A comparative study of two layer versus three-layer repair of mediolateral episiotomy

Background: Since majority of the women attending study hospital are belonging to lower socioeconomic strata and active involvement of paramedical staff in providing obstetric care, this study was undertaken to find the utility of a two-layer repair of mediolateral episiotomy and compare it with the standard method of closure in relation to its simplicity, cost-effectiveness and superiority if any, over the traditional three-layered repair of episiotomy.Methods: This was a prospective interventional study comparing 100 women who underwent two-layer closure with 100 women who underwent three-layer closure of episiotomy in a tertiary care hospital in Pune, India over a period of 2 years from October 2012 to October 2014. The parameters assessed were operative time, number of suture materials required, immediate post procedure pain and complications at follow-up. Qualitative and quantitative data was analysed using unpaired t-test, chi square test and Fisher exact test.Results: Both the groups were comparable in terms of hospital stay and wound complications such as oedema, dehiscence, hematoma, requirement of resuturing, cosmesis and long-term complications such as dyspareunia. However, two-layer repair required less operative time, lesser number of suture materials and decreased pain during hospital stay as there was statistically significant difference observed between the two groups.Conclusions: In this study experience, it can be concluded that two-layer repair of episiotomy is faster, with less post-operative pain and more cost effective. Hence it provides mother with better services.

Preparation of osmotic pump tablets ginsenoside Rg3 of solid dispersion and its release characteristic in vitro / 中草药

Objective: To compare the differences on release behaviors between the mono-layer and two-layer osmotic pump tablets of ginsenoside Rg3 solid dispersion and to find out the advantages and disadvantages of each preparation. Methods: The mono-layer and two-layer osmotic pump tablets of ginsenoside Rg3 solid dispersion were prepared and the prescription optimization was examined by comparing the in vitro release behaviors such as type and amount of the osmotic active substances, amount of suspending agent, amount of porogen in the coating solution, and thickness of the coating. Results: Mono-layer and two-layer osmotic pump tablets were well accorded with the zero-order equation. Fitting with the zero-order release model, the coefficients of the mono-layer and two-layer osmotic pump tablets were r1=0.998 1 and r2=0.990 6, respectively. Conclusion: Two-layer Rg3 osmotic pump tablets could release more completely than mono-layer osmotic pump tablets, but have more complex preparation process.

Effects of perfluorochemical on in vitro long-term hypothermic heart preservation in rats / 上海交通大学学报（医学版）

Objective To investigate the effects of perfluorochemical ( PFC) on in vitro long-term hypothermic heart preservation in rats. Methods Thirty Wistar rats were randomly divided into control group ( Celsior solution), Celsior + O_2 group (Celsior solution plus oxygen) and PFC/Celsior + O_2 group (two-layer method plus oxygen) , with 10 rats in each group. Langendorff model of isolated rat heart was prepared. The isolated heart was preserved at 4 ℃ for 8 h, and hemodynamic parameters, coronary effluent flow, and leakage of creatine kinase ( CK), lactate dehydrogenase ( LDH) and aspartate transaminase (AST) were detected after reperfusion. Besides, the myocardial ultrastructure was also observed. Results Compared with control group and Celsior + O_2 group, the left ventricular developed pressure and ± dp/dt in PFC/ Celsior + O_2 group significantly increased ( P < 0.01), while LDH, CK and AST leakage significantly decreased ( P < 0.01). However, there was no significant difference in the above paramters between Celsior + O_2 group and control group (P>0.05). Compared with control group and Celsior + O_2 group, the impairment of myocardial ultrastructure in PFC/ Celsior + O_2 group after hypothermic preservation was alleviated. Conclusion PFC as a supplementation to oxygen in heart preservation solution could enhance myocardial protection during in vitro long-term hypothermic heart preservation in rats via the improvement of energy metabolism.

Anastomosis colónicas en una sola capa continua con poligliconato (maxon) vs. anastomosis en dos capas con catgut crómico y seda: Estudio experimental / Single layer colonic anastomoses using maxon vs. two layer anastomoses using chromic catgut and silk: structured abstract

Background. The safety of an intestinal anastomosis is usually measured by its complication rate, especially the incidence of anastomotic leakage. A wide variety of methods have been described to reestablish intestinal continuity including single-layer continuous or two-layer interrupted anastomosis. Objectives. To evaluate if the single-layer continuous anastomosis using polygluconate is safer and reliable than two-layer interrupted anastomosis with chromic catgut and silk. Material and methods. A prospective, experimental, randomized and comparative analysis was conducted in 20 dogs. They were divided in two groups; group 1 underwent two-layer interrupted anastomosis and group 2 underwent sigle-layer continuous technique. Anastomoses were timed. Both groups were under observation. Anastomotic leakage, and other complications were evaluated. The animals were sacrified and the anastomosis was taken out together with 10 cm of colon on both sides of the anastomosis. Breaking strength, histologic evaluation and hydroxyproline determination were performed. Results. Ten two-layer anastomosis and ten single-layer anastomosis were performed. A median of 25 minutes (range: 20-30 minutes) was required to construct the anastomoses in group 1 versus 20 minutes (range: 12-25 minutes) in group 2. All animals survived and no leakage was observed. Wound infection ocurred in four dogs (20%). Median breaking strength was 230 mm Hg in group 1 and 210 mm Hg in group 2. Hydroxyproline concentration was 8.94 mg/g in group 1 (range: 5.33-16.71) and 9.94 mg/g in group 2 (range: 2.96-21.87). There was no difference among groups about the inflammatory response evaluated by pathology. There was no statistical significance in any variable evaluated. Conclusions. This study demonstrates that a single-layer continuous is similar in terms of safety to the two-layer technique, but because of its facility to perform, the single-layer technique could be superior.

Antecedentes. Una de las preocupaciones más importantes en cirugía colorrectal es la presencia de dehiscencia o fístula de la anastomosis. Múltiples técnicas han sido descritas para realizar anastomosis, entre las que se incluyen las anastomosis en una sola capa o en dos capas. Objetivos. Evaluar si la anastomosis colonica en una capa con poligliconato es más segura y efectiva que la anastomosis colonica en dos capas con catgut crómico y seda. Material y métodos. Se llevó a cabo un estudio prospectivo, experimental, aleatorio y comparativo en 20 perros. Se dividieron a los animales en dos grupos; grupo 1: anastomosis en dos capas y grupo 2: anastomosis en una sola capa. Se evaluó el tiempo de duración de la anastomosis. Todos los animales se mantuvieron en observación evaluando datos de complicaciones como fístulas colocutáneas o dehiscencia de la anastomosis. En el día diez del postoperatorio se sacrificaron. Se resecó el segmento de la anastomosis abarcando 10 cm proximales y 10 cm distales. Se midió la presión de ruptura, se realizó análisis histopatológico y se determinó la cantidad de hidroxiprolina de la línea de la anastomosis. Resultados. Se incluyeron diez perros en el grupo 1 y diez perros en el grupo 2. La mediana del tiempo de duración de la anastomosis en el grupo 1 fue de 25 minutos (rango: 20-30 minutos) y en el grupo 2 de 20 minutos (rango: 12-25 minutos) (p = NS). No se presentaron datos de fístula, dehiscencia o estenosis de la anastomosis. Cuatro perros presentaron infección en la herida. La presión de ruptura del grupo 1 fue de 230 mm Hg (115-360) y del grupo 2 fue de 210 mm Hg (100-300). La concentración de hidroxiprolina en el grupo 1 fue de 8.94 mg/gramo (rango: 5.33-16.71), y en el grupo 2 fue de 9.94 mg/gramo (rango: 2.96-21.87). No se encontró diferencia significativa en las variables analizadas. Se comparó el grado de reacción inflamatoria en ambos grupos, no hubo diferencia estadística. Conclusiones. Los dos procedimientos son seguros y confiables de realizar, aunque por su mayor facilidad, estos datos apoyan la utilización del método de una sola capa.

Gastroduodenostomy after Gastrectomy for Gastric Cancer Comparative study of the single-layer and two-layer sutured anastomosis

PURPOSE: The technique of anastomosis for gastroduodenostomy is thought to be of importance to success in the postoperative period and to the development of certain complications. Most surgeons a use two-layer anastomosis method. However, interest in single-layer anastomosis has increased. Therefore, we investigated the differences between single-layer and two-layer methods for anastomosis by comparing clinicopathological parameters and clinical courses. METHODS: This report is a retrospective clinical analysis of 265 patients of gastric cancer who underwent gastroduodenostomy following distal gastrectomy at the Department of Surgery, Chonbuk National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: There was no significant difference observed between the two groups with regard to the mode of presentation, mean age, sex, or pathological characteristics of the tumor. The time for the anastomosis was shorter in the single-layer group (30.1+/-1.0 vs 37.1+/-2.1 minutes, p<0.001), the time of gas out was earlier in the single-layer group (4.4+/-1.1 vs 4.7+/-1.2 days, p=0.027) and the time of food intake was earlier in the single-layer group (5.7+/-0.8 vs 6.3+/-1.4 days, p<0.001) than in the two-layer group. Although the complication rate was not significantly different between the two groups, anastomotic leak was observed in 4 cases (2.7%) of the single-layer group and 3 cases (2.6%) of the two-layer group, and passage disorders were observed in 4 cases (2.7%) of the single-layer group and 5 cases (4.3%) of the two-layer group. CONCLUSION: A gastrodudenostomy using the single-layer anastomosis method has an advantage over the two-layer method for anastomosis with respect to the time for anastomosis, the time of gas out and time of food intake. Therefore the single-layer anastomosis method can be effectively employed in gastric cancer surgery.

A New Method of Two Layer Vasovasostomy / 대한비뇨기과학회지

The frequency with which vasovasostomy is performed has increased dramatically because a significant percentage of the millions of men who underwent vasectomy in the last decade are now seeking to regain their fertility. Considerable controversy exists regarding the most effective surgical method. The Silber`s two layer anastomosis technique is the best one until now, but that is a time consuming procedure and difficult in a beginner, and all of the knots are should be placed just outside of the mucosa. In an attempt to develop an easier and faster and less complicated method of performing two layer microsurgical vasovasostomy, we developed a new operating method of two layer anastomosis. Thenkey points of the new technique is that an anastomosis is completed with a double wedged 9-0 nylon suture for one suture by one time, continuously. All of the knots are placed outside of the vas. The new two-layer microsurgical anastomosis was used starting in 1994. We have used this method in 15 patients. Average skin to skin operation time is two and half and three hours. Sperm count was normal limits in 10 patients after 6 months after operation, in 2 patients between 3 weeks and 3 months after operation, oligospermia in 2 patients and azoospermia was in 1 patient 6 months after operation. We conclude this method is a good one, since the new two-layer technique is easier, faster, less complicated than original two-layer anastomosis, although this is a early results and describes the initial experience with this new microsurgical technique.

Comparative evaluation about factors influencing the success rate of microscopic vasovasostomy / 대한비뇨기과학회지

From December 1983 to January 1991, 67 of 117 men who underwent microscopic vasovasostomy were evaluated. Patency (anatomical success) and pregnancy (functional success) rates are not significantly different between microscopic two-layer vasovasostomy(86.7%, 50%) and microscopic modified two-layer vasovasostomy (86.5%. 61.4%). We examined postoperative pregnancy rates according to obstructive intervals, gross appearance of vas fluid and sperm granuloma. Pregnancy rates according to obstructive intervals were 55.3 % (5-years less), 43.7% (5 to 10 years) and 25%(10 years of more) respectively. Pregnancy rate after vasovasostomy was inversely related to the duration of the obstructive interva1. Pregnancy rates according to gross appearance of vas fluid were 55.6% (15/27) for watery fluid. 37.5% (3/8) for opalescent fluid and 0%(0,2) for creamy fluid. Pregnancy rates according to presence or absence of histologically' proved sperm granuloma at vasectomy site were 54.5 % (presence) and 50% (absence). Our results suggest that surgical skill rather than method may be more important for the improved success rate of vasovasostomy. and success rates are related to the obstructive interval, gross appearance of vas fluid and the presence or absence of sperm granuloma at vasectomy site.

Detection of Siderophore from Halophilic Archaea with Two-layer Plate / 微生物学通报

A two-layer plate was developed for in situ detection of siderophore from halophilic archaea. Halophilic archaea could grow on the upper nutrient layer without addition of iron and excrete siderophore under iron-limited stress.The lower layer was the detection agar,which contained universal blue-coloured ferric-CAS complex.The presence of the siderophore was indicated by the decolorization of the blue complex, resulting in a yellow-orange halo around colonies growing on the upper nutrient layer,when the excreted siderophore penetrated from the upper nutrient layer into the lower detection agar.The results showed that the two-layer plate method was applicable to the detection of siderophore from halophilic archaea, which was more convenient and definite than former approach for halophilic archaea siderophore detection.

Experimental Study on Ileocystoplasty: 1. A New Technique of Ileocystoplasty: Two Layer Open-flap Method / 대한비뇨기과학회지

The treatment of bladder contraction remains as one of the most difficult problems in urological field today despite numerous attempts to overcome this difficulty. Many etiologic factors can be elicited as for the cause of such contractions; more common and important ones being interstitial cystitis, tuberculous infection, various chemical and radiation damages etc. Extensive subtotal bladder resection may also result in limited fluid capacity. All of these can produce severe urinary symptoms of frequency and incontinence and further bilateral renal damages. Until recently the prevalent treatment for the disease complex caused by contracted bladder was diversion of urine either to large bowel or skin, or the use of an indwelling urethral catheter. eliminating the bladder as a reservoir. Although these techniques were proven to be valuable for a certain extent there have been many undesirable aspects. Among the undesirable aspects of diversion of urine are 1. recurrent chronic pyelonephritis caused by organisms from the skin or feces. 2, hydronephrosis from stricture of anastomotic sites, and 3. electrolyte imbalance following transplantation of ureter to bowel. The use of an isolated intestinal segment to segment bladder capacity merits s serious consideration, and the technique of ileocystoplasty may be a possible solution to these difficultise. Results of recent reports on clinical and experimental application of this technique are promising though their methods vary greatly. In the majority a closed tube was anastomosed to the bladder in varying positions but some applied the ileum as an open sheet. The latter method was applied by some in the belief that on open patch of ileum would empty itself more efficiently than a closed type since closed type of ileocystoplasty frequently retained urine. However, control of bleeding during preparation of ileal open sheet have been a major difficulty for application of an open-sheet technique. The purpose of this investigation was to develop a new technique for augmentation of bladder capacity in physiologic manner with diminution of bleeding during the procedure. MATERIALS AND METHODS: Healthy eight Korean dogs weighing from 15 to 18kg were used. Female dogs were exclusively utilized for the convenience of urinary drainage and catheterization postoperatively. pregnant dogs were not used. In each dog, the bladder was mobilized and then subtotally resected leaving one third of the normal bladder. The level of excision was just above the trigone sothat the ureteral orifices were undisturbed. A 20cm segment of ileum approximately 20cm, from the ileocecal valve was isolated with an intact pedicle of mesentery. The continuity of the bowel was restored by end-to-end anastomosis. The isolated ileum was folded at the middle portion with two clamps each placed on half of isolated segment in length for control of bleeding when incision was made on stitch type and then a cap type of ileal bladder with two layers was sutured to the bladder stump by a mucosa-to-mucosa technique forming a bladder composed principally by ileum. The peritoneal cavity was closed without drainage.In the immediate postoperative period urinary drainage was maintained by urethral catheter. RESULTS AND SUMMARY: l. Eight dogs were subjected to ileocystoplasty by the use of two layer ileal open flap. One of them expired because of an accident and seven others survived without incident. 2. The use of the clamps on ileal segment was reliable in controlling bleeding for wider incision to make open ileal flap. 3. Ratio of augmentation of bladder capacity by this technique was twice of that by closed loop technique. 4. The fluid capacity of reconstructed bladder of this technique approached to the tidal capacity 5. One patient with contraction of bladder due to tuberculosis has been satisfactorily palliated by this technique.