Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique / Fixação de lente intraocular intraescleral transconjuntival sem sutura: técnica de Yamane modificada

ABSTRACT Purpose: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. Methods: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. Results: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. Conclusion: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

RESUMO Objetivo: Avaliar a eficácia e a segurança da técnica de Yamane modificada com a fixação de lenta intraocular transconjuntival sem sutura. Métodos: O implante de lente intraocular intraescleral e transconjuntival sem sutura foi realizado em pacientes com afacia e lentes intraoculares luxadas. Uma incisão em córnea clara (2,8 mm) foi feita no quadrante temporal e uma lente intraocular de três peças foi implantada na câmara anterior. Os hápticos da lente intraocular foram externalizados com uma agulha 27G através de túneis esclerais transconjuntivais nas posições de 6 e 12 horas. Os túneis esclerais transconjuntivais foram preparados para se ajustarem à posição e curvatura hápticas. O local dos túneis esclerais foi de 2 mm do limbo com um comprimento de 2 mm na esclera e foi destinado ao final da câmara posterior. As pontas dos hápticos foram cauterizadas para criar uma saliência terminal. Os hápticos foram empurrados para tras e as saliências foram implantadas nos túneis esclerais. Resultados: A coorte do estudo incluiu 21 pacientes com afacia unilateral e lentes intraocular deslocada. Todos os pacientes foram examinados no pós-operatório e no dia 1, 7, 1 mês e 3 meses do pós-operatório. Todos os exames revelaram formação da uma câmara anterior e lentes intraoculares bem centralizadas. Nenhuma complicação hápticas relacionada à exposição, sensação de corpo estranho ou desconforto foram observadas. Conclusão: O implante de lente intraocular transconjuntival intraescleral sem sutura é uma alternativa cirúrgica eficaz, segura e prática. Esta técnica foi superior ao método de Yamane no que diz respeito ao conforto e duração cirúrgica. Mais estudos com avaliações de seguimento mais prolongados são necessários para verificar as complicações de longo prazo.

First two brazilian cases: correction of ascending aortic aneurysm and aortic valve stenosis with sutureless/rapid deployment aortic prosthesis

Abstract Ascending aortic aneurysm is usually associated with aortic valve diseases, especially aortic stenosis. The standard technique involves the substitution of the dilated aortic segment with a Dacron tube and replacement of the aortic valve with a regular prosthesis. The correction of ascending aortic aneurysm with aortic valve replacement using the new sutureless and rapid deployment prosthesis was performed by a minimally invasive approach and for the first time in a Brazilian Center.

Teoría Bifásica del Movimiento Dentario Aplicada Mediante Micro-Osteo-Perforaciones / Teeth Movement Bifasic Theory Applied by Micro-Osteo-Perforations

RESUMEN: Un desafío común en la ortodoncia es la realización de cierres de espacio en brechas largas con pérdida ósea significativa producto de extracciones tempranas, sitio de extracciones traumáticas o expansiones en adultos con tabla vestibular delgada. El propósito de este artículo es difundir una teoría del movimiento dental desarrollada a partir de una serie de investigaciones que intentan probarla en animales como seres humanos. Las dos fases de remodelación de hueso son la "activación - reabsorción" (proceso catabólico) y "activación-formación" (proceso anabólico) de las superficies del hueso, resultando en los cambios de tamaño, forma y posición del hueso. La inflamación es necesaria para el movimiento dentario. Se puede estimular ambas fases mediante pequeñas perforaciones del hueso que pueden ser realizadas de forma segura en la superficie vestibular o lingual de las tablas corticales pudiendo ser superficiales o profundas. Se muestran ejemplos clínicos de pacientes tratados con el enfoque de la Teoría bifásica mediante estimulación ósea transgingival. Se concluye que esta teoría bifásica permite explicar la favorable respuesta que se observa en situaciones clínicas complejas cuando se estimula el movimiento con micro-osteoperforaciones.

ABSTRACT: A common challenge in orthodontics is the task of space closures in long gaps with significant bone loss due to early extractions, site of traumatic extractions or expansions in adults with thin vestibular table. The purpose of this article is to disseminate a theory of dental movement developed from a series of investigations that try to test it in animals as human beings. The two phases of bone remodeling are the "activation - resorption" (catabolic process) and "activation-formation" (anabolic process) of bone surfaces, resulting in changes in bone size, shape and position. Inflammation is necessary for tooth movement. Both phases can be stimulated by small perforations of the bone that can be performed safely on the vestibular or lingual surface of the cortical boards, which may be superficial or deep. Clinical examples of patients treated with the biphasic theory approach by transgingival bone stimulation are shown. It is concluded that this biphasic theory allows to explain the favorable response observed in complex clinical situations when the movement is stimulated with micro-osteoperforations.

Early experience with ligasure thyroidectomy in a Nigeria Teaching Hospital

Background: The principles of safe and efficient thyroid surgery had been established and the technique has remained the same for over the century without any major significant changes. The introductions of electrosurgical devices constitute a major shift in the technique of thyroid surgery. Objective: We present our early experience with the use of LIGASURE vessel sealing system for the procedure of thyroidectomy. Materials and Methods: This was a quasi-experimental study comparing outcome of LigaSure thyroidectomy in a prospective nonrandomized cohort with another retrospective cohort of preintervention clamp-and-tie thyroidectomy. Results: A total of 30 patients with a clinical diagnosis of goiter were recruited into the study. There were two males and 28 females with a mean age of 42.6 years. Diagnosis was simple multinodular goiter 24 (80%), controlled toxic nodular goiter 3 (10%), grave disease 1 (3.3%), and multinodular goiter with retrosternal extension 2 (6.7%). The mean thyroid weight was 121.0 g. The mean duration of surgery was 59 min compared to 128 min for traditional technique (P < 0.01). The mean blood loss of 116 ml was significantly less than 328 ml following the traditional technique (P < 0.01). Mean duration of hospital stay was 1.9 days, compared to 3.55 days in the traditional technique group (P = 0.02). Troubling postoperative complications of change in voice quality occurred in only one patient (3.3%). Conclusion: LigaSure thyroidectomy was found to be easier and faster to carry out with no learning curve and easy to learn and adapt

Thrombocytopenia after aortic valve replacement: comparison between sutureless perceval s valve and perimount magna ease bioprosthesis

Abstract Introduction: The incidence of postoperative thrombocytopenia after aortic valve replacement (AVR) with the Perceval S Sutureless bioprosthesis remains unclear. The aim of this study was to report thrombocytopenia associated with the use of sutureless AVR. Methods: The data was collected retrospectively for patients who had isolated AVR with sutureless Perceval S valve (Group A: 72 patients) and was compared with patients who underwent isolated sutured AVR with Perimount Magna Ease Bioprosthesis (Group B: 101 patients) in our institution between June 2014 and January 2017. Results: Cardiopulmonary bypass and cross-clamp time were significantly shorter in group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A versus 44% mean (day 1.7) in group B (P=0.0001). Absolute platelet count on postoperative day 1-6 in group A was significantly less than in group B (P≤0.05). Platelet count recovered to preoperative value in 44% patients in group B versus only in 26% patients in group A at discharge (P=0.018). Moderate thrombocytopenia occurs more often in group A (41% vs. 26%) (P=0.008) while severe thrombocytopenia (<50 x 109) was observed in 6% in group A but never in group B. Platelets (P=0.007) and packed red blood cells (P=0.009) transfusion was significantly higher in the group A. Conclusion: The implantation of sutureless Perceval aortic valves was associated with a significant drop in platelet count postoperatively with slow recovery and higher platelets and packed red blood cells transfusion requirements. A prospective randomised trial is needed to confirm our findings.

Aortic valve replacement with a conventional stented bioprosthesis versus sutureless bioprosthesis: a study of 763 patients

Abstract Objective: The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. Methods: From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). Results: Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.

Early clinical results of perceval sutureless aortic valve in 139 patients: freeman experience

Abstract Objective: The aim of this retrospective study is to evaluate the safety and performance of the Perceval sutureless valve in patients undergoing aortic valve replacement. We report the 30-day clinical outcomes of 139 patients. Methods: From January 2014 to December 2016, 139 patients underwent sutureless aortic valve replacement. Their operation notes, National Adult Cardiac Surgery Database and perioperative transoesophageal echocardiography findings were studied retrospectively. Results: Ninety-two patients underwent isolated aortic valve replacement (group A) with Perceval valve and 47 patients had combined procedures of aortic valve replacement and coronary artery bypass grafting (group B). The patients received a size S (n=23), M (n=39), L (n=42) or XL (n=35) prosthesis. Perceval valve was successfully implanted in 135 (97.1%) patients. Mean cross-clamping time and bypass time were 40 and 63 minutes for isolated cases, while 68 and 107 minutes for combined cases. Three (2.1%) patients died within 30 days. Four patients suffered stroke and 5 patients went into acute renal failure. Median intensive care unit and hospital stay was 2 and 8.5, respectively. Four valves were explanted due to significant paravalvular leak after surgery. Five patients had permanent pacemaker as a result of complete heart block and mean postoperative drainage was 295 mL for isolated case and 457 mL for combined cases. The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: Early postoperative results showed that Perceval valve is safe. Further follow up is needed to evaluate the long-term outcome with this bioprosthesis.

The impact and cost-effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Repair Programme in Eastern and Central Africa

Introduction: cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006.Methods: we analyzed anonymised data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods.Results: the median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods.Conclusion: cleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits

Spontaneous pregnancy outcome after surgical repair of clinically palpable varicocele in young men with abnormal semen analysis

Objective: The beneficial effect of varicocele repair in male infertility remains unresolved. The aim of this study was to identify the benefit from varicocele treatment based on pregnancy rate rather than improvement of semen quality.Subjects and Methods: This study included 141 infertile men with varicocele detected by clinical examination and confirmed by venous reflux on continuous wave Doppler ultrasonography (US). Measurement of Body Mass Index (BMI) and hormonal assays were performed in all patients. A total of 233 sub-inguinal varicocele repairs were done. Couples were followed up with semen analysis and pregnancy detection for 6, 12 and 18 months. Statistical analysis was performed using the chi-square, t-test and Mann-Whitney test where appropriate (p <0.05 accepted as statistically significant).Results: The spontaneous pregnancy rate was significantly greater in men with low or normal BMI. There were statistically significant differences between postoperative mean sperm count (64.7±6.8 and 10.5±1.8 million/ml) and progressive motility (38.3±2.4 and 17.7±1.8%) for spontaneous pregnancy and non-pregnancy, respectively. There were also significant changes from pre- to postoperative mean sperm concentration (21.5±2.1 and 64.7±3.8 million/ml), progressive motility (12.9±1.8 and 31.7±1.4%) and normal morphology (54±1.3 and 81.3±4.6%) in the spontaneous pregnancy cohort. Comparing pre- and postoperative serum hormone levels, FSH and prolactin decreased significantly in spontaneous pregnancy (6.57±0.65 to 4.6±0.53 IU/L and 166.2±11.8 to 149.3±10.4 pmol/L, respectively) and increased in non-pregnancy (9.05±0.71 IU/L and 187.8±13.3 pmol/L, respectively).Conclusion: Spontaneous pregnancy after sub-inguinal varicocelectomy is significantly affected by BMI, sperm concentration, progressive motility and morphology. The decrease of FSH may predict the spontaneous pregnancy outcome

Hernioplastia sintensión con doble prótesis (tapón y malla): resultados del Servicio de Cirugía General, Hospital Nacional de Itauguá / Hernioplasty without tension double prosthesis (mesh and plug): results of the Surgery Service General, National Hospital Itauguá

Las técnicas de reparacion sin sutura de tejidos, libres de tensión, ha significado un descenso de los índices de recurrencia a cifras inferiores al 1%. Todas ellas tienen en común el uso de material biocompatible de prolipopileno y son procedimientos que tienen una curva de aprendizaje corta. La HSTDP es una técnica sencilla, reproducible y con resultados satisfactorios. La técnica consistió en situar un cono plug de malla de prolipopileno sobre el defecto original de la hernia, según propuesta Rutkow y Robbins y posteriormente colocar la malla de polipropileno sobre la pared posterior del conducto inguinal y rodeando las estructuras del cordón espermático, fijándola según la técnica de Lichtenstein. La doble situación de la prótesis, en el defecto original y con un refuerzo anterior, permite tratar de forma más fisiológica y segura el defecto original y a la vez supone un refuerzo de las estructuras anatómicas de la región inguinal...

Introduction: the introduction of tension-free tissue-free repair techniques has meant a decrease in recurrence rates to figures below 1%. All of them have in common the use of biocompatible polypropylene material and are procedures that have a short learning curve. They are applied in almost any hospital, they have a lower frequency of early complications, their results are reproducible by any surgeon (provided they practice it as the authors describe it). Objective: to analyze the applicability and preliminary results of tensionless hernioplasty using double prostheses (plug plus mesh) (HSTDP). Patients and Methods: a descriptive observational study of a transverse section, partially retrospective, which included 165 adult patients with inguinal hernia admitted to the General Surgery Service of the Itauguá National Hospital from January 2006 to July 2008, according to the selection protocol and of preset jobs. The technique consisted of placing a polypropylene mesh cone or plug over the original hernia defect, as proposed by Rutkow and Robbins, and subsequently placing a polypropylene mesón the posterior wall of the inguinal canal and surrounding the spermatic cord structures, fixing it according to the Lichtenstein technique. Results: there was a predominance of indirect hernias and Gilbert's operative classification III. The median postoperative stay was 25,5 hours. The most frequent postoperative complication has been the presence of seromas in 4 cases (2,2 %) and infection in 7 cases (4 %). No case of prosthetic intolerance was evidenced. The median follow-up has been 14 months, with no recurrences. Conclusions: HSTDP is a simple, reproducible technique with satisfactory results. The double situation of the prosthesis, in the original defect and with a previous reinforcement, allows to treat the original defect in a more physiological and safe way and at the same time it supposes a reinforcement of the anatomical structures of the inguinal region.