New Technique For Treatment Research Articles

WP1.6 - Intraoperative fascial traction for the treatment of large hernias - results of a multicentre study

Abstract Background The incidence of incisional hernias after median laparotomy is about 20%. Intraoperative fascial traction (IFT) is a new technique for treatment of large hernias. Materials and methods In this study data from five hospitals using IFT between 12/2020 and 9/2023 was analysed. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. All patients underwent a standardized clinical and ultrasound examination during follow-up. Quality of life was assessed using the HerQLes questionnaire. Results A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9±14.1 years, 41% were female, BMI was 31.0±7.3kg/m², hernia width was 15.7±5.1cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days. In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%). During the mean follow-up of 15.7±12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5. Conclusion This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment. Further randomised studies of IFT should follow to support these data.

Optimal drilling at femoral head-neck junction for treatment of the femoral head necrosis: Experimental and numerical evaluation

Advanced core decompression (ACD) is a relative new technique for treatment of early stages of avascular femoral head necrosis. Although it is a promising treatment option, there is a need to modify this technique for achieving higher hip survival rates. An idea was to combine this technique with the lightbulb procedure in order to get a complete removal of the necrosis. This study aimed at evaluating the fracture risk of the femora treated by the combined Lightbulb-ACD technique as the basis for clinical application. Subject-specific models were generated from CT scan data of five intact femora. Several treated models were then created from each intact bone and simulated during normal walking activity. Biomechanical testing was additionally performed on 12 pairs of cadaver femora to confirm the simulation results. The finite element results revealed that the risk factor of the treated models with a 8mm-drill increased, but was not significantly greater than that of their corresponding intact models. However, for the femur treated with a 10mm-drill, the risk factor increased significantly. Fracture always initiated on the femoral neck, i.e. it was either subcapital or transcervical fracture. Our biomechanical testing results correlated well with the simulation data which confirmed the usefulness and effectiveness of the bone models. The combined Lightbulb-ACD technique using a 10mm drill increased the fracture risk of femur postoperatively. A drill of up to 8mm at the anterior head-neck junction did not however lead to the weakening of the femur so that full load bearing may be possible.

Magnetic Resonance-Guided Adaptive Radiation Therapy for Prostate Cancer: The First Results from the MOMENTUM study—An International Registry for the Evidence-Based Introduction of Magnetic Resonance-Guided Adaptive Radiation Therapy

Magnetic resonance (MR)-guided radiation therapy (MRgRT) is a new technique for treatment of localized prostate cancer (PCa). We report the 12-month outcomes for the first PCa patients treated within an international consortium (the MOMENTUM study) on a 1.5T MR-Linac system with ultrahypofractionated radiation therapy. Patients treated with 5×7.25 Gy were identified. Prostate specific antigen-level, physician-reported toxicity (Common Terminology Criteria for Adverse Events [CTCAE]), and patient-reported outcomes (Quality of Life Questionnaire PR25 and Quality of Life Questionnaire C30 questionnaires) were recorded at baseline and at 3, 6, and 12 months of follow-up (FU). Pairwise comparative statistics were conducted to compare outcomes between baseline and FU. The study included 425 patients with localized PCa (11.4% low, 82.0% intermediate, and 6.6% high-risk), and 365, 313, and 186 patients reached 3-, 6-, and 12-months FU, respectively. Median prostate specific antigen level declined significantly to 1.2 ng/mL and 0.1 ng/mL at 12 months FU for the nonandrogen deprivation therapy (ADT) and ADT group, respectively. The peak of genitourinary and gastrointestinal CTCAE toxicity was reported at 3 months FU, with 18.7% and 1.7% grade ≥2, respectively. The QLQ-PR25 questionnaire outcomes showed significant deterioration in urinary domain score at all FU moments, from 8.3 (interquartile range [IQR], 4.1-16.6) at baseline to 12.4 (IQR, 8.3-24.8; P=.005) at 3 months, 12.4 (IQR, 8.3-20.8; P=.018;) at 6 months, and 12.4 (IQR, 8.3-20.8; P=.001) at 12 months. For the non-ADT group, physician- and patient-reported erectile function worsened significantly between baseline and 12 months FU. Ultrahypofractionated MR-guided radiation therapy for localized PCa using a 1.5T MR-Linac is effective and safe. The peak of CTCAE genitourinary and gastrointestinal toxicity was reported at 3 months FU. Furthermore, for patients without ADT, a significant increase in CTCAE erectile dysfunction was reported at 12 months FU. These data are useful for educating patients on expected outcomes and informing study design of future comparative-effectiveness studies.

Best application of low-cost enhancement treatment for agricultural drain wastewater

This study aimed to apply a new technique of treatment inside stream using polyethylene sheets strips as a very cheap method for enhancing the quality of agriculture wastewater to meet the irrigation reuse needs. The study was carried out on a pilot plant that was constructed by EU research project named “drains water quality enhancement” inside Faqous Wastewater Treatment plant nearby Bahr El Bakar agricultural drain in El Sharqiyah Governorate, Egypt. Polyethylene strips were used as in stream media treatment where the operation program was made to determine the best positioning for applied serial lines to achieve the target water quality for reuse purposes, The study used four intervals first was 30 cm in channel 2 ,the second was 70cm in channel 3, the third was 100cm in channel 4 ,and the fourth was 150 cm in channel 5 to get the best enhancing efficiency and the removal ratios for Biochemical Oxygen demand (BOD), Chemical Oxygen demand( COD) & Heavy metals (HM). Each channel contains six serial curtain lines to determine the study parameters. The results showed that the first interval 30 cm achieved removal ratios 44.6 %for BOD, 27 %for COD, and 41.7% for HM, while interval 70 cm produced removal ratios 46 %for BOD, 27.7 %for COD, and 43.3% for HM, for the third interval 100 cm the study get the removal ratios 51.6 %for BOD, 30 %for COD, and 46 % for HM, and finally for interval 150 cm the resulted removal ratio were 52.6 %for BOD, 30.5 %for COD, and 48 % for HM. The study proved that the curtain lines interval should be equal to or more than double the water depth in the stream to achieve higher removal efficiency in all measured parameters.

Assessment of endovenous microwave catheter ablation in the treatment of primary lower limb varicose veins

Background: Lower limbs varicose veins are common in the adult population, The CEAP classification is a conventional way of staging varicose vein disease.Traditional treatment is surgery, which involves disconnection of sapheno-femoral and/or sapheno-opopliteal junctions with or without stripping of the superficial axial vein. the endovenous ablation is now the most widely used procedure and approximately occlusion rate of 95%. the Endovenous ablation techniques is Endovenous Microwave Ablation (EMA) which works by generating radio-frequency energy. It generates radiofrequency energy with the MICROTAZE OT-110 M machine. Aim: The aim of this study is using endovenous microwave ablation as a new technique in treatment of lower limb varicose veins according to the results, advantages, disadvantages and complications. Subjects and Methods: This study was conducted on 30 patients with varicose veins of lower limbs. It was conducted in the department of vascular surgery, Al- Azhar University Hospitals – Cairo (Al-Hussein and and said-Galal Hospitals). After taking a written consent, patients were subjected to Clinical evaluation and Duplex Ultrasound. Results: over weighted and patients with 30-50 years were the most. A statistically significant improvement was observed in AVVQ at different follow-up intervals.

Palatal Implantation Using Platelet Rich Plasma and Radio Frequency Palatal Surgery for Management of Obstructive Sleep Apnea

Background: Obstructive Sleep Apnea (OSA) is a common health problem affecting large number of people all over the world with great psychological and physiological burdens. The aim of this study is to investigate the effect of radio frequency palatal Surgery and platelet rich plasma in the soft palate as a new technique in treatment of obstructive sleep apnea OSA. Patients and Methods: This study included 30 patients with mild to moderate OSA Group A: n=15 (Tonsillectomy and palatal radio frequency surgery) and Group B n=15 (Tonsillectomy and Platelet Rich Plasma (PRP) palatal injection, this study investigate the effect of body mass index, retropalatal anteroposterior diameter, Epworth Steepness Scale Apnea Hypopnia Index in treatment of OSA in both groups. This study found that both techniques improved day time sleepiness with reduction of Apnea-Hypopnea Index (AHI), also there was marked improvement in radiological parameters in the form of increase of the anteroposterior diameter and retro-palatal cross section area, there was reduction of Body Mass Index BMI in postoperative in both groups but there was superiority of group A over group B in improvement of this parameters, group A success rate was 86.6% and Group B was 80%. Conclusion: Radio frequency palatal surgery and platelet rich plasma, both are effective as a treatment of obstructive sleep apnea due to retro-palatal collapse.

Laser Reconstruction of Spinal Discs Experiments and Clinic

Degenerative disease of the intervertebral discs (DDD) is currently a serious problem facing the world community. The surgical methods and conservative therapy used today, unfortunately, do not stop the pathological process, but serve as a palliative method that temporarily relieves pain and improves the patient’s quality of life. Therefore, at present, there is an active search for new methods of treating DDD. Among new techniques of treatment, biological methods, and minimally invasive surgery, including the use of laser radiation, which, depending on the laser parameters, can cause ablative or modifying effects on the disc tissue, have acquired considerable interest. Here, we analyze a new approach to solving the DDD problem: laser tissue modification. This review of publications is focused on the studies of the physicochemical foundations and clinical applications of a new method of laser reconstruction of intervertebral discs. Thermomechanical action of laser radiation modifies tissue and leads to its regeneration as well as to a long-term restoration of disc functions, elimination of pain and the return of patients to normal life.

Evaluation of Omphalocele Treatment Using New Surgical Technique

Introduction: The aim of this study was to evaluate a new technique for treatment of omphalocele using mesh fixation to skin with preserved omphalocele sac. Materials and Methods: Chart of patients who treated with mesh fixation were reviewed. Demographic features, mortality and morbidity following treatment were recorded. Results: in the current study 68 patients (f=32, m=36) were included. Of 68 csaes, 44(64.7%) had giant omphalocele. Among all cases, 20(29.4%) had isolated omphalocele. Mortality was 26.5%(18 of 68). Of survived cases, 21(42%) had detached mesh. Adhesion band was seen in 4(8.2%) of cases. Sepsis was seen in 11.8% of the cases. Conclusion: According to the result of the study, suggested technique is promising and had several benefits. Duration of hospital staying, duration of intubation was less than previous techniques

Single vertebral manipulative therapy (Kitchener’s Technique): a new technique for treatment of acute and subacute spinal root compression

Introduction: Spinal Root Compression Syndromes (SRCS) are common, costly, and significant cause of long-term sick leave and work loss. There is No consensus on the best approach. One intervention often used is manipulative therapy. Objective: The aim of this study was to determine if Single Vertebral Manipulative Therapy (Kitchener’s Technique) (SVMT) is effective in alleviating pain levels and regaining physical functioning in comparison to standard medical care (SMC), among 18-55-year-old active working personnel. Methods: Prospective, longitudinal, 2-arm controlled study comparing SMC plus SVMT (32 patients) with only SMC (21 patients). The primary outcome measures were changes in root-related pain on the numerical rating scale and physical functioning at 6 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS). Results: Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus SVMT group than in the SMC group at both week 2 (P<0.001) and week 6 (P=0.001). Mean numerical rating scale pain scores were also significantly better in the group that received SVMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus SVMT group than in the SMC group at both week 2 (P<0.001) and week 6 (P=0.001). Conclusion: Results suggest that SVMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only SMC, for patients aged 18-55 years with SRCS.

New Concept for Severely Burned Ear Reconstruction: Grafting of the Frame Using Banked Ear Cartilage Combined with Costal Cartilage.

Background:Damage and loss of ear cartilage can easily occur in a burned ear accompanied by severe extensive burns due to exposure of the cartilage or chondritis. Deformity can also occur due to later development of scar contracture despite minimal damage to the ear cartilage when the injury occurred. We have developed a new technique for treatment of a deep burn in the whole ear.Methods:In the new technique, the ear is amputated, and soft tissues are denuded. The cartilage is banked in a subcutaneous pocket in the chest and later regrafted in combination with costal cartilage.Results:Although techniques for regrafting banked ear cartilage have been reported, the reconstructed ear cannot acquire a good shape because of absorption of the cartilage or lack of intensity to sustain the outline of the ear. Meanwhile, when we tried to reconstruct an ear by only using costal cartilage, we found it difficult to fabricate a frame because most patients are adults in whom the costal cartilage is too rigid and fragile to be shaved or combined. In our technique, the frame has both the advantages of sufficient intensity in costal cartilage and a smooth curved surface together with elasticity in the ear cartilage. Ears reconstructed by our technique have a natural appearance.Conclusion:Our technique can be used for cases in which treatment for another large area of the body surface needs to be performed first to save the patient’s life.

A retrospective assessment of the complications and associated risk factors of laparoscopic cholecystectomy

Aim: The aim of the present study to assess the risk factors and complications of Laparoscopic Cholecystectomy. Material and Methods: This was a retrospectively analysed study conducted in the Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India, from December 2018 to November 2019. 100 patients who were diagnosed with cholelithiasis and had laparoscopic cholecystectomy were included in this study. We analysed the type and frequency of intraoperative and postoperative complications, as well as factors that increase the risk for development of complications. We noted causes and incidence of conversions and the way they resolved. We noted gender, age, body mass index (BMI), white blood cell count, and level of C-reactive protein (CRP), preoperative ultrasonographic findings, Patho histological findings of the surgically removed gallbladder, as well as their correlation with the occurrence of complications. Results: Out of the 100 patients in the study, 68 were female (68%), and 32 were male (32%). The most common complications noted were: iatrogenic perforations of the gallbladder- 5 (5%), bleeding from the tissues adjacent to the gallbladder 3 (3%), gallstones spilt into the peritoneal cavity 2 (2%). Intraoperative bleeding from the cystic artery occurred in 1 (1%), bleeding from the port in 1 (1%) and bleeding from the ligaments of the liver in 1 patients (1%). The transection of the common bile duct, a major complication, occurred in only one patient (1%). The most common postoperative complications were: bleeding from the abdominal cavity more than 100 ml/24h (in 3 patients or 3%), bile leaks through the drain > 50-100 ml/24h (2 patients, or 2%). In addition, the ultrasonographic findings of empyema, gangrene of the gallbladder wall, and increased gallbladder wall thickness > 3 mm (group II) is a significant predictor of complications and conversion (OR = 4.92, 95% CI 1.61-18.13, p< 0.001). Patho histologic analysis of the surgically extracted gallbladder with the diagnosis of acute cholecystitis was also the significant predictor for complications and conversion (OR 1.82, 95% CI 2.52-16.66, P< 0.001). Conclusion: the laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay.

Elastoplasty: A New Technique for Treatment of steoporotic Vertebral Compression Fractures

Objective: Vertebral compression fractures (VCF) cause significant disability and pain and are usually treated by vertebroplasty using polymethylmethacrylate (PMMA), which has several drawbacks, including fractures and exothermic neural damage associated to lea-kage. VK100 silicone is a new polymer for vertebroplasty to resolve these disadvantages. Material and Methods: This study follows the evolution of seventy patients with VCF who received a VK100 elastoplasty. The period of follow up was a year average. Results: Four patients had asymptomatic silicone leakage, none had neural damage and, at the end of follow up, there had been no adjacent fractures. Patients reported less pain. Conclusion: We conclude VK100 is a good option for vertebroplasty to treat osteoporotic spinal compression fractures.

MODIFIED KSHARSUTRA TECHNIQUE IN COMPLEX FISTULA IN ANO - A CASE STUDY

Fistula in ano is an anorectal disorder in which two openings are present. One is located near perianal re-gion and another is at anal canol or rectum. Fistula in ano is itself a challenging disease for patients because of mortality is not associated but daily routine life of patients become crushed. Ayurveda also said about Bhagandar (fistula in ano) that it is Kashta Shadhya Vyadhi i.e. difficult to treat because its take time and recurrence rate is also associated. But Ayurveda has described the Kshar sutra therapy for the treatment of fistula in ano which have high success rate, but time taken. With time, revolution has also come in Ayurve-dic treatment modalities for anorectal fistulas. A modified Ksharsutra technique is new technique for treatment of complex fistula in ano. The name of this technique is interception of fistulous tract and appli-cation of Ksharsutra (IFTAK). This technique has high success rate with minimal complication, early re-covery and there is no recurrence is associated. Cosmetically, this technique is good.

Calcific Plaque Modification by Acoustic Shock Waves: Intravascular Lithotripsy in Coronary Interventions.

Constituting a significant proportion of lesions treated with transcatheter interventions in the coronary arteries, moderate-to-severe calcification portends lower procedural success rates, increased periprocedural major adverse events, and unfavorable long-term clinical outcomes compared with noncalcific plaques. Adapted from the lithotripsy technology for treatment of nephrolithiasis, intravascular lithotripsy is a new technique for treatment of severely calcific lesions that uses acoustic shock waves in a balloon-based system to induce fracture in the calcium deposits to facilitate luminal gain and stent expansion. Herein, we summarize the physics and characteristics of the currently available intravascular lithotripsy system (Shockwave Medical, Santa Clara, CA), the clinical data on intravascular lithotripsy use in the coronary arteries, and future directions for adoption of the technique in percutaneous coronary intervention.

Résultats du traitement des fractures-luxation interphalangiennes avec plaque console palmaire munie de crochets

IntroductionProximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. HypothesisVolar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. MethodsIn this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. ResultsAfter three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5 %) patients was 85.7±13.2 degree which was not significantly different from opposite side on other hand (p=0.1). In two patients range of motion was 65.5±5.4 degree and painful. Postoperative pain in 19 patients was 2.5±0.8 so that there was no pain in 17(76.2 %) patients, three (14.1 %) patients had mild pain and two (9.5 %) patients had moderate pain (5.4±1.2). Two patients complained of plate irritation of especially at end of proximal interphalangeal flexion. ConclusionClinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. Level of evidenceIV, Therapeutic study.

Catalytic Ozonation of Dairy Farming Wastewater Using a Mn–Fe–Ce/γ-Al2O3 Ternary Catalyst: Performance, Generation, and Quenching of Hydroxyl Radicals

Effluent from a cow breeding base was remediated via a catalytic ozonation process that used Mn–Fe–Ce/γ-Al2O3 as the catalyst, which was prepared by the impregnation roasting method. The catalyst was found to significantly influence the treatment effects for hydroxyl radical generation. HO• generation was qualitatively and quantitatively investigated using 5,5-dimethyl-1-pyrroline-n-oxide (DMPO) reagent, electron paramagnetic resonance (EPR), and coumarin fluorescence techniques, and scanning electron microscopy–energy-dispersive X-ray spectroscopy (SEM–EDX), Brunauer–Emmett–Teller (BET) method, X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS) tests were performed to illustrate the structure and physical chemistry properties of the catalyst. The results showed that the modified Mn–Fe–Ce/γ-Al2O3 ternary catalyst has excellent catalytic performance and that the introduction of Mn, Fe, and Ce promotes the formation of abundant oxygen defects on the catalyst surface, which is assumed to be responsible for HO• generation. The conversion of Ce(III)/Ce(IV) and electron transfer/ejection due to the substitution of Ce(III)/Ce(IV) for Mn(II)/Fe(II)/Fe(III) were considered the fundamental intrinsic reasons underlying oxygen defect formation. In addition, the conditions for HO• quenching in the system were studied with the reaction time and catalyst dosage as parameters. The results supply a new technique for treatment of dairy farming wastewater and offer guidance for understanding the reaction mechanism of ternary supporting transition-metal catalysts.

A new approach for treatment of congenital melanocytic nevi with hypertrichosis: the Depilendolaser technique

Congenital melanocytic nevi (CMN) are proliferations of cutaneous melanocytes which are present at birth or may develop during the first postnatal weeks. In 50% of the cases, hypertrichosis is also present. Lasers as CO2, normal mode ruby, Q-switched ruby, Q-switched alexandrite (755 nm) and Qswitched neodymium:yttrium-aluminium-garnet (Nd:YAG) 532 and 1064 nm can be used for the treatment of some CMN. There is a new technique of treatment for the congenital melanocytic nevi with hypertrichosis with a good improvement on reducing pigmentation and hypertrichosis. The authors describe their experience with a new laser technique for the depigmentation and the epilation of CMN with hypertrichosis: the Depilendolaser (Depigmentation Epilation, Endolaser) technique. In this procedure, CMN were treated with a subcutaneous approach by a LBO diode-pumped laser Quanta D - Quanta System S.p.A., Italy (wavelength = 532 nm) and with a cutaneous approach by Versapulse Select Lumenis® (wavelength = 532 nm). Histology was performed on CMN tissue samples. Over a 2-year period, 25 subjects were treated using Quanta D ® (wavelength = 532 nm) power 8 W, frequency 4.9 Hz and 0.48 J/60 ms pulse, through a 300-μm fibre optic for treatment from underneath the derma to the surface, and using the frequency-doubled Q-switched Nd:YAG laser (wavelength = 532 nm) Versapulse Select (Lumenis Ltd.,Yokneam, Israel) QS 532 nm, round spot size of 3 mm in diameter, fluence 2 J/cm2, energy 0.20 J/10 ms pulse and frequency 10 Hz, for the treatment from the surface to the depths. The Depilendolaser technique resulted to produce greater hair loss in the treated area with significant depigmentation and a relevant aesthetic improvement. Histopathological examination of the lesions after treatment, in comparison with non-treated areas of the same gigantic nevi, shows loss of pigmented melanocytic nests and hair follicles—often numerous and normotrophic in these congenital nevi—disappear after treatment with the new laser technique. The authors describe a new laser technique for depigmentation and epilation and their experience in the treatment of CMN with hypertrichosis. Data collected in this study showed first of all an extreme safety and tolerability of the procedure in children and young patients, with no adverse effects such as skin atrophy, pathological scarring and aesthetic improvement. Level of evidence: Level I, therapeutic; risk/prognostic study.

Results of fracture-dislocation of interphalangeal treatment with volar buttressing hook plating techniques

IntroductionProximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. HypothesisVolar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. MethodsIn this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. ResultsAfter three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5%) patients was 85.7±13.2 degree which was not significantly different from opposite side on other hand (p=0.1). In two patients range of motion was 65.5±5.4 degree and painful. Postoperative pain in 19 patients was 2.5±0.8 so that there was no pain in 17(76.2%) patients, three (14.1%) patients had mild pain and two (9.5%) patients had moderate pain (5.4±1.2). Two patients complained of plate irritation of especially at end of proximal intrphalangeal flexion. ConclusionClinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. Level of EvidenceIV, Therapeutic study.

Promising new technique for treatment of hemorrhoids- Our experience

Background: Stapled Hemorrhoidopexy (SH) is a new technique with less pain than conventional hemorrhoidectomy and can be used in the management of second, third and fourth degree hemorrhoidal disease.&#x0D; Objective: To show the effectiveness of Stapled Hemorrhoidopexy as a treatment option of symptomatic hemorrhoid.&#x0D; Methods: This is an observational study. The medical records of 72 patients who had under gone Stapled Hemorrhoidopexy for symptomatic hemorrhoid disease from July 2011 to June 2013 in BIRDEM General Hospital under a same surgeon were evaluated. Data regarding postoperative pain, early and late postoperative outcome were recorded. Patient's satisfaction assessed at 18 months follow up.&#x0D; Results: The study included 72 patients (50 men, 22 women) between 22 - 74 years of age (median age 39 years). The operating time was around 35 minutes. The median hospital stay was 40 hours (11- 72 hours). Early complications were fecal urgency (13.8%), urinary retention (22%), and rectal bleeding (2.77%). Late complication was pruritus ani (12.5%), thrombosis external hemorrhoids (1.38%), staple line stenosis (1.38%), recurrent hemorrhoid (2.77%), anal fissure (2.77%), and persistent mucous discharge (5.55%). The recurrence rate was 2.77% at 18 months follow up.&#x0D; Conclusion: Stapled hemorrhoidopexy can be safely performed with low recurrence and complication rates while offering a relatively painless postoperative period for the patient.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 65-69

Tissue Coagulation in Laser Hemorrhoidoplasty - An Experimental Study.

BackgroundLaser hemorrhoidoplasty (LHP) is a new technique for treatment of hemorrhoids. The exact extent of coagulation is not visible at the time of the procedure. There currently is no experimental or clinical data on the subject.ObjectiveTo evaluate the length of coagulation defect according to power and activation time of 1470nm diode laser on the perianal tissue model.MethodsFresh anorectal tissue of twenty-four pigs was used to produce 54 experimental samples. Each sample was randomly assigned to the laser power of 6, 8 and 10 W and 1, 2 or 3-second pulses. The procedure was performed using Biolitec Ceralas © diode laser with 1.85 mm optical fiber. The fiber was inserted in a manner, similar to intrahemorrhoidal laser application. Samples were evaluated using low-power and high-power light microscopy by a single pathologist. The length of tissue injury was measured on high-magnification microscopy.ResultsThe longest tissue injury (mean 3.93 mm) was caused by the longest laser exposure time (3 sec) with no significant difference between laser power used.Conclusions8 W 3-second application of the 1470nm diode laser results in coagulation area approximately 4 mm, and further coagulation should be initiated approximately 5 mm from the first one.