Types Of Surgical Methods Research Articles

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years.

To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.

Survival analysis of implants after surgical treatment of peri-implantitis based on bone loss severity and surgical technique: a retrospective study

BackgroundFew trials have compared the results of surgical treatment for peri-implantitis based on severity of peri-implantitis and surgical method. This study investigated the survival rate of implants based on type of surgical method used and initial severity of peri-implantitis. Classification of severity was determined based on bone loss rate relative to fixture length.MethodsMedical records of patients who underwent peri-implantitis surgery from July 2003 to April 2021 were identified. Classification of peri-implantitis was divided into 3 groups (stage 1: bone loss < 25% (of fixture length), stage 2: 25% < bone loss < 50%, stage 3: bone loss > 50%) and performance of resective or regenerative surgery was investigated. Kaplan-Meier survival curves and Cox hazards proportional models were used to analyze the cumulative survival rate of implants. Median survival time, predicted mean survival time, hazard ratio (HR), and 95% confidence interval (CI) were calculated.ResultsBased on Kaplan-Meier analysis, 89 patients and 227 implants were included, and total median postoperative survival duration was 8.96 years. Cumulative survival rates for stage 1, 2, and 3 were 70.7%, 48.9%, and 21.3%, respectively. The mean survival time for implants in stage 1, 2, and 3 was 9.95 years, 7.96 years, and 5.67 years, respectively, with statistically significant difference (log-rank p-value < 0.001). HRs for stage 2 and stage 3 were 2.25 and 4.59, respectively, with stage 1 as reference. Significant difference was not found in survival time between resective and regenerative surgery groups in any peri-implantitis stage.ConclusionsThe initial bone loss rate relative to the fixture length significantly correlated with the outcome after peri-implantitis surgery, demonstrating a notable difference in the long-term survival rate. Difference was not found between resective surgery and regenerative surgery in implant survival time. Bone loss rate could be utilized as a reliable diagnostic tool for evaluating prognosis after surgical treatment, regardless of surgical method used.Trial registrationRetrospectively registered. (KCT0008225)

Orthopedic and surgical rehabilitation children with unilateral cleft/palat

Introduction. Maxillofacial fissures are the most common form of congenital malformations of the face and the maxillofacial region. These forms of malformations may vary from simple shapes to particularly non-specific forms. The cleft lip and palate are characterized by anatomical and functional disorders. In unilateral total splits, anatomical disorders are characterized by bone deformities. The upper jaw is divided into two segments by the fissure that passes on the upper lip, alveolar and hard palatal process and soft palatal region. The clinical manifestations of these forms of malformations appear with severe aesthetic facial deformities and functional disorders that can lead to a chain of clinical diseases that endagers even the vital functions of the child.Background. During the years of research in order to find a better optimal way to treat the cleft palate, there was described a lot of controversary methods and steps to reduce the dimension of the cleft, using prenasoalveolar molding appliances and different types of surgical methods(one or 2 steps plasty of the palate).Materials and methods. Six patients with total palatal splitting were examined. There were done impression and obtained study gypsum models during preoperative to the primary stage of plasty and postoperatively to the secondary stage of plasty of the hard palate.Results. According to the measurements and calculations, we came to the conclusion that the two-stage plasty, only with passive therapy of separation of the nasal cavity from the oral cavity with the help of palatal plates, has a displace-ment efficiency of the splitting segments of 46%, while one-stage palatal plasty with active preoperative nasal-alveolar molding with intermaxillary traction has a closure value of 76% (after Elcin).Conclusion. One-stage cleft palate surgery, which preoperatively undergoes orthodontic nasal-alveolar molding ther-apy, is more effective in closing the cleft at the level of the alveolar processes than two-stage plastic surgery without preoperative nasal-alveolar orthodontic therapy.

The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease

Objectives: To compare patients with lumbar spine degenerative disease treated by minimally invasive surgery using tubular retractor system and conventional surgical method.Study Design: Cross-sectional study with historical data.Patients and Methods: The single-institution series included 48 adult patients treated with one of the two surgical methods during a one-year period. The patients were divided between a case group consisting of minimally invasively treated patients and a control group of those operated on by conventional surgery. The research data were the following: age, gender, duration of symptoms, type of spinal pathology, type of surgical method, number of surgical levels treated, neurological status, pain intensity assessed by Visual Analogue Scale, duration of surgery and length of hospital stay. Modified Odom’s criteria were used as a primary outcome measure. All data were documented from electronic medical records, statistically analyzed, and correlated between The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease the groups. The level of statistical significance was set at p&amp;lt;0.001.Results: A significant improvement of neurological status after surgery was recorded in all patients (case group, Fisher’s exact test, p=0.002, control group, Fisher’s exact test p=0.012). The pain intensity was significantly reduced after surgery in both groups (case group, Wilcoxon test, p&amp;lt;0.001, control group, Wilcoxon test, p&amp;lt;0.001). A statistically significant difference was observed between the case and the control group in the length of hospital stay (Mann-Whitney U test, p&amp;lt;0.001) and in time elapsed from surgery to patient mobilization (Mann-Whitney U test, p&amp;lt;0.001). In all other data examined, no statistically significant difference was noted between the case and control groups.Conclusion: Surgical treatment of lumbar spine degenerative disease results in significant improvement of neurological status and in reduced pain intensity. Minimally invasive surgery using tubular retractors results in shorter length of stay and earlier patient mobilization.

Association of a Modified Blumgart Anastomosis With the Incidence of Pancreatic Fistula and Operation Time After Laparoscopic Pancreatoduodenectomy: A Cohort Study.

ObjectiveTo explore the association between a modified Blumgart anastomosis technique and the operative time and surgical complications.MethodsThis is a retrospective cohort study that analyzed the data of patients who underwent laparoscopic pancreaticoduodenectomy from January 2015 to March 2021. The primary outcome was to explore the association between the modified Blumgart anastomosis technique and operative time.ResultsA total of 282 patients were enrolled. There were 177 cases of pancreatic duct-to-mucosa anastomosis in the traditional surgery group, and 105 cases of the modified three-step Blumgart anastomosis in the modified group. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (P > 0.05). The surgical method was an independent predictor of operative time. Overall complications postsurgery were less common in the modified group than in the traditional group. The incidence of postoperative pancreatic fistula was higher in the traditional group than in the modified group (45 cases (25.4%) and 11 cases (10.5%), respectively). Fourteen cases (7.9%) in the traditional group and four case (3.8%) in the modified group had postoperative pancreatic fistula of grades B + C. The two groups had statistically significant differences (P < 0.05). The results of the linear regression showed that the type of surgical method was associated with operation time (95% CI, −73.074 to −23.941, β: −0.438, P < 0.001).ConclusionThis modified three-step Blumgart pancreaticojejunostomy was associated with the operation time.

Surgical Treatment of Osteochondral Lesions of the Talar Dome: Review

Background. The relevance of the talar dome osteochondral lesions problem is assosiated with the difficulties of diagnosis, the lack of unified treatment algorythm and the great number of unsatisfactory clinical and functional results. In the last decade, there has been increasing interest in this topic in the literature, which is demonstrated by a great number of publications with series of observations or clinical cases. However, attempts to create the universal algorithm for this group of patients treatment are limited by the low level of existing studies evidence, high frequency of the new data publications, as well as the impossibility of using a number of surgical methods in different countries for legislative or other reasons. The aim is to determine the current state of the problem of the talar dome osteochondral lesions surgical treatment and to identify types of surgical interventions in patients with the studied pathology. Material and methods. 120 international articles published from 2000 to 2021, as well as 18 domestic publications for the period from 2007 to 2021 were selected for the literature analysis. The search for publications was carried out in the PubMed/MedLine and eLibrary databases. Results. The most widespread are surgical interventions aimed at stimulation of the bone marrow, and plastic surgery using osteochondral auto - and allografts. Currently, there is no consensus on the indications for different types of surgical methods, and the previously used indications are being questioned. This determines the need to improve diagnostic and treatment concepts. Conclusion. The studied literature cannot fully answer a number of questions related to the methods of surgical treatment of patients with symptomatic osteochondral lesions of the talar dome and indications for them. A more detailed assessment of the medium- and long-term clinical outcomes of various surgical methods and the development of algorithms for this group of patients treatment, specific for different countries, are needed.

A Split Mouth Study on Crestal Bone Architectural Changes by Flapped and Flapless Implant Surgical Procedures

Background: Rehabilitations by dental implants have often been utilized as an efficient procedure for restoring missing teeth. For implant placement two types of surgical methods are well documented. Conventional surgical approach involves raising a mucoperiosteal flap to gain access and see the underlying alveolar bone, instead there is this procedure which does not involve the reflection of the flap. Both the techniques are known to have their individual benefits and shortcomings. The present study was aimed to evaluate the longitudinal comparison and evaluation of hard tissue changes around endosseous implants placed using flapped as well as flapless surgical procedures in mandibular first molar region.&#x0D; Materials and Methods: A total of 10 healthy patients with bilateral mandibular first molar were involved in the study and 20 endosseous implants were inserted (10 in each group). Radiographic assessment was done for deviations in the marginal bone levels on both mesial and distal side and their average value was calculated at 1 month, and 3 months. All these parameters were statistically analyzed using the paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05.&#x0D; Results: During the 3 months observation period, the change in crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less reduction in the crestal bone height compared to the flap group.&#x0D; Conclusion: Both flap and the flapless techniques of endosseous implant placement had statistically significant effect on peri-implant bone loss over the 3 month period.

Surgical Treatment of Comminuted Olecranon Fracture Using Locking Compression Plate Fixation

Purpose: Several types of surgical methods from tension band wiring to plate fixation are used in olecranon fractures. In comminuted olecranon fractures, plate fixation is recommended as it is difficult to obtain stable fixation of the bone fragments and joint congruency. The authors performed operations using compression locking plate for olecranon fractures corresponding to Mayo classification IIB and IIIB, and report the radiologic and functional results.Methods: Twenty-one patients who underwent plate fixation surgery for comminuted olecranon fractures at our hospital from September 2011 to April 2019 were enrolled in this study. Patients were retrospectively analyzed for at least 1 year. The classification of olecranon fracture was performed using the Mayo classification. For the analysis of the postoperative results, radiological union time, postoperative range of motion, complications, and functional results based on Mayo elbow performance score (MEPS) were evaluated.Results: The union was achieved in all cases and three posttraumatic arthritis were observed at the final follow-up. The average range of motion was 134.3° in flexion, –9.8° in extension. The mean MEPS was 93.1. There was no statistically significant difference in MEPS between the group that used technique of interfragmentary fixation and the group that did not (p=0.534).Conclusion: Surgical treatment using a locking compression plate fixation in comminuted olecranon fracture resulted in excellent functional results. Restoration of articular surface using Kirschner wire or interfragmentary screw between small bone fragments is considered a useful method for obtaining good functional results.

Management of retinitis pigmentosa by Wharton\u2019s jelly derived mesenchymal stem cells: preliminary clinical results

PurposeThe aim of this study is to determine if umbilical cord Wharton’s jelly derived mesenchymal stem cells implanted in sub-tenon space have beneficial effects on visual functions in retinitis pigmentosa patients by reactivating the degenerated photoreceptors in dormant phase.Material and methodsThis prospective, open-label, phase-3 clinical trial was conducted between April of 2019 and October of 2019 at Ankara University Faculty of Medicine, Department of Ophthalmology. 32 RP patients (34 eyes) were included in the study. The patients were followed for 6 months after the Wharton’s jelly derived mesenchymal stem cell administration, and evaluated with consecutive examinations. All patients underwent a complete routine ophthalmic examination, and best corrected visual acuity, optical coherens tomography angiography, visual field, multifocal and full-field electroretinography were performed. The quantitative results were obtained from a comparison of the pre-injection and final examination (6th month) values.ResultsThe mean best corrected visual acuity was 70.5 letters prior to Wharton’s jelly derived mesenchymal stem cell application and 80.6 letters at the 6th month (p = 0.01). The mean visual field median deviation value was 27.3 dB before the treatment and 24.7 dB at the 6th month (p = 0.01). The mean outer retinal thickness was 100.3 μm before the treatment and 119.1 μm at 6th month (p = 0.01). In the multifocal electroretinography results, P1 amplitudes improved in ring1 from 24.8 to 39.8 nv/deg2 (p = 0.01), in ring2 from 6.8 to 13.6 nv/deg2 (p = 0.01), and in ring3 from 3.1 to 5.7 nv/deg2 (p = 0.02). P1 implicit times improved in ring1 from 44.2 to 32.4 ms (p = 0.01), in ring2 from 45.2 to 33.2 ms (p = 0.02), and in ring3 from 41.9 to 32.4 ms (p = 0.01). The mean amplitude improved in 16 Tds from 2.4 to 5.0 nv/deg2 (p = 0.01) and in 32 Tds from 2.4 to 4.8 nv/deg2 (p = 0.01) in the full-field flicker electroretinography results. Full field flicker electroretinography mean implicit time also improved in 16 Tds from 43.3 to 37.9 ms (p = 0.01). No ocular or systemic adverse events related to the two types of surgical methods and/or Wharton’s jelly derived mesenchymal stem cells itself were observed during the follow-up period.ConclusionRP is a genetic disorder that can result in blindness with outer retinal degeneration. Regardless of the type of genetic mutation, sub-tenon Wharton’s jelly derived mesenchymal stem cell administration appears to be an effective and safe option. There are no serious adverse events or ophthalmic / systemic side effects for 6 months follow-up. Although the long-term adverse effects are still unknown, as an extraocular approach, subtenon implantation of the stem cells seems to be a reasonable way to avoid the devastating side effects of intravitreal/submacular injection. Further studies that include long-term follow-up are needed to determine the duration of efficacy and the frequency of application.Trial registrationSHGM56733164. Redistered 28 January 2019 https://shgm.saglik.gov.tr/organ-ve-doku-nakli-koordinatorlugu/56733164/203 E.507.

Comparison of hemorrhoidectomy using harmonic scalpel and electrocautery: A randomized controlled trial

AimHemorrhoids of grade III and IV require surgical management. Recurrence and postoperative pain have been reported to be associated with the type of surgical method. The aim of this study was to compare the hemorrhoidectomy using harmonic and electrocautery scalpel. Materials and methodsThe present study was a randomized clinical trial, enrolling patients with grade III and IV hemorrhoids. The patients were randomly divided into the two groups A and B, to receive hemorrhoidectomy using electrocautery and harmonic scalpel, respectively. Outcomes such as postoperative pain, bleeding and recurrence of hemorrhoids were recorded for all the patients. The data were analyzed statistically using SPSSv22. ResultsThe demographic data was not significantly different among the two groups P < 0.05. The incidence of postoperative bleeding was greater in electrocautery group, however, non-significantly, p = 0.41. The recurrence of hemorrhoids was reported in 2 patients following 3 months in group A. At 6-month follow-up, 71.4% patients in group A and 28.6% in group B had recurrence of hemorrhoids. The pain was significantly lesser in group B p = 0.017. ConclusionHemorrhoidectomy using harmonic scalpel is significant associated with reduced postoperative pain. Postoperative bleeding was also non-significantly lesser in this group.

Surgery for Pulmonary Hydatidosis in Turkey in 2014: A Nationwide Study.

Turkey remains among the countries where hydatid disease is endemic. In this study, it was aimed to determine the number of operations performed for the treatment of pulmonary hydatid disease in Turkey during 2014 and to present the distribution of these operations according to the different regions of the country. The Turkish Thoracic Society Thoracic Surgery Study Group connected with the thoracic surgeons in each city through telephone. A data set was sent by email. The age, sex, contact with animals that might be a risk of gaining the hydatid disease, the side of the disease, the type of surgical method, other organ involvement were recorded and collected from each data set to form the final data, and the results were evaluated. Turkey comprises of 81 cities that are grouped in seven different regions. The number of operations was calculated for each city and region to present the distribution. Overall, 101 centers from 81 cities were considered in the study. A total of 715 pulmonary hydatid cyst operations were performed in 690 patients during the study period. The most common operation technique was cystotomy and capitonnage through thoracotomy (76%). The highest incidence rate of operated patients was in the Eastern Anatolian Region (2.15 patients per 100 000 person-years). Pulmonary hydatid disease still has a high incidence rate particularly in the southeast and east of Turkey, which are mainly rural areas and where stockbreeding is very common. Cystotomy and capitonnage is still the most common surgical method used to treat pulmonary hydatid cysts. Preventive methods should be performed strictly in these cities and regions to decrease the risk of infection.

COLORECTAL CARCINOMA;

Background: Colorectal carcinoma is one of the most frequently diagnosed malignant diseases in men and women respectively. The frequency of postoperative complications was more in the open colorectal surgery than the laproscopic technique. Objectives: To examine the prevalence of early post operative complications/problems in patients whom treated surgery for colorectal carcinoma with open and laproscopic methods. Study Design: Cross-sectional study. Place and Duration of Study: Ghulam Muhammad Mahar Medical College Hospital, Sukkur and Jinnah Postgraduate Medical Centre, Karachi from 1st January 2016 to 31st December 2017. Material and Methods: One hundred and twenty patients included both men and women whom had undergone colorectal carcinoma surgery with open and laproscopic techniques. Patients aged between 20 to 61 years. Collected and recorded information demographically, prevalence of early postoperative complications and types of surgical methods was acquired. Patients who had rectal or any other carcinoma were excluded from study. Results: Out of 120 patients, 64 (53.33%) men and 56 (46.67%) women, mean age of both gender calculated 38.95+11.5 respectively. Surgical wound infection observed in 18 (15%) and not found in 102 (75%) patients. 10 (8.33%) patient observed abdominal abscess and 110 (91.67%) had no abdominal abscess. Out of 18 wound infected patients 8 (6.7%) had treated laproscopic surgery and 10 (8.33%) had treated open CRC surgery. In abdominal abscess patients 3 (2.5%) and 7 (5.83%) had treated LCS (laproscopic surgery) and open CRC surgery respectively. The presence of wound infection significantly associated with type of surgical method by using chi-square method having p-value 0.028. The presence of abdominal abscess was significantly associated with surgical technique having p-value 0.026. Conclusion: The frequency of early post operative complication was more common in the open colorectal carcinoma surgery than in laproscopic surgery. The presence of wound infection and abdominal abscess was found significantly associated with surgical methods or techniques.

Functional outcome of Vacuum Assisted Closure (VAC) dressing therapy for the management of non-healing wound and traumatic wound

Introduction: Wound healing is a complex, dynamic process and delayed wound healing significant health problem in India. Various type of surgical methods have been developed for wound healing such as Advanced Wound Care Therapies (AWCT)/ Vacuum-Assisted Closure (VAC) and myo-cutaneous or fascio-cutaneous tissue transfers, Stander dressing therapy etc. VAC Therapy is a Non-Invasive therapy. This therapeutic technique using for the management of large chronically infected wounds more recently used in the treatment of traumatic wounds and non-healing wounds. Aim: Aim of this study is to evaluate functional outcome of vacuum-assisted closure (VAC) dressing therapy for the management of non-healing wounds and traumatic wounds. Materials and methods: Our study was conducted on 30 patients in the Department of Orthopaedics, Kamineni Hospital, LB Nagar Hyderabad from May 2017 to June 2018. Out of 30 patients 18 male and 12 females, Mean age ranging from 19 to 58 for males and 20 to 60 for females. In our study, maximum cases were reported Road traffic accident 20 (67%) patients, followed by machinery injury in 6 (20%) patients and 4 (13%) patients had a fall from height. Vacuum Assisted Closure (VAC) dressing therapy applied for non-healing wounds and traumatic wounds. Results: Out of 30 wounds taken in the study, 20 wounds reduced in area & were resurfaced with split thickness skin grafting and 5 wounds showed reduction in area & were subjected to secondary closure. During start of VAC dressing therapy, all wounds were infected. At the end of VAC dressing, all wounds became swab negative during course of VAC dressing therapy, no patient required surgical debridement and there was gradual decrease in size of wound. Discussion: Our study showed that in VAC dressing therapy after day 3, there were 40% of patients who had no bacterial growth, and on day 7 there were 88% of patients who growth, whereas in saline-wet-to-moist patients only 10% of patients had no bacterial growth on the 8th day. Our study showed that VAC dressing therapy increases the vascularity and rate of granulation tissue formation compared to standard wound dressing therapy. Conclusion: VAC dressing provides sterile and controlled environment to large, educating wound surfaces by controlled application of sub-atmospheric pressure and prepares wounds for closure through split skin grafting and secondary closure in short time leading to less overall morbidity with decreased hospital stay.

In-Hospital Mortality After Spinal Surgery in Hemodialysis Patients: An 11-Year Population-Based Study

Patients with end-stage renal disease (ESRD) are at an increased risk of surgical mortality. We aimed to investigate the factors associated with in-hospital mortality in patients with ESRD who underwent spinal surgery, which remains to be determined. An age- and sex-matched cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 2000 and December 2012. Kaplan-Meier curves were plotted with log-rank test to compare the differences between these 2 groups. The Cox proportional hazard model was used to estimate the hazard ratio of in-hospital mortality adjusted with potential confounding. In total, 4109 participants with pre-existing ESRD and 8218 patients without ESRD were included. The in-hospital mortality in ESRD (10.17%) was greater than without ESRD (1.39%). Spinal surgery patients with pre-existing ESRD had a 6.78-fold increase in-hospital mortality risk compared with those without ESRD. Spinal surgery patients with ESRD of any age, male or female, and comorbidities experienced a greater incidence of hospital mortality. In patients with ESRD, operations on spinal cords and spinal canal structures had the greatest hospital mortality (14.87%) compared with spinal fusion (3.46%) or excision or destruction of intervertebral disc (3.01%). Kaplan-Meier survival curves showed that patients with ESRD experienced greater hospital mortality than patients without ESRD in all 3 spinal surgery methods (log rank P < 0.0001). Spinal surgery patients with ESRD have greater in-hospital mortality than patients without ESRD. Age, sex, history of comorbidities, and types of surgical methods were associated with greater in-hospital mortality among patients with ESRD.

Varicocele and Testicular Pain: A Review.

Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.

Comparative study between vasectomy and epididymectomy for preparation of teaser Ram

Teaser rams were used for discovering estrus in ewes because this techniqueis very important for super ovulation,embryo transfer and transgenic animalsprograms.sever techniques were used for preparation of teaser animalsespecially in sheeps so this study was designed to compare between twosurgical methods (vasectomy and epididymectomy).Six Assaf of breed rams,Clinical reproduction system,libido and laboratoryexamination (volume ejaculate,mass and individual motility and spermconcentration). were performed 2 week before experiment for qualificationof the general health of the animals the animals were divided into two equalgroups, Vasectomy in the first group and epididymectomy in theanother.Cases were followed up clinically, laboratory examination andhistological.Results showed that surgery of epididymectomy takes longer time thanvasectomy.Vasectomiesed animals showed sever pain during first tow dayswith simple adhesion in the site of operation, while epididymectomy causedsever adhesion between the testis and skin with odema in the site ofoperation also the pain was sever in addition to, it takes longer time than invasectomy. The seminal fluid examination showed disappear of life spermsimmediately after operation vasectomy or epididymectomy also histologicalchanges were obtained in both types of surgical methods ,which includereduce in the rate of spermatogenisis, thickness of basement membren,whilethese changes were more sever after vasectomy.Results of this study was showed that epididymectomy technique shouldsuperior results than vasectomy for longer time.

Bilateral tumors of the upper urothelium

The incidence of tumors of the upper urothelium is high in our country, apart from their relation to specific regions (BEN and PBEN) and their frequent bilateralism. Bilateral forms are present in significant percentage and are followed, in most cases, by renal failure, which speaks in favor of conservative surgery, if possible. The aim of the study was to present epidemiological, pathoanatomical and clinical characteristics of bilateral tumors of the upper urothelium and evaluate the results of their treatment. Our retrospective study analyzed 12 patients with bilateral tumors of the upper urothelium who were treated in the period from 1992 to 1996, according to their epidemiological, clinical, pathoanatomical and pathohistological characteristics, type of surgical treatment and relevant success. In the observed period, bilateral tumors of the upper urothelium were found in 8.2% of our patients. In the group of 12 patients, 5 females and 7 males, 11 cases were from the region of Balkan Endemic Nephropathy (BEN). Renal failure was recorded in high percentage (66%). Radical surgical treatment--total nephroureterectomy was performed in 9 kidney units, and conservative operation in 15 units. Relapse significantly depended on tumor stage and grade, not on type of surgical treatment in the majority of cases. Five-year survival was 58.33%; major cause of death was associated with further evolution of tumor, recurrence and tumor dissemination, respectively, while renal failure complications were the cause of death in one case. The success of treatment mainly depends on tumor stage and grade and not on type of surgical method in conservative treatment, but renal failure and its complications are an important risk factor in these patients.

上顎歯列の狭窄を伴う顎変形症に対して，Ｌｅ Ｆｏｒｔ Ｉ型骨切り術に口蓋傍正中分割を加えた２例

Surgical orthodontic treatment of jaw deformity with marked maxillo-mandibular dental arch disharmony sometimes requires surgical expansion or reduction of the dentition, and various types of surgical methods have been reported. In this study, surgical lateral expansion was performed in two cases of jaw deformity with a constricted maxillary dental arch, using the Le Fort I osteotomy with a parasagittal split of the palatine bone reported by Obwegeser.In case 1, since relapse after postoperative orthodontic treatment was not taken into account, the dental arch widthdecreased. In case 2, although surgical expansion was insufficient due to marked constriction of the maxillary dentition, lateral expansion by postoperative orthodontic treatment was performed, and expansion of the maxillary dental arch was possible.This method was considered useful, since greater palatine arteriovenous and tooth root injury can be avoided. Furthermore, although control of postoperative relapse is important, our results suggested that the maxillary dental arch can be further expanded bypostoperative orthodontic treatment.

Study of lymphatic mapping and sentinel node identification in early stage cervical cancer

Objective. The aim of our study was to compare the identification of sentinel lymph nodes (SLN) by blue dye and 99m Tc; to evaluate detection rate per patient and specific side detection rate (SSDR) of SLN, distribution of SLN and distribution of positive SLN and false negative rate of the methods. Patients and methods. From February 2000 until September 2004, we included 183 women with early stage cervical carcinoma. We evaluated two methods of detection of SLN (100 cases by Patent blue, 83 cases by Patent blue with 99mTc). We stratified the group upon the size of the tumor and upon the type of surgical method (laparoscopy, laparotomy). Results. SLN identification increased in cases when we used combination of both methods (Tc + blue dye) SSDR = 93% versus the use of blue dye only SSDR = 71% (OR:5,76, CI 95% −2.9 −11.4, <0.0001). Distribution of 462 SLN—45.0% external iliac artery and vein, 42.6% supraobturator, 4.8 bifurcation and common illiac artery and vein, 4.6% praesacral, 3% medial part of lateral parametrium. Distribution of 44 positive SLN—approximately 38.6% external illiac artery and vein, 45.5% supraobturator, 6.8% bifurcation and common illiac artery and vein, 4.5% praesacral, 4.5% medial part of lateral parametrium. One false negative SN was in presacral area. Conclusion. Detection of SLN by combination of 99mTc and blue dye was statistically significantly better than blue dye alone. Our study documents high sensitivity, specificity and low false negativity of the method.

Repeating rhytidoplasty with SMAS, malar fat pad, and labiomandibular fold treatment: the NO primary procedure.

To repeat a rhytidoplasty means to do it again, with the exclusive aim of correcting the consequences on the facial aging. A short historic outline of the SMAS evolution is made. When the rhytidoplasty is repeated, the following aspects have to be taken into consideration: 1. The preoperative study, that includes analyzing previous rhytidoplasties; satisfaction or nonsatisfaction; sideburn, its location; hairline, its location; scars, their location and aspects; irregularities, their characteristics; nerve injuries, their detection; flaccidity, its evolution. 2. The surgical method to be practiced, which consists of skin dissection, subcutaneous fatty tissue treatment; SMAS treatment, and skin treatment. The types of surgical methods are: how the inferior third of the face and neck are corrected through the great mobility of the SMAS in this region, while in the medium third of the face the "nasolabial fold" and the midface flaccidity are corrected by treating the "malar fat pad." 3. In the chin region, the formation of a "labiomandibular fold" and how it is liberated and treated is described.