Early Suture Research Articles

Complete dehiscence of a DALK graft after early suture removal

Sir, Deep anterior lamellar keratoplasty (DALK) involves removal of the diseased anterior layers of the corneal stroma and preserves the healthy Descemet membrane (DM) and endothelium of the host. As the DM is kept intact in DALK surgery, it is arguable that the healing is faster and the wound more durable compared to penetrating keratoplasty (PK). The main drawback of DALK is the occurrence of a high amount of postoperative astigmatism. Although sutures after PK are removed over a period of 1–2 years, early suture removal after DALK can be carried out to combat high postoperative astigmatism. We describe a case of complete dehiscence of a DALK graft after early suture removal.

Crustal architecture of the Shangdan suture zone in the early Paleozoic Qinling orogenic belt, China: Record of subduction initiation and backarc basin development

The early Paleozoic Shangdan suture zone in the Qinling orogenic belt (China) marks the main tectonic boundary between the North China and South China blocks. The mafic rocks along this suture zone make up three distinct geochemical groups: (1) MORB-like; (2) boninite-like, and (3) island arc type. The MORB-like basalts display the highest values of TiO2 (0.86wt.%–1.99wt.%), LREE depletion and no negative Nb–Ta anomalies. However, their enrichment in LILEs relative to N-MORB indicates subduction influence in their melt source. The boninite-like rocks display lower TiO2 (0.09wt.%–0.41wt.%) and FeO* (4.3wt.%–10.25wt.%) contents, lower Ti/V ratios and total REEs, and high Cr (303–1495ppm) and Ni (102–383ppm) values. These geochemical features collectively indicate that magmas of the boninite-like rocks were derived from partial melting of a refractory mantle source. However, distinctly different ages of the boninite-like rocks imply that not all boninite-like rocks in the Shangdan suture zone formed in association with subduction initiation. The 524Ma boninite-like doleritic rocks record the subduction initiation magmatism, whereas the younger boninite-like dolerites with more depleted geochemical signatures represent a magmatic stage associated with backarc spreading around 474Ma. The arc-type lavas display strong negative Nb–Ta and Zr–Hf anomalies, characteristic of intra-oceanic island arc rocks. The combined geological, geochemical and regional tectonic features of the ophiolitic rocks along the Shangdan suture zone in the North Qinling orogenic belt provide a record of subduction initiation, island arc development and backarc rifting in the early Paleozoic, reminiscent of the modern IBM arc-trench system.

Kindliche Kniebinnenverletzungen

Patella dislocations are the most common knee injuries causing hemarthrosis in children. Flake fractures represent the main complication of these injuries and require fixation. First time dislocations are treated conservatively. Recurrent dislocations are managed operatively. Precise analysis of the underlying dispositional and pathological factors is important to determine the appropriate operative procedure. To protect the growth plate, special techniques are required. Tibial spine fractures are bony avulsions of the anterior cruciate ligament (ACL). Management includes closed reduction in hyperextension and immobilization in a knee cast. Tibial spine fractures which cannot be reduced require operative treatment using either arthroscopic or open reduction and stabilization without injuring the growth plate. Intraligamentous ACL injuries are increasingly observed in children and adolescents. The risk of meniscus tears or chondral damage is high in these injuries. In case of persistent ACL instability, early reconstruction is recommended. Various techniques have been described; however, there is no consensus regarding the most favorable technique. The attending physician must be familiar with different ACL reconstruction techniques and with the anatomy of the growth plate. Meniscus tears require early suturing. Healing rates are good in children.

Paraguay‐Araguaia Belt Conductivity Anomaly: A fundamental tectonic boundary in South American Platform imaged by electromagnetic induction surveys

We discovered and mapped a 1200 km‐long zone of enhanced electrical conductivity through a large array of magnetometers, over a narrow corridor parallel to the Paraguay and Araguaia belts which surround the Amazon craton. The anomaly has been further studied using magnetotelluric measurements made along a 300 km profile crossing the Paraguay belt; modeling shows the anomaly at this location as a very strong 100 km‐wide upper‐crust to mid‐crust conductor, located under a region where surficial rocks show an increase in deformation and metamorphism within the belt. From the high conductivity of the anomalous structure, its observed geometry and surface rock exposures, the most likely interpretation of its source is graphitized biogenic material in metasediments, now deeply underthrust in a Neoproterozoic or Early Cambrian suture zone. This result strongly supports the hypothesis that the collision between the Amazon plate and the western Paraná block has probably closed an ocean in the Paraguay belt region, contrary to former propositions of an ensialic evolution for this belt. Although the precise age of this ocean closure have been a matter of debate, our finding significantly constrains the tectonic setting of West Gondwana amalgamation involving the Amazon plate and its surrounding blocks.

Cranial sutures work collectively to distribute strain throughout the reptile skull

The skull is composed of many bones that come together at sutures. These sutures are important sites of growth, and as growth ceases some become fused while others remain patent. Their mechanical behaviour and how they interact with changing form and loadings to ensure balanced craniofacial development is still poorly understood. Early suture fusion often leads to disfiguring syndromes, thus is it imperative that we understand the function of sutures more clearly. By applying advanced engineering modelling techniques, we reveal for the first time that patent sutures generate a more widely distributed, high level of strain throughout the reptile skull. Without patent sutures, large regions of the skull are only subjected to infrequent low-level strains that could weaken the bone and result in abnormal development. Sutures are therefore not only sites of bone growth, but could also be essential for the modulation of strains necessary for normal growth and development in reptiles.

Smad7 Modulates TGFβ Signaling During Cranial Suture Development to Maintain Suture Patency

Craniosynostosis, the premature fusion of one or more sutures between the calvarial bones, is a common birth defect. Mutations in genes encoding receptors for the transforming growth factor-beta (TGFβ) family of signaling molecules have been associated with craniosynostosis, but how TGFβ signaling is regulated during suture development is not known. In the present study, we found that expression of Smad2 and Smad3, intracellular mediators of canonical TGFβ signaling, gradually increases during early postnatal suture development in rat in both the coronal suture (CS), which remains patent throughout life, and the posterior frontal suture (PFS), which undergoes programmed closure by postnatal day 22. The amounts of phosphorylated Smad2 and Smad3 proteins showed a similar gradual increase in the PFS and CS, but in the CS, Smad2/3 activation was suppressed after neonatal day 10. The suppression of Smad2/3 activation in the CS correlated with upregulation of Smad7 expression. We demonstrate that siRNA-mediated knockdown of Smad7 caused increased phosphorylation of Smad2 and Smad3 and induced osseous obliteration of the CS from postnatal days 10 to 22. The Smad7 siRNA-induced CS closure was associated with significantly increased levels of Fgf10 and phosphorylated ERK1/2 in the suture mesenchyme. Moreover, addition of the Erk1/2 inhibitor U0126 partially blocked Smad7-siRNA-induced CS closure. These findings suggest that canonical TGFβ signaling induces suture closure at least in part through activation of FGF and ERK signaling and that Smad7 plays an important role in maintaining suture patency by suppressing canonical TGFβ signaling during suture development.

Die perforierende Keratoplastik im Kindesalter - das ewige Dilemma

Penetrating keratoplasty (PKP) in children is associated with specific age-related problems. In contrast to adults, children can be examined less easily and they are not readily complaining about symptoms. Thus, the rate of intra- and postoperative complications is higher than in adults. In addition, amblyopia is a major issue before the age of seven years potentially resulting in irreversible reduction of visual acuity. Potential indications for surgery are classified as follows: (i) congenital cloudiness (e.g., congenital hereditary endothelial dystrophy--CHED), (ii) acquired traumatic scars, (iii) acquired non-traumatic scars (e.g., infections, keratoconus) and (iv) irreversible graft failure. Our experience concerning 126 paediatric PKPs between 1980 and 2002 in children under age 16 is reported. Five case reports of PKPs performed in Homburg/Saar from 2006 are added. To minimise the risk of immunological graft rejection and chronic endothelial cell loss, we prefer PTK, lamellar keratoplasty or ipsilateral autologous rotational keratoplasty whenever possible. In cases of sclerocornea we feel that PKP should be avoided in view of the histopathology, in cases of Peters' anomaly an optical sector iridectomy may be considered as a valid alternative to high-risk PKP. In cases of buphthalmos the IOP must be controlled before PKP (e.g., previous trabeculotomy). In cases of central penetrating cornea and lens injuries we advocate simultaneous PKP and IOL implantation in the quiet interval after primary wound closure to achieve quick optical rehabilitation. We prefer smaller grafts and interrupted sutures in children. In addition, early suture removal is attempted, especially in cases of progressive corneal neovascularisation threatening the graft. If in doubt, examinations are performed in general anaesthesia readily. Corneal grafting in children should be performed as soon as necessary (less amblyopia!), but as late as possible (better cooperation!). In children, critical indication, repeated in-depth counselling of the parents, good cooperation with the anaesthetist and excellent cooperation with the paediatric ophthalmologist are indispensable in order to achieve good morphological and functional results after PKP.

Journal Scan

Journal Scan

Craniofacial Suture Fusion in Primates

Timing of craniofacial suture fusion is important to questions of demographics and primate ontogeny. There has been much work concerning the fusion of calvarial sutures over the last century, but little work focusing on facial sutures. Here we assess the relationships of facial suture fusion among primates. 1436 skulls of Homo, Pan, Gorilla, Pongo, Hylobates, Macaca and Papio were observed at 5 facial suture sites for stage of fusion. Calvarial volume (early) and dental eruption (late) were utilized as indicators of stage of ontogeny. Patterns of fusion were assessed by Gutmann scaling. Homogeneity of slopes and ANOVA were used to determine differences in timing of fusion. All groups demonstrated reproducible patterns of fusion within groups but variation suggesting slightly different sites of onset and termination of suture fusion between species groups. For calvarial growth, groups segregated by regression slopes, Homo having a very steep slope, indicating remodeling throughout ontogeny, less steep slopes for Pongo, Macaca, and Papio, and flat regression slopes Pan, Gorilla, and Hylobatiadae, indicating very early facial suture remodeling. Similar patterns are observed when dental eruption is used for staging. Thus, Homo appears to be unique in its delay and patency of sutures into late ontogeny. Only Gorilla and Hylobatidae are observed to, as a general rule, fuse all facial suture sites by senescence.Grant Funding Source: N//A

1260 BLADDER REPLACEMENT ACCORDING TO “VESCICA ILEALE PADOVANA (VIP)” TECHNIQUE USING THE NEW V-LOC® AUTOSTATIC SUTURE

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (I)1 Apr 20131260 BLADDER REPLACEMENT ACCORDING TO “VESCICA ILEALE PADOVANA (VIP)” TECHNIQUE USING THE NEW V-LOC® AUTOSTATIC SUTURE Alessio Filianoti, Marco Racioppi, Daniele D'agostino, Luca Di Gianfrancesco, and Pierfrancesco Bassi Alessio FilianotiAlessio Filianoti Rome, Italy More articles by this author , Marco RacioppiMarco Racioppi Rome, Italy More articles by this author , Daniele D'agostinoDaniele D'agostino Rome, Italy More articles by this author , Luca Di GianfrancescoLuca Di Gianfrancesco Rome, Italy More articles by this author , and Pierfrancesco BassiPierfrancesco Bassi Rome, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2614AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The phase of creation and reconfiguration of the ileal neobladder after radical cistectomy affects in a decisive way the length of operation and the rate of early complications. The use of a self-blocking suture is the ideal path to improve and shorten this phase. We are going to introduce the “Vescica Ileale Padovana (VIP)” technique, using the V-LOC® device (Glycomer™ 631), a new autostatic suture available without necessity of making knots. METHODS In our Department we used the new self-blocking reabsorbable suture V-LOC® on 17 pts (14 m & 3 f) undergoing radical cistectomy and orthotopic ileal bladder replacement according to the VIP technique. After cistectomy performed according to usual technique, we collected 45 or 55 cm of ileum necessary for VIP reconstruction. We used the V-Loc® 3/0 stitch for the entire reconstruction, making a one-layer running suture on both the posterior and the anterior wall. We evaluated the time of reconstructive surgery, the cost of suture material and the perfect hydraulic closure of the ileal bladder performing an hydraulic test made at the end of reconstruction and a voiding cistography 12 days and 3 month after surgery. We used as control group 17 patients with bladder replacement using Standard Vicryl 3/0 stitches in double layer suture using the same paramethers. RESULTS We reported: - Significant surgical time reduction. In our experience classic surgical reconstructive phase takes about 100 minutes to be completed. Using the V-Loc® device, surgical time has been reduced at least 30 minutes. - Substantial costs variation. We used 26/30 Vicryl 3/0 spools versus 4 V-Loc® 3/0 spools with a total charge of 152$ versus 100$. - Significant differences in terms of surgical outcomes: the voiding cystography performed 12 days & 3 month after surgery, showed a perfect hydraulic closure of the ileal bladder in all V.I.P. pts. CONCLUSIONS The reconstruction of the orthotopic ileal neobladder using the self-blocking stitch has showed effective and safe results. The procedure has been more simple and faster. The hydraulic tests made at the end of reconstruction showed a perfect hydraulic closure of the ileal bladder. The results were confirmed by a voiding cystography. So no early or late suture dehiscences have been recorded. We've also noticed a good Bladder capacity ( >300 ml). © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e516 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessio Filianoti Rome, Italy More articles by this author Marco Racioppi Rome, Italy More articles by this author Daniele D'agostino Rome, Italy More articles by this author Luca Di Gianfrancesco Rome, Italy More articles by this author Pierfrancesco Bassi Rome, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Recanalization of Thrombosed Arteriovenous Fistulas for Hemodialysis by Minimal Venotomy

The present work describes the preliminary results of a new method of minimally invasive thrombectomy in the treatment of thrombosed arteriovenous fistula (AVF) with dilated aneurysm. Data from 25 patients who were treated with this minimal venotomy technique were retrospectively reviewed. The minimal venotomy was made on the dilated fistula, and thrombectomy was performed with forceps and Fogarty catheters through the venotomy site. Technical and clinical success was achieved in all 25 patients. There were two major and two minor complications (8% each). The two major complications consisted of bleeding at the venotomy site after early suture removal.

Femtosecond laser enabled keratoplasty for advanced keratoconus

Purpose:To assess the efficacy and advantages of femtosecond laser enabled keratoplasty (FLEK) over conventional penetrating keratoplasty (PKP) in advanced keratoconus.Materials and Methods:Detailed review of literature of published randomized controlled trials of operative techniques in PKP and FLEK.Results:Fifteen studies were identified, analyzed, and compared with our outcome. FLEK was found to have better outcome in view of better and earlier stabilization uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and better refractive outcomes with low astigmatism as compared with conventional PKP. Wound healing also was noticed to be earlier, enabling early suture removal in FLEK.Conclusions:Studies relating to FLEK have shown better results than conventional PKP, however further studies are needed to assess the safety and intraoperative complications of the procedure.

Use of early transverse annular compression sutures for complete placenta previa during cesarean delivery

ObjectiveTo compare the difference in maternal outcomes between early and late use of transverse annular compression sutures (TACS) during cesarean delivery among women with complete placenta previa (CPP). MethodsA retrospective study of 36 women with CPP was conducted. Percentiles of blood loss before TACS were calculated. The transfusion rate, sensitivity, specificity, Youden index, positive predictive value, and negative predictive value were also estimated. Patients were assigned to either the early TACS group or the late TACS group based on the highest Youden index. Maternal outcomes of the 2 groups were compared. ResultsThe Youden index for transfusion rate was highest when blood loss before TACS reached 500mL. Blood loss before intervention in the late TACS group was significantly higher than in the early TACS group (735.0±123.7mL versus 396.9±76.3mL; P<0.001). More women in the late TACS group than in the early TACS group required blood transfusion (60.0% versus 12.5%; P=0.004) and the volume of blood transfused was significantly lower in the early TACS group than in the late TACS group (137.5±377.5mL versus 806.7±619.3mL; P=0.001). ConclusionEarly implementation of TACS could lead to improved maternal outcomes.

Combined topical 5‐Fluoruracil and extensive surgery in the management of corneo‐conjunctival squamous cell carcinoma.

AbstractPurpose To evaluate safety and efficacy of combined neo‐adjuvant topical chemotherapy with 1%5‐Fluoruracil (1%5‐FU), followed by extensive surgery and adjuvant (post‐surgical) 1%5‐FU topical chemotherapy in the management of corneo‐congiuntival squamous cell carcinoma (SCC).Methods Twenty‐nine consecutive patients, with histological evidence of SCC, were included in this prospective study. Each patient was treated by combined neo‐adjuvant topical chemotherapy (1%5FU, four time daily for four week, 1 cycle), followed by extensive surgery (5 mm of free conjunctival surgical margins) with contemporary amniotic membrane reconstruction. Adjuvant topical chemotherapy was started 3 months after surgery (1%5‐FU, four time daily for four week, 1 cycle). Follow‐up was performed every 3 months for the first year and every 6 months thereafter, including clinical confocal microscopy. Follow‐up was longer than 36 months.Results Mean follow up was 56±11(range, 36‐78 years). Good functional, anatomic and aesthetic results were obtained by surgery. Two patients (5%) needed short‐term surgical amniotic membrane repositioning due to early sutures dehiscence. 1%5FU, used both as an adjuvant or neo‐adjuvant treatment caused low‐to‐mild temporary local irritation. No‐one patient discontinued therapy because of 5‐FU side effects. No other long‐ or short‐term side effects were documented. No local recurrences were documented during follow up.Conclusion Combined neo‐adjuvant topical chemotherapy with 1%5FU, extensive surgery and adjuvant 1%5FU topical chemotherapy appear a safe and effective combined treatment in the management of conjunctival SCC.

Early Endoscopic Detection and Subsequent Removal of Sphincter Penetrating Anastomotic Sutures May Prevent Irreversible Urinary Incontinence After Radical Prostatectomy

Iatrogenic sphincter lesions are possible reasons for sphincteric incompetence and postprostatectomy urinary incontinence. The aim of this study was to identify early possible sphincter injuries as causes for urinary incontinence after radical prostatectomy by endoscopic evaluation of the anastomotic region. Among 374 patients who had undergone radical prostatectomy from 2005 to 2009 at our institution, we investigated patients with early postoperative urinary incontinence. Nineteen incontinent patients were identified with the symptomatic triad of early incontinence, reduced urinary flow, and post-void residual (PVR) volume after catheter removal. Patients were examined endoscopically, and the clinical effect of early suture removal in patients with sphincter penetration was evaluated. Urethrocystoscopic evaluation revealed an isolated sphincter penetration as reason for early postoperative incontinence in 15/19 cases. The suture penetration was observed predominantly in the 3-degree (7/19) and 9-degree (8/19) positions and less frequently in the 12-degree (2/19) and 6-degree (2/19) positions. Four of (21%) 19 patients did show an additional sphincter transection. The penetrating sutures of the urethrovesical anastomosis were removed during the endoscopic procedure, and initial urinary incontinence could be corrected in all cases of isolated sphincter penetration. Early severe urinary incontinence, reduced urinary flow, and PVR volume after radical prostatectomy may indicate sphincter penetration by anastomosis sutures. In our patients, early transurethral punctual removal of the penetrating sutures could decrease the early postoperative incontinence rate.

Detrital zircon provenance of Upper Ordovician and Silurian strata in the northeastern Yangtze Block: Response to orogenesis in South China

Upper Ordovician to Silurian strata along the northeastern margin of the Yangtze Block, South China Craton, were deposited in a syn-orogenic basin related to the Early Paleozoic Kwangsian Orogeny in the adjoining Cathaysia Block. U–Pb age data for 450 detrital zircons from six sandstones samples range in age from Archean to the early Paleozoic. All samples have a dominant age peak between 0.8 and 0.9Ga and subordinate peaks around 2.5Ga and 1.8Ga, with the youngest samples also containing zircons between 0.47 and 0.43Ga. The detrital zircon age spectrum is indicative of derivation from the southeast with Precambrian grains derived from the basement of Cathaysia Block and the Early Neoproterozoic Jiang-Shao suture, and Early Paleozoic zircons derived from igneous activity associated with the Kwangsian Orogeny. The restriction of Paleozoic detritus to the latter phases of the Kwangsian Orogeny (which started by 460Ma) suggests progressive exhumation of the Cathaysia Block, perhaps due to thrusting over the Yangtze Block, with the latter remaining a site of active sedimentation during orogenesis.

Sensory neuropathy following suspension of the vaginal apex to the proximal uterosacral ligaments

Reports of sensory neuropathy attributed to uterosacral ligament suspension (USLS) have emerged. The objectives of this study were to assess the rate of sensory neuropathy symptoms following transvaginal USLS at a single institution during a 5-year period and to describe the evaluation, management, and outcomes in these patients. A retrospective review of records identified 278 women who underwent transvaginal USLS during the study period. Inpatient and outpatient records within the first 4 weeks postsurgery were reviewed. Women with new-onset buttock and/or lower-extremity pain, numbness, weakness or a combination of these symptoms were identified. Demographic data, intraoperative data, and management modalities and outcomes were collected. Nineteen (6.8 %) women met criteria for inclusion. The most common symptom was buttock pain (73.7 % of cases). Pain radiation to the ipsilateral posterior thigh was present in 11 cases (57.9 %). The majority of women (73.7 %) reported pain symptoms on the right side. Conservative treatment modalities were initially implemented in all women. Four women (21 %) underwent suture removal a median of 1.75 months after USLS. Full symptom resolution was reported in 13 (68.4 %) women a median of 6 months after USLS. The remaining women experienced partial symptom resolution with ongoing conservative management. Sensory neuropathy is common in women who undergo transvaginal USLS. As quality of life may be significantly affected, any symptoms of buttock or lower-extremity pain in the immediate postoperative period warrant a thorough evaluation and close follow-up, with early suture removal consideration.

Characteristics and treatment of skin and soft-tissue defects caused by 5·12 Wenchuan earthquake

To investigate the features and the treatment of skin and soft-tissue defects caused by 5·12 Wenchuan Earthquake. From May 12 to June 7 in 2008, 37 injured persons (43 wounds) were treated in West China Hospital, including 20 males and 17 females with a mean age of 40 years old (range: 2 - 85). The wound locations included head (n = 2), trunk (n = 3), upper arm (n = 5), forearm (n = 5), thigh (n = 13) and lower extremity (n = 15). Their sizes ranged from 5 cm × 4 cm - 27 cm × 20 cm. In 19 cases (51.3%), the bacterial culture results of wound secretion were positive. After thorough debridement and supportive treatment, the wounds were covered by hydropathic dressings. When the infections were under control and granulation tissues grew well, the method of either skin grafting (41 wounds) or flap transposition (2 wounds) was employed to repair the wounds. The survival rate of skin flaps or free skin was used to evaluate the therapeutic efficacy. From Days 6-15 post-admission, the wounds were repaired by skin grafting or flap transposition. All free skin grafts and flaps achieved an excellent survival. Two flaps survived completely, 33 grafts survived > 95% and other 8 grafts > 90%. The stay of hospitalization lasted for 12 - 23 days. None of the patients had any symptom of severe systemic infections and all survived. Skin and soft-tissue defect wounds caused by earthquake are usually present in extremities and head. And there is a high incidence of local infections and severe contaminations. Early debridement, symptomatic supports and suturing by skin or flap transposition may repair the wounds as early as possible and contribute to a rapid recovery of patients.

From Subduction to Collision in the Northern Tibetan Plateau: Evidence from the Early Silurian Clastic Rocks, Northwestern China

The Qilian Orogen records early Paleozoic collisional suturing of the Qaidam Block and the Central Qilian Block to the North China Craton. The composition and U-Pb age of detrital zircons and the composition of Cr-spinels from the Early Silurian Lujiaogou and Angzanggou formations in the northern part of orogen indicate derivation from evolving oceanic and continental source terranes. Heavy-mineral chemistry indicates the incorporation of suprasubduction zone–type ophiolitic detritus in addition to continent-derived material. Integrating these chemical and age data with regional data on the duration of subduction-related magmatic activity, syn- and postcollisional granitic rocks, and high-pressure metamorphic rocks constrains the transformation from oceanic subduction to continental collision to 450–440 Ma. The collision resulted in a flood of detritus into the northern part of the orogen from the Central Qilian Block, which masked input from the intervening magmatic arc, implying rapid exposure of the block.

Early, minimally invasive closure of anastomotic leaks: a new concept

Chronic pelvic sepsis after ileoanal or coloanal anastomosis precludes ileostomy closure and, even if closure is ultimately possible, function of the neorectum is badly affected. Early closure of the anastomotic leak might prevent chronic pelvic sepsis and its adverse sequelae. In our experience of early closure in a consecutive group of six patients with a leaking low anastomosis (five with ileoanal pouch anastomosis and one after a low anterior resection), we were able to achieve anastomotic closure in five by means of initial endosponge therapy followed either by early suture (four patients) or endoscopic clip repair (one patient). Early minimally invasive closure of low anastomotic leaks is therefore possible provided that the para-anastomotic cavity is drained well prior to closure and the anastomosis is defunctioned.