Partial Incision Research Articles

Partial incision blunt scissors lamellar keratectomy under topical anesthesia for the treatment of presumed calcific corneal degeneration in dogs.

The aim of the study was to investigate clinical features of lamellar keratectomy for presumed calcific corneal degeneration in a population of geriatric dogs using blunt scissors dissection under topical anesthesia. Retrospective analysis of dogs with clinically diagnosed calcific degeneration treated by keratectomy under topical anesthesia between 2015 and 2021 at two veterinary ophthalmology practices was performed. Descriptive data regarding signalment, concurrent systemic and ocular disease, complications, healing time, and recurrence were collected. Kaplan-Meier survival analysis was performed to calculate 1-year recurrence probability. Sixty-five eyes in 57 dogs met inclusion criteria. All 54 eyes with follow-up healed within a median of 14 days (7-74), including 17 with complicating factors of infection or deep stromal ulceration. Globe rupture occurred intraoperatively in three eyes (4.6%), for which subsequent conjunctival graft was performed. Calculated 1-year recurrence probability from 47 eyes followed long term was 25%. Multivariate Cox proportional hazard modeling showed a significant association between documented systemic disease and time to recurrence (p = .035), irrespective of topical EDTA use (p = .432). Median follow-up time available for all cases was 249 days. Blunt lamellar dissection with corneal scissors can be performed in dogs under topical anesthesia, yielding healing times and recurrence comparable to previously reported treatments for calcific corneal degeneration. Globe rupture is an inherent risk of both the disease and procedure and occurred in 4.6% of treated eyes. This approach expands non-anesthetic treatment options for affected patients but should only be performed with advanced microsurgical training and client counseling on individual risk and benefit.

Overcoming seed coat–imposed dormancy in wild species ofCajanusandRhynchosia

AbstractOccurrence of physical dormancy or hard seed coat prevents proper utilization and conservation of wild species ofCajanusandRhynchosia, which offers a source of many useful traits. Hence, an attempt has been made to understand the variability in hardseededness and the pretreatments (hot air treatment for 3, 5, 7, and 14 days; hot air treatment for 30 and 60 min; sulfuric acid scarification for 2 and 5 min; partial incision on seed coat) to overcome it in 44 accessions of 10 wild pigeon pea species. The level of hardseededness varied from 36% to 100% with an average of 76.5%. Likewise, time to 1% germination or time taken to initiate germination (T1), time to 50% germination (T50), and mean germination time (MGT) varied between 16.18–249.9 h, 94.7–607.7 h, and 37.5–153.2 h, respectively. Overall, all the treatments reduced hardseededness and improved germination over the control, with partial incision on seed coat being the best treatment for all the species recording 70%–98% germination, except forRhynchosia aurea(30%) andCajanus cajanifolius(59%). The hot water treatment for 30 and 60 min was the best treatment forC. cajanifoliusrecording germination of 66%–70% as compared to 11% in control. The sulfuric acid scarification for 2 min was the best pretreatment for overcoming dormancy and improving germination inRhynchosia bracteata,Rhynchosia rothii, andRhynchosia rufescens. The result indicated a significant inter‐ and intraspecific variation in the effectiveness of pretreatments in overcoming physical dormancy, suggesting that the optimum pretreatment for overcoming hardseededness should be standardized for each accession. Also, the dormancy‐breaking pretreatments not only reduced hardseededness and improved final germination percent but it also reduced time for T1, T50, and MGT, suggesting that use of such pretreatments before sowing could result into higher, uniform, and rapid germination.

Mixed-Thickness Tunnel Access (MiTT) through a Linear Vertical Mucosal Incision for a Minimally Invasive Approach for Root Coverage Procedures in Anterior and Posterior Sites: Technical Description and Case Series with 1-Year Follow-Up.

The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1-2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum-enamel junction (CEJ). Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery.

BACKGROUNDThe transanal opening of intersphincteric space (TROPIS) procedure, performed to treat complex anal fistulas, preserves the external anal sphincter (EAS) but involves partial incision of the internal anal sphincter (IAS). AIMTo ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises (KE) in the postoperative period can prevent incontinence due to IAS division. METHODSPatients operated on for high complex fistulas and having no preoperative continence problem (score = 0) were included in the study. All patients were operated on by the TROPIS procedure and were recommended KE (pelvic contraction exercises) 50 times/day. KE were commenced on the 10th postoperative day and continued for 1 year. Incontinence was evaluated objectively (by modified Vaizey’s scores) in the immediate postoperative period (Pre-KE group) and on long-term follow-up (Post-KE group). The incontinence scores in both groups were compared to evaluate the efficacy of KE. RESULTSOf 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study. There were 90 males, the mean age was 42.3 ± 12.8, and the median follow-up was 30 mo (18-42 mo). Three patients were lost to follow-up. There were 65 recurrent fistulas, 92 had multiple tracts, 42 had associated abscess, 46 had horseshoe fistula and 34 were supralevator fistulas. All were magnetic resonance imaging-documented high fistulas (> 1/3 EAS involved). Overall incontinence occurred in 31% patients (Pre-KE group) with urge and gas incontinence accounting for the majority of cases (28.3%). The mean incontinence scores in the Pre-KE group were 1.19 ± 1.96 (in 31 patients, solid = 0, liquid = 7, gas = 8, urge = 24) and in the Post-KE group were 0.26 ± 0.77 (in 13 patients, solid = 0, liquid = 2, gas = 3, urge = 10) (P = 0.00001, t-test).CONCLUSIONDivision of the IAS led to incontinence, mainly urge incontinence, and also to a mild degree of gas and liquid incontinence. However, regular KE led to a significant reduction in incontinence (both in the number of affected patients and the severity of scores in these patients).

V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE?

You have accessJournal of UrologyCME1 May 2022V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE? Consuelo Conde Redondo, Alejandro García Viña, María Núñez, Ana Ruano Mayo, Álvaro Zamora Horcajada, Fernando Natal Rodriguez, and Luis Cuellar Martín Consuelo Conde RedondoConsuelo Conde Redondo More articles by this author , Alejandro García ViñaAlejandro García Viña More articles by this author , María NúñezMaría Núñez More articles by this author , Ana Ruano MayoAna Ruano Mayo More articles by this author , Álvaro Zamora HorcajadaÁlvaro Zamora Horcajada More articles by this author , Fernando Natal RodriguezFernando Natal Rodriguez More articles by this author , and Luis Cuellar MartínLuis Cuellar Martín More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) is a relatively common progressive fibrotic disorder that affects the tunica albuginea. Traditionally, men will present with a new penile curvature, which may be associated with pain in the acute phase. Prevalence is 0.4–20%, increasing in cases of diabetes mellitus. The treatment must be carried out when the plate is stabilized. METHODS: In this video we present a review of the different therapeutic approaches to Peyronie's disease. RESULTS: Non-surgical treatment. Non-surgical therapies include the penile extender, The reduction in curvature was enhanced when increasing the usage time. Greater than 6 hours ’use daily resulted in a 36.2 ° reduction compared to baseline (51.4%), whilst less than 4 hours produced a 19.7 ° improvement (28.8%). Intraplaque therapy with clostridium histoliticum collagenase which is used to dissolve the plaques. The therapy is based on four cycles with two injections per cycle. Under local anesthesia we perform an erection and a controlled fracture of the plaque. Treatment with xiapex has a cost of eight times the treatment of simple plication, the use of 6 to 7 months of treatment of 8 vials and 14 consultations, the success rate is 34 to 40%. Treatment of Peyronie's disease with bovine pericardium. Corporoplasty with a bovine pericardium graft with a total or partial incision of the plaque is a technique that shortens the surgical time by avoiding obtaining autologous tissue. The published success rate is 41-93% with a satisfaction rate close to 100% if a residual curvature rate of less than 10% is obtained. Treatment of Peyronie's disease with tachosil patch. The advancement of the surgery leads us to look for alternatives that are easy to perform and that shorten surgical times, the total or partial incision of the peyronie plate plus tachosil graft leads us to obtain surgical results with a success rate of 83.8%. Tachosil is a sealing fibrin patch that is placed over the wound made, then covered with a compress moistened with warm saline for three minutes. Treatment of Peyronie's disease with Vivostat. Activated autologous fibrin is also being used as a sealant. During anesthetic induction, 120 ml of blood from the patient is obtained to which citrate is added, subsequently it is put for 25 minutes in the processor unit and a solution of 5 to 6 ml of autologous fibrin is obtained ready for use. We make some transverse incisions in the plate without having to resect it, later with the help of the vivostat applicator we fill the incisions made with the autologous fibrin solution we have obtained. Regardless of the surgical technique used, all patients should undergo penile rehabilitation with the help of vacuum device or an extender, to avoid shrinkage and shortening. CONCLUSIONS: There is no single approach to peyronie disease, it depends on the surgical skills of the surgeon and the involvement of the patient to achieve success Source of Funding: anyone © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e968 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Consuelo Conde Redondo More articles by this author Alejandro García Viña More articles by this author María Núñez More articles by this author Ana Ruano Mayo More articles by this author Álvaro Zamora Horcajada More articles by this author Fernando Natal Rodriguez More articles by this author Luis Cuellar Martín More articles by this author Expand All Advertisement PDF DownloadLoading ...

Endoscopic management of spontaneous esophageal and postoperative motility disorders

Considerable progress has been made in therapeutic endoscopy over recent years and new techniques now offer access to a new space, the submucosal space, thus paving the way for new therapeutic perspectives, in particular, for functional endoscopy. The first of these applications, POEM (Per-oral endoscopic myotomy), has become, since the beginning of the 2010's, an endoscopic alternative to Heller myotomy for the treatment of achalasia. The results of this technique have been fully documented, and the technique has replaced pneumatic dilatation and become the standard treatment for this indication with equivalent effectiveness compared to traditional surgery, but with less morbidity. Indeed, the overall efficacy is around 90%, results are stable over time, and severe morbidity is less than 1%. Later, other motility disorders, such as spastic disorders, have been treated, certainly with less impressive outcomes than for achalasia, but still, of interest. This approach has also been applied to post-fundoplication motility disorders, whose de novo prevalence can be as high as 20%, and for which management is complex; this represents another new non-surgical perspective. The POEM procedure for this indication, in addition to myotomy, allows performance of a partial incision of the wrap with substantial symptomatic relief. In conclusion, the technique seems to have a bright future as it is progressively applied to more and more motility disorders.

Characterization of failure of single carbon nanotube fibers under extreme transverse loading

Carbon nanotube (CNT) fibers have been extensively investigated along the longitudinal direction and are well-known for their high axial tensile strength and modulus. However, after being manufactured into textiles or composites, these fibers are usually subjected to transverse loading during their normal service life. Deformation and failure of CNT fibers induced by external loads in the transverse direction lack examination. This study integrated single-fiber quasi-static and dynamic transverse loading techniques with scanning electron microscopy (SEM) and high-speed imaging, respectively. An extreme condition was considered as the indenter was a sharp razor blade. Failure behavior of single CNT fibers transversely loaded by the blade at different velocities was visualized, and axial mechanical response of these fibers was measured. The fracture surface of CNT fibers was examined by SEM. Additional experimental investigations were performed on commercialized two organic (aramid and ultrahigh molecular weight polyethylene) and two inorganic (ceramic and glass) fibers. It is revealed that CNT fibers experienced initial contact with the blade, followed by partial incision, and ultimately tensile failure. Furthermore, the energy dissipation and dispersion capabilities of CNT fibers per unit mass were demonstrated to surpass that of commercialized high-performance fibers during extreme transverse loading. As the loading rate increased, the energy dissipation of CNT fibers was further improved by 2.1 times. Such high performance of CNT fibers in resisting extreme transverse loading was presumably attributed to the high hardness, strength, and stiffness of CNTs in the transverse direction and weak intermolecular interactions in the axial direction. This study expands material characterization of CNT fibers in the transverse direction and reveals the fundamental failure mechanism of CNT fibers in the harsh environment, which is deemed useful to develop the fiber-scale model for textiles and composites.

Accuracy and safety of partial thickness femtosecond laser radial and arcuate keratotomy incisions in porcine eyes

BackgroundTo evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.MethodsPartial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth, quality, and consistency. Optical coherence tomography was used to determine the accuracy and precision of incision depth. Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss. Quality was evaluated by ease of opening and examination of interfaces.ResultsIn two micro radial incision groups, intended incision depths of 50% and 80% resulted in mean achieved depths of 50.01% and 77.69%, respectively. In three arcuate incision groups, intended incision depths of 80%, 600 μm or 100 μm residual uncut bed thickness resulted in mean achieved depths of 80.16%, 603.03 μm and residual bed of 115 μm, respectively. No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85–116 µm. The incisions were easy to open, and interfaces were smooth.ConclusionsA femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions. Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.

How to Perform a High-Quality Endoscopic Submucosal Dissection

How to Perform a High-Quality Endoscopic Submucosal Dissection

Diagnosis and surgical treatment of symptomatic lumbar spinal epidural liposis

To explore diagnosis and surgical treatment of symptomatic lumbar spinal epidural lipoplasia. A retrospective analysis of 19 patients with symptomatic lumbar spinal epidural hyperplasia treated with hemilaminectomy and interbody fusion and internal fixation from February 2012 to November 2018 were performed, including 7 males and 12 females, aged from 48 to 72 years old with an average of (57.6±1.2) years old;the course of disease ranged from 6 to 60 months with an average of (18.6±5.1) months;plane requiring decompression:L2, 3-L5S1 on 4 cases, L2, 3-L4, 5 on 5 cases, L3, 4-L4, 5 on 2 cases, L3, 4-L5S1 on 6 cases, L4, 5-L5S1 on 2 cases. Visual analogue scale (VAS) before operation and 6 months after opertaionwere used to evaluate relief of leg pain and back pain, Oswestry Disability Index (ODI) was used to evaluate recovery of functiona, and Fischgrund was used to assess overall efficacy. All patients were followed up from 12 to 37 months with an average of (16.3±3.8) months. Ninteen patients were successfully completed operation, and all adipose tissues in the compressed segment of the spinal canal were removed. Operation time was from 125 to 260 min with an average of (186± 15) min, and blood bleeding was from 150 to 500 ml with an average of (280±46) ml. Two patients occurred partial incision fat liquefaction and exudate did not heal, the incision was opened to remove effusion, the dressing was changed and anti-inflammatory treatments were performed. No complications such as cauda equina injury, cerebrospinal fluid leakage, and broken nails occurred. Preopertaive VAS of back pain and leg pain were 5.3±0.7 and 6.8±0.8, respectively, while 2.1±0.4 and 2.3±0.5 respectively at 6 months after opertaion, there were statisticalsignificant difference between 6 months after operation and before operation (P<0.05). Postoperative ODI score at 6 months was 12.1±2.3, and significantly improved than that of before operation 45.5±2.8 (P<0.05). According to Fischgrund criteria, 13 patients got excellent result, 4 good, and 2 fair. Patients with symptomatic lumbar spinal epidural lipoplasia undergo hemilaminectomy and internal fixation of compression segment could relieve compression of dura mater and cauda equina, and achieve good clinical results.

1, N 6 ‐Ethenoadenosine, a Damaged Ribonucleotide in DNA: Impact on Translesion Synthesis and Repair

Ribonucleotides in DNA are poorly understood as instigators of DNA damage. In DNA, they can promote genomic instability by causing mutations and are also linked to several diseases. We investigated the impact of ribonucleotide rATP and its damaged analog 1,N6-ethenoadenosine (1,N6-εrA) on hpol η-mediated translesion synthesis (TLS) and RNase H2-mediated repair. Mass spectral analysis showed that 1,N6-εrA in DNA generates extensive frameshifts during TLS, which can lead to genomic instability. In addition to this, insertion of deoxypurines (dATP and dGTP) was dominantly seen opposite 1,N6-εrA in steady-state kinetic analysis for the TLS process. The repair studies revealed that RNase H2 recognizes but exhibits partial incision activity across from 1,N6-εrA in DNA, which can lead to the persistence of this adduct into DNA. Our findings identify the mutagenic potential of an unrepaired damaged ribonucleotide 1,N6-εrA in DNA, which can change the reading frame of mRNA.

Parotitis caused by Mycobacteroides abscessus subspecies abscessus

Rapidly growing mycobacteria rarely causes parotitis. We report a rare case of Mycobacteroides abscessus subspecies abscessus (MAB) parotitis in a previously healthy 26-year-old woman. She presented to the previous hospital with a swelling over the right parotid region, and a computed tomography scan revealed multiple abscesses in the swollen parotid gland. Histopathology showed granulomatous inflammation with acid-fast bacilli; however, a subsequent culture failed to isolate mycobacterium. Despite repeated antibiotic therapy and multiple surgical interventions including partial incision and drainage of the abscesses, the parotitis did not resolved. At six months after presentation, she was referred to our institute. We performed enlarged resection of the necrotic tissue and abscesses, and the sample cultivated after homogenization was positive for mycobacterium. The isolate was finally identified as MAB. She underwent long-term postoperative antibiotic therapy for MAB, with a favorable outcome. To the best of our knowledge, this is the first case of MAB parotitis where the subspecies has been identified. MAB is much more intractable than the other subspecies. We highlight the importance of the correct identification of MAB, which leads to the appropriate treatment.

Total resection of a giant retroperitoneal and mediastinal ganglioneuroma\u2014case report and systematic review of the literature

BackgroundGanglioneuromas (GNs) are extremely rare, slowly growing, benign tumors that can arise from Schwann cells, ganglion cells, and neuronal or fibrous tissues. Due to their origin from the sympathetic neural crest, they show neuroendocrine potential; however, most are reported to be hormonally inactive. Nevertheless, complete surgical removal is recommended for symptom control or for the prevention of potential malignant degeneration.Case ReportA 30-year-old female was referred to our oncologic center due to a giant retroperitoneal and mediastinal mass detected in computed tomography (CT) scans. The initial symptoms were transient nausea, diarrhea, and crampy abdominal pain. There was a positive family history including 5 first- and second-degree relatives. Presurgical biopsy revealed a benign ganglioneuroma. Total resection (TR) of a 35 × 25 × 25 cm, 2550-g tumor was obtained successfully via laparotomy combined with thoracotomy and partial incision of the diaphragm. Histopathological analysis confirmed the diagnosis. Surgically challenging aspects were the bilateral tumor invasion from the retroperitoneum into the mediastinum through the aortic hiatus with the need of a bilateral 2-cavity procedure, as well as the tumor-related displacement of the abdominal aorta, the mesenteric vessels, and the inferior vena cava. Due to their anatomic course through the tumor mass, the lumbar aortic vessels needed to be partially resected. Postoperative functioning was excellent without any sign of neurologic deficit.ConclusionHere, we present the largest case of a TR of a GN with retroperitoneal and mediastinal expansion. On review of the literature, this is the largest reported GN resected and was performed safely. Additionally, we present the first systematic literature review for large GN (> 10 cm) as well as for resected tumors growing from the abdominal cavity into the thoracic cavity.

"Point line anterograde dissection" for the safe preparation of supraclavicular flap

Objective: To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ". Methods: A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded. Results: The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Conclusion: PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

A Six-Year Review of the Latest Oculoplastic Surgical Development.

The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty. Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years. A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018). After screening 1456 abstracts from search results, 1377 were eliminated due to irrelevant content. Full text of the remaining 79 articles and relevant cross-references were reviewed and summarized. Studies on cosmetic epicanthoplasty reported Z-plasty or modifications (n=8), advancement flap (n=4) or skin redraping procedures (n=1), removal or release of the orbicularis muscle (n = 14), with (n = 6) or without (n = 11) tightening medial canthal tendon. In lateral canthoplasty, approaches to preserve continuity of eyelid margin prevent lateral canthal deformity with inconspicuous incision via gray line (n = 2) or upper eyelid (n = 2) were described. Techniques of upper blepharoplasties described included open incision method (n = 9) with (n = 5) or without (n = 3) orbicularis resection, subbrow approach (n = 1), nonincisional suture blepharoplasty (n = 2), or partial incision blepharoplasty (n = 1). For lower blepharoplasties, techniques described included blepharoplasty with fat transposition (n = 7), transconjunctival blepharoplasty (n = 3), transcutaneous blepharoplasty and canthopexy (n = 1) or orbicularis flap (n = 2), minimally invasive or laser-assisted blepharoplasty (n = 2). The recent trend of periocular surgical rejuvenation focuses on preserving soft tissue volume, avoiding skin or use hidden incision, taking the eyebrow and midface position into account, and measures to minimize iatrogenic eyelid malposition.

Modified double-eyelid blepharoplasty with the combined partial- And minimal-incision method.

Double-eyelid surgery remains a popular esthetic surgery in East Asian people. The partial-incision method provides the benefits of full-incision and nonincision techniques. It can create a predictable and durable double-eyelid crease. To create a long-lasting double-eyelid crease with a minimal scar, the author has described the modified partial incision technique with a small and minimal incision. A preoperative design was developed with the patient in an upright sitting position. A partial incision was made between the medial limbus and the middle pupillary line; the minimal incision was made just adjacent to the lateral limbus. After local anesthesia, a strip of orbicularis oculi below the incision was dissected, and the pretarsal orbicularis oculi, anterior tarsal fascia and part of the anterior tarsal fat were removed. The skin, dermis and orbicularis oculi were sutured together with the pretarsal fascia. From July 2016 to September 2018, 138 patients received a modified partial-incision double-eyelid surgery. A total of 119 patients were followed up. The postoperative shape and height were stable. Five patients developed loss of the unilateral fold (2.17%), and one patient complained of bilateral narrow eyelid folds (0.87%). No serious complications were noted. The modified partial-incision technique for creating a double eyelid described here provides stable results with no visible scar and no serious complications.

Treatment of ulnar coronoid process fracture via a modified anteromedial approach

To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

Laparoscopic paracaval adenoma

Presenter: Paola Tarchi University Hospital of Trieste Background: A 29 years old lady underwent an abdominal ultrasound for an aspecific pain and an incidental paracaval liver lesion was found. Subsequent contrast-enhanced US and MRI were strongly suggestive for a liver adenoma. The MRI with Primovist showed a 3.3 x 3.2 cm adenoma in S9 with interesting proximity both to the confluence of a big inferior right hepatic vein into the IVC and to the posterior aspect of the right portal pedicle. The patient did not have a surgical indication but the clinical scenario was complicated by the strong desire of the patient to get pregnant. The management of liver adenomas smaller than 5 cm during pregnancy is not clear in the Literature, as some Authors suggest only active surveillance. Our decision was to perform a laparoscopic resection of the adenoma with the aim to avoid its risk of rupture due to increased hormone-induced growth during pregnancy. Methods: Patient was placed in a standard French position and 5-operative 12 mm trocars were placed in the abdomen, resembling a reverse J shaped letter. The extracorporeal Pringle manouvre was prepared by encircling the hepatic pedicle with an umbilical tape, extracted through a chest tube from the left flank. Mobilization of the right hemiliver is crucial for the exposure of the operative field and for this purpose the falciform, posterior coronary and right triangular ligaments were interrupted. The right lobe was lifted up through the partial incision of the lower aspect of the hepatocaval ligament with a caudal approach and following the IVC axis. The parenchymal transaction was performed using a combination of an ultrasonic dissector and an energy device. Results: The transaction line followed the margin of the pseudocapsule of the adenoma, from left to right. Bloodless transaction was allowed thanks to the hypovolemic state managed by keeping the stroke volume variation between 15 and 20%. Conclusion: The final histopathology showed a hepatocellular adenoma of steatotic type with focal dysplastic hepatocytes, in the context of a microvescicular steatosis.

Photodynamic Therapy with Phthalomethyl D: Perspectives against SARS-CoV-2

Background: Photodynamic therapy (PDT) is the generation of cytotoxic agents through the dynamic interaction between a photosensitizer excited by light at a specific wavelength. When associated with phthalocyanines, they are efficient in incorporating target cells and exhibiting high rates of triplet generation. This study aimed to characterize PDT associated with the phototherapeutic agent Phthalomethyl D, developed by the authors, in the process of repair, healing and immune improvement for possible application against SARS-CoV-2. Methods: Sixty-nine mice were used, divided into 2 groups: GI, treated with ILIB laser, without a phototherapeutic agent, and subjected to surgery for viral induction; GII, same as GI plus association of Phthalomethyl D. They were divided into subgroups and reevaluated at 7, 14, and 21 days, and then divided into 3 subgroups of 6 animals each, subjected to treatment at 24 h, 48 h, 72 h, 5 and 7 days. Results: Both groups had a high rate of partial incision closure and acute inflammatory control. Microscopically, there was a greater amount of amorphous fundamental substance, fibrocytes, fibroblasts, and giant cells and reduction in the number of keratinocytes, in the amount of keratin, and epidermal thickness in GII than in GI. Conclusions: PDT with Phthalomethyl D stimulates the processes of healing/repair and immunomodulation during viral infection, initially favoring the inflammatory response and, after 21 days, contributing to the anti-inflammatory response profile, making this approach possible in the treatment of individuals infected with SARS-CoV-2.