Postoperative changes of anterior chamber depth and lens suspensory ligament in patients with ultra-high myopia and cataract and related influencing factors / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of anterior chamber depth(ACD)and lens suspensory ligament after phacoemulsification and intraocular lens(IOL)implantation in patients with ultra-high myopia cataract and related influencing factors.METHODS: A total of 45 patients(60 eyes)with ultra-high myopia and cataract in our hospital from October 2016 to December 2022 were selected. All patients received phacoemulsification and IOL implantation. The patients were randomly divided into implantation group and non-implantation group. Implantation group was combined with capsular tension ring(CTR)implantation, and non-implantation group did not implant CTR during operation. The changes of ACD and lens suspensory ligament length before and after operation were compared and the correlation was analyzed. To observe the differences of ACD and the length of lens suspensory ligament between the two groups before and after operation.RESULTS: The ACD of patients with ultra-high myopia complicated with cataract at 1 and 3mo after operation was higher than that before operation(all P<0.05). The positions of 3:00, 6:00, 9:00, 12:00 and the average length of lens suspensory ligament at 1 and 3mo post-operation were shorter than those pre-operation(all P<0.05). There was no significant difference in the positions of 3:00, 6:00, 9:00, 12:00 and average length of suspensory ligament between 1mo and 3mo after operation(all P>0.05). The preoperative average length of lens suspensory ligament in patients with ultra-high myopia cataract was positively correlated with the ocular axis and the preoperative ACD(all P<0.05). There was no significant difference in ACD between the implantation group and the non-implantation before and at 1 and 3mo after operation(P>0.05). There was no significant difference in the length of lens suspensory ligament between implantation group and non-implantation group at the position of 6:00 before operation and 1mo after operation(P>0.05), but there was difference in lens suspensory ligament between groups at 3mo after operation and the position of 6:00(P<0.05). Furthermore, there was no significant difference at the positions of 3:00, 9:00, 12:00 and the average length of lens suspensory ligament between the implantation group and non-implantation group before and at 1 and 3mo after operation(P>0.05).CONCLUSION: The ACD deepen and lens suspensory ligament shortened in patients with ultra-high myopia and cataract after phacoemulsification; the length of lens suspensory ligament was affected by the combined use of CTR.

A rare case report on complete cervical agenesis with vaginal atresia and suspended didelphys uterus with hematometra and left haematosalpinx

Congenital uterine malformations are deviations from normal anatomy resulting due to defective fusion of Mullerian ducts or the paramesonephric ducts in the developing embryo. These anomalies may be isolated or in combination with urological abnormalities. The mean prevalence of female congenital malformations in general population is up to ⁓ 7%. Patients with these anomalies usually present during pubertal age due to absence of onset of menses, cyclical abdominal pain, or in reproductive age group as infertility or recurrent pregnancy loss depending upon the degree of malformation. Cervical agenesis is a rare Mullerian anomaly with an incidence of 1 in 80,000 females. It represents 3% of all uterine anomalies. It is rarely associated with a functioning uterus (4.8%). Cervical agenesis is often associated with vaginal atresia (less than 50%). It is important to classify these anomalies for easy diagnosis and plan appropriate preoperative treatment.

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study / 中南大学学报(医学版)

OBJECTIVES@#To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.@*METHODS@#From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA).@*RESULTS@#All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05).@*CONCLUSIONS@#Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture. Methods: Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC. Results: All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%. Conclusion: Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

Ultrasonographic, macroscopic and histological characterization of the proximal insertion of the suspensory ligament in Crioulo horses / Caracterização ultrassonográfica, macroscópica e histológica da inserção proximal do ligamento suspensório em cavalos Crioulos

Although ultrasound (US) is a routine diagnostic modality, it still presents limitations for the diagnosis of lesions such as those in the proximal insertion of the suspensory ligament (PISL) because of its composition, which includes muscle fibers and adipose tissue interspersed with the ligament fibers. The objective of the present study was to describe the ultrasonographic, macroscopic and histological aspects of the PISL of thoracic limbs (TL) and pelvic limbs (PL) in Crioulo horses (CH). We selected 34 specimens of TL (right and left) and 10 specimens of PL of horses with a mean age of 5.7 years, from a private clinic or sent to the Department of Veterinary Pathology of UFSM, which died from different causes. The animals had no previous history of lameness in selected limbs associated with PISL injuries. The 34 specimens of PISL of TL were divided into CH (n=25) and Thoroughbred horses (TBH) (n=9), which composed the control group, and 11 specimens of PISL of PL were divided into CH (n=8) and TBH (n=3), which also served as control. The US examination was performed in the PISL using a Sonosite Edge device, 5-10 MHz linear transducer, with cross-sectional and longitudinal palmaromedial and palmarolateral images of the proximal surface of metacarpus III, II and IV (MCIII/MCII/MCIV). In PL, the evaluation was performed four centimeters below the chestnut in the plantaromedial aspect of metatarsus III and II (MTIII/MTII). PISL lobulated shape and size were compared with those of the contralateral limb, as well as the regularity of the palmar bone surface of MC III, II and IV. Subsequently, dissection of the PISL lobes was performed, as well as its macroscopic evaluation, which preceded the histological processing of the samples. In specimens of the CH breed, PISL showed echogenicity varying from peripheral dorsal hyperechogenic zones that merge into echogenic and hypoechogenic zones, where lobulation occurs. In the samples from the TBH group, PISL was also lobulated, but with differences in the echogenicity pattern such as diffuse hypoechogenicity and echogenicity. Macroscopically, CH samples presented a large amount of adipose tissue that corresponds to the dorsal peripheral zone of PISL, which ends in the connective tissue that delimits the ligamentous lobes. On a macroscopic cross-section of PISL, muscle fibers in red are mixed with white ligament fibers in the center of the ligament. This macroscopic finding was not observed in TBH samples, in which muscle fibers overlap ligament fibers throughout the ligament extension and a small amount of fat is present in the dorsal periphery of the ligament. PISL of PL had a triangular shape with echogenicity characteristics very similar to those observed in TL. In ultrasonographic, macroscopic and histological evaluation, PISL samples of TL and PL in CH showed a larger amount of peripheral dorsal adipose tissue, as well as a larger number of merged ligament and muscle fibers compared with those in TBH.(AU)

Embora uma modalidade diagnóstica rotineira, a ultrassonografia ainda possui algumas limitações para o diagnóstico de lesões como as que afetam a inserção proximal do ligamento suspensório (IPLS). Uma dessas limitações é relacionada à composição desse ligamento que inclui fibras musculares e tecido adiposo intercalados entre as fibras ligamentares. O objetivo do presente trabalho foi descrever os aspectos ultrassonográficos (US), macroscópicos e histológicos da IPLS de membros torácicos (MT) e membros pélvicos (MP) de equinos da raça crioulo (CC). Foram selecionados 34 espécimes de MT (direito e esquerdo) e 10 espécimes de MP de equinos com idade média de 5,7 anos, que vieram a óbito por diferentes causas, oriundos de uma clínica privada ou destinados ao Laboratório de Patologia Veterinária da UFSM. Não havia histórico prévio de claudicações nos membros selecionados que pudessem estar relacionadas a lesões da IPLS. Os 34 espécimes da IPLS MT foram divididos pela raça CC (n=25) e Puro Sangue Inglês (PSI) (n=9), o qual serviu como grupo controle e, 11 espécimes da IPLS do MP divididos em raça CC (n=8) e PSI (n=3) também como grupo controle. O exame US foi realizado na IPLS com um aparelho Sonosite Edge, transdutor linear de 5-10 MHz, com imagens transversais e longitudinais palmaromedial e palmarolateral da face proximal do metacarpiano (MC) III, II e IV. No MP a avaliação foi realizada quatro centímetros abaixo da castanha no aspecto plantaromedial do metatarsiano III e II (MTIII / MTII). Foram também observadas à forma lobulada da IPLS e o tamanho em comparação ao membro contralateral, bem como a regularidade da superfície óssea palmar do MC III, II, IV. Posteriormente foi realizada a dissecação dos lobos IPLS, bem como a avaliação macroscópica dos mesmos que antecedeu o processamento das amostras para histologia. Em espécimes CC, a IPLS possui uma ecogenicidade que varia de zonas periféricas dorsais hiperecogênicas que se mesclam a zonas ecogênicas e hipoecogênicas onde ocorre a sua lobulação. Nas amostras do grupo PSI, a IPLS também é lobulada, mas com diferenças no padrão de ecogenicidade como, hipoecogenicidade e ecogenicidade difusas. Macroscopicamente, as amostras CC apresentaram uma grande quantidade de tecido adiposo que corresponde à zona periférica dorsal da IPLS, a qual termina no tecido conjuntivo que delimita os lobos ligamentares. Em uma secção transversal macroscópica da IPLS as fibras musculares em vermelho se mesclam as fibras ligamentares brancas no centro do ligamento. Este achado macroscópico não foi observado na raça PSI, onde as fibras musculares intercalam as fibras ligamentares em toda a extensão do ligamento e pequenas quantidades de gordura estão presentes na periferia dorsal do mesmo. A IPLS no MP possui um formato triangular com características de ecogenicidade muito similares as citadas no MT. Na avaliação US, macroscópica e histológica as amostras da IPLS em MT e MP de equinos na raça CC demonstraram uma maior quantidade de tecido adiposo dorsal periférico bem como, uma maior quantidade de fibras musculares e ligamentares mescladas em comparação às amostras PSI.(AU)

Comparative study of lens subluxation in patients with angle-closure glaucoma and shallow anterior chamber with different axial lengths / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate whether there is a difference in the probability of partial zonular dehiscence and subluxation in patients with angle-closure glaucoma and shallow anterior chamber combined with cataract. <p>METHODS: A retrospective analysis was performed,for patients with angle-closure glaucoma and patients of shallow anterior chamber with cataract admitted to our hospital from February 2017 to March 2019. The patients underwent cataract surgeries and were divided into two groups: Group A(visual axis <22mm)and Group B(visual axis ≥22mm). Central anterior chamber depth(ACD)was measured with ultrasound biomicroscopy(UBM); Axial length(AL, length of optic axis)was measured with IOL-Master; Calculation of the ratio of AC depth to axial length(ACD/AL)was performed. The consistency of the anterior chamber depth in all directions in UBM images was analyzed. In cataract surgeries, partial zonulysis with or without lens subluxation was recorded.<p>RESULTS: The result indicated that the rate of partial zonular dehiscence in group B was higher than that in group A(8.46%±1.44% <i>vs</i> 7.56%±1.51%, <i>P</i><0.05). <p>CONCLUSION: When performing cataract surgery in patients of angle-closure glaucoma and shallow anterior chamber in group B, attention should be paid to the probability of zonular abnormality.

Clinical features of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the clinical characteristics of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation, and to analyze the influence of operation on visual acuity and intraocular pressure (IOP). ·METHODS:Totally 38 cases (38 eyes) of the secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation in ophthalmology department of our hospital from December 2014 to December 2016 were enrolled and their medical records were analyzed retrospectively to observe the clinical characteristics of glaucoma. Preoperative mydriasis was carried out and surgical methods were chosen according to the lenses location and extent of suspensory ligament. Preoperative and postoperative anterior chamber depth, corneal endothelial cell density, IOP, visual field, visual acuity and complications were analyzed. ·RESULTS:The average intraocular pressure was 18.17± 1.43mmHg at postoperatively 10d,which was significantly lower than 38. 77 ± 2. 45mmHg before operation, the difference had statistical significance (P<0.05). The IOP of 25 eyes returned to normal (≤21mmHg) at 3d after surgery. The IOP of 34 eyes with the usage of IOP lowering medication returned to normal at postoperative 10d. The IOP of 4 eyes came to normal after undergoing glaucoma drainage valve implantation again. There were 5 eyes with visual acuity ranged 0.1 to <0.2,17 eyes 0.2 to <0.5,16 eyes≥0.5 preoperatively,and 2 eyes,17 eyes and 19 eyes postoperatively, the difference was not significant (P>0.05). The postoperative anterior chamber depth was 2.45 ± 0.44mm, which was significantly higher than 1.23 ± 0.35mm before operation, the difference had statistical significance (P < 0. 05). The postoperative corneal endothelial cell density was 878.34 ± 322.12/mm2 and decreased significantly, compared with 1735.32 ± 340. 32/mm2before operation, the difference had statistical significance (P<0.05). There were 8 eyes with corneal edema,4 eyes with iris adhesion or varying degrees of atrophy,3 eyes with anterior chamber hemorrhage,and 2 eyes with pupil exudate at 3d after surgery. · CONCLUSION: Clinical symptoms and signs of secondary glaucoma in patients with lens suspensory ligament laxity or occult subluxation are more complex, which needs to be distinguished with other types of glaucoma in clinical treatment, and its surgical methods shall be chosen according to different suspensory ligament site and lens subluxation scope.

Clinical observation of the secondary suspensory foldable intraocular lens implanted in aphakia eyes after vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effects of secondary suspensory foldable intraocular lens ( IOL ) implanted in aphakia eyes after vitrectomy.? METHODS: The clinical data were retrospectively analyzed in 25 eyes of 25 patients treated with secondary suspensory intraocular lens implantation after vitrectomy. The surgery was performed through a incision 2. 4mm away from corneal edge, followed by solarometer positioning 8:00 and 2:00, and foldable intraocular lens was loaded and implanted by an injector, after that suspension line knot of lens was made, which length was equal to the distance between the loops of intraocular lens. The intraocular lens was fixed to sclera by a "W"shaped suspension suture. The patients were followed up for 3 ～ 26mo postoperatively, and visual acuity, intraocular pressure, cornea, anterior chamber reaction, intraocular lens position, fundus were observed.? RESULTS: All patients received preoperatively best corrected visual acuity at 1wk after surgery, and the refractive condition was within ± 1. 5 DC. The intraocular pressure was all normal. The number of corneal endothelial cells ( n/mm2 ) was 2394. 33 ± 201. 31 before surgery, and was 2283. 30±217. 82 at 3mo(P>0. 05). The percentage of corneal hexagonal endothelials was 52. 67％±6. 28％ preoperatively, and came to 51. 81％± 6. 41％ at 3mo ( P>0. 05 ). The central corneal thickness (mm) was 541.10±40.31 at the beginning, and was 543.10 ±41. 77 at 3mo (P>0. 05). Small amount of bleeding under choroid occurred in one eye, and intraocular lens dropped into vitreous body in another. Dislocation or shifting of intraocular lens, corneal decompensation or retinal detachment was not observed.? CONCLUSION: The clinical effect of secondary suspensory foldable intraocular lens implanted in aphakia eyes after vitrectomy was satisfactory. Minimal invasive surgery through small incision and accurate implantation are applied to increase safety while reducing complications, thus improve the effects of surgery.

Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation

BACKGROUND: Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction. METHODS: A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups. RESULTS: The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups. CONCLUSIONS: The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.

Observation of artificial lens implantation suture fixation into capsular bag when cataract suspensory ligament rupture without capsular tension ring / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.

Arthroscopic Control for Safe and Secure Seating of Suspensory Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction Using Three Different Techniques

PURPOSE: The purpose of this study was to evaluate the efficacy of our technique that allows direct visualization of seating of suspensory devices in anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Three different suspensory devices (TightRope RT, RetroButton, and EndoButton) were used in ACL reconstruction using 3 different techniques (outside-in, anteromedial [AM] portal, and transtibial techniques). Positioning of a guiding material and seating pattern of the suspensory devices were evaluated according to the surgical technique and suspensory device used. RESULTS: On the transtibial technique, 21 of total 26 cases (81%) of single bundle reconstructions and 22 of total 22 cases (100%) of double bundle reconstructions required superolateral capsulotomy where buttons were found in 21 of total 21 cases (100%) and 17 of 22 cases (77%), respectively. On the AM portal technique, all patients required capsulotomy and the button was found in only 18 of total 32 cases (56%) even after capsulotomy. On the outside-in technique, all patients required capsulotomy and the button was found in 86 of total 86 cases (100%). CONCLUSIONS: Our technique for direct visualization of seating of the suspensory devices was more effective in outside-in and single bundle transtibial ACL reconstruction. However, it was less effective in double bundle transtibial and AM portal ACL reconstructions.

Lateral Knee Pain after Outside-in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the TightRope RT

The anterior cruciate ligament (ACL) TightRope RT (TR) was recently introduced as a novel cortical suspension device for ACL reconstruction. It has an adjustable graft loop that gives the surgeon some advantages during ACL reconstruction. We report three patients who required removal of the TR after an outside-in anatomical ACL reconstruction because of lateral knee pain. We assumed that the knee pain was associated with friction between the TR button of the posterolateral bundle and iliotibial band (ITB). Placing the TR button close to the lateral epicondyle and tissue interposition between the TR button and lateral femoral cortex may be potential risk factors for ITB irritation. Therefore, we recommend not placing the TR button close to the top of the lateral epicondyle and reducing the tissue interposition between the TR button and lateral femoral cortex as much as possible.

Anal cushion suspensory and external hemorrhoid airfoil-shaped suture in treatment of ring-ship mixed hemorrhoid / 中国医师进修杂志

Objective To discuss the clinical effects of anal cushion suspensory and external hemorrhoid airfoil-shaped suture in treatment of ring-ship mixed hemorrhoid,improve the level of the surgical treatment of ring-ship mixed hemorrhoid.Methods One hundred and twenty patients with ring-ship mixed hemorrhoid were divided into treatment group (60 cases treated by anal cushion suspensory and external hemorrhoid airfoil-shaped suture) and control group (60 cases treated by Milligan-Morgan operation) according to the operation method.The postoperative pain,hospitalization time,wound healing time,postoperative complications,etc were observed and compared.Results The cure rate was 100.0％ (60/60) in treatment group and 70.0％ (42/60) in control group,and there was significant difference between two groups (P ＜ 0.05).The hospitalization time,wound healing time was (8.58 ± 0.89),(14.00 ± 0.72) d in treatment group,(10.20 ± 0.30),(19.00 ± 0.21) d in control group,and there was significant difference between two groups (P ＜ 0.05).The incidence of postoperative complications and the degree of postoperative pain in treatment group was lower than that in control group,and there was significant difference between two groups (P ＜ 0.05).Conclusion Anal cushion suspensory and external hemorrhoid airfoil-shaped suture in treatment of ring-ship mixed hemorrhoid has advantage of shorter wound healing time,less postoperative pain,less postoperative complications.

Treatment of Triple Fracture of the Superior Shoulder Suspensory Complex / 대한정형외과학회잡지

The Superior Shoulder Suspensory Complex (SSSC) is a bony and soft tissue ring comprising the glenoid process, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromion. The SSSC maintains a normal stable relationship between the upper extremity and the axial skeleton. High-energy injury, such as traffic accident or a fall, can cause disruption of the SSSC. Single traumatic disruption of the SSSC is common. However, double disruption of the SSSC is infrequent and surgical management is generally necessary. We have experienced a case of triple fracture involving the coracoid process, the acromion, and the distal end of the clavicle. Such disruption of the SSSC has not been previously reported in our country and only one case has been reported in the Western literature; the authors obtained positive clinical results with surgical treatment. We report here on this case and include a review of the relevant literature.

Modelo de indução de lesão no ligamento suspensório equino com utilização de punch para biópsia cutânea / Suspensory ligament lesion model in horses using a skin biopsy punch

O objetivo deste estudo foi avaliar um novo modelo de lesão no ligamento suspensório (LS). Sob anestesia geral, um punch para biópsia cutânea de 0,6cm de diâmetro foi utilizado para criar uma lesão no centro do LS de ambos os membros torácicos e pélvicos, em seis equinos. Todos os animais se recuperam da cirurgia sem nenhuma complicação importante. Realizaram-se avaliações clínicas e ultrassonográficas no período pós-operatório. Durante as primeiras duas semanas, no local da lesão, houve redução no edema de leve para discreto e da dor de discreta para ausente. As lesões foram facilmente observadas ao exame ultrassonográfico 72 horas após a cirurgia como áreas anecoicas homogêneas, representando uma média (± erro padrão) de 33,5±5 por cento da área do LS. Não houve alteração significativa na área de lesão durante as primeiras duas semanas (P=0,77). Concluiu-se que o modelo proposto foi eficiente para promover lesões controladas e homogêneas simultaneamente nos quatro LS, sem causar desconforto importante aos equinos. Esses achados, associados à possibilidade de se avaliar previamente o LS por meio de biópsia, demonstram que esse modelo de indução de lesões ligamentosas se apresenta com um método útil, principalmente se aplicado ao estudo de terapias destinadas a melhorar o processo de reparo do LS.

The aim was to study a novel model of suspensory ligament (SL) lesion. Under general anesthesia, a punch for skin biopsy (0.6cm of diameter) was used to create a circular lesion in the middle of SL simultaneously in the four members of six horses. All horses recovered without any important complication. Clinical and ultrasonographic evaluations were made during the post operative period. During the first two weeks, edema changed from mild to discreet, and pain changed from discreet to none around the surgical site. The lesions were easily observed by ultrasonography 48h after surgery as a homogenous anechoic area representing a mean (± SEM) 33.5±5 percent of the SL area, and did not change size during the first two weeks (P=0.77). In conclusion, the proposed model was efficient to promote controlled and homogeneous lesions in the four SL simultaneously without causing important discomfort to the horses. Taking in account these findings together with the possibility of evaluation of the ligament biopsy previously to any treatment, this method may be useful especially in studies testing therapies for tissue repair.

The suspensory apparatus and digital flexor muscles of the llama (Lama glama) 1: The thoracic limb / El aparato suspensorio y los músculos flexores digitales de la llama (Lama glama) 1: El miembro torácico

The digital flexor muscles of the thoracic limb of four llamas were dissected and illustrated to provide data about the suspensory (support) apparatus and weight bearing structures. An extensive literature search was performed and yielded incomplete information about these anatomical structures. The popularity of the llama world wide as a domesticated animal used for show and fiber has increased in the recent years. It is helpful to describe the anatomy fully to aid in understanding of the species and treatment of pathologic conditions. The description of the anatomical structures and the original illustrations demonstrate genuine peculiarities and differences between the llama and domestic ruminants. In llamas, the three heads of the deep digital flexor muscle (DDF) originate and connect with each other in a very peculiar combination, with one tendon receiving an attachment from the flexor carpi ulnaris muscle (FCU). The superficial digital flexor muscle (SDF) has a thin tendon which is fused with the palmar fascia and then broadens. There are no interflexor muscles. Additionally, unexpected lumbricalis muscles are found in the distal limb and vary in number between the fore and hind limb. The anatomy of the suspensory apparatus in the thoracic limb is evaluated in this paper.

Fueron disecados e ilustrados los músculos flexores digitales del miembro torácico de cuatro llamas con la finalidad de aportar datos sobre el aparato suspensor (de apoyo) que soportan estas estructuras. Se realizó una extensa búsqueda bibliográfica dada la incompleta información existente de estas estructuras anatómicas. La popularidad de la llama en todo el mundo como uno de los animales domésticos utilizados ha aumentado en los últimos años. Es importante describir detalladamente la anatomía de esta especie para su tratamiento en condiciones patológicas. La descripción de las estructuras anatómicas y las ilustraciones originales demuestran peculariedades genuinas y diferencias entre la llama y los rumiantes domésticos. En llamas, las tres cabezas del músculo flexor profundo de los dedos se originan y se conectan entre ellas en una muy peculiar combinación, con uno de los tendones recibiendo un fascículo del músculo flexor ulnar del carpo. El músculo flexor superficial de los dedos tiene un tendón delgado el cual se fusiona con la fascia palmar y luego se amplía. No existen músculos interflexores. Adicionalmente, fueron encontrados músculos lumbricales en la extremidad distal y variaban en número entre los miembros. Finalmente, en este trabajo se evalúa el aparato suspensorio del miembro torácico.

The suspensory apparatus and digital flexor muscles of the llama (Lama glama) 2: The pelvic limb / El aparato suspensorio y los músculos flexores digitales de la llama (Lama glama) 2: El miembro pélvico

This paper provides data (text and illustrations) about the digital flexor muscles of the pelvic limb and the / metatarsophalangeal joint, evaluating the suspensory (support) apparatus and weight bearing structures. Similar to the above mentioned paper, a literature search provided incomplete information about these anatomical structures. As in the thoracic limb, unique anatomically variations exist in the pelvic limb of the llama. The caudal tibial muscle is fused with the lateral head of the deep digital flexor muscle (DDF), and the soleus muscle is missing. A symmetrical unexpected lumbricalis pedis muscle was found; the tendons are fusing with the axial branches of the lateral tendon of the long digital extensor muscle. A quadratus plantae muscle, also unexpected is present on the medial aspect of the tarsal region. The superficial digital flexor muscle (SDF) resembles that of the domestic ruminants. The metacarpo/ metatarsophalangeal joints, referred to as the fetlock joints (FJ) are very different from those of the domestic ruminants. Particular structures were found and they will be described and illustrated in the text. The anatomy of the suspensory (support) apparatus in the pelvic limb is evaluated in this paper.

El presente artículo ofrece datos (texto e ilustraciones) sobre el músculo flexor digital del miembro pélvico y la articulación metatarsofalángica, evaluando el aparato suspensorio (de apoyo) y el peso que soportan estas estructuras. La literatura proporciona información incompleta acerca de estas estructuras anatómicas. Al igual que en el miembro torácico, existen variaciones anatómicamente únicas en el miembro pélvico de la llama. El músculo tibial caudal se fusiona con la cabeza lateral del músculo flexor digital profundo (FDP), y el músculo soleo no existía. Fue encontrada una simetría inesperada del músculo lumbrical del pie; los tendones se encontraban fusionados con las ramas axiales del tendón lateral del músculo extensor digital largo. Un músculo cuadrado plantar, se encontraba presente en la cara medial de la región tarsal. El músculo flexor digital superficial (FDS) se asemeja al de rumiantes domésticos. Las articulaciones metacarpo/metatarsofalángicas, denominadas articulaciones del nudillo (AN) son muy diferentes de las de rumiantes domésticos. Fueron encontradas estructuras particulares que se describen e ilustran en el texto. Se evalúa la anatomía del aparato suspensorio (de apoyo) en el miembro pélvico.

Ligamento suspensório da articulação metacarpo/metatarso falangianas nos eqüinos: aspectos evolutivos, anatômicos, histofisiológicos e das afecções / Suspensory ligament of equine metacarpus/metatarsus falangeal joint: evolutive anatomical, histophysiological aspects and pathologies

Esta revisão reúne e discute aspectos anatômicos, histofisiológicos e afecções do ligamento suspensório (LS) da articulação metacarpo/metatarso falangiana dos eqüinos. Considerou-se a importância desses aspectos para subsidiar o diagnóstico e o tratamento de afecções no LS, visto que freqüentemente animais portadores dessas doenças permanecem em atividades sob efeito de tratamentos paliativos que, apesar de proporcionarem alívio álgico, quase sempre não garantem a cura definitiva e, por conseguinte, não garantem o bem-estar absoluto do animal.

This review discusses anatomical, histophysiological and pathological aspects of the suspensory ligament (SL) of metacarpal/metatarsal joint in the horse. This knowledge is important to aid in diagnosing and treating the SL diseases in the athlete horses, considering that affected animals remain on training activities under palliative treatments that insure pain relieve, but do not guarantee fully and definitively welfare of the horses.

Reconstruction of breast suspensory structure for correction of breast ptosis / 中国微创外科杂志

Objective To summarize clinical experience of reconstruction of breast suspensory structure in correction of mild-to-moderate breast ptosis.Methods Through a periareolar incision,the flabby deep layer of the superficial fascia beneath the upper breast gland was completely removed.Then the gland was lifted up to the normal position and the superior pole of the gland was fixed to the pectoral fascia at the second intercostal space.By using the dermal bra technique,an appropriate amount of skin was excised,and the dermis was fixed to the anterior surface of the breast gland. Or a monofilament polypropylene mesh was implanted and fixed to the anterior or posterior surface of the upper breast gland.Postoperatively,remarkable scar fibrosis reaction developed to form strong supporting structures just like natural ones.Glandular plication or implant augmentation was simultaneously employed to enhance the projection,if necessary.Results A total of 32 cases of mild-to-moderate breast ptosis was treated with this technique,including 10 cases of mastopexy only,20 cases of mastopexy with implant augmentation,and 2 cases of mastopexy using monofilament polypropylene mesh.The operation time was 90~150 min(mean,110 min).The intraoperative blood loss was 30~100 ml(mean,58 ml).No complications such as nipple or areola necrosis or sensory disturbance were found.Follow-up observations for 6~12 months(mean,11.3 months) showed a satisfactory rate of 90.6%(29/32).Conclusions Reconstruction of breast suspensory structure is a simple,safe,and effective method for correction of mild-to-moderate breast ptosis without hyperplasia of mammary glands.