Small incision trabeculectomy avoiding Tenon''s capsule. A new procedure for glaucoma surgery

Plasma ET-1 was measured around the clock on different calendar dates in healthy subjects and in subjects with diabetes and/or with high blood pressure and/or a history of vascular complications (HVDR). A transverse approach, with each subject contributing a single 24-h mean, assessed any about-weekly or half-weekly variation in ET-1. A circasemiseptan component resolved by single cosinor for nondiabetic (but not for diabetic) HVDR subjects (p = 0.010) differs in its timing of overall high values (p < 0.050) from that found in healthy subjects (p = 0.006). The results are aligned with circasemiseptan patterns in other circulatory variables and morbidity/mortality statistics.     

Preperitoneal prosthetic inguinal herniorrhaphy without a relaxing incision

A consecutive series of 276 men had 317 inguinal hernias repaired by the preperitoneal approach. Of these, 162 (59 per cent) had 194 (61 per cent) "complete" repairs using Marlex prostheses. Fifty-five of 152 indirect hernias (36 per cent) were patched similarly. Seventeen of twenty-two mixed bilateral defects (77 per cent) had a prosthetic patch. Thrity-three of forty-eight repairs (68 per cent) for recurrent hernia in forty-five men also employed Marlex. Two patients died postoperatively. Four of 194 repairs using Marlex failed. These preliminary results indicate that the advantages of preperitoneal exposure can be complemented by an initially satisfactory technic of repair using a prosthesis instead of the classic relaxing incision, which is difficult to use with this posterior approach.     

A new principle for unilateral complete cleft lip repair, the lateral columellar flap method

This article presents a different method for unilateral complete cleft lip repair. The tissue deficiency of the medial lip segment is filled with a flap from the lateral surface of the columella, which is in continuity with the lip segment. The lateral columellar flap and the medial lip segment are lowered in one piece vertically downward to such a position that the height of the arch of the Cupid's bow is equal on both sides. No lateral advancement is done. The suture line of the medial and lateral lip segments is an uninterrupted straight line, which imitates the natural line of the philtral column. The repaired lip has more fullness than the lips repaired with the conventional methods. The procedure is described in detail.     

A new repositioning system for the proximal segment in sagittal split ramus osteotomy of the mandible

Intrathoracic extra-medullary hematopoiesis is a compensatory mechanism usually seen in thalassemia. The authors report a case with multiple mediastinal localisations fortuitously discovered. CT has allowed diagnosis and led percutaneous biopsy.     

两个非综合征型唇腭裂家系染色体定位研究

目的:通过对两个非综合征型唇腭裂家系基因连锁分析,寻找与非综合征型唇腭裂紧密连锁的染色体区域.方法:对非综合征型唇腭裂家系成员进行全基因组扫描,并对结果中有连锁意义的区域进一步精密扫描,将扫描数据用参数连锁、非参数连锁和交互连锁分析,确定哪些染色体区段存在连锁.结果:1q32.2-41区域的参数和非参数连锁分数值在精密扫描中均明显升高;2p25.1-24.2区域参数结果并无意义,但非参数分析却显示了积极的连锁意义;交互乘法模型分析1q32.2-41和2p25.1-24.2区域存在积极的交互相乘作用.结论:本研究中的2个非综合征型唇腭裂家系,1q32.2-41和2p25.1-24.2区域可能存在易感基因,且1q32.2-41和2p25.1-24.2区域存在着相乘交互作用.     

A new way of access into the internal jugular vein

This paper describes a new technique for the canulation of the internal jugular vein. A transsection of the neck at the level of C4 (upper border of the thyroid cartilage) (Figure 1) shows the relative position of the internal jugular vein, the carotid artery and the sternocleidomastoid muscle. The internal jugular vein at this level is more superficial than is usually imagined. A cutaneous point of entry placed at the level of the thyroid cartilage on the medial border of the sternocleidomastoid muscle would be directly above, at the zenith of the carotid artery. From that point, moving a needle externally hugging the posterior aspect of the muscle will make it possible to reach the vein while actually moving away from the carotid artery.     

A new condylar positioning appliance for two-jaw osteotomies (Le Fort I and sagittal split ramus osteotomy)

We have presented a new appliance for easy, rapid, and exact repositioning of the proximal segment of the mandible in two-jaw osteotomies (Le Fort I and sagittal split ramus osteotomy).     

A model for the cleft lip nasal deformity

The underlying pathology of the cleft lip nasal deformity has yet to be fully realized, and cleft lip rhinoplasty continues to challenge the reconstructive surgeon. A new model is proposed, which is composed of elements that represent known anatomical structures of the nose. These structures are considered elemental to the mechanism of the primary cleft lip nasal deformity. The lobule is reduced to four arches. Five points on the skull provide foundations for these arches, which react interdependently to extrinsic forces and positional change. When certain changes are imposed on the model, predictable alterations in the configuration of the model imitate the observed deformities in the spectrum of the cleft lip nasal deformity, unilateral and bilateral, mild through severe. The model is described with illustrations, anatomic dissection, physical models, and selected clinical cases. A better understanding of the mechanisms of the cleft nasal deformities can be obtained through analysis of the model.     

分离机制下一种互联网安全接入方法

重点研究身份与位置分离机制下源地址真实性保障方面的方法,提出了身份与位置分离网络中唯一且不变的终端身份标识EID结构,并设计了一种保障源地址真实性的安全接入方法,并且给出了相应的协议流程和协议格式,保证了身份与位置分离网络中源地址即终端身份标识EID的真实性.最后使用SVO形式化逻辑对其安全性进行了证明.     

Choice of the site of incision for cataract surgery without suture according to preoperative astigmatism

PURPOSE: To compare surgically induced astigmatism, postoperative astigmatism and uncorrected visual acuity after cataract surgery depending on the site of a 4 mm sutureless incision (superior scleral or corneal temporal) and on the preoperative astigmatism. METHODS: According to preoperative astigmatism and to the site of incision 4 groups have been distinguished. Group I: with-the-rule preoperative astigmatism and superior scleral incision, group II: with-the-rule preoperative astigmatism and corneal temporal incision, group III: against-the-rule preoperative astigmatism and superior scleral incision, group IV: against-the-rule preoperative astigmatism and temporal incision. The patients had a preoperative and postoperative (Day 1, 8, 30, 180, 360) keratometry. Surgically induced astigmatism, preoperative and postoperative astigmatism have been expressed according to Naeser method. The uncorrected visual acuity at Day 30 has been compared in each group. RESULTS: Preoperative astigmatism was similar in the four groups. Surgically induced astigmatism was -0.18 diopter (D) at day 30 and -0.41 D at day 360 for the scleral incisions and +0.60 D at day 30 and +0.33 D at day 360 for the temporal incisions. The postoperative astigmatism was +0.5 D at day 30 and +0.27 at day 360 for the group I and +1.22 D at day 30 and +0.95 D at day 360 for group II. There was no statistical difference in the uncorrected visual acuity. Postoperative astigmatism was -0.8 D at day 30 and -1.03 D at day 360 in group III and -0.04 D at day 30 and -0.31 D at day 360 in group IV. The visual acuity was significantly better in group IV than in group III. CONCLUSION: In cases of preoperative with-the-rule astigmatism < or = 0.75 D the two sites of incisions are possible. In cases of WTR astigmatism over 0.75 D we perform a superior scleral approach. In cases of against-the-rule astigmatism the temporal incision is the only one to consider.     

Urologic laparoscopy with a new blunt-tipped trocar: safe, rapid access without the use of fascial sutures

Fifteen patients underwent successful laparoscopic procedures where a new blunt-tipped trocar was used both to gain initial access to and to insufflate the abdominal cavity. The use of this new trocar obviates the need for the use of the Veress needle and appears to be both time-saving and possibly safer. Unlike the Hasson-type trocar, the blunt trocar technique does not require the use of fascial sutures for prevention of air leaks.     

A new surgical management of esophageal stenosis without esophagectomy

In many cases, reflux esophagitis following surgical treatment for esophageal stenosis is caused by the recurrence of that after esophagectomy and esophogogastrostomy. We performed a new management without esophagectomy for a 66-year-old man with sliding hiatal hernia and esophageal stenosis induced by reflux esophagitis. A Expanding Metalic Stent (MES) was inserted to the stenotic portion of the esophagus, and then Collis-Nissen's procedure was done through left thoracotomy and phrenotomy. The postoperative course was satisfactory, and no gastroes-ophageal reflux was detected with the use of 24h pH-monitoring of the esophagus after surgery.     

Initial results of a new access device for hemodialysis technical note

A new subcutaneous device (Dialock; Biolink Corp., Middleboro, MA) provides vascular access to patients who currently require hemodialysis (HD). The device consists of a port-like valve, implanted subcutaneously below the clavicle, which provides a linear flow passage to two catheters placed in the right atrium via the jugular vein. The valve is accessed percutaneously with needle-cannulas that functionally convert the device to twin catheters for connecting the patient to the HD lines. Interdialytic patency is maintained using a standard heparin lock. The device has been implanted in 10 outpatients under local anesthesia, with almost immediate use for HD (median, 3 days) and has functioned successfully for more than 6 months (mean +/- SD, 4.0 +/- 1.7; > 400 dialysis sessions). Blood flows over 300 ml/min were consistently achieved (average, 320 +/- 50) with venous and arterial pressures of 197 +/- 42 mmHg and -241 +/- 31 mmHg, respectively. After 40 patient-months, condition of the needle puncture sites remains satisfactory. Four systemic infections have occurred in three patients; all have resolved without the need for device removal. There have been no infections at the puncture sites. One patient whose heparin lock was not changed for 23 days (for reasons unrelated to the device) required fibrin sheath stripping of his catheters. Patient and nurse acceptance has been excellent. The device may offer substantial improvement over conventional devices for HD access.     

A new model for occluding the left coronary artery in the rabbit without thoracotomy

A small, nonmagnetic coil was fluoroscopically guided into the left circumflex coronary artery (LCXA) at the midventricular level via the left femoral artery in seven rabbits. Coronary artery occlusion was confirmed by intracoronary contrast injection, electrocardiographic changes, akinesis of the posterolateral wall distal to the occluded area, and histopathological staining of the myocardium. This new model of a closed-chest coronary artery occlusion in the rabbit may be suitable for acute ischemic myocardium studies that do not require reperfusion.     

Lexical access without attention? Explorations using dichotic priming.

The authors used lexical decision in a dichotic listening situation and measured identity priming across channels to explore whether unattended stimuli can be processed lexically. In 6 experiments, temporal synchronization of prime and target words was manipulated, and acoustic saliency of the unattended prime was varied by embedding it in a carrier sentence or in babble speech. When the prime was acoustically salient, a cross-channel priming effect emerged, and participants were aware of the prime. When the prime was less salient, no identity priming was found, and participants failed to notice the prime. Saliency was manipulated in ways that did not degrade the prime. Results are inconsistent with models of late filtering, which predict equal priming irrespective of prime saliency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A robotic system for percutaneous renal access

PURPOSE: Percutaneous renal access can be challenging, particularly when the collecting system is not distended. Precise entry into a selected calyx facilitates subsequent percutaneous manipulations, but this skill requires extensive experience. In an attempt to improve accuracy while decreasing technical challenges, we developed a robotic system that automates the task of fluoroscopic image-guided percutaneous needle placement. MATERIALS AND METHODS: The prototype system consisted of a three degree-of-freedom robot with a needle injector end-effector. Imaging was provided by a biplanar fluoroscope. After correction of image distortion and fluoroscope calibration, robot to image-space registration was completed. To validate the system's ability to insert a needle into a calyx, ex vivo porcine kidneys suspended in agarose gel and distended with iodinated contrast solution were used as a model. In situ renal access tests with three 20 kg. pigs were performed. Access was confirmed by passing a flexible wire or aspirating iodinated contrast from the collecting system. RESULTS: The diameter of target calyces ranged from 3 to 7 mm. The in vitro accuracy of final needle tip positioning was 0.43 mm. In the ex vivo model, successful "one stick" access occurred on 10 of 12 attempts (83%). In situ access on the first attempt was successful for 6 of 12 target calyces (50%). Needle or tissue deflection accounted for each failure. CONCLUSION: The feasibility of a robotic system to assist in the percutaneous access of small and delicate renal calyces has been demonstrated. Additional work in reducing procedural steps and correcting for tissue deflection during needle passage is necessary to improve accuracy and to allow for clinical application.     

A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections

This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections.