Enlargement Technique Research Articles

Aortic Root Enlargement or Sutureless Valve Implantation?

Aortic valve replacement (AVR) in patients with a small aortic annulus is a challenging issue. The importance of prosthesis–patient mismatch (PPM) post aortic valve replacement (AVR) is controversial but has to be avoided. Many studies support the fact that PPM has a negative impact on short and long term survival. In order to avoid PPM, aortic root enlargement may be performed. Alternatively and keeping in mind that often some comorbidities are present in old patients with small aortic root, the Perceval S suturelles valve implantation could be a perfect solution. The Perceval sutureless bioprosthesis provides reasonable hemodynamic performance avoiding the PPM and providing the maximum of aortic orifice area. We would like to see in the near future the role of the aortic root enlargement techniques in the era of surgical implantation of the sutureless valve (SAVR) and the transcatheter valve implantation (TAVI).

Idiopathic Progressive Subglottic Stenosis: Surgical Techniques

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.

A comprehensive approach including a new enlargement technique to prevent complications after De Quervain tendinopathy surgery

The goal of this study was to evaluate the outcome of our surgical approach aimed at preventing complications following surgery for De Quervain tendinopathy. Our stepwise surgical procedure is described in detail. We reviewed 56 cases operated by a senior surgeon over 5years, and re-evaluated them with a minimum 15months’ follow-up. Complications mentioned in the literature (poor wound healing, adhesions, nerve injury, incomplete decompression, tendon subluxation) were not present in any of the cases; the satisfaction rate was very high. Slight residual discomfort was noted in 16 cases. Among them, 13 had an associated pathology. In summary, the outcome after the comprehensive approach presented here is highly predictable. Properly applied, good to excellent results can be expected in most patients. Potential postoperative complications are effectively prevented. Some caution is needed in cases of associated pathologies.

Reversible Data Hiding Based on Image Interpolation with a Secret Message Reduction Strategy

In 2012, Lee et al. proposed an interpolation enlargement technique using neighboring pixels as the base on which secret messages are embedded in enlarged interpolated pixels. This method can effectively predict the pixel between two adjacent pixels so as to reduce the distortion caused by the hidden secret messages. However, in this study we found that while Lee et al.’s neighboring pixel prediction method can successfully achieve a predictive value, embedded secret messages of different sizes will cause great distortion when a large secret message is hidden in the predicted value. Therefore, the purpose of our research is to determine how to process secret messages in advance to reduce the harm caused by embedding. We propose a secret message reduction strategy that changes positive secret messages to both positive and negative to decrease their values and thereby reduce stego-image distortion.

A Comparison of Time Needed for Instrumentation of Simulated Curved Canals by Using Different Files

Background : A more flexible file was needed for instrumentation of curved canals using step back enlargement technique Ni-Ti files has been shown to be exceptionally elastic , having a lower bending moment and lower permanent set after torsion with similar gauge stainless steel files . Aim of the study: is to compare the time needed to prepare curved resin simulated root canals with Ni-Ti, S.S., and SS K-Flex files using a step –back enlargement technique. Materials and methods: 30 simulated root canals were constructed using size 20 silver points as a mold, then divided into 3 groups: group 1: Canals instrumented with SS K – files, group 2: Canals instrumented with stainless steel K- flex files. And group 3: Canals instrumented with Ni – Ti files. Results: The comparison between the three groups using ANOVA and T- test, showed a significant difference in time needed to fully instrument the canals. CONCLUSION: Ni- Ti files required more time to instrument the canals than other files.

Surgical Treatment of Anomalous Aortic Origin of Coronary Arteries: The Reimplantation Technique and Its Modifications

Although anomalous aortic origin of a coronary artery has been described as a benign anomaly in the past, several reports suggest that such an anomaly may be the cause of sudden death in children and younger adults. Increased cardiac output during exercise may result in compression of the anomalous coronary artery when it runs between the aorta and the pulmonary artery or when its aortic origin is narrowed and its proximal course is intramural. It is unlikely that this rare anomaly would be identified during infancy, but once diagnosis has been made, indication to proceed with surgery is controversial. Nevertheless, if surgery is recommended, several operative techniques may be used, depending on the specific anatomy; unroofing, direct reimplantation, patch enlargement, and even coronary artery bypass grafting have been proposed. In this short report, we focus on different techniques of coronary reimplantation. As we already know from the arterial switch operation in neonates and from aortic root repair or replacement in adults, sufficient mobilization is necessary to allow direct reimplantation in the correct sinus to avoid kinking and other distortion.

Pre-clinical evaluation of a minimally invasive laryngeal pacemaker system in mini-pig.

Microlaryngoscopic enlargement techniques have been the standard treatment for bilateral vocal fold paralysis (BVFP) for decades. Laryngeal pacing is a promising alternative treatment based on the electrostimulation of the posterior cricoarytenoid (PCA) muscle. This paper reports on the results of a pre-clinical study aiming to evaluate this method. Eight Göttingen mini-pigs were implanted with a laryngeal pacemaker (LP) implant prototype and with two LP electrodes, one in each PCA muscle. The 6-week follow-up included endoscopic stimulation controls in general anaesthesia and radiographic controls of electrode integrity and position stability. Stimulation parameters for optimal glottal opening were evaluated via videolaryngoscopy. Histopathology was performed upon conclusion of the study. 7/8 (87.5 %) animals were successfully implanted with the LP implant prototype and two LP electrodes. In general, stimulation was effectively delivered and correlated with the expected PCA muscle activation. 2/14 (14.3 %) electrodes dislocated and 1/14 (7.1 %) electrode tip broke. The LP system used in this experiment to induce vocal fold abduction by means of selective functional electrical stimulation of the PCA showed promising results. It may be a valid alternative to the current golden standard for BVFP treatment. Clinical studies are needed to confirm the medical relevance of the LP.

Voice and respiratory outcomes after permanent transoral surgery of bilateral vocal fold paralysis.

Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare. Prospective observational multicenter study. Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively. Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly. Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes. 2b.

Arytenoidcordectomy for bilateral vocal cord paralysis: Primary and revision procedure

Background: Definitive enlargement of the glottis with preservation of adequate voicing in patients with bilateral recurrent nerve paralysis remains a surgical challenge especially in patients with previous unsuccessful surgery. Study design: Report of a novel surgical technique for glottis enlargement and presentation of midterm results. Methods: Four adult patients with bilateral recurrent nerve paralysis were subjected to submucosal arytenoidcordectomy through a thyreofissure approach with ventricular folds transposition and long-term translaryngeal stenting. Two of them had had previous surgeries at the glottic level. Preoperative data as well as postoperative functional results are reviewed. Follow-up ranged from 8 to 28 months. Results: In all patients tracheostomy closure was achieved. Midterm follow-up revealed stable airway, adequate for the patients' routine physical activities. Postoperatively patients phonated with the ventricular folds and the resulting voice quality was good. Conclusions: We describe a novel approach formanagement of impaired airway because of bilateral recurrent nerve paralysis and/or stenosis. It comprises intralaryngeal soft tissue resection, enlargement of the cartilaginous framework of the larynx and long-term translaryngeal stenting. The surgical approach described here proved to be successful both in patientswith simple bilateral vocal fold motion impairment and in those, who have been already unsuccessfully treated with other surgery. Nevertheless the technique should be regarded as an option only in complicated revision cases, rather than a primary intervention in bilateral vocal fold paralysis.

Aortic Root Enlargement During Aortic Valve Replacement: Nicks and Manouguian Techniques

Aortic valve replacement can be complicated by a small aortic annulus necessitating the placement of an undersized prosthetic valve. In an effort to avoid prosthesis-patient mismatch, root enlargement techniques have been utilized. Herein is a review of the Manouguian and Nicks techniques for posterior root enlargement.

Master apical file size - smaller or larger: a systematic review of microbial reduction.

The purpose of this systematic review was to determine, in patients undergoing root canal treatment, whether apical enlargement of canals affected microbial reduction. A PICO (population, intervention, comparison and outcome) strategy was developed to identify previously published studies dealing with apical size of canal and microbial reduction. The MEDLINE, Embase, Cochrane and PubMed databases were searched. Additionally, the bibliographies of all relevant articles and textbooks were manually searched. Based on inclusion and exclusion criteria, two reviewers independently selected the relevant articles. Due to the variety of methodologies and different techniques used to measure outcome for master apical file enlargement, it was not possible to standardize the research data and to apply a meta-analysis. Seven articles were identified that met the inclusion criteria. Five of the seven articles generally concluded that canal enlargement reduced bioburden in the root canal system. Two articles reported no difference in canals enlarged to size 25 or 40. The results of the systematic review confirmed that more evidence-based research in this area is needed. With the limited information currently available, the best current available clinical evidence suggests that contemporary chemomechanical debridement techniques with canal enlargement techniques do not eliminate bacteria during root canal treatment at any size.

Femtosecond laser-assisted capsulotomy rescue for capsulorhexis enlargement.

The anterior capsulorhexis is one of the difficult steps during cataract surgery. An anterior capsule opening that is too small can lead to capsule phimosis. We describe a technique for capsulotomy enlargement with the help of an image-guided femtosecond laser for cataract surgery. In 5 cases with a capsulorhexis diameter smaller than 4.0 mm, phacoemulsification and intraocular lens insertion were performed before the capsulotomy was enlarged. In all cases, it was possible to remove the additional capsule ring without complications. An anterior capsule tear did not occur in any case. The technique has potential for routine use in cases with a small anterior capsule opening. Neither author has a financial or proprietary interest in any material or method mentioned.

A Novel Technique of Single Patch Repair of Right Partial Anomalous Pulmonary Venous Return to the Superior Vena Cava by Right Atrial Edge Rotation

In patients with partial anomalous pulmonary venous return of the right superior pulmonary veins to the superior vena cava, surgical repair generally consists of either intraatrial baffle with or without caval enlargement, or superior caval transection and cavoatrial anastomosis to the right atrial appendage. Wediscuss here a novel technique of superior caval enlargement without need for patch material or reimplantation.

A Study of Digital Image Enlargement and Enhancement

Most image enlargement techniques suffer the problem of zigzagged edges and jagged images following enlargement. Humans are sensitive to the edges of objects; if the edges in the image are sharp, the visual is considered to be high quality. To solve this problem, this paper presents a new and effective method for image enlargement and enhancement based on adaptive inverse hyperbolic tangent (AIHT) algorithm. Conventional image enlargement and enhancement methods enlarge the image using interpolation, and subsequently enhance the image without considering image features. However, this study presents the method based on Adaptive Inverse Hyperbolic Tangent algorithm to enhance images according to image features before enlarging the image. Experimental results indicate that the proposed algorithm is capable of adaptively enhancing the image and extruding object details, thereby improving enlargements by smoothing the edge of the objects in the image.

A modified approach to aortic root reconstruction in children: An extended 2-patch root enlargement technique

A modified approach to aortic root reconstruction in children: An extended 2-patch root enlargement technique

A statistical image resolution enhancement approach for mixed-resolution video

Many scalable video compression techniques utilise a mixed-resolution scheme, which down-samples some frames at the encoder to produce reduced-resolution frames while keeping resolutions of other frames unchanged as full resolutions, in order to achieve higher compression gain. Image enlargement technique is required at the decoder to recover the original full-resolution frames for this mixed-resolution video system set-up. This article proposes a Bayesian approach to enlarge the reduced-resolution frame via its maximum a-posterior estimation, using the information from the observed reduced-resolution frame, plus more detailed information extracted from available neighbouring frames in full resolution. Experiments are conducted to justify that the proposed approach outperforms a few conventional approaches.

Chirurgie cosmétique de l’appareil génital masculin

To describe the indications and results of techniques to change the appearance of the penis for aesthetic reasons. Provide recommendations concerning cosmetic surgery of the male genitalia. We have selected from Medline Database, articles published between 1990 and 2011. Forty articles have been selected excluding papers reporting populations less than five cases per type of procedure. There is no consensus on the size below which it is justifiable to accept or attempt to modify the size of the penis. Length of the penis in maximal tension less than 9.5 cm or 10 cm in erection can be considered as an acceptable limit, in a patient who suffers from it. The assessment of men asking for penile enlargement must include a psychosexological or psychiatric evaluation, looking for a dysmorphophobia or another psychiatric condition. Penile extenders under medical control must be the first-line treatment option for patient seeking penile lenghtening procedure when justified. In case of failure, three techniques can be used alone or in combination: penile lengthening by section of the suspensory ligaments and suprapubic skin advancement, lipectomy of Mons pubis and scrotal webbing section. The results are modest, the rate of complications significant and satisfaction low. Girth enlargement techniques by injection of autologous fat give inconsistent aesthetic results and satisfaction rates are low. All other techniques remain experimental. Cosmetic surgery of the penis is associated with a high risk of forensic exposure and surgery should be only proposed after a multidisciplinary consensus, followed by a time of reflection given to the patient after full disclosure. Applications for the purpose of reconstruction surgery after trauma or consequences of cancer treatment are justified.

Annulus upsizing for mitral valve re-replacement in children

Mitral valve replacement remains the last resort for treatment of congenital mitral valve disease. Enlarging the mitral annulus at the time of mitral valve replacement may allow implantation of a larger prosthesis in children. All mitral valve replacement procedures from 1990 to 2012 were included, and mitral annulus enlargement techniques were analyzed. A control group of patients undergoing replacement of a previously implanted mechanical mitral valve prosthesis was compared with the cohort of patients who underwent annular enlarging procedures. Primary end points were increases in annulus size and Z score, and freedom from paced rhythm. Among 205 mitral valve replacement procedures, 16 (8%) included techniques to upsize the mitral annulus in 15 patients, all but 1 of whom had undergone prior mitral valve replacement. These patients were compared with a control cohort of 53 patients undergoing mitral valve re-replacement without annulus enlargement. The annulus was upsized by 18% ± 11% (compared with 16% ± 20% in controls, P = .5) using open balloon dilation in 4 patients, radial annular incisions in 5 patients, and patch augmentation of the aorto-mitral continuity in 7 patients. The mean valvar diameter Z score increased from -0.2 ± 1.3 to +1.1 ± 1.4 (P < .001), compared with an increase from -0.3 ± 1.2 to 0.9 ± 1.1 in controls (P < .001). During a mean follow-up of 6.5 ± 6.4 years, 4 of 12 patients required permanent pacing in the upsizing group (predominantly with patch augmentation), versus 5 of 53 patients in the control group. In children undergoing mitral valve replacement, various techniques can be used to upsize the mitral annulus and allow implantation of a larger prosthesis. There is a nontrivial risk of heart block with annulus upsizing, which deserves further study.

Use of Macrolane VRF 30 in Emicircumferential Penis Enlargement

Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use. The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling. The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed. The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma, and another experienced fat necrosis. The vast majority (n = 72) of patients reported being "very satisfied" with the results. The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.

Partial functional quantization and generalized bridges

In this article, we develop a new approach to functional quantization, which consists in discretizing only a finite subset of the Karhunen-Loeve coordinates of a continuous Gaussian semimartingale $X$. Using filtration enlargement techniques, we prove that the conditional distribution of $X$ knowing its first Karhunen-Loeve coordinates is a Gaussian semimartingale with respect to a bigger filtration. This allows us to define the partial quantization of a solution of a stochastic differential equation with respect to $X$ by simply plugging the partial functional quantization of $X$ in the SDE. Then we provide an upper bound of the $L^p$-partial quantization error for the solution of SDEs involving the $L^{p+\varepsilon}$-partial quantization error for $X$, for $\varepsilon >0$. The $a.s.$ convergence is also investigated. Incidentally, we show that the conditional distribution of a Gaussian semimartingale $X$, knowing that it stands in some given Voronoi cell of its functional quantization, is a (non-Gaussian) semimartingale. As a consequence, the functional stratification method developed in [6] amounted, in the case of solutions of SDEs, to using the Euler scheme of these SDEs in each Voronoi cell.