Fuentes de energía en apendicectomía laparoscópica en un programa académico de Cirugía general en Colombia / Energy sources in laparoscopic appendectomy in an academic program of General Surgery in Colombia

Introducción. La apendicectomía por laparoscopia se considera el patrón de oro en el tratamiento de la apendicitis aguda. Sin embargo, su disponibilidad es limitada en nuestro sistema de salud, principalmente por los costos asociados. El objetivo de este estudio fue evaluar la relación entre el uso de los diferentes tipos de energía y los métodos de ligadura de la base apendicular, con las complicaciones postoperatorias, al igual que describir los costos asociados. Métodos. Estudio observacional analítico de una cohorte retrospectiva de pacientes mayores de 15 años a quienes se les realizó apendicectomía por laparoscopia, en un hospital universitario entre los años 2014 y 2018. Se utilizaron modelos de regresión logística y lineal para evaluar la relación entre métodos de ligadura del meso y base apendicular, desenlaces operatorios y costos. Resultados. Se realizaron 2074 apendicectomías por laparoscopia, 58,2 % (n=1207) en mujeres, la edad mediana fue de 32 años. En el 71,5 % (n=1483) la apendicitis aguda no fue complicada. La energía monopolar para la liga-dura del meso apendicular fue la utilizada más frecuentemente en 57,2 % (n=1187) y el Hemolok® el más utilizado para la ligadura de la base apendicular en el 84,8 % (n=1759) de los pacientes. No se observaron diferencias estadísticamente significativas en la tasa de infección del sitio operatorio, reintervención o íleo. El uso de energía simple redujo los costos del procedimiento de manera significativa durante el período evaluado. Discusión. El uso de energía monopolar demostró ser una técnica segura, reproducible y de menor costo en comparación con el uso de energía bipolar, independientemente de la fase de la apendicitis aguda. Lo anterior ha permitido que se realicen más apendicectomías por laparoscopia y que los médicos residentes de cirugía general puedan realizar procedimientos laparoscópicos de forma más temprana

Introduction. Laparoscopic appendectomy is considered the gold standard in the treatment of acute appendicitis. However, its availability is limited in our health system mainly due to the associated costs. The objective of this study is to evaluate the relationship between the use of different types of energy and the methods of ligation of the appendicular base with postoperative complications, as well as to describe the associated costs. Methods. Retrospective observational study of a cohort of patients older than 15 years old who underwent laparoscopic appendectomy in a university hospital between 2014 and 2018. Logistic and linear regression models were used to evaluate the relationship between methods of ligation of the meso and appendicular base, operative outcomes and costs. Results: 2074 laparoscopic appendectomies were performed. Of those, 58.2% (n=1207) were women, median age was 32 years. In 71.5% (n=1483), acute appendicitis was uncomplicated. Monopolar energy for ligation was the most frequently used for ligation of the appendicular meso in 57.2% (n=1187) and Hem-o-lok® the most used for ligation of the appendicular base in 84.8% (n=1759) of the patients. There were no statistically significant differences in the rate of surgical site infection, reoperation, or ileus. The use of simple energy reduced the costs of the procedure significantly during the study period. Discussion. The use of monopolar energy proved to be a safe, reproducible and a lower cost technique compared to the use of bipolar energy, regardless of the phase of acute appendicitis. This has allowed more laparoscopic appendectomies to be performed and the general surgery residents to perform laparoscopic procedures earlier

Ligadura de varices esofágicas por videoendoscopia en pacientes con hemorragia digestiva alta / Ligature of varicose veins by videoendoscopy in patients with upper digestive bleeding

Introducción: Las varices esofágicas son canales vasculares que unen la circulación venosa portal y la sistémica. Se forman como consecuencia de la hipertensión portal, predominantemente en la submucosa del tercio inferior del esófago. Objetivo: Caracterizar a pacientes con rotura de varices esofágicas según principales variables clinicoepidemiológicas y terapéutico-endoscópicas. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal de 20 pacientes con hemorragia digestiva alta por rotura de varices esofágicas, los cuales recibieron tratamiento endoscópico con bandas elásticas en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de noviembre de 2016 a febrero de 2018. En el análisis estadístico se utilizó el porcentaje como medida de resumen y se aplicó la prueba de independencia de la Χ2 para identificar alguna asociación significativa entre variables. Resultados: Existió un predominio del sexo masculino (80,0 %) y del grupo etario de 51 a 60 años (40,0 %). La mayoría de los afectados presentó cirrosis hepática (60,0 %) como causa de la hipertensión portal y hematemesis (50,0 %) como forma de hemorragia digestiva alta; asimismo, el gran tamaño de las varices fue el principal factor de riesgo asociado a la rotura (70,0 %) y, luego de practicado el tratamiento endoscópico, no se produjo resangrado en la casi totalidad de los pacientes (95,0 %). Conclusiones: La aplicación de este procedimiento terapéutico resultó ser satisfactoria y no provocó complicación alguna.

Introduction: The esophageal varicose veins are vascular channels that unite the portal venous and systemic circulation. They are formed as consequence of the portal hypertension, predominantly in the submucosa of the inferior section of the esophagus. Objective: To characterize patients with break of esophageal varicose veins according to main clinical epidemiological and therapeutic-endoscopic variables. Methods: An observational, descriptive and longitudinal study of 20 patients with upper digestive bleeding due to break of esophageal varicose veins was carried out, they received endoscopic treatment with banding in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from November, 2016 to February, 2018. In the statistical analysis the percentage was used as summary measure and the chi-square test was applied to identify the existence of some significant association among variables. Results: There was a prevalence of the male sex (80.0 %) and the 51 to 60 age group (40.0 %). Most of the patients presented liver cirrhosis (60.0 %) as cause of the portal hypertension and hematemesis (50.0 %) as form of upper digestive bleeding; also, the great size of the esophageal varicose veins was the main risk factor associated with the break (70.0 %) and, after the implementation of the endoscopic treatment, there was no second bleeding in almost all the patients (95.0 %). Conclusions: The application of this therapeutic procedure was satisfactory and it didn't cause any complication.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Trends of suicidal hanging in Western Mumbai region

Background: The present study was conducted with aims to determine various epidemiological factors of death due to hanging in the western Mumbai region and variation in types of hanging deaths.Methods: Four year study conducted at H. B. T. Medical College & cooper Hospital, Mumbai for period of January 2015 to December 2018. During study period total 6338 of medico-legal autopsies were conducted, of which 228 (3.59%) autopsies were of death due to hanging.Results: T228 out of 6338 medicolegal autopsies were of death due to hanging making incidence rate 3.59 % of hanging. Age group most commonly involved in hanging was 21-30 years constitutes 41.22% cases of hanging deaths. Male victims constitute of 59.64% cases and female victims were 40.36% cases. In 96.5% cases place of hanging was closed place inside room 3.5% cases hangings takes place in open place. Most common ligature material used for hanging was dupatta/odani constitute 46.5% cases followed by rope in 20.17% cases.Conclusions: Young age group population between 21-40 years are more susceptible victims of suicides by hanging constitute 65.78% cases. Proper parental and social guidance and support could prevent suicides in this age group. Timely counselling of such vulnerable group victims could preventable. Effective prevention strategies are needed to promote awareness of prevention of suicides in young age group.

An expert-led and artificial intelligence system-assisted tutoring course to improve the confidence of Chinese medical interns in suturing and ligature skills: a prospective pilot study / 보건의료교육평가

PURPOSE: Lack of confidence in suturing/ligature skills due to insufficient practice and assessments is common among novice Chinese medical interns. This study aimed to improve the skill acquisition of medical interns through a new intervention program. METHODS: In addition to regular clinical training, expert-led or expert-led plus artificial intelligence (AI) system tutoring courses were implemented during the first 2 weeks of the surgical block. Interns could voluntarily join the regular (no additional tutoring), expert-led tutoring, or expert-led+AI tutoring groups freely. In the regular group, interns (n=25) did not receive additional tutoring. The expert-led group received 3-hour expert-led tutoring and in-training formative assessments after 2 practice sessions. After a similar expert-led course, the expert-led+AI group (n=23) practiced and assessed their skills on an AI system. Through a comparison with the internal standard, the system automatically recorded and evaluated every intern's suturing/ligature skills. In the expert-led+AI group, performance and confidence were compared between interns who participated in 1, 2, or 3 AI practice sessions. RESULTS: The end-of-surgical block objective structured clinical examination (OSCE) performance and self-assessed confidence in suturing/ligature skills were highest in the expert-led+AI group. In comparison with the expert-led group, the expert-led+AI group showed similar performance in the in-training assessment and greater improvement in the end-of-surgical block OSCE. In the expert-led+AI group, the best performance and highest post-OSCE confidence were noted in those who engaged in 3 AI practice sessions. CONCLUSION: This pilot study demonstrated the potential value of incorporating an additional expert-led+AI system–assisted tutoring course into the regular surgical curriculum.

A Complex Suicide by Ligature Strangulation and Hanging Using Two Different Ligatures / 대한법의학회지

Hanging is the most common method of suicide in Malaysia. However, hanging in combination with suicidal ligature strangulation is uncommon. The victim is a 31-year-old man, with no previous medical or psychiatric disorders. He accomplished self-strangulation using a shoelace and hanging himself with a High-Definition Multimedia Interface cable. Three loops of a shoelace ligature were present around the neck. A single knot was present on the front, and a double knot at the back of the neck. Internal examination of the neck revealed small bilateral hemorrhages of the sternocleidomastoid muscles. No laryngeal cartilage or hyoid bone fractures were observed. No other evidence of injury was noted other than moderate pulmonary edema. The post-mortem toxicology results were negative. The cause of death was ascertained as neck compression due to ligatures. Scene assessment and post-mortem findings concur with suicide. This report describes an unusual case of suicidal ligature strangulation, in combination with hanging using two different ligatures.

Clipaje endoscópico de la arteria esfenopalatina para el tratamiento de la epistaxis posterior / Endoscopic sphenopalatine artery ligation for posterior epistaxis

Resumen Antecedentes Los casos de epistaxis posterior representan alrededor del 10 al 20% de las epistaxis. El tratamiento convencional para este tipo de padecimientos son los taponamientos nasales. El abordaje quirúrgico (cauterización y/o clipaje) está indicado cuando existe falla del tratamiento médico convencional; sin embargo, en la actualidad, se considera como primera opción. Material y métodos Se revisaron todos los casos de epistaxis posterior tratados en el Hospital Español de México de enero de 2007 a enero de 2017. Se realizó estadística descriptiva e inferencial para comparar al grupo conservador (taponamiento nasal) versus el grupo quirúrgico (clipaje). Resultados Se revisaron 242 expedientes; de ellos, se excluyeron 108. Se incluyeron 134 pacientes: 96 correspondieron al grupo quirúrgico y 38 al conservador. El 60.20% perteneció al género masculino y el 39.80% al femenino. La media para la edad fue de 60 años. El grupo quirúrgico (3.4 ± 1.9 días) requirió menos días de estancia hospitalaria en comparación con el conservador (4.8 ± 3.0 días), p < 0.01. Los pacientes con una epistaxis del lado derecho en el grupo quirúrgico tuvieron un mayor tiempo quirúrgico (p = 0.001) y más días de estancia hospitalaria (p = 0.006). Conclusiones La epistaxis sucede en la mayoría de los casos de forma idiopática; es frecuente en hombres mayores de 60 años con enfermedades cardiopulmonares, sin conocerse de forma precisa su fisiopatología. La epistaxis derecha tratada quirúrgicamente resulta tener más morbilidad. El abordaje quirúrgico es seguro, eficaz y acorta los días de estancia hospitalaria en comparación con el tratamiento conservador.

Abstract Background The cases of posterior epistaxis represent approximately 10 to 20% of all epistaxis. The conventional treatment for this type of ailment is nasal packing. A surgical approach (cauterization and/ or clipping) is indicated when there is a failure of the conventional medical treatment; however, it is currently considered as the first option. Material and methods All the epistaxis cases treated at the Hospital Español de México from January 2007 to January 2017 were reviewed. Descriptive and inferential statistics were used to compare the conservative group (nasal packing) versus the surgical one (clipping). Results 242 dossiers were reviewed, of which 108 were excluded. 134 patients were included: 96 belonged to the surgical group and 38 to the conservative one. 60.20% were male and 39.80% were female. The mean age was 60 years. The surgical group (3.4 ± 1.9 days) required fewer days of hospital stay compared to the conservative group (4.8 ± 3.0 days), p < 0.01. Patients with right-sided epistaxis in the surgical group had a longer surgical time (p = 0.001) and more days of hospital stay (p = 0.006). Conclusions Epistaxis occurs in most cases idiopathically, often in men over 60 years with cardiopulmonary diseases, without a precise knowledge of its physiopathology. Right epistaxis treated surgically results in more morbidity. The surgical approach is safe, effective and shortens the days of hospital stay compared to the conservative treatment.

Estrangulación suicida atípica / Atypical self-induced strangulation

Resumen El hallazgo de un cadáver con signos de suspensión y en circunstancias dudosas plantea la posibilidad de que la muerte esté relacionada a la intervención de terceros. Presentamos el caso de un varón de 36 años que fue encontrado muerto, con una compresión cervical mecánica extrínseca, en una vía pública, sin testigos del hecho. Inicialmente, se investigó el caso como un homicidio, con diagnóstico diferencial de suicidio. El estudio exhaustivo del sitio de la muerte, más el examen post-mórtem completo, incluyendo: autopsia, histopatología y toxicología, permitió descartar la posibilidad de la acción de terceros y confirmar la hipótesis diagnóstica de una estrangulación autoinducida, de ubicación atípica, ejecutada con lazo.

Abstract Finding a suspended body in doubtful circumstances raises the possibility that the manner of death is homicide. We present the case of a 36 years-old male who was found dead, with extrinsic mechanical cervical compression, on a public place, there were no witnesses of the fact. Initially, the case was investigated as a homicide, with differential diagnosis of suicide. The comprehensive analysis of the scene and a complete post-mortem examination: including autopsy, histopathology and toxicology results, allowed us to rule out the possibility of the action of third parties and confirm the hypothesis of a self-induced atypical strangulation.

Treatment of 16 cases of skin defect by stretch regeneration according to law of tension stress / 中华创伤骨科杂志

Objective To investigate the clinical therapeutic effects of stretch regeneration according to law of tension stress for skin defects.Methods We reviewed the 16 patients with skin defect who had been treated at Department of Traumatic Orthopaedics and Hand Surgery,The First Affiliated Hospital,Guangxi Medical University by skin traction band made of a sterile blood transfusion apparatus and sterile nylon strips from March 2016 to July 2017.They were 12 males and 4 females,aged from 7 to 68 years (average,33 years).The areas of their skin defects ranged from 6 cm × 3 cm to 20 cm × 5 cm.After thorough debridement,a simple skin traction band made of a sterile blood transfusion apparatus and a number of aseptic nylon strips was placed on both margins of the wound,1 cm apart from the margin.The distances between wound holes ranged from 1.5 to 2.0 cm.The simple tension band was installed along the wound margins.After operation,the skin traction band was gradually tightened,according to the tension,blood supply to the skin margins and feeling of the distal end of the affected limb,to close the wound until interrupted suture of the skin was conducted.Results The wounds were closed by interrupted suture directly after application of the skin traction band in 13 of the 16 patients.The wounds were repaired by secondary vacuum sealing drainage (VSD) and skin graft in 2 cases with foot avulsed injury and infection in whom the traction band was pulled out along the wound skin margins.Skin graft was applied in one case with massive forearm skin defect and infection after the traction band failed.Follow-ups from 3 to 19 months revealed that application of the skin traction band led to linear scar healing,soft scar,little pigmentation,no tickle,no adjacent joint dysfunction due to skin contracture and normal pain sensation in most of the patients.Conclusion Stretch regeneration according to law of tension stress is an effective,simple and economical treatment of skin defects,deserving popularization.

Corrección de la incompetencia labial mediante extracción de primeros premolares en paciente Clase II: Reporte de caso

Uno de los grandes problemas a tratar por el ortodoncista es la incompetencia labial. Ésta se presenta cuando el labio superior pierde tonicidad y se torna hipotónico mientras que el inferior se vuelve hipertónico. Esta es una característica de los pacientes clase II, cuya inclinación de incisivos superiores se encuentra aumentada y produce la falla en el selle de los labios. Gracias a la ortodoncia es posible corregir dicho defecto por medio de un diagnóstico y plan de tratamiento adecuado, que conlleva el estudio clínico y radiográfico del caso. Con esto el especialista podrá brindar la solución al problema inicial de la consulta. El objetivo del presente trabajo de investigación fue mejorar el perfil del paciente y corregir la incompetencia labial. Mediante la extracción dental de primeros premolares superiores y gracias a la aplicación de la técnica MBT mediante el uso de retro ligadura se pudo cumplir el objetivo inicial, mejorando la estética y la función de las estructuras dento faciales.

One of the major problems to be treated by the orthodontist is the labial incompetence. This occurs when the upper lip loses tonicity and becomes hypotonic while the lower becomes hypertonic. This is a characteristic of class II patients, whose inclininación of upper incisors is increased and causes the failure to seal the lips. Thanks to orthodontics can correct the defect by a diagnosis and appropriate treatment plan, involving the clinical and radiographic study of the case. With this, the specialist can provide the solution to the initial problem of the query. The objective of this research was to improve the patient's profile and correct lip incompetence. By tooth extraction of first premolars and thanks to the implementation of the MBT technique using retro ligature could meet the initial objective, improving the aesthetics and function of dento facial structures.

Utilização de abraçadeiras de náilon 6, 6 (poliamida) como método de ligadura para orquiectomia de campo em bovinos / Use of 6, 6 nylon (polyamide) cable ties as a method for massive vascular ligature in bovine field orchiectomy / Empleo de abrazaderas de nylon 6, 6 (poliamida) como método de ligadura para castración de campo en bovinos

Este artigo apresenta e discute os resultados de um estudo sobre a orquiectomia eletiva realizada em campo pela técnica aberta, na Região Noroeste do Estado do Paraná, em 880 bovinos, utilizando abraçadeira de náilon 6.6 (poliamida) para ligaduras vasculares hemostáticas. Os animais responderam bem a cirurgia realizada sob contenção física em tronco de contenção, com anestesia local intratesticular, sem quaisquer problemas operatórios. A única complicação observada foi a ocorrência de miíases em 25 animais (3,09%). O método empregado teve fácil execução e baixo custo, sendo plenamente efetivo na substituição do fio de náilon cirúrgico para promover hemostasia preventiva, com redução do tempo cirúrgico. Os resultados permitem sugerir o uso de abraçadeiras de náilon 6.6 (poliamida) para as ligaduras vasculares emorquiectomias realizadas em campo nos bovinos, como método seguro e eficiente, capaz de reduzir o tempo de procedimento cirúrgico.(AU)

This paper reports the results of a study about elective field orchiectomy performed by open technique, in the northwestern region of Paraná State, Brazil, in 880 bulls, using 6.6 nylon (polyamide) cable ties for hemostatic vascular ligature. The cattle responded well to surgery performed under physical restraint and intra-testicular local anesthesia, without any surgical intercurrence. The only complication was the occurrence of myiases in 25 animals (3.09%). The method was inexpensive and easy to perform, being fully effective in replacing nylon sutures to promote preventive surgical hemostasis, and significantly reducing surgical time. These results indicate the use of 6.6 nylon (polyamide) cable ties for hemostatic vascular ligatures in field orchiectomyin bovine cattle, as a safe and efficient method, capable to reduce surgical time.(AU)

Este artículo presenta y discute los resultados de un estudio sobre la castración electiva realizada en campo por la técnica abierta, en la Región Noroeste del Estado de Paraná, en 880 bovinos, empleando abrazadera de nylon 6.6 (poliamida) para ligaduras vasculares . Los animales respondieron bien a la cirugía realizada bajo sujeción física y anestesia local intratesticular, sin cualquier problema quirúrgico. La única complicación observada fue la aparición de miíasis en 25 animales (3,09%). El método empleado ha sido de fácil ejecución y bajo costo, siendo plenamente eficaz en la sustitución del hilo de nylon quirúrgico para promover la hemostasia preventiva, con reducción del tiempo quirúrgico. Los resultados sugieren el empleo de abrazaderas de nylon 6.6 (poliamida) para ligaduras vasculares en castraciones de bovinos realizadas en campo, como método seguro y eficiente, capaz de reducir el tiempo del procedimiento quirúrgico.(AU)

Mongolian Gerbil as a Novel Animal Model for Ligature-induced Periodontitis

Inflammation from chronic and acute infections of distal organs and tissues such as periodontitis is a risk factor for atherosclerotic vascular processes. Recently, a new model of atherosclerosis with vascular pathologies was developed in the Mongolian gerbil. In this study, we attempted to develop a model of ligature-induced periodontitis in gerbils and compared the characteristics of that periodontitis model with that in rats and mice. Each gerbil, rat, and mouse was randomly assigned to groups of control and periodontitis. A thread was placed around the cervix of the right and left first molars in the mandible with knots placed on the mesial side of each molar. At day 14 after the ligation, the animals were sacrificed and their mandibles were dissected. To measure alveolar bone loss along with inflammation, histopathological and micro-CT analyses were carried out. Gerbils showed tooth characteristics of deeper gingival crevice, longer cusp, longer root trunk and shorter root than those of rats and mice. The increased CEJ-ABC distance in distal and PDL area in furcation was also observed in ligated gerbils. An inflammatory response in the connective tissue under the junctional epithelium was also shown in all the animals. As a result, we confirmed the induction of periodontitis by ligature in the gerbils. We therefore consider the gerbil to be a useful model for investigating relationship between periodontitis and vascular disease in the same animal.

Evaluation of the Influence of Experimental Periodontitis on the Sexual Behaviour of Male Wistar Rats.

Aim: Few studies have been reported a correlation between periodontal disease and erectile dysfunction in men. The aim of the present study was to evaluate the sexual behaviour of adult male rats with experimental periodontitis. Materials and Methods: Fourteen male rats were divided into the following two groups: non-ligature, control (n = 7) and experimental with ligature (n = 7). The latter group had a ligature placed around each lower first molar for the development of experimental periodontitis. After 29 days of induction of periodontitis, the sexual behaviour of the male rats was recorded between 20:00-21:00, with lighting provided by a dim light. Initially, the males were placed in an observation cage for an adaption period of 900 seconds. After this time, a sexually receptive female was introduced into the cage with the male. On the thirtieth day the rats were sacrificed and samples of hemimandible were collected for radiographic analysis. Results: The rats in the ligature group showed a decrease (p < 0.05) in the intrusion frequency compared with the control group and ejaculation was not observed in the ligature group during the maximum recording time. It was confirmed that periodontitis was induced in the group with ligature due to the greater distance from the cementoenamel junction to the alveolar crest in the radiographic analysis (p <0.01). Conclusion: Experimental periodontitis may contribute to a reduction in the sexual behaviour of male rats.

Two-year survival analysis of twisted wire fixed retainer versus spiral wire and fiber-reinforced composite retainers: a preliminary explorative single-blind randomized clinical trial / 대한치과교정학회지

OBJECTIVE: Traditional retainers (both metal and fiber-reinforced composite [FRC]) have limitations, and a retainer made from more flexible ligature wires might be advantageous. We aimed to compare an experimental design with two traditional retainers. METHODS: In this prospective preliminary clinical trial, 150 post-treatment patients were enrolled and randomly divided into three groups of 50 patients each to receive mandibular canine-to-canine retainers made of FRC, flexible spiral wire (FSW), and twisted wire (TW). The patients were monitored monthly. The time at which the first signs of breakage/debonding were detected was recorded. The success rates of the retainers were compared using chi-squared, Kaplan-Meier, and Cox proportional-hazard regression analyses (α = 0.05). RESULTS: In total, 42 patients in the FRC group, 41 in the FSW group, and 45 in the TW group completed the study. The 2-year failure rates were 35.7% in the FRC group, 26.8% in the FSW group, and 17.8% in the TW group. These rates differed insignificantly (chi-squared p = 0.167). According to the Kaplan-Meier analysis, failure occurred at 19.95 months in the FRC group, 21.37 months in the FSW group, and 22.36 months in the TW group. The differences between the survival rates in the three groups were not significant (Cox regression p = 0.146). CONCLUSIONS: Although the failure rate of the experimental retainer was two times lower than that of the FRC retainer, the difference was not statistically significant. The experimental TW retainer was successful, and larger studies are warranted to verify these results.

Analysis on clinical application of vedio-assisted thoracoscopic therapy for spontaneous pneumothorax with GIA surgical stapler / 中国医学装备

analysis on 103 cases of spontaneous pneumothorax patients between September, 2012 and December,2014. Then the patients were randomly divided into two groups according to the different therapies on pulmonary bulla, 52 in GIA surgical stapler group and 51 in ligature group. Comparison: The postoperative situations of the two groups.Results: The operation time and intraoperative bleeding volume of observation group are obvious less than control group(t=7.58,t=16.87;P<0.01), but oxygen saturation of observation group is obvious higher than control group(t=1.34,P<0.01). The operation fee of observation group is obvious higher than control group(t=38.26, P<0.01).2 cases of postoperative recurrence in observation group(3.84%), but 10 cases in control group(19.60%).The two recurrence rates have statistical significance(x2=4.77,P<0.05). The postoperative complications incidence is 5.77% in observation group,but 21.56% in control group.The two The postoperative complications incidences have statistical significance(x2=5.47,P<0.05).Conclusion: As opposed to ligature, under the therapy for spontaneous pneumothorax with GIA surgical stapler by thoracoscopy, the operation time is shorter, intraoperative bleeding volume is less, and recurrence rate is lower in 2 years. Ligature fits the sporadic pulmonary bulla patients.

Comparación de sistema de sellado de vasos y ligadura convencional en tiroidectomías / Comparison of vessel sealing system and conventional ligation in thyroidectomy

Cada día es más frecuente en la cirugia tiroidea, el uso de sistemas electromecánicos como método hemostático, en oposicion a la hemostasia convencional. Se realiza un estudio comparativo entre el sistema de sellado de vasos sanguíneos LigaSure® y la hemostasia convencional con ligadura. Se analizaron 113 historias de pacientes sometidos a cirugia tiroidea, evaluando estudios preoperatorios, indicación quirúrgica, complicaciones intra y postoperatorias, reintervención, tiempo quirúrgico, días de hospitalización y resultados de anatomía patológica. Entre enero 2002 y diciembre del 2012, se realizaron 113 tiroidectomías; 52 con el método habitual de ligadura y en 61 pacientes se utilizó como método hemostático el LigaSure®. El promedio de edad fue de 41,3 y 46 años respectivamente; el diagnóstico fue de carcinoma papilar en 19,2% y 22,9%. El tiempo de duración del acto quirúrgico en el grupo de hemostasia convencional fue de 78,8 minutos y en el grupo con sellado de vaso de 74,4 minutos, con un drenaje postoperatorio de 85 y 71 cc para cada grupo. Los días de hospitalizacion fue 3,1 y 2,19. En cuanto a complicaciones: el hematoma post operatorio, con reintervencion (2 casos en ligadura convencional, 1 con el LigaSure®); lesión del nervio recurrente laríngeo (1 caso en cada grupo), hipocalcemia transitoria (3 casos en el grupo convencional y 1 caso en el grupo de LigaSure®); un paciente ameritó traqueostomía en el grupo de LigaSure®. En conclusión, la hemostasia en la tiroidectomía utilizando el metodo de sellado de vasos con LigaSure®, permite la realización del acto quirurgico con comodidad y seguridad, con una ligera ventaja que al utilizar métodos convencionales.

Every day, it is more common in thyroid surgery, the use of electromechanical systems, as hemostatic method in thyroid surgery, as opposed to conventional hemostasis. A comparative study between blood vessel sealing system LigaSure® and conventional hemostasis with ligation was carried out. 113 patients records who underwent thyroid surgery, evaluating preoperative studies, surgical indication, intra and postoperative complications, reoperation, surgical time, days of hospitalization and pathological anatomy results were analized. Between january 2002 and december 2012, 113 thyroidectomies were performed; 52 with the usual ligature method and 61 patients with the LigaSure® hemostatic method. The average age was 41.3 and 46 years respectively; papillary carcinoma was diagnosed in 19,2% and 22,9%. The duration of surgery in the conventional hemostasis group was 78.8 minutes and 74.4 minutes in the vessel sealing group, with a postoperative drainage of 85 and 71 cc for each group. The days of hospitalization were 3.1 and 2.19. In terms of complications: postoperative hematoma with reoperation (2 cases in the conventional group and 1 case in the LigaSure® group); recurrent laryngeal nerve lesion (1 case in each group), transient hypocalcemia (3 cases in the conventional group and 1 case in the LigaSure® group); one patient required tracheostomy in the LigaSure® group. In conclusion, hemostasis in thyroidectomy using the LigaSure® vessel sealing method, allows the realization of surgery in comfort and safety with a slight advantage to conventional methods.

An Unusual Hanging Case Mistaken as Homicidal Strangulation in the Scene of a Fire / 대한법의학회지

Here, we report an autopsy case of an unusual hanging that was misinterpreted as a case of homicidal strangulation, as th body was found on the scene of a house fire. A 29-year-old unmarried woman hanged herself from the gas pipe using a bath towel. Subsequently, the pipe broke and a fire broke out after an explosion. However, as the initial postmortem investigation revealed the absence of cherry-pink lividity and as a burnt bath towel was found around her neck, this case was misunderstood as a case of arson after homicidal strangulation. The cause and manner of death in this case were finally determined based on the autopsy findings of ligature marks that are typically noted in cases of hanging and the presence of a burnt electric lock and a broden gas pipe that were noted at the suicide scene.

Caracterização das alterações teciduais em dois modelos de indução de doença periodontal experimental em camundongos / Characterization of tissue changes in two models of experimental induction of periodontal disease in mice

A periodontite é uma doença infecciosa caracterizada por um processo inflamatório crônico do periodonto mediada e modulada pelo hospedeiro. Esta patologia resulta na destruição do tecido conjuntivo gengival e dos tecidos de suporte dos dentes. De modo a avaliar tanto a patogênese da doença periodontal quanto as diversas modalidades de tratamento, diferentes modelos animais de periodontite experimental têm sido propostos e utilizados. O benefício do uso destes modelos resulta no fato de que eles permitem uma avaliação da doença de uma forma longitudinal, com características de início e progressão semelhantes em diversos animais. O objetivo deste estudo foi caracterizar e avaliar comparativamente as alterações teciduais provocadas por dois modelos de doença periodontal experimental em camundongos: ligadura e gavagem oral. Para isto, foram utilizados 48 camundongos C57/BL6 wild type (WT), divididos em 4 grupos: Grupo C - Controle negativo, Grupo L ­ Ligadura (indução da doença periodontal por meio de ligaduras), Grupo G-Pg ­ Gavagem de Porphyromonas gingivalis (indução por meio de inoculações de Pg) e Grupo G-PgFn ­ Gavagem de Porphyromonas gingivalis + Fusobacterium nucleatum. Os animais foram sacrificados em dois períodos experimentais: 45 e 60 dias após o início da indução da doença periodontal. Observou-se perda óssea alveolar significativa apenas no grupo L, por meio de análise estereométrica, microtomografia computadorizada(µCT) e imunohistoquímica. A colonização bacteriana nos grupos de gavagem foi confirmada por meio de PCR em tempo real. Concluímos que o modelo de ligadura foi efetivo em induzir a doença periodontal nos parâmetros utilizados ao contrário da gavagem oral

Periodontitis is an infectious disease characterized by a chronic inflammatory process of periodontal mediated and modulated by the host. This disease results in the destruction of conective tissue and supporting tissues of the teeth. In order to evaluate both the pathogenesis of periodontal disease and the various treatment modalities, different animal models of experimental periodontitis have been proposed and used. The benefit of using these models results in the fact that they allow an evaluation of a longitudinal disease with similar characteristics of start and progression in several animals. The aim of this study was to characterize and evaluate tissue changes caused by two models of experimental periodontal disease in mice: ligature and oral gavage. For this, 48 C57/BL6 mice wild type (WT) mice were divided into 4 groups: Group C - Negative Control, Group L - Ligature (induction of periodontal disease by ligatures), Group G-Pg - Porphyromonas gingivalis Gavage (induction by Pg inoculations) and Group G-PgFn - Porphyromonas gingivalis + Fusobacterium nucleatum Gavage. The animals were sacrificed at two experimental periods: 45 and 60 days after the induction onset of periodontal disease. Significant bone loss only in the group L by means of stereometric analysis, computed microtomography (µCT) and immunohistochemistry was observed. The bacterial colonization in groups of gavage was confirmed by PCR in real time. We conclude that the model of ligature was effective in inducing periodontal disease parameters used in contrast to oral gavage

Superficial morphology and mechanical properties of in vivo aged orthodontic ligatures

INTRODUCTION: The degradation of elastic ligatures in the oral environment results in the need of periodic replacement to maintain the optimal force during the orthodontic treatment. The purpose of this study was to perform a clinical prospective randomized study of the degradation of orthodontic elastomeric ligatures in the oral environment by scanning electron microscopy (SEM) and tensile strength test. METHOD: Two hundred elastic ligatures were randomly selected and placed around the brackets of 5 volunteers and removed in groups of 10, at different times (1, 2, 3, and 4 weeks). The control group was performed by another fifty ligatures which were not submitted to the oral degradation. The analyses were done by scanning electron microscopy (SEM) and strength mechanical test. RESULTS: The tensile strength test results showed reduction in the ultimate strength values after four weeks ageing in the oral environment and no statistical difference in the yield strength values (p < 0.05). The orthodontic elastomeric ligatures surface was significantly degraded in the oral cavity after four weeks. The elastomeric degradation began in the first week when the increase in the roughness could be detected just in some areas. Afterwards, the surface became gradually rougher and, after 4 weeks, it was totally rough with some crack areas. CONCLUSIONS: The elastic ligatures aged in the oral environment showed higher superficial degradation and lower loss of mechanical properties after the maximum experimental period.

INTRODUÇÃO: a degradação das ligaduras elásticas no ambiente bucal resulta na necessidade de substituição periódica para manter-se a força ótima durante o tratamento ortodôntico. OBJETIVO: a proposta desse trabalho foi realizar um estudo clínico prospectivo randomizado da degradação de ligaduras elásticas ortodônticas envelhecidas no ambiente bucal por microscopia eletrônica de varredura e por ensaio de tração. MÉTODOS: duzentas ligaduras foram randomicamente selecionadas e inseridas ao redor dos braquetes de 5 pacientes voluntários e, então, removidas, em grupos de 10, após diferentes tempos (1, 2, 3 e 4 semanas). O grupo controle foi formado por outras 50 ligaduras que não foram submetidas à degradação intrabucal. RESULTADOS: o ensaio mecânico demonstrou diminuição no limite de resistência à fratura após 4 semanas de degradação e não demonstrou diferença estatisticamente significativa no limite de elasticidade. A análise por microscopia eletrônica de varredura revelou que a superfície dos elastômeros tornou-se significativamente degradada após 4 semanas. A degradação teve início na primeira semana, quando o acréscimo de rugosidade superficial pôde ser detectado em algumas áreas. Posteriormente, a superfície tornou-se gradativamente mais rugosa, sendo que após 4 semanas toda a região apresentou-se rugosa e com algumas fraturas superficiais. CONCLUSÕES: as ligaduras elásticas envelhecidas no ambiente bucal apresentaram maior degradação superficial e menor perda das propriedades mecânicas após o período experimental máximo.

Evaluation of the susceptibility to pigmentation of orthodontic esthetic elastomeric ligatures

OBJECTIVE: The purpose of this laboratory study was to evaluate changes in the pigmentation of esthetic elastomeric ligatures after immersion in a staining solution. METHODS: Sixty ligatures were selected and divided into 12 groups according to their brand and also considering their condition, i.e., unstretched or stretched. The groups were divided into: Morelli (clear), TP Orthodontics (clear), American Orthodontics (clear), 3M/Unitek (clear), American Orthodontics (pearl color) and 3M/Unitek (pearl color), separated into groups of 5 unstretched and five stretched ligatures. Assessment of their color changes was performed by means of digital photograph and computer analysis using Adobe Photoshop. Standardized digital photographs were taken at T0 (before the staining process, with unstretched ligatures) and at T1 (following the 5-days staining process). The staining solution was composed of artificial saliva and foods with staining potential. At T1 the ligatures were either stretched or unstretched. RESULTS: The results of this study showed that esthetic elastomeric ligatures are prone to staining. Among the evaluated brands, TP Orthodontics and American Orthodontics clear ligatures were the most stable. Moreover, 3M/Unitek pearl ligatures demonstrated statistically significant changes in all variables. CONCLUSIONS: Esthetic elastomeric ligatures are susceptible to staining and no statistically significant difference was found between unstretched or stretched ligatures, with the sole exception of the TP Orthodontics brand. The 3M/Unitek's pearl color ligatures displayed the greatest staining potential.

OBJETIVO: avaliar alterações da pigmentação de ligaduras elásticas estéticas após imersão em solução de pigmentação. MÉTODOS: Sessenta ligaduras foram selecionadas e divididas em doze grupos de acordo com a marca comercial utilizada e nas condições normal e distendida. Os grupos foram divididos em: Morelli transparente, TP Orthodontics transparente, American Orthodontics transparente, Unitek/3M transparente, American Orthodontics pérola e Unitek/3M pérola, separados quanto à condição normal e distendida, totalizando 5 ligaduras em cada condição. A avaliação das mudanças de coloração foi realizada por meio de fotografia digital e análise computadorizada usando o programa Adobe Photoshop. Foram realizadas fotografias digitais padronizadas nos tempos T0 - antes do processo de pigmentação, com as ligaduras em estado normal; e T1 - após o processo de pigmentação, que durou cinco dias. A solução de pigmentação utilizada foi composta por saliva artificial e por alimentos que possuem potencial de coloração. No tempo T1, as ligaduras se encontravam em estado distendido e em estado normal (sem distensão). RESULTADO: os resultados do presente estudo demonstraram que ligaduras elásticas estéticas são suscetíveis à pigmentação. Dentre as marcas comerciais avaliadas a TP Orthodontics e American Orthodontics transparente foram as mais estáveis. Já a Unitek/3M pérola demonstrou alterações estatisticamente significativas em todas as variáveis avaliadas. CONCLUSÃO: ligaduras elásticas estéticas são suscetíveis à pigmentação, não havendo diferença estatisticamente significativa entre o estado normal e o estado distendido, com exceção na marca TP Orthodontics. A marca Unitek/3M pérola demonstrou ser a que apresenta maior potencial para pigmentação.