String Technique Research Articles

Thoracoscopic purse string technique for minimally invasive Ivor Lewis esophagectomy.

Thoracolaparoscopic esophagectomy with chest anastomosis (TLE-chest) is increasingly performed for middle and lower esophageal cancer; however, gastroesophageal anastomosis for this surgery remains both challenging and inefficient. To address this issue, we previously reported our MIE technique with Ivor-Lewis anastomosis. Here we present the video to introduce our TLE-chest operation procedures. TLE-chest with a combined thoracoscopic and laparoscopic technique was performed by one group of surgeons. From October 2011 to September 2013, 80 esophageal cancer patients were treated with TLE-chest using this improved anastomotic technique. The surgery was successful for all patients, although the anastomosis in one patient required intraoperative manual repair. No patients required open conversion. In this video, dissociation of stomach, and dissection of lymph nodes, creation of gastric tube and staple line embedding, jejunostomy were carried out by laparoscopic surgery. Dissection of esophageal cancer and mediastinal lymph nodes were done through rib 3 or 4 by a 3-4 cm video-assisted right anterior minithoracotomy, then esophago-gastric anastomosis was performed in right thoracic cavity This video shows the R0 resection of T3N0M0 esophageal cancer. Totally, 36 lymph nodes were dissected, including 21 mediastinal lymph nodes and 15 abdominal lymph nodes. The patient recovered well and was discharged on day 8 after the surgery, with good short term outcomes. A safe, cost effective purse string stapled anastomotic technique has been presented for TLE-chest in our video. It is consistent with the oncology principles.

A comparison of two techniques for tungsten carbide ring removal

IntroductionEmergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the “umbilical tape” or “string technique” and, in the case of tungsten carbide, breaking the ring using locking pliers. ObjectiveWe sought to compare the speed and effectiveness of tungsten carbide ring removal using these two techniques. MethodsTen tungsten carbide rings were placed upon the finger of a standard medical simulation mannequin. The rings chosen were one-half size smaller than the mannequin's finger. Edema distal to the ring was simulated using foam tape. A single novice operator performed 10 trials using each of the techniques after a 10-minute orientation session. The success or failure of the technique and the time for removal were recorded for each trial. The mean removal times for the trials were compared using a paired t test. ResultsAll trials were successful. The rings were removed substantially faster using the locking pliers method (mean 23.1 seconds [95% CI 15.4-30.8] vs. mean 135.4 seconds [95% CI 130.2-150.6]). However, the locking pliers technique destroyed all rings and caused sharp ring fragments to be thrown up to 37 in. ConclusionsBoth the umbilical tape or string technique and the locking pliers technique successfully removed tungsten carbide rings in our model. The locking pliers technique is significantly faster but destroys the ring and creates potentially harmful shrapnel.

Ambulatory serial drainage of ascitis or pleural effusion by a multiperforated catheter port system.

e19500 Background: Symptomatic pleural effusion or recurrent ascitis effusions are frequent in end-stage malignancies, induce serial drainage and impair quality of live. Methods: We report our experience with a multiperforated 10 Fr silicone catheter totally implanted in pleural or peritoneal cavities, by Seldinger access, connected to a subcutaneous port system surgically implanted, with local anaesthesia. To avoid tumour seeding along the catheter , it is used a purse string technique to water-tight the entry point of catheter. Patient on demand serial drainage of serosal effusion by percutaneous access to the port can be performed in outpatient department. To reduce risk of device obstruction, we rinse with saline serum under pressure to generate a turbulent outflow to flush any deposit after drainage. Results: Between January 2008 and April 2010, 28 patients underwent implants of 12 peritoneal and 18 pleural (2 bilateral) implantable multiperforated catheter port systems with a prospective follow up. There were 10 men and 18 women with a mean age of 64 years (range: 39-84 years). Primary malignancies were breast (9), pancreas (4), ovarian (4), stomach (2), endometrial (2), kidney (2), skin melanoma (2), prostate (1), peritoneum (1), and lymphoma with cardiac insufficiency (1). Twenty-seven patients obtained partial or complete relief of their symptoms. The number of aspirations performed was between 2 and 25 over a period of 8 to 454 days for 2,560 days of catheter implantation. Eight patients died within 3 weeks after placement of the system and 6 survived more than 6 months. One case of pneumothorax has been diagnosed after early symptoms recurrence and successfully aspirated throw the port. One case of infection of pleural fluid had been detected by systematic bacteriological sampling without clinical manifestation. One case of port infection was du to a previous asymptomatic infection of ascitis with multiple fluid collections and requires port removal. No case of tumour seeding or port system obstruction was observed. Conclusions: This outpatient management palliative technique is an easy option with high rate of efficacy, safety and comfort to control symptoms induced by pleural or ascitis recurrent effusion.

Single-suture, linear closure modification of the purse string technique

Single-suture, linear closure modification of the purse string technique

Penile Incarceration Secondary to an S-shaped Lead Pipe: Removal With Dremel Moto-Tool

Background: Penile incarceration or strangulation is a urologic emergency. Objectives: Several techniques to remove metallic objects strangulating the penis are described in the literature. The method utilized depends on the severity of the incarceration and the tools that are readily accessible. Prompt action and resourcefulness, with expeditious removal, prevents organ ischemia and vascular or mechanical sequelae. Case Report: We describe a case in which a Dremel Moto-Tool was used to remove a lead pipe strangulating a penile shaft, after failure of the string technique. Conclusion: A hospital-based Emergency Medical Services and Rescue program is a valuable resource to provide the tools needed for management of penile strangulation. Features of safe removal, including protecting the tissues from heat damage and mechanical injury from the cutting blade, are described.

Fast and precise points-to analysis

Many software engineering applications require points-to analysis. These client applications range from optimizing compilers to integrated program development environments (IDEs) and from testing environments to reverse-engineering tools. Moreover, software engineering applications used in an edit-compile cycle need points-to analysis to be fast and precise. In this article, we present a new context- and flow-sensitive approach to points-to analysis where calling contexts are distinguished by the points-to sets analyzed for their call target expressions. Compared to other well-known context-sensitive techniques it is faster in practice, on average, twice as fast as the call string approach and by an order of magnitude faster than the object-sensitive technique. In fact, it shows to be only marginally slower than a context-insensitive baseline analysis. At the same time, it provides higher precision than the call string technique and is similar in precision to the object-sensitive technique. We confirm these statements with experiments using a number of abstract precision metrics and a concrete client application: escape analysis.

The multi–purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies

The maze procedure is the most effective surgical procedure for atrial fibrillation. In recent years, a number of different surgical ablation devices were introduced and gradually replaced the need for the procedure to be performed by using the cut-and-sew technique. In this article a new surgical approach is presented using a full maze IV lesion set, without atriotomies. Between January 2005 and June 2006, 12 patients underwent operations with the multi-purse string technique: 9 patients as a combined procedure with coronary artery bypass grafting, 2 patients as a combined procedure with aortic valve replacement, and 1 patient as a standalone procedure. In 5 additional patients, a small left atrial atriotomy was required to ensure the completeness of the mitral valve isthmus lesion. A combination of bipolar radiofrequency and cryothermal energies was used in all cases. All patients were part of our comprehensive follow-up and local atrial fibrillation registry. No perioperative morality, cerebrovascular accidents/transient ischemic attacks, or both were documented in this series. In a mean follow-up of 13 +/- 6 months, 1 late death was documented, and 91% of the patients are free from atrial fibrillation or flutter. Our experience suggests that the maze IV procedure can be performed without the need for atriotomies by using the multi-purse string approach. The intermediate results are promising, with high rates of success in ablating atrial fibrillation. Future studies should be performed to validate the safety of the use of bipolar radiofrequency devices endocardially on a beating heart.

Penile incarceration with metal objects--a review of procedure choice based on penile trauma grade.

To outline treatment guidelines according to level of penile trauma for penile incarceration by metal devices. A post-1950 (hand-held powered cutting tool era) Medline search was performed. Cases were divided into four groups: string techniques and variants with and without aspiration of blood from the glans; aspiration techniques; cutting devices; and surgical techniques. Trauma grade (according to Bhat et al., 1991), site time (incarceration time), removal technique, removal time, anesthesia and recovery time were assessed. The string technique and variants were used for grades 1-3. They had short removal (30-120 min), site (3-72 h) and recovery (1-24 h) times. Occasional glans decompressive with blood aspiration was required. Anesthesias included none (wrapping without glans aspiration), i.m. morphine and general (glans aspiration). Pure aspiration techniques used multiple needle punctures for grades 2-3. Aspiration cases had short site times (8-14 h), but required a spinal or general anesthesia. Cutting device cases (grades 1-5) required general anesthesia, had a short removal times (45-90 min), but long site (7 h-30 days) and recovery (2-66 days) times. Surgical degloving was utilized mainly for grade 5 cases, required spinal or general anesthesia, had short site (2-30 days), but long recovery (9-28 days). The string, wrapping, aspiration techniques and cutting devices are suited for grades 1-3. Cutting requires a shield to avoid blade trauma and water-cooling to prevent thermal injury. Suspected underlying devitalized tissue (e.g. grade 4) is examined by Wood's lamp. Failure to identify gangrenous tissue will result in post interventional complications and a prolonged recovery time.

Questions and Answers: Research Related to the Teaching of String Technique

The purpose of this study was to review research studies in the area of string technique and pedagogy. Nearly 50 research reports were reviewed and categorized into those concerned with predictions of success in a string program, class organization, and the development of right- and left-hand position. Results of various studies were reported and implications for teaching were discussed.

Surgical Pearl: Purse string suture in the management of poorly delineated melanomas

The purse string suture technique has received little attention in the surgical literature. Its application in dermatologic surgery has been mainly to reduce the size of a surgical defect to allow placement of a smaller, full-thickness skin graft.1-4 We have found the purse string suture to be effective in the management of poorly demarcated melanoma. We have used the purse string technique in 10 patients with biopsy-confirmed melanoma. For most of them, the clinical margin of the neoplasm was poorly defined. All underwent excision of the clinically detectable lesion, using recommended guidelines of 5 mm for in situ melanoma, 1 cm for invasive melanoma with Breslow's depth less than 1 mm, and 2 cm for intermediate-thickness melanomas.5,6 The oval surgical defects were then managed with an intradermal circumferential purse string suture, with 3-0 or 4-0 nonabsorbable polypropylene.4 The purse string was tied, thereby either reducing the size of or in some cases completely closing the defect. The pathology reports were received in 48 to 72 hours. If a positive margin was present, the patient returned for additional surgery. The original oval defect was re-created after the removal of the purse string suture. This greatly facilitated a more precise measurement for additional margins and excision of the residual tumor. The newly created larger defect was often managed again with a purse string suture. If clear surgical margins were achieved, the purse string suture was removed after 21 days. The type of final reconstruction and its timing were primarily dependent on size and location of the lesion, as well as the degree of confidence in obtaining clear margins. We used fullthickness skin grafts, flaps, primary closure, and second-intention healing as final reconstructive options. No significant complications were observed. A biopsy-confirmed lentigo maligna on the right cheek (Fig. 1) with poorly definable clinical margins was outlined with the aid of a Wood's lamp and excised with a 5 mm margin. The oval From the Dermatology Service, Walter Reed Army Medical Center. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the United States Army. Reprints not available from the authors. J Am Acad Dermatol 1998;38:99-101. 16/74/85559 Surgical Pearl: Purse string suture in the management of poorly delineated melanomas

Tensile Stress Relaxation in High-Strength Spring Steel Wire

Abstract Stress relaxation data were obtained in tension tests using the vibrating string technique (measuring the resonance frequency) in spring steel wire of ASTM Grade A 228 (also known as music wire). The steel wire of 0.56 mm diameter had a 0.29% offset tensile yield strength of 1689 MPa. Tests were conducted at low temperatures in the range of 23 to 140°C, and at initial stress levels of up to 75% of the 0.20% offset yield strength of the wire. The test duration was to 4000 h at 23°C and to 100 h at temperatures to 140°C. The test results indicate a faster rate of stress relaxation during the early stage of stress relaxation, and subsequently a slower rate of stress relaxation rate with increasing time, as is usually observed. An empirical equation has been determined that fits the experimental data very well under the given test conditions.

Prevention of prolapse in pediatric enterostomas with purse string technique

Eighty-five intestinal stomas (40 small bowel enterostomies and 45 colostomies) were performed by a purse string technique with no instances of prolapse.

A simple purse string suture technique for treatment of colostomy prolapse and intussusception

A simple purse string technique for treatment of colostomy prolapse and intussusception is described. It is suggested as an alternative to more complicated procedures.

Contemporary String Technique

Contemporary String Technique

The Role Of Purse String Closure As The Primary Treatment Of Hemangioma

Hemangioma is a common congenital disorder which happens in neonates or infant, with predilection sites in the face and neck. Not every case of hemangioma requires a surgical treatment. Some will regress spontaneously. In some cases which requires resection, the aesthetic aspects of the repair must be considered as the sites of the lesion involved the face and neck areas, which is greatly exposed.Two patients with hemangioma of the left cheek were admitted to Plastic Surgery Department of Cipto Mangunkusumo Hospital. The patients underwent excision and primary closure with purse string technique. Patients were evaluated at one week after surgery and a month after to assess scar appearance. Follow up evaluation revealed less visible scar compared to the immediate result. A well-known technique used by many plastic surgeons is the circular incision followed by purse-string closure. The use of this technique was known to produce less visible scar. Hemangiomas acts as a tissue expander, which make it applicable to close the defect using purse string closure.

Vive La Difference! Key to String Pedagogy and Technique

Vive La Difference! Key to String Pedagogy and Technique

Tone Quality – the First Objective of String Technique

Tone Quality – the First Objective of String Technique

To Shift or Not to Shift

MANY a high school orchestra violinist has pondered this question while reading concert or contest numbers for the first time, or while studying his part preparatory to tryouts. His degree of accuracy and his quickness of response to this will bring either joy or dismay to the heart of the director. Indeed, there may be a few directors who have raised their eyebrows in seeking this answer which means so much to the effective playing of their string sections. One ventures to include directors because there may be some who are primarily band men or vocalists, and, while they may know the effects they want from the strings, they are on slightly unfamiliar ground when confronted with certain problems of violin technique such as shifting in all its many uses and aspects. No one will deny that this very intimate part of a violinist's equipment can be learned best by actually doing it with one's own bow and fingers. Even though the orchestra director may lack this intimate acquaintance with the problem of shifting, he may learn some things by observation, while others will become clear only by gaining some knowledge of the general principles underlying this important part of string technique. In a brief attempt to shed some light on this problem we will leave out of the discussion bow technique-which is the ability to play the different styles of bowing such as martele, staccato, spiccato, etc.-and the skill necessary in playing the varied rhythmical patterns which are present on every page of orchestra music. Back of these skills is the ability to co6rdinate the left-hand fingers with the movements of the bow. This discussion presupposes this ability. The sum of all these bow and left-hand skills plus the use of the positions is the problem of shifting and of the portamento.