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Sample records for bridge repair technique

  1. Subscapularis Tendon Repair Using Suture Bridge Technique

    PubMed Central

    Park, Yong Bok; Park, Young Eun; Koh, Kyoung Hwan; Lim, Tae Kang; Shon, Min Soo; Yoo, Jae Chul

    2015-01-01

    The subscapularis tendon plays an essential role in shoulder function. Although subscapularis tendon tears are less common than other rotator cuff tears, tears of the subscapularis tendon have increasingly been recognized with the advent of magnetic resonance imaging and arthroscopy. A suture bridge technique for the treatment of posterosuperior rotator cuff tears has provided the opportunity to improve the pressurized contact area and mean footprint pressure. However, suture bridge fixation of subscapularis tendon tears appears to be technically challenging. We describe an arthroscopic surgical technique for suture bridge repair of subscapularis tendon tears that obtains ideal cuff integrity and footprint restoration. Surgery using such a suture bridge technique is indicated for large tears, such as tears involving the entire first facet or more, tears with a disrupted lateral sling, and combined medium to large supraspinatus/infraspinatus tears. PMID:26052489

  2. Suture-bridge subscapularis tendon repair technique using low anterior portals.

    PubMed

    Park, Jin-Young; Park, Jun-Suk; Jung, Jae-Kyung; Kumar, Praveen; Oh, Kyung-Soo

    2011-02-01

    A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge creation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approached using other arthroscopic techniques. From a biomechanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique. PMID:20890701

  3. Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

    PubMed Central

    Lee, Kwang Won; Bae, Kyoung Wan; Choy, Won Sik

    2013-01-01

    Background We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. Results Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and

  4. Tendon-bone contact pressure and biomechanical evaluation of a modified suture-bridge technique for rotator cuff repair.

    PubMed

    Baums, Mike H; Geyer, Michael; Büschken, Meike; Buchhorn, Gottfried H; Spahn, Gunter; Klinger, Hans-Michael

    2010-07-01

    The aim of the study was to evaluate the time-zero mechanical and footprint properties of a suture-bridge technique for rotator cuff repair in an animal model. Thirty fresh-frozen sheep shoulders were randomly assigned among three investigation groups: (1) cyclic loading, (2) load-to-failure testing, and (3) tendon-bone interface contact pressure measurement. Shoulders were cyclically loaded from 10 to 180 N and displacement to gap formation of 5- and 10-mm at the repair site. Cycles to failure were determined. Additionally, the ultimate tensile strength and stiffness were verified along with the mode of failure. The average contact pressure and pressure pattern were investigated using a pressure-sensitive film system. All of the specimens resisted against 3,000 cycles and none of them reached a gap formation of 10 mm. The number of cycles to 5-mm gap formation was 2,884.5 + or - 96.8 cycles. The ultimate tensile strength was 565.8 + or - 17.8 N and stiffness was 173.7 + or - 9.9 N/mm. The entire specimen presented a unique mode of failure as it is well known in using high strength sutures by pulling them through the tendon. We observed a mean contact pressure of 1.19 + or - 0.03 MPa, applied on the footprint area. The fundamental results of our study support the use of a suture-bridge technique for optimising the conditions of the healing biology of a reconstructed rotator cuff tendon. Nevertheless, an individual estimation has to be done if using the suture-bridge technique clinically. Further investigation is necessary to evaluate the cell biological healing process in order to achieve further sufficient advancements in rotator cuff repair. PMID:19826786

  5. 33 CFR 115.40 - Bridge repairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Bridge repairs. 115.40 Section 115.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LOCATIONS AND CLEARANCES; ADMINISTRATIVE PROCEDURES § 115.40 Bridge repairs. Repairs to a bridge which...

  6. 33 CFR 115.40 - Bridge repairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Bridge repairs. 115.40 Section 115.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LOCATIONS AND CLEARANCES; ADMINISTRATIVE PROCEDURES § 115.40 Bridge repairs. Repairs to a bridge which...

  7. 33 CFR 115.40 - Bridge repairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Bridge repairs. 115.40 Section 115.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LOCATIONS AND CLEARANCES; ADMINISTRATIVE PROCEDURES § 115.40 Bridge repairs. Repairs to a bridge which...

  8. 33 CFR 115.40 - Bridge repairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Bridge repairs. 115.40 Section 115.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LOCATIONS AND CLEARANCES; ADMINISTRATIVE PROCEDURES § 115.40 Bridge repairs. Repairs to a bridge which...

  9. 33 CFR 115.40 - Bridge repairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Bridge repairs. 115.40 Section 115.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LOCATIONS AND CLEARANCES; ADMINISTRATIVE PROCEDURES § 115.40 Bridge repairs. Repairs to a bridge which...

  10. Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

    PubMed Central

    Lee, Sung-Moon; Lee, Young-Kuk; Shin, Hong-Kwan

    2014-01-01

    Background The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results. Methods Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively. Results The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient. Conclusions Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint. PMID:25177460

  11. 24. Moody Bridge truss repair plans showing existing area of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. Moody Bridge truss repair plans showing existing area of damage along with repair procedures for correcting damage and returning truss to structural integrity. - Moody Bridge, Spanning South Fork Eel River, Garberville, Humboldt County, CA

  12. Structural health monitoring of composite repair patches in bridge rehabilitation

    NASA Astrophysics Data System (ADS)

    Wu, Zhanjun; Ghosh, Kumar; Qing, Xinlin; Karbhari, Vistasp; Chang, Fu-Kuo

    2006-03-01

    In recent years, there are many issues involving safety on old bridges, aircrafts and other structures, which threaten the lives of the people using those structures, as well as the structures themselves. To prevent future failure, various measures are being taken. Structure rehabilitations with carbon fiber reinforced composite patches have been adopted and demonstrated to be an excellent way to enhance/repair the structures and prolong the service life. However, there are still many problems residing in this kind of technology that remain unsolved, for example, the failure of the interface between composite repair patches and their host structures. This is a critical issue that must be addressed in order to show the viability of composite patches. In order to study debond occurring between composite repair patches and their host structures, a structure health monitoring scheme was demonstrated on a concrete bridge model in the laboratory. The system is based on active sensing with diagnostic lamb waves, in which piezoelectric transducers are used as both sensors and actuators. In the test, six SMART Layers, each having eight piezoelectirc transducers, were integrated with two composite repair strips on the deck slab of the concrete bridge model. For the three diagnostic layers with each composite repair patch, two layers were bonded on the top surface of the patch, and the other is embedded at the interface between the composite repair patch and the deck slab of the concrete bridge model. The loading procedure of the test included three phases. First, the bridge model was preloaded to initiate cracks on the deck slabs and the repair patches were then implemented. Second, the load was raised to reach the shear capacity of the girders of the bridge model and then the repair patches were implemented on those girders. Lastly, the structure was loaded to damage the deck slabs. During the test, the initiation and development of debond between composite repair patches

  13. Bridging Suture Repair for Acetabular Chondral Carpet Delamination

    PubMed Central

    Kaya, Mitsunori; Hirose, Toshiaki; Yamashita, Toshihiko

    2015-01-01

    Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair. This article describes the technique of bridging suture repair for carpet delamination in detail; the technique enables the surgeon to stabilize the delaminated acetabular cartilage. Intra-articular soft anchors and an acetabular rim knotless anchor footprint provide a stable repair for delaminated cartilage. This technique is especially helpful in cases with acetabular cartilage carpet delamination. PMID:26759774

  14. Cobbler's Technique for Iridodialysis Repair

    PubMed Central

    Pandav, Surinder Singh; Gupta, Parul Chawla; Singh, Rishi Raj; Das, Kalpita; Kaushik, Sushmita; Raj, Srishti; Ram, Jagat

    2016-01-01

    We describe a novel “Cobbler's technique” for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The “Cobbler's technique” allows a maximally functional and cosmetic result for iridodialysis. PMID:26957855

  15. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.

    PubMed

    Park, Maxwell C; ElAttrache, Neal S; Tibone, James E; Ahmad, Christopher S; Jun, Bong-Jae; Lee, Thay Q

    2007-01-01

    Rotator cuff repair via transosseous tunnels can improve footprint contact area and pressure when compared with suture anchor techniques. A double-row technique has been used clinically to improve footprint coverage by a repaired tendon. We hypothesized that a transosseous-equivalent rotator cuff repair via tendon suture bridges would demonstrate improved pressurized contact between the tendon and tuberosity when compared with a double-row technique. In 6 fresh-frozen human shoulders, a transosseous-equivalent rotator cuff repair was performed: a suture limb from each of 2 medial anchors was bridged over the tendon and fixed laterally with an interference screw (4 suture bridges). In 6 of the contralateral specimens, two types of repair were performed randomly in each specimen: (1) a double-row repair and (2) a transosseous-equivalent repair with a single screw (2 suture bridges). For all repairs, pressure-sensitive film was placed at the tendon-footprint interface, and software was used to obtain measurements. The mean pressurized contact area between the tendon and insertion was significantly greater for the 4-suture bridge technique (124.2 +/- 16.3 mm2, 77.6% footprint) compared with both the double-row (63.3 +/- 28.5 mm2, 39.6% footprint) and 2-suture bridge (99.7 +/- 22.0 mm2, 62.3% footprint) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was greater for the 4-suture bridge technique (0.27 +/- 0.04 MPa) than for the double-row technique (0.19 +/- 0.01 MPa) (P = .002). The transosseous-equivalent rotator cuff repair technique can improve pressurized contact area and mean pressure between the tendon and footprint when compared with a double-row technique. A transosseous-equivalent technique, using suture bridges, may help optimize the healing biology at a repaired rotator cuff insertion. PMID:17321161

  16. Nondestructive evaluation techniques for enhanced bridge inspection

    SciTech Connect

    Thomas, G.; Benson, S.; Durbin, P.; Del Grande, N.; Haskins, J.; Brown, A.; Schneberk, D.

    1993-10-01

    Nondestructive evaluation of bridges is a critical aspect in the US aging infrastructure problem. For example in California there are 26,000 bridges, 3000 are made of steel, and of the steel bridges, 1000 are fracture critical. California Department of Transportation (Caltrans), Federal Highway Administration, and Lawrence Livermore National Laboratory (LLNL) are collaborating to develop and field NDE techniques to improve bridge inspections. We have demonstrated our NDE technologies on several bridge inspection applications. An early collaboration was to ultrasonically evaluate the steel pins in the E-9 pier on the San Francisco Bay Bridge. Following the Loma-Prieta earthquake in 1989 and the road way collapse at the E-9 pier, a complete nondestructive evaluation was conducted by Caltrans inspectors and several ultrasonic indications were noted. LLNL worked with Caltrans to help identify the source of these reflections. Another project was to digitally enhance high energy radiographs of bridge components such as cable end caps. We demonstrated our ability to improve the detection of corrosion and fiber breakage inside the end cap. An extension of this technology is limited view computer tomography (CT). We implemented our limited view CT software and produced cross-sectional views of bridge cables from digitized radiographic films. Most recently, we are developing dual band infrared imaging techniques to assess bridge decks for delaminations. We have demonstrated the potential of our NDE technology for enhancing the inspection of the country`s aging bridges.

  17. Pipeline repair technique cuts downtime

    SciTech Connect

    Bellamy, G.; Jouanneau, J.F.; Quin, R.; Wiet, P.

    1985-02-11

    This article deals with a project that explored the cold-tapping technique for repairing or modifying sea gas lines. The technique allows work to be carried out on a section of pipeline without the need, as before, for the flooding of the line, and subsequent dewatering and drying of the line. Lost production time is greatly reduced. Cold-tapping is performed on a pipe depressurized at the same level as the sea-bed hydrostatic pressure. The system is designed to withstand an accidental depressurization of the pipe to the atmosphere pressure with a safety factor of one third. The technique is simple, allows for accurate positioning of the plugs, and offers a maximum reliability due to an efficient monitoring and a wide range of backup procedures. Keeping the line entirely free of extra pieces of equipment after the operation is also a major advantage. The entire operation described took 34 hours during which all the required tasks were performed flawlessly. Analysis of the data collected during the test program showed that cold-tapping required a maximum of four extra barge days. It was demonstrated that the method can save up to eight weeks of gas-pipeline shutdown time.

  18. Defect repair performance using the nanomachining repair technique

    NASA Astrophysics Data System (ADS)

    Morikawa, Yasutaka; Kokubo, Haruo; Nishiguchi, Masaharu; Hayashi, Naoya; White, Roy; Bozak, Ron; Terrill, Lee

    2003-08-01

    Nanomachining is a new technique for repairing photomask defects. The advantages of this technique are no substrate damage, precise edge placement position and Z height accuracy when compared with current Laser zapper or FIB GAE repair techniques. This technique can be applied to any type of opaque defects at any type of film materials and quartz bump defects on Alternating Aperture Phase Sifting Masks (AAPSM). Furthermore, these characteristics enable complex pattern repairs of most advanced photomasks for 193nm lithography and enables iterative repair to achieve improved printing performance when analyzed with an AIMS 193nm tool. Dai Nippon Printing Co., Ltd. (DNP) has been producing AAPSMs in mass production for quite some time. The standard type of AAPSMs manufactured has been etched quartz, single trench with an undercut structure. On this structure, there is a potential for quartz defects underneath the chrome overhang based on the combination of dry and wet etching to create the undercut. For this study, we fabricated this kind of designed quartz defects and repaired them using the nanomachining system. These types of defects are particularly difficult to repair perfectly because they exist underneath the chrome overhang. We will show some options to achieve better printing results through the repair of these kinds of defects. In this report, we confirmed basic performance of this technique such as edge placement accuracy, Z height accuracy and AIMS printability. Additionally, we also tried to repair some complex defects such as quartz defects of AAPSM, quartz defects of CPL mask and oversized Serifs for application options. We will show these nanomachining repairs with evaluation results of printing performance simulated by the AIMS 193nm tool.

  19. Efficacy of Different Rotator Cuff Repair Techniques.

    PubMed

    Gurnani, Navin; van Deurzen, Derek Friedrich Petrus; Flipsen, Mark; Raven, Eric Ernest Joseph; van den Bekerom, Michel Pieter Jozef

    2015-05-01

    The purpose of this review article is to describe the currently used techniques for rotator cuff repair and after treatment. The literature was searched for the different surgical techniques and additional treatment including: [1] full arthroscopic and arthroscopic assisted rotator cuff repair, [2] acromioplasty as an additional treatment to rotator cuff repair, [3] the use of plasma rich platelets (PRP) after rotator cuff repair, [4] the single and double row fixation techniques, [5] long head of the biceps brachii tenotomy or tenodesis with rotator cuff repair, [6] scaffolds in rotator cuff surgery, and [7] early motion or immobilization after rotator cuff repair. The rationale, the results, and the scientific evidence were reported for the eligible procedures. PMID:26055023

  20. 75 FR 61354 - Safety Zone; Interstate 5 Bridge Repairs, Columbia River, Portland, OR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-05

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Interstate 5 Bridge Repairs, Columbia River... Interstate 5 Bridge. The safety zone is necessary to ensure the safety of the workers involved as well as the...; Interstate 5 Bridge Repairs, Columbia River, Portland, OR. (a) Location. The following area is a safety...

  1. Anodization As A Repair Technique

    NASA Technical Reports Server (NTRS)

    Groff, Roy E.; Maloney, Robert D.; Reeser, Robert W.

    1988-01-01

    Thin, hard oxide layer added to aluminum part. Surfaces on aluminum part worn out of tolerance by no more than 0.004 in. often repaired by anodizing to build up aluminum oxide layers. Oxide layers very hard and grounded to desired final dimensions.

  2. Techniques for aortic arch endovascular repair.

    PubMed

    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  3. 33 CFR 165.T08-0698 - Safety Zone; Port of Galveston, Pelican Island Bridge Repair.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Guard District § 165.T08-0698 Safety Zone; Port of Galveston, Pelican Island Bridge Repair. (a... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Safety Zone; Port of Galveston, Pelican Island Bridge Repair. 165.T08-0698 Section 165.T08-0698 Navigation and Navigable Waters...

  4. Surgical repair of complete atrioventricular defect (Nunn technique).

    PubMed

    El-Rassi, Issam; Charafeddine, Fatimah; Tabbakh, Anas; Aboutaka, Mohammad; Khater, Daniele; Arabi, Mariam; Bitar, Fadi

    2015-01-01

    Two procedures have been traditionally used for the surgical repair of complete atrioventricular canal. The single-patch technique includes the division of valve leaflets, and the use of one patch to close the ventricular and the atrial septal defects, whereas the double-patch technique uses two separate patches, without the division of the bridging leaflets. Between 1997 and 2007, another technique emerged, the modified single-patch technique, or the 'Australian' technique, whereby the ventricular septal defect (VSD) is closed by the direct apposition of the bridging leaflets against the crest of the defect. Because of the absence of the ventricular septal patch, concerns have been raised about the possible left ventricular outflow tract obstruction (LVOTO), or atrioventricular valve (AVV) distortion, especially in case of a deep VSD, or if the defect extends superiorly. The results of the modified single-patch technique in terms of mortality, immediate and long-term AVV function and LVOTO have been similar to the standard techniques in most reports. This article will describe in detail the operative technique and review the relevant literature. PMID:26443542

  5. Knee Extensor Mechanism Repairs: Standard Suture Repair and Novel Augmentation Technique.

    PubMed

    Meyer, Zachary; Ricci, William M

    2016-08-01

    Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges. PMID:27441933

  6. Investigation of chloride induced corrosion of bridge pier and life-cycle repair cost analysis using fiber reinforced polymer composites

    NASA Astrophysics Data System (ADS)

    Dhakal, Dinesh

    Bridges are the long term investment of the highway agencies. To maintain the required service level throughout the life of a bridge, a series of maintenance, repair, and rehabilitation (MRℝ) works can be performed. To investigate the corrosion deterioration and maintenance and repair practices in the bridge pier columns constructed in chloride-laden environment, a questionnaire survey was conducted within the 50 state Departments of Transportation (DOTs). Based on the survey data, two corrosion deterioration phases were identified. They were corrosion crack initiation phase and corrosion propagation phase. The data showed that the mean corrosion crack initiation phase for bridge pier column having cover of 50 mm, 75 mm, and 100 mm was 18.9 years, 20.3 years, and 22.5 years, respectively. The corrosion propagation phase starts after the corrosion crack initiation. The corrosion propagation is defined in a single term, corrosion damage rate, measured as percentage of area damaged due to corrosion cracking, spalling, and delamination. From the survey, the corrosion damage rate was found 2.23% and 2.10% in the bridge pier columns exposed to deicing salt water and exposed to tidal splash/spray, respectively. For this study, two different corrosion damage rates were proposed before and after the repair criteria for minor damage repair as practiced by DOTs. This study also presents the collected data regarding the corrosion effectiveness of using sealers and coatings, cathodic protection, corrosion inhibitors, carbon fiber/epoxy composites, and glass fiber/epoxy composites as maintenance and repair technique. In this study, the cost-effectiveness of wrapping carbon fiber/epoxy composites and glass fiber/epoxy composites in bridge pier columns constructed in a chloride-laden environment was investigated by conducting life-cycle cost analysis. As a repair work, externally bonded two layer of carbon fiber/epoxy and glass fiber/epoxy composites were installed by wet

  7. Repairing Posteromedial Meniscocapsular Separation: A Technique Using Inside-Out Meniscal Repair Needles

    PubMed Central

    Joshi, Anant; Usman, Sajeer; Sabnis, Bhushan; Kini, Abhishek

    2016-01-01

    Posteromedial meniscocapsular separation of the knee has received renewed interest, with many articles describing a high incidence in association with anterior cruciate ligament injury. Various techniques have been described to address these lesions using all-inside meniscal repair sutures or using rotator cuff repair instruments through the posteromedial portal. Most orthopaedic surgeons are accustomed to using the “inside-out” meniscal repair technique with a double-armed suture. This technique is cost-effective and, in our opinion, more efficient in repairing such tears. We present our technique of repairing peripheral meniscocapsular lesions using an inside-out meniscal repair system. We believe that this technique is easily reproducible, is less time-consuming, and ensures a good “bite” of the capsular tissue, producing a robust repair. PMID:27073773

  8. 77 FR 21436 - Safety Zone, East River, Brooklyn Bridge Scaffolding Repair, Brooklyn, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-10

    ...The Coast Guard is establishing a temporary safety zone on the navigable waters of the East River, in the vicinity of the Brooklyn Bridge. This action is necessary to provide for the safety of life and property on the navigable waters during emergency repairs to stabilize and remove the damaged scaffolding under the eastern span of the bridge. This rule is intended to restrict all vessels from......

  9. 18. Construction technique, detail, bridges along elevated right ofway of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. Construction technique, detail, bridges along elevated right- of-way of Shaker Rapid Transit through east side city of Cleveland. 'Showing use of Pyrobar to decrease load of bridge (East 81st Street); the Pyrobar is shown placed on wet concrete. Workmen at left are finishing laying concrete over pyrobar.' 1915 - Shaker Heights Rapid Transit Line, Cleveland, Cuyahoga County, OH

  10. 78 FR 61937 - Safety Zone; Port of Galveston, Pelican Island Bridge Repair

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-07

    ...The Coast Guard is establishing a temporary safety zone in Galveston to maintain public safety during the Pelican Island Bridge Repair Project. This action is necessary to protect public boaters and their vessels from potential safety hazards. Entry into this zone is prohibited unless specifically authorized by the Captain of the Port of Houston-Galveston or a designated...

  11. Deep patch technique for landslide repair. Final report

    SciTech Connect

    Helwany, B.M.

    1994-10-01

    The report describes the laboratory testing of the `USFS deep patch` technique and a CTI modification of this technique for repairing landslides with geosynthetic reinforcement. The technique involves replacing sections of roadway lost due to landslides on top of a geosynthetically-reinforced embankment. The CTI modification involves replacing the reinforced slope with a geosynthetically-reinforced retaining wall with a truncated base. Both techniques rely on the cantilevering ability of the reinforced mass to limit the load on the foundation with a high slide potential. The tests with road base showed that (1) both the USFS and CTI repair reduced effectively the adverse effects of local landsliding on the highway pavement by preventing crack propagation; (2) the USFS repair increased the stability of the repaired slope, which was in progressive failure, by reducing the stresses exerted on it; and (3) the CTI repair produced substantially greater stresses on its foundation due to the truncated base of the reinforced mass.

  12. Bridge deck repairs with polymer concrete patching materials

    NASA Astrophysics Data System (ADS)

    Edgecomb, W. C., Jr.

    1983-01-01

    The FHWA polymer concrete as formulated at Brookhaven National laboratory (BNL) was mixed, placed into spalls and finished on grade with steel trowels on more than a dozen bridges. This polymer concrete was a two-component system consisting of a liquid monomer component comprised of methyl methacrylate base, which contained a cross linking agent with promoters and an inhibitor, and a powder component which contained reactive polymers, blend of silica sands, initiator, and color pigments. These formed an impregnable material of approximately 8000 psi. Cure time for this project's cold weather formulation to obtain this strength was approximately 2 hours at 40 F.

  13. Achilles Tendon Repair, A Modified Technique

    PubMed Central

    Keyhani, Sohrab; Mardani-Kivi, Mohsen; Abbasian, Mohammadreza; Emami-Moghaddam Tehrani, Mohammad; Lahiji, Farivar Abdollahzadeh

    2013-01-01

    Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair. Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. Results: Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications. PMID:25207295

  14. Health assessment of bonded composite repairs with frequency response techniques

    NASA Astrophysics Data System (ADS)

    White, Caleb; Whittingham, Brendan; Li, Henry C. H.; Herszberg, Israel; Mouritz, Adrian P.

    2007-01-01

    Structural health monitoring (SHM) technology may be applied to composite bonded repairs to enable the continuous through-life assessment of the repair's efficacy. This paper describes an SHM technique for the detection of debonding in composite bonded patches based on frequency response. The external doubler repair, commonly used to patch aircraft structures, is examined in this paper. An experimental investigation was conducted using carbon/epoxy doubler repairs bonded to carbon/epoxy substrates, with piezoelectric devices used to measure variations in the frequency response of the repaired structure due to debonding of the external doubler. Three piezoelectric devices were adhered to the structure; the actuator to the external doubler and two sensors to the parent panel. To simulate real repair design requirements (minimum surface perturbation) piezoelectric devices were installed on 'internal' surfaces. Clearance for the actuator was created by the removal of damaged material. The frequency response signature of the repaired structure with simulated debonds is analysed with respect to the response of fully bonded repairs. Results are discussed with implications for the development of a technique to monitor the integrity of external bonded repairs.

  15. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture

    PubMed Central

    Lee, Kwang Won; Lee, Gyu Sang; Choy, Won Sik

    2015-01-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing. PMID:26640635

  16. Stochastic optimization techniques for NDE of bridges using vibration signatures

    NASA Astrophysics Data System (ADS)

    Yi, Jin-Hak; Feng, Maria Q.

    2003-08-01

    A baseline model updating is the first step for the model-based non destructive evaluation for civil infrastructures. Many researches have been drawn to obtain a more reliable baseline model. In this study, heuristic optimization techniques (or called as stochastic optimization techniques) including the genetic algorithm, the simulated annealing, and the tabu search, were have been investigated for constructing the reliable baseline model for an instrumented new highway bridge, and also were compared with the result of conventional sensitivity method. The preliminary finite element model of the bridge was successfully updated to a baseline model based on measured vibration data.

  17. Estimating outdoor and indoor dust lead levels from accidental bridge repair containment releases

    SciTech Connect

    Cohen, J.T.; Conway, R.F.

    1999-07-01

    A 1998 New York City Department of Transportation (NYCDOT) environmental impact statement (EIS) evaluated the proposed removal of deteriorated lead paint from NYCDOT-owned bridges. The EIS health risk assessment quantified the potential impact of particulate releases on blood lead levels among members of the public living and working near affected bridges. The risk assessment consisted of a fate and transport component and an exposure-dose component. The fate and transport component, modeled using the EPA's Industrial Source Complex (ISC3) model, calculated the impact of paint removal activities on ambient air lead concentrations and dust lead deposition rates. The exposure-dose component, modeled using EPA's Integrated Exposure Uptake Biokinetic (IEUBK) model, the Bowers et al. Adult Lead model, and the O'Flaherty lead model, calculated the impact of additional lead in air, street dust, interior house dust, and soil on blood lead levels, a conventional measure of body lead burden. The analysis was complicated because the ISC3 model provides a dust lead deposition rate ({micro}g/m{sup 2}-day), while the IEUBK, Bowers et al., and O'Flaherty models demand as input specification of dust lead concentrations ({micro}g lead per g dust). This paper describes a model developed for the EIS that quantifies long term average dust lead concentrations associated with typical bridge containment releases, and short term dust lead concentration spikes following worst case release events associated with bridge repair containment structure failures. The model reflects the influence of both lead and other debris associated with bridge repair activities, the contribution of background debris to street dust, and the impact of rainfall on removal of both lead and other material from the street dust reservoir.

  18. Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

    PubMed Central

    Rubenis, Imants; Lam, Patrick H.; Murrell, George A.C.

    2015-01-01

    Background: Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty. Purpose: To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair. Results: At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001). Conclusion: Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of

  19. Endoscopic repair technique for traumatic penetrating injuries of the clivus.

    PubMed

    Liebelt, Brandon D; Boghani, Zain; Haider, Ali S; Takashima, Masayoshi

    2016-06-01

    Unlike basilar skull fractures, penetrating traumatic injuries to the clivus are uncommon. We present two novel and interesting cases of traumatic crossbow arrow injury and penetrating screwdriver injury to the clivus. A review of the literature describing methods to repair these injuries was performed. A careful, systematic approach is required when working up and treating these injuries, as airway preservation is critical. An adaptation to the previously described "gasket-seal" method for skull base repair was utilized to repair the traumatic cerebrospinal fluid (CSF) fistulas. This repair technique is unique in that it is tailored to a much smaller defect than typical post-surgical defects. Two patients are presented, one with a post-traumatic CSF fistula after penetrating crossbow injury to the clivus and one with a penetrating screwdriver injury to the clivus. The patients were treated successfully with transnasal endoscopic repair with fascia lata graft and a nasoseptal flap, a novel adaptation to the previously described "gasket-seal" technique of skull base repair. PMID:26924184

  20. Prosthetics and Techniques in Repair of Animal's Abdominal Wall.

    PubMed

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  1. Pectoralis Major Muscle Rupture Repair: Technique Using Unicortical Buttons

    PubMed Central

    Metzger, Paul D.; Bailey, James R.; Filler, Robert D.; Waltz, Robert A.; Provencher, Matthew T.; Dewing, Christopher B.

    2012-01-01

    Over the past few decades, there has been increased awareness of pectoralis major muscle injuries necessitating further evaluation of management options and, in particular, surgical repair. Injury typically occurs when an eccentric load is applied to the muscle, such as with bench pressing, and failure usually occurs through the tendon. Although nonoperative management is sometimes appropriate, given the injury's propensity for young, active male patients, surgical intervention is often warranted. Because the injury typically occurs at the muscle-tendon interface, surgery focuses on repair of the avulsed tendon into its anatomic attachment site. We describe the use of a unicortical suture button to repair the ruptured tendon. This technique achieves the goals of strong fixation and anatomic repair of the tendon back into its native footprint. PMID:23766966

  2. Intermediate hearth repair technique at Thyssen Stahl AG

    SciTech Connect

    Kowalski, W.; Bachhofen, H.J.; Ruether, P.; Ballewski, T.

    1996-12-31

    Nowadays various techniques for the fastest possible intermediate repair and/or emplacement of refractory materials above the tuyere level allow a significant extension of furnace campaign life. The latter are hence now exclusively determined by the service life of the hearth. The improvement of hearth monitoring and the estimation of residual brick strength of the refractory lining on the basis of temperature measurements in the hearth enable the location of individual zones of premature wear. These measurement methods, which were developed by Thyssen Stahl AG, aid the decision to undertake selective repair of the hearth. Three areas of repair are differentiated: taphole zone; hearth wall, localized; and hearth wall, extensive. This hearth repair method is described in this report using the example of hearth refurbishing blast furnace 8, Hamborn.

  3. Prosthetics and Techniques in Repair of Animal's Abdominal Wall

    PubMed Central

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  4. Unique Technique for Open Surgical Repair after Failed Endovascular Aneurysm Repair with Proximal Anastomoses

    PubMed Central

    Hirota, Jun; Mori, Kazuki; Shuto, Takashi; Okamoto, Keitaro; Sato, Aiko; Wada, Tomoyuki; Anai, Hirofumi; Miyamoto, Shinji

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR. PMID:27375808

  5. Laparoscopic Paravaginal Defect Repair: Surgical Technique and a Literature Review.

    PubMed

    Chinthakanan, Orawee; Miklos, John R; Moore, Robert D

    2015-11-01

    Paravaginal defects, commonly seen in patients with anterior vaginal wall prolapse, are due to the detachment of pubocervical fascia from the arcus tendineus fascia pelvis (ATFP), at or near its lateral attachment. The majority of anterior vaginal wall prolapse is thought to be caused by paravaginal defects. Richardson et al. first described and demonstrated the anatomy of the paravaginal defect, as well as described the initial technique of the abdominal approach to repair. Since that time, the laparoscopic approach for repair has been developed and described with success rates of laparoscopic paravaginal defect repair reported in the range of 60% to 89%. This minimally invasive approach to address anterior wall prolapse eliminates the need for a vaginal incision, reduces risk of vaginal shortening and can be completed at the same time as other laparoscopic procedures, such as hysterectomy, sacralcolpopexy, and/or Burch Urethropexy. Compared to the open abdominal approach, there is improved visualization, less risk of bleeding, and faster recovery with the laparoscopic method. Compared to an anterior colporrhaphy, laparoscopic paravaginal repair is a much more anatomic repair of lateral defects and does not result in vaginal shortening. The laparoscopic paravaginal repair should be considered as the first-line treatment of anterior vaginal wall prolapse caused by lateral defects, including at time of laparoscopic/robotic sacralcolpopexy. PMID:26680393

  6. Exploration Challenges: Transferring Ground Repair Techniques to Space Flight Application

    NASA Technical Reports Server (NTRS)

    McLemore, Carole A.; Kennedy, James P.; Rose, Frederick A.; Evans, Brian W.

    2007-01-01

    Fulfilling NASA's Vision for Space Exploration will demand an extended presence in space at distances from our home planet that exceed our current experience in space logistics and maintenance. The ability to perform repairs in lieu of the customary Orbital Replacement Unit (ORU) process where a faulty part is replaced will be elevated from contingency to routine to sustain operations. The use and cost effectiveness of field repairs for ground based operations in industry and the military have advanced with the development of technology in new materials, new repair techniques and new equipment. The unique environments, accessibility constraints and Extra Vehicular Activity (EVA) issues of space operations will require extensive assessment and evolution of these technologies to provide an equivalent and expected level of assurance to mission success. Challenges include the necessity of changes in design philosophy and policy, extremes in thermal cycling, disruptive forces (such as static charge and wind entrainment) on developed methods for control of materials, dramatically increased volatility of chemicals for cleaning and other compounds due to extremely low pressures, the limits imposed on dexterity and maneuverability by current EVA equipment and practices, and the necessity of unique verification methodology. This paper describes these challenges in and discusses the effects on the established ground techniques for repair. The paper also describes the leading repair methodology candidates and their beneficial attributes for resolving these issues with the evolution of technology.

  7. Groin hernia repair by laparoscopic techniques: current status and controversies.

    PubMed

    Arregui, Maurice E; Young, Susan B

    2005-08-01

    Laparoscopic hernia repair remains controversial, and its position in current hernia surgery remains in flux. In this article we attempt to put the laparoscopic approach in perspective by describing the rationale for its development. We summarize studies comparing it with open repairs, including recent publications, meta-analyses, and systematic reviews; and we then contrast the data with recent findings of the United States Veterans Affairs Cooperative study 456. We discuss the current and future status of the laparoscopic approach to inguinal hernia repair and present an update of our own laparoscopic totally extraperitoneal technique without mesh fixation. From 1994 to 2004 we performed 314 hernia repairs on 224 patients with no intraoperative complications, no conversions to an open procedure, and no mortality. Thirty (14%) minor postoperative complications occurred. There were three herniated lipomas (preperitoneal fat) but no true peritoneal reherniations. We evaluate critical points of laparoscopic hernia repair including extensive preperitoneal dissection, mesh configuration, size and fixation, cost reduction, and the learning curve. PMID:15983713

  8. [TECHNIQUES IN MITRAL VALVE REPAIR VIA A MINIMALLY INVASIVE APPROACH].

    PubMed

    Ito, Toshiaki

    2016-03-01

    In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair. PMID:27295773

  9. The "loop with anchor" technique to repair mitral valve prolapse.

    PubMed

    Isoda, Susumu; Osako, Motohiko; Kimura, Tamizo; Mashiko, Yuji; Yamanaka, Nozomu; Nakamura, Shingo; Maehara, Tadaaki

    2012-01-01

    The current surgical technique of using an artificial chord (composed of expanded polytetrafluoroethylene [ePTFE] sutures) to repair mitral prolapse is technically difficult to perform. Slippery knot tying and the difficulty of changing the chordae length after the hydrostatic test are frustrating problems. The loop technique solves the problem of slippery knot tying but not the problem of changing the chordae length. Our "loop with anchor" technique consists of the following elements: construction of an anchor at the papillary muscle; determining the loop length; tying the loop to the anchor; suturing the loop to the mitral valve; the hydrostatic test; and re-suturing or changing the loop, if needed. Adjustments can be made for the entire procedure or for a portion of the procedure. PMID:22156285

  10. Determining flexor-tendon repair techniques via soft computing

    NASA Technical Reports Server (NTRS)

    Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

    2001-01-01

    An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

  11. Tricuspid Valve Re-Repair in Ebstein Anomaly Using the Cone Technique

    PubMed Central

    Kim, Do Jung; Suh, Jee Won; Shin, Yu Rim; Shin, Hong Ju; Park, Han Ki

    2016-01-01

    The management of recurrent tricuspid regurgitation after tricuspid valve repair in patients with Ebstein anomaly is difficult, and tricuspid valve replacement is most commonly performed in such patients. We report two cases of recurrent tricuspid regurgitation in patients with Ebstein anomaly that were successfully re-repaired using the cone technique. The cone repair technique is a useful surgical method for reconstructing a competent tricuspid valve, and can be applied in patients who have undergone previous tricuspid valve repair. PMID:26889444

  12. Arthroscopic technique for patch augmentation of rotator cuff repairs.

    PubMed

    Labbé, Marc R

    2006-10-01

    The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm

  13. A new technique for hypoglossal-facial nerve repair.

    PubMed

    Atlas, M D; Lowinger, D S

    1997-07-01

    Hypoglossal reinnervation of the facial nerve may be required after a proximal facial nerve injury. The classic hypoglossal-facial graft procedure involves transection of the donor hypoglossal nerve, resulting in hemiglottic paralysis that, in association with paralysis of other cranial nerves, may cause speech and swallowing difficulties. Multiple lower cranial nerve palsies in conjunction with facial paralysis, as may occur after procedures such as skull base surgery, contraindicate the use of such techniques. The successful use of XII-VII "interposition jump grafts" without hemiglossal weakness has been described However, a prolonged recovery period and weaker facial reanimation have been seen. In order to attain maximum facial reinnervation while preserving hypoglossal function, we have developed a new technique of XII-VII repair. This method involves mobilization of the intratemporal portion of the facial nerve remnant, achieving a single anastomosis with the hypoglossal nerve, which has been partially incised. This technique has been used in three patients to date, with 6 to 11 months follow-up. In all cases facial tone and symmetry have been restored and voluntary facial expression accomplished. The authors conclude that by employing the techniques described highly satisfactory cosmetic and functional results may be expected, without compromising hypoglossal nerve function. PMID:9217143

  14. Eddy Current Rail Inspection Using AC Bridge Techniques

    PubMed Central

    Liu, Ze; Koffman, Andrew D; Waltrip, Bryan C; Wang, Yicheng

    2013-01-01

    AC bridge techniques commonly used for precision impedance measurements have been adapted to develop an eddy current sensor for rail defect detection. By using two detection coils instead of just one as in a conventional sensor, we can balance out the large baseline signals corresponding to a normal rail. We have significantly enhanced the detection sensitivity of the eddy current method by detecting and demodulating the differential signal of the two coils induced by rail defects, using a digital lock-in amplifier algorithm. We have also explored compensating for the lift-off effect of the eddy current sensor due to vibrations by using the summing signal of the detection coils to measure the lift-off distance. The dominant component of the summing signal is a constant resulting from direct coupling from the excitation coil, which can be experimentally determined. The remainder of the summing signal, which decreases as the lift-off distance increases, is induced by the secondary eddy current. This dependence on the lift-off distance is used to calibrate the differential signal, allowing for a more accurate characterization of the defects. Simulated experiments on a sample rail have been performed using a computer controlled X-Y moving table with the X-axis mimicking the train’s motion and the Y-axis mimicking the train’s vibrational bumping. Experimental results demonstrate the effectiveness of the new detection method. PMID:26401427

  15. Eddy Current Rail Inspection Using AC Bridge Techniques.

    PubMed

    Liu, Ze; Koffman, Andrew D; Waltrip, Bryan C; Wang, Yicheng

    2013-01-01

    AC bridge techniques commonly used for precision impedance measurements have been adapted to develop an eddy current sensor for rail defect detection. By using two detection coils instead of just one as in a conventional sensor, we can balance out the large baseline signals corresponding to a normal rail. We have significantly enhanced the detection sensitivity of the eddy current method by detecting and demodulating the differential signal of the two coils induced by rail defects, using a digital lock-in amplifier algorithm. We have also explored compensating for the lift-off effect of the eddy current sensor due to vibrations by using the summing signal of the detection coils to measure the lift-off distance. The dominant component of the summing signal is a constant resulting from direct coupling from the excitation coil, which can be experimentally determined. The remainder of the summing signal, which decreases as the lift-off distance increases, is induced by the secondary eddy current. This dependence on the lift-off distance is used to calibrate the differential signal, allowing for a more accurate characterization of the defects. Simulated experiments on a sample rail have been performed using a computer controlled X-Y moving table with the X-axis mimicking the train's motion and the Y-axis mimicking the train's vibrational bumping. Experimental results demonstrate the effectiveness of the new detection method. PMID:26401427

  16. Repair and tissue engineering techniques for articular cartilage

    PubMed Central

    Makris, Eleftherios A.; Gomoll, Andreas H.; Malizos, Konstantinos N.; Hu, Jerry C.; Athanasiou, Kyriacos A.

    2015-01-01

    Chondral and osteochondral lesions due to injury or other pathology commonly result in the development of osteoarthritis, eventually leading to progressive total joint destruction. Although current progress suggests that biologic agents can delay the advancement of deterioration, such drugs are incapable of promoting tissue restoration. The limited ability of articular cartilage to regenerate renders joint arthroplasty an unavoidable surgical intervention. This Review describes current, widely used clinical repair techniques for resurfacing articular cartilage defects; short-term and long-term clinical outcomes of these techniques are discussed. Also reviewed is a developmental pipeline of regenerative biological products that over the next decade could revolutionize joint care by functionally healing articular cartilage. These products include cell-based and cell-free materials such as autologous and allogeneic cell-based approaches and multipotent and pluripotent stem-cell-based techniques. Central to these efforts is the prominent role that tissue engineering has in translating biological technology into clinical products; therefore, concomitant regulatory processes are also discussed. PMID:25247412

  17. Technique for Determining Bridge Displacement Response Using MEMS Accelerometers.

    PubMed

    Sekiya, Hidehiko; Kimura, Kentaro; Miki, Chitoshi

    2016-01-01

    In bridge maintenance, particularly with regard to fatigue damage in steel bridges, it is important to determine the displacement response of the entire bridge under a live load as well as that of each member. Knowing the displacement response enables the identification of dynamic deformations that can cause stresses and ultimately lead to damage and thus also allows the undertaking of appropriate countermeasures. In theory, the displacement response can be calculated from the double integration of the measured acceleration. However, data measured by an accelerometer include measurement errors caused by the limitations of the analog-to-digital conversion process and sensor noise. These errors distort the double integration results. Furthermore, as bridges in service are constantly vibrating because of passing vehicles, estimating the boundary conditions for the numerical integration is difficult. To address these problems, this paper proposes a method for determining the displacement of a bridge in service from its acceleration based on its free vibration. To verify the effectiveness of the proposed method, field measurements were conducted using nine different accelerometers. Based on the results of these measurements, the proposed method was found to be highly accurate in comparison with the reference displacement obtained using a contact displacement gauge. PMID:26907287

  18. Technique for Determining Bridge Displacement Response Using MEMS Accelerometers

    PubMed Central

    Sekiya, Hidehiko; Kimura, Kentaro; Miki, Chitoshi

    2016-01-01

    In bridge maintenance, particularly with regard to fatigue damage in steel bridges, it is important to determine the displacement response of the entire bridge under a live load as well as that of each member. Knowing the displacement response enables the identification of dynamic deformations that can cause stresses and ultimately lead to damage and thus also allows the undertaking of appropriate countermeasures. In theory, the displacement response can be calculated from the double integration of the measured acceleration. However, data measured by an accelerometer include measurement errors caused by the limitations of the analog-to-digital conversion process and sensor noise. These errors distort the double integration results. Furthermore, as bridges in service are constantly vibrating because of passing vehicles, estimating the boundary conditions for the numerical integration is difficult. To address these problems, this paper proposes a method for determining the displacement of a bridge in service from its acceleration based on its free vibration. To verify the effectiveness of the proposed method, field measurements were conducted using nine different accelerometers. Based on the results of these measurements, the proposed method was found to be highly accurate in comparison with the reference displacement obtained using a contact displacement gauge. PMID:26907287

  19. Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques

    PubMed Central

    Zamor, Kimberly C; Eskandari, Mark K; Rodriguez, Heron E; Ho, Karen J; Morasch, Mark D; Hoel, Andrew W

    2015-01-01

    Background Practice guidelines regarding management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) are based on low quality evidence and there is limited literature that addresses optimal revascularization techniques. The purpose of this study is to compare outcomes of LSA coverage during TEVAR and revascularization techniques. Study Design We performed a single-center retrospective cohort study from 2001–2013. Patients were categorized by LSA revascularization and by revascularization technique, carotid-subclavian bypass (CSB) or subclavian-carotid transposition (SCT). Thirty-day and mid-term stroke, spinal cord ischemia, vocal cord paralysis, upper extremity ischemia, primary patency of revascularization, and mortality were compared. Results Eighty patients underwent TEVAR with LSA coverage, 25% (n=20) were unrevascularized and the remaining patients underwent CSB (n=22, 27.5%) or SCT (n=38, 47.5%). Mean follow-up time was 24.9 months. Comparisons between unrevascularized and revascularized patients were significant for a higher rate of 30-day stroke (25% vs. 2%, p=0.003) and upper extremity ischemia (15% vs. 0%, p=0.014). However, there was no difference in 30-day or mid-term rates of spinal cord ischemia, vocal cord paralysis, or mortality. There were no statistically significant differences in 30-day or midterm outcomes for CSB vs. SCT. Primary patency of revascularizations was 100%. Survival analysis comparing unrevascularized vs. revascularized LSA, was statistically significant for freedom from stroke and upper extremity ischemia, p=0.02 and p=0.003, respectively. After adjustment for advanced age, urgency and coronary artery disease, LSA revascularization was associated with lower rates of peri-operative adverse events (OR 0.23, p=0.034). Conclusions During TEVAR, LSA coverage without revascularization is associated with an increased risk of stroke and upper extremity ischemia. When LSA coverage is required during

  20. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    PubMed

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  1. Integrating modal-based NDE techniques and bridge management systems using quality management

    NASA Astrophysics Data System (ADS)

    Sikorsky, Charles S.

    1997-05-01

    The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.

  2. Laparoscopic Repair of Ileal Conduit Parastomal Hernia Using the Sling Technique

    PubMed Central

    Chand, Bipan

    2008-01-01

    Laparoscopic parastomal hernia repair has become a viable option to overcome the challenges that face the hernia surgeon. Multiple techniques have been described over the last 5 years, one of which is the lateralizing “sling” technique, first described by Sugarbaker in1980. In this study, we report the technique and our early results with the laparoscopic modified Sugarbaker repair of parastomal hernias after ileal conduit. PMID:18435893

  3. Branched endograft repair of mycotic ascending aortic aneurysm using the snorkel technique.

    PubMed

    Quinney, Brenton Ellisor; Jordan, William

    2011-07-01

    Mycotic aneurysms are difficult clinical cases that can be approached by several methods. Debridement of infected tissue with in situ or extra-anatomic bypass is the traditional treatment. In poor operative candidates or reoperative cases, endovascular therapies can be an alternative. We present a 9-year-old with an ascending aortic mycotic aneurysm temporized with an endovascular repair as a bridge to definitive open surgery. PMID:21719552

  4. Modified Mason-Allen Suture Bridge Technique: A New Suture Bridge Technique with Improved Tissue Holding by the Modified Mason-Allen Stitch

    PubMed Central

    Lee, Bong Gun; Cho, Nam Su

    2012-01-01

    We present a new method of suture bridge technique for medial row fixation using a modified Mason-Allen stitch instead of a horizontal mattress. Medial row configuration of the technique is composed of the simple stitch limb and the modified Mason-Allen stitch limb. The limbs are passed through the tendon by a shuttle relay. The simple stitch limb passes the cuff once and the modified Mason-Allen stitch limb passes three times which creates a rip stop that prevents tendon pull-out. In addition, the Mason-Allen suture bridge configuration is basically a knotless technique which has an advantage of reducing a possibility of strangulation of the rotator cuff tendon, impingement or irritation that may be caused by knot. PMID:22949957

  5. The Onstep Method for Inguinal Hernia Repair: Operative Technique and Technical Tips

    PubMed Central

    Andresen, Kristoffer

    2016-01-01

    Inguinal hernia repair is one of the most common surgical procedures and several different surgical techniques are available. The Onstep method is a new promising technique. The technique is simple with a number of straightforward steps. This paper provides a full description of the technique together with tips and tricks to make it easy and without complications. PMID:27379255

  6. Comparison of Roll Stitch Technique and Core Suture Technique for Extensor Tendon Repair at the Metacarpophalangeal Joint level

    PubMed Central

    Namazi, Hamid; Mozaffarian, Kamran; Golmakani, Mohammad Reza

    2016-01-01

    Background: Proper suturing technique is needed to ensure good outcome in extensor tendon surgery. Different techniques have been reported for the repair of extensor tendon injuries at the level of the metacarpophalangeal joint (MCPJ). These reports were in vitro studies on cadaver models. Repair techniques must be clinically tested, to determine results. Objectives: The purpose of this in vivo study was to compare results of extensor tendon repair, using roll stitch and core suture techniques. Patients and Methods: Forty two fingers, in 38 patients (aged 15- 45 years), with simple complete extensor tendon injuries in the MCPJ area, were identified and operated by a single surgeon. The patients were divided into two groups, according to the technique used for tendon repair. The first group consisted of 21 digits, in 19 patients, who were repaired with roll stitch technique, while the second group consisted of 21 digits, in 19 patients, who were repaired with core suture technique. The same splint and rehabilitation regimen (early passive range of motion) were given to all patients. The splints were removed at 6 weeks after surgery and range of motion of the operated fingers was measured and compared to uninjured hands, after 12 weeks. Results: Five patients were lost to follow up or excluded from the study. There was no rupture of the repaired tendons in the groups. There was no statistically significant difference in mean MCPJ flexion, proximal interphalangeal joint (PIPJ) flexion, distal interphalangeal joint (DIPJ) flexion and total range of motion of the fingers, between the two groups. However, extension lag was significantly more common in the second group (11 of 19 digits) compared the first group (four of 17 digits). Conclusions: Roll stitch technique had superior outcome compared to the modified Kessler technique, when performed in the MCPJ area. Level of evidence: Therapeutic (Level III)

  7. Advances of Peripheral Nerve Repair Techniques to Improve Hand Function: A Systematic Review of Literature

    PubMed Central

    P, Mafi; S, Hindocha; M, Dhital; M, Saleh

    2012-01-01

    Concepts of neuronal damage and repair date back to ancient times. The research in this topic has been growing ever since and numerous nerve repair techniques have evolved throughout the years. Due to our greater understanding of nerve injuries and repair we now distinguish between central and peripheral nervous system. In this review, we have chosen to concentrate on peripheral nerve injuries and in particular those involving the hand. There are no reviews bringing together and summarizing the latest research evidence concerning the most up-to-date techniques used to improve hand function. Therefore, by identifying and evaluating all the published literature in this field, we have summarized all the available information about the advances in peripheral nerve techniques used to improve hand function. The most important ones are the use of resorbable poly[(R)-3-hydroxybutyrate] (PHB), epineural end-to-end suturing, graft repair, nerve transfer, side to side neurorrhaphy and end to side neurorrhaphy between median, radial and ulnar nerves, nerve transplant, nerve repair, external neurolysis and epineural sutures, adjacent neurotization without nerve suturing, Agee endoscopic operation, tourniquet induced anesthesia, toe transfer and meticulous intrinsic repair, free auto nerve grafting, use of distal based neurocutaneous flaps and tubulization. At the same time we found that the patient’s age, tension of repair, time of repair, level of injury and scar formation following surgery affect the prognosis. Despite the thorough findings of this systematic review we suggest that further research in this field is needed. PMID:22431951

  8. Laparoscopic HIPEC: A bridge between open and closed-techniques

    PubMed Central

    Lotti, Marco; Capponi, Michela Giulii; Piazzalunga, Dario; Poiasina, Elia; Pisano, Michele; Manfredi, Roberto; Ansaloni, Luca

    2016-01-01

    Hyperthermic intraperitoneal chemotherapy (HIPEC) is currently delivered after cytoreductive surgery in patients with several kinds of peritoneal surface malignancies. Different methods for delivering HIPEC have been proposed all of them being variations between two modalities: the open technique and the closed technique. The open technique assures optimal distribution of heat and cytotoxic solution, with the disadvantage of heat loss and leakage of cytotoxic drugs. The closed technique prevents heat loss and drug spillage, increases drug penetration, but does not warrant homogeneous distribution of the perfusion fluid. A novel procedure that combines the advantages of the two techniques by means of laparoscopy is herein presented. PMID:26917929

  9. Repair techniques for celion/LARC-160 graphite/polyimide composite structures

    NASA Technical Reports Server (NTRS)

    Jones, J. S.; Graves, S. R.

    1984-01-01

    The large stiffness-to-weight and strength-to-weight ratios of graphite composite in combination with the 600 F structural capability of the polyimide matrix can reduce the total structure/TPS weight of reusable space vehicles by 20-30 percent. It is inevitable that with planned usage of GR/PI structural components, damage will occur either in the form of intrinsic flaw growth or mechanical damage. Research and development programs were initiated to develop repair processes and techniques specific to Celion/LARC-160 GR/PI structure with emphasis on highly loaded and lightly loaded compression critical structures for factory type repair. Repair processes include cocure and secondary bonding techniques applied under vacuum plus positive autoclave pressure. Viable repair designs and processes are discussed for flat laminates, honeycomb sandwich panels, and hat-stiffened skin-stringer panels. The repair methodology was verified through structural element compression tests at room temperature and 315 C (600 F).

  10. Comparison of imaging techniques in the diagnosis of bridging bronchus.

    PubMed

    Baden, W; Schaefer, J; Kumpf, M; Tzaribachev, N; Pantalitschka, T; Koitschev, A; Ziemer, G; Fuchs, J; Hofbeck, M

    2008-05-01

    Bridging bronchus (BB) is a rare, congenital bronchial anomaly that is frequently associated with congenital cardiac malformations, especially left pulmonary artery sling. It represents an anomalous bronchus to the right originating from the left main bronchus. Discrimination from other bronchial anomalies is important, since BB is frequently associated with bronchial stenoses due to abnormal cartilage rings. This case study describes the findings of bronchoscopy, bronchography and multidetector computed tomography (MDCT) in three patients. Bronchoscopy was helpful in the description of the severity and length of bronchial stenoses. However, it was not possible to establish a diagnosis of BB based on this method in two patients, since it is difficult or even impossible to differentiate the bifurcation from the pseudocarina. It was not possible to establish the correct diagnosis in all patients based on bronchography or MDCT. MDCT was able to depict the relationship of bronchial and vascular structures, which is particularly important in patients with pulmonary artery sling. Multidetector computed tomography is preferable to bronchography as it is less invasive and due to its short acquisition time it can be performed in children with severe respiratory disease. In the current authors' experience, detection of cartilage rings still requires flexible bronchoscopy. PMID:18448507

  11. Surgical repair of chronic rupture of the distal end of the biceps brachii. A modified anterior surgical repair technique.

    PubMed

    Sharma, Dinesh K; Goswami, Ved; Wood, Jane

    2004-06-01

    The authors have used a modified surgical technique for repair of the distal end of the biceps brachii in three patients who presented with chronic rupture, all more than 6 weeks old. All patients were males; two lesions were on the dominant right side and one was on the non-dominant left side. An anterior incision was made over the cubital fossa, a hole was drilled over the radial tuberosity and a simple pull-through technique with an Ethibond suture was used to attach the tendon to an endobutton over the posterior surface of the radius. All patients returned to their employment and preinjury activity levels by six months. There were no postoperative complications and clinically all repairs remained intact. The patients regained their normal range of movements in 3 months; all but one regained the endurance and strength of their bicep in 6 months as assessed by Cybex testing. Surgical repair of the distal end of the biceps using the technique reported has given excellent results in these three patients. PMID:15287407

  12. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    PubMed Central

    Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  13. Repair of a fractured implant overdenture gold bar: A clinical and laboratory technique report

    PubMed Central

    Vohra, Fahim; Al Fawaz, Amani

    2013-01-01

    This clinical report explains a convenient, efficient, yet effective alternative for management of fractured substructure cast bars for implant-retained overdentures. The technique allows the fracture to be repaired at low cost and short time without remaking the substructure and the denture and further allowing the patient to keep their denture. The report sketches the clinical and laboratory procedures involved in the repair. PMID:24926222

  14. Successful Repair of Type I Endoleak Using the Frozen Elephant Trunk Technique

    PubMed Central

    Kim, Seon Hee; Song, Seunghwan; Kim, Sang-pil; Lee, Chung Won; Son, Joohyung

    2016-01-01

    Thoracic endovascular aortic repair (TEVAR) has emerged as an effective therapy for a variety of thoracic aortic pathologies. However, various types of endoleak remain a major concern, and its treatment is often challenging. We report a case of type I endoleak occurring 19 months after zone II hybrid TEVAR. The endoleak was successfully repaired by the frozen elephant trunk technique, without removal of a previous stent graft, combined with ascending aorta and total arch replacement. PMID:27525241

  15. Linear beam raster magnet driver based on H-bridge technique

    DOEpatents

    Sinkine, Nikolai I.; Yan, Chen; Apeldoorn, Cornelis; Dail, Jeffrey Glenn; Wojcik, Randolph Frank; Gunning, William

    2006-06-06

    An improved raster magnet driver for a linear particle beam is based on an H-bridge technique. Four branches of power HEXFETs form a two-by-two switch. Switching the HEXFETs in a predetermined order and at the right frequency produces a triangular current waveform. An H-bridge controller controls switching sequence and timing. The magnetic field of the coil follows the shape of the waveform and thus steers the beam using a triangular rather than a sinusoidal waveform. The system produces a raster pattern having a highly uniform raster density distribution, eliminates target heating from non-uniform raster density distributions, and produces higher levels of beam current.

  16. Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

    PubMed Central

    Jungmann, Pia M.; Baum, Thomas; Bauer, Jan S.; Karampinos, Dimitrios C.; Link, Thomas M.; Li, Xiaojuan; Trattnig, Siegfried; Rummeny, Ernst J.; Woertler, Klaus; Welsch, Goetz H.

    2014-01-01

    Background. New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair. PMID:24877139

  17. Elephant trunk technique for hybrid aortic arch repair.

    PubMed

    Miyamoto, Yuji

    2014-03-01

    The original elephant trunk technique was developed by Borst in 1983 for the treatment of aortic arch aneurysms. This technique reduced operative risks, but was associated with cumulative mortality rates of 6.9 % for the first stage and 7.5 % for the second stage. Patients also waited a long time between two major surgical procedures. Only 50.4 % of patients underwent the second-stage surgery, and there was a significant interval mortality rate of 10.7 %. With the advent of stent-graft techniques, two different hybrid elephant trunk techniques were developed. One technique is first-stage elephant trunk graft placement followed by second-stage endovascular completion. The conventional elephant trunk graft provides a good landing zone for the stent-graft, and endovascular completion is a useful alternative to conventional second-stage surgery. This method has few major complications, and a postoperative paraplegia rate of 1.1 %. The other technique is the frozen elephant trunk technique. This technique eliminates the need for subsequent endovascular completion, and is particularly useful for the treatment of acute type A dissection because it can achieve a secure seal. However, it is associated with a higher rate of spinal cord ischemia than other methods such as the original elephant trunk technique. The left subclavian artery (LSA) is often lost when performing a hybrid elephant trunk procedure. Revascularization of the LSA should be performed to prevent arm ischemia and neurological complications such as paraplegia or stroke, although the level of evidence for this recommendation is low. PMID:23943042

  18. Obstetrics anal sphincter injury and repair technique: a review.

    PubMed

    Temtanakitpaisan, Teerayut; Bunyacejchevin, Suvit; Koyama, Masayasu

    2015-03-01

    The Urogynecology Committee of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) has held seminars and workshops on various urogynecological problems in each country in the Asia-Oceania area in order to encourage young obstetricians and gynecologists. In 2013, we organized the operative seminar for obstetrical anal sphincter injuries (OASIS) in which we prepared porcine models to educate young physicians in a hands-on workshop at the 23rd Asian and Oceanic Congress of Obstetrics and Gynaecology in Bangkok, Thailand. Laceration of the anal sphincter mostly occurs during vaginal delivery and it can develop into anal sphincter deficiency, which causes fecal incontinence, if an appropriate suture is not performed. OASIS has become an important issue, especially in developing countries. The prevalence of OASIS of more than the third degree is around 5% in primary parous women and the frequency is higher when detected by ultrasonographic evaluation. Several risk factors, such as macrosomia, instrumental labor, perineal episiotomy and high maternal age, have been recognized. In a society where pregnant women are getting older, OASIS is becoming a more serious issue. An intrapartum primary appropriate stitch is important, but the 1-year outcome of a delayed operation after 2 weeks postpartum is similar. A randomized controlled study showed that overlapping suture of the external sphincter is better than that of end-to-end surgical repair. The Urogynecology Committee of the AOFOG would like to continue with educative programs about the appropriate therapy for OASIS. PMID:25545893

  19. Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea

    PubMed Central

    Sinha, Ajit Kumar; Goyal, Sumit

    2016-01-01

    Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. Summary of Background Data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches. Materials and Methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6–18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit. Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed. Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches. PMID:27114672

  20. Small-strain measurement in bridge connections using the digital image correlation (DIC) technique

    NASA Astrophysics Data System (ADS)

    Desai, Niranjan

    2016-04-01

    Structural health monitoring (SHM) is emerging as a vital tool to help civil engineers improve the safety, maintainability, and reliability of critical structures and assists infrastructure owners with timely information for the continued safe and economic operation of their structure. SHM involves implementing a strategy that identifies and characterizes damage or undesirable performance in engineering structures. The goal of this research project was to determine the smallest strains measurable using standard digital image correlation (DIC) based SHM equipment. This practical investigation that had strong ties to the industry was motivated by damage observed in a real-world bridge, which was initially undetected. Its early detection would have led to reduced repair costs. To accomplish the aforementioned goal, tests were performed on a laboratory specimen that replicated a steel beam-to-column connection of the concerned bridge, involving progressively loading it in a manner in which it was loaded in the actual bridge, while simultaneously measuring the strains that developed in it using the aforementioned DIC-based equipment and software. Under the controlled conditions in the laboratory, the minimum resolution of the state-of-the-art system used in this investigation was determined. Due to the challenges faced in making these small-strain measurements even under highly controlled laboratory conditions, it was concluded that it is currently unrealistic to use the existing DIC technology in a real-world situation to measure strains as small as those that would need to be measured to detect the onset of damage in bridge connections. More work needs to be done in this area.

  1. One- Versus Two-Incision Technique for Distal Biceps Tendon Repair

    PubMed Central

    Johnson, Timothy S.; Johnson, David C.; Allen, Answorth A.; Weiland, Andrew J.; Cavanaugh, John; Noonan, Dennis; Lyman, Stephen

    2008-01-01

    There are several techniques that have been described for distal biceps tendon repair but there is still controversy regarding the optimal technique. Our hypothesis is that the single-incision technique will have a similar complication rate and functionally equivalent restoration of function compared with the two-incision approach. A retrospective review of consecutive biceps tendon repairs was performed at one institution over a 5-year period. Thirty-six patients met the inclusion criteria and 26 were available for follow-up including subjective assessment, physical examination, and strength testing. Patients were divided into two groups based on the surgical approach utilized: 12 patients underwent single-incision repair and 14 had a two-incision repair. The average follow-up was 33 months (minimum 13; maximum 75). There were no statistically significant differences in regards to flexion strength or endurance, supination strength or endurance, or complication rates between the two techniques. In conclusion, both surgical techniques led to adequate restoration of strength with a low complication rate. Both techniques are safe to perform and should be guided by surgeon comfort with the approach. PMID:18815854

  2. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

    PubMed

    Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

    2013-12-01

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR. PMID:23674274

  3. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    SciTech Connect

    Patel, Rakesh P.; Katsargyris, Athanasios Verhoeven, Eric L. G.; Adam, Donald J.; Hardman, John A.

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  4. Computational techniques for the assessment of fracture repair.

    PubMed

    Anderson, Donald D; Thomas, Thaddeus P; Campos Marin, Ana; Elkins, Jacob M; Lack, William D; Lacroix, Damien

    2014-06-01

    The combination of high-resolution three-dimensional medical imaging, increased computing power, and modern computational methods provide unprecedented capabilities for assessing the repair and healing of fractured bone. Fracture healing is a natural process that restores the mechanical integrity of bone and is greatly influenced by the prevailing mechanical environment. Mechanobiological theories have been proposed to provide greater insight into the relationships between mechanics (stress and strain) and biology. Computational approaches for modelling these relationships have evolved from simple tools to analyze fracture healing at a single point in time to current models that capture complex biological events such as angiogenesis, stochasticity in cellular activities, and cell-phenotype specific activities. The predictive capacity of these models has been established using corroborating physical experiments. For clinical application, mechanobiological models accounting for patient-to-patient variability hold the potential to predict fracture healing and thereby help clinicians to customize treatment. Advanced imaging tools permit patient-specific geometries to be used in such models. Refining the models to study the strain fields within a fracture gap and adapting the models for case-specific simulation may provide more accurate examination of the relationship between strain and fracture healing in actual patients. Medical imaging systems have significantly advanced the capability for less invasive visualization of injured musculoskeletal tissues, but all too often the consideration of these rich datasets has stopped at the level of subjective observation. Computational image analysis methods have not yet been applied to study fracture healing, but two comparable challenges which have been addressed in this general area are the evaluation of fracture severity and of fracture-associated soft tissue injury. CT-based methodologies developed to assess and quantify

  5. The “Inside-out” Technique for Hernia Repair with Mesh Underlay

    PubMed Central

    Berhanu, Aaron E.

    2015-01-01

    Background: An improved method for mesh repair of ventral/incisional hernias after component separation is presented. The use of a Carter-Thomason suture passer (Cooper Surgical, http://www.coopersurgical.com) allows for safe passage of preplaced sutures on the mesh from within the abdominal cavity through the anterior rectus sheath. This “inside-out” method makes the underlay of mesh fast and easy by improving visualization and control of sharp instruments as they are passed through the abdominal cavity. Preplacement of sutures circumferentially on the mesh also improves the distribution of tension around the repair, which may ultimately reduce the risk of hernia recurrence. Methods: The “inside-out” technique was performed on 23 patients at a single tertiary academic medical center from November 2011 to February 2014. We have followed these patients for a median of 24.5 months to assess for postoperative complications and hernia recurrence. Results: We report an acceptable hernia recurrence rate (2 of 23 = 8.7%). One recurrence was observed in a patient who underwent repair of a recurrent ventral hernia and the other had significant loss of domain requiring an inlay mesh. Conclusions: The “inside-out” technique for ventral hernia repair with a mesh underlay after component separation using a Carter-Thomason suture passer is easy, safe, and reliable. We have observed no hernia recurrence in patients who underwent repair for a primary ventral hernia with an underlay technique. PMID:26180723

  6. New minimally invasive technique of parastomal hernia repair – methods and review

    PubMed Central

    Skoneczny, Paweł; Przywózka, Alicja; Czyżewski, Piotr; Bury, Kamil

    2015-01-01

    Introduction Parastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment – fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions. Aim To describe the novel concept of parastomal hernia repair – HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases. Material and methods Twelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients’ condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery. Results After 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0–10 scale after 6 weeks of follow-up was 8 (range: 7–10). Conclusions The HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair. PMID:25960785

  7. The Successful Transfer of Space Derived Convergent Spray Technology(TM): An Application for Industrial Roof Coatings and Interstate Bridge Repair

    NASA Technical Reports Server (NTRS)

    McMillan, Vernotto

    1999-01-01

    Although the levels of volatile organic compound (VOC) emissions from industrial roof coatings and paint operations have been reduced in recent years, the roof coating partnership was an effort to further reduce VOC emission levels and to also demonstrate the use of reclaimed automobile tire rubber as a filler material in roof coating systems. Different materials and coatings were evaluated and tested before the final selection was used to coat the roofs of two small buildings at NASA's MSFC (Marshall Space Flight Center) during fiscal year 1997. The primary objective of the Bridge repair partnership was to strategically leverage public and private sector funds for the purpose of developing a bridge repair process that was cheaper, better, and faster than conventional methods. It was also, imperative that this process be environmentally friendly and capable of performing under extreme conditions for a period of not less than 2 years.

  8. Innovative chimney-graft technique for endovascular repair of a pararenal abdominal aortic aneurysm.

    PubMed

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A; Krajcer, Zvonimir

    2015-02-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  9. Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

    PubMed Central

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.

    2015-01-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  10. Eversion-Inversion Labral Repair and Reconstruction Technique for Optimal Suction Seal

    PubMed Central

    Moreira, Brett; Pascual-Garrido, Cecilia; Chadayamurri, Vivek; Mei-Dan, Omer

    2015-01-01

    Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The classic techniques described in the literature for labral repair all use loop or pass-through intrasubstance labral sutures to achieve a functional hip seal. This hip seal is important for hip stability and optimal joint biomechanics, as well as in the prevention of long-term osteoarthritis. We describe a novel eversion-inversion intrasubstance suturing technique for labral repair and reconstruction that can assist in restoration of the native labrum position by re-creating an optimal seal around the femoral head. PMID:26870648

  11. A technique for preliminary appraisal of potential and observed scour as applied to state-maintained highway bridges in Maryland

    USGS Publications Warehouse

    Doheny, E.J.; Helinsky, B.M.; McGregor, R.A.

    1996-01-01

    This report describes a technique that can be used to assess potential and observed scour at highway bridges over waterways. Channel-stability assessments were conducted at 876 State highway, U.S. highway, and Interstate highway bridges over waterways in the State of Maryland. Conventional data-collection techniques were used in the field to collect bridge and stream-channel data for each bridge. A potential-scour index and an observed- scour index were developed by assigning numerical-index values to specific diagnostic characteristics of the bridge and stream channel. Potential-scour ratings and observed-scour ratings for assessed bridges were obtained by summing numerical-index values that were assigned to each diagnotic characteristic in the potential-scour index and the observed-scour index.

  12. New technique for retrograde cerebral perfusion during arch aneurysm repair.

    PubMed

    Bartoccioni, S; Lanzillo, G; deJong, A A; Fiaschini, P; Martinelli, G; Fedeli, C; Di Lazarro, D; Mercati, U

    1995-09-01

    Many techniques are used to reduce brain damage during surgery for dissecting aneurysms of the ascending aorta and arch. Recently, new techniques of protection were proposed, consistent with hypothermic circulatory arrest in association with retrograde cerebral perfusion via superior vena cava. We propose a simple, time-saving method, which does not require any manipulation of the heart. We use a multilumen cannula for cardioplegia (D 860-DIDECO FUNDARO') with pressure transducer. This cannula is inserted in superior vena cava by means of a simple purse-string, and linked to the arterial line with a "Y" derivation, allowing retrograde perfusion of the brain and monitoring the perfusion pressure at every moment. The superior vena cava placed downstream from the cannula is closed by a small vascular clamp, to avoid blood reflux in the right atrium. This method is time- and money-saving, is readily available, and can be prepared whenever necessary, also in the middle of the surgical procedure. PMID:7488786

  13. Sportsmen’s Groin—Diagnostic Approach and Treatment With the Minimal Repair Technique

    PubMed Central

    Muschaweck, Ulrike; Berger, Luise Masami

    2010-01-01

    Context: Sportsmen’s groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms. Methods: The authors developed an innovative open suture repair—the Minimal Repair technique—to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures. Results: The following advantages of the Minimal Repair technique were found: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median). Conclusion: The Minimal Repair technique is an effective and safe way to treat sportsmen’s groin. PMID:23015941

  14. Development of a Repair Technique for Filament Wound Composite Cases of VEGA Launcher

    NASA Astrophysics Data System (ADS)

    Mataloni, A.; Perugini, P.; Pantanella, G.; Caldaronello, C.; Biagi, M.

    2012-07-01

    The solid rocket motors cases of the VEGA family are made with the filament winding technology. These large structures are constituted by high strength carbon/epoxy materials, that allow strong weight reduction with respect to traditional metal cases. The present work describes the selection process and the experimental activity that led to define and validate on subscale components the repair technique of damaged structures. A preliminary trade off, based on a characterization at coupon level, identified the best repair material able to fit both the structural and technological requirements. The problem has been then split from a structural point of view, developing parallel techniques for the repair of pressure vessels (body of the case component), subjected to high tensile loads, and skirt components, typically subjected to compressive loads. Experimental tests have been finally performed, comparing the structural performance of the undamaged items with the repaired one, and verifying that the initial strength and stiffness have been fully recovered. Starting from the validated repair approach, a feasibility study for the technological scale up of the process has been done.

  15. Evaluation of convergence behavior of metamodeling techniques for bridging scales in multi-scale multimaterial simulation

    SciTech Connect

    Sen, Oishik; Davis, Sean; Jacobs, Gustaaf; Udaykumar, H.S.

    2015-08-01

    The effectiveness of several metamodeling techniques, viz. the Polynomial Stochastic Collocation method, Adaptive Stochastic Collocation method, a Radial Basis Function Neural Network, a Kriging Method and a Dynamic Kriging Method is evaluated. This is done with the express purpose of using metamodels to bridge scales between micro- and macro-scale models in a multi-scale multimaterial simulation. The rate of convergence of the error when used to reconstruct hypersurfaces of known functions is studied. For sufficiently large number of training points, Stochastic Collocation methods generally converge faster than the other metamodeling techniques, while the DKG method converges faster when the number of input points is less than 100 in a two-dimensional parameter space. Because the input points correspond to computationally expensive micro/meso-scale computations, the DKG is favored for bridging scales in a multi-scale solver.

  16. The Role of Current Techniques and Concepts in Peripheral Nerve Repair.

    PubMed

    Houschyar, K S; Momeni, A; Pyles, M N; Cha, J Y; Maan, Z N; Duscher, D; Jew, O S; Siemers, F; van Schoonhoven, J

    2016-01-01

    Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies. PMID:26904282

  17. The Role of Current Techniques and Concepts in Peripheral Nerve Repair

    PubMed Central

    Houschyar, K. S.; Momeni, A.; Pyles, M. N.; Cha, J. Y.; Maan, Z. N.; Duscher, D.; Jew, O. S.; Siemers, F.; van Schoonhoven, J.

    2016-01-01

    Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies. PMID:26904282

  18. Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique

    PubMed Central

    Andersen, Lars Peter Holst; Klein, Mads; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    Background Incisional hernia after abdominal surgery is a well-known complication. Controversy still exists with respect to the choice of hernia repair technique. The objective of this study was to evaluate the long-term recurrence rate as well as surgical complications in a consecutive group of patients undergoing open repair using an onlay mesh technique. Methods Consecutive patients undergoing open incisional hernia repair with onlay-technique between 01/05/1995 and 01/09/2007 at a single institution were included in the study. For follow-up patients were contacted by telephone, and answered a questionnaire containing questions related to the primary operation, the hernia and general risk factors. Patients were examined by a consultant surgeon in the outpatient clinic or in the patient's home if there was suspicion of an incisional hernia recurrence. Results The study included 56 patients with 100% follow-up. The median follow-up was 35 months (range 4–151). Recurrent incisional hernia was found in 8 of 56 patients (15%, 95% CI: 6–24). The overall complication rate was 13% (95% CI, 4–22). All complications were minor and needed no hospital admission. Conclusion This study with a long follow-up showed low recurrence and complication rates in patients undergoing incisional hernia repair with the open onlay technique. PMID:19400934

  19. Arthroscopic Technique for Chondrolabral Capsular Preservation During Labral Repair and Acetabular Osteoplasty

    PubMed Central

    Nwachukwu, Benedict U.; McCormick, Frank; Martin, Scott D.

    2013-01-01

    Traditional techniques for acetabular osteoplasty in femoral acetabular impingement have required surgical detachment of the labrum at the chondrolabral junction. Such approaches compromise labral blood flow and contribute to a limited ability for healing at the chondrolabral junction. In this technical note and accompanying video, we present a technique for preservation of the chondrolabral junction during labral repair and acetabular osteoplasty. We elevate the chondrolabral complex subperiosteally off the acetabular rim, and the acetabular shelf is then contoured under fluoroscopic guidance. The labrum is then repaired and reconstituted to a new anatomic footprint. We find this technique to be advantageous because it preserves the blood flow to the labrum, thereby maximizing healing potential. Outcome studies are warranted to further elucidate the functional and outcome benefits of this surgical technique. PMID:24265986

  20. Note: A non-invasive electronic measurement technique to measure the embedded four resistive elements in a Wheatstone bridge sensor

    NASA Astrophysics Data System (ADS)

    Ravelo Arias, S. I.; Ramírez Muñoz, D.; Cardoso, S.; Ferreira, R.; Freitas, P.

    2015-06-01

    The work shows a measurement technique to obtain the correct value of the four elements in a resistive Wheatstone bridge without the need to separate the physical connections existing between them. Two electronic solutions are presented, based on a source-and-measure unit and using discrete electronic components. The proposed technique brings the possibility to know the mismatching or the tolerance between the bridge resistive elements and then to pass or reject it in terms of its related common-mode rejection. Experimental results were taken in various Wheatstone resistive bridges (discrete and magnetoresistive integrated bridges) validating the proposed measurement technique specially when the bridge is micro-fabricated and there is no physical way to separate one resistive element from the others.

  1. Note: A non-invasive electronic measurement technique to measure the embedded four resistive elements in a Wheatstone bridge sensor

    SciTech Connect

    Ravelo Arias, S. I.; Ramírez Muñoz, D.; Ferreira, R.; Freitas, P.

    2015-06-15

    The work shows a measurement technique to obtain the correct value of the four elements in a resistive Wheatstone bridge without the need to separate the physical connections existing between them. Two electronic solutions are presented, based on a source-and-measure unit and using discrete electronic components. The proposed technique brings the possibility to know the mismatching or the tolerance between the bridge resistive elements and then to pass or reject it in terms of its related common-mode rejection. Experimental results were taken in various Wheatstone resistive bridges (discrete and magnetoresistive integrated bridges) validating the proposed measurement technique specially when the bridge is micro-fabricated and there is no physical way to separate one resistive element from the others.

  2. Repair and prevention of cerebrospinal fluid leakage in transsphenoidal surgery: a sphenoid sinus mucosa technique.

    PubMed

    Amano, Kosaku; Hori, Tomokatsu; Kawamata, Takakazu; Okada, Yoshikazu

    2016-01-01

    Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphenoidal surgery (TSS). To avoid this postsurgical complication, we usually repair the CSF leaking area using an autologous material, such as fat, fascia, or muscle graft and sometimes nasonasal septal flap. In this report, we propose a technique using a novel autologous material, sphenoid sinus mucosa (SSM), to repair intraoperative CSF leakage or prevent it postoperatively. On 26 February 2007, we introduced the technique of using SSM to repair or prevent CSF leakage in TSS. Until 30th of June 2014, we performed 500 TSSs for patients with pituitary or parasellar lesions. They were 195 men and 305 women with a mean age of 48.5 years (range, 5-85 years). We used SSM for patching or suturing the arachnoid laceration or dural defect, in lieu of fat or fascia harvested from abdomen or thigh, or made pedicle flap of SSM instead of nasonasal septal flap to cover the sellar floor. Comparing the previous 539 cases not using these techniques before 26 February 2007, intraoperative CSF leakage increased from 49 to 69.4% (p < 0.0001) due to more aggressive surgical technique, mainly related to more extensive approaches and lesion removals, but the rate of using fat was reduced significantly from 35.5 to 19.4% (p = 0.00021) in small or moderate CSF leaks during TSS without increasing the reoperation rate for postoperative CSF leaks (1.86 vs 1.2%, p = 0.45). The technique of using SSM to repair intraoperative CSF leaks or prevent them postoperatively in TSS was considered useful, effective, less invasive, easier for graft harvesting (same surgical field), and providing natural anatomical reconstruction, without potential donor site morbidity. We can recommend it as a standard method for CSF leaks repair and prevention in TSS. PMID:26338198

  3. A 5-year Review of Darning Technique of Inguinal Hernia Repair

    PubMed Central

    Olasehinde, Olalekan O; Adisa, Adewale O; Agbakwuru, Elugwaraonu A; Etonyeaku, Amarachukwu C; Kolawole, Oladapo A; Mosanya, Arinze O

    2015-01-01

    Context: The Darning technique of inguinal hernia repair is a tissue-based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting. Study Design: A descriptive retrospective study. Patients and Methods: Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed. Statistical Analysis Used: simple frequencies, proportions and cross-tabulations. Results: A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow-up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001). Conclusions: The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting. PMID:25838768

  4. Cartilage repair techniques of the talus: An update

    PubMed Central

    Baums, Mike H; Schultz, Wolfgang; Kostuj, Tanja; Klinger, Hans-Michael

    2014-01-01

    Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature. PMID:25035819

  5. Mesh tuck repair of ventral hernias of the abdomen: a new, simplified technique for sublay herniorrhaphy.

    PubMed

    East, J M

    2007-12-01

    There is biomechanical advantage to placing mesh in the retro-myofascial plane for repair of ventral abdominal hernias. Intra-abdominal pressure applied to the periphery of the mesh increases apposition to the abdominal wall rather than causing distraction and this translates, in general, into lower recurrence rates than after "inlay" and "onlay" mesh placement. Traditionally, retro-myofascial mesh is placed in the pre-peritoneal or retro-muscular space. Both traditional techniques require extensive dissection and placement of large sheets of mesh which can cause symptomatic impairment of abdominal wall compliance. Pre-peritoneal dissection can be particularly tedious due to pathological adherence of peritoneum to the posterior abdominal wall in longstanding primary and incisional hernias. In the technique described, mesh is tucked into the retro-myofascial plane without any dissection into pre-peritoneal, retro-muscular or peritoneal spaces. The operation is less tedious, takes less time to perform, can often be done under local anaesthesia, demands less mesh and achieves similar recurrence rates to traditional retro-myofascial mesh repairs. Sixty-one operations have been performed by the author using this technique, with a recurrence rate of 8.2% after 13 years to 3 months of follow-up (median, 3.75 years) and 9.3% if patients with less than one year of follow-up are excluded Factors predisposing to recurrence after mesh repair of ventral hernias are numerous and complex. A fair comparison of recurrence rates between this technique and traditional retro-myofascial repairs requires a randomized controlled trial but the crude recurrence rate for this operation falls well within the range reported for traditional repairs from other studies. PMID:18646495

  6. The clinical application of “jetting suture” technique in annular repair under microendoscopic discectomy

    PubMed Central

    Qi, Lei; Li, Mu; Si, Haipeng; Wang, Liang; Jiang, Yunpeng; Zhang, Shuai; Li, Le

    2016-01-01

    Abstract To introduce a new designed suture technique in annular repair under the microendoscopic discectomy (MED) surgery and to evaluate the clinical application of the technique in annular repair under MED with at least 2-year follow-up period. A new method of annular repair was designed and named “jetting suture” technique. Thirty consecutive patients with lumbar disc herniation were enrolled in the prospective single-cohort observational study. Patients were followed up at intervals of preoperative, postoperative 1 week, 3 months, 6 months, 1 year, and last follow-up. The clinical outcomes were evaluated by using Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index, and modified Mcnab criteria. The procedure was successfully performed in all cases. No case required conversion to an open procedure. The mean age of patients was 36.6 years. Average blood loss was 45.8 ± 10.2 mL. The preoperative symptoms were alleviated significantly after surgery. All the standardized measures improved significantly at the last follow-up, including JOA score (10.1 to 26.6; P < 0.05) and Oswestry Disability Index (75.3 to 9.6; P < 0.05). Improvement rate of JOA score was 86.4%. Approximately 83.4% of patients reported good or excellent outcomes based on modified Mcnab criteria. No postoperative complication and recurrence of disc herniation was reported. The designed “jetting suture” technique in annular repair under MED can be performed safely and effectively. It could be a viable alternative to annular repair under lumbar discectomy. PMID:27495101

  7. Open repair of chronic complicated type B aortic dissection using the open distal technique

    PubMed Central

    Sandhu, Harleen; Afifi, Rana O.; Azizzadeh, Ali; Charlton-Ouw, Kristofer; Miller, Charles C.; Safi, Hazim J.

    2014-01-01

    Aim The present study aimed to analyze early and late outcomes after open repair of chronic type B aortic dissection. Methods We retrospectively reviewed our cases of open descending thoracic aortic aneurysm (DTAA) with chronic dissection from 1991-2013. Long-term survival and aortic reinterventions were analyzed and patient comorbidities were evaluated in order to determine the risk of adverse outcomes. Furthermore, the technique for “distal first approach” is described. Results Between 1991 and 2013, 240 (40%) descending thoracic aortic repairs with associated chronic dissection were performed. Mean age is 59 years and 178 (74%) are men. The majority of patients (218, 91%) underwent repair using the adjunct of distal aortic perfusion with cerebral spinal fluid drainage. Early mortality was 8.3% (20/240). Permanent neurologic deficit occurred in 1.3% (3/240). Stroke occurred in 2.9% (7/240), and dialysis on discharge in 6% (12/240). 5-, 10-, 15-, and 20-year survival was 72%, 60%, 45%, and 39%, respectively. Freedom from reoperation on the operated segment was 97%, 94%, 94% and 94% at 5, 10, 15 and 20 years. Conclusions Open repairs of chronic descending thoracic dissections can be performed with respectable morbidity and mortality. Risk of neurologic deficit remains low with use of adjuncts, and risk of reintervention on the involved aortic segment is also low. These results allow comparison with endovascular repair for chronic aortic dissection. PMID:25133100

  8. The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair

    PubMed Central

    Parnes, Nata; Ciani, Mario; Carr, Brian; Carey, Paul

    2015-01-01

    The annual incidence and number of repairs of SLAP lesions in the United States are constantly increasing. Surgical repairs of type II SLAP lesions have overall good success rates. However, a low satisfaction rate and low rate of return to preinjury level of play remain a challenge with elite overhead and throwing athletes. Recent anatomic studies suggest that current surgical techniques over-tension the biceps anchor and the superior labrum. These studies suggest that restoration of the normal anatomy will improve clinical outcomes and sports performance. We present a “double-pulley” technique for arthroscopic fixation of type II SLAP lesions. In this technique the normal anatomy is respected by preserving the mobility of the articular aspect of the superior labrum while reinforcing the biceps anchor and its posterior fibers medially. PMID:26900552

  9. A New Technique for Patch Augmentation of Rotator Cuff Repairs

    PubMed Central

    Mihara, Shuzou; Ono, Teruyasu; Inoue, Hirofumi; Kisimoto, Tetsurou

    2014-01-01

    Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small- to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. PMID:25126505

  10. Components separation in complex ventral hernia repair: surgical technique and post-operative outcomes.

    PubMed

    Ross, Samuel W; Oommen, Bindhu; Heniford, B Todd; Augenstein, Vedra A

    2014-03-01

    There are over 350,000 ventral hernia repairs (VHR) performed in the United States annually and a variety of laparoscopic and open surgical techniques are described and utilized. Complex ventral hernias such as recurrent hernias, those with infected mesh, open wounds, coexisting enteric fistulas, parastomal hernias, and massive hernias-especially those with loss of abdominal domain-require sophisticated repair techniques. Many of these repairs are performed via an open approach. Ideally, the aim is to place mesh under the fascia with a large overlap of the defect and obtain primary fascial closure. However, it is often impossible to bring together fascial edges in very large hernias. Component separation is an excellent surgical technique in selected patients which involves release of the different layers of the abdominal wall and in turn helps accomplish primary fascial approximation. The posterior rectus sheath, external oblique or the transverse abdominis fascia can be cut and allows for closure of fascia in a tension free manner in a majority of patients. In this chapter we describe the various techniques for component separation, indications for use, how to select an appropriate type of release and post-operative outcomes. PMID:24700223

  11. Clinical use of a combined grasping and locking core suture technique for flexor tendon repair in zone II.

    PubMed

    Al-Qattan, Mohammad M

    2013-12-01

    Previous authors have used either a grasping or a locking technique for flexor tendon repair in zone II. A combined (grasping and locking) 10-strand repair was used by the author in 22 adults (n = 28 fingers) with lacerations of both flexor tendons in zone II. The combined repair is known to be strong (mean tensile strength of 164 N), and the technique was used in selected cases who were thought to be at higher risk of rupture either because of excessive digital oedema (in early tendon repairs) or because of tendon retraction (in late primary tendon repairs). The 10-strand repair was bulky and, hence, only the profundus tendon was repaired; and "venting" of the pulley system was done proximal to the repair site as recommended by other authors. Supervised early active mobilisation was done immediately after the operation. At final follow-up, the outcome was calculated using the original Strickland-Glogovac grading system. There were no ruptures and the final outcome was considered excellent in 19 patients (n = 25 fingers), good in two patients (n = 2 fingers), and fair in the remaining patient (n = 1 finger). It was concluded that the bulky 10-strand repair may be used for zone II finger flexor tendon lacerations as long as a profundus-(?) only repair and "venting" of the pulley system are performed. PMID:23829500

  12. An Enhanced Vacuum Cure Technique for On-Aircraft Repair of Carbon-Bismaleimide Composites

    NASA Astrophysics Data System (ADS)

    Rider, Andrew N.; Baker, Alan A.; Wang, Chun H.; Smith, Graeme

    2011-06-01

    Carbon/bismaleimide (BMI) composite is increasingly employed in critical load carrying aircraft structures designed to operate at temperatures approaching 180°C. The high post-cure temperature (above 220°C) required to fully react the BMI resin, however, renders existing on-aircraft prepreg or wet layup repair methods invalid. This paper presents a new on-aircraft repair technique for carbon/BMI composites. The composite prepregs are first warm-staged to improve the ability to evacuate entrapped air. Then the patch is cured in the scarf cavity using the vacuum bag technique, followed by off-aircraft post-cure. The fully cured patch then can be bonded using a structural adhesive.

  13. Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair.

    PubMed

    Gonzalez, Rodrigo; Rehnke, Robert D; Ramaswamy, Archana; Smith, C Daniel; Clarke, John M; Ramshaw, Bruce J

    2005-07-01

    When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 +/- 2 vs 68 +/- 2 years, P < 0.0001), had greater body mass index (34 +/- 2 vs 29 +/- 1 kg/m2, P = 0.02), and had larger hernia defects (318 +/- 49 vs 101 +/- 16 cm2, P < 0.0001) than patients in the CST group. The LR resulted in shorter length of hospital stay (4.9 +/- 0.9 vs 9.6 +/- 1.8 days, P < 0.0001), lower incidence of ileus (7% vs 48%, P < 0.0001), and lower incidence of wound complications (2% vs 33%, P < 0.001) than the CST. Both techniques resulted in similar operative times, transfusion requirements, and mortality. Recurrences occurred in 7 per cent of patients at mean follow-up of 16 months in the CST group and 0 per cent at mean follow-up of 9 months after LR. The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community. PMID:16089127

  14. An Alternative Bundle-to-Bundle Suturing Technique for Repairing Fresh Achilles Tendon Rupture.

    PubMed

    Zhao, Jingjing; Yu, Bin; Xie, Ming; Huang, Ruokun; Xiao, Kai

    2016-01-01

    The main concern about conventional Achilles tendon repair surgical techniques is how to maintain the initial strength of the ruptured Achilles tendon through complicated suturing methods. The primary surgical problem lies in the properties of the soft tissue; the deterioration of the Achilles tendon, especially in its elasticity; and the surface lubricity of the local tissues. In the present study, we describe an innovative bundle-to-bundle suturing method that addresses these potential problems. PMID:26970908

  15. A technique for the laparoscopic repair of paraoesophageal hernia without mesh.

    PubMed

    D'Netto, Trevor J; Falk, Gregory L

    2014-04-01

    Laparoscopic paraoesophageal hernia repair is a challenging procedure, both in surgical technical difficulty and in prevention of recurrence, in the setting of operating on an older patient cohort with associated co-morbidities. However, modifications based on sound surgical principles can lead to better outcomes. This article describes and illustrates in detail the technique for the laparoscopic repair of paraoesophageal hernia without mesh with cardio-oesophageal junction fixation. The data and results of the study supporting this technique have been published previously by Gibson et al. (Surgical Endoscopy 27: 618-623, 2013). The previously published article has reported on the numbers of patients, mean age, American Society of Anesthesiologists Physical Status Classification System, body mass index, duration of follow-up, complications, Visick scores and quality of life pre- and post-operatively. The principles of complete reduction of the hernia sac, preservation of both crura, mobilisation of the phreno-oesophageal ligament and phreno-gastric attachments, adequate mediastinal mobilisation of the oesophagus and the cardio-oesophageal junction into the abdomen without tension, preservation of both vagi, a tension-free crural repair including the fascial aspects adjacent to the diaphragm, an anterior hiatal repair in combination with the recognised posterior approximation, a loose fundoplication and a secure cardiopexy to the median arcuate ligament and multiple points of attachment; we have found leads to good operative results(Gibson et. al.) without the need for mesh. This article outlines in detail the operative technique guided by these principles with annotated intra-operative photographs illustrating the anatomy and procedure. The technique used by our team since March 2009 for the last 154 cases, based on the experience of an aggregate of 544 cases since 1999, we believe results in an acceptable level of symptomatic and anatomic recurrence without using

  16. Application of ultrasonic surface wave techniques for concrete bridge deck condition assessment

    NASA Astrophysics Data System (ADS)

    Li, Mengxing; Anderson, Neil; Sneed, Lesley; Maerz, Norbert

    2016-03-01

    Ultrasonic surface wave (USW) is a well-established technique for the performance monitoring of concrete structures. In order to investigate the capability and reliability of this technique for concrete bridge deck condition assessment, a portable seismic property analyzer (PSPA) with USW capabilities was used to assess the condition of a reinforced concrete bridge deck exhibiting visible evidence of significant deterioration. After the investigation was completed, variable thicknesses of concrete were removed from upper surface of the concrete deck by milling and hydrodemolition, with greater thickness being removed where the concrete was more deteriorated. The thickness of removed concrete during the hydrodemolition process was mapped by Light Detection and Ranging (LiDAR). A comparison of the thickness of concrete removed and the USW data indicates that there is a qualitative correlation between the USW results at each test location and the thickness of concrete removed at those same test locations. Results suggest that the PSPA, and comparable USW techniques, could be potentially effective for estimating the thicknesses of concrete that would be removed during milling and hydrodemolition, although more work is needed to study the relationship between USW and removal thickness data in order to be used for quantity estimations.

  17. Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.

    PubMed

    Savvidou, Christiana; Tsai, Tsu-Min

    2015-06-01

    The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation. PMID:26078499

  18. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: Basics of technique and its nuances

    PubMed Central

    Kanojia, Ravi Prakash; Bhardwaj, Neerja; Dwivedi, Deepak; Kumar, Raj; Joshi, Saajan; Samujh, Ram; Rao, K. L. N.

    2016-01-01

    Aim: To review the technique of thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (TREAT) and results reported in literature and with authors’ experience. Patients and Methods: The technique of TREAT was reviewed in detail with evaluation in patients treated at authors’ institution. The patients were selected based on selection criteria and were followed postoperatively. The results available in literature were also reviewed. Results: A total of 29 patients (8 females) were operated by TREAT. Mean age was 2.8 days (range 2-6 days). Mean weight was 2.6 kg (range 1.8-3.2 kg). There was a leak in four patients, and two patients had to be diverted. They are now awaiting definitive repair. Twenty-one patients have completed a mean follow-up of 1.5 years and are doing well except for two patients who had a stricture and underwent serial esophageal dilatations. The results from current literature are provided in tabulated form. Conclusions: TREAT is now a well-established procedure and currently is the preferred approach wherever feasible. The avoidance of thoracotomy is a major advantage to the newborn and is proven to benefit the recovery in the postoperative patient. The technique demonstrated, and the tweaks reported make the procedure easy and is helpful to beginners. The outcome is very much comparable to the open repair as proven by various series. Various parameters like leak rate, anastomotic stricture are the same. The outcome is comparable if you TREAT these babies well. PMID:27365905

  19. Repair of massive ventral hernias with the separation of parts technique: reversal of the 'lost domain'.

    PubMed

    Hadad, Ivan; Small, William; Dumanian, Gregory Ara

    2009-04-01

    Massive ventral hernia repairs are sometimes complicated by the "loss of domain". The separation of parts hernia repair reverses the loss of domain by increasing intra-abdominal volume, but not by elevating the hemidiaphragms into the thoracic cavity. Hernia repair in patients with a "loss of abdominal domain" is thought to be associated with postoperative pulmonary difficulties. A retrospective chart review was performed on 102 patients treated by a single surgeon. The 10 patients with matching preoperative and postoperative abdominal CT scans were computer-analyzed for intra-abdominal volume changes and diaphragm height measurements. Postoperative pulmonary complications in these 102 patients were recorded. Intra-abdominal volume increased after separation of parts hernia repair from 8600 +/- 2800 mL to 9700 +/- 2700 mL (P = 0.01). Diaphragm height did not statistically change. Two of the 102 patients had prolonged intubations, and seven other patients were ventilated briefly. The separation of parts technique is able to close large ventral hernias without a high incidence of pulmonary complications as a result of its ability to expand the abdominal domain without a change in diaphragmatic height. PMID:19385289

  20. Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience

    PubMed Central

    Qazi, Hasan A.R.; Do, Minh; Rewhorn, Matthew; Häfner, Tim; Liatsikos, Evangelos; Kallidonis, Panagiotis; Dietel, Anja; Stolzenburg, Jens Uwe

    2015-01-01

    Introduction To describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes. Material and methods 12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure. Results Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data. Conclusions Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE. PMID:26251753

  1. The Combined “Double Pulley”–Simple Knot Technique for Arthroscopic Shoulder Posterior Labral Repair and Capsular Shift

    PubMed Central

    Parnes, Nata; Carey, Paul; Morman, Monica; Carr, Brian

    2016-01-01

    Posterior shoulder instability is more prevalent than traditionally believed. Surgical repairs of posterior shoulder instability have overall good success rates. However, in elite overhead and throwing athletes, a low rate of return to the preinjury level of play after repair remains a challenge. The 2 goals of posterior shoulder stabilization surgery are secure fixation of the labrum to the glenoid and retensioning of the posterior capsulolabral complex. Recent studies have shown significant advantages of arthroscopic anatomic repair over open nonanatomic techniques. We report a combined double pulley–simple knot technique for arthroscopic fixation of posterior labral tears and capsular shift. The technique incorporates several advantages of this hybrid fixation method. PMID:27069863

  2. Modeling of the balanced bridge mine detection sensor using the transmission line matrix (TLM) technique

    NASA Astrophysics Data System (ADS)

    Sherbondy, Kelly D.

    1995-06-01

    A numerical time-domain technique known as the transmission line matrix (TLM) method is used to analyze a ground penetrating radar (GPR) concept known historically as balanced bridge. This GPR concept is a dielectric anomaly (mine) detection sensor which operates in the UHF frequency band. This mine sensor consists of two receive broadband antennas separated by a single center transmit antenna. Traditionally, if care is taken in the construction of the antennas, the direct coupling and ground reflection energies are combined and nulled out by a hardware coupler when the sensor configuration is over homogeneous soil. When one of the two receiving antennas is over a dielectric anomaly (mine), the differenced energies from the two receiving antennas no longer produces a null and a peaked response is observed. This mine sensing technique has performed well under experimental tests at Fort Belvoir and Fort A.P. Hill, Virginia. Testing results, at different sites using different mine types, have indicated the sensor's performance in terms of probability of detection and false-alarm rates. The TLM method is used to describe the balanced bridge mine detector's response to targets and clutter as well as its unique capabilities in an attempt to shed light into occurring fundamental wave interactions.

  3. Giant Inguinoscrotal Hernia Repaired by Lichtensteins Technique Without Loss of Domain -A Case Report

    PubMed Central

    HN, Dinesh; N, Shreyas

    2014-01-01

    Giant inguinal hernia is a formidable surgical problem. It is defined as inguinal hernia extending up to mid thigh or below in standing position. Giant inguinal hernia is usually associated with compromised quality of life due to sexual discomfort and constant weight bearing. It is a challenge for the operating surgeon since it is rare. It may require multistage repair with recurrence being common. A 45-year-old male patient presented with Giant inguinal hernia and compromised quality of life due to pain and sexual discomfort. Lichtenstein’s polypropylene mesh repair was done after reducing the sac contents (omentum and transverse colon) with partial omentectomy. There was no loss of intra-abdominal domain. Postoperative period was uneventful. In literature many techniques are available to increase the intra-abdominal cavity (a) Creating progressive preoperative pneumoperitoneum (b) Creation of ventral wall defect (c) surgical debulking of hernia contents. Recurrence is prevented by reconstruction of the abdominal wall using Marlex mesh and a Tensor fasciae lata flap. Laparoscopic repair is associated with more recurrence. Lichtenstein’s technique is one of the preferred treatments. PMID:25386483

  4. Modification of the Koyanagi Technique for the Single-Stage Repair of Proximal Hypospadias.

    PubMed

    Chen, Yuhong; Zhang, Jinming; Ji, Chenyang; Liang, Weiqiang; Pan, Shujuan; Wu, Biying

    2016-06-01

    We describe a modification of the Koyanagi technique for hypospadias in an attempt to reduce complications and improve results. Between January 2005 and July 2012, 21 patients underwent treatment of proximal hypospadias using a modified hypospadias repair. The procedure involved making a U-incision similar to that in a Thiersch-Duplay repair to preserve the blood supply to the tubular neourethra. The neourethra was reconstructed by island penile skin. An M-incision was made in the glans, and the meatus was attached to tip of glans. Flaps were harvested from both sides of the penis preventing postoperative penile turn. Cosmetic and functional, long-term (mean, 12 months) recovery was excellent. Complications consisted of 3 cases of urethrocutaneous fistula (14.2%), which were corrected surgically, and 2 cases of penile skin necrosis. There were no instances of meatal stenosis, diverticulum, or urethral stricture. Bifid scrotum was present in 6 patients, and associated penoscrotal transposition was present in 15 patients. Both of these associated defects were corrected at the time of surgery. The modified technique permits 1-stage repair of proximal hypospadias with a low complication rate, the satisfactory recovery. PMID:27176562

  5. Development and validation of nondestructive inspection techniques for composite doubler repairs on commercial aircraft

    SciTech Connect

    Roach, D.; Walkington, P.

    1998-05-01

    Composite doublers, or repair patches, provide an innovative repair technique which can enhance the way aircraft are maintained. Instead of riveting multiple steel or aluminum plates to facilitate an aircraft repair, it is possible to bond a single boron-epoxy composite doubler to the damaged structure. In order for the use of composite doublers to achieve widespread use in the civil aviation industry, it is imperative that methods be developed which can quickly and reliably assess the integrity of the doubler. In this study, a specific composite application was chosen on an L-1011 aircraft in order to focus the tasks on application and operation issues. Primary among inspection requirements for these doublers is the identification of disbonds, between the composite laminate and aluminum parent material, and delaminations in the composite laminate. Surveillance of cracks or corrosion in the parent aluminum material beneath the doubler is also a concern. No single nondestructive inspection (NDI) method can inspect for every flaw type, therefore it is important to be aware of available NDI techniques and to properly address their capabilities and limitations. A series of NDI tests were conducted on laboratory test structures and on full-scale aircraft fuselage sections. Specific challenges, unique to bonded composite doubler applications, were highlighted. An array of conventional and advanced NDI techniques were evaluated. Flaw detection sensitivity studies were conducted on applicable eddy current, ultrasonic, X-ray and thermography based devices. The application of these NDI techniques to composite doublers and the results from test specimens, which were loaded to provide a changing flaw profile, are presented in this report. It was found that a team of these techniques can identify flaws in composite doubler installations well before they reach critical size.

  6. Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear—A Meta-Analysis

    PubMed Central

    Woodmass, Jarret M.; Bois, Aaron J.; Boorman, Richard S.; Thornton, Gail M.

    2016-01-01

    Articular surface partial-thickness rotator cuff tears (PTRCTs) are commonly repaired using two different surgical techniques: transtendon repair or repair after completion of the tear. Although a number of studies have demonstrated excellent clinical outcomes, it is unclear which technique may provide superior clinical outcomes and tendon healing. The purpose was to evaluate and compare the clinical outcomes following arthroscopic repair of articular surface PTRCT using a transtendon technique or completion of the tear. A systematic review of the literature was performed following PRISMA guidelines and checklist. The objective outcome measures evaluated in this study were the Constant Score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, physical examination, and complications. Three studies met our criteria. All were prospective randomized comparative studies with level II evidence and published from 2012 to 2013. A total of 182 shoulders (mean age 53.7 years; mean follow-up 40.5 months) were analyzed as part of this study. Both procedures provided excellent clinical outcomes with no significant difference in Constant Score and other measures between the procedures. Both procedures demonstrated improved clinical outcomes. However, there were no significant differences between each technique. Further studies are required to determine the long-term outcome of each technique.

  7. Combined Use of the Mathieu and Incised Urethral Plate Techniques for Repair of Distal Penile Hypospadias.

    PubMed

    Nilamani, Mohanty; Bhusan, Nayak Bibhuti; Annadaprasad, Patnaik

    2015-12-01

    Though both the Mathieu and incised urethral plate techniques are individually described for single-stage repair of distal penile hypospadias, each has its own shortcomings. We describe the combination of the two techniques by taking their advantages and reducing their limitations. Thirteen patients belonging to the age group of 3-22 years with distal penile hypospadias and mild chordee were operated by this technique with a mean follow-up of 8 months. One patient had urethrocutaneous fistula, and another patient had partial skin necrosis which healed spontaneously without fistula. Both of these complications occurred in adult patients. None developed urethral stenosis, and the cosmesis of the glans was excellent in all cases. This technique is very helpful in patients having small flat glans and shallow urethral groove. PMID:26730091

  8. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment.

    PubMed

    Nguyen, D Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J; Woo, Savio L-Y; van Dijk, C Niek; Blankevoort, Leendert

    2013-10-01

    Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n=5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n=5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30° in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1±8.1 N/mm vs. 41.9±18.0 N/mm [p>0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture

  9. Capstan screw rotator cuff repair: a novel two-row mini-open technique

    PubMed Central

    Goubran, Alex; Jaques, Aishling; Smith, Christopher; Bunker, Tim

    2014-01-01

    Background Prospective data collection occurred between 2000 and 2010 on 143 consecutive patients with symptomatic rotator cuff tears, aiming to examine the end-result of a new technique of mini-open double row repair: the Capstan screw technique. Methods All patients had a pre- and postoperative Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES) score and range of movement measurements. All were followed up for a minimum of 1 year with an exit questionnaire. Subscapularis repairs, small (<1 cm) and massive (>5 cm) supraspinatus repairs were excluded. Ninety-nine patients fitted the inclusion and exclusion criteria of whom 87 had a complete data set. Results The mean (SD) pre-operative OSS was 21.85 (8.6) and the mean (SD) postoperative OSS was 44.58 (5.2) (p < 0.0001). The mean (SD) pre-operative ASES score was 51.5 (19.4) and the mean (SD) postoperative ASES score was 86.42 (17.06) (p < 0.0001). Flexion improved from a mean of 119° to 170° (p < 0.0001). The clinical re-tear rate was 3.4% and the imaged re-tear rate was 6.8%. In total, 91% of patients were satisfied with the procedure. There were no deep infections and two (2%) minor wound infections. There was no single instance of deltoid dysfunction. Conclusions The Capstan screw technique represents a simple, rapid, strong and reliable mini-open technique.

  10. The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors

    PubMed Central

    Hawi, Nael; Krettek, Christian; Hawi, Ahmed; Meller, Rupert

    2015-01-01

    The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization. PMID:26258030

  11. Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results

    PubMed Central

    2013-01-01

    Background Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an “open” access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. Methods and design The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment. The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. Discussion The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences

  12. A Novel Repair Technique for the Internal Thermal Control System Dual-Membrane Gas Trap

    NASA Technical Reports Server (NTRS)

    Leimkuehler, Thomas O.; Patel, Vipul; Reeves, Daniel R.; Holt, James M.

    2005-01-01

    A dual-membrane gas trap is currently used to remove gas bubbles from the Internal Thermal Control System (ITCS) coolant on board the International Space Station (ISS). The gas trap consists of concentric tube membrane pairs, comprised of outer hydrophilic tubes and inner hydrophobic fibers. Liquid coolant passes through the outer hydrophilic membrane, which traps the gas bubbles. The inner hydrophobic fiber allows the trapped gas bubbles to pass through and vent to the ambient atmosphere in the cabin. The gas trap was designed to last for the entire lifetime of the ISS, and therefore was not designed to be repaired. However, repair of these gas traps is now a necessity due to contamination from the on-orbit ITCS fluid and other sources on the ground as well as a limited supply of flight gas traps. This paper describes a novel repair technique that has been developed that will allow the refurbishment of contaminated gas traps and their return to flight use.

  13. Development of an integrated remote monitoring technique and its application to para-stressing bridge system

    NASA Astrophysics Data System (ADS)

    Miyamoto, Ayaho; Motoshita, Minoru; Casas, Joan R.

    2013-12-01

    Bridge monitoring system via information technology is capable of providing more accurate knowledge of bridge performance characteristics than traditional strategies. This paper describes not only an integrated Internet monitoring system that consists of a stand-alone monitoring system (SMS) and a Web-based Internet monitoring system (IMS) for bridge maintenance but also its application to para-stressing bridge system as an intelligent structure. IMS, as a Web-based system, is capable of addressing the remote monitoring by introducing measuring information derived from SMS into the system through Internet or intranet connected by either PHS or LAN. Moreover, the key functions of IMS such as data management system, condition assessment, and decision making with the proposed system are also introduced in this paper. Another goal of this study is to establish the framework of a para-stressing bridge system which is an intelligent bridge by integrating the bridge monitoring information into the system to control the bridge performance automatically.

  14. Development program to certify composite doubler repair technique for commercial aircraft

    SciTech Connect

    Roach, D.P.

    1997-07-01

    Commercial airframes exceeding 20 service years often develop crack and corrosion flaws. Bonded composite doublers offer a cost effective method to safely extend aircraft lives. The Federal Aircraft Authority (FAA) has completed a project to introduce composite doubler repair technology to the commercial aircraft industry. Instead of riveting steel or aluminum plates for repair, a single composite doubler may be bonded to the damaged structure. Adhesive bonding eliminates stress concentrations caused by fastener holes. Composites are readily formed into complex shapes for repairing irregular components. Also, composite doublers can be tailored to meet specific anisotropy needs, eliminating structural stiffening in directions other than those required. Other advantages include corrosion resistance, a high strength-to-weight ratio, and potential time savings in installation. One phase of this study developed general methodologies and test programs to ensure proper performance of the technique. A second phase focused on reinforcement of an L-1011 door frame, and encompassed all lifetime tasks such as design, analysis, installation, and nondestructive inspection. This paper overviews the project and details the activities conducted to gain FAA approval for composite doubler use. Structural tests evaluated the damage tolerance and fatigue performance of composite doublers while finite element models were generated to study doubler design issues. Nondestructive inspection procedures were developed and validated using full-scale test articles. Installation dry-runs demonstrated the viability of applying composite doublers in hangar environments. The project`s documentation package was used to support installation of a Boron-Epoxy composite repair on a Delta Air Lines L-1011 aircraft. A second product of the results is a Lockheed Service Bulletin which allows the door corner composite doubler to be installed on all L-1011 aircraft. 9 refs., 10 figs., 2 tabs.

  15. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    SciTech Connect

    Ricci, Carmelo; Ceccherini, Claudio Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-02-15

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  16. Investigation of bacterial nucleotide excision repair using single-molecule techniques.

    PubMed

    Van Houten, Bennett; Kad, Neil

    2014-08-01

    Despite three decades of biochemical and structural analysis of the prokaryotic nucleotide excision repair (NER) system, many intriguing questions remain with regard to how the UvrA, UvrB, and UvrC proteins detect, verify and remove a wide range of DNA lesions. Single-molecule techniques have begun to allow more detailed understanding of the kinetics and action mechanism of this complex process. This article reviews how atomic force microscopy and fluorescence microscopy have captured new glimpses of how these proteins work together to mediate NER. PMID:24472181

  17. A bridging technique to analyze the influence of boundary conditions on instability patterns

    SciTech Connect

    Hu Heng; Damil, Noureddine; Potier-Ferry, Michel

    2011-05-10

    In this paper, we present a new numerical technique that permits to analyse the effect of boundary conditions on the appearance of instability patterns. Envelope equations of Landau-Ginzburg type are classically used to predict pattern formation, but it is not easy to associate boundary conditions for these macroscopic models. Indeed, envelope equations ignore boundary layers that can be important, for instance in cases where the instability starts first near the boundary. In this work, the full model is considered close to the boundary, an envelope equation in the core and they are bridged by the Arlequin method . Simulation results are presented for the problem of buckling of long beams lying on a non-linear elastic foundation.

  18. Effects of three surface conditioning techniques on repair bond strength of nanohybrid and nanofilled composites

    PubMed Central

    Nassoohi, Negin; Kazemi, Haleh; Sadaghiani, Morad; Mansouri, Mona; Rakhshan, Vahid

    2015-01-01

    Background: Repair bond strength of different composite resins has been assessed in few studies. In addition, reports on the efficacy of surface treatments are debated. Therefore, this in vitro study was conducted to evaluate the effect of three surface treatments on two nanocomposites versus a microhybrid composite. Materials and Methods: In this experimental study, 135 composite blocks (45 specimens per composite) of microhybrid (Filtek Supreme Z250, 3M ESPE, USA), nanohybrid (Filtek Supreme XT, 3M ESPE), and nanofilled (Filtek Supreme Z350, 3M ESPE) were thermocycled (5000 rounds) and then surface roughened (except in a control group of 9 specimens of three composite types). Each composite type was divided into three subgroups of surface treatments: (1) Bur abrading and phosphoric acid (PA) etching, (2) sandblasting and PA etching, and (3) hydrofluoric etching and silane application (n = 15 × 9, complying with ISO TR11405). Composite blocks were repaired with the same composite type but of a different color. Microtensile bond strength and modes of failure were analyzed statistically using two-way analyses of variance, Tukey and Chi-square tests (α = 0.05). Results: There were significant differences between three composite resins (P < 0.0001) and treatment techniques (P < 0.0001). Their interaction was nonsignificant (P = 0.228). The difference between nanofilled and nanohybrid was not significant. However, the microhybrid composite showed a significantly higher bond strength (Tukey P < 0.05). Sandblasting was significantly superior to the other two methods, which were not different from each other. Conclusion: Within the limitations of this in vitro study, it seems that microhybrid composite might have higher repair strengths than two evaluated nanocomposites. Among the assessed preparation techniques, sandblasting followed by PA etching might produce the highest bond strength. PMID:26759592

  19. Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

    PubMed Central

    Wolf, Petra; Harder, Yves; Kern, Yasmin; Paprottka, Philipp M.; Machens, Hans-Günther; Lohmeyer, Jörn A.

    2013-01-01

    Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair. PMID:23984064

  20. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia

    PubMed Central

    Kfoury, Elias; Almanfi, Abdelkader; Dougherty, Kathryn G.

    2016-01-01

    Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature. PMID:27303239

  1. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia.

    PubMed

    Kfoury, Elias; Almanfi, Abdelkader; Dougherty, Kathryn G; Krajcer, Zvonimir

    2016-06-01

    Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature. PMID:27303239

  2. Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway through FDA Investigational Device Approval

    PubMed Central

    Proffen, Benedikt L.; Perrone, Gabriel S.; Roberts, Gordon; Murray, Martha M.

    2016-01-01

    Injuries to the anterior cruciate ligament (ACL) are currently treated with replacement of the torn ligament with a graft of tendon harvested from elsewhere in the knee. This procedure, called "ACL reconstruction," is excellent for restoring gross stability to the knee; however, there are relatively high graft failure rates in adolescent patients,4, 12, 60 and the ACL reconstruction procedure does not prevent the premature osteoarthritis seen in patients after an ACL injury.1, 46, 52 Thus, new solutions are needed for ACL injuries. Researchers have been investigating the use of scaffolds, growth factors and cells to supplement a suture repair of the ACL (bio-enhanced repair). In this paper, we will review the varied approaches, which have been investigated for stimulating ACL healing and repair in preclinical models and how one of these technologies was able to move from promising preclinical results to FDA acceptance of an Investigational Device Exemption (IDE) application for a first-in-human study. PMID:25631206

  3. A multiscale modeling technique for bridging molecular dynamics with finite element method

    SciTech Connect

    Lee, Yongchang Basaran, Cemal

    2013-11-15

    In computational mechanics, molecular dynamics (MD) and finite element (FE) analysis are well developed and most popular on nanoscale and macroscale analysis, respectively. MD can very well simulate the atomistic behavior, but cannot simulate macroscale length and time due to computational limits. FE can very well simulate continuum mechanics (CM) problems, but has the limitation of the lack of atomistic level degrees of freedom. Multiscale modeling is an expedient methodology with a potential to connect different levels of modeling such as quantum mechanics, molecular dynamics, and continuum mechanics. This study proposes a new multiscale modeling technique to couple MD with FE. The proposed method relies on weighted average momentum principle. A wave propagation example has been used to illustrate the challenges in coupling MD with FE and to verify the proposed technique. Furthermore, 2-Dimensional problem has also been used to demonstrate how this method would translate into real world applications. -- Highlights: •A weighted averaging momentum method is introduced for bridging molecular dynamics (MD) with finite element (FE) method. •The proposed method shows excellent coupling results in 1-D and 2-D examples. •The proposed method successfully reduces the spurious wave reflection at the border of MD and FE regions. •Big advantages of the proposed method are simplicity and inexpensive computational cost of multiscale analysis.

  4. Recurrence rate of different techniques for repair of coarctation of aorta: A 10 years experience

    PubMed Central

    Dehaki, Maziar Gholampour; Ghavidel, Alireza Alizadeh; Givtaj, Nader; Omrani, Gholamreza; Salehi, Shahyad

    2010-01-01

    Background and Aim: The main goal of this study was to assess the frequency of recurrent coarctation after repair using different surgical methods. Methods: Surgical results of repairs for coarctation of aorta (Co-A) in 188 patients under the age 14 years who were treated in Rajaee Heart Center, Tehran, Iran, were evaluated retrospectively. The most common methods included patch-graft aortoplasty (59%), resection with end-to-end anastomosis (20.7%) and subclavian flap aortoplasty (SCFA) (16.5%). The remaining patients underwent bypass tube graft and excision with placement of a tube graft. Seventy eight percent had discrete stenosis while 22% had long segment narrowing. The patients were followed for 81.6±32.8 months. Results: The overall mortality rate was 2.6%. The highest incidence rate of recoarctation was found in the patch-graft aortoplasty group (12.7%) and the lowest was found in SCFA (3.2%). The incidence of recoarctation in long-segment lesions was significantly higher than that in the discrete ones (30% vs. 4%, P<0.001). In patients <1 year, the incidence of recoarctation was lower than that in the other age groups. Conclusion: The patch-graft aortoplasty technique had the highest incidence of recoarctation and SCFA had the lowest rate. Long-segment Co-A had a higher chance of recoarctation. In contrast to some previous reports, the incidence of recoarctation was not higher in the age below 1 year. PMID:21234190

  5. The development of internal repair and rehabilitation techniques for cast iron joints and small diameter steel pipe

    SciTech Connect

    Matsuzaki, M.; Yasui, K.; Tsuji, T.

    1988-01-01

    Osaka Gas Co., Ltd. and Toho Gas Co., Ltd. have accomplished trenchless repair-rehabilitation techniques for cast iron mains, branches, services and house pipes as complete systems in order to maintain its buried pipelines efficiently. An outline of these systems is presented in this paper. Osaka Gas is the second largest and Toho Gas is the third largest gas company in Japan, both gas companies have 5,800,000 customers and pipelines extending approximately to 52,000 km. To maintain such gas pipelines whose length is much more longer than the circumference of the earth, a large amount of investment is required, because excavation of existing pipelines has become more and more difficult. In such a situation, it has become urgent to develop trenchless techniques to repair gas pipelines and to prevent leakage. From these viewpoints Osaka Gas and Toho Gas have developed several complete, internal repair-rehabilitation techniques for cast iron mains, branches, services, and house pipes.

  6. Interstitial Tear of the Subscapularis Tendon, Arthroscopic Findings and Technique of Repair

    PubMed Central

    Saremi, Hossein

    2016-01-01

    Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as “Air bag sign” and repair technique of the pathology is explained. PMID:27200399

  7. Thoracic endovascular aortic repair of a severely angulated aorta using a double-wire technique.

    PubMed

    Kawatani, Yohei; Nakamura, Yoshitsugu; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    When endovascular treatment is performed, angulation of the access route for a device can make the operative procedure difficult. We encountered a case in which we successfully completed thoracic endovascular aortic repair (TEVAR) in a patient with severely angulated aorta by applying 'double-wire technique'. The patient was an 80-year-old woman. An aneurysm with a 71-mm diameter was observed in the descending aorta. We performed TEVAR. Device delivery could not be achieved by a conventional procedure using one guide wire since the peripheral aorta was severely angulated. Therefore, in addition to a guide wire for main body, a stiff wire and a stiff sheath were introduced to straighten the angulation. The device was successfully introduced and TEVAR was completed. We used the Relay Plus(®) that facilitates tracking through the angulation. The device has a dual structure consisting of a hard sheath and a flexible sheath. We performed TEVAR successfully. PMID:27421301

  8. The mechanical properties of H13 die steel repaired by a biomimetic laser technique

    NASA Astrophysics Data System (ADS)

    Cong, Dalong; Zhou, Hong; Yang, Miaoqiang; Zhang, Zhihui; Zhang, Peng; Meng, Chao; Wang, Chuanwei

    2013-12-01

    The H13 steel specimens with cracks were repaired by pulsed laser welding with filler wire and the laser parameters were analyzed to obtain the weld without defects. Strengthening units with different spacing were fabricated to improve the tensile strength and thermal fatigue resistance of the weld by laser technique on the surfaces of specimens, that is, PS-1, PS-2 and PS-3 for tensile specimens and PS for thermal fatigue specimen. The results indicated that the units have a beneficial effect on improving the tensile strength and thermal fatigue resistance of welded components of H13 steel. The improvement can be attributed to the microstructure characteristics within the units and the spacing of adjacent units is a key factor which affects the strength of weld by biomimetic treatment.

  9. Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique

    PubMed Central

    Raup, Valary T.; Eswara, Jairam R.; Marshall, Stephen D.; Brandes, Steven B.

    2015-01-01

    Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique. PMID:26483985

  10. GIA-Aneurysmorrhaphy and Dermal Detachment: A Novel Technique to Repair Arteriovenous Fistula Aneurysms.

    PubMed

    Chang, Jason; Prema, Jateen; Pedersen, Rose; Li, Yiping; Liebl, Max; Patel, Kaushal; Mueller, Mark

    2016-05-01

    This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12 months), until thrombosis (1 patient for 13 months), or continue to be in use (9 patients, mean patency 18 months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3 months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients. PMID:26965822

  11. Magnetic resonance techniques to quantify tissue damage, tissue repair, and functional cortical reorganization in multiple sclerosis.

    PubMed

    Filippi, M; Agosta, F

    2009-01-01

    A dramatic paradigm shift is taking place in our understanding of the pathophysiology of multiple sclerosis (MS). An important contribution to such a shift has been made possible by the advances in magnetic resonance imaging (MRI) technology, which allows structural damage to be quantified in the brains of patients with MS and to be followed over the course of the disease. Modern quantitative MR techniques have reshaped the picture of MS, leading to the definition of the so- called "axonal hypothesis" (i.e., changes in axonal metabolism, morphology, or density are important determinants of functional impairment in MS). Metrics derived from magnetization transfer and diffusion-weighted MRI enable us to quantify the extent of structural changes occurring within T2-visible lesions and normal-appearing tissues (including gray matter), with increased pathological specificity over conventional MRI to irreversible tissue damage; proton MR spectroscopy adds valuable pieces of information on the biochemical nature of such changes. Finally, functional MRI can provide new insights into the role of cortical adaptive changes in limiting the clinical consequences of MS-related irreversible structural damage. Our current understanding of the pathophysiology of MS is that this is not only a disease of the white matter, characterized by focal inflammatory lesions, but also a disease involving more subtle and diffuse damage throughout the white and gray matter. The inflammatory and neurodegenerative components of the disease process are present from the earliest observable phases of the disease, but appear to be, at least partially, dissociated. In addition, recovery and repair play an important role in the genesis of the clinical manifestations of the disease, involving both structural changes and plastic reorganization of the cortex. This new picture of MS has important implications in the context of treatment options, since it suggests that agents that protect against

  12. New meniscus repair by an all-inside knot suture technique.

    PubMed

    Fukushima, Kazumasa; Okano, Tatsumasa; Negishi, Shinichi; Horaguchi, Takashi; Sato, Kenji; Saito, Akiyoshi; Ryu, Junnosuke

    2005-06-01

    The indications for the all-inside knot suture technique include tears in the red-red zone or red-white zone in the meniscus, and a horizontal tear, a vertical tear, and a peripheral tear. First, find an appropriate place for a suture insertion site with a Kateran needle or a spinal needle. Make sure it exits beyond the tear in the meniscus. Once the insertion site is chosen, a suture is passed into and through the joint. The suture is slowly pulled back. You should be able to feel the tip of the suture come out of the joint capsule. If you want to make a vertical suture to suture the tear, move the suture vertically apex. Then insert the suture back into the joint through the capsule. Make sure the suture stays inside the joint. Find and grab the suture with a punch inserted from the clear cannula. Pull the suture out of the joint through the clear cannula with the punch. Tighten the knot with a knot pusher. Then confirm the stability of the sutured site with the probe. Our all-inside knot suture technique can be performed arthroscopically, allowing reliable repair of the torn meniscus. PMID:15944646

  13. The Preclose Technique in Percutaneous Endovascular Aortic Repair: A Systematic Literature Review and Meta-analysis

    SciTech Connect

    Jaffan, Abdel Aziz A.; Prince, Ethan A.; Hampson, Christopher O.; Murphy, Timothy P.

    2013-06-15

    Purpose. To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR).MethodsA systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012.ResultsThirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size ({>=}20F). Conclusion. The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.

  14. Arthroscopic Posterior Shoulder Stabilization With an Iliac Bone Graft and Capsular Repair: A Novel Technique

    PubMed Central

    Smith, Tomas; Goede, Fabian; Struck, Melena; Wellmann, Mathias

    2012-01-01

    Several surgical approaches have been described for the treatment of recurrent posterior shoulder instability. Many authors have performed posterior bone block procedures with good results not only in the presence of glenoid bone loss or dysplasia but also in the case of capsular hyperlaxity and poor soft-tissue quality. Open techniques often require an extensive approach with the disadvantage of a poor cosmetic result and possible insufficiency of the deltoid muscle. Furthermore, the treatment of concomitant pathologies and the correct placement of the bone graft are difficult. Therefore we describe an all-arthroscopic posterior shoulder stabilization technique with an iliac bone graft and capsular repair that is intended to improve the pre-existing open procedure. The key steps of the operation are the precise placement and screw fixation of the bone block at the posterior glenoid under arthroscopic control and the subsequent posterior capsular refixation and plication using 2 suture anchors to create an extra-articular graft position. PMID:23766993

  15. Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

    PubMed Central

    Zhu, Xinyong; Tian, Wen; Li, Jiye; Sun, Pengjun; Pei, Lijuan; Wang, Shijie

    2015-01-01

    Background Concomitant incisional and parastomal hernias is a challenging condition. We used a hybrid technique of sublay and onlay to treat patients with this condition. Material/Methods The clinical data of 32 consecutive patients treated from February 2008 to April 2014 for concomitant incisional and parastomal hernias were retrospectively reviewed. The mean diameter was 9 (range 4–13) cm of the incisional hernias, and 6 (range 4.5–8) cm of the parastomal hernias. Results The mean operative time was 247 (range 220–290) min. The mean hospital stay was 20 (range 14–27) days. All surgical wounds healed by primary intention. Seven patients had postoperative seroma and were well managed with puncture and compression. All 32 patients were followed up for a mean of 48 (range 5–68) months. Four patients recurred with parastomal hernias and were treated with secondary surgery. No further recurrence occurred until the last follow-up. Conclusions This hybrid technique of sublay and onlay is only suitable for the repair of complex incisional and parastomal hernias. PMID:26186130

  16. Comparison of CO2 laser welding with suture technique for repair of tendons

    NASA Astrophysics Data System (ADS)

    Popovic, Neven A.; Johnstone, Frederic L.; Kilkelly, Francis X.; McKinney, LuAnn; Van De Merwe, Willem P.; Smith, Allan C.

    1995-05-01

    The purpose of this study was to evaluate the efficacy, histology, and strength of laser welding in repair of sharply transected rat Achilles tendons. In 26 adult, male Sprague-Dawley rats, the severed tendons were repaired with a 7-0 nylon, modified Kessler core suture followed by either a running 9-0 nylon epitendinous suture or a circumferential CO2 laser epidendinous weld using 25% human albumin as a solder. All repairs were timed and post- operative tensile strength was analyzed with material testing equipment. In addition, histologic testing was performed on both types of repairs. The mean time to complete the epitendinous repair in the laser group was 3.5 minutes and in the suture group, 8 minutes. The mean ultimate tensile strength in 6 normal tendons was 40.9 Newtons (N) with group standard deviation of 5.2 N. When compared with normal controls, post-operatively both types of tendon repairs resulted in tensile failure at lower forces. The ultimate tensile strength for the epitendinous suture repair and the laser welds were 13% and 6% of normal controls, respectively. Twenty tendons with epidendinous suture repair had mean ultimate tensile strength of 5.4 (+/- 1.2) N, while the 17 tendons with laser wends failed at 2.6 (+/- 0.9) N. Histologic evaluation of tendons repaired with CO2 laser revealed areas of coagulation and edema on the surface of tendon edges. Post-operatively, greater tissue changes were noted in laser treated tendons than those repaired with sutures. Laser welding of epitenon is possible and can be completed faster than the suture repair. The repaired tendon surface appears smoother and less bulky after laser treatment. However, significantly decreased immediate post-operative strength was demonstrated by the use of Kruskal-Wallis one way analysis of variance and Turkey's pairwise comparison.

  17. Arthroscopic Management of Full-Thickness Rotator Cuff Tears in Major League Baseball Pitchers: The Lateralized Footprint Repair Technique.

    PubMed

    Dines, Joshua S; Jones, Kristofer; Maher, Patrick; Altchek, David

    2016-01-01

    Clinical outcomes of surgical management of full-thickness rotator cuff tears in professional baseball players have been uniformly poor. We conducted a study to investigate return-to-play data and functional performance using a novel arthroscopic repair technique. We hypothesized that arthroscopic rotator cuff repair would result in a high rate of return to professional pitching and favorable functional outcomes. We identified 6 consecutive Major League Baseball (MLB) pitchers who underwent surgical repair of full-thickness rotator cuff injuries using the lateralized footprint repair technique. At most recent follow-up, patients were evaluated to determine their ability to return to athletic activity. Functional outcomes were also assessed using player performance statistics. By mean follow-up of 66.7 months (range, 23.2-94.6 months), 5 (83%) of the 6 pitchers had returned to their preinjury level of competition for at least 1 full season. Despite the high rate of return to MLB play, few pitchers resumed pitching productivity at their preoperative level; mean number of innings pitched decreased from 1806.5 to 183.7. A slight performance reduction was also found in a comparison of preoperative and postoperative pitching statistics. Of note, the return rate was higher for players over age 30 years than for those under 30 years. Overhead athletes require a delicate balance of shoulder mobility and stability to meet functional demands. Anatomical adaptations at the glenohumeral joint should be considered when performing rotator cuff repair in these patients in order to preserve peak functional performance. This novel repair technique affords a high rate of return to MLB play, though elite overhead throwers should be counseled that pitching productivity might decrease after surgery. PMID:26991564

  18. Impact of changing trends in technique and learning curve on outcome of hypospadias repair: An experience from tertiary care center

    PubMed Central

    Ansari, M. S.; Agarwal, Shikhar; Sureka, Sanjoy Kumar; Mandhani, Anil; Kapoor, Rakesh; Srivastava, Aneesh

    2016-01-01

    Introduction: Apart from numerous clinical factors, surgical experience and technique are important determinants of hypospadias repair outcome. This study was aimed to evaluate the learning curve of hypospadias repair and the impact of changing trends in surgical techniques on the success of primary hypospadias repair. Materials and Methods: We retrospectively analyzed of data of 324 patients who underwent primary repair of hypospadias between January 1997 and December 2013 at our center. During the initial 8 years, repairs were performed by multiple 5 different urologists. From 2005 onwards, all procedures were performed by a single urologist. The study cohorts was categorized into three groups; Group I, surgeries performed between 1997–2004 by multiple surgeons, Group II, between 2005–2006 during the initial learning curve of a single surgeon, and Group III, from 2007 onwards after completion of the learning curve of the single surgeon. The groups were compared in respect to surgical techniques, overall success and complications. Results: Overall 296 patients fulfilled the inclusion criterion, 93 (31.4%), 50 (16.9%), and 153 (51.7%) in Group I, II, and III, respectively. Overall success was achieved in 60 (64.5%), 32 (64%), and 128 (83.7%) patients among the three groups respectively (P < 0.01). Nineteen (20.4%), 20 (40%), and 96 (62.7%) patients underwent tubularized incised plate repair in Group I, II, and III, with successful outcome in 12 (63.2%), 15 (75%), and 91 (94.8%) patients, respectively (P < 0.01). The most common complication among all groups was urethrocutaneous fistula, 20 (21.5%) in Group I, 11 (22%) in Group II, and 17 (11.1%) in Group III. Conclusion: There is a learning curve for attaining surgical skills in hypospadias surgery. Surgeons dedicated for this surgery provide better results. Tubularized incised plate urethroplasty appear promising in both distal and proximal type hypospadias. PMID:27555680

  19. Development of a wireless bridge monitoring system for condition assessment using hybrid techniques

    NASA Astrophysics Data System (ADS)

    Whelan, Matthew J.; Fuchs, Michael P.; Gangone, Michael V.; Janoyan, Kerop D.

    2007-04-01

    The introduction and development of wireless sensor network technology has resulted in rapid growth within the field of structural health monitoring (SHM), as the dramatic cable costs associated with instrumentation of large civil structures is potentially alleviated. Traditionally, condition assessment of bridge structures is accomplished through the use of either vibration measurements or strain sensing. One approach is through quantifying dynamic characteristics and mode shapes developed through the use of relatively dense arrays of accelerometers. Another widely utilized method of condition assessment is bridge load rating, which is enabled through the use of strain sensors. The Wireless Sensor Solution (WSS) developed specifically for diagnostic bridge monitoring provides a hybrid system that interfaces with both accelerometers and strain sensors to facilitate vibration-based bridge evaluation as well as load rating and static analysis on a universal platform. This paper presents the development and testing of a wireless bridge monitoring system designed within the Laboratory for Intelligent Infrastructure and Transportation Technologies (LIITT) at Clarkson University. The system interfaces with low-cost MEMS accelerometers using custom signal conditioning for amplification and filtering tailored to the spectrum of typical bridge vibrations, specifically from ambient excitation. Additionally, a signal conditioning and high resolution ADC interface is provided for strain gauge sensors. To permit compensation for the influence of temperature, thermistor-based temperature sensing is also enabled. In addition to the hardware description, this paper presents features of the software applications and host interface developed for flexible, user-friendly in-network control of and acquisition from the sensor nodes. The architecture of the software radio protocol is also discussed along with results of field deployments including relatively large-scale networks and

  20. Thoracic endovascular repair for acute type A aortic dissection: operative technique

    PubMed Central

    Shah, Aamir

    2016-01-01

    Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair. New endovascular devices and advanced image-guided procedures are continually evolving. This article summarizes the pathology of aortic dissection and focuses on currently available endovascular solutions for transapical and transfemoral stent graft deployment for acute aortic dissection involving the ascending aorta for selected patients who are ineligible for open surgical repair. PMID:27563553

  1. Thoracic endovascular repair for acute type A aortic dissection: operative technique.

    PubMed

    Shah, Aamir; Khoynezhad, Ali

    2016-07-01

    Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair. New endovascular devices and advanced image-guided procedures are continually evolving. This article summarizes the pathology of aortic dissection and focuses on currently available endovascular solutions for transapical and transfemoral stent graft deployment for acute aortic dissection involving the ascending aorta for selected patients who are ineligible for open surgical repair. PMID:27563553

  2. Use of Fibula Bridge Graft Technique to Treat a Distal Tibia Non Union- A Case Report

    PubMed Central

    Rajani, Amyn; Thakkar, C J; Shah, Ravi; Shyam, Ashok

    2013-01-01

    Introduction: Compound distal tibia fractures have high incidence of nonunions and have varied presentation as far as status of fibula is concerned. If fibula is sufficiently healthy we can use it for bridging the nonunion of tibia. Case Report: We present a case of 20 year old female with compound and segmental tibia fracture. Primary stablisation by external fixation and later cast brace application achieved union at the proximal end of the segmental fragment with non union at the distal end. This was then treated with bridge grafting of fibula and screw fixation of fibula to the tibia. Five years follow shows good clinical and functional outcome without any complications. Conclusion: Its infrequent to find fibula spanning across the tibia nonunion, however when available this can be used as bridge graft to promote healing.

  3. The clinical application of "jetting suture" technique in annular repair under microendoscopic discectomy: A prospective single-cohort observational study.

    PubMed

    Qi, Lei; Li, Mu; Si, Haipeng; Wang, Liang; Jiang, Yunpeng; Zhang, Shuai; Li, Le

    2016-08-01

    To introduce a new designed suture technique in annular repair under the microendoscopic discectomy (MED) surgery and to evaluate the clinical application of the technique in annular repair under MED with at least 2-year follow-up period.A new method of annular repair was designed and named "jetting suture" technique. Thirty consecutive patients with lumbar disc herniation were enrolled in the prospective single-cohort observational study. Patients were followed up at intervals of preoperative, postoperative 1 week, 3 months, 6 months, 1 year, and last follow-up. The clinical outcomes were evaluated by using Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index, and modified Mcnab criteria.The procedure was successfully performed in all cases. No case required conversion to an open procedure. The mean age of patients was 36.6 years. Average blood loss was 45.8 ± 10.2 mL. The preoperative symptoms were alleviated significantly after surgery. All the standardized measures improved significantly at the last follow-up, including JOA score (10.1 to 26.6; P < 0.05) and Oswestry Disability Index (75.3 to 9.6; P < 0.05). Improvement rate of JOA score was 86.4%. Approximately 83.4% of patients reported good or excellent outcomes based on modified Mcnab criteria. No postoperative complication and recurrence of disc herniation was reported.The designed "jetting suture" technique in annular repair under MED can be performed safely and effectively. It could be a viable alternative to annular repair under lumbar discectomy. PMID:27495101

  4. Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

    PubMed Central

    Beyersdoerfer, Sascha Tobias; Vollmar, Brigitte; Mittlmeier, Thomas; Gierer, Philip

    2016-01-01

    Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response. PMID:27446949

  5. Comparison of Synthetic and Biologic Mesh in Ventral Hernia Repair Using Components Separation Technique.

    PubMed

    Sandvall, Brinkley K; Suver, Daniel W; Said, Hakim K; Mathes, David W; Neligan, Peter C; Dellinger, E Patchen; Louie, Otway

    2016-06-01

    Ventral hernia repair (VHR) for large abdominal wall defects is challenging. Prior research established that the use of mesh is superior to suture closure alone and that component separation is an effective technique to combat loss of abdominal domain. Studies comparing component separation technique (CST) outcomes utilizing synthetic versus biologic mesh are limited. A retrospective review was conducted of 72 consecutive patients who underwent VHR with CST between 2006 and 2010 at our institution. Surgeon preference and the presence of contamination guided whether synthetic mesh (27 patients) or biologic mesh (45 patients) was used. Mean follow-up interval for all comers was 13.9 months and similar in both groups (P > 0.05). Degree of contamination and severity of premorbid medical conditions were significantly higher in the biologic mesh group, as reflected in the higher Ventral Hernia Working Group (VHWG) score (2.04 versus 2.86). Clinical outcomes, as measured by both minor and major complication rates and recurrence rates, were not significantly different. Minor complication rates were 26% in the synthetic group and 37% in the biologic group and major complication rates 15% in the synthetic group and 22% in the biologic group. There was 1 recurrence (4%) in the synthetic mesh group versus 5 (11%) in the biologic mesh group. Multivariable analysis for major complications revealed no significant difference for either synthetic or biologic mesh while controlling for other variables. Subset analysis of uncontaminated cases revealed recurrence rates of 4% in the synthetic mesh group and 6% in the biologic mesh group. VHR using CST and either synthetic mesh or biologic mesh resulted in low recurrence rates with similar overall complication profiles, despite the higher average VHWG grading score in the biologic mesh group. Our results support the VHWG recommendation for biologic mesh utilization in higher VHWG grade patients. In VHWG grade 2 patients, our clinical

  6. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration

    PubMed Central

    Makris, Eleftherios A.; Hadidi, Pasha; Athanasiou, Kyriacos A.

    2011-01-01

    Extensive scientific investigations in recent decades have established the anatomical, biomechanical, and functional importance that the meniscus holds within the knee joint. As a vital part of the joint, it acts to prevent the deterioration and degeneration of articular cartilage, and the onset and development of osteoarthritis. For this reason, research into meniscus repair has been the recipient of particular interest from the orthopedic and bioengineering communities. Current repair techniques are only effective in treating lesions located in the peripheral vascularized region of the meniscus. Healing lesions found in the inner avascular region, which functions under a highly demanding mechanical environment, is considered to be a significant challenge. An adequate treatment approach has yet to be established, though many attempts have been undertaken. The current primary method for treatment is partial meniscectomy, which commonly results in the progressive development of osteoarthritis. This drawback has shifted research interest towards the fields of biomaterials and bioengineering, where it is hoped that meniscal deterioration can be tackled with the help of tissue engineering. So far, different approaches and strategies have contributed to the in vitro generation of meniscus constructs, which are capable of restoring meniscal lesions to some extent, both functionally as well as anatomically. The selection of the appropriate cell source (autologous, allogeneic, or xenogeneic cells, or stem cells) is undoubtedly regarded as key to successful meniscal tissue engineering. Furthermore, a large variation of scaffolds for tissue engineering have been proposed and produced in experimental and clinical studies, although a few problems with these (e.g., byproducts of degradation, stress shielding) have shifted research interest towards new strategies (e.g., scaffoldless approaches, self-assembly). A large number of different chemical (e.g., TGF-β1, C-ABC) and

  7. 23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair...

  8. 23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 23 Highways 1 2012-04-01 2012-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair...

  9. 23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair...

  10. 23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair...

  11. 23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair...

  12. C-terminal region of bacterial Ku controls DNA bridging, DNA threading and recruitment of DNA ligase D for double strand breaks repair

    PubMed Central

    McGovern, Stephen; Baconnais, Sonia; Roblin, Pierre; Nicolas, Pierre; Drevet, Pascal; Simonson, Héloïse; Piétrement, Olivier; Charbonnier, Jean-Baptiste; Le Cam, Eric; Noirot, Philippe; Lecointe, François

    2016-01-01

    Non-homologous end joining is a ligation process repairing DNA double strand breaks in eukaryotes and many prokaryotes. The ring structured eukaryotic Ku binds DNA ends and recruits other factors which can access DNA ends through the threading of Ku inward the DNA, making this protein a key ingredient for the scaffolding of the NHEJ machinery. However, this threading ability seems unevenly conserved among bacterial Ku. As bacterial Ku differ mainly by their C-terminus, we evaluate the role of this region in the loading and the threading abilities of Bacillus subtilis Ku and the stimulation of the DNA ligase LigD. We identify two distinct sub-regions: a ubiquitous minimal C-terminal region and a frequent basic C-terminal extension. We show that truncation of one or both of these sub-regions in Bacillus subtilis Ku impairs the stimulation of the LigD end joining activity in vitro. We further demonstrate that the minimal C-terminus is required for the Ku-LigD interaction, whereas the basic extension controls the threading and DNA bridging abilities of Ku. We propose that the Ku basic C-terminal extension increases the concentration of Ku near DNA ends, favoring the recruitment of LigD at the break, thanks to the minimal C-terminal sub-region. PMID:26961308

  13. T2* relaxometry and volume predict semi-quantitative histological scoring of an ACL bridge-enhanced primary repair in a porcine model.

    PubMed

    Biercevicz, Alison M; Proffen, Benedikt L; Murray, Martha M; Walsh, Edward G; Fleming, Braden C

    2015-08-01

    Magnetic resonance imaging (MRI) variables, such as T2* and volume, can predict the healing ligament structural properties. How these MR variables relate to semi-quantitative histology of the healing ACL is yet unknown. We hypothesized that T2* and volume would predict the histological scoring of a healing ACL. Yucatan minipigs underwent ACL transection and received bridge-enhanced ACL repair or no treatment. The surgical legs were harvested after 52 weeks and imaged using a high resolution 2-echo sequence. For each ligament, the volume and median T2* values were determined. The ACL specimens were then histologically analyzed using the advanced Ligament Maturity Index (LMI). The T2* of the healing ligaments significantly predicted the total LMI score as well as the cell, collagen and vessel sub-scores; R(2)  = 0.78, 0.67, 0.65, and 0.60, respectively (p ≤ 0.001). The ligament volume also predicted the total LMI score, cell, and collagen sub-scores; R(2)  = 0.39, 0.33, 0.37, and 0.60, respectively (p ≤ 0.001). A lower ligament T2* or a higher volume was associated with higher histological scores of the healing ligaments. This study provides a critical step in the development of a non-invasive method to evaluate ligament healing on a microscopic scale. PMID:25764143

  14. Assessment of Concrete Repair Techniques for Radiologically Contaminated Tank Farm Pump and Valve Pits

    SciTech Connect

    MINTEER, D.J.

    2000-09-19

    As part of the scope of Project W-314, ''Tank Farm Restoration and Safe Operations,'' the condition of pump and valve pit walls and floors is being assessed, and repairs made as needed, to support upgrading the infrastructure necessary to safely transfer tank waste for treatment. Flaws in the surfaces of the pits (e.g., concrete crack/faults, protective coating deterioration) must be repaired to ensure containment integrity and to facilitate future decontamination of the pits. This engineering study presents a cost/risk/benefit evaluation of concrete and protective coating repair methods in pump and valve pits using various manual and remote tool systems.

  15. The Successful Transfer of Space Derived Convergent Spray: An Application for Industrial Roof Coatings and Interstate Bridge Repair

    NASA Technical Reports Server (NTRS)

    McMillan, Vernotto C.

    1998-01-01

    A partnership was formed between the National Aeronautics and Space Administration (NASA), the Environmental Protection Agency (EPA), and United Technologies USBI Company to develop, demonstrate, and evaluate a technology that uses a solventless spray process for depositing a lightweight, highly filled roof coating on low-sloped commercial roofs. Although the levels of volatile organic compound (VOC) emissions from industrial roof coating's and paint operations have been reduced in recent years, this partnership,was an effort to further reduce VOC emission levels and to also demonstrate the use of reclaimed automobile tire rubber as a filler material in roof coating systems. Different materials and coatings were evaluated and tested before the final selection used to coat the roofs of two small buildings at NASA's Marshall Space Flight Center during fiscal year 1997. The project successfully leveraged the investment of EPA, NASA and private sector resources to demonstrate a pre-commercial roofing coating process. This process utilizes the Convergent Spray Technologies process, which was initially developed by USBI to apply highly-filled, thermal protection coatings to the Space Shuttle Solid Rocket Boosters. A second partnership between the NASA, Federal Highway Administration, Alabama Department of Transportation and USBI Company was formed to develop and demonstrate the Convergent Spray Technology as a method of applying a skid resistant coating to interstate roads and concrete bridge decking's. Again, different materials and coatings were evaluated and tested before the final selection of ground flint and resin. Two field demonstrations were performed during fiscal year 1997 for the purpose of evaluating the coating system under actual highway conditions. These coatings were applied on Interstate 65 near Huntsville Alabama, and in the Mobile Bankhead tunnel. The system performed this task without the use of harmful solvents, and accomplished the process in a

  16. Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients.

    PubMed

    Mongon, Mauricio Leal; Piva, Felipe Alberto; Mistro Neto, Sylvio; Carvalho, Jose Andre; Belangero, William Dias; Livani, Bruno

    2013-04-01

    Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl's technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18-41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783-785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands. PMID:23371841

  17. Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries

    PubMed Central

    Devlin, Steven M.; Hurtig, Mark B.; Waldman, Stephen D.; Rudan, John F.; Bardana, Davide D.; Stewart, A. James

    2013-01-01

    Objective: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Design: Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Results: Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries. PMID:26069658

  18. Bridge health assessment system with fatigue analysis algorithm

    NASA Astrophysics Data System (ADS)

    Wang, Xuan; Wang, M. L.; Zhao, Yang

    2005-05-01

    A modern bridge is such a complicated system that is difficult to analyze by conventional mathematic tools. A rational bridge monitoring requires a good knowledge of the actual condition of various structural components. Fatigue analysis of concrete bridges is one of the most important problems. Concrete bridges are often undergoing a fatigue deterioration, starting with cracking and ending with large holes through the web. There is a need for the development of efficient health assessment system for fatigue evaluation and prediction of the remaining life. This information has clear economical consequences, as deficient bridges must be repaired or closed. The goal of this research is to provide a practical expert system in bridge health evaluation and improve the understanding of bridge behavior during their service. Efforts to develop a functional bridge monitoring system have mainly been concentrated upon successful implementation of experienced-based machine learning. The reliability of the techniques adopted for damage assessment is also important for bridge monitoring systems. By applying the system to an in-service PC bridge, it has been verified that this fuzzy logic expert system is effective and reliable for the bridge health evaluation.

  19. Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments.

    PubMed

    Damiani, G R; Riva, D; Pellegrino, A; Gaetani, M; Tafuri, S; Turoli, D; Croce, P; Loverro, G

    2016-04-01

    117 women with severe pelvic organ prolapse (POP; stage > 2) were enrolled to elucidate a 24-month outcome of POP surgery, using conventional or mesh repair with 3 techniques. 59 patients underwent conventional repair and 58 underwent mesh repair. Two types of mesh were used: a trocar-guided transobturator polypropylene (Avaulta, Bard Inc.) and a porcine dermis mesh (Pelvisoft, Bard Inc.). Women with recurrences, who underwent previous unsuccessful conventional repair, were randomised. Primary outcome was the evaluation of anatomic failures (prolapse stage > 1) in treated and untreated compartments. Anatomic failure was observed in 11 of 58 patients (19%; CI 8.9-29) in the mesh group and in 16 of 59 patients (27.1%; p value = 0.3) in the conventional group. 9 of 11 failures in the mesh group (15.5%; CI 6.2-24.8) were observed in the untreated compartment (de novo recurrences), 14.3% in Pelvisoft and 16.7% in Avaulta arm, while only 1 recurrence in the untreated compartment (1.7%) was observed in the conventional group (odds ratio 10.6, p = 0.03). PMID:26492359

  20. Delineation of tidal scour through marine geophysical techniques at Sloop Channel and Goose Creek bridges, Jones Beach State Park, Long Island, New York

    USGS Publications Warehouse

    Stumm, Frederick; Chu, Anthony; Reynolds, Richard J.

    2001-01-01

    Inspection of the Goose Creek Bridge in southeastern Nassau County in April 1998 by the New York State Department of Transportation (NYSDOT) indicated a separation of bridge piers from the road bed as a result of pier instability due to apparent seabed scouring by tidal currents. This prompted a cooperative study by the U.S. Geological Survey with the NYSDOT to delineate the extent of tidal scour at this bridge and at the Sloop Channel Bridge, about 0.5 mile to the south, through several marine- geophysical techniques. These techniques included use of a narrow-beam, 200-kilohertz, research-grade fathometer, a global positioning system accurate to within 3 feet, a 3.5 to 7-kilohertz seismic-reflection profiler, and an acoustic Doppler current profiler (ADCP). The ADCP was used only at the Sloop Channel Bridge; the other techniques were used at both bridges. Results indicate extensive tidal scour at both bridges. The fathometer data indicate two major scour holes nearly parallel to the Sloop Channel Bridge -- one along the east side, and one along the west side (bridge is oriented north-south). The scour-hole depths are as much as 47 feet below sea level and average more than 40 feet below sea level; these scour holes also appear to have begun to connect beneath the bridge. The deepest scour is at the north end of the bridge beneath the westernmost piers. The east-west symmetry of scour at Sloop Channel Bridge suggests that flood and ebb tides produce extensive scour. The thickness of sediment that has settled within scour holes could not be interpreted from fathometer data alone because fathometer frequencies cannot penetrate beneath the sea-floor surface. The lower frequencies used in seismic-reflection profiling can penetrate the sea floor and underlying sediments, and indicate the amount of infilling of scour holes, the extent of riprap under the bridge, and the assemblages of clay, sand, and silt beneath the sea floor. The seismic- reflection surveys detected 2

  1. Correction of angular limb deformity in two subspecies of flamingo (Phoenicopterus ruber) utilizing a transphyseal bridging technique.

    PubMed

    Zollinger, Tawnia J; Backues, Kay A; Burgos-Rodriguez, Armando G

    2005-12-01

    Three hand-raised American flamingo (Phoenicopterus ruber ruber) chicks and one hand-raised Chilean flamingo (Phoenicopterus ruber chilensis) developed valgus angular limb deformities of the proximal tarsometatarsal bone. All flamingos underwent surgical correction to unequally retard the growth plate using transphyseal bridging. Positive profile pins were placed in the proximal epiphysis and distal to the growth plate in the metaphysis on the convex side of the affected tarsometatarsus. Various banding techniques were used in each flamingo to create tension. Three of the four flamingos responded in 7-14 days with correction or slight overcorrection of the valgus limb deformity. The fourth flamingo's leg deformity did not improve for reasons thought to be related to improper implant placement. Growth plate retardation by transphyseal bridging proved successful in correcting valgus limb deformity of the proximal tarsometatarsus. This technique may be considered as an option for correction of angular limb deformities of the proximal tarsometatarsus in flamingos less than 90-120 days of age. PMID:17312728

  2. A technique for repair of traumatic parasternal lung herniation: case report.

    PubMed

    Cernilia, J; Lin, J; Ott, R; Scannell, G; Waxman, K

    1995-06-01

    A case of traumatic lung herniation through an area of costalsternal separation in a 36-year-old male is presented. Persistent pain and the threat of strangulated lung tissue prompted repair that was accomplished with an expanded polytetrafluoroethylene Gortex tissue patch. PMID:7602639

  3. Modeling DNA Repair: Approaching In Vivo Techniques in the Hyperthermophile Sulfolobus Solfataricus

    SciTech Connect

    Blanton, J.; Fuss, J.; Yannone, S.M.; Tainer, J.A.; Cooper, P.K.

    2005-01-01

    Archaea are found in some of the most extreme environments on earth and represent a third domain of life distinct from Eukarya and Eubacteria. The hyperthermophilic archaeon Sulfolobus solfataricus, isolated from acidic hot springs (80oC, pH 3) in Yellowstone National Park, has emerged as a potential model system for studying human DNA repair processes. Archaea are more closely related to Eukarya than to Eubacteria, suggesting that archaeal DNA repair machinery may model the complex human system much more closely than that of other prokaryotes. DNA repair requires coordinated protein-protein interactions that are frequently transient. Protein complexes that are transient at extreme temperatures where archaea thrive may be more stable at room temperature, allowing for the characterization of otherwise short-lived complexes. However, characterization of these systems in archaea has been limited by the absence of a stable in vivo transformation and expression system. The work presented here is a pilot study in gene cloning and recombinant protein expression in S. solfataricus. Three genes associated with DNA repair were selected for expression: MRE11, PCNA1, and a putative CSB homologue. Though preparation of these recombinant genes followed standard methods, preparation of a suitable vector proved more challenging. The shuttle vector pSSV64, derived from the SSV1 virus and the E. coli vector pBSSK+, was most successfully isolated from the DH5α E. coli strain. Currently, alternative vectors are being designed for more efficient genetic manipulations in S. solfataricus.

  4. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    SciTech Connect

    Ketelsen, Dominik; Kalender, Guenay; Heuschmid, Martin; Syha, Roland; Mangold, Stefanie; Claussen, Claus D.; Brechtel, Klaus

    2011-10-15

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  5. Bonding, Bridging, and Linking Social Capital and Self-Rated Health among Chinese Adults: Use of the Anchoring Vignettes Technique

    PubMed Central

    Chen, He; Meng, Tianguang

    2015-01-01

    Three main opposing camps exist over how social capital relates to population health, namely the social support perspective, the inequality thesis, and the political economy approach. The distinction among bonding, bridging, and linking social capital probably helps close the debates between these three camps, which is rarely investigated in existing literatures. Moreover, although self-rated health is a frequently used health indicator in studies on the relationship between social capital and health, the interpersonal incomparability of this measure has been largely neglected. This study has two main objectives. Firstly, we aim to investigate the relationship between bonding, bridging, and linking social capital and self-rated health among Chinese adults. Secondly, we aim to improve the interpersonal comparability in self-rated health measurement. We use data from a nationally representative survey in China. Self-rated health was adjusted using the anchoring vignettes technique to improve comparability. Two-level ordinal logistic regression was performed to model the association between social capital and self-rated health at both individual and community levels. The interaction between residence and social capital was included to examine urban/rural disparities in the relationship. We found that most social capital indicators had a significant relationship with adjusted self-rated health of Chinese adults, but the relationships were mixed. Individual-level bonding, linking social capital, and community-level bridging social capital were positively related with health. Significant urban/rural disparities appeared in the association between community-level bonding, linking social capital, and adjusted self-rated health. For example, people living in communities with higher bonding social capital tended to report poorer adjusted self-rated health in urban areas, but the opposite tendency held for rural areas. Furthermore, the comparison between multivariate analyses

  6. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques

    PubMed Central

    Vijayan, S; Bentley, G; Briggs, TWR; Skinner, JA; Carrington, RWJ; Pollock, R; Flanagan, AM

    2010-01-01

    Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years. PMID:20697474

  7. Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

    PubMed Central

    Andresen, Kristoffer; Laursen, Jannie

    2016-01-01

    Background. When a new surgical technique is brought into a department, it is often experienced surgeons that learn it first and then pass it on to younger surgeons in training. This study seeks to clarify the problems and positive experiences when teaching and training surgeons in the Onstep technique for inguinal hernia repair, seen from the instructor's point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from Germany, UK, France, Belgium, Italy, Greece, and Sweden. Results. Four main themes were found, with one theme covering three subthemes: instruction of others (experience, patient selection, and tailored teaching), comfort, concerns/fear, and anatomy. Conclusion. Surgeons receiving a one-day training course should preferably have experience with other types of hernia repairs. If trainees are inexperienced, the training setup should be a traditional step-by-step programme. A training setup should consist of an explanation of the technique with emphasis on anatomy and difficult parts of the procedure and then a training day should follow. Surgeons teaching surgery can use these findings to improve their everyday practice. PMID:27144225

  8. Statistical damage identification techniques applied to the I-40 bridge over the Rio Grande River

    SciTech Connect

    Doebling, S.W.; Farrar, C.R.

    1998-03-01

    The statistical significance of vibration-based damage identification parameters is studied via application to the data from the tests performed on the Interstate 40 highway bridge in Albuquerque, New Mexico. A test of statistical significance is applied to the mean and confidence interval estimates of the modal properties and the corresponding damage indicators. The damage indicator used in this study is the change in the measured flexibility matrix. Previously presented deterministic results indicate that damage is detectable in all of the damage cases from these data sets. The results of this study indicate that the changes in both the modal properties and the damage indicators are statistically significant for all of the damage cases. However, these changes are distributed spatially for the first three damage cases and do not localize the damage until the fourth and final damage case.

  9. An investigation of a sterile access technique for the repair and adjustment of sterile spacecraft

    NASA Technical Reports Server (NTRS)

    Farmer, F. H.; Fuller, H. V.; Hueschen, R. M.

    1973-01-01

    A description is presented of a unique system for the sterilization and sterile repair of spacecraft and the results of a test program designed to assess the biological integrity and engineering reliability of the system. This trailer-mounted system, designated the model assembly sterilizer for testing (MAST), is capable of the dry-heat sterilization of spacecraft and/or components less than 2.3 meters in diameter at temperatures up to 433 K and the steam sterilization of components less than 0.724 meter in diameter. Sterile access to spacecraft is provided by two tunnel suits, called the bioisolator suit systems (BISS), which are contiguous with the walls of the sterilization chambers. The test program was designed primarily to verify the biological and engineering reliability of the MAST system by processing simulated space hardware. Each test cycle simulated the initial sterilization of a spacecraft, sterile repair of a failed component, removal of the spacecraft from the MAST for mating with the bus, and a sterile recycle repair.

  10. [Repair of large urogenital necrosis of obstetrical origin by pedicled myocutaneous plasty of the greater lip. Technique and results].

    PubMed

    Falandry, L

    1991-03-01

    The vesicovaginal fistulae encountered in Africa are a real plague. Their origin is obstetrical as a rule, and they occur in young women, often in primiparas. They are seldom simple as they have been operated repeatedly and involve associated lesions and a large loss of substance, so that they raise complex problems of repair. The experience with the treatment of 230 obstetrical fistulae by the same surgeon in Africa leads the author to describe a repair technique fit for complex fistulae, especially those involving an extensive loss of substance and associated lesions (rectovaginal fistula, perineal destruction). With a low approach, the procedure consists in using a filler tissue, namely a skin flap removed from a greater lip, for which the vasculature is maintained by the preservation of a thick musculous and fatty pedicle, cut from the fibers of the bulbocavernosus muscle. Once sutured around the orifice of the fistula, this graft closes it while fostering its healing. Out of the 14 patients treated with this technique, the results achieved were regarded as good for 10 (72%), including 7 after a first operation and 3 after second surgery. In 9 cases, there were associated lesions, including 5 rectovaginal fistulae and 4 cases of complete tearing of the perineum. We have had 4 failures, including 3 definitive ones, and a partial failure with the persistence of urine incontinence in station due to be destruction of the ureter. When the simpler Martius' procedure (on which ours is patterned) is no longer sufficient, the use of a pedicled skin-fat graft taken from the greater lip allows considerably restricting the indications of palliative surgery. Our technique increases the percentage of success for fistulae regarded as irreparable or after the usual repair procedures have failed. PMID:2055973

  11. Repairing calvarial defects with biodegradable polycaprolactone-chitosan scaffolds fabricated using the melt stretching and multilayer deposition technique.

    PubMed

    Thuaksuban, Nuttawut; Nuntanaranont, Thongchai; Suttapreyasri, Srisurang; Boonyaphiphat, Pleumjit

    2015-01-01

    The ability to repair bone defects of polycaprolactone-chitosan scaffolds containing 20% chitosan (PCL-20%CS) fabricated using the melt stretching and multilayer deposition (MSMD) technique was assessed and compared with commercial scaffolds. Two calvarium defects of 11 mm in diameter were created in each of the fifteen New Zealand white rabbits. The PCL-20%CS scaffolds were implanted in one site (group A) while another site was performed with PCL-tricalcium phosphate (TCP) scaffolds containing 20% TCP (PCL-20%TCP) fabricated by fused deposition modeling technique (FDM) (group B). At two, four and eight weeks thereafter, new bone regeneration within the defects was assessed using histomorphometric and micro-computed tomography (µ-CT) analysis. The result of histological sections demonstrated that chronic inflammatory reaction was generally detected along scaffolds of group A, but it was not found in group B. Over 8 weeks, the µ-CT analysis indicated that the average amount of new bone of group A was slightly less than that of group B (p>0.05). In conclusion, efficacy of the PCL-20%CS MSMD scaffolds for repairing bone defects was less than that of the PCL-20%TCP FDM scaffolds. However, MSMD scaffolding is still the technique of choice, but needed some modifications. PMID:26407197

  12. Near complete aortic transection and its successful repair using a novel cardiopulmonary bypass technique.

    PubMed

    Shah, Dania Aijaz; Shah, Adil Aijaz; Shah, Syed Jawad; Khan, Muhammad Naseer; Fatimi, Saulat Hasnain

    2015-09-01

    The case of a 38-year old female, victim of a road traffic accident who presented with a near complete aortic transection is presented. An emergent repair employing cardiopulmonary bypass was attempted in the operating room. Anticipating a high-risk of compromise to cerebral perfusion from air micro-emboli, the bypass was attempted with an innovative approach involving the successful cannulation of the pulmonary artery and descending aorta. The patient survived and was found to be doing well on subsequent post-operative visits. PMID:26338761

  13. [Technique of repair of acquired inguinal hernia by anterior reinforcement of the Fruchaud floor with polypropylene mesh].

    PubMed

    Ferrari, C A

    1998-01-01

    The main cause of acquired inguinal hernia is weakness of Fruchaud's deep muscolofascial floor, following metabolically-determined collagen disorders. A technique for the anterior reinforcement of this structure with polypropylene mesh is described here. Following intermuscular decollement, the mesh is placed in direct contact with the surface formed by the transversalis fascia and the transversus abdominis muscle and stretched as extensively as possible. Because the posterior aspect of the inguinal canal is the true barrier to abdominal pressure, the author believe that its direct reinforcement, without interposition of the internal oblique muscle, constitutes the most correct anatomo-surgical approach to hernia repair. This is the case for both indirect hernias, in which the internal ring is reconstructed at a deeper level, and for direct hernias, in which the "tent effect" of the prosthesis is prevented. Ninety-two primary inguinal hernias (56 indirect, 29 direct and 7 direct and indirect) in 87 patients were repaired with this technique. Seventy-nine patients were followed up from 2 to 24 months. Early complications included: 7 ecchymosis, 3 seromas, 2 subcutaneous infections, 3 testicular swellings. Incision and testicular pain for longer than 6 months occurred in 2 cases. No prosthetic infections or recurrences have been detected up to the present. PMID:9577132

  14. Martin Mayman's early memories technique: bridging the gap between personality assessment and psychotherapy.

    PubMed

    Fowler, J C; Hilsenroth, M J; Handler, L

    2000-08-01

    In this article, we describe Martin Mayman's approach to early childhood memories as a projective technique, beginning with his scientific interest in learning theory, coupled with his interest in ego psychology and object relations theory. We describe Mayman's contributions to the use of the early memories technique to inform the psychotherapy process, tying assessment closely to psychotherapy and making assessment more useful in treatment. In this article, we describe a representative sample of research studies that demonstrate the reliability and validity of early memories, followed by case examples in which the early memories informed the therapy process, including issues of transference and countertransference. PMID:10941700

  15. Reliability-based lifetime maintenance of aging highway bridges

    NASA Astrophysics Data System (ADS)

    Enright, Michael P.; Frangopol, Dan M.

    2000-06-01

    As the nation's infrastructure continues to age, the cost of maintaining it at an acceptable safety level continues to increase. In the United States, about one of every three bridges is rated structurally deficient and/or functionally obsolete. It will require about 80 billion to eliminate the current backlog of bridge deficiencies and maintain repair levels. Unfortunately, the financial resources allocated for these activities fall extremely short of the demand. Although several existing and emerging NDT techniques are available to gather inspection data, current maintenance planning decisions for deficient bridges are based on data from subjective condition assessments and do not consider the reliability of bridge components and systems. Recently, reliability-based optimum maintenance planning strategies have been developed. They can be used to predict inspection and repair times to achieve minimum life-cycle cost of deteriorating structural systems. In this study, a reliability-based methodology which takes into account loading randomness and history, and randomness in strength and degradation resulting from aggressive environmental factors, is used to predict the time- dependent reliability of aging highway bridges. A methodology for incorporating inspection data into reliability predictions is also presented. Finally, optimal lifetime maintenance strategies are identified, in which optimal inspection/repair times are found based on minimum expected life-cycle cost under prescribed reliability constraints. The influence of discount rate on optimum solutions is evaluated.

  16. Thoracic endovascular aortic repair of a severely angulated aorta using a double-wire technique

    PubMed Central

    Kawatani, Yohei; Nakamura, Yoshitsugu; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    When endovascular treatment is performed, angulation of the access route for a device can make the operative procedure difficult. We encountered a case in which we successfully completed thoracic endovascular aortic repair (TEVAR) in a patient with severely angulated aorta by applying ‘double-wire technique’. The patient was an 80-year-old woman. An aneurysm with a 71-mm diameter was observed in the descending aorta. We performed TEVAR. Device delivery could not be achieved by a conventional procedure using one guide wire since the peripheral aorta was severely angulated. Therefore, in addition to a guide wire for main body, a stiff wire and a stiff sheath were introduced to straighten the angulation. The device was successfully introduced and TEVAR was completed. We used the Relay Plus® that facilitates tracking through the angulation. The device has a dual structure consisting of a hard sheath and a flexible sheath. We performed TEVAR successfully. PMID:27421301

  17. A new primary cleft lip repair technique tailored for Asian patients that combines three surgical concepts: Comparison with rotation--advancement and straight-line methods.

    PubMed

    Funayama, Emi; Yamamoto, Yuhei; Furukawa, Hiroshi; Murao, Naoki; Shichinohe, Ryuji; Hayashi, Toshihiko; Oyama, Akihiko

    2016-01-01

    Various techniques have been described for unilateral cleft lip repair. These may be broadly classified into three types of procedure/concept: the straight-line method (SL; Rose-Thompson effect); rotation-advancement (RA; upper-lip Z-plasty); and the triangular flap method (TA; lower-lip Z-plasty). Based on these procedures, cleft lip repair has evolved in recent decades. The cleft lip repair method in our institution has also undergone several changes. However, we have found that further modifications are needed for Asian patients who have wider philtral dimples and columns than Caucasians, while following the principles of the original techniques mentioned above. Here, we have incorporated the advantages of each procedure and propose a refined hybrid operating technique, seeking a more appropriate procedure for Asian patients. To evaluate our new technique, a comparison study was performed to evaluate RA, SL, and our technique. We have used our new technique to treat 137 consecutive cleft lip cases of all types and degrees of severity, with or without a cleft palate, since 2009. In the time since we adopted the hybrid technique, we have observed improved esthetics of the repaired lip. Our technique demonstrated higher glance impression average scores than RA/SL. PMID:26653337

  18. Bridging Mediterranean cultures in the IYS: A documentary exhibition on irrigation techniques in water scarcity conditions

    NASA Astrophysics Data System (ADS)

    Barontini, Stefano; Louki, Amina; Ben Slima, Zied; Ezzahra Ghaouch, Fatima; Labaran, Raisa; Raffelli, Giulia; Peli, Marco; Vitale, Nicola

    2015-04-01

    Brescia, an industrial city in Northern Italy, is now experiencing a crucial change in its traditional structure. In recent years in fact it has been elected as living and working seat by many foreigners and it is now one of the cities with the greatest percentage of migrants in the Country. This is an important challenge for the city and an opportunity to merge, compare and integrate different cultures to build its future. In this context some students of different Courses (engineering and medicine), belonging both to the Arabian and local community, met together and with researchers in the study team 'Al-B¯i r¯u n¯i , for culture, science and society'. The team aims at organising cultural events in which, starting from the figure of the Persian scientist Ab¯u Raih. ¯a n Al-B¯i r¯u n¯i (about 973, 1051), the contribution of the Arabian and Islamic culture to the development of the European one in the middle ages is investigated. Moving from the initial idea of the study team Al-B¯i r¯u n¯i and from the suggestions of the World Soil Day 2014 and of the International Year of Soils 2015, we built a documentary exhibition entitled 'Irrigation techniques in water scarcity conditions'. The exhibition, which stresses the importance of the irrigation techniques for the soil conservation, is focused on the idea of disseminating two main concepts, i.e. (1) the technological continuity of some water supply systems in countries, around the Mediterranean Sea, affected by similar conditions of water availability, and (2) the possibility of building environments where, due to severe or extreme climatic conditions, the sustainability is reached when the man lives in equilibrium with the nature. The exhibition, which is written in Italian and will move around in the city during all 2015, consists of about twenty posters organized into three main chapters, corresponding to three main classes of water supply systems which are common in most of the countries surrounding

  19. Perineal urethrostomy stenosis repair with buccal mucosa: description of technique and report of four cases.

    PubMed

    Kamat, Nagesh

    2008-11-01

    Perineal urethrostomy stenosis can be a difficult problem to treat, especially in patients with balanitis xerotica obliterans. We have devised a technique of using the buccal mucosa, with the idea of forming a composite stoma comprising skin and buccal mucosa. We describe the technique and short-term results in 4 patients. PMID:18789512

  20. Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

    PubMed Central

    Agrawal, Vivek; Pietrzak, William S.

    2015-01-01

    Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed. Materials and Methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant–Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative. Results: Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing. Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction. Level of Evidence: Level IV case series. PMID:26288537

  1. Comparison of ultrasound and optical coherence tomography techniques for evaluation of integrity of spontaneously repaired horse cartilage.

    PubMed

    Virén, T; Huang, Y P; Saarakkala, S; Pulkkinen, H; Tiitu, V; Linjama, A; Kiviranta, I; Lammi, M J; Brünott, A; Brommer, H; Van Weeren, R; Brama, P A J; Zheng, Y P; Jurvelin, J S; Töyräs, J

    2012-04-01

    The aim of this study was to compare sensitivity of ultrasound and optical coherence tomography (OCT) techniques for the evaluation of the integrity of spontaneously repaired horse cartilage. Articular surfaces of horse intercarpal joints, featuring both intact tissue and spontaneously healed chondral or osteochondral defects, were imaged ex vivo with arthroscopic ultrasound and laboratory OCT devices. Quantitative ultrasound (integrated reflection coefficient (IRC), apparent integrated backscattering coefficient (AIB) and ultrasound roughness index (URI)) and optical parameters (optical reflection coefficient (ORC), optical roughness index (ORI) and optical backscattering (OBS)) were determined and compared with histological integrity and mechanical properties of the tissue. Spontaneously healed tissue could be quantitatively discerned from the intact tissue with ultrasound and OCT techniques. Furthermore, several significant correlations (p < 0.05) were detected between ultrasound and OCT parameters. Superior resolution of OCT provided a more accurate measurement of cartilage surface roughness, while the ultrasound backscattering from the inner structures of the cartilage matched better with the histological findings. Since the techniques were found to be complementary to each other, dual modality imaging techniques could provide a useful tool for the arthroscopic evaluation of the integrity of articular cartilage. PMID:22439802

  2. Improved image guidance technique for minimally invasive mitral valve repair using real-time tracked 3D ultrasound

    NASA Astrophysics Data System (ADS)

    Rankin, Adam; Moore, John; Bainbridge, Daniel; Peters, Terry

    2016-03-01

    In the past ten years, numerous new surgical and interventional techniques have been developed for treating heart valve disease without the need for cardiopulmonary bypass. Heart valve repair is now being performed in a blood-filled environment, reinforcing the need for accurate and intuitive imaging techniques. Previous work has demonstrated how augmenting ultrasound with virtual representations of specific anatomical landmarks can greatly simplify interventional navigation challenges and increase patient safety. These techniques often complicate interventions by requiring additional steps taken to manually define and initialize virtual models. Furthermore, overlaying virtual elements into real-time image data can also obstruct the view of salient image information. To address these limitations, a system was developed that uses real-time volumetric ultrasound alongside magnetically tracked tools presented in an augmented virtuality environment to provide a streamlined navigation guidance platform. In phantom studies simulating a beating-heart navigation task, procedure duration and tool path metrics have achieved comparable performance to previous work in augmented virtuality techniques, and considerable improvement over standard of care ultrasound guidance.

  3. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    SciTech Connect

    Patel, Rafiuddin; Juszczak, Maciej T.; Bratby, Mark J.; Sideso, Ediri; Anthony, Susan; Tapping, Charles R.; Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy; Uberoi, Raman

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  4. Assesment of uniaxial compressive strenght of repair mortars by using in situ non destructive techniques

    NASA Astrophysics Data System (ADS)

    Szemerey-Kiss, Balázs; Török, Ákos

    2014-05-01

    The present paper provides information on the strength assessment of restoration mortars by using ultrasonic pulse velocity. The aims of the tests were to determine the compressive strength of the mortars by using non destructive test methods. Four commercially available types of restoration mortars were tested. Besides the pure mortars, specimens with 30 and 50 wt% of limestone sand aggregate (from Sóskút quarry) were also made. The material properties of the tested mortars have been described in details previously (Szemerey-Kiss et al. 2013). Cubic test specimens of 3cm x 3cm x 3cm were prepared from the mortars and after casting and consolidation 10 cubes of each mortar type were tested. Ultrasonic pulse velocity was measured according to the guidelines given by EN 14579:2005. Uniaxial compressive strength of test specimens were measured following the instructions of EN 1015-11:2000. An exponential mathematical formula was outlined that describes the uniaxial compressive strength of mortars based on ultrasonic pulse velocity data. The best fit was found for two mortars while the formula with different constants could be also used for other mortars, too. These experiments have proved that non destructive tests can be used in the assessment of the strength of historic mortars. References: Szemerey-Kiss, B., Török, Á., Siegesmund S 2013. The influence of binder/aggregate ratio on the properties and strength of repair mortars. Environmental Earth Sciences, 69:1439-1449.

  5. EVALUATION OF PATIENTS UNDERGOING FIXATION OF DIAPHYSEAL HUMERAL FRACTURES USING THE MINIMALLY INVASIVE BRIDGE-PLATE TECHNIQUE

    PubMed Central

    Superti, Mauro José; Martynetz, Fábio; Falavinha, Ricardo Sprenger; Fávaro, Rodrigo Caldonazzo; Boas, Luis Felipe Villas; Filho, Salim Mussi; Martynetz, Juliano; Ribas, Bruno

    2015-01-01

    Objective: The aim was to describe the experience of our group in treating humeral shaft fractures using the bridge–plate technique via an anterior approach. Methods: Seventeen patients with acute diaphyseal humeral fractures with an indication for surgical treatment who were operated in 2006–2010 were evaluated. The AO and Gustilo & Anderson classifications were used. All the patients were operated using the anterior bridge-plate technique and completed a follow–up period of at least twelve months. Results: Sixteen men and one woman were treated. Their mean age was 31.8 years (18–52). Among the injury mechanisms found were: five motorcycle accidents, four car accidents, three fractures due to firearm projectiles, two falls to the ground and finally, with one case each, assault, crushing and being run over. Eight patients had open fractures: two grade I, one grade II, four grade IIIa and one grade IIIb, according to the Gustilo-Anderson classification. In relation to the AO classification, we found: one 12A1, three 12A2, four 12A3, one 12B1, four 12 B2, three 12B3 and one 12C2. The mean postoperative follow-up was 25 months (12–48). As complications, two patients had pain in the elbow and a ROM deficit and one had deep infection. The mean time taken to achieve consolidation was 17.5 weeks. There was no loss of reduction, pseudarthrosis or malunion in this series of patients. Conclusion: The authors believe that the technique described has low rates of complications and morbidity, with good initial results, although the series is limited by the small sample. PMID:27042639

  6. Successful surgical repair of a triple cardiac rupture using modified cohesive double patch technique.

    PubMed

    Dorobantu, Lucian Florin; Stiru, Ovidiu; Iliescu, Vlad Anton

    2016-02-01

    Introduction The association between both left and right ventricular free wall ruptures (FWR) and post-infarction anterior ventricular septal defect (VSD) is an exceptional situation. Case report We present the case of a patient who developed a VSD and two FWRs (of the left and right ventricle, respectively) shortly after the onset of an anterior AMI. We surgically closed this complex rupture using the cohesive double patch technique with two Teflon patches combined with an infarct exclusion technique. The left and right ventricular patches were attached cohesively to the septal wall and the infarcted area was excluded without reducing the left ventricular cavity. Conclusion Association between post-infarction ventricular septal rupture and both left and right free wall ruptures are a very rare and dangerous situation. The modified cohesive double patch technique associated the modified Cooley technique seems to be the correct surgical solution. PMID:27385145

  7. Technique of subnormothermic ex vivo liver perfusion for the storage, assessment, and repair of marginal liver grafts.

    PubMed

    Knaak, Jan M; Spetzler, Vinzent N; Goldaracena, Nicolas; Louis, Kristine S; Selzner, Nazia; Selzner, Markus

    2014-01-01

    The success of liver transplantation has resulted in a dramatic organ shortage. In most transplant regions 20-30% of patients on the waiting list for liver transplantation die without receiving an organ transplant or are delisted for disease progression. One strategy to increase the donor pool is the utilization of marginal grafts, such as fatty livers, grafts from older donors, or donation after cardiac death (DCD). The current preservation technique of cold static storage is only poorly tolerated by marginal livers resulting in significant organ damage. In addition, cold static organ storage does not allow graft assessment or repair prior to transplantation. These shortcomings of cold static preservation have triggered an interest in warm perfused organ preservation to reduce cold ischemic injury, assess liver grafts during preservation, and explore the opportunity to repair marginal livers prior to transplantation. The optimal pressure and flow conditions, perfusion temperature, composition of the perfusion solution and the need for an oxygen carrier has been controversial in the past. In spite of promising results in several animal studies, the complexity and the costs have prevented a broader clinical application so far. Recently, with enhanced technology and a better understanding of liver physiology during ex vivo perfusion the outcome of warm liver perfusion has improved and consistently good results can be achieved. This paper will provide information about liver retrieval, storage techniques, and isolated liver perfusion in pigs. We will illustrate a) the requirements to ensure sufficient oxygen supply to the organ, b) technical considerations about the perfusion machine and the perfusion solution, and c) biochemical aspects of isolated organs. PMID:25145990

  8. Animal models of cartilage repair

    PubMed Central

    Cook, J. L.; Hung, C. T.; Kuroki, K.; Stoker, A. M.; Cook, C. R.; Pfeiffer, F. M.; Sherman, S. L.; Stannard, J. P.

    2014-01-01

    Cartilage repair in terms of replacement, or regeneration of damaged or diseased articular cartilage with functional tissue, is the ‘holy grail’ of joint surgery. A wide spectrum of strategies for cartilage repair currently exists and several of these techniques have been reported to be associated with successful clinical outcomes for appropriately selected indications. However, based on respective advantages, disadvantages, and limitations, no single strategy, or even combination of strategies, provides surgeons with viable options for attaining successful long-term outcomes in the majority of patients. As such, development of novel techniques and optimisation of current techniques need to be, and are, the focus of a great deal of research from the basic science level to clinical trials. Translational research that bridges scientific discoveries to clinical application involves the use of animal models in order to assess safety and efficacy for regulatory approval for human use. This review article provides an overview of animal models for cartilage repair. Cite this article: Bone Joint Res 2014;4:89–94. PMID:24695750

  9. A spectrum-driven damage identification technique: Application and validation through the numerical simulation of the Z24 Bridge

    NASA Astrophysics Data System (ADS)

    Masciotta, Maria-Giovanna; Ramos, Luís F.; Lourenço, Paulo B.; Vasta, Marcello; De Roeck, Guido

    2016-03-01

    The present paper focuses on a damage identification method based on the use of the second order spectral properties of the nodal response processes. The explicit dependence on the frequency content of the outputs power spectral densities makes them suitable for damage detection and localization. The well-known case study of the Z24 Bridge in Switzerland is chosen to apply and further investigate this technique with the aim of validating its reliability. Numerical simulations of the dynamic response of the structure subjected to different types of excitation are carried out to assess the variability of the spectrum-driven method with respect to both type and position of the excitation sources. The simulated data obtained from random vibrations, impulse, ramp and shaking forces, allowed to build the power spectrum matrix from which the main eigenparameters of reference and damage scenarios are extracted. Afterwards, complex eigenvectors and real eigenvalues are properly weighed and combined and a damage index based on the difference between spectral modes is computed to pinpoint the damage. Finally, a group of vibration-based damage identification methods are selected from the literature to compare the results obtained and to evaluate the performance of the spectral index.

  10. Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 7. Equipment Repair QPCB Task Sort for Medical and Dental Equipment Repair.

    ERIC Educational Resources Information Center

    Technomics, Inc., McLean, VA.

    This publication is Attachment 7 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties in medical and dental equipment repair. (BT)

  11. Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique.

    PubMed

    Leanza, V; Intagliata, E; Leanza, G; Cannizzaro, M A; Zanghì, G; Vecchio, R

    2013-01-01

    Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons. PMID:24342163

  12. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique.

    PubMed

    Vilá Mollinedo, Luis Gustavo; Jaime Uribe, Andrés; Aceves Chimal, José Luis; Martínez-Rubio, Roberto Pablo; Hernández-Romero, Karen Patricia

    2016-01-01

    Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta. PMID:27547381

  13. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique

    PubMed Central

    Vilá Mollinedo, Luis Gustavo; Jaime Uribe, Andrés; Aceves Chimal, José Luis; Martínez-Rubio, Roberto Pablo; Hernández-Romero, Karen Patricia

    2016-01-01

    Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta. PMID:27547381

  14. Modified end-to-end anastomosis for the treatment of congenital tracheal stenosis with a bridging bronchus.

    PubMed

    Stock, Cameron; Nathan, Meena; Murray, Ryan; Rahbar, Reza; Fynn-Thompson, Francis

    2015-01-01

    An infant with a ventricular septal defect; Vertebral anomalies, Anal atresia, Cardiac anomalies, Tracho Esophageal fistula (TEF), Renal anomalies, Limb anomalies syndrome; and tracheal stenosis with a bridging bronchus underwent repair of the ventricular septal defect and trachea-bronchial reconstruction at age 11 months. Herein we describe our surgical approach to resection of the bridging bronchus and a technique using a modified end-to-end tracheal anastomosis for the correction of this complex anomaly. PMID:25555968

  15. Closed-Loop Double Endobutton Technique for Repair of Unstable Distal Clavicle Fractures

    PubMed Central

    Struhl, Steven; Wolfson, Theodore S.

    2016-01-01

    Background: Displaced fractures of the distal clavicle are inherently unstable and lead to nonunion in a high percentage of cases. The optimal surgical management remains controversial. Hypothesis: Indirect osteosynthesis with a closed-loop double endobutton construct would result in reliable fracture union and obviate the need for additional surgery. Study Design: Case series; Level of evidence, 4. Methods: Eight patients with an acute unstable Neer type IIB distal clavicle fracture were treated with a closed-loop double endobutton implant. Mean follow-up averaged 3.4 years (range, 1-9 years). Two patients were lost to follow-up. The remaining 6 patients underwent a detailed functional and radiologic evaluation. Results: Definitive fracture healing was achieved in all patients. There were no complications, and no patients required additional surgery related to the index procedure. The mean Constant score was 97 at final follow-up. Conclusion: The closed-loop double endobutton technique was reliable and effective in achieving fracture union in all patients with unstable Neer type IIB fractures of the distal clavicle. This technique obviates the need for late hardware removal that is often necessary when direct osteosynthesis is used and avoids potential complications associated with coracoclavicular cerclage constructs that require knot fixation. PMID:27504466

  16. Comparison of Lichtenstein inguinal hernia repair with the tension-free Desarda technique: a clinical audit and review of the literature.

    PubMed

    Zulu, Halalisani Goodman; Mewa Kinoo, Suman; Singh, Bhugwan

    2016-07-01

    Ours was a retrospective chart review of all elective open inguinal hernia repairs performed in a single unit at King Edward VIII Hospital, South Africa over an 18-month period. Comparison was made regarding duration of operation, length of hospital stay and complications such as pain, haematoma formation and recurrence between the Lichtenstein and Desarda techniques. The latter was noted to have a shorter operative time and avoided cost and possible complications of mesh usage, which are significant in resource-deprived settings. A larger comparative study with longer follow-up is needed to evaluate the wider suitability of the Desarda repair. PMID:27317612

  17. 49 CFR 237.133 - Supervision of repairs and modifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Supervision of repairs and modifications. 237.133 Section 237.133 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Repair and Modification of Bridges § 237.133 Supervision of repairs...

  18. 49 CFR 237.133 - Supervision of repairs and modifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Supervision of repairs and modifications. 237.133 Section 237.133 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Repair and Modification of Bridges § 237.133 Supervision of repairs...

  19. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique – own experience

    PubMed Central

    Patkowski, Dariusz

    2014-01-01

    Introduction Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus. Aim To evaluate the usefulness of the PIRS technique. Material and methods Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010. Results In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery. Conclusions Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery). PMID:24729810

  20. Bridge permeameter

    DOEpatents

    Graf, Darin C.; Warpinski, Norman R.

    1996-01-01

    A system for single-phase, steady-state permeability measurements of porous rock utilizes a fluid bridge arrangement analogous to a Wheatstone bridge. The arms of the bridge contain the sample and calibrated flow resistors.

  1. Meningocele repair

    MedlinePlus

    ... dysraphism repair; Meningomyelocele repair; Neural tube defect repair; Spina bifida repair ... a medical team with experience in children with spina bifida. Your baby will likely have an MRI (magnetic ...

  2. Combined Orbital Floor and Medial Wall Fractures Involving the Inferomedial Strut: Repair Technique and Case Series Using Preshaped Porous Polyethylene/Titanium Implants

    PubMed Central

    Cho, Raymond I.; Davies, Brett W.

    2013-01-01

    Background Combined orbital floor and medial wall fractures can be technically challenging to repair, particularly when the inferomedial strut is involved. A surgical repair technique is described utilizing a single preshaped porous polyethylene/titanium implant to span both defects. Methods Retrospective interventional case series. Results Fracture repair was performed on 17 orbits (16 patients) between October 2009 and February 2012. Subsequent surgical revision was required in three cases (18%). Visual acuity was stable or improved in all cases. Of 7 patients with preoperative diplopia, 5 improved and 2 remained stable postoperatively, and there were no cases of new or worsened diplopia following surgery. Postoperative asymmetry in Hertel exophthalmometry averaged 1.0 mm (range 0 to 2 mm). Preoperatively, average orbital volume was 122.7% compared with control (range 109 to 147%, standard deviation [SD] 9.6), which improved to 100.3% postoperatively (range 92 to 110%, SD 5.7). The average decrease in orbital volume was 22.5% (range 10 to 54%, SD 11.4, p < 0.001). Conclusions With careful preoperative planning and meticulous surgical technique, combined orbital floor and medial wall fractures involving the inferomedial strut can be successfully repaired with a preshaped porous polyethylene/titanium implant through a transconjunctival/transcaruncular approach with inferior oblique disinsertion. PMID:24436754

  3. Outcome of arthroscopic subscapularis tendon repair: Are the results improving with improved techniques and equipment?: A retrospective case series

    PubMed Central

    Arun, G R; Kumar, Pradeep; Patnaik, Sarthak; Selvaraj, Karthik; Rajan, David; Singh, Anant; Kumaraswamy, Vinay

    2016-01-01

    Background: Rotator cuff tears are a common cause of shoulder pain and dysfunction. More recently, there has been a renewed interest in understanding the subscapularis tears. There are multiple articles in the literature showing the short term results of isolated subscapularis tendon repair. However, the midterm and long term outcome studies for arthroscopic subscapularis repair are few. This study evaluates the functional outcome after arthroscopic subscapularis repair. Materials and Methods: The records of 35 patients who underwent an arthroscopic subscapularis repair between May 2008 and June 2012 were included in this retrospective study. The records of all patients were reviewed. There were 22 males and 13 female patients with mean age of 58.2 years (range 41-72 years). All patients had a complete history, physical examination, and radiographs of their shoulders. Visual analogue scale (VAS), range of movements, power of cuff muscles, and modified University of California at Los Angeles (UCLA) score were assessed. Results: The mean followup was 2.8 years (range 2-4 year). Functional outcome after arthroscopic subscapularis repair has an excellent outcome as analysed by clinical outcome, VAS score and UCLA score. Results were analyzed and had statistically significant values. The VAS for pain improved significantly (P < 0.001), and the mean modified UCLA score improved significantly (P < 0.001) from 14.24 ± 4.72 preoperatively to 33.15 ± 2.29 at 2 years postoperative. According to the UCLA system, there were 22 excellent, 11 good, and 2 fair results. Around 95% of patients returned to their usual work after surgery. Conclusion: At a median followup of 2 years, 95% of patients had a good to excellent result after an arthroscopic subscapularis tendon repair. We conclude that the midterm results show that arthroscopic subscapularis repair remains a good option for the treatment of patients with subscapularis tendon repair. PMID:27293291

  4. A scaffold-enhanced light-activated surgical adhesive technique: surface selection for enhanced tensile strength in wound repair

    NASA Astrophysics Data System (ADS)

    Soller, Eric C.; Hoffman, Grant T.; Heintzelman, Douglas L.; Duffy, Mark T.; Bloom, Jeffrey N.; McNally-Heintzelman, Karen M.

    2004-07-01

    An ex vivo study was conducted to determine the effect of the irregularity of the scaffold surface on the tensile strength of repairs formed using our Scaffold-Enhanced Biological Adhesive (SEBA). Two different scaffold materials were investigated: (i) a synthetic biodegradable material fabricated from poly(L-lactic-co-glycolic acid); and (ii) a biological material, small intestinal submucosa, manufactured by Cook BioTech. The scaffolds were doped with protein solder composed of 50%(w/v) bovine serum albumin solder and 0.5mg/ml indocyanine green dye mixed in deionized water, and activated with an 808-nm diode laser. The tensile strength of repairs performed on bovine thoracic aorta, liver, spleen, small intestine and lung, using the smooth and irregular surfaces of the above scaffold-enhanced materials were measured and the time-to-failure was recorded. The tensile strength of repairs formed using the irregular surfaces of the scaffolds were consistently higher than those formed using the smooth surfaces of the scaffolds. The largest difference was observed on repairs formed on the aorta and small intestine, where the repairs were, on average, 50% stronger using the irregular versus the smooth scaffold surfaces. In addition, the time-to-failure of repairs formed using the irregular surfaces of the scaffolds were between 50% and 100% longer than that achieved using the smooth surfaces of the scaffolds. It has previously been shown that distributing or dispersing the adhesive forces over the increased surface area of the scaffold, either smooth or irregular, produces stronger repairs than albumin solder alone. The increase in the absolute strength and longevity of repairs seen in this new study when the irregular surfaces of the scaffolds are used is thought to be due to the distribution of forces between the many independent micro-adhesions provided by the irregular surfaces.

  5. 49 CFR 237.133 - Supervision of repairs and modifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Repair and Modification of Bridges § 237.133... under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who... railroad bridge supervisor shall ensure that railroad traffic or other live loads permitted on the...

  6. 49 CFR 237.133 - Supervision of repairs and modifications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Repair and Modification of Bridges § 237.133... under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who... railroad bridge supervisor shall ensure that railroad traffic or other live loads permitted on the...

  7. 49 CFR 237.133 - Supervision of repairs and modifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Repair and Modification of Bridges § 237.133... under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who... railroad bridge supervisor shall ensure that railroad traffic or other live loads permitted on the...

  8. Mitral valve repair: an echocardiographic review: Part 2.

    PubMed

    Maslow, Andrew

    2015-04-01

    Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair. PMID:25440616

  9. Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

    PubMed

    Taşatan, Ersin; Emre, Tuluhan Yunus; Demircioğlu, Demet Tekdöş; Demiralp, Bahtiyar; Kırdemir, Vecihi

    2016-01-01

    An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the

  10. Meniscal Repair

    PubMed Central

    Yoon, Kyoung Ho

    2014-01-01

    The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well. PMID:24944971

  11. Direct distal aortic arch graft cannulation after the elephant trunk procedure: technique for central cannulation during second-stage repair.

    PubMed

    Quintana, Eduard; Pochettino, Alberto

    2015-07-01

    Arterial cannulation after the elephant trunk (ET) procedure at the time of second-stage distal repair can be achieved through multiple routes. Common strategies for arterial perfusion at the time of second-stage aortic repair include retrograde perfusion (femoral/iliac vessels), transapical or left subclavian artery cannulation. In the event these cannulation options are not practical or advisable, we offer an alternative approach through cannulation of the distal aortic arch Dacron graft through the left thorax. Advantages include forward distal perfusion, minimal proximal ischaemic time, prevention of thromboembolic events from thrombus attached to the ET and avoidance of malperfusion syndromes. PMID:25281849

  12. A rapid non-radioactive technique for measurement of repair synthesis in primary human fibroblasts by incorporation of ethynyl deoxyuridine (EdU).

    PubMed

    Limsirichaikul, Siripan; Niimi, Atsuko; Fawcett, Heather; Lehmann, Alan; Yamashita, Shunichi; Ogi, Tomoo

    2009-03-01

    Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder. Afflicted patients show extreme sun-sensitivity and skin cancer predisposition. XP is in most cases associated with deficient nucleotide excision repair (NER), which is the process responsible for removing photolesions from DNA. Measuring NER activity by nucleotide incorporation into repair patches, termed 'unscheduled DNA synthesis (UDS)', is one of the most commonly used assays for XP-diagnosis and NER research. We have established a rapid and accurate procedure for measuring UDS by replacement of thymidine with 5-ethynyl-2'-deoxyuridine (EdU). EdU incorporated into repair patches can be directly conjugated to fluorescent azide derivatives, thereby obviating the need for either radiolabeled thymidine or denaturation and antibody detection of incorporated bromodeoxyuridine (BrdU). We demonstrate that the EdU incorporation assay is compatible with conventional techniques such as immunofluorescent staining and labeling of cells with micro-latex beads. Importantly, we can complete the entire UDS assay within half a day from preparation of the assay coverslips; this technique may prove useful as a method for XP diagnosis. PMID:19179371

  13. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing.

    PubMed

    Lubowitz, James H; MacKay, Gordon; Gilmer, Brian

    2014-08-01

    An internal brace is a ligament repair bridging concept using braided ultrahigh-molecular-weight polyethylene/polyester suture tape and knotless bone anchors to reinforce ligament strength as a secondary stabilizer after repair and return to sports, which may help resist injury recurrence. An internal brace may provide augmentation during knee medial and posteromedial corner anatomic repair. In patients with combined, chronic, symptomatic anterior cruciate ligament (ACL)-posteromedial corner laxity, combined ACL reconstruction with posteromedial corner reconstruction is indicated. Our ACL technique was previously published with video illustration in Arthroscopy and Arthroscopy Techniques. The purpose of this article is to describe, with video illustration, knee posteromedial corner reconstruction using anatomic repair with internal brace augmentation. PMID:25276610

  14. Occurrence and surgical repair of third degree perineal lacerations in adult female camels (Camelus dromedarius) by one-stage (Goetz) technique

    PubMed Central

    Anwar, S.; Purohit, G.N.

    2013-01-01

    Retrospective analysis of third degree perineal lacerations in 7 female camels (6-17 yrs of age) that were surgically corrected by one stage repair (Goetz technique) is presented. Majority (3/7) of the camels was primiparous and all parturitions had a history of calving assistance. Six (6/7) camels recovered by first intention of healing. Dehiscence of perineal structure occurred in only one camel due to infection and healed by second intention. Subsequent matings resulted in pregnancy in four camels and one camel died due to unrelated causes. We conclude that perineal lacerations can occur in primiparous camels with difficult assisted deliveries and that one stage repair of perineal lacerations in camels improves the perineal conformation and such camels may easily regain normal fertility. PMID:26623316

  15. DNA repair

    SciTech Connect

    Friedberg, E.C.; Hanawalt, P.C. )

    1988-01-01

    Topics covered in this book included: Eukaryote model systems for DNA repair study; Sensitive detection of DNA lesions and their repair; and Defined DNA sequence probes for analysis of mutagenesis and repair.

  16. Bridge permeameter

    DOEpatents

    Graf, D.C.; Warpinski, N.R.

    1996-08-13

    A system is described for single-phase, steady-state permeability measurements of porous rock which utilizes a fluid bridge arrangement analogous to a Wheatstone bridge. The arms of the bridge contain the sample and calibrated flow resistors. 8 figs.

  17. Arthroscopic rotator cuff repair.

    PubMed

    Burkhart, Stephen S; Lo, Ian K Y

    2006-06-01

    Arthroscopic rotator cuff repair is being performed by an increasing number of orthopaedic surgeons. The principles, techniques, and instrumentation have evolved to the extent that all patterns and sizes of rotator cuff tear, including massive tears, can now be repaired arthroscopically. Achieving a biomechanically stable construct is critical to biologic healing. The ideal repair construct must optimize suture-to-bone fixation, suture-to-tendon fixation, abrasion resistance of suture, suture strength, knot security, loop security, and restoration of the anatomic rotator cuff footprint (the surface area of bone to which the cuff tendons attach). By achieving optimized repair constructs, experienced arthroscopic surgeons are reporting results equal to those of open rotator cuff repair. As surgeons' arthroscopic skill levels increase through attendance at surgical skills courses and greater experience gained in the operating room, there will be an increasing trend toward arthroscopic repair of most rotator cuff pathology. PMID:16757673

  18. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    SciTech Connect

    Park, Joon Young Kim, Shin Jung Kim, Hyoung Ook; Kim, Yong Tae; Lim, Nam Yeol Kim, Jae Kyu; Chung, Sang Young Choi, Soo Jin Na Lee, Ho Kyun

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  19. Bridge diagnosis at 55 mph

    SciTech Connect

    Azevedo, S

    1998-10-01

    The Federal Highway Administration (FHWA) has helped sponsor a research project at Lawrence Livermore that produced a beneficial new tool as well as an R&D 100 Award. The HERMES Bridge Inspector will provide an invaluable capability to diagnose the problems of deteriorating bridge decks and do it accurately, efficiently, nondestructively, and, perhaps most important to motorists, without closing bridges. Almost 30% of 600,000 large highway bridges in the U.S. are classified "deficient" by the FHWA, and HERMES can make a significant contribution toward solving the problem of infrastructure assessment and repair. With further development, HERMES holds promise for other concrete inspection problems, such as railroads, tunnels, and runways. HERMES, or High-performance Electromagnetic Roadway Mapping and Evaluation System, is a radar-based sensing system mounted in a trailer. It can be pulled by a vehicle at traffic speeds over a bridge deck to collect information about the roadway subsurface -- its sensors gathering data 30 centimeters or more into concrete. An onboard computer system processes the data into three-dimensional images that pinpoint problems in the roadway concrete and give engineers quantitative information about deterioration in the bridge deck. Engineers can then better assess what repairs or reconstruction is necessary and avoid the cost overruns and delays that result from inexact problem diagnoses.

  20. The Totally Extraperitoneal Method versus Lichtenstein's Technique for Inguinal Hernia Repair: A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Clinical Trials

    PubMed Central

    Koning, G. G.; Wetterslev, J.; van Laarhoven, C. J. H. M.; Keus, F.

    2013-01-01

    Background Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared with Lichtenstein's technique is needed. Methodology/Principal Findings The review was performed according to the ‘Cochrane Handbook for Systematic Reviews’. Searches were conducted until January 2012. Patients with primary uni- or bilateral inguinal hernias were included. Only trials randomising patients to TEP and Lichtenstein were included. Bias evaluation and trial sequential analysis (TSA) were performed. The error matrix was constructed to minimise the risk of systematic and random errors. Thirteen trials randomized 5404 patients. There was no significant effect of the TEP compared with the Lichtenstein on the number of patients with chronic pain in a random-effects model risk ratio (RR 0.80; 95% confidence interval (CI) 0.61 to 1.04; p = 0.09). There was also no significant effect on number of patients with recurrences in a random-effects model (RR 1.41; 95% CI 0.72 to 2.78; p = 0.32) and the TEP technique may or may not be associated with less severe adverse events (random-effects model RR 0.91; 95% CI 0.73 to 1.12; p = 0.37). TSA showed that the required information size was far from being reached for patient important outcomes. Conclusions/Significance TEP versus Lichtenstein for inguinal hernia repair has been evaluated by 13 trials with high risk of bias. The review with meta-analyses, TSA and error matrix approach shows no conclusive evidence of a difference between TEP and Lichtenstein on the primary outcomes chronic pain, recurrences, and severe adverse events. PMID:23349689

  1. A Fundamental Study on Detection of Defects in the Web Gap Region of Steel Plate Girder Bridges by the Plate Wave Ultrasonic Technique

    NASA Astrophysics Data System (ADS)

    Shirahata, H.; Greimann, L.; Wipf, T.; Phares, B.; Nakagawa, N.

    2004-02-01

    Applicability of the plate wave technique was investigated in this study to detect small defects in the web gap region of the steel plate girder. Torsion induced fatigue cracking is one of the most serious problems for steel bridges. As the conventional inspection method, visual inspection has been applied. However, this method is not always accurate. In addition, accessibility of the inspectors is also a serious problem. This study aims at the application of the plate wave ultrasonic testing to detect a fatigue crack in the web gap area and monitor its propagation. As the first step, the influence of a stiffener and detectability of one or more holes in the web gap were investigated.

  2. Development of Inspection Robots for Bridge Cables

    PubMed Central

    Kim, Se-Hoon; Lee, Jong-Jae

    2013-01-01

    This paper presents the bridge cable inspection robot developed in Korea. Two types of the cable inspection robots were developed for cable-suspension bridges and cable-stayed bridge. The design of the robot system and performance of the NDT techniques associated with the cable inspection robot are discussed. A review on recent advances in emerging robot-based inspection technologies for bridge cables and current bridge cable inspection methods is also presented. PMID:24459453

  3. Self-repair of cracks in brittle material systems

    NASA Astrophysics Data System (ADS)

    Dry, Carolyn M.

    2016-04-01

    One of the most effective uses for self repair is in material systems that crack because the cracks can allow the repair chemical to flow into the crack damage sites in all three dimensions. In order for the repair chemical to stay in the damage site and flow along to all the crack and repair there must be enough chemical to fill the entire crack. The repair chemical must be designed appropriately for the particular crack size and total volume of cracks. In each of the three examples of self repair in crackable brittle systems, the viscosity and chemical makeup and volume of the repair chemicals used is different for each system. Further the chemical delivery system has to be designed for each application also. Test results from self repair of three brittle systems are discussed. In "Self Repair of Concrete Bridges and Infrastructure" two chemicals were used due to different placements in bridges to repair different types of cracks- surface shrinkage and shear cracks, In "Airplane Wings and Fuselage, in Graphite" the composite has very different properties than the concrete bridges. In the graphite for airplane components the chemical also had to survive the high processing temperatures. In this composite the cracks were so definite and deep and thin that the repair chemical could flow easily and repair in all layers of the composite. In "Ceramic/Composite Demonstrating Self Repair" the self repair system not only repaired the broken ceramic but also rebounded the composite to the ceramic layer

  4. Treating patients with abdominal aortic aneurysm with endovascular repair and the crossover chimney technique in the internal iliac artery to protect the unilateral internal iliac artery

    PubMed Central

    Guo, Xi; Li, Peng; Liu, Guang-Rui; Huang, Xiao-Yong; Huang, Lian-Jun

    2015-01-01

    This study aims to explore the treatment methods for patients with abdominal aortic aneurysms (AAAs) that required occlusion of the openings of the bilateral internal iliac arteries (IIAs) in endovascular aneurysm repair (EVAR) and to evaluate the efficacy of these treatments. Four patients with AAA were treated with endovascular aneurysm repair (EVAR) and the crossover chimney technique in the bilateral internal iliac arteries (IIAs). We inserted and released the abdominal aortic stent as usual and implanted the bypass stent graft simultaneously. The intraoperative immediate angiography showed complete isolation of the AAA and patency of the bypass. One month after surgery, it showed contrast engorgement in the bypass stent in three patients. The IIA on the bypass side and its branches had good developing. Another case in which we utilized a COOK stent, occlusion started at the opening of the bypass stent, with no occurrence of other complications. For patients in whom AAAs involve bilateral iliac arteries and the openings of the bilateral IIAs need to be occluded, EVAR and a crossover chimney technique can protect the unilateral IIA. PMID:26885136

  5. Ascending Aortic Slide for Interrupted Aortic Arch Repair.

    PubMed

    Urencio, Miguel; Dodge-Khatami, Ali; Greenleaf, Chris E; Aru, Giorgio; Salazar, Jorge D

    2016-09-01

    For repair of interrupted aortic arch, unfavorable anatomy challenges a tension-free anastomosis. We describe a useful alternative surgical technique used in five neonates/infants, involving splitting the ascending aorta from the sinotubular junction to the arch origin, leftward and posterior "sliding" of the flap with anastomosis to the distal arch creating a native tissue bridge, and reconstruction with a patch. With wide interruption gaps between proximal and distal aortic portions, the ascending aortic slide is a safe and reproducible technique, providing a tension-free native tissue bridge with potential for growth, and a scaffold for patch augmentation in biventricular hearts, or for Norwood stage I in univentricular palliation. PMID:27587504

  6. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

    PubMed Central

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2015-01-01

    Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques

  7. Safer Bridges

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Safer bridges are among a number of spinoff benefits from NASA procedures for testing 'cfracture toughness" of a structural part, meaning its ability to -siscracktsh at might cause failure. The New River Bridge in West Virginia, shown under construction, is the world's largest single span bridge. U.S. Steel fracture toughness requirements for such bridges include NASA-developed test procedures. Bridge materials and other metal structures may develop flaws during their service lifetimes. Such flaws can affect the structural integrity of the part. Thus, it is important to know the "fracture toughness" of a structural part, or its ability to resist cracks. NASA has long experience in developing fracture toughness tests for aerospace hardware. Since 1960, NASA-Lewis has worked closely with the American Society for Testing & Materials. Lewis and NASA-funded industrial contractors have made many important contributions to test procedures, now recommended by ASTM, for measuring fracture toughness.

  8. Clubfoot repair

    MedlinePlus

    ... release; Talipes equinovarus - repair; Tibialis anterior tendon transfer Images Clubfoot repair - series References Kelly DM. Congenital Anomalies ... provided herein should not be used during any medical emergency or for the diagnosis or treatment of ...

  9. New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

    SciTech Connect

    Juszkat, Robert Kulesza, Jerzy; Zarzecka, Anna; Jemielity, Marek; Staniszewski, Ryszard; Majewski, Waclaw

    2011-02-15

    To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a-the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.

  10. A new technique for the use of intrathecal fluorescein in the repair of cerebrospinal fluid rhinorrhea using a hypodense diluent.

    PubMed

    Guimarães, R; Becker, H

    2001-01-01

    The intrathecal injection of fluorescein is used in the diagnosis and treatment of skull base liquoric fistulas since it allows precise localization of the site of drainage. The fluorescein is always diluted in cerebrospinal fluid (CSF) resulting in a hyperdense solution in relation to the CSF. For this reason it is necessary to put the patient in the Trendelenburg position for 30 to 40 minutes so that the fluorescein reaches the cerebral cisterns and is visualized at the level of the fistulae. From October 1997 to May 1999 intrathecal fluorescein in a hypodense solution was used in the repair of 23 skull base defects associated with CSF rhinorrhea. This hypodense solution was obtained by diluting 0.5 cm3 of 5% fluorescein in 10 cm3 of distilled water. This solution density is 1001, which is hypodense when compared to CSF (density range 1004-1006) and therefore allows fluorescein to reach rapidly the cerebral cisterns when the patient is recumbent. The author discusses the advantages and the lack of complications with the use of fluorescein in a hypodense solution. PMID:11799862