Tissue Pliability Research Articles

Critical appraisal of Genelyn soft embalming for cadaveric surgical skill training: A systematic review.

Genelyn is a proprietary embalming solution used for preserving cadavers for surgical skill training (SST) and undergraduate teaching. The aim of this review is to examine the Genelyn embalming method critically by analyzing scientific publications that have employed this method for SST and undergraduate education. The systematic review process involved searching for all relevant articles in PubMed, Google Scholar, and Embase using the keywords "Genelyn," Genelyn embalming," "Genelyn embalmed cadaver," and "surgical skill training. All studies on Genelyn embalming published up to August 14, 2024, in the English language were eligible for inclusion. The literature review yielded 92 studies, 43 of which met the inclusion criteria. The Anatomical Quality Assurance (AQUA) tool from the International Evidence-Based Anatomy (iEBA) working group was used to assess and analyze the risk of bias in all the selected full-text articles. The selected studies reported that Genelyn embalming provided life-like joint range of motion, tissue pliability, and color. Cadaveric studies assessing embalming solutions typically had smaller sample sizes, and few of them compared Genelyn embalmed cadavers (GECs) with the other soft embalming solutions. Unlike Theil's embalming, Genelyn embalming is cost-effective, with easy steps for the preparation and storage of the solution and convenient handling of cadavers. Therefore, GECs serve as an efficient tool for SSTs.

Novel Treatment of Laryngomalacia: A Case Series

Background: Laryngomalacia is a prevalent neonatal condition characterized by the increased pliability of laryngeal tissues, leading to airway obstruction and associated respiratory complications. It necessitates a nuanced approach to diagnosis and management, given its variable clinical presentation and potential for significant morbidity. Objective: This study aims to investigate the clinical presentation, management, and outcomes of neonates with laryngomalacia, focusing on the efficacy of individualized treatment approaches including bronchoscopy, laser ablation, and various ventilation strategies. Methods: This retrospective case series analyzed data from two neonates treated for laryngomalacia at Children Center Hospital Tehran between 2021 and 2022. Inclusion criteria were neonates beyond 28 weeks gestation without congenital abnormalities and with an RDS score ≥8. Exclusion criteria included preterm neonates (<28 weeks), an RDS score <8, and congenital abnormalities. Data collection involved measures such as respiratory assistance, stridor, feeding issues, oxygen requirement, hospital stay duration, ventilation days, gestational age, RDS score, retraction severity, and amniotic blood gas values. Ethical considerations were observed throughout the study. Results: The first neonate, a 29-day-old female with a gestational age of 36 weeks and 5 days, required HFNC and laser ablation, leading to the resolution of stridor and feeding difficulties. Her hospital stay was 46 days. The second neonate, a 16-day-old male born at 38 weeks gestation, experienced complications including VAP and required a more extended treatment course, including intubation, NIV, CPAP, and HFNC, culminating in an 80-day hospital stay. Conclusion: The study highlights the importance of personalized and adaptable treatment strategies in managing laryngomalacia in neonates. The variability in clinical presentations and responses to treatment underscores the need for ongoing research and the development of refined management protocols. A multidisciplinary approach, incorporating timely diagnosis and flexible intervention, is crucial for optimal patient outcomes.

Preparation of Soft Embalmed Cadavers by the Modified Thiel Embalming Technique for Surgical Skill Training and Development of a Universal Quantitative Scoring System to Assess the Suitability of Soft Embalmed Cadavers for Such Training Purposes.

Background Cadaver dissection plays an important role in learning anatomy. A surgeon must have a thorough knowledge of anatomy of the operating region to perform safe surgery. Skill laboratories give opportunities to surgeons to practice on cadavers before venturing onto real patients. The most common method of cadaver preservation is through formalin fixation. In the process of fixation, formalin destroys the tissue characteristics and also has issues such as smell, eye irritation, hardening of tissue, and risk of carcinogenesis. The Thiel embalming technique and its modifications were developed to address those issues. Our primary objective was to find the benefits of soft embalmed cadavers over formalin-fixed bodies and, secondly, to find out microbial flora in soft embalmed cadavers. Study design This is a basic study. Methods Four cadavers were prepared for the soft embalming purpose for our workshop for surgeons on spine fixation. Due to unavailability, we replaced 4-chloro-3-methylphenol 1% with phenol 1%. The bodies were preserved in refrigerators at 4°C before being used for the workshop purpose. The delegates and faculties were given a questionnaire to assess their experience of the cadavers in terms of odor, irritation, tissue characteristics, joint mobility, and imaging characteristics. The results were calculated using statistical analysis. Swabs were taken from a few of the cadavers for culture to find the organisms. Results There were 14 questions in the questionnaire, and the data collected were divided into two groups, faculties, and delegates. JASP software was used to analyze the data. The questions addressed various aspects of cadavers such as color, odor, tissue pliability, joint flexibility, imaging characteristics, mucosal irritation, and earlier experience in working with cadavers. Cronbach α was used to find the correlation between the various characteristics analyzed. The authors intend to name the domains being measured: surgical suitability (scores of items 8 to 12), imaging suitability (scores of items 5 and 6), and smell score (scores of items 5 and 6). It can be a guide to constructing and refining a better quantitative scale to measure the "quality of soft-embalmed cadavers for surgical training." Conclusions Skill laboratories give opportunities to young surgeons and trainees to learn and improve their skills before applying them to real patients. This was our first attempt to develop soft embalmed cadavers at our center and our state. We used the parent solution with some variations as per the availability of chemicals at our place and found that the features of the preserved cadavers were good and well-suited to address our purpose. Therefore, with some variations in the parent formulations, centers situated in remote and less developed places can formulate their own solution to develop soft embalmed cadavers and establish cadaver skill laboratories. This will benefit the local surgeons and trainees. The authors tried to develop a few domains through statistical analysis, which can be used to assess and compare the quality of cadavers prepared at various centers.

Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues.

Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.

575 Single-stage Trilaminar Skin Reconstruction Following Full-Thickness Burn Injury

Abstract Introduction Complex burns are highly morbid injuries that can cause severe disfigurement and can be devastating to one’s quality of life and psychosocial well-being. Currently, there are no simple, single-stage procedures available for extensive or multifocal burns to address full-thickness trilaminar defects. Our team has previously demonstrated the viability of an adipose-first reconstruction to address hypodermal defects. In this study, we demonstrate the efficacy of a combined adipose plus finely minced skin to achieve a single-stage trilaminar skin reconstruction. Methods Full-thickness burns were created on female Yorkshire swine. After 48-hours, escharectomies were performed to the level of fascia. The wounds were layered with adipose harvested from female Yorkshire swine. In one group, autologous split-thickness skin grafts were cut into pixel size (0.3x0.3 mm) grafts and layered on top of the adipose. Pigs were maintained for 4-weeks with weekly photography, ultrasound, followed by endpoint histology and tension measurements. Results At the end of the 4-week period, adipose combined with pixel graft demonstrated improved epithelialization and less contracture (p< 0.01). Thickness and mobility measurements were consistent in both groups. This findings were similar to our previous approaches using adipose following surgical debridement. Tissue pliability in the pixel grafting group was maintained to a high degree. Cross sections were performed which showed the persistence of fat graft at the base of the wounds. Conclusions Immediate, single-stage trilaminar reconstruction of full-thickness complex burns reduces contracture, mitigates adhesion, and restores normal soft-tissue thickness, therefore, presenting a paradigm changing approach in the current practice of burn injuries to the mobile surfaces. Applicability of Research to Practice Our results support the therapeutic potential of adipose-based soft-tissue reconstruction of burns to both enhance hypodermal augmentation and mitigate fibrotic complications including contracture and adhesions. Our data suggest that this approach is compatible with the standard of care skin grafting, and in fact provides improved epidermal thickness and pliability.

Secondary Reconstruction of Head and Neck Cancer Defects-Principles in its Practice.

Secondary reconstruction is requested by patients who have completed their head and neck cancer treatment. The reason for the request for reconstruction may be to improve the functional deficits, achieve aesthetic refinements or most commonly both.The article looks at various issues related to reconstruction in the secondary setting and suggesting the ways to approaching patients requesting secondary reconstruction. While considering secondary reconstruction, various factors need to be considered. These include issues related to the disease, the treatment received as well as the patient's comorbid conditions. Aggressive disease and multiple recurrences should deter from undertaking complex reconstructions. Lack of tissue pliability resulting in a woody neck due to radiation makes dissection difficult and wound healing poor. The reconstructive requirements include release of contractures inside the mouth, reconstruction of the missing jaws, replacement of the missing volume of the tongue and correction of the incompetent angle of mouth. Goals of reconstruction should be prioritized by the surgical team. Free soft tissue or bone containing flaps would be provided ideal tissue to meet the reconstructive requirements in secondary reconstruction. However, several impediments could exist for their safe use. Release of contractures and provision of adequate soft tissue should be given priority and must be addressed before bony reconstruction is contemplated. Bony reconstruction of both mandible and maxilla is possible, with the former being more difficult to deliver good results due to the associated soft tissue fibrosis. Virtual surgical planning with the aid of Stereo lithographic models and planning software will improve the quality of bony reconstruction. Detailed counseling sessions involving patient and the family are essential before embarking on secondary reconstruction as the patient expectations and the surgical outcome may not be easy to match. However excellent improvement in function and appearance will be possible in many patients with appropriate reconstructive procedure.

Rehydration and restoration of fingerprint ridge detail in mummified post‐mortem tissue: Literature review and investigation of a simplified formulation

Mummified tissue presents challenges for fingerprinting due to rigidity, shrinkage, and other features obscuring epidermal ridge detail. A new cost-effective in-house solution was developed to obtain good quality fingerprints from mummified remains. The simplified procedure uses a sodium carbonate:sodium acetate mixture easily prepared using commonly available chemical products. An overview of the methods and solutions utilized to date for rehydration and restoration illustrates the main benefits of the developed formulation: the solution provided better tissue pliability and turgor than the sodium carbonate:ethanol formulation of Rüffer previously employed; the prepared solution proved stable for weeks at room temperature and poses minimum hazard risk to users. It functions as a weak base (pH 9.3) and is sufficiently corrosive to allow tissue softening over a flexible timeframe of 1-5days without causing any damage. The degree of effectiveness for rehydration of mummified tissue and restoration of ridge detail is attributed to three synergistic aspects: increased turgor as provided by a penetrating humectant and water; softening and pliability as a result of pH and any specific chemical interaction that affects calcium in collagen; ridge detail definition as a function of turgor and softening, with some secondary corrosive dependency related to the pH of a solution.

Cross-Sectional Area Measurement Techniques of Soft Tissue: A Literature Review.

Evaluation of the biomechanical properties of soft tissues by measuring the stress–strain relationships has been the focus of numerous investigations. The accuracy of stress depends, in part, upon the determination of the cross‐sectional area (CSA). However, the complex geometry and pliability of soft tissues, especially ligaments and tendons, make it difficult to obtain accurate CSA, and the development of CSA measurement methods of soft tissues continues. Early attempts to determine the CSA of soft tissues include gravimetric method, geometric approximation technique, area micrometer method, and microtomy technique. Since 1990, a series of new methods have emerged, including medical imaging techniques (e.g. magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging (USI)), laser techniques (e.g. the laser micrometer method, the linear laser scanner (LLS) technique, and the laser reflection system (LRS) method), molding techniques, and three‐dimensional (3D) scanning techniques.

Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting.

Vocal fold scarring is the cause of severe dysphonia and represents a therapeutic challenge; dysphagia can also be present in case of soft tissue defect due to previous oncological surgery. The ideal surgical solution should concurrently provide vocal fold augmentation and re-establishment of tissue elasticity. Nanofat technique has given so far promising results in remodeling skin scars and improving tissue pliability. The present paper describes for the first time the use of nanofat injected into the vocal fold cover for pliability restoration, combined with traditional microfat for vocal fold augmentation. Seven patients (aged 23-77 years) affected by severe dysphonia, related to extensive vocal fold scarring (3 of them were also affected by dysphagia for liquid consistencies), underwent a single procedure of concurrent microfat and nanofat vocal fold injection under direct microlaryngoscopy in general anesthesia. Results were evaluated by objective outcome measures and auto evaluation performed by questionnaires concerning the phonatory and swallowing efficiency. The voice quality and the perceived swallowing capability of all patients improved after surgery and are stable at follow-up (4-8 months). The reported preliminary data show that nanofat, due to its regenerative potential related to adipose-derived stem cells and growth factors, can be a promising adjunct to traditional fat augmentation to improve elasticity of the delicate multilayered structure of the vocal fold and to enhance its vibratory capabilities. Further experience on a wider number of patients and long-term follow-up are necessary to confirm the validity of this technique.

Treatment With Topical Deferoxamine Improves Cutaneous Vascularity and Tissue Pliability in an Irradiated Animal Model of Tissue Expander-Based Breast Reconstruction.

Postmastectomy radiation therapy is an important component of the multimodality approach to later-stage breast cancers. Unfortunately, despite its proven survival benefits, postmastectomy radiation therapy is deleterious to the skin and soft tissue, causing increased complications and worse aesthetic outcomes after breast reconstruction.There is currently no effective pharmaceutical agent to mitigate the soft tissue fibrosis and hypovascularity associated with soft tissue radiation. We hypothesized that a novel topical formulation of deferoxamine (DFX) will result in improved cutaneous vascularity and soft tissue pliability in an animal model of irradiated tissue expander-based breast reconstruction. This study consisted of 16 hairless rats divided into 4 equal groups: a control group (expander only), a tissue expanded and irradiated group, a tissue expanded + DFX group, and a tissue expanded/irradiated/DFX group. A novel topical formulation of DFX consisted of reconstituted drug dissolved in agents designed to enhance dermal penetrance. Vessels per high-power field (vHPF) were quantified histologically; micro-computed tomography angiography was used to assess vessel volume fraction (VVF) and vessel length density. Irradiated skin had less vascularity compared with control (3.81 vHPF vs 8.25 vHPF, P = 0.03; 0.79% VVF vs 1.53% VVF, P = 0.06). Treatment of irradiated skin with topical DFX reversed these effects, resulting in vascular findings similar to the control group histologically (7.94 vHPF vs 8.25 HPF, P = 0.985) and via micro-computed tomography angiography (1.05% VVF vs 1.53% VVF, P = 0.272). Similarly, radiation resulted in less volume expansion compared with controls (0.72 vs 0.8 mL, P = 0.04), whereas treatment with topical DFX reversed this effect, allowing for an expansion volume similar to the control group (0.81 vs 0.80 mL, P = 0.999). In an animal model of irradiated tissue expander-based breast reconstruction, treatment with topical DFX improved the cutaneous vascularity and tissue pliability, resulting in vascular density and final tissue expansion volumes similar to those found in the nonirradiated control group. Topical DFX may be an effective agent for the treatment of soft tissue radiation injury; future studies are indicated to further characterize this novel drug formulation.

Justification for the initial medical data for the development of an anthropomorphic test dummy

To protect against the adverse impact of shock acceleration, technical protection equipment is being developed, the effectiveness of which is verified during the tests. Special place among these tests belongs to physical analogue of human body- anthropomorphic testing dummy. The experiments with the participation of volunteers allowed to develop anthropometric, biomechanical and consumers requirements to anthropoid testing dummy, which are corresponded to small (5 percentile), medium (50 percentile) and big Russian servicemen (95 percentile). There were also established demands to body weight, stature - body height, sitting height, height of shoulders over the seat, chest circumference, mass of the main segments of anthropoid testing dummy (head and neck, upper, middle and lower parts of a trunk, shoulder, forearm, hand, leg, foot). An anthropoid testing dummy, modeling servicemen with small sizes, must have 58 kg weight, 165,6 cm body height, 86 cm sitting height and 88,8 cm chest circumference; a dummy, modeling middle servicemen, must have 68 kg weight, 173 cm body height, 92,2 cm sitting height and 98,5 cm chest circumference; a dummy, modeling big servicemen, must have 101,2 kg weight, 190 cm body height,96,5 cm sitting height and 101,2 cm chest circumference. During the experiments with the participation of volunteers, pliability of soft tissues of human, being in connection with restraint system, was studied. It allows modeling mechanical characteristics of anthropoid testing dummy’s torso and ensure adequate reaction to inertial load of a body. There are given demands to dynamical firmness of anthropoid testing dummy and to its qualities, ensuring peculiarities of its use during natural and semi-natural testing.

Adipose-Derived Stem Cells in Aesthetic Surgery.

Adipose-derived stem cells (ADSC) have come to be viewed as a ubiquitous solution for aesthetic and reconstructive problems involving loss of tissue volume and age or radiation-induced loss of tissue pliability and vascularity. As the theoretical potential of "stem cell therapy" has captured the public imagination, so the commercial potential of novel therapies is being exploited beyond scientifically sound, hypothesis-driven paradigms and in the absence of evidence establishing clinical efficacy and safety. Moreover, with variations in methods of isolation, manipulation, and reintroduction described, it is unclear how the practitioner with an interest in ADSC can harness the clinical potential in reproducible and scientifically measurable ways. This Continuing Medical Education (CME) article presents a summary of our understanding of what ADSC are, their utility within the field of aesthetic surgery, and the current and future directions for adipose stem cell research.

Efficiency of lung ventilation for people performing wind instruments.

Wind instruments musicians are particularly prone to excessive respiratory efforts. Prolonged wind instruments performing may lead to changes in respiratory tracts and thus to respiratory muscles overload. It may result in decreasing lung tissue pliability and, as a consequence, in emphysema. Aim of the research has been to describe basic spirometric parameters for wind players and causes of potential changes. Slow and forced spirometry with the use of Micro Lab Viasys (Micro Medical, Great Britain) was conducted on 31 wind musicians (group A). A survey concerning playing time and frequency, weight of instruments, and education on diaphragmatic breathing was conducted. The control group included 34 healthy persons at similar age (group B). The results were statistically described using Excel and Statistica programmes. The respiratory parameters were within the range of physiological norms and forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) exceeded in both groups the values of 100%. Forced vital capacity and expiratory vital capacity (EVC) values were significantly lower in the group of musicians than in the control group (p < 0.001). In 45% the group A used diaphragmatic breathing, in 31% of examinees mixed respiratory tract was observed. The significant discrepancy of individual parameters was obtained regarding age and the length of time when performing wind instrument. Spirometric parameters relative to standards may prove a good respiratory capacity. Peak expiratory flow (PEF) and FEV1 may indicate that a proper technique of respiration during performance was acquired. The length of time when performing wind instrument may influence parameters of dynamic spirometry. Med Pr 2016;67(4):427-433.

Vibratory onset and offset times in children: A laryngeal imaging study

ObjectivesThe aim of the study was to evaluate the differences in vibratory onset and offset times across age (adult males, adult females, and children) and waveform types (total glottal area waveform, left glottal area waveform, and right glottal area waveform) using high-speed videoendoscopy. MethodsIn this prospective study, vibratory onset and offset times were evaluated in a total of 86 participants. Forty-three children (23 girls, 18 boys) between 5 and 11 years and 43 gender matched vocally normal young adults (23 females and 18 males) in the age range (21–45 years) were recruited. Vibratory onset and offset times were calculated in milliseconds from the total, left, and right Glottal Area Waveform (GAW). A two-factor analysis of variance was used to compare the means among the subject groups (children, adult male, and adult female) and waveform type (total GAW, left GAW, right GAW) for onset and offset variables. Post hoc analyses were performed using the Fishers Least Significant Different test with Bonferroni correction for multiple comparisons. ResultsChildren exhibited significantly shorter vibratory onset and offset times compared to adult males and females. Differences in vibratory onset and offset times were not statistically significant between adult males and females. Across all waveform types (i.e. total GAW, left GAW, and right GAW), no statistical significance was observed among the subject groups. ConclusionThis is the first study reporting vibratory onset and offset times in the pediatric population. The study findings lay the foundation for the development of a large age- and gender-based database of the pediatric population to aid the study of the effects of maturation of vocal fold vibration in adulthood. The findings from this study may also provide the basis for evaluating the impact of numerous lesions on tissue pliability, and thereby has potential utility for the clinical differentiation of various lesions.

Technical note: Real-time sonoelastography evaluation of achilles tendon

Sonoelastography (SE) is a new USG-based technique that is being used to assess the elasticity and pliability of various tissues and lesions. We evaluated normal and abnormal Achilles tendons and correlated SE findings with those of high-resolution USG. This article briefly discusses the principle and technique of sonoelastography and the variations in elasticity and pliability between normal and abnormal Achilles tendons.

A head-to-head hands-on comparison of ERCP mechanical simulator (EMS) and Ex-vivo Porcine Stomach Model (PSM).

BACKGROUND: ERCP mechanical simulator (EMS) and ex-vivo porcine stomach model (PSM) have been described. No direct comparison was reported on endoscopists' perception regarding their efficacy for ERCP training OBJECTIVE: Comparative assessment of EMS and PSM. DESIGN: Questionnaire survey before and after practice. SETTING: Hands-on practice workshops. SUBJECTS: 22 endoscopists with prior experience in 111±225 (mean±SD) ERCP. INTERVENTIONS: Participants performed scope insertion, selective bile duct cannulation with guide wire and insertion of a single biliary stent. Simulated fluoroscopy with external pin-hole camera (EMS), or with additional transillumination (PSM) was used to monitor exchange of accessories. MAIN OUTCOME MEASURE: Participants rated their understanding and confidence before and after hands-on practice, and credibility of each simulator for ERCP training. Comparative efficacy of EMS and PSM for ERCP education was scored (1=not, 10=very) based on pre and post practice surveys: realism (tissue pliability, papilla anatomy, visual/cannulation realism, wire manipulation, simulated fluoroscopy, overall experience); usefulness (assessment of results, supplementing clinical experience, easy for trainees to learn new skills) and application (overall ease of use, prepare trainees to use real instrument and ease of incorporation into training). RESULTS: Before hands-on practice, both EMS and PSM received high scores. After practice, there was a significantly greater increase in confidence score for EMS than PSM (p<0.003). Participants found EMS more useful for training (p=0.017). LIMITATIONS: Subjective scores. CONCLUSIONS: Based on head-to-head hands-on comparison, endoscopists considered both EMS and PSM credible options for improving understanding and supplementing clinical ERCP training. EMS is more useful for basic learning.

A comparison of embalming fluids for use in surgical workshops

There is a growing need to learn surgical skills without risk to patients. One of the major determining factors on the suitability of specimens for surgical workshops is the fluid used for embalming. This study sought to compare three different arterial embalming preparations to a single fresh cadaver. Eleven cadavers embalmed using Graz (single cadaver), Dodge (four cadavers) and Genelyn (five cadavers) preparations were compared using four criteria; joint flexibility measured with a goniometer, tissue pliability rated on standardized videos of instrument handling, tissue color analyzed on standardized photographs and resistance to fungal growth identified by inoculation and observation of tissue blocks. The cadaver embalmed according to the Graz method had joint flexibility comparable to fresh tissue while the Dodge and Genelyn cadavers were less flexible. Tissue pliability was significantly affected by the Dodge and Genelyn methods while the Graz method tissue remained most like fresh tissue. The Graz method cadaver had color that was most akin to fresh tissue and the Dodge method cadavers were relatively more like fresh than the Genelyn. The Dodge and Genelyn method had quite similar fungicidal properties (3/11 Dodge and 2/9 Genelyn embalmed cadavers susceptible) while the Graz method cadaver did not grow mould. Variation exists between cadavers; however, the Graz method produced a cadaver with more flexible joints, better tissue quality and muscle color closest to the fresh specimen. The Dodge and Genelyn methods are similar with the exception of tissue color where the Dodge method was more similar to fresh tissue.

Evaluation of a New Endoscopic Ultrasound (EUS) Simulator (EASIE-RTM) for Teaching Basic and Advanced Skills of EUS

Purpose: EUS is a valuable diagnostic and therapeutic modality. Various types of EUS simulators have been used for teaching EUS. A novel model was recently developed, the modified Erlangen Active Simulator for Interventional Endoscopy (EASIE-RTM), with the capability of training physicians in diagnostic and therapeutic aspects of EUS. The aims of this study were to assess this instrument's visual realism and tissue pliability compared to humans, anatomical correlation to human anatomy, usefulness in teaching basic and advanced EUS skills, overall simulation realism, ease of use and ease of incorporation into fellowship training.Table: [1360] Mean, median, mode, interval, range, and percentage of attending give the mode and giving a score of 5 and above for each itemMethods: The study was designed as a prospective observational survey. 75 attending gastroenterologists participated in a 2-hour didactic session followed by a 2-hour hands-on training with the EASIE-RTM model at 1 of 5 centers. They had the opportunity to identify anatomical structures and perform fine needle aspiration (FNA) and pseudocyst drainage. Following completion of the hands-on session, they completed an evaluation form based on a 7-point Likert scale which included 9 questions assessing the instrument's visual realism and tissue pliability compared to humans, anatomical correlation to humans, usefulness in teaching basic and advanced EUS, overall simulation realism, usefulness as an educational tool, ease of use and ease of incorporation into fellowship programs. Results: Of the 75 gastroenterology attendings, 7/75 (9.33%) had no prior experience with EUS, 21/75 (28%) had 1-3 years, 16/75 (21.33%) had 4-10 years, and 4/75 (5.33%) had more than 10 years of EUS experience. No attending indicated having less than 1 year of EUS experience and 27/75 attendings (36%) did not indicate the number of years of EUS experience. A median score of 6 (agree) and a mode of 6 were obtained for most of the items (6/9, 66.67%). The lowest mode was a 5 (somewhat agree). The narrowest range of 3 (interval of 4-7) was obtained for the item assessing the usefulness of this model as an educational tool and its ease of use. A high percentage of participants gave a score of 5 and above for each item. Conclusion: It appears that the EASIE-RTM EUS Simulator may have potential as a useful educational/teaching tool for basic and advanced EUS skills as it appears to provide visual realism and tissue pliability compared to humans, has reasonable anatomical correlation to humans, is easy to use and easy to incorporate into fellowship training programs. Future studies are now needed that compare the performance of trainees who practice with the EASIE-RTM model prior to patient experience compared to a control group with no EASIE-RTM training to see whether their skills are significantly improved in the clinical setting. Disclosure: Dr Kai Matthes is the director of Endosim, LLC (Berlin, MA) and received material support from olympus America, Inc. The remainder of the authors disclosed no financial, professional, or personal relationships relevant to this study.

Surgical repair of genitourinary fistulae: comparison of our experience at Turkey and Niger

Report of the personal experience at repairing urogenital fistulae comparing the etiology, management, and outcomes in a developed and underdeveloped countries. Fifty-three patients with urogenital fistulae were surgically repaired at two different countries. Twenty-nine of those were treated in Istanbul, Turkey during last 10-year period and the other 24 patients were operated in Maradi, Niger in August 2007. Detailed information on obstetric history and previous surgical procedures were questioned in all of the patients. Specific evaluation included instillation of dye in the bladder to locate the site of the fistula and intravenous urography were applied to patients with suspected urogenital fistula to confirm the fistula tract. The site, number and the size of fistula, as well as the pliability of tissues was assessed before the operation. The position of patients for surgery and the route of repair were individualized according to the appropriate access to the fistulae. Patients were reviewed 4-10 weeks after surgery to determine the end results of the operations. Over all, obstetric complications (47%) were the most common cause of urogenital fistulae. Gynecologic surgeries were responsible for 41% of the cases. Although obstetric causes were prominent at patients in Niger, gynecological surgery was the main cause in Turkey. The most common type of fistulae was vesicovaginal. With regard to surgical approach to urogenital fistulae; the transabdominal approach was chosen in 12 (22.6%) of patients and transvaginal repair was performed in 41 (77.4%) of patients; 94.34% of the patients were completely dry after the first attempt. A high percentage of patients with genital fistulae can be rendered dry and continent by assessment of these conditions; meticulous attention must be applied for the absence of inflammation and infection at the fistula site before the operation. Surgical team must be experienced at both abdominal and vaginal repair. Broad-spectrum antibiotics and continuous bladder drainage must be applied to all patients for at least 2 weeks. Interposition flaps must be used in complex cases.

O45 Reproductive assisted services for HIV infected couples in Brazil: demand and barriers to access

tions available for effective treatment of sexual disorders, reduction of associated psychiatric symptoms and are being used clinically. Methodology: A systematic review was performed from the database of cochrane library, pubmed, pedro databases, embase, amed, mantis, cinhal. Various electromyography studies have shown the effective permutation of various electrotherapeutic equipments like ultrasound, electrical stimulation, bio-feedback equipments and physiotherapeutic techniques like creed’s manoeuvre; stroking, soft tissue mobilization helps in regaining soft tissue pliability, penile erection and suppleness during vaginal penetration. Various exercises like abdominal, pelvic floor, gluteal muscles also reinforce the effects and helps in perfection. Few studies have shown that associated psycho-physiological relaxation reduces anxiety, fretfulness and apprehension regularises tone and thereby corrects psycho morbidity by harmonizing segments of limbic system. Result: It tranquillize and unruffled patients by plummeting muscle spasm, regularizing cardiovascular abnormality by regularizing cardiac cycle by regulating ventricular contraction and improving peripheral circulation at the same time perk up respiratory system by reducing the use accessory muscle of respiration, reduces anxiety associated bronchospasm so alveolar functioning. Exercise offers a low-cost alternative treatment adjunct which is less controversial, economical and easy to adapt and can be weigh against the operative methods. Improved pelvic floor muscle and reductions in stress and twinge etc. may bring out a great difference like return to the normal erection, control over dribbling and emotional stress. Conclusion: Colossal strives and relevant studies have shown success of physiotherapy as a therapeutic adjunct but very little has been documented till now, however this concept need’s more evidence based researches and studies. In future we can formulate specific protocols and physiotherapy techniques to the various stages of the diseases. Certainty, Physiotherapy can do little comparative to the medicine’s but can prove very effective adjunct for moderating and restraining of the disease. An inexpensive approach with properly supervised physiotherapy can be extremely helpful and may show benefits for patients.