Occult vaginal cancer recurrence after hysterectomy: a case report and literature review

Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.     

Rapid construction of sigmoid bladder augmentation using absorbable staples: Long-term results and comparison to standard colocystoplasty in children with neurogenic bladder

ObjectiveAbsorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty.Materials and methodsBetween 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis.ResultsEight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4–17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12–80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4–16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis.ConclusionsComplications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty.     

Systematic review of changes in maxillary incisor exposure and upper lip position with Le Fort I type osteotomies with or without cinch sutures and/or VY closures

The aim was to systematically review the maxillary incisor exposure and upper lip position changes with Le Fort I type osteotomies for advancement ± impaction with rigid internal fixation, taking into account the use of cinch sutures and VY closures. Electronic databases (Cochrane Library, Medline, Embase, and Web of Science) were searched using medical subject headings (MeSH), key words, truncations, and Boolean operators. Hand searching was also undertaken. Of 979 articles identified, 15 were included (11 retrospective, two prospective, and two unspecified). Relevant study details and outcomes were recorded on a spreadsheet, along with an assessment of their quality. In total, these studies assessed 419 patients (266 female, 118 male) with a mean age of 26.4 years (range 14–57 years). Soft tissue changes were assessed on lateral cephalometric radiographs. The mean maxillary hard tissue advancement and impaction ranged between 0.94 and 8.77 mm and −0.56 and 4.2 mm, respectively. The ranges of ratios demonstrated that from pronasale (0.24–0.35) to labrale superius (0.36–1.43), the soft tissues followed the underlying horizontal hard tissue movement increasingly more closely. Alar base cinch sutures and VY closures tended to increase these ratios. The soft tissue response was more variable vertically. None of the studies reported on maxillary incisor exposure change. More good quality prospective studies are needed.     

新生大鼠颅骨缝体外牵张模型的建立

目的探讨建立新生SD大鼠颅骨器官培养模型的方法。方法取1周龄SD大鼠颅顶骨正中矢状缝组织块,大小为8mm×10mm,进行器官培养,对照组和实验组均安装螺旋弹簧,实验组施加0.2g(0.00196N)张力,对照组不施力,两组分别于0、1、6、24、48h收获标本。对实验组和对照组标本进行苏木精-伊红染色,作组织形态学的观察。结果实验组较对照组有明显的成骨细胞活动及毛细血管增生,显示牵张模型的骨缝组织呈活跃增生,分化相、成骨区明显,未见组织坏死及细菌感染。结论外源性张力有扩宽骨缝的作用,骨缝器官可在体外培养中成功存活并继续生长、发育。     

无后囊膜支撑眼巩膜缝线固定后房型人工晶体植入术的临床观察

目的 观察无后囊支撑眼采用巩膜缝线固植入后房型人工晶体的临床疗效.方法 采用巩膜缝线固定人工晶体上攀和下攀于睫状体沟内的方法植入后房型人工晶体.结果 25 例25 只眼,术后随访6～48 个月,平均24.5 个月.视力0.5以上者18 只眼,0.2～0.4者6 只眼,0.1 者1 只眼.结论 采用巩膜缝线固定法植入后房型人工晶体后能使无后囊支撑眼患者获得更好的术后视力和恢复双眼单视.     

采用华利康避免缝线异物存留的3148例手术报告

现代手术越做越细,器械越来越精,但重建组织、修复切口离不开缝线。传统的普通丝线,待做完手术,成为永久异物存留于机体中,至少异物存留是美中不足,还有可能导致伤口感染手术失败。作为医生无不追求手术能没有缝线及异物存留,进口薇乔、国产华利康等可吸收人工合成缝合线因此深受欢迎。现报告我院在选择性手术中完全使用华利康3148例,效果满意。     

环形缝扎加胃底折叠术预防晚期血吸虫病病人术后再出血效果

目的 目的 评估食管下段梯状环形缝扎黏膜下血管及胃底折叠术对晚期血吸虫病 （晚血） 门脉高压症并发上消化道 出血的治疗效果。 方法 方法 2006-2011年选择患晚血门脉高压症患者, 随机分为联合手术治疗组 （联合组） 与单纯手术治疗 组 （单纯组）。单纯组患者行门奇静脉断流术, 联合组在此基础上加行食管下段梯状环形缝扎黏膜下血管及胃底折叠术。 术后通过胃镜检查随访, 比较2种术式的治疗效果。结果 结果 共选择晚血患者158例, 联合治疗组75例, 单纯治疗组83例。 术后两组治疗有效率分别为81.3 % （61/75） 和30.1% （25/83）（χ2 =39.44, P < 0.01）, 发生再出血率分别为2.7 %（2/75） 和 12.0% （10/83）（χ2 =24.36, P < 0.01）, 两组差异有统计学意义。结论 结论 食管下段梯状环形缝扎黏膜下血管及胃底折叠术对 预防术后再出血效果明显, 且术式安全, 可作为治疗晚血门脉高压症的常规手术方式。     

器械吻合在食管癌手术中的应用体会

目的 总结吻合器在食管癌手术中重建消化道的临床经验,探讨器械吻合在食管癌手术中的应用价值.方法 回顾性分析974例食管癌患者应用吻合器行胃食管胸内吻合的资料.结果 发生吻合口瘘14例,其中10例治愈,4例死亡;吻合口狭窄27例,1例放置食管记忆合金支架、另26例行食管狭窄扩张后恢复正常饮食;吻合口出血2例,术中缝合治愈.结论 熟练的应用吻合器不但能减轻手术创伤,缩短胃食管吻合的时间,并且可明显降低吻合口瘘和狭窄等并发症的发生率.     

Evaluation of Breaking Force of Different Suture Materials Used in Dentistry: An In Vitro Mechanical Comparison

The success of surgical procedures is strictly related to the biomechanical properties of the suture. Mechanical comparisons are scarcely reported in the literature, so the purpose of the present study was to evaluate and compare the mechanical behavior of different sutures commonly used in oral surgery in terms of traction resistance. Sutures made of eight different materials were analyzed: silk (S), polyglycolide-co-caprolactone (PGCL), polypropylene (PP), rapid polyglycolide (rPGA), standard polyglycolide (PGA), polyamide (PA), polyester (PE), and polyvinylidene fluoride (PVDF). For each material, three different sizes were tested: 3-0, 4-0, and 5-0. The breaking force of each suture was assessed with a uniaxial testing machine after being immersed in artificial saliva at 37 °C. The outcomes analyzed were the breaking force, the needle–thread detachment breaking-point and the node response after forward–reverse–forward (FRF) tying when subjected to a tensile force. The 3-0 rPGA provided the maximum resistance, while the lowest value was recorded for the 5-0 PGCL. In general, 3-0 and 4-0 gauges showed non-statistically significant differences in terms of needle–thread detachment. The highest needle–thread detachment was found for the 3-0 PGA, whereas the lowest value was observed for the 5-0 PGCL. After tying the knot with an FRF configuration, the thread that showed the highest resistance to tension was the 3/0 silk, while the thread with the lowest resistance was the 5/0 silk. These data should be considered so that the operator is aware of as many aspects as possible on the behavior of various materials to ensure successful healing.