Minimally invasive strabismus surgery for rectus muscle posterior fixation

AIMS: To present a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle posterior fixation. METHODS: This study reports the results of 32 consecutive MISS rectus muscle posterior fixation surgeries performed on 19 patients by applying only two small L-shaped openings where the two retroequatorial scleromuscular sutures were placed. RESULTS: On the first postoperative day, in primary position, redness was hardly visible in 16 eyes (50%) and only moderate redness was visible in 6 eyes (19%). No serious complication occurred. Preoperative visual acuity and refraction remained unchanged at 6 months (p > 0.1). The preoperative convergence excess (n = 13) decreased from 10.3 +/- 4.1 to 5.2 +/- 4.0 degrees at 6 months (p < 0.005). In all patients operated on for gaze incomitance (n = 6) improvement was achieved at 6 months. CONCLUSIONS: This study shows that keyhole minimal-dissection rectus muscle posterior fixation surgery is feasible and effective to improve ocular alignment. The MISS technique seems to be superior in the direct postoperative period since only minimal conjunctival swelling and no corneal complications were observed.

[Opinions of German-Speaking Experts about Strabismus Surgery.]

BACKGROUND: There is a lack of studies about how to proceed surgically in rare strabismus diseases. It was the aim of this study to inteview experienced German-speaking strabismologists about how they perform surgery in rare but also some frequent strabismic conditions. The focus was on the choice of the technique, the timing, and the dosage. METHOD: A validated questionnaire was sent to 11 experienced strabismus surgeons. It contained questions about the following topics: congenital fibrosis syndrome, Jaentsch-Brown syndrome, intermittent exotropia, maximum dosage for rectus muscle surgery, Kestenbaum surgery, sixth nerve palsy, heterophorias, myokymia of the superior oblique muscle, thyroid endocrine orbitopathy, dissociated vertical deviation, adjustable sutures, advancement of previously recessed rectus muscles, retroequatorial myopiexia, and congenital esotropia. RESULTS: Ten experts answered the questionnaire (91 %). There was a large consent for many topics. However, for many procedures there was disagreement about the dosage and the timing. Since some questions addressed rare diseases and many strabismologists use only certain types of surgical procedures, some questions could only be answered by a few surgeons. CONCLUSIONS: German-speaking strabismologist show a large consensus about the type of surgical procedure to use, but often disagree about the dosage and timing of the operation.

Non-selective cutaneous sensory neurectomy as an alternative treatment for auto-mutilation lesion following arthrodesis in three dogs

OBJECTIVE: To describe an alternative method for the treatment of non-responsive self-mutilation injuries in three dogs after carpal/tarsal arthrodesis. STUDY DESIGN: Case series ANIMALS: Two dogs with carpal injury and one dog with tarsal injury treated by arthrodesis METHODS: All dogs developed self-mutilation injuries due to licking and/or chewing of the toes within 21-52 days of surgery. Clinical signs did not resolve within one week after conservative treatment with wound debridement and protective bandages. Following general anaesthesia, a deep horseshoe-shaped skin incision, including the subdermal tissue, was performed proximal to the self-mutilation injury transecting the sensory cutaneous afferent nerves. The skin incision was closed with simple interrupted sutures. RESULTS: All wounds healed without complication. Self-mutilation resolved completely within 24 hours after surgery in all dogs. No recurrence was observed (5 months to 3 years). CONCLUSION: Non-selective cutaneous sensory neurectomy may lead to resolution of self-mutilation following arthrodesis in dogs. CLINICAL RELEVANCE: Failure of conservative treatment in self-mutilation injuries often leads to toe or limb amputation as a last resort. The technique described in this case series is a simple procedure that should be considered prior to amputation. The outcome of this procedure in dogs self-multilating due to neurological or behavioral disturbances unrelated to carpal or tarsal arthrodesis is not known.

Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste

OBJECTIVES The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

Novel prototype sewing device, EndoSew ® , for minimally invasive surgery: an extracorporeal ileal conduit construction pilot study in 10 patients

What's known on the subject? and What does the study add? The EndoSew® prototype was first tested in a porcine model several years ago. The investigators found it both simple to master and reliable, its greatest advantage being a 2.4-fold time saving compared with straight laparoscopic suturing. In addition to that publication, there is a single case report describing the performance of an open EndoSew® suture to close parts (16 cm) of an ileal neobladder. The time for suturing the 16 cm ileum was 25 min, which is in line with our experience. The knowledge on this subject is limited to these two publications. We report on the first consecutive series of ileal conduits performed in humans using the novel prototype sewing device EndoSew®. The study shows that the beginning and the end of the suture process represent the critical procedural steps. It also shows that, overall, the prototype sewing machine has the potential to facilitate the intracorporeal suturing required in reconstructive urology for construction of urinary diversions. Objective To evaluate the feasibility and safety of the novel prototype sewing device EndoSew® in placing an extracorporeal resorbable running suture for ileal conduits. Patients and Methods We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew® running suture. The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew® only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14. Secondary endpoints were the time requirements and complications ≤30 days after surgery. Results A complete EndoSew® running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure. In three patients, two additional single freehand stitches were needed to anchor the thread and to seal tiny leaks. Consequently, all suture lines in 6/10 patients were watertight with EndoSew® suturing alone and in 10/10 patients after additional freehand stitches. The median (range) sewing time was 5.5 (3–10) min and the median (range) suture length was 4.5 (2–5.5) cm. There were no suture-related complications. Conclusions The EndoSew® procedure is both feasible and safe. After additional freehand stitches in four patients all sutures were watertight. With further technical refinements, EndoSew® has the potential to facilitate the intracorporeal construction of urinary diversions.

Only Neochordoplasty Achieves Physiological Trans-valvular Pressure Gradients After Repair Of Acute Posterior Leaflet Prolapse In Porcine Mitral Valves

Objective: Minimizing resection and preserving leaflet tissue has been previously shown to be beneficial for mitral valve function and leaflet kinematics after repair of acute posterior leaflet prolapse in porcine valves. We examined the effects of different additional methods of mitral valve repair (neochordoplasty, ring annuloplasty, edge-to-edge repair and triangular resection) on hemodynamics at different heart rates in an experimental model. Methods: Severe acute P2 prolapse was created in eight porcine mitral valves by resecting the posterior marginal chordae. Valve hemodynamics was quantified under pulsatile conditions in an in vitro heart simulator before and after surgical manipulation. Mitral regurgitation was corrected using four different methods of repair on the same valve: neochordoplasty with expanded polytetrafluoroethylene sutures alone and together with ring annuloplasty, edge-to-edge repair and triangular resection, both with non-restrictive annuloplasty. Residual mitral valve leak, trans-valvular pressure gradients, flow and cardiac output were measured at 60 and 80 beats/min. A validated statistical linear mixed model was used to analyze the effect of treatment. The p values were calculated using a two-sided Wald test. Results: Only neochordoplasty with expanded polytetrafluoroethylene sutures but without ring annuloplasty achieved similar hemodynamics compared to those of the native mitral valve (p range 0.071-0.901). Trans-valvular diastolic pressure gradients were within a physiologic range but significantly higher than those of the native valve following neochordoplasty with ring annuloplasty (p=0.000), triangular resection (p=0.000) and edge-to-edge repair (p=0.000). Neochordoplasty alone was significantly better in terms of hemodynamic than neochordoplasty with a ring annuloplasty (p=0.000). These values were stable regardless of heart rate or ring size. Conclusions: Neochordoplasty without ring annuloplasty is the only repair technique able to achieve almost native physiological hemodynamics after correction of leaflet prolapse in a porcine experimental model of acute chordal rupture.

Sutureless aortic valve replacement: a systematic review and meta-analysis.

BACKGROUND Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. METHODS Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. CONCLUSIONS The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.

Illustrated Catalogue of Standard Surgical Instruments and Allied Lines

Section "A": Dissecting and Post-Mortem Instruments Diagnostic Instruments and Apparatus Microscopes and Microscopic Accessories Laboratory Apparatus and Glass Ware Apparatus for Blood and Urine Analysis Apparatus for Phlebotomy, Cupping and Leeching Apparatus for Infusion and Transfusion Syringes for Aspiration and Injection Osteological Preparations Section "B": Anaesthetic, General Operating, Osteotomy, Trepanning, Bullet, Pocket Case, Cautery, Ligatures, Sutures, Dressings, Etc. Section "B" continued Section "C": Eye, Ear, Nasal, Dermal, Oral, Tonsil, Tracheal, Laryngeal,Esophageal, Stomach, Intestinal, Gall Bladder Section "C": continued Section "D": Rectal, Phimosis, Prostatic, Vesical, Urethral, Ureteral, Instruments Section "E": Gynecic, Hysterectomy, Obstetrical, Instrument Satchels, Medicine Cases Section "F": Electric Cautery Transformers, Electro-Cautery Burners and Accessories, Electric Current Controllers, Electro-Diagnostic Outfits, Electrolysis Instruments Electro-Therapeutic Lamps, Faradic Batteries, Galvanic Batteries Section "G": Office Furniture, Office Sterilizing Apparatus, Hospital Supplies, Surgical Rubber Goods, Sick Room Utensils, Invalid Rolling Chairs, Invalid Supplies Section "H": Artificial Limbs, Deformity Apparatus, Fracture Apparatus, Splints, Splint Material, Elastic Hosiery, Abdominal Supporters, Crutches, Trusses, Suspensories, Etc. Index

Stable isotope and Mg/Ca record of Globigerinoides ruger morphotypes

Tests of the planktonic foraminifer Globigerinoides ruber (white; d'Orbigny) have become a standard tool for reconstructing past oceanic environments. Paleoceanographers often utilize the Mg/Ca ratios of the foraminiferal tests for reconstructing low-latitude ocean glacial-interglacial changes in sea surface temperatures (SST). We report herein a comparison of Mg/Ca measurements on sample pairs (n = 20) of two G. ruber (white) morphotypes (G. ruber sensu stricto (s.s.) and G. ruber sensu lato (s.l.)) from surface and downcore samples of the western Pacific and Indian Oceans. G. ruber s.s. refers to specimens with spherical chambers sitting symmetrically over previous sutures with a wide, high arched aperture, whereas G. ruber s.l. refers to a more compact test with a diminutive final chamber and small aperture. The G. ruber s.s. specimens generally show significantly higher Mg/Ca ratios compared to G. ruber s.l. Our results from the Mg/Ca ratio analysis suggest that G. ruber s.l. specimens precipitated their shells in slightly colder surface waters than G. ruber s.s. specimens. This conclusion is supported by the differences in delta18O and delta13C values between the two morphotypes. Although it is still unclear if these two morphotypes represent phenotypic variants or sibling species, our findings seem to support the hypothesis of depth and/or seasonal allopatry within a single morphospecies.

Discursos identitarios y articulación política en el campo popular argentino

El presente artículo explora los diferentes elementos político-ideológicos sobre los que se construyen los discursos identitarios de una serie de organizaciones del llamado movimiento piquetero analizando el modo en que dichos elementos operan en las modalidades que adquiere la articulación política en el campo popular argentino. Me interesa observar, en este sentido, los tipos de suturas o cierres, presentes en los discursos identitarios, que se hacen a la hora de explicar y aprehender el universo de lo social en general y el de lo político en particular. Distinguiré una serie de dimensiones en torno de las cuales, las organizaciones van tomando posición y estructurando sus discursos. Desde esta perspectiva, orientada por los aportes teóricos de Ernesto Laclau y Chantal Mouffe, se busca comparar las diferentes fijaciones de sentido que se observan en cada dimensión de los discursos y sus derivaciones respecto a las posibilidades de desarrollar procesos de articulación política

Discursos identitarios y articulación política en el campo popular argentino

El presente artículo explora los diferentes elementos político-ideológicos sobre los que se construyen los discursos identitarios de una serie de organizaciones del llamado movimiento piquetero analizando el modo en que dichos elementos operan en las modalidades que adquiere la articulación política en el campo popular argentino. Me interesa observar, en este sentido, los tipos de suturas o cierres, presentes en los discursos identitarios, que se hacen a la hora de explicar y aprehender el universo de lo social en general y el de lo político en particular. Distinguiré una serie de dimensiones en torno de las cuales, las organizaciones van tomando posición y estructurando sus discursos. Desde esta perspectiva, orientada por los aportes teóricos de Ernesto Laclau y Chantal Mouffe, se busca comparar las diferentes fijaciones de sentido que se observan en cada dimensión de los discursos y sus derivaciones respecto a las posibilidades de desarrollar procesos de articulación política

Discursos identitarios y articulación política en el campo popular argentino

El presente artículo explora los diferentes elementos político-ideológicos sobre los que se construyen los discursos identitarios de una serie de organizaciones del llamado movimiento piquetero analizando el modo en que dichos elementos operan en las modalidades que adquiere la articulación política en el campo popular argentino. Me interesa observar, en este sentido, los tipos de suturas o cierres, presentes en los discursos identitarios, que se hacen a la hora de explicar y aprehender el universo de lo social en general y el de lo político en particular. Distinguiré una serie de dimensiones en torno de las cuales, las organizaciones van tomando posición y estructurando sus discursos. Desde esta perspectiva, orientada por los aportes teóricos de Ernesto Laclau y Chantal Mouffe, se busca comparar las diferentes fijaciones de sentido que se observan en cada dimensión de los discursos y sus derivaciones respecto a las posibilidades de desarrollar procesos de articulación política

Composition of rocks and minerals from the Bolshoy Lyakhovsky Island (New Siberian Islands)

In the southeast of the Bolshoi Lyakhovsky Island there are outcrops of tectonic outliers composed of low-K medium-Ti tholeiitic basic rocks represented by low altered pillow basalts, as well as by their metamorphosed analogs: amphibolites and blueschists. The rocks are depleted in light rare-earth elements and were melted out of a depleted mantle source enriched in Th, Nb, and Zr also contributed to the rock formation. The magma sources were not affected by subduction-related fluids or melts. The rocks were part of the Jurassic South Anyui ocean basin crust. The blueschists are the crust of the same basin submerged beneath the more southern Anyui-Svyatoi Nos arc to depth of 30-40 km. Pressure and temperature of metamorphism suggest a setting of "warm" subduction. Mineral assemblages of the blueschists record time of a collision of the Anyui-Svyatoi Nos island arc and the New Siberian continental block expressed as a counter-clockwise PT trend. The pressure jump during the collision corresponds to heaping of tectonic covers above the zone of convergence 12 km in total thickness. Ocean rocks were thrust upon the margin of the New Siberian continental block in late Late Jurassic - early Early Cretaceous and mark the NW continuation of the South Anyui suture, one of the main tectonic sutures of the Northeastern Asia.

Benthic foraminifera of the central Indian Ocean

Late Oligocene to late Pliocene vertical water-mass stratification along depth traverses in the northern Indian Ocean is depicted in this paper by benthic foraminifer index faunas. During most of this time, benthic faunas indicate well-oxygenated, bottom-water conditions at all depths except under the southern Indian upwelling and in the Pliocene in the southern Arabian Sea. Faunas suggest the initiation of lower oxygen conditions at intermediate depths in the northern Indian Ocean beginning in Oligocene Zone P21a. Lower oxygen conditions intensified during primary productivity pulses, possibly related to increased upwelling vigor, in the latest Oligocene and throughout most of the late middle through late Miocene. During times of elevated primary production, there may be more oxygen flux into sedimentary pore waters and the shallow infaunal habitat may become more oxygenated. One criterion for locating the source of "new" water masses is vertical homogeneity of benthic foraminifer indexes for well-oxygenated water masses from intermediate through abyssal depths. In the northern Mascarene Basin, this type of faunal homogeneity with depth corroborates the proposal that the northern Indian Ocean was an area of sinking well-oxygenated waters through most of the Miocene before Zone N17. Oxygenated, possibly "new" intermediate-water masses in the low- to middle-latitude Mascarene and Central Indian basins first developed in the late Oligocene. These well-oxygenated waters were probably more fertile than the Antarctic Intermediate Waters (AAIW) that cover intermediate depths in these areas today. Production of intermediate waters more similar to modern AAIW is indicated by the sparse benthic population of epifaunal rotaloid species in the northern Mascarene Basin during middle Miocene Zone N9 and from early through late Pliocene time. Deep-water characteristics are more difficult to interpret because of the extensive redeposition at the deeper sites. Redeposited intermediate, rather than shallow, water fossils and erosion from north to south in the Mascarene Basin are incompatible with the sluggish circulation from south to north through the western Indian Ocean basins today. Such erosion could result from the vigorous sinking of an intermediate-depth water mass of northern origin. Before late Oligocene Zone P22, benthic faunas indicate a twofold subdivision of the troposphere, with the boundary between upper and lower well-oxygenated water masses located from 2500-3000 mbsl. No characteristic bottom-water fauna developed before the end of late Oligocene Zone P22. Deep and abyssal benthic indexes suggest the development of water masses similar to those of the present day in the latest Miocene. Faunas containing deep-water benthic indexes, including the uvigerinids, suggestive of a water mass similar to modern Indian Deep Water (IDW), appeared during the late Miocene in the northern Mascarene and Central Indian basins. In the early Pliocene, this deep-water fauna was found only in the Central Indian Basin, whereas a fauna typical of modern Antarctic Bottom Water (AABW) spread through deep waters at 2800 mbsl in the Mascarene Basin. By late Pliocene Zone N21, however, deep-water faunas similar to their modern analogs were developed in both the eastern and western basins. Abyssal faunas, studied only in the Mascarene Basin, show more or less similarity to those under modern AABW. Bottom-water faunas containing Nuttallides umbonifera or Epistominella exiguua were first differentiated at the end of Zone P22, then appeared episodically during the early Miocene. These AABW-type faunas reappeared and migrated updepth into deep waters during the glacial episodes at the end of the Miocene and at the beginning of the Pliocene. By late Pliocene Zone N21, however, a bottom-water fauna similar to that under eastern Indian Bottom Water (IBW) developed in the Mascarene Basin. Modern bottom-water characteristics of the Mascarene Basin must have developed after ZoneN21.