Comparison of sharp dissection, electrocautery, and ultrasonic activated scalpel with regard to endothelial damage, preparation time, and postoperative bleeding during radial artery harvesting

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Tissue microarray technology and collagen evaluation to analyze surgical trauma performed with usual blade or ultrasonic harmonic scalpels in rats

Abstract Purpose: To compare wound healing performed with cold blade (CSB) and ultrasonic harmonic scalpel (UHS) in the abdominal aponeurosis of rats. Methods: Eighty Wistar rats divided into two groups and underwent midline incision in the linea alba with cold blade and harmonic ultrasonic scalpel. Analysis were performed in subgroups of 10 animals after 3, 7, 14 and 21 days. Macroscopically was observed the presence of hematoma, infection, wound dehiscence, fistula and adherences. Microscopically were used collagen and immunohistochemical staining methods. Results: Macroscopic, complications showed no statistical difference. Immunohistochemical analysis for MMP-9 was more intense in UHS group (p<0.05). TGF β presented its lower expression in UHS group at 14 and 21 days, with no statistical difference at 3 and 7 days (p<0.05). α-AML expression appeared higher in UHS group after 14 days and remained similar in others (p<0.05). Collagen deposition had no change in type I, and increased in type III in UHS; at 7th day the deposition was higher in CSB group; at 14th was similar in both groups (p<0.001). Conclusion: UHS compared to the CSB has higher lesion area at the time of the incision; as well as it led to the delay of regeneration and scar maturation process.

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

SUMMARY OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

Cirurgia peri-implantar com o uso de ultrassom cirúrgico piezoelétrico / Peri-implant surgery with ultrasound piezoelectric device

O objetivo deste artigo foi relatar um caso clínico com uso do instrumento piezoelétrico e enxertia no seio maxilar na mesma sessão clínica. Uma paciente do sexo feminino, 71 anos de idade, apresentou-se com queixa de desconforto na região maxilar direita, motivo da fratura radicular no dente 26. Após a análise tomográfica, a altura óssea residual era de 3 mm. Assim, através de uma janela cirúrgica vestibular e pelo levantamento da membrana do seio maxilar com dispositivo piezoelétrico, foi instalado um implante dentário. O procedimento foi completado pela colocação de uma membrana reabsorvível e um biomaterial liofilizado associado ao PRP. As potencialidades do dispositivo piezoelétrico (diminuição do aquecimento no corte, não perfuração da membrana Schneideriana, bem como o sangramento reduzido) o tornam ideal do ponto de vista regenerativo e para colocação dos implantes dentários no seio maxilar.

The aim of this article was to report a clinical case using the piezoelectric device for simultaneous maxillary sinus lifting and dental implant placement. A 71 years-old female patient presented to the clinics with discomfort at the region of tooth 26 due to root fracture. After CBCT examining, the residual bone height was 3 mm. Thus, it was decided to open a lateral buccal window and to lift the sinus membrane using the piezosurgical unit, followed by dental implant placement. The procedure was completed by insertion of a collagen resorbable membrane associated to lyophilized bone and PRP. The potentials of piezosurgery (less heating, less membrane perforation, and reduced bleeding) make it ideal for regenerative procedures involving implant placement at the maxillary sinus region.

Factors associated with the occurrence of Triatoma sordida (Hemiptera: Reduviidae) in rural localities of Central-West Brazil

This study estimates the factors of artificial environments (houses and peridomestic areas) associated with Triatoma sordida occurrence. Manual searches for triatomines were performed in 136 domiciliary units (DUs) in two rural localities of Central-West Brazil. For each DU, 32 structural, 23 biotic and 28 management variables were obtained. Multiple logistic regression analysis was performed in order to identify statistically significant variables associated with occurrence of T. sordida in the study areas. A total of 1,057 specimens (99% in peridomiciles, mainly chicken coops) of T. sordida were collected from 63 DUs (infestation: 47%; density: ~8 specimens/DU; crowding: ~17 specimens/infested DU; colonisation: 81%). Only six (0.6%) out of 945 specimens examined were infected with Trypanosoma cruzi. The final adjusted logistic regression model indicated that the probability of T. sordida occurrence was higher in DU with wooden chicken coops, presence of > 30 animals in wooden corrals, presence of wood piles and presence of food storeroom. The results show the persistence of T. sordida in peridomestic habitats in rural localities of Central-West Brazil. However, the observed low intradomestic colonisation and minimal triatomine infection rates indicate that T. sordida has low potential to sustain high rates of T. cruzi transmission to residents of these localities.

Eficacia, seguridad y eficiencia de las nuevas tecnologías en cirugía tiroidea / Effectiveness, safety and efficiency of new technologies in thyroid surgery

Introduction: Surgery of the thyroid gland is the most performed procedure by the endocrine surgeon. In the last years, new techniques have been incorporated in this procedure. Our objective is to analyse the impact of these techniques in our department. Methods: We performed a retrospective and comparative study among three samples of patients submitted for total thyroidectomy. Group I: Sample of 96 patients operated between 2004 and 2007 performing total thyroidectomy. In this period we didn't use ultrasonic scalpel (US) nor intraoperative neuromonitoring (INM). Group II: Sample of 108 patients operated between 2008 and 2010. In this group we used US for hemostasis. Group III: Sample of 82 patients operated between 2011 and 2012. In this group we used both US and INM. The groups are compared: complications, postoperative stay, surgical time and costs per patient. Results: We analysed the following complications: haemorrhage, postoperative hipocalcemia and recurrent nerve palsy. We didn't find significant differences among the samples of patients but there were a less percentage of recurrent palsy in the third group (4.9 percent vs 12.5 and 11.1 percent). We found significant differences when stay, surgical time and costs were analysed. Conclusion: The use of new techniques in thyroid surgery has supposed an improvement not only in the clinic outcomes but in the surgical time.

Objetivo: La cirugía de la glándula tiroides representa el procedimiento más frecuente que realiza el cirujano endocrino. En los últimos años se han ido incorporando nuevas técnicas aplicadas a este procedimiento. El objetivo de nuestro trabajo es analizar el impacto que dichas técnicas han tenido en nuestro servicio. Material y Métodos: Estudio retrospectivo y comparativo entre tres muestras de pacientes a los que se realizó tiroidectomía total. Grupo I: Muestra de 96 pacientes intervenidos entre 2004 y 2007 a los que se realizó tiroidectomía total. En este período no se utilizó bisturí ultrasónico (BU) ni neuromonitorización intraoperatoria (NMI). Grupo II: Muestra de 108 pacientes intervenidos entre 2008 y 2010. En este grupo se realizó hemostasia con BU. Grupo III: Muestra de 82 pacientes intervenidos entre 2011 y 2012. Se utilizó tanto el BU como la NMI. Se comparan los grupos en cuanto a: complicaciones, estancia postoperatoria, tiempo quirúrgico y coste por paciente. Resultados: Las complicaciones analizadas fueron: hemorragia, hipocalcemia postoperatoria y parálisis del nervio laríngeo recurrente. No encontramos diferencias significativas entre los grupos aunque sí hay una menor tasa de parálisis recurrenciales en el tercer período (4,9 por ciento vs 12,5 y 11,1 por ciento). Hemos obtenido diferencias significativas en estancia, tiempo quirúrgico y coste por paciente. Conclusión: La inclusión de las nuevas técnicas en cirugía tiroidea ha supuesto una mejora en los resultados clínicos así como un ahorro de tiempo de quirófano.

Ultrasonido (UAL): intraparenquimatoso para realizar el bolsillo para el implante mamario / Ultrasound (UAL:) intraparenchymal for make the pocket for the breast implant

Aquí se utiliza la energía ultrasónica para ayudar a construir el bolsillo del implante mamario, permite la preservación de tejido vascular, linfático y estructuras nerviosas, lo que disminuye la morbilidad asociada al procedimiento convencional. Al preservar las estructuras nobles disminuye la infl amación posoperatoria y acorta considerablemente la duración de la equimosis con respecto a procedimientos no ultrasónicos. Sus virtudes son: ejecución más rápida del procedimiento completo, se evita la utilización de drenajes, mayor confort en el posoperatorio inmediato y tardío, así como disminución de las probabilidades de formación de biofi lm periimplante.

Here the ultrasound to help build the breast implant pocket energy is used, allows the preservation of vascular, lymphatic tissue, and nerve structures, which reduces the morbidity associated with conventional method. By preserving the fi ne structures reduces postoperative infl ammation and signifi cantly shortens bruising regarding ultrasonic use. Its virtues are, but speed of execution of the entire procedure, avoid using drains, comfort in the immediate and late post, as well as decreases the odds of peri implant biofi lm creation

Use of a new retrograde filling material (Biodentine) for endodontic surgery: two case reports / 国际口腔科学杂志·英文版

Mineral trioxide aggregate (MTA) is considered at the present time as the gold standard for root-end filling in endodontic surgery. However, this biocompatible material presents several drawbacks such as a long setting time and handling difficulties. The aim of this article is to present a new commercialized calcium silicate-based material named Biodentine with physical improved properties compared to MTA in a clinical application. Two endodontic microsurgeries were performed by using specific armamentarium (microsurgical instrumentation, ultrasonic tips) under high-power magnification with an operatory microscope. Biodentine was used as a root-end filling in order to seal the root canal system. The two cases were considered completely healed at 1 year and were followed for one more year. The 2-year follow-up consolidated the previous observation with absence of clinical symptoms and radiographic evidence of regeneration of the periapical tissues.

Radio-frequency ablation helps preserve nephrons in salvage of failed microwave ablation for a renal cancer in a solitary kidney

Recurrent tumors after renal ablative therapy present a challenge for clinicians. New ablative modalities, including microwave ablation [MWA], have very limited experience in methods of retreating ablation failures. Additionally, in MWA, no long-term outcomes have been reported. In patients having local tumor recurrence, options for surveillance or surgical salvage must be assessed. We present a case to help assess radio-frequency ablation [RFA] for salvage of failed MWA. We report a 63-year-old male with a 4.33-cm renal mass in a solitary kidney undergoing laparoscopic MWA with simultaneous peripheral fiber-optic thermometry [Lumasense, Santa Clara, CA, USA] as primary treatment. Follow-up contrast-enhanced computed tomography [CT] scan was performed at 1 and 4.3 months post-op with failure occurring at 4.3 months as evidenced by persistent enhancement. Subsequently, a laparoscopic RFA [LRFA] with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy. Clinical and radiological follow-up with a contrast-enhanced CT scan at 1 and 11 months post-RFA showed no evidence of disease or enhancement. Creatinine values pre-MWA, post-MWA, and post-RFA were 1.01, 1.14, and 1.17 mg/ml, respectively. This represents a 15 decrease in estimated glomerular filtration rate [eGFR] [79 to 67 ml/min] post-MWA and no change in eGFR post-RFA. Local kidney tumor recurrence often requires additional therapy and a careful decision making process. It is desirable not only to preserve kidney function in patients with a solitary kidney or chronic renal insufficiency, but also to achieve cancer control. We show the feasibility of RFA for salvage treatment of local recurrence of a Tib tumor in a solitary kidney post-MWA

A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: An in vitro study using scanning electron microscopy.

Background: The commonly accepted idea concerning root planing is that excessive removal of cementum is not necessary for removal of endotoxins. The ideal instrument should enable the removal of all extraneous substances from the root surfaces, without causing any iatrogenic effects. Aim: To compare the remaining calculus, loss of tooth substance, and roughness of root surface after root planing with Gracey curette, ultrasonic instrument (Slimline® insert FSI-SLI-10S), and DesmoClean® rotary bur. Materials and Methods: The efficiency of calculus removal, the amount of lost tooth substance, and root surface roughness resulting from the use of hand curette, ultrasonic instrument, and rotary bur on 36 extracted mandibular incisors were examined by SEM. We used three indices to measure the changes: Remaining calculus index (RCI), Loss of tooth substance index (LTSI), and Roughness loss of tooth substance index (RLTSI). Twelve samples were treated with each instrument. The time required for instrumentation was also noted. Statistical Analysis: Kruskal-Wallis ANOVA was used for multiple group comparisons and the Mann-Whitney test for group-wise comparisons. Analysis was carried out with SPSS® software (version 13). Results and Conclusion: The RCI and LTSI showed nonsignificant differences between the three groups. RLTSI showed a significant difference between Slimline™ and hand curette as well as Slimline™ and Desmo-Clean™. Slimline™ showed the least mean scores for RCI, LTSI, and RLTSI. Thus, even though the difference was not statistically significant, Slimline™ insert was shown to be better than the other methods as assessed by the indices scores and the instrumentation time.