evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3% evolved with minor complications of skin granuloma.CONCLUSION: The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint.

  4. Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions, and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis Within Medicare Beneficiaries from 2000 to 2011.

    Science.gov (United States)

    Sclafani, Joseph A; Constantin, Alexandra; Ho, Pei-Shu; Akuthota, Venu; Chan, Leighton

    2017-02-15

    A retrospective, observational study. The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (ICD-9) diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) underwent spinal surgery, and one-third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. Interventional techniques and physical therapy are

  5. Novel technique for addressing streak artifact in gated dual-source MDCT angiography utilizing ECG-editing

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Laura T.; Boll, Daniel T. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States)

    2008-11-15

    Streak artifact is an important source of image degradation in computed tomographic imaging. In coronary MDCT angiography, streak artifact from pacemaker leads in the SVC can render segments of the right coronary artery uninterpretable. With current technology in clinical practice, there is no effective way to eliminate streak artifact in coronary MDCT angiography entirely. We propose a technique to minimize the impact of streak artifact in retrospectively gated coronary MDCT angiography by utilizing small shifts in the reconstruction window. In our experience, previously degraded portions of the coronary vasculature were able to be well evaluated using this technique. (orig.)

  6. Comparison of surgical conditions in 2 different anesthesia techniques of esmolol-induced controlled hypotension in breast reduction surgery

    Science.gov (United States)

    Besir, Ahmet; Cekic, Bahanur; Kutanis, Dilek; Akdogan, Ali; Livaoglu, Murat

    2017-01-01

    Abstract Background: Breast reduction surgery is a common cosmetic surgery with a high incidence of blood loss and transfusion. In this surgery, the reduction of blood loss related to surgical manipulation and the volume of resected tissue is a target. In the present study, we compared the effects of esmolol-induced controlled hypotension on surgical visibility, surgical bleeding, and the duration of surgery in patients anesthetized with propofol/remifentanil (PR) or sevoflurane/remifentanil (SR). Methods: Patients in the American Society of Anesthesiologists I/II risk group undergoing breast reduction surgery were prospectively randomized into PR (n = 25) and SR (n = 25) groups. Controlled hypotension was induced with esmolol in both groups. During the intraoperative period, the heart rate (HR), mean arterial pressure (MAP), operation duration, volume of intraoperative blood loss, volume of blood received through postoperative drains, volume of resected tissues, and surgical area bleeding score were recorded. Results: The duration of operation in the incisional period was shorter in group PR compared to group SR (P = 0.04). The change in HR was lower in incision and hemostasis periods in the group PR compared to the group SR (P blood received through drains on postoperative postoperative day 1, day 2, and in total were found to be significantly lower in group PR compared to group SR. Surgical visibility scoring was more effective in group PR compared to SR. Conclusion: In the breast reduction surgery performed under esmolol-induced controlled hypotension, the effect of propofol + remifentanil anesthesia on the duration of incisional surgery, surgical visibility, and volume of surgical blood loss was more reliable and effective compared to that of sevoflurane + remifentanil, which seems to be an advantage. PMID:28272228

  7. Application of accelerate rehabilitation surgical techniques in cesarean section%加速康复外科技术在剖宫产术中的应用

    Institute of Scientific and Technical Information of China (English)

    吴秀玲; 张蕾; 徐文娟

    2011-01-01

    Objective To compare the medical treatment efficiency and expense between applying accelerate rehabilitation surgical techniques and regular healing solution in caesarean birth. Method To divide one hundred patients who take Caesarean birth into two groups at random, one group was accelerate rehabilitation surgical. techniques group and the other was regular healing solution group. The time for being in hospital, expense and syndrome were compared. Result The time for being in hospital( P<0.01 ) and expense( P<0.05 ) of the accelerate rehabilitation surgical techniques group was less than the regular healing solution group obviously, meanwhile there was't prominent difference about the syndrome( P>0.05 ). Conclusion: The patients who take caesarean birth will recover sooner, be in hospital shorter and cost less through applying the accelerate rehabilitation surgical techniques.%目的 应用加速康复外科和常规治疗方案的剖宫产手术患者在医疗效率指标和费用方面进行对照研究.方法 将100例剖宫产手术患者按住院号随机分为加速康复外科治疗组和常规治疗组,比较两组患者住院的时间、费用和并发症.结果 与常规治疗组比较,加速康复外科治疗组患者住院时间明显缩短(P0.05).结论 通过围手术期加速康复外科方案的治疗,剖宫产手术患者术后康复加快,住院时间缩短,医疗费用下降.

  8. Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance

    OpenAIRE

    Funasaki, Hiroki; Hayashi, Hiroteru; Sakamoto, Kanako; Tsuruga, Rei; Marumo, Keishi

    2015-01-01

    Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals...

  9. Electrical hand tools and techniques: A compilation. [utilization of space technology for tools and adapters

    Science.gov (United States)

    1974-01-01

    Space technology utilization for developing tools, adapters, and fixtures and procedures for assembling, installing, and servicing electrical components and equipment are discussed. Some of the items considered are: (1) pivotal screwdriver, (2) termination locator tool for shielded cables, (3) solder application tools, (4) insulation and shield removing tool, and (5) torque wrench adapter for cable connector engaging ring. Diagrams of the various tools and devices are provided.

  10. Outcome of a one-stage tensile stress surgical technique and early postoperative rehabilitation in the treatment of neglected achilles tendon rupture.

    Science.gov (United States)

    Badalihan, Ayinazi; Aihemaiti, Amina; Shawutali, Nuerai; Jielile, Jiasharete; Jialihasi, Ayidaer; Tangkejie, Wulanbai; Nuerdoula, Yeermike; Satewalede, Turde; Hunapiya, Beisen; Niyazebieke, Hadelebieke; Hezibieke, Hayilat; Zhao, Qin; Bahetijiang, Ahezhuoli; Kelamu, Mailamuguli; Qianman, Bayixiati

    2015-01-01

    The present study evaluated the effect of single-stage internal traction combined with early postoperative active rehabilitation and the yurt bone suture method, a new surgical technique, on the clinical outcomes after surgical repair of Achilles tendon. A total of 51 patients with neglected Achilles tendon rupture who underwent the yurt bone suture treatment also participated in an accelerated postoperative rehabilitation program. The clinical outcome was evaluated for 18 weeks using the Leppilahti scoring system, bilateral ultrasound examination, and computed tomography examination. The ultrasound and computed tomography examinations revealed that Achilles tendon elongation and adhesion occurred in none of the patients. All the patients could perform the single leg heel raise exercise for a mean of 30 ± 7.6 seconds at 12 weeks postoperatively. In addition, the patients could participate in sport exercises and heavy physical activities by around 13 weeks postoperatively. The mean Leppilahti score was 85.8 ± 3.7 at 8 weeks postoperatively, and it had increased to 96.1 ± 3.2 and 100.0 ± 0.0 at 12 and 18 weeks, respectively, after the operation. The 1-stage internal traction technique, combined with early postoperative active rehabilitation and the yurt bone surgical technique, resulted in good clinical outcomes for the treatment of neglected Achilles tendon rupture. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Utilization of fringe projection technique for evaluation of wound dimensions and of healing progress

    Science.gov (United States)

    Saito, Marcia T.; Yoshimura, Elisabeth M.; Palácios, Francisco F.; Lino, Antonio C. L.; Palácios, Guillermo F.; Sousa, Marcelo V. P.

    2013-03-01

    Background: The methods used for evaluating wound dimensions, especially the chronic ones, are invasive and inaccurate. The fringe projection technique with phase shift is a non-invasive, accurate and low-cost optical method. Objective: The aim is to validate the technique through the determination of dimensions of objects of known topography and with different geometries and colors to simulate the wounds and tones of skin color. Taking into account the influence of skin wound optical factors, the technique will be used to evaluate actual patients' wound dimensions and to study its limitations in this application. Methods: Four sinusoidal fringe patterns, displaced ¼ of period each, were projected onto the objects surface. The object dimensions were obtained from the unwrapped phase map through the observation of the fringe deformations caused by the object topography and using phase shift analysis. An object with simple geometry was used for dimensional calibration and the topographic dimensions of the others were determined from it. After observing the compatibility with the data and validating the method, it was used for measuring the dimensions of real patients' wounds. Results and Conclusions: The discrepancies between actual topography and dimensions determined with Fringe Projection Technique and for the known object were lower than 0.50 cm. The method was successful in obtaining the topography of real patient's wounds. Objects and wounds with sharp topographies or causing shadow or reflection are difficult to be evaluated with this technique.

  12. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century.

    Science.gov (United States)

    Postacchini, F; Postacchini, R

    2011-01-01

    Removal of a herniated disc with the use of the operative microscope was first performed by Yasargil (Adv Neurosurg. 4:81-2, 1977) in 1977. However, it began to be used more and more only in the late 1980s (McCulloch JA (1989) Principles of microsurgery for lumbar disc disease. Raven Press, New York). In the 1990s, many spinal surgeons abandoned conventional discectomy with naked-eye to pass to the routine practice of microdiscectomy. The merits of this technique are that it allows every type of disc herniation to be excised through a short approach to skin, fascia and muscles as well as a limited laminoarthrectomy. For these reasons, it has been, and still is, considered the "gold standard" of surgical treatment for lumbar disc herniation, and the method used by the vast majority of spinal surgeons. In the 1990s, the advent of MRI and the progressive increase in definition of this modality of imaging, as well as histopathologic and immunochemical studies of disc tissue and the analysis of the results of conservative treatments have considerably contributed to the knowledge of the natural evolution of a herniated disc. It was shown that disc herniation may decrease in size or disappear in a few weeks or months. Since the second half of the 1990s there has been a revival of percutaneous procedures. Some of these are similar to the percutaneous automated nucleotomy; other methods are represented by intradiscal injection of a mixture of "oxygen-ozone" (Alexandre A, Buric J, Paradiso R. et al. (2001) Intradiscal injection of oxygen ozone for the treatment of lumbar disc herniations: result at 5 years. 12th World Congress of Neurosurgery; 284-7), or laserdiscectomy performed under CT scan (Menchetti PPM. (2006) Laser Med Sci. 4:25-7). The really emerging procedure is that using an endoscope inserted into the disc through the intervertebral foramen to visualize the herniation and remove it manually using thin pituitary rongeurs, a radiofrequency probe or both (Chiu JC

  13. A modified serial blood sampling technique and utility of dried-blood spot technique in estimation of blood concentration: application in mouse pharmacokinetics.

    Science.gov (United States)

    Kurawattimath, Vishwanath; Pocha, Krishna; Mariappan, T Thanga; Trivedi, Ravi Kumar; Mandlekar, Sandhya

    2012-03-01

    Pharmacokinetic (PK) studies in mice usually require discrete and parallel blood sampling owing to a restriction on the volume of blood that can be withdrawn. This results in dosing large number of animals and generating composite PK profile. To reduce the number of animals and generate individual animal PK profiles, we developed a serial sampling technique via tail vein bleeding in mice, in which only 20-30 μL blood was withdrawn per time point. Due to the small blood volume, a dried-blood spot (DBS) technique was applied for sample processing. The utility of this technique was demonstrated using three test compounds (amodiaquine, chloroquine and chlorthalidone), with varying degrees of blood-to-plasma partition ratios. The PK studies were carried out in male Balb/c mouse weighing 25-30 g. The compounds were administered intravenously via the saphenous vein. Blood was collected by composite (retro-orbital plexus) or serial (tail vein bleeding) sampling techniques at different time points. Blood samples were processed as blood lysate or DBS. Blood or plasma samples were analyzed by sensitive and rapid UPLC-MS/MS methods. The blood concentrations (both from blood lysate and DBS) obtained from serial sampling matched with those from composite sampling. The ratio of blood AUC to plasma AUC correlated well with the in vitro blood-to-plasma partition ratio of the compounds. The systemic clearance and volume of distribution at steady state calculated from blood or plasma AUCs were in proportion to the respective AUCs. Our results indicated that the serial sampling technique would reduce the number of animals and also compound usage, as well as improve the quality of pharmacokinetic data. Also, the serial sampling technique does not require the use of anesthesia and allows estimation of inter-animal variability in PK. A small volume serial sampling is possible due to the availability of the DBS technique.

  14. Surgical and pathomorphological results of total mesorectumectomy by using waterjet dissection technique in patients with rectal cancer

    Directory of Open Access Journals (Sweden)

    D. V. Sidorov

    2016-01-01

    Full Text Available Background. The paper presents our own experience of using a waterjet dissector ERBEJET2® in the course of surgical interventions for colorectal cancer. This experience is unique for Russia.Materials and methods. Waterjet dissection method associated with total  mesorectumectomy was used by us in 20 patients suffering from rectal cancer. An average age of patients was 59.2 ± 13.9 years. In all the patients surgeries were performed for adenogenic colorectal cancer, morphologically verified at the preoperative stage. Resected preparations were studied on morphological level. For comparison, two control groups of 20 patients were selected, in which the rectum mobilization was performed by using monopolar coagulator and harmonic scalpel. The studied groups were matched by gender, age, location and the tumor extent. All the surgeries were performed by one surgical team.Results. Results of the study demonstrated advantages of waterjet dissection when performing total mesorectumectomy due to a minimum depth of tissue damage on the lateral margin of resection.Conclusion. Waterjet dissectors have taken their place in the extensive list of tools used when performing surgical interventions for colorectal cancer, that allows to expect an improvement of functional and oncological results of the surgical treatment.

  15. Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults

    Directory of Open Access Journals (Sweden)

    Ali Refatllari

    2015-12-01

    CONCLUSION: Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization.

  16. The effects of implant surface roughness and surgical technique on implant fixation in an in vitro model.

    NARCIS (Netherlands)

    Shalabi, M.M.; Wolke, J.G.C.; Jansen, J.A.

    2006-01-01

    OBJECTIVES: The aim of the present study was to determine the relationship between implant surface parameters, surgical approach and initial implant fixation. MATERIAL AND METHODS: Sixty tapered, conical, screw-shaped implants with machined or etched surface topography were implanted into the

  17. Surgical Treatment of Renal Cell Carcinoma with Inferior Vena Cava Thrombus: Using Liver Mobilization Technique to Avoid Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Tawatchai Taweemonkongsap

    2008-04-01

    CONCLUSION: These results support the aggressive surgical removal of RCC with IVC thrombus as the initial treatment. Most of the thrombi can be approached and safely controlled by a transabdominal approach without any form of bypass. Tumour thrombus removal provides a high survival chance and offers improvement in quality of life.

  18. 2013~2014年清洁手术抗菌药物使用率与切口感染率相关性分析%Correlation analysis of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision from 2013 to 2014

    Institute of Scientific and Technical Information of China (English)

    曹栋; 孙福生; 范春

    2015-01-01

    ObjectiveTo study the correlation between the utilization rate of antibacterials and surgical site infection rates in clean surgical incision.Methods All the clean surgical incisions in our hospital from January in 2013 to December in 2014 were enrolled in this study. The utilization rate of antibacterials and surgical site infection rates were retrospectively investigated according to each month. On the condition that the utilization rate of antibacterials and surgical site infection rates were independent variable and dependent variable alternately, with Pearson Correlation Analysis and scatter diagram, we studied the relationship of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision. Results Before logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.196,P=0.36>0.05.After logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.069, P=0.75>0.05. The results showed that there was no correlation between the utilization rate of antibacterials and surgical site infection rates, wether logarithmic transformation or not. The scatter diagram of the utilization rate of antibacterials and surgical site infection rates also demonstrated the same results. Conclusion To decrease the utilization rate of antibacterials in clean surgical incision not lead to increase of surgical site infection rates.%目的:探讨清洁手术抗菌药物使用率与切口感染率之间的相关性。方法对本院2013年1月至2014年12月清洁手术进行回顾性调查,按月份分别统计抗菌药物使用率和切口感染率。以抗菌药物使用率与切口感染率互为自变量与因变量,进行Pearson相关性分析和散点图评价。结果抗菌药物使用率与切口感染率对数转换前Pearson相关性分析,相关系数r=0.196, P

  19. FY1995 development of a endoscopic surgical system utilizing multi-modal functional images; 1995 nendo tashu kino gazo wo mochiiru teishinshu naishikyo shujutsu system no kaihatsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-05-01

    The purpose of this study is to develop an endoscope system for neurosurgery that can provide not only conventional endoscopic images but also ultraviolet-visible spectra, fluorescence spectra, near infrared spectra, and ultra-soundimages of tissue aiming for real-time identification of pathological tissue. The system also incorporates surgical manipulator and devices such as micro forceps and laser surgical instruments for endoscopic image guided surgery. Surgical Manipulator should be a high performance and easy to operate surgical instrument as well as conventional surgical tools such as scissors and knife. Since living tissue deforms during surgical operation, pre-operative three dimensional information for registration of pathological tissue should be modified based on information obtained during surgery. Thus surgical manipulator should be operated under guidance of surgeon's observation. Consequently, surgical manipulator should have various types of imaging and measurement devices such as an endoscope and an ultrasound imaging probe at its end effectors. Based on this concept, a prototype of a new multi channel surgical manipulator system CM cube (CM3, Computer aided Micro Multichannel Manipulator) that has various types of imaging and measurement devices such as ultra-violet-visible camera for spectroscopic measurement, ultra-sound imaging probe, three dimensional endoscope, together with micro surgical instruments and laser surgical systems has been developed. Its performance was evaluated through in vitro/in vivo experiments and clinical application. (NEDO)

  20. Neural Network Algorithm for Designing FIR Filters Utilizing Frequency-Response Masking Technique

    Institute of Scientific and Technical Information of China (English)

    Xiao-Hua Wang; Yi-Gang He; Tian-Zan Li

    2009-01-01

    This paper presents a new joint optimization method for the design of sharp linear-phase finite-impulse response (FIR) digital filters which are synthesized by using basic and multistage frequency-response-masking (FRM) techniques. The method is based on a batch back-propagation neural network algorithm with a variable learning rate mode. We propose the following two-step optimization technique in order to reduce the complexity. At the first step, an initial FRM filter is designed by alternately optimizing the subfilters. At the second step, this solution is then used as a start-up solution to further optimization. The further optimization problem is highly nonlinear with respect to the coefficients of all the subfilters. Therefore, it is decomposed into several linear neural network optimization problems. Some examples from the literature are given, and the results show that the proposed algorithm can design better FRM filters than several existing methods.

  1. Characterization of failure modes in deep UV and deep green LEDs utilizing advanced semiconductor localization techniques.

    Energy Technology Data Exchange (ETDEWEB)

    Tangyunyong, Paiboon; Miller, Mary A.; Cole, Edward Isaac, Jr.

    2012-03-01

    We present the results of a two-year early career LDRD that focused on defect localization in deep green and deep ultraviolet (UV) light-emitting diodes (LEDs). We describe the laser-based techniques (TIVA/LIVA) used to localize the defects and interpret data acquired. We also describe a defect screening method based on a quick electrical measurement to determine whether defects should be present in the LEDs. We then describe the stress conditions that caused the devices to fail and how the TIVA/LIVA techniques were used to monitor the defect signals as the devices degraded and failed. We also describe the correlation between the initial defects and final degraded or failed state of the devices. Finally we show characterization results of the devices in the failed conditions and present preliminary theories as to why the devices failed for both the InGaN (green) and AlGaN (UV) LEDs.

  2. Non-Linearity in Wide Dynamic Range CMOS Image Sensors Utilizing a Partial Charge Transfer Technique

    Directory of Open Access Journals (Sweden)

    Izhal Abdul Halin

    2009-11-01

    Full Text Available The partial charge transfer technique can expand the dynamic range of a CMOS image sensor by synthesizing two types of signal, namely the long and short accumulation time signals. However the short accumulation time signal obtained from partial transfer operation suffers of non-linearity with respect to the incident light. In this paper, an analysis of the non-linearity in partial charge transfer technique has been carried, and the relationship between dynamic range and the non-linearity is studied. The results show that the non-linearity is caused by two factors, namely the current diffusion, which has an exponential relation with the potential barrier, and the initial condition of photodiodes in which it shows that the error in the high illumination region increases as the ratio of the long to the short accumulation time raises. Moreover, the increment of the saturation level of photodiodes also increases the error in the high illumination region.

  3. Non-Linearity in Wide Dynamic Range CMOS Image Sensors Utilizing a Partial Charge Transfer Technique

    Science.gov (United States)

    Shafie, Suhaidi; Kawahito, Shoji; Halin, Izhal Abdul; Hasan, Wan Zuha Wan

    2009-01-01

    The partial charge transfer technique can expand the dynamic range of a CMOS image sensor by synthesizing two types of signal, namely the long and short accumulation time signals. However the short accumulation time signal obtained from partial transfer operation suffers of non-linearity with respect to the incident light. In this paper, an analysis of the non-linearity in partial charge transfer technique has been carried, and the relationship between dynamic range and the non-linearity is studied. The results show that the non-linearity is caused by two factors, namely the current diffusion, which has an exponential relation with the potential barrier, and the initial condition of photodiodes in which it shows that the error in the high illumination region increases as the ratio of the long to the short accumulation time raises. Moreover, the increment of the saturation level of photodiodes also increases the error in the high illumination region. PMID:22303133

  4. Monoolein and chitosan gels as potential carriers of the rhBMP-2, using decortication surgical technique in Wistar rats as experimental model.

    Science.gov (United States)

    Issa, João Paulo Mardegan; Spadaro, Augusto César Cropanese; Bentley, Maria Vitória L B; Iyomasa, Mamie Mizusaki; Siéssere, Selma; Regalo, Simone Cecílio Hallak; Defino, Helton Luiz Aparecido

    2008-10-01

    The purpose of this work was to evaluate the new bone tissue, comparing two different carriers for rhBMP-2, monoolein and chitosan gels, using the decortication and nondecorticatication surgical technique in rat mandibles, evaluated by histomorphometrical method. It was used 56 male Wistar rats (300 g), divided into 8 groups according to the rhBMP-2 carrier used, monoolein or chitosan gels; surgical technique, bone decortication or nondecortication; and period of time, 3 or 6 weeks until the sacrifice by perfusion. Results obtained in this study showed that the rhBMP-2/monoolein and rhBMP-2/chitosan used in this experimental model was able to induce osteogenesis, contributing to the bone healing process. The bone repair process was time dependent, so that at 6 weeks there was an improved amount of new bone in relation to 3 weeks, considered each analyzed group, and the decortication was able to expose the bone marrow and speed up the bone healing process, which was showed by histomorphometrical methods. Both of carriers were capable to adapt to the bone surgical area, according to the clinical observations, and had favorable properties in relation to protein releasing, revealed by the amount of new bone tissue found in the histological analysis.

  5. A simple technique for the utilization of postmortem tracheal and bronchial tissues for ultrastructural studies.

    Science.gov (United States)

    Ferguson, C C; Richardson, J B

    1978-07-01

    Human tracheal and bronchial tissues were taken from autopsy cases within five hours of death. The tissue was placed in a modified Krebs-Henseleit solution at either 37 degrees C. or 7 degrees C. A combination of 95 per cent oxygen and 5 per cent carbon dioxide was bubbled through the Krebs-Henseleit solution. Two hours after equilibration of the tissue in the bath at 37 degrees C. and electrical field stimulation was applied to the tissue and, if the tissue was physiologically active, it was utilized for further studies. At the termination of these studies the tissue was processed for electron microscopy. Control tissue was taken directly from the same area as the test tissue and was processed for electron microscopy without immersion in the Krebs-Henseleit solution. The tissue, after immersion in the Krebs-Henseleit solution for at least three hours, showed evidence of substantial recovery from the period of anoxia.

  6. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis.

    Science.gov (United States)

    Al-Moraissi, E A; Elmansi, Y A; Al-Sharaee, Y A; Alrmali, A E; Alkhutari, A S

    2016-03-01

    A systematic review and meta-analysis was conducted to answer the clinical question "Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments?" A systematic and electronic search of several databases with specific key words, a reference search, and a manual search were performed from respective dates of inception through November 2014. The inclusion criteria were clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing the piezoelectric surgical osteotomy technique to the standard rotary instrument technique in lower third molar surgery. Postoperative sequelae (oedema, trismus, and pain), the total number of analgesics taken, and the duration of surgery were analyzed. A total of nine articles were included, six RCTs, two CCTs, and one retrospective study. Six studies had a low risk of bias and three had a moderate risk of bias. A statistically significant difference was found between piezoelectric surgery and conventional rotary instrument surgery for lower third molar extraction with regard to postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken (P=0.0001, P=0.0001, Ppiezoelectric osteotomy group (Ppiezoelectric surgery significantly reduced the occurrence of postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken compared to the conventional rotary instrument technique in lower third molar surgery, but required a longer surgery time.

  7. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  8. Automatic Generation of English-Japanese Translation Pattern Utilizing Genetic Programming Technique

    Science.gov (United States)

    Matsumura, Koki; Tamekuni, Yuji; Kimura, Shuhei

    There are a lot of constructional differences in an English-Japanese phrase template, and that often makes the act of translation difficult. Moreover, there exist various and tremendous phrase templates and sentence to be refered to. It is not easy to prepare the corpus that covers the all. Therefore, it is very significant to generate the translation pattern of the sentence pattern automatically from a viewpoint of the translation success rate and the capacity of the pattern dictionary. Then, for the purpose of realizing the automatic generation of the translation pattern, this paper proposed the new method for the generation of the translation pattern by using the genetic programming technique (GP). The technique tries to generate the translation pattern of various sentences which are not registered in the phrase template dictionary automatically by giving the genetic operation to the parsing tree of a basic pattern. The tree consists of the pair of the English-Japanese sentence generated as the first stage population. The analysis tree data base with 50,100,150,200 pairs was prepared as the first stage population. And this system was applied and executed for an English input of 1,555 sentences. As a result, the analysis tree increases from 200 to 517, and the accuracy rate of the translation pattern has improved from 42.57% to 70.10%. And, 86.71% of the generated translations was successfully done, whose meanings are enough acceptable and understandable. It seemed that this proposal technique became a clue to raise the translation success rate, and to find the possibility of the reduction of the analysis tree data base.

  9. [Long-term follow up of patients surgically treated for pyelo-ureteral disease by the Anderson-Hynes technique].

    Science.gov (United States)

    Polito, M; Galosi, A B; Minardi, D; Nonni, M; Cinti, P; Riccardi, A

    1997-02-01

    A series of 48 patients with hydronephrosis (mean age 31 yrs.) underwent on Anderson-Hynes pyeloplasty. Assessment was carried out in 30 pts. after a mean observation time of 90 months, with a minimum 5 years follow-up. Clinical examination, laboratory investigations, renal ultrasonography, urography and renal scan were performed pre-operatively and at follow-up. There was one patient with evidence of stenosis in the ureteropelvic junction; one patient developed urinary leakage post-operatively and required surgical correction. All patients had symptoms pre-operatively and no one had symptoms post-operatively. Four patients had calcolosis associated, postoperatively all pts. were stone free; four years later one patient developed litiasis. We observed that the results of surgical intervention in hydronephrosis are excellent especially in patients aged less than 30 years.

  10. Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

    OpenAIRE

    Gore, Sinclair M.; WISHART, GORDON C.; Malata, Charles M.

    2012-01-01

    Objective: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. Methods: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Results: Clearance of periductal mastitis and infection has been ...

  11. Surgical treatment of traumatic eventration with polyester button and polypropylene mesh to strengthen the suture technique in equine

    OpenAIRE

    Orlandini, Carla Faria; Steiner, Denis; Boscarato, André Giarola; Gimenes, Gabriel Coelho; Alberton, Luiz Romulo

    2016-01-01

    Background Defects in the abdominal wall of horses have high relapse rate. This is mainly in lateral eventrations and hernias caused by trauma from kicks of other horses or installation structures. The eventration region normally becomes swollen and there may be complications due to intestinal loop incarceration. The surgical treatment, consisting of reconstruction of the abdominal wall, frequently require biological or synthetic materials for the reinforcement of the suture line and tension ...

  12. On the QoS for ATM Networks Using a New Buffer Utilization Technique

    Institute of Scientific and Technical Information of China (English)

    Md. Julius Hossain; Md. Nurul Huda

    2003-01-01

    A buffer sharing scheme need to meet many competing objectives like robustness to changes in traffic conditions,fairness, efficiency, implementation simplicity, etc. Of the existing techniques, Push Out (PO) is optimum in terms of overall cell loss performance, but its delay performance is worse than that of all other methods for the multiple space priority. Another scheme named Dynamic Threshold (DT) is robust and adaptive which has good delay performance. A hybrid technique named Dynamic Threshold with native Push Out (DnP) shows the best delay performance but its loss performance is worse specially for higher priority traffic. A novel policy called Balanced Buffer Push Out (BBPO) is proposed here that aims to achieve a better loss performance than DT and better delay performance than PO for multipriority traffic. Using computer simulation the loss performance and delay performance of DT, PO, DnP and BBPO are measured for bursty traffic, and a comparison of the results is presented. The proposed scheme exhibits the best loss performance on an average among all the schemes. Although for higher priority traffic the loss performance of PO is better than that of BBPO, the delay performance of BBPO is better than that of PO.

  13. Colonization of Lutzomyia shannoni (Diptera: Psychodidae) utilizing an artificial blood feeding technique.

    Science.gov (United States)

    Mann, Rajinder S; Kaufman, Phillip E

    2010-12-01

    Laboratory colonization of hematophagous insects must include an efficient method of blood feeding, preferably by artificial means. Strict rules for obtaining animal use permits, extensive animal maintenance costs, and indirect anesthesia effects on animal health warrant the development of an artificial membrane feeding technique for sand fly colonization in laboratories. An attempt was made to colonize Lutzomyia shannoni using an artificial blood feeding membrane to replace the use of live animals commonly used for sand fly blood-feeding purposes. Lutzomyia shannoni readily fed through a pig intestine membrane exposed at an angle of 45°. However, it did not feed through a chicken skin membrane. Olfactory attractants were unable to improve blood-feeding efficiency. Plaster of Paris was the most suitable oviposition substrate. Female L. shannoni adults laid no eggs on moist sand substrate. Sand fly adults held in groups of ten or more laid higher numbers of eggs than did individually maintained sand flies. Inclusion of the L. longipalpis oviposition hormone dodecanoic acid or the presence of previously laid eggs did not stimulate L. shannoni oviposition. The average L. shannoni egg, larval, and pupal duration were 9.3, 36.7, and 17.8 days, respectively. The addition of a 20% sugar solution improved adult female longevity. Females survived longer (14.8 days) than males (11.9 days). Lutzomyia shannoni was successfully colonized in the laboratory for up to four generations using this artificial membrane technique.

  14. Endovascular stenting in superior vena cava syndrome: utility of a through-and-through guidewire technique

    Energy Technology Data Exchange (ETDEWEB)

    Clark, T.W.I. [Dalhousie Univ., Queen Elizabeth II Health Sciences Centre, Section of Interventional Radiology, Dept. of Diagnostic Imaging, Halifax, NS (Canada)

    2000-08-01

    Objective: To describe an ancillary technique when a conventional femoral approach to superior vena cava (SVC) stent placement is not feasible because of buckling of balloon catheters or stent-deployment systems during device advancement. Patients and methods: Three patients in whom device advancement across the SVC lesion from a femoral or axillary approach was unsuccessful were managed by accessing the right jugular vein; SVC lesions were crossed from an antegrade direction, and the jugular guidewire was secured at the femoral access site to create a through-and-through guidewire. Results: Countertraction on the through-and-through guidewire during stent placement and dilation permitted unhindered advancement of stent delivery systems and catheters across the SVC. Technical and clinical success was achieved in each patient with relief of SVC syndrome within 24-72 hours. Survival ranged from 26 to 137 days. Conclusion: A through-and-through guidewire technique is useful when stenting a highly stenotic or thrombosed SVC in patients with superior vena cava syndrome. (author)

  15. Portable (handheld) clinical device for quantitative spectroscopy of skin, utilizing spatial frequency domain reflectance techniques

    Science.gov (United States)

    Saager, Rolf B.; Dang, An N.; Huang, Samantha S.; Kelly, Kristen M.; Durkin, Anthony J.

    2017-09-01

    Spatial Frequency Domain Spectroscopy (SFDS) is a technique for quantifying in-vivo tissue optical properties. SFDS employs structured light patterns that are projected onto tissues using a spatial light modulator, such as a digital micromirror device. In combination with appropriate models of light propagation, this technique can be used to quantify tissue optical properties (absorption, μa, and scattering, μs', coefficients) and chromophore concentrations. Here we present a handheld implementation of an SFDS device that employs line (one dimensional) imaging. This instrument can measure 1088 spatial locations that span a 3 cm line as opposed to our original benchtop SFDS system that only collects a single 1 mm diameter spot. This imager, however, retains the spectral resolution (˜1 nm) and range (450-1000 nm) of our original benchtop SFDS device. In the context of homogeneous turbid media, we demonstrate that this new system matches the spectral response of our original system to within 1% across a typical range of spatial frequencies (0-0.35 mm-1). With the new form factor, the device has tremendously improved mobility and portability, allowing for greater ease of use in a clinical setting. A smaller size also enables access to different tissue locations, which increases the flexibility of the device. The design of this portable system not only enables SFDS to be used in clinical settings but also enables visualization of properties of layered tissues such as skin.

  16. Utilizing Statistical Semantic Similarity Techniques for Ontology Mapping——with Applications to AEC Standard Models

    Institute of Scientific and Technical Information of China (English)

    Pan Jiayi; Chin-Pang Jack Cheng; Gloria T. Lau; Kincho H. Law

    2008-01-01

    The objective of this paper is to introduce three semi-automated approaches for ontology mapping using relatedness analysis techniques. In the architecture, engineering, and construction (AEC) industry, there exist a number of ontological standards to describe the semantics of building models. Although the standards share similar scopes of interest, the task of comparing and mapping concepts among standards is challenging due to their differences in terminologies and perspectives. Ontology mapping is therefore necessary to achieve information interoperability, which allows two or more information sources to exchange data and to re-use the data for further purposes. The attribute-based approach, corpus-based approach, and name-based approach presented in this paper adopt the statistical relatedness analysis techniques to discover related concepts from heterogeneous ontologies. A pilot study is conducted on IFC and CIS/2 ontologies to evaluate the approaches. Preliminary results show that the attribute-based approach outperforms the other two approaches in terms of precision and F-measure.