Absence Of Suture Research Articles

A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique

Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail. The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty. We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months. We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery. We believe that this procedure is a viable alternative to distal hypospadias repair.

Assessment of wound integrity in manual small incision cataract surgery in a tertiary hospital in South India

Background: The study aimed to assess the wound integrity in small incision cataract surgery (SICS) by modified Siedel’s test. Material and methods: Forty eyes of 40 patients who underwent small incision cataract surgery from a rural background in South India were enrolled in the study after obtaining consent along with the surgical consent from January to March 2020. A complete history was taken, ocular examination and keratometry were performed. B-scan was conducted for patients with mature cataracts. Fundus examination was performed with slit-lamp biomicroscopy and 90 D lens. On the first post-operative day, the best-corrected visual acuity was recorded using the Snellen chart. Anterior segment examination was conducted. Wound integrity was assessed using modified Siedel’s test. Results: In our study, males constituted 55% of the study population, and females — 45%. The age or sex of the patient did not have a bearing on the need for suture in the patients who underwent small incision cataract surgery (p = 0.283). The cataract grade also did not affect the need for a suture in the study population (p = 0.280). All the patients in our study did not have a positive Seidel’s test, notwithstanding the age or sex of the patient, grade of cataract, site of incision, the presence or absence of suture, or the site of the incision, that is superior or superotemporal. Conclusion: Manual small incision cataract surgery can be considered a relatively safe and effective procedure for wound integrity and vision improvement.

Percutaneously created sutureless anastomosis.

An 80-year-old male diabetic patient with end-stage renal disease was evaluated for decreasing access flow and difficult cannulation of his established percutaneous arteriovenous fistula (pAVF), created 6 months ago with the Ellipsys vascular access system (Avenu Medical, San Juan Capistrano, Calif).1Mallios A. Jennings W.C. Boura B. Costanzo A. Bourquelot P. Combes M. Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System.J Vasc Surg. 2018; 68: 1150-1156Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar, 2Mallios A. Fonkoua H. Allouache M. Boura B. Percutaneous arteriovenous dialysis fistula.J Vasc Surg. 2020; 71: 1395Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Mallios A. Bourquelot P. Franco G. Fonkoua H. Allouache M. Boura B. et al.Mid-term results of percutaneous arteriovenous fistula creation with the Ellipsys vascular access system, technical recommendations and an algorithm for maintenance.J Vasc Surg. 2020 Apr 7; ([Online ahead of print])Abstract Full Text Full Text PDF Scopus (26) Google Scholar The patient's ipsilateral hand was cool without distal pulses. Percutaneous transluminal angioplasty of the pAVF anastomosis had only modestly improved access flow because of significant diffuse arterial calcifications. Bilateral distal arterial occlusions were present and the pAVF remained dysfunctional. Further and more aggressive attempts with percutaneous transluminal angioplasty were thought likely to result in severe hand ischemia (steal syndrome); therefore, arterial inflow proximalization was established using a 4- to 7-mm graft (W. L. Gore & Associates, Flagstaff, Ariz) with a lateral axillary artery anastomosis and an end-to-end outflow anastomosis to the mature cephalic vein, ligating the distal pAVF inflow site. An excellent thrill was recovered immediately over the entire length of the cephalic vein in the arm. Distal circulation improved substantially. A/Cover, B, and Video 1 show a perioperative view of the percutaneously created Ellipsys anastomosis between the proximal radial artery and perforating vein of the elbow. To our knowledge, this is the first direct visualization of an Ellipsys pAVF anastomosis in a human. The anatomic configuration and natural course of the pAVF are apparent along with the absence of suture or fibrosis, yielding a shape similar to surgical proximal radial artery AVFs described by Jennings et al.4Jennings W. Mallios A. Mushtaq Proximal radial artery arteriovenous fistula for hemodialysis vascular access.J Vasc Surg. 2018; 67: 244-253Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar C (medial view), D (anterior view), and Video 2 show the ligated pAVF anastomosis. Need for ligation of a pAVF has been a concern of some critics because of the multiple venous branches. This report demonstrates that in the rare case in which ligation is necessary, an Ellipsys pAVF may be easily ligated without consequence or technical challenges. The patient's informed consent was obtained before submission of this manuscript. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkM2YxZjljYzQzMTczOTJhZDVmYzdiMjVmYjJmMDc3YSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjU5NjgwMTEyfQ.P2iwekbqoGENyxeFwVBltgYalZQe974yt_1Pylg0oqw2wFHO3H5CWSPevIxJUo12W3mIV07CWaNMIpXXz890jVkEezWvpGPFAxKusFybJG_J-dUhtw2jZOOPABJPZG57mLmCApG-jTPEMAHW9pySwjjAkCUSrKAtXkkDyhYRg9KC4hAUWNilnBi-_azL08GN--bXaVldB4WfATLWRNN0AD8X_3mTXzlx_QakMBjMTbIc_JlN1rqNjO2zj3X2xxIyscs4nu7HNDe4Yl8ALcJg4rbz3dXNZm9xYBzLti2FU-yetHtrydtcxMLAVp3Fyk5IF4QMtPBmJ6GImX4mAYjwgg Download .mp4 (0.98 MB) Help with .mp4 files Video 1Perioperative view of the percutaneously created Ellipsys anastomosis between the proximal radial artery and perforating vein of the elbow.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4Yjk0MWI1ZWQwOTI1YzFjNmE0ZTAyMTJkN2YyODFjNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjU5NjgwMTEyfQ.HCPbtwp0lEn6tVnP5ipUjgo9Onu8BqDai6EaTcoSnwhdy1nK0swZeXM-bhdYhkOHKJoygNoK2-KvvS0ogyTxmhdk4F4pH_uKLQ0aBVKS1U7mXOouNT7J4OYjQRKkWFFxHaJWdePogqOgipV0cU_g0q4Mvzdqrwz-NM5QJTjg-rCAciba72xGohrwgvkUD24fZ21KOdzuGHnQD3HJlUmu5pbDBMCl6oLq5Uq970eaiRxZt66Y9ky_xXvbywthSc5h81x5QAqsGyLpDWA7oyrVn61ol7zdANzYpKlKsL9YKEgXAoBS8SNAMubTKpBlYIGCQrUtMDl602MclcggLFcrRA Download .mp4 (0.63 MB) Help with .mp4 files Video 2Ligated percutaneous arteriovenous fistula anastomosis.

Frenectomia lingual com uso do laser de alta potência em odontopediatria: relato de caso

Ankyloglossia, also known as a prey tongue, represents a developmentalanomaly characterized by a change in the tongue’s braking resulting inlimitations of tongue movements. The treatment of this pathology canbe through the frenotomy or the frenectomy, which are differentiatedaccording to its extension. Therefore, this report aims to demonstratethe report of clinical case of lingual frenectomy with high-power laser,demonstrating its benefits and presenting the satisfactory resultsobtained. The case presented refer to pediatric patient, one year old, whoattended the Clinic of the Specialization Course in Pediatric Dentistryof the Institute of Multidisciplinary Dentistry with their legal guardian(mother), with indication for lingual frenectomy. The high-power laser (ofdiode) was used for the accomplishment of the surgery. The advantagesof high-power surgical laser, such as shorter surgical time, cleaneroperative field, hemostasis, reduction of pain and postoperative infection,less tissue contraction, absence of suture, reduction of trauma, edema andoptimization of healing.

Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study

ABSTRACT Introduction Blindness due to cataract presents an enormous problem especially in developing countries like India, not only in terms of human morbidity but also in terms of economic loss and social burden. The cataract surgeon of today is challenged to control the sphere as well as the cylinder of the refraction after surgery. Small incision cataract surgery (SICS) is now the method of choice in many parts of the world. This present study has been carried out with the aim to compare the postoperative corneal astigmatism between the two groups of patients undergoing SICS with posterior chamber intraocular lens (PCIOL) implantation with two difference types of incisions, i.e., frown and straight. Material and methods A prospective study was carried out in 60 patients enrolled from the Department of Ophthalmology of Pondicherry Institute of Medical Sciences who underwent SICS with superiorly placed straight and frown incision with PCIOL (each group consisting of 30 patients) during the period from May 2005 to October 2006. Results In this study, 60 patients having senile cataract in the age group of 50 to 75 years were studied. Out of these, the majority were in the age group of 60 to 64 (28.33%) years and only 26.66% were more than 70 years. The male:female ratio was 1:1. In our study, we found that frown incision had significantly better (p < 0.001) mean net astigmatism as compared with the straight incision. Conclusion We conclude that small incision size and absence of suture are the most important factors that contribute to less astigmatism and faster stabilization of SICS, where phacoemulsification cannot be performed. The duration for stabilization of postoperative astigmatism in straight incision group is 6 weeks, whereas it is 3 weeks in frown incision. Frown superior incision has got added advantage of early wound stabilization than straight incision, allowing the patient to resume their daily activities at an early stage. Superior incision group (both frown and straight) had increased amount of with-the-rule (WTR) astigmatism which later shifted to against-the-rule. There was a significant difference in net astigmatism between frown and straight. Postoperative astigmatism also depends on preoperative astigmatism. Patients with preoperative WTR benefited from superior incision cataract surgery. How to cite this article Tripathi S, Srinivasan M, Gupta S. Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study. Int J Adv Integ Med Sci 2017;2(3):111-116.

Absence of the sagittal suture does not result in scaphocephaly

Premature fusion or craniosynostosis of suture(s) of the calvaria is known to result in skull deformation. However, absence of sutures may be interpreted as premature closure of a suture of the calvaria. In the study, the authors investigated skull configuration in skulls found to have isolated absence of the sagittal suture. For this study, 400 adult and child skulls from all of the authors' osteological collections were analyzed. Of these 400 skulls, three specimens were found to have isolated absence of the sagittal suture (one child and two adults). None of these three skulls were found to have scaphocephaly as a result of the suture absence. No other malformations were found on any specimen. One clinical case is also presented with radiologic findings on the absence of the sagittal suture that also did not have resultant skull malformation. The authors found that the isolated absence of the sagittal suture does not produce a scaphocephalic skull shape.

The Changes of With-the-rule Astigmatism After Clear Corneal Temporal Incision Cataract Surgery

Purpose: The effect of suture presence or position of intraocular lens was evaluated on the astigmatic changes in cataract patients suffering from with-the-rule astigmatism who underwent temporal clear corneal incision cataract surgeries. Methods: According to the presence or absence of suture and the lens position (either 180˚ or 90˚), 49 eyes of 47 patients were divided into four groups. Astigmatism was determined using an autorefractor and by topography before surgery, and at one day, one week, one month, and two months after surgery. Results: The suture group showed significant reduction in astigmatism at postoperative day 1 and week 1 by autorefractor and topography compared with the non-suture group. The group with intraocular lens insertion axis at 180˚ did not show significant reduction of astigmatism by autorefractor evaluation. Astigmatism determination by topography in this group was 1.00±0.73D, 1.01±0.77D and 1.01±0.81D at postoperative week 1, month 1, and month 2, respectively, and this showed significant reduction of astigmatism compared with preoperative astigmatism (1.32±1.17D) and group with intraocular lens insertion axis at 90˚. In particular, the group with the sutured temporal incision and with an inserted intraocular lens axis at 180˚ showed significant reduction of astigmatism by autorefraction. Conclusions: When performing cataract surgery in with-the-rule astigmatism patients, suturing the temporal incision and inserting the intraocular lens axis at 180˚ can reduce astigmatism and minimize the effect of surgically-induced astigmatism.

Endophtalmies après les nouvelles procédures

New procedures such as intravitreal injections, 25-G or 23-G vitrectomies, and intravitreal implantations are less aggressive, but they can be complicated by bacterial endophthalmitis. Additionally, injected drugs such as corticosteroids or antimitotics might facilitate the occurrence of infections. Therefore, even if easy to perform, these new procedures must be performed in strict aseptic conditions, as demonstrated in the studies with antiangiogenic factors, where the incidence of endophthalmitis was divided by 4 when the rules of surgical asepsis were respected. In cases of intravitreal injection of triamcinolone, the main differential diagnosis is pseudoendophthalmitis, an aseptic inflammatory reaction with hyalitis and hypopyon, which occurs within 3 days and spontaneously resolves. Endophthalmitis after 25-G surgery might be related to the absence of suture and to the vitreous incarcerated in the sclerotomy.