Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats.

Termino-lateral neurorrhaphies have been used up to the beginning of this century. After this period, they have no longer been reported. We tested the efficacy of a new type of latero-terminal neurorrhaphy and evaluated the role of the epineural sheath. A group of 10 rats had the fibular nerve sectioned and the distal ending was sutured to the lateral face of the tibial nerve without removing the epineurium. All experiments were made on the right side, the left one remaining untouched in half of the animals of each group. The other half were denervated by sectioning and inverting the endings of the fibular nerves. In this way, tibial cranial muscles were either normal or denervated in the left side and reinnervated through latero-terminal neurorrhaphy in the right side. After 7.7 months, the animals were subjected to electrophysiological tests, sacrificed, and the nerves and muscles were taken for histological exams. A response of the tibial cranial muscle was obtained in 75% of the animals. The distal ending of the fibular nerve showed an average of 498 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (mu 2):841.30 for M2n and 1798.33 for M2d. We concluded that the termino-lateral neurorrhaphy was functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The presence of the epineurium was no impediment to axonal regeneration or to the passage of electrical stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of diclofenac sodium on the healing process of end-to-end anastomosis in carotid arteries of rabbits. Histopathological and biomechanical studies

Aim. Diclofenac sodium is a non-steroidal anti-inflammatory drug commonly used to attenuate painful inflammatory reactions in surgery. However, it may delay healing in the skin and gastrointestinal tract. The aim of this study was to evaluate the influence of Diclofenac in vascular healing. Methods. Ninety rabbits had their carotid arteries sectioned and reconstructed by end-to-end anastomosis with interrupted sutures. The animals were randomly allocated into 3 groups of 30 each and treated by intramuscular route with saline (control), 5 mg/kg/day of diclofenac sodium (DS-5), and 10 mg/kg/day of diclofenac sodium (DS-10). Treatment began on the day of surgery and lasted 4 days. Angiography, biomechanical properties (failure load, failure elongation, yield point, yield point elongation, and stiffness were obtained from the load/elongation curve), macroscopic and histological examinations (hematoxylin-eosin, Masson, Calleja, Picrossirius-red), and scanning electron microscopy were studied in both arteries on the 3rd and 15th postoperative days. Results. No significant differences in biomechanical properties were observed either in the 3 groups or the experimental times. The carotid artery healing process was similar in the 3 groups. Conclusion. Diclofenac sodium did not cause alterations nor delayed carotid artery healing.

Ectrópio palpebral em portador da síndrome de Down e conjuntivite alérgica: Relato de caso

This is a case report of a patient with Down's syndrome with an important mechanical ectropion and elongation of the lower lid related to chronic allergic conjunctivitis, besides cataract and keratoconus. The tarsal strip technique and ressection of redundant and thick conjunctiva was the surgical approach chosen for this case. Functional and cosmetic outcomes were considered satisfactory.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

Background: Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation. Aims: To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model. Materials and Methods: One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation. Results: A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined. Conclusion: The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described. © Indian Journal of Dermatology 2013.

Acquisition of suture skills during medical graduation by instructor-directed training: A randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning. © 2013 Springer-Verlag Italia.

An approximate method for the solution of an influence function foil rolling model

Fleck and Johnson (Int. J. Mech. Sci. 29 (1987) 507) and Fleck et al. (Proc. Inst. Mech. Eng. 206 (1992) 119) have developed foil rolling models which allow for large deformations in the roll profile, including the possibility that the rolls flatten completely. However, these models require computationally expensive iterative solution techniques. A new approach to the approximate solution of the Fleck et al. (1992) Influence Function Model has been developed using both analytic and approximation techniques. The numerical difficulties arising from solving an integral equation in the flattened region have been reduced by applying an Inverse Hilbert Transform to get an analytic expression for the pressure. The method described in this paper is applicable to cases where there is or there is not a flat region.