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Sample records for bridge repair technique

  1. Summary of Repair Techniques for Aluminum Bridging.

    DTIC Science & Technology

    1982-10-01

    OCT 82 CERL-TR-M-324 UNCLASSIFIED F/G 13/8 NL mEEEimuinuIEEBI-EEIIIIIE 111-2 11112.2~ 111L25 nu 111I. M RO f PIHULL]TIN 7[ ..k contrutio of Enginrs ...aluminum bridging. A literature search was conducted to identify the various aluminum repair processes available. The merits of each method as a field...Army C’onsfruclion EnPrincering Restarch A literature search was conducted to assess various L.a jratorv I(’I.RIl, 1I’P. welding and joining repair

  2. The Roman Bridge: a "double pulley – suture bridges" technique for rotator cuff repair

    PubMed Central

    Franceschi, Francesco; Longo, Giuseppe Umile; Ruzzini, Laura; Rizzello, Giacomo; Maffulli, Nicola; Denaro, Vincenzo

    2007-01-01

    Background With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. Methods We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. Conclusion This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier

  3. The Roman Bridge: a "double pulley - suture bridges" technique for rotator cuff repair.

    PubMed

    Franceschi, Francesco; Longo, Umile Giuseppe; Ruzzini, Laura; Rizzello, Giacomo; Maffulli, Nicola; Denaro, Vincenzo

    2007-12-18

    With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid

  4. Rapid repair techniques for severely earthquake-damaged circular bridge piers with flexural failure mode

    NASA Astrophysics Data System (ADS)

    Sun, Zhiguo; Li, Hongnan; Bi, Kaiming; Si, Bingjun; Wang, Dongsheng

    2017-04-01

    In this study, three rapid repair techniques are proposed to retrofit circular bridge piers that are severely damaged by the flexural failure mode in major earthquakes. The quasi-static tests on three 1:2.5 scaled circular pier specimens are conducted to evaluate the efficiency of the proposed repair techniques. For the purpose of rapid repair, the repair procedure for all the specimens is conducted within four days, and the behavior of the repaired specimens is evaluated and compared with the original ones. A finite element model is developed to predict the cyclic behavior of the repaired specimens and the numerical results are compared with the test data. It is found that all the repaired specimens exhibit similar or larger lateral strength and deformation capacity than the original ones. The initial lateral stiffness of all the repaired specimens is lower than that of the original ones, while they show a higher lateral stiffness at the later stage of the test. No noticeable difference is observed for the energy dissipation capacity between the original and repaired pier specimens. It is suggested that the repair technique using the early-strength concrete jacket confined by carbon fiber reinforced polymer (CFRP) sheets can be an optimal method for the rapid repair of severely earthquake-damaged circular bridge piers with flexural failure mode.

  5. Modified suture-bridge technique to prevent a marginal dog-ear deformity improves structural integrity after rotator cuff repair.

    PubMed

    Ryu, Keun Jung; Kim, Bang Hyun; Lee, Yohan; Lee, Yoon Seok; Kim, Jae Hwa

    2015-03-01

    The arthroscopic suture-bridge technique has proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing the footprint contact area and pressure. However, a marginal dog-ear deformity is encountered not infrequently when this technique is used, impeding full restoration of the torn cuff. To evaluate the structural and functional outcomes of the use of a modified suture-bridge technique to prevent a marginal dog-ear deformity compared with a conventional suture-bridge method in rotator cuff repair. Cohort study; Level of evidence 2. A consecutive series of 71 patients aged 50 to 65 years who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears was evaluated. Patients were divided into 2 groups according to repair technique: a conventional suture-bridge technique (34 patients; group A) versus a modified suture-bridge technique to prevent a marginal dog-ear deformity (37 patients; group B). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) score. All patients were followed up clinically at a minimum of 1 year. When the 2 surgical techniques were compared, postoperative structural integrity by Sugaya classification showed the distribution of types I:II:III:IV:V to be 4:20:2:4:4 in group A and 20:12:4:0:1 in group B. More subjects in group B had a favorable Sugaya type compared with group A (P < .001). The postoperative healed:retear rate was 26:8 in group A and 36:1 in group B, with a significantly lower retear rate in group B (P = .011). However, there were no significant differences in ROM and all functional outcome scores between the 2 groups postoperatively. When surgical techniques were compared across healed

  6. The low-profile Roman bridge technique for knotless double-row repair of the rotator cuff.

    PubMed

    Longo, Umile Giuseppe; Franceschi, Francesco; Spiezia, Filippo; Marinozzi, Andrea; Maffulli, Nicola; Denaro, Vincenzo

    2011-03-01

    With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. We present a low-profile arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. A 5.5 mm Bio-Corkscrew suture anchor (Arthrex, Naples, FL, USA), double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL, USA), is placed in the anteromedial aspect of the footprint. Two suture limbs from a single suture are both passed through a single anterior point in the rotator cuff. One suture limb is retrieved from the cannula. The second suture limb is passed through a single posterior point in the rotator cuff producing two points of fixation in the tendon, with a tendon bridge between them. The same suture limb is retrieved through the lateral portal, and then inserted into the bone by means of a Pushlock (Arthrex, Naples, FL, USA), placed approximately 1.5-2 cm posterior to the first anchor. This second suture is passed again in the posterior aspect of the cuff. The limbs of the first suture are pulled to compress the tendon in the medial aspect of the footprint. The two free suture limbs are used to produce suture bridges over the tendon by means of a Pushlock (Arthrex, Naples, FL, USA), placed 1 cm distal to the lateral edge of the footprint relative to the medially placed suture anchors anterior to posterior. This technique allows us to perform a low-profile (single pulley-suture bridges) repair for knotless double-row repair of the rotator cuff.

  7. 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 do...

  8. 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 do...

  9. 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 do...

  10. 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 do...

  11. 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 do...

  12. Assessing complications and cost-utilization in ventral hernia repair utilizing biologic mesh in a bridged underlay technique.

    PubMed

    Basta, Marten N; Fischer, John P; Kovach, Stephen J

    2015-04-01

    The inability to reapproximate fascia in complex ventral hernia (CVH) repair remains challenging. Single-stage bridging reconstructions have been reported, however, with high rates of recurrence and wound complications. We describe a single-surgeon experience with bridging biologic CVH repair. We reviewed 37 patients undergoing CVH repair with bridging biologic mesh by the senior author from January 1, 2007 to January 1, 2013. Surgical history and operative characteristics were analyzed for predictors of hernia recurrence and wound complications. Average age was 53 ± 15 years, body mass index was 31.1 ± 8.1 kg/m(2), and history of prior repair in 18 patients. Common indications were trauma, intra-abdominal infection, and prior intra-abdominal surgery. Incidence of wound complications was 51.4%, most commonly wound breakdown and infection. With average follow-up of 13 months, recurrence rate was 18.9% at an average of 8.2 months postoperatively. Analysis demonstrated postoperative wound infection as the only predictor of recurrence (odds ratio = 22.1, P = .017). Hernia recurrence rate was 18.9% with bridged biologic CVH repairs, strongly associated with postoperative wound infection. This suggests that patients with postoperative infections may benefit from closer surveillance and more aggressive wound management. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. 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

  14. Bridge Tenodesis: A Secure Fixation Technique for Biceps Long Head Tendinopathy During Arthroscopic Rotator Cuff Repair Using a Suture-Bridge Technique.

    PubMed

    Park, Jin-Young; Lee, Jae-Hyung; Oh, Kyung-Soo; Chung, Seok-Won; Bang, Jin-Young; Noh, Young-Min

    2016-10-01

    Tendinopathy of the long head of the biceps is often found as an intra-articular pathology in the glenohumeral joint. Because long head of the biceps lesions are common, surgical intervention to properly manage the long head of the biceps has become an important issue. Both tenodesis and tenotomy have been shown to provide benefits in biceps long head tendinopathy. But because of concerns about muscle power reduction, cramping, and "Popeye's deformity," which may result from biceps tenotomy, biceps tenodesis is a good option for treating biceps lesions. Here, we describe a time-saving, simple, and secure biceps tenodesis method during rotator cuff repairs, which is a combination of an adjacent soft-tissue tenodesis and a bony suprapectoral tenodesis, by performing a combined tenodesis (soft + bony), and we believe that the shoulder joint will gain more strength and loosening complications will be reduced.

  15. 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

  16. 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

  17. Climbing techniques for bridge inspection

    NASA Astrophysics Data System (ADS)

    Kaslan, Erol C.

    1998-03-01

    California has about 24,000 publicly owned bridges that require routine structural evaluations to comply with National Bridge Inspection Standard (NBIS) mandates. Of these, about 800 are identified as possessing fatigue prone or fracture critical details requiring thorough tactile investigations. Gaining access to bridge elements to perform these investigations has become increasingly difficult and costly. The traditional uses of under bridge inspection trucks, lift equipment and rigging are economically and practically limited by bridge size, structure type, traffic demands and support costs. In some cases, bridges that have become damaged by earthquakes cannot safely support the loads of heavy personnel lift equipment. The California Department of Transportation (Caltrans)'s Office of Structural Materials and Office of Structure Maintenance and Investigations evaluated the use of rock climbing and mountaineering techniques as an alternative means of gaining access for bridge inspections. Under a small research grant, a bridge climbing training course was developed through a local University of California outdoor recreation group and 7 engineers and technicians were initially trained. A comprehensive Code of Safe Practices was created and standards of training, procedures and equipment required for bridge inspections were established. A successful climb investigation on a large, previously inaccessible arch bridge was completed at the end of the training that proved the techniques safe, economical and effective. Within one year, 20 bridge maintenance engineers were trained, and a formal program was established to organize, schedule, equip and certify engineers and technicians for bridge climbing. Several other offices within Caltrans as well as the California Department of Water Resources have since adopted these techniques for specialized structural inspection tasks. Climbing techniques are now used routinely in California as an alterative means of gaining access

  18. [Comparative study of the repair of full thickness tear of the supraspinatus by means of "single row" or "suture bridge" techniques].

    PubMed

    Arroyo-Hernández, M; Mellado-Romero, M A; Páramo-Díaz, P; Martín-López, C M; Cano-Egea, J M; Vilá Y Rico, J

    2015-01-01

    The purpose of this study is to analyze if there is any difference between the arthroscopic reparation of full-thickness supraspinatus tears with simple row technique versus suture bridge technique. We accomplished a retrospective study of 123 patients with full-thickness supraspinatus tears between January 2009 and January 2013 in our hospital. There were 60 simple row reparations, and 63 suture bridge ones. The mean age in the simple row group was 62.9, and in the suture bridge group was 63.3 years old. There were more women than men in both groups (67%). All patients were studied using the Constant test. The mean Constant test in the suture bridge group was 76.7, and in the simple row group was 72.4. We have also accomplished a statistical analysis of each Constant item. Strength was higher in the suture bridge group, with a significant statistical difference (p 0.04). The range of movement was also greater in the suture bridge group, but was not statistically significant. Suture bridge technique has better clinical results than single row reparations, but the difference is not statistically significant (p = 0.298).

  19. Clinical Outcomes of Modified Mason-Allen Single-Row Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears: Comparison With the Double-Row Suture-Bridge Technique.

    PubMed

    Shin, Sang-Jin; Kook, Seung-Hwan; Rao, Nandan; Seo, Myeong-Jae

    2015-08-01

    Various repair techniques have been reported for the operative treatment of bursal-sided partial-thickness rotator cuff tears. Recently, arthroscopic single-row repair using a modified Mason-Allen technique has been introduced. The arthroscopic, modified Mason-Allen single-row technique with preservation of the articular-sided tendon provides satisfactory clinical outcomes and similar results to the double-row suture-bridge technique after conversion of a partial-thickness tear to a full-thickness tear. Cohort study; Level of evidence, 3. A retrospective study was conducted on 84 consecutive patients with symptomatic, bursal-sided partial-thickness rotator cuff tears involving more than 50% thickness of the tendon. A total of 47 patients were treated by the modified Mason-Allen single-row repair technique, preserving the articular-sided tendon, and 37 patients were treated by the double-row suture-bridge repair technique after conversion to a full-thickness tear. The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores and a visual analog scale (VAS) for pain and satisfaction of patients. Magnetic resonance imaging (MRI) was used to analyze the integrity of tendons at 6-month follow-up. Patients were followed up for a mean of 32.5 months. In the 47 patients treated with the modified Mason-Allen suture technique, the VAS score decreased from a preoperative mean of 5.3 ± 0.3 to 0.9 ± 0.5 at the time of final follow-up. There was a statistically significant increase in the mean ASES score (from 45.4 ± 2.9 to 88.6 ± 4.5) and mean Constant score (from 66.9 ± 2.6 to 88.1 ± 2.4) (P < .001). Four of 47 patients (8.5%) demonstrated retears at 6-month postoperative MRI. There was no statistical difference in terms of functional outcomes and the retear rate compared with those of patients with the suture-bridge repair technique (3 patients, 8.1%). However, the mean number of suture anchors used in the

  20. 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

  1. Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair.

    PubMed

    Wu, ZiYing; Zhang, Chong; Zhang, Peng; Chen, TianWu; Chen, ShiYi; Chen, JiWu

    2016-01-01

    Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6 ± 78.0 N, P = 0.04 for KSB group; P < 0.001 for USB group), stiffness (58.0 ± 10.7 N/mm, P = 0.005 for KSB group; P < 0.001 for USB group), and lowest elongation (1.49 ± 0.39 mm, P = 0.009 for KSB group; P = 0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5 ± 65.0 N) than USB repair (363.5 ± 52.3 N, P = 0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P = 0.396 for stiffness and P = 0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.

  2. Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

    PubMed Central

    Zhang, Peng; Chen, TianWu; Chen, ShiYi

    2016-01-01

    Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6 ± 78.0 N, P = 0.04 for KSB group; P < 0.001 for USB group), stiffness (58.0 ± 10.7 N/mm, P = 0.005 for KSB group; P < 0.001 for USB group), and lowest elongation (1.49 ± 0.39 mm, P = 0.009 for KSB group; P = 0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5 ± 65.0 N) than USB repair (363.5 ± 52.3 N, P = 0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P = 0.396 for stiffness and P = 0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair. PMID:27975065

  3. Techniques in Endovascular Aneurysm Repair

    PubMed Central

    Phade, Sachin V.; Garcia-Toca, Manuel; Kibbe, Melina R.

    2011-01-01

    Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies. PMID:22121487

  4. Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study.

    PubMed

    Wennergren, John Emil; Askenasy, Erik P; Greenberg, Jacob A; Holihan, Julie; Keith, Jerrod; Liang, Mike K; Martindale, Robert G; Trott, Skylar; Plymale, Margaret; Roth, John Scott

    2016-08-01

    Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates. A multicenter, retrospective database of all ventral hernia repairs performed from 2010-2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation. A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group. Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on

  5. Rapid repair of severely earthquake-damaged bridge piers with flexural-shear failure mode

    NASA Astrophysics Data System (ADS)

    Sun, Zhiguo; Wang, Dongsheng; Du, Xiuli; Si, Bingjun

    2011-12-01

    An experimental study was conducted to investigate the feasibility of a proposed rapid repair technique for severely earthquake-damaged bridge piers with flexural-shear failure mode. Six circular pier specimens were first tested to severe damage in flexural-shear mode and repaired using early-strength concrete with high-fluidity and carbon fiber reinforced polymers (CFRP). After about four days, the repaired specimens were tested to failure again. The seismic behavior of the repaired specimens was evaluated and compared to the original specimens. Test results indicate that the proposed repair technique is highly effective. Both shear strength and lateral displacement of the repaired piers increased when compared to the original specimens, and the failure mechanism of the piers shifted from flexural-shear failure to ductile flexural failure. Finally, a simple design model based on the Seible formulation for post-earthquake repair design was compared to the experimental results. It is concluded that the design equation for bridge pier strengthening before an earthquake could be applicable to seismic repairs after an earthquake if the shear strength contribution of the spiral bars in the repaired piers is disregarded and 1.5 times more FRP sheets is provided.

  6. A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model.

    PubMed

    Fei, Wenyong; Guo, Weichun

    2015-06-16

    The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2(nd), 4(th), or 8(th) week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8(th) week. The load to failure of the SB group was 134.59 ± 17.69 N at the 8(th) postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4(th) and 8(th) weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.

  7. 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.

  8. Chapter 8: Current techniques and concepts in peripheral nerve repair.

    PubMed

    Siemionow, Maria; Brzezicki, Grzegorz

    2009-01-01

    Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.

  9. 78 FR 61937 - Safety Zone; Port of Galveston, Pelican Island Bridge Repair

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-07

    ... CFR Part 165 RIN 1625-AA00 Safety Zone; Port of Galveston, Pelican Island Bridge Repair AGENCY: Coast... zone in Galveston to maintain public safety during the Pelican Island Bridge Repair Project. This... Pelican Island Bridge; therefore immediate action is needed to protect public boaters and their vessels...

  10. Arthroscopic Rotator Cuff Repair: Indication and Technique.

    PubMed

    Gilotra, Mohit; O'Brien, Michael J; Savoie, Felix H

    2016-01-01

    Shoulder arthroscopy and rotator cuff repair techniques are frequently used by most practicing orthopaedic surgeons. A thorough patient history and physical examination can often confirm the presence of a rotator cuff tear, and imaging can be used to evaluate the extent of the injury. The indication for rotator cuff repair is a painful shoulder refractory to nonsurgical management. Arthroscopic techniques, including capsular and coracohumeral ligament releases to decrease tension on the repair, facilitate successful rotator cuff repair. Biomechanically, a double-row transosseous-equivalent rotator cuff repair provides excellent results for medium-size rotator cuff tears. Larger, retracted rotator cuff tears may be better repaired with oblique convergence sutures and a medial single-row rotator cuff repair. The biology of healing, the preservation of blood supply, and the trephination of the bony healing bed are essential parts of all rotator cuff repair procedures. Protection of the rotator cuff repair with an abduction sling for 4 to 8 weeks postoperatively and the delay of active motion until early healing has occurred will improve outcomes.

  11. 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.

  12. Techniques for aortic arch endovascular repair.

    PubMed

    Hongku, 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.

  13. Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear.

    PubMed

    Kim, Sae Hoon; Kim, Jangwoo; Choi, Young Eun; Lee, Hwa-Ryeong

    2016-03-01

    Medial row failure has been reported in the suture bridge technique of rotator cuff repair. This study compared the healing response of suture bridge configuration repair (SBCR) and parallel type transosseous repair (PTR). Acute rotator cuff repair was performed in 32 rabbits. Both shoulders were repaired using PTR or SBCR. In PTR, simple PTR was performed through 2 parallel transosseous tunnels created using a microdrill. In SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. At 1, 2, and 5 weeks postoperatively, comparative biomechanical testing was performed in 8 rabbits, and histologic analysis, including immunohistochemical staining for CD31, was performed in 4 rabbits. Failure loads at 1 week (38.12 ± 20.43 N vs 52.00 ± 27.23 N; P = .284) and 5 weeks (97.93 ± 48.35 N vs 119.60 ± 60.81 N; P = .218) were not statistically different between the SBCR and PTR groups, respectively, but were significantly lower in the SBCR group than in the PTR group (23.56 ± 13.56 N vs. 44.25 ± 12.53 N; P = .009), respectively, at 2 weeks. Markedly greater fibrinoid deposition was observed in the SBCR group than in the PTR group at 2 weeks. For vascularization, there was a tendency that more vessels could be observed in PTR than in SBCR at 2 weeks (15.9 vs 5.6, P = .068). In a rabbit acute rotator cuff repair model, SBCR exhibited inferior mechanical strength, and fewer blood vessels were observed at the healing site at 2 weeks postoperatively. Medial row tendon failure was more common in SBCR. Surgeons should consider the clinical effect of SBCR when performing rotator cuff repair. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Innovative coke-oven repair techniques

    SciTech Connect

    Emish, G.J.; Ramani, R.V.

    1995-10-01

    Certain innovative coke-oven repair techniques are reviewed that represent an engineered approach to a successful rehabilitation of all types of coke-oven batteries. These techniques have been developed during the last 10 years and experience gained on a number of repair projects has shown that these techniques operate as a cohesive and comprehensive method of end flue and through-wall repairs to gain additional years of operating life to coke-oven batteries. Extended operations approaching 10 to 15 additional years of service at lower costs than a pad-up rebuild and, while meeting the environmental emission regulations, are attainable using the techniques of: Proper tie-in joint preparation; Improved bricking up methodology; Preheating refractory during bricking up; Installation of spring-loaded bracing system; and installation of flexible coke-oven doors. Repair methods that do not incorporate the above techniques are subject to premature failure of the refractory. The old methods of wall cool down and installing refractory as if the battery was brand new are outdated technology. A technology supplier, with new techniques, can coordinate the construction contractor and the battery heating to obtain a successful coke-oven and flue or through-wall repair.

  15. 33 CFR 165.T08-0698 - Safety Zone; Port of Galveston, Pelican Island Bridge Repair.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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 COAST... Guard District § 165.T08-0698 Safety Zone; Port of Galveston, Pelican Island Bridge Repair. (a...

  16. The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

    PubMed Central

    Murray, Martha M.; Flutie, Brett M.; Kalish, Leslie A.; Ecklund, Kirsten; Fleming, Braden C.; Proffen, Benedikt L.; Micheli, Lyle J.

    2016-01-01

    Background: This study assessed the safety of the newly developed bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR), which involves suture repair of the ligament combined with a bioactive scaffold to bridge the gap between the torn ligament ends. As the intra-articular environment is complex in its response to implanted materials, this study was designed to determine whether there would be a significant rate of adverse reaction to the implanted scaffold. Hypothesis: The primary hypothesis was that the implanted scaffold would not result in a deep joint infection (arthrocentesis with positive culture) or significant inflammation (clinical symptoms justifying arthrocentesis but negative culture). The secondary hypotheses were that patients treated with BEAR would have early postoperative outcomes that were similar to patients treated with ACL reconstruction with an autologous hamstring graft. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 20 patients were enrolled in this nonrandomized, first-in-human study. Ten patients received BEAR treatment and 10 received a hamstring autograft ACL reconstruction. The BEAR procedure was performed by augmenting a suture repair with a proprietary scaffold, the BEAR scaffold, placed in between the torn ends of the ACL at the time of suture repair. The BEAR scaffold is to our knowledge the only device that fills the gap between the torn ligament ends to have current Investigational Device Exemption approval from the Food and Drug Administration. Ten milliliters of autologous whole blood were added to the scaffold prior to wound closure. Outcomes were assessed at 3 months postoperatively. The outcomes measures included postoperative pain, muscle atrophy, loss of joint range of motion, and implant failure (designated by an International Knee Documentation Committee grade C or D Lachman test and/or an absence of continuous ACL tissue on magnetic resonance images). Results: There were no joint

  17. 77 FR 21436 - Safety Zone, East River, Brooklyn Bridge Scaffolding Repair, Brooklyn, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-10

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone, East River, Brooklyn Bridge Scaffolding... Bridge. This action is necessary to provide for the safety of life and property on the navigable waters... bridge. This rule is intended to restrict all vessels from a portion of the East River during the repair...

  18. 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... Bridge would be completed by the time notice could be published and comments taken. Under 5 U.S.C. 553(d...

  19. 26. Photocopy of 1968 repair drawing for 'WalpoleWestminster Bridge Over: ...

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

    26. Photocopy of 1968 repair drawing for 'Walpole-Westminster Bridge Over: Connecticut River', unattributed. (Filed with N.H. Department of Transportation, Bridge Design Division plan archives, Concord, N.H.) Sheet: Deck and Expansion Joint Details June 13, 1968 - Walpole-Westminster Bridge, Spanning Connecticut River between Walpole, NH & Westminster, VT, Walpole, Cheshire County, NH

  20. Knotted versus knotless suture bridge repair of the achilles tendon insertion: a biomechanical study.

    PubMed

    Cox, Joseph T; Shorten, Peter L; Gould, Gregory C; Markert, Ronald J; Barnett, Michael D; Laughlin, Richard T

    2014-11-01

    Surgical treatment of insertional Achilles tendinopathy often involves detachment and debridement of the Achilles tendon insertion. A recent study has shown that knotted suture bridge fixation of the Achilles to the calcaneus is biomechanically superior to single-row fixation, but there is an absence of literature on the use of different suture bridge constructs to repair the Achilles tendon. There will be no significant difference in the load to failure, mode of failure, tendon strain, tendon stiffness, repair site gapping, or footprint size when comparing knotted suture bridge repair to knotless suture bridge repair of the Achilles tendon after detachment for insertional Achilles tendinopathy. Controlled laboratory study. A single specimen from each pair of 10 cadaveric Achilles tendons was randomized to 1 of 2 Achilles insertion repair groups: knotted (n = 10) or knotless (n = 10) suture bridge repair. Repaired footprint size was measured, and then cyclic testing from 10 to 100 N for 2000 cycles was performed. This was followed by measurement of tendon strain, repair site displacement, load to failure, and tendon stiffness. The knotted suture bridge repair had a significantly higher load to failure compared with the knotless suture bridge (mean ± SD, 317.8 ± 93.6 N vs 196.1 ± 12.1 N, respectively; P = .001). All constructs failed at the tendon-suture interface. Tendon strain after cyclic testing was significantly greater in the knotless (1.20 ± 1.05) compared with the knotted (0.39 ± 0.4) suture repair groups (P = .011). There was no significant difference in footprint size between the knotted (230.3 ± 63.3 mm(2)) and knotless (248.5 ± 48.8 mm(2)) groups (P = .40). There was also no significant difference in stiffness (knotted = 76.4 ± 8.0 N/mm; knotless = 69.6 ± 10.9 N/mm; P = .17) and repair site displacement after cyclic testing (knotted = 2.8 ± 1.2 mm; knotless = 3.6 ± 1.1 mm; P = .17). During suture bridge repair of the Achilles tendon after

  1. The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study.

    PubMed

    Park, Ji Soon; McGarry, Michelle H; Campbell, Sean T; Seo, Hyuk Jun; Lee, Yeon Soo; Kim, Sae Hoon; Lee, Thay Q; Oh, Joo Han

    2015-09-01

    Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. Controlled laboratory study. A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P < .05 for all). Regarding contact area, no significant differences were found between 90 and 120 N at all positions, although there were significant differences between 60 and 90 N. The construct failure test demonstrated no significant differences in any parameters according to various tensions (P > .05 for all). Increasing bridging suture tension to over 90 N did not improve contact area but did increase

  2. 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

  3. Probabilistic Fatigue Life Updating for Railway Bridges Based on Local Inspection and Repair.

    PubMed

    Lee, Young-Joo; Kim, Robin E; Suh, Wonho; Park, Kiwon

    2017-04-24

    Railway bridges are exposed to repeated train loads, which may cause fatigue failure. As critical links in a transportation network, railway bridges are expected to survive for a target period of time, but sometimes they fail earlier than expected. To guarantee the target bridge life, bridge maintenance activities such as local inspection and repair should be undertaken properly. However, this is a challenging task because there are various sources of uncertainty associated with aging bridges, train loads, environmental conditions, and maintenance work. Therefore, to perform optimal risk-based maintenance of railway bridges, it is essential to estimate the probabilistic fatigue life of a railway bridge and update the life information based on the results of local inspections and repair. Recently, a system reliability approach was proposed to evaluate the fatigue failure risk of structural systems and update the prior risk information in various inspection scenarios. However, this approach can handle only a constant-amplitude load and has limitations in considering a cyclic load with varying amplitude levels, which is the major loading pattern generated by train traffic. In addition, it is not feasible to update the prior risk information after bridges are repaired. In this research, the system reliability approach is further developed so that it can handle a varying-amplitude load and update the system-level risk of fatigue failure for railway bridges after inspection and repair. The proposed method is applied to a numerical example of an in-service railway bridge, and the effects of inspection and repair on the probabilistic fatigue life are discussed.

  4. Probabilistic Fatigue Life Updating for Railway Bridges Based on Local Inspection and Repair

    PubMed Central

    Lee, Young-Joo; Kim, Robin E.; Suh, Wonho; Park, Kiwon

    2017-01-01

    Railway bridges are exposed to repeated train loads, which may cause fatigue failure. As critical links in a transportation network, railway bridges are expected to survive for a target period of time, but sometimes they fail earlier than expected. To guarantee the target bridge life, bridge maintenance activities such as local inspection and repair should be undertaken properly. However, this is a challenging task because there are various sources of uncertainty associated with aging bridges, train loads, environmental conditions, and maintenance work. Therefore, to perform optimal risk-based maintenance of railway bridges, it is essential to estimate the probabilistic fatigue life of a railway bridge and update the life information based on the results of local inspections and repair. Recently, a system reliability approach was proposed to evaluate the fatigue failure risk of structural systems and update the prior risk information in various inspection scenarios. However, this approach can handle only a constant-amplitude load and has limitations in considering a cyclic load with varying amplitude levels, which is the major loading pattern generated by train traffic. In addition, it is not feasible to update the prior risk information after bridges are repaired. In this research, the system reliability approach is further developed so that it can handle a varying-amplitude load and update the system-level risk of fatigue failure for railway bridges after inspection and repair. The proposed method is applied to a numerical example of an in-service railway bridge, and the effects of inspection and repair on the probabilistic fatigue life are discussed. PMID:28441768

  5. Cost Effective Repair Techniques for Turbine Airfoils. Volume 2

    DTIC Science & Technology

    1979-04-01

    BLADES , *GUIDE VANES , *REPAIR, TURBOFAN ENGINES , DIFFUSION BONDING, COST EFFECTIVENESS Identifiers: (U) * Turbine vanes , TF-39 engines , Activated...REPAIR TECHNIQUES FOR TURBINE AIRFOILS J. A. WEIN W. R. YOUNG GENERAL ELECTRIC COMPANY AIRCRAFT ENGINE GROUP CINCINNATI, OHIO 45215 APRIL 1979...Author: GENERAL ELECTRIC CO CINCINNATI OH AIRCRAFT ENGINE BUSINESS GROUP Unclassified Title: (U) Cost Effective Repair Techniques for

  6. Rotator cuff repair with a tendon-fibrocartilage-bone composite bridging patch.

    PubMed

    Ji, Xiaoxi; Chen, Qingshan; Thoreson, Andrew R; Qu, Jin; An, Kai-Nan; Amadio, Peter C; Steinmann, Scott P; Zhao, Chunfeng

    2015-11-01

    To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model. Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/s. The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; P<.001). Stiffness at the greater tuberosity repair site and the patch-infraspinatus tendon repair site was significantly higher than the control repair site (93.96 [27.72] vs 42.62 [17.48] N/mm P<.001; 65.94 [24.51] vs 42.62 [17.48] N/mm P=.02, respectively). The tendon-fibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch-greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Rotator Cuff Repair with a Tendon-Fibrocartilage-Bone Composite Bridging Patch

    PubMed Central

    Ji, Xiaoxi; Chen, Qingshan; Thoreson, Andrew R.; Qu, Jin; An, Kai-Nan; Amadio, Peter C.; Steinmann, Scott P.; Zhao, Chunfeng

    2015-01-01

    Background To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model. Methods Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/sec. Findings The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; P<.001). Stiffness at the greater tuberosity repair site and the patch-infraspinatus tendon repair site was significantly higher than the control repair site (93.96 [27.72] vs 42.62 [17.48] N/mm P<.001; 65.94 [24.51] vs 42.62 [17.48] N/mm P=.02, respectively). Interpretation The tendon-fibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch–greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate. PMID:26190097

  8. Photochemical tissue bonding: a promising technique for peripheral nerve repair.

    PubMed

    Johnson, T Shane; O'Neill, Anne C; Motarjem, Pejman M; Amann, Christopher; Nguyen, Tuan; Randolph, Mark A; Winograd, Jonathan M; Kochevar, Irene E; Redmond, Robert W

    2007-12-01

    Photochemical tissue bonding (PTB) is a novel tissue repair technique that uses visible light and a photosensitizing dye to crosslink proteins on tissue surfaces. This technique has been successfully demonstrated in a number of tissue repair models. An ideal nerve repair technique would be atraumatic and avoid placement of foreign bodies at the repair site. The epineurium is suited to photochemical repair as it is thin, translucent and has a relatively high collagen content. This study was designed to determine if PTB could be successfully applied in a peripheral nerve repair model. Forty Sprague Dawley rats underwent transection of the sciatic nerve. Animals were then randomized to four treatment groups; epineurial suture repair, epineurial cuff with PTB, epineurial cuff alone, and no repair. Functional recovery was assessed at 10 day intervals using walking track analysis and sciatic function index calculations. At 90 days postoperatively animals were sacrificed and sciatic nerves harvested for histology and histomorphometry. Functional recovery in the suture repair and epineural cuff with PTB groups were not significantly different (-70.6 +/- 17.8 versus -76.9 +/- 10.3, P = 0.64) at 90 days postrepair. Histology showed good axonal regeneration with all repair techniques. Histomorphometric analysis found no significant difference between the repair groups. This study illustrates that peripheral nerves can be successfully repaired using a photochemical tissue bonding technique with results similar to those achieved with the current gold standard. With further development and refinement PTB may prove a useful tool in peripheral nerve repair.

  9. A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol.

    PubMed

    Clanton, Thomas O; Haytmanek, C Thomas; Williams, Brady T; Civitarese, David M; Turnbull, Travis Lee; Massey, Matthew B; Wijdicks, Coen Abel; LaPrade, Robert F

    2015-08-01

    While the nonoperative management of Achilles tendon ruptures is a viable option, surgical repair is preferred in healthy and active populations. Recently, minimally invasive percutaneous repair methods with assistive devices have been developed. The purpose of this study was to biomechanically analyze 3 commercially available, minimally invasive percutaneous techniques compared with an open Achilles repair during a simulated, progressive rehabilitation program. It was hypothesized that no significant biomechanical differences would exist between repair techniques. Controlled laboratory study. A simulated, midsubstance Achilles rupture was created 6 cm proximal to the calcaneal insertion in 33 fresh-frozen cadaveric ankles. Specimens were then randomly allocated to 1 of 4 different Achilles repair techniques: (1) open repair, (2) the Achillon Achilles Tendon Suture System, (3) the PARS Achilles Jig System, or (4) an Achilles Midsubstance SpeedBridge Repair variation. Repairs were subjected to a cyclic loading protocol representative of progressive postoperative rehabilitation: 250 cycles at 1 Hz for each loading range: 20-100 N, 20-200 N, 20-300 N, and 20-400 N. The open repair technique demonstrated significantly less elongation (5.2 ± 1.1 mm) when compared with all minimally invasive percutaneous repair methods after 250 cycles (P < .05). No significant differences were observed after 250 cycles between the Achillon, PARS, or SpeedBridge repairs, with mean displacements of 9.9 ± 2.2 mm, 12.2 ± 4.4 mm, and 10.0 ± 3.9 mm, respectively. When examined over smaller cyclic intervals, the majority of elongation, regardless of repair, occurred within the first 10 cycles. Within the first 10 cycles, open repairs achieved 71.2% of the total elongation observed after 250 cycles. Corresponding values for the Achillon, PARS, and SpeedBridge repairs were 81.8%, 77.9%, and 69.0%, respectively. No significant differences were observed in the total number of cycles to failure

  10. Wheatstone bridge technique for magnetostriction measurements.

    PubMed

    Sullivan, M

    1980-03-01

    A basic Wheatstone bridge, with additional electronic instrumentation, has been used in the measurement of magnetostriction. This method allows a resolution of approximately 10% on measurements of magnetostrictions less than 0.75 parts per million.

  11. Assessment of Foreign Bridge Standards and Techniques

    DTIC Science & Technology

    2004-09-01

    2003) Asphaltic Bitumen Stabilized Other Total Concrete Surfacing Gravel km 1,851 0 0 0 1,851Expressways ____ ____ mile 1,150 0 0 0 1,150 Highways km...Sheets F3 Birecik Bridge 1050 850 Figure F7. Cross-section details of Birecik Bridge, cm 0_4- Sb -b - 53.3 m 600 m Figure F8. Dimensions of the arch of

  12. Estimating bridge stiffness using a forced-vibration technique for timber bridge health monitoring

    Treesearch

    James P. Wacker; Xiping Wang; Brian Brashaw; Robert J. Ross

    2006-01-01

    This paper describes an effort to refine a global dynamic testing technique for evaluating the overall stiffness of timber bridge superstructures. A forced vibration method was used to measure the frequency response of several simple-span, sawn timber beam (with plank deck) bridges located in St. Louis County, Minnesota. Static load deflections were also measured to...

  13. 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

  14. A modified self-calibrating technique for an ultrasonic bridge

    NASA Astrophysics Data System (ADS)

    Komsky, I. N.; Achenbach, J. D.

    A second-generation ultrasonic bridge is presented for dry-contact self-calibrated measurements of wave velocities and amplitude changes over the gauge length of the ultrasonic bridge. The modified bridge and the modified self-calibrating technique are applied to the detection of radial edge cracks emanating from a countersunk rivet in a rivet joint of two aluminum plates. The transmission of ultrasound across the rivet joint for a sequence of placements of the bridge at increasing distances from the center of the rivet for ultrasound propagation parallel and normal to the crack direction is investigated. Waveforms for the propagation of ultrasound normal and parallel to the crack are shown.

  15. Knee Articular Cartilage Repair and Restoration Techniques

    PubMed Central

    Richter, Dustin L.; Schenck, Robert C.; Wascher, Daniel C.; Treme, Gehron

    2015-01-01

    Context: Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or total knee arthroplasty are rarely advised. Numerous surgical techniques have been developed to address focal cartilage defects. Cartilage treatment strategies are characterized as palliation (eg, chondroplasty and debridement), repair (eg, drilling and microfracture [MF]), or restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]). Evidence Acquisition: PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years. Study Design: Clinical review. Level of Evidence: Level 4. Results: In general, smaller lesions (<2 cm2) are best treated with MF or OAT. Furthermore, OAT shows trends toward greater longevity and durability as well as improved outcomes in high-demand patients. Intermediate-size lesions (2-4 cm2) have shown fairly equivalent treatment results using either OAT or ACI options. For larger lesions (>4 cm2), ACI or OCA have shown the best results, with OCA being an option for large osteochondritis dissecans lesions and posttraumatic defects. Conclusion: These techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage. PMID:26502188

  16. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results

    PubMed Central

    Imam, Mohamed Abdelnabi; Abdelkafy, Ashraf

    2016-01-01

    Background: The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. Methods: Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, the Constant-Murley (CM) Score and Range of motion (ROM). Secondary outcome measures included a Visual Analogue Scale (VAS) for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D) for quality of life assessment. Results: At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. Conclusion: Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up. PMID:27163096

  17. 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.

  18. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

    PubMed

    Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

    2017-07-01

    The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p < 0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

  19. Nerve Cross-Bridging to Enhance Nerve Regeneration in a Rat Model of Delayed Nerve Repair

    PubMed Central

    2015-01-01

    There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1) CP neurons that regenerated their axons within three months or 2) CP motor nerves that reinnervated the extensor digitorum longus (EDL) muscle within five months was determined by counting and motor unit number estimation (MUNE), respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays. PMID:26016986

  20. Nerve cross-bridging to enhance nerve regeneration in a rat model of delayed nerve repair.

    PubMed

    Gordon, Tessa; Hendry, Michael; Lafontaine, Christine A; Cartar, Holliday; Zhang, Jennifer J; Borschel, Gregory H

    2015-01-01

    There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1) CP neurons that regenerated their axons within three months or 2) CP motor nerves that reinnervated the extensor digitorum longus (EDL) muscle within five months was determined by counting and motor unit number estimation (MUNE), respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays.

  1. 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.

  2. Comparison of the Clinical and Radiological Oucomes of Conventional Double row and Double row Suture Bridge Repairs in Rotator Cuff Tears

    PubMed Central

    Muiño, José María Silberberg; Gimenez, Martín Alejandro; Salvucci, Mauro Gabriel Maroa; Ferro, Diego; Rullan, Ramón Muiña; Blanchero, Pablo

    2017-01-01

    Objectives: To compare clinical and radiological results of two types of rotator cuff (RC) repairs: the double row and double row-suture bridge. Methods: Forty-two patients with a complete tear (medium and large size) of the RC were repaired by a double row arthroscopic technique. Minimum follow-up was 19 months (range, 19-28 months). Clinical outcomes were assessed by the Modified Constant Scale and satisfaction rate by an independent observer; VAS, UCLA and ASES. Radiological results were assed by a postoperative MRI by a musculoskeletal radiologist. Results: Series of 22 patients in the double row technique (Group A) and 20 patients in the double-row suture bridge (Gruop B). Statistically there was a significant improvement in the Constant Scale, satisfaction rate, muscle assessment, VAS, UCLA and ASES in both groups after the surgical procedure. There were no significant clinical differences between both groups at any time after the surgical procedure. According to MRI postop, 19/22 shoulders in Group A and 18/20 in Group B remained intact, with no significant differences between the two groups. Conclusion: RC repairs with double row and double-row-suture bridge techniques provide clinical and radiological good and excelent results. In our retrospective, mid-size study, we have found no differences between these two repair techniques.

  3. Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair

    PubMed Central

    Franceschi, Francesco; Longo, Umile Giuseppe; Ruzzini, Laura; Rizzello, Giacomo; Maffulli, Nicola; Denaro, Vincenzo

    2008-01-01

    Background Rotator cuff tears are frequently associated with pathologies of the long head of the biceps tendon (LHBT). Tenotomy and tenodesis of the LHBT are commonly used to manage disorders of the LHBT. Methods We present an arthroscopic soft tissue LHBT tenodesis associated with a Roman Bridge (double pulley – suture bridges) repair Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. A shuttle is passed through an anterior point of the rotator cuff and through the LHBT by means of a Penetrator or a BirdBeak suture passer (Arthrex, Naples, FL). A tenotomy of the LHBT is performed. All the sutures from the anteromedial anchor are passed through a single anterior point in the rotator cuff using a shuttle technique. All the sutures from the posteromedial anchor are passed through a single posterior point in the rotator cuff. The sutures in the medial row are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. The two free suture limbs are then used to produce suture bridges over the tendon, using a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. The same double pulley – suture bridges technique is repeated for the other two suture limbs from the two medial anchors. Conclusion This technique allows to perform a double pulley – suture bridges repair for a rotator cuff tear, associated with a soft tissue tenodesis for the management of LHBT pathology. The tenodesis of the LHBT is performed just with the passage of a shuttle inside the LHBT, after passing it through the anterior portion of the rotator cuff, with successive detachment of the LHBT from the glenoid. It is a

  4. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

    PubMed Central

    Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh

    2017-01-01

    ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017

  5. Primary hypospadias repair techniques: A review of the evidence

    PubMed Central

    Snodgrass, Warren; Bush, Nicol

    2016-01-01

    This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques. PMID:28057982

  6. Augmentation techniques for rotator cuff repair.

    PubMed

    Papalia, Rocco; Franceschi, Francesco; Zampogna, Biagio; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    There is a high rate of recurrence of tear and failed healing after rotator cuff repair. Several strategies have proposed to augment rotator cuff repairs to improve postoperative outcome and shoulder performance. We systematically review the literature on clinical outcome following rotator cuff augmentation. We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials, from inception of the database to 20 June 2012, using various combinations of keywords. The reference lists of the previously selected articles were then examined by hand. Only studies focusing on clinical outcomes of human patients who had undergone augmented rotator cuff repair were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS). Thirty-two articles were included in the present review. Two were retrospective studies, and 30 were prospective. Biologic, synthetic and cellular devices were used in 24, 7 and 1 studies, respectively. The mean modified Coleman methodology score was 64.0. Heterogeneity of the clinical outcome scores makes it difficult to compare different studies. None of the augmentation devices available is without problems, and each one presents intrinsic weaknesses. There is no dramatic increase in clinical and functional assessment after augmented procedures, especially if compared with control groups. More and better scientific evidence is necessary to use augmentation of rotator cuff repairs in routine clinical practice.

  7. Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model

    PubMed Central

    Redler, Lauren H.; Byram, Ian R.; Luchetti, Timothy J.; Tsui, Ying Lai; Moen, Todd C.; Gardner, Thomas R.; Ahmad, Christopher S.

    2014-01-01

    Background: Redundancies in the rotator cuff tissue, commonly referred to as “dog ear” deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited. Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model. Study Design: Controlled laboratory study. Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests. Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant

  8. Monitoring Of Generator Stator Core Lamination Repairs Using Thermographic Techniques

    NASA Astrophysics Data System (ADS)

    Stevens, D. C.

    1983-03-01

    Thermographic techniques have for years been used to locate minor interlaminar faults in the stator cores of steam turbine-driven generators. The technique has been largely employed in a quality control or routine maintenance function. However similar thermo-graphic techniques can be used to detect interlaminar faults and monitor repairs of an extensively damaged stator core of a large hydroelectric generator.

  9. Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.

    PubMed

    Gartsman, Gary M; Drake, Gregory; Edwards, T Bradley; Elkousy, Hussein A; Hammerman, Steven M; O'Connor, Daniel P; Press, Cyrus M

    2013-11-01

    The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  10. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis

    PubMed Central

    Askenasy, Eric P.; Greenberg, Jacob A.; Keith, Jerrod N.; Martindale, Robert G.; Roth, J. Scott; Mo, Jiandi; Ko, Tien C.; Kao, Lillian S.; Liang, Mike K.

    2016-01-01

    Abstract Background: Repair of large ventral hernia defects is associated with high rates of surgical site occurrences (SSO), including surgical site infection (SSI), site dehiscence, seroma, hematoma, and site necrosis. Two common operative strategies exist: Component separation (CS) with primary fascial closure and mesh reinforcement (PFC-CS) and bridged repair (mesh spanning the hernia defect). We hypothesized that: (1) ventral hernia repair (VHR) of large defects with bridged repair is associated with more SSOs than is PFC, and (2) anterior CS is associated with more SSOs than is endoscopic, perforator-sparing, or posterior CS. Methods: Part I of this study was a review of a multi-center database of patients who underwent VHR of a defect ≥8 cm from 2010–2011 with at least one month of follow-up. The primary outcome was SSO. The secondary outcome was recurrence. Part II of this study was a systematic review and meta-analysis of studies comparing bridged repair with PFC and studies comparing different kinds of CS. Results: A total of 108 patients were followed for a median of 16 months (range 1–50 months), of whom 84 underwent PFC-CS and 24 had bridged repairs. Unadjusted results demonstrated no differences between the groups in SSO or recurrence; however, the study was underpowered for this purpose. On meta-analysis, PFC was associated with a lower risk of SSO (odds ratio [OR] = 0.569; 95% confidence interval [CI] = 0.34–0.94) and recurrence (OR = 0.138; 95% CI = 0.08–0.23) compared with bridged repair. On multiple-treatments meta-analysis, both endoscopic and perforator-sparing CS were most likely to be the treatments with the lowest risk of SSO and recurrence. Conclusions: Bridged repair was associated with more SSOs than was PFC, and PFC should be used whenever feasible. Endoscopic and perforator-sparing CS were associated with the fewest complications; however, these conclusions are limited by heterogeneity between studies and

  11. Arthroscopic suture bridge rotator cuff repair: functional outcome, repair integrity, and preoperative factors related to postoperative outcome.

    PubMed

    Rimmke, Nathan; Maerz, Tristan; Cooper, Ross; Yadavalli, Sailaja; Anderson, Kyle

    2016-01-01

    To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair. Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography. Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41-79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P < 0.001), VAS pain score (4.69 ± 2.17 to 0.63 ± 1.29, P < 0.001), forward elevation range of motion (144.1° ± 29.9 to 159.69° ± 13.9, P = 0.002), and internal rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs. 2.05 cm ± 0.48, P < 0.001). Preoperative tear size was significantly associated with a postoperative retear (P < 0.001). The duration of preoperative symptoms was significantly associated with pain (P = 0.029), pain improvement (P = 0.013), internal rotation ROM (P = 0.002), and internal rotation strength (P = 0.004). Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes. IV, Case Series.

  12. Robotic-assisted mitral valve repair: surgical technique.

    PubMed

    Algarni, Khaled D; Suri, Rakesh M; Daly, Richard C

    2014-01-01

    Robotic-assisted mitral valve repair represents the least invasive surgical approach currently available for anatomical mitral valve repair in patients with myxomatous mitral valve disease. Standard mitral valve repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional mitral valve repair done via an open sternotomy approach, the quality of mitral valve repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic mitral valve repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful mitral valve repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.

  13. Biomechanical properties under cyclic loading of seven meniscus repair techniques.

    PubMed

    Becker, Roland; Stärke, Christian; Heymann, Marlen; Nebelung, Wolfgang

    2002-07-01

    The purpose of the current study was to obtain additional information about the biomechanical behavior of different fixation techniques for meniscus repair using recently developed biodegradable implants and suture repair techniques. The posterior horns of human menisci were used to investigate the meniscus repair construct of the Arrow, Screw, Stinger, Fastener, T-fix, and horizontal and vertical mattress suture. A 20 mm-longitudinal incision was made in the meniscus, similar to a bucket handle lesion, 3 mm from the meniscosynovial rim and was repaired. One hundred cycles between 5 N and 15 N were done using a tension load machine with a loading rate of 10 N/second. The stiffness, displacement, and pullout strength were examined. The significantly highest stiffness was found for the vertical mattress suture (17.1 N/mm) and Stinger (15 N/mm) followed by the Arrow (13.7 N/mm), T-fix (10.5 N/mm), and horizontal mattress suture (10 N/mm). Superior load to failure was obtained for the suture repair in comparison with the biodegradable implants. Despite the lower pullout strength of biodegradable implants, similar stiffnesses were found for the Stinger and Arrow in comparison with the mattress suture technique. These techniques provide the most rigid fixation that is essential for tissue healing.

  14. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Tetrameric Ctp1 coordinates DNA binding and DNA bridging in DNA double-strand-break repair

    SciTech Connect

    Andres, Sara N.; Appel, C. Denise; Westmoreland, James W.; Williams, Jessica S.; Nguyen, Yvonne; Robertson, Patrick D.; Resnick, Michael A.; Williams, R. Scott

    2015-01-12

    Ctp1 (also known as CtIP or Sae2) collaborates with Mre11-Rad50-Nbs1 to initiate repair of DNA double-strand breaks (DSBs), but its functions remain enigmatic. In this paper, we report that tetrameric Schizosaccharomyces pombe Ctp1 contains multivalent DNA-binding and DNA-bridging activities. Through structural and biophysical analyses of the Ctp1 tetramer, we define the salient features of Ctp1 architecture: an N-terminal interlocking tetrameric helical dimer-of-dimers (THDD) domain and a central intrinsically disordered region (IDR) linked to C-terminal 'RHR' DNA-interaction motifs. The THDD, IDR and RHR are required for Ctp1 DNA-bridging activity in vitro, and both the THDD and RHR are required for efficient DSB repair in S. pombe. Finally, our results establish non-nucleolytic roles of Ctp1 in binding and coordination of DSB-repair intermediates and suggest that ablation of human CtIP DNA binding by truncating mutations underlie the CtIP-linked Seckel and Jawad syndromes.

  16. Tetrameric Ctp1 coordinates DNA binding and DNA bridging in DNA double-strand-break repair

    DOE PAGES

    Andres, Sara N.; Appel, C. Denise; Westmoreland, James W.; ...

    2015-01-12

    Ctp1 (also known as CtIP or Sae2) collaborates with Mre11-Rad50-Nbs1 to initiate repair of DNA double-strand breaks (DSBs), but its functions remain enigmatic. In this paper, we report that tetrameric Schizosaccharomyces pombe Ctp1 contains multivalent DNA-binding and DNA-bridging activities. Through structural and biophysical analyses of the Ctp1 tetramer, we define the salient features of Ctp1 architecture: an N-terminal interlocking tetrameric helical dimer-of-dimers (THDD) domain and a central intrinsically disordered region (IDR) linked to C-terminal 'RHR' DNA-interaction motifs. The THDD, IDR and RHR are required for Ctp1 DNA-bridging activity in vitro, and both the THDD and RHR are required for efficientmore » DSB repair in S. pombe. Finally, our results establish non-nucleolytic roles of Ctp1 in binding and coordination of DSB-repair intermediates and suggest that ablation of human CtIP DNA binding by truncating mutations underlie the CtIP-linked Seckel and Jawad syndromes.« less

  17. 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.

  18. 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

  19. Repair of type I endoleak by chimney technique after endovascular abdominal aortic aneurysm repair

    PubMed Central

    Kim, Na Hee; Kim, Woo Chul; Cho, Soon Gu; Hong, Kee Chun

    2014-01-01

    Endovascular aneurysm repair is a minimally invasive, durable and effective alternative to open surgery for treatment of abdominal aortic aneurysms (AAA). However, in patients who do not have an adequate sealing zone, open surgical repair is required, which may increase mortality and morbidity. An alternative treatment in patients with challenging anatomy is the so-called "chimney graft" technique. Here, we describe a case using the chimney graft technique for treatment of juxtarenal type I endoleak followed by a previous conventional stent graft insertion to the AAA with good results. PMID:24851230

  20. Tumescent local anesthetic technique for inguinal hernia repairs

    PubMed Central

    Chyung, Ju Won; Kwon, Yujin; Cho, Dong Hui; Lee, Kyung Bok; Park, Sang Soo; Yoon, Jin; Jang, Yong Seog

    2014-01-01

    Purpose We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. Methods The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. Results The mean operation time (±standard deviation) and hospital stay were 64.5 ± 17.6 minutes and 2.7 ± 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 ± 14 months. Conclusion Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs. PMID:25485241

  1. A novel technique of concealed penis repair.

    PubMed

    Kim, Jung Jun; Lee, Dong-Gi; Park, Kwan Hyun; Baek, Minki

    2014-04-01

    The correction of concealed penis requires challenging surgical techniques. We describe a novel technique involving inner preputial skin substitution after degloving through a ventral approach that allows sufficient penile skin coverage and evaluated the efficacy and safety of our technique. From February 2009 to March 2009, 12 boys with concealed penises underwent correction via our novel technique. We administered a questionnaire about penile size, morphology, and voiding status to parents to evaluate their satisfaction with the results. The mean age of patients at the time of operation was 4.71 ± 4.01 years, and the mean duration of follow-up was 5.11 ± 1.45 months. Parental satisfaction grades (0 to 4) concerning penile size increased from 1.00 ± 1.04 to 2.83 ± 0.94 (p = 0.002) after surgery, penile morphology from 1.00 ± 0.95 to 3.00 ± 0.85 (p = 0.001), and voiding status from 1.08 ± 1.00 to 3.33 ± 0.78 (p < 0.001) at the last follow-up visit. The parental satisfaction rates regarding postoperative changes in size and morphology were 83.3 and 91.7%, respectively. Nine parents (75%) said they would recommend the surgery to others. There were no complications, including postoperative hematoma, infection, and tissue necrosis. Our method of correcting concealed penis was demonstrated to be technically feasible and safe. It provides a good cosmetic appearance and excellent parental satisfaction ratings regarding size, morphology, and voiding function. Georg Thieme Verlag KG Stuttgart · New York.

  2. Simple Technique of Bridging Wide Gap in Esophageal Atresia with Tracheoesophageal Fistula - "Surgical Innovation".

    PubMed

    Sharma, A K; Mangal, D

    2017-01-01

    The survival of the patients with esophageal atresia an tracheo esophageal fistula is believed to be an epitome of the success of the neonatal surgery. Restoring the continuty of the food pipe by esophagus to esophagus anastomosis is the best option. Preservation of natural esophagus by delayed repair in a wide gap esophageal atresia is a preferred technique worldwide, however such a management required prolonged hospitalization and dedicated nursing care, which is often not available in most of the centres in India. Esophageal substitutes in wide gap requires multiple operations and have long term problems, so remains the last option. I use the technique of oblique anastomosis which had distrinct advantage over circular anastomosis in the management of esophageal atresia1. This techniqe helps in bridging wide gap to some extent & minimal stricture formation.

  3. Cost Effective Repair Techniques for Turbine Airfoils. Volume I

    DTIC Science & Technology

    1978-11-01

    Turbine blades and vanes in current engines are subjected to the most hostile environment...payoff potential in turbine vanes / blades . The criteria used included: • Incidence of damage - Scrapped or damaged turbine airfoils at the ALC centers...Corporate Author: GENERAL ELECTRIC CO CINCINNATI OHIO AIRCRAFT ENGINE GROUP Unclassified Title: (U) Cost Effective Repair Techniques for Turbine

  4. Damage Tolerant Repair Techniques for Pressurized Aircraft Fuselages

    DTIC Science & Technology

    1994-01-01

    34Don’t fight forces, use them.’ R. Buckminster Fuller , Shelter (1932) The finite element analysis method was chosen to complement traditional direct...the model. 32 Damage Tolerant Repair Techniques for Pressurized Aircraft Fuselages 2.4.5 Finite Element Analysis Results The results give a fuller

  5. 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.

  6. Single molecule techniques in DNA repair: A primer

    PubMed Central

    Hughes, Craig D.; Simons, Michelle; Mackenzie, Cassidy E.; Van Houten, Bennett; Kad, Neil M.

    2016-01-01

    A powerful new approach has become much more widespread and offers insights into aspects of DNA repair unattainable with billions of molecules. Single molecule techniques can be used to image, manipulate or characterize the action of a single repair protein on a single strand of DNA. This allows search mechanisms to be probed, and the effects of force to be understood. These physical aspects can dominate a biochemical reaction, where at the ensemble level their nuances are obscured. In this paper we discuss some of the many technical advances that permit study at the single molecule level. We focus on DNA repair to which these techniques are actively being applied. DNA repair is also a process that encompasses so much of what single molecule studies benefit – searching for targets, complex formation, sequential biochemical reactions and substrate hand-off to name just a few. We discuss how single molecule biophysics is poised to transform our understanding of biological systems, in particular DNA repair. PMID:24819596

  7. Arthroscopy for shoulder instability and a technique for arthroscopic repair.

    PubMed

    Wiley, A M

    1988-01-01

    At this time the principal role of the arthroscope in the management of dislocating shoulder seems to be the identification of the intra-articular pathology. The findings should enable a surgeon to carry out an appropriate open repair, and the results of such surgery are excellent. Is there a place for arthroscopic repair? Some patients sometimes request it; others have had a failed open repair, or wish to avoid a scar. The author has devised a removable "Rivet," which fixes a loose labrum and the inferior glenohumeral ligament back on to a roughened glenoid margin. Use of this technique avoids some of the hazards that occur with implanting a staple or similar device in the joint. The "Rivet" is removed after 4-6 weeks. Ten patients have been so treated, with a follow-up of 6 months to 2 years. There was one failure, with a return of dislocation.

  8. A novel technique in repair of radial meniscus tear

    PubMed Central

    Aşcı, Murat; Kurnaz, Recep; Balta, Orhan; Güneş, Taner

    2017-01-01

    Introduction: Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complet radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. Aim: We developed a new suture technique named Cross Horizontal Loop(CHL). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop(HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (CHL vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests Materials-Methods: We used 20 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:10) menisci were repaired with standart horizontal loop technique, and in the second group (n:10) cross horizontal loop technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cyclus X 5-30 N). Results: Both groups have similar failure load (71,4±17,52 N vs. 77,9±28,49 N; p:0,559) and stiffness (24,46±19,19 N vs. 24,48±15,87 N; p:0,818). CHL group has less peak displacement (6,26±1,24 mm vs. 8,4±1,92 mm; p:0,010). Conclusions: This novel repair technique decreases the amount of displacement according to standard technique while as strong as standart technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use. Tablo 1. Radial Yırtıkların Gruplara Göre Dağılımı Gruplar Değiskenler Horizontal Cross Horizontal Loop t/Z p n Ort±SS n Ort±SS Peak Displacement (mm) 9 6,26±1,24 11 8,4±l,92 2,880 0,010* Peak Force (N) 9 35,82±1,47 11 38,5±2,67 2,842 0,015* Static Peak Force (N) 9 71,4±17,52 11

  9. Simple Technique Overcoming a Persistent Problem in Cleft Palate Repair.

    PubMed

    Kotrashetti, S M; Dube, Gunjan; Thakkar, Bhushan; Ahuja, Manav

    2016-12-01

    Cleft palate repair mandates use of a mouth gag and Dingmans moth gag is the most commonly used for the same; but the use of Dingmans mouth gag may have the demerit of the suture getting tethered at various places of the instrument during cleft palate closure particularly in the hands of the beginner surgeon. This article discusses about a simple technique of using a rubber dam sheet to cover the frame of the mouth gag. The technique discussed in this article is simple, cost effective method to overcome the potential disadvantage of suture adherence during repair of palatal tissue. The technique also has the potential to reduce the total operative time which needs a further study to validate the same.

  10. Iris mattress suture: a technique for sectoral iris defect repair.

    PubMed

    Tsao, Sean W; Holz, Huck A

    2015-03-01

    Achieving a cosmetic and functional outcome from iris defect repair is a surgical challenge. We describe an adaptation of techniques to address a case of 2.5 clock hours of sectoral iris tissue defect. Our method combines Siepser's modified closed-chamber sliding knot technique with the placement of a double-armed iris mattress suture to approximate iris tissue to the scleral wall and thereby create a pseudo-iris root. This technique reduces glare and achieves a cosmetic outcome for the patient.

  11. Single pass, single suture technique for repair of traumatic mydriasis.

    PubMed

    Angmo, Dewang; Agarwal, Tushar; Khokhar, Sudarshan

    2013-01-01

    We describe a 52-year-old man with pseudophakia and traumatic mydriasis who presented with severe glare. A modification of the Siepser sliding knot technique-single pass, single suture technique-allows the surgeon to create a locking knot at the extraocular space while maintaining a closed chamber, a safer and easier method for traumatic mydriasis repair. A reduction of pupil size from 8.0×7.8 mm to 5.5 mm was noted. The patient's complaint of glare was relieved and the glare acuity was 20/40 at 6 months follow-up. We present a new, simpler application of the Siepser slipknot which can be used successfully for repair of traumatic mydriasis.

  12. A technique of repairing acid burns of the stomach.

    PubMed Central

    Gupta, S.

    1988-01-01

    A technique of repairing acid burns of the stomach which are followed by fibrosis and stricture formation, is described. The operation has been done on 3 patients with a maximum follow-up of 4 years. The method has an advantage over conventional gastrojejunostomy of enlarging small gastric remnants especially when an oesophageal bypass is either necessary at the same time or later on. Also normal gastroduodenal continuity is maintained. Images Fig. 1 Fig. 2 Fig. 3 PMID:3408163

  13. The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure: An Early Feasibility Cohort Study.

    PubMed

    Murray, Martha M; Flutie, Brett M; Kalish, Leslie A; Ecklund, Kirsten; Fleming, Braden C; Proffen, Benedikt L; Micheli, Lyle J

    2016-11-01

    This study assessed the safety of the newly developed bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR), which involves suture repair of the ligament combined with a bioactive scaffold to bridge the gap between the torn ligament ends. As the intra-articular environment is complex in its response to implanted materials, this study was designed to determine whether there would be a significant rate of adverse reaction to the implanted scaffold. The primary hypothesis was that the implanted scaffold would not result in a deep joint infection (arthrocentesis with positive culture) or significant inflammation (clinical symptoms justifying arthrocentesis but negative culture). The secondary hypotheses were that patients treated with BEAR would have early postoperative outcomes that were similar to patients treated with ACL reconstruction with an autologous hamstring graft. Cohort study; Level of evidence, 2. A total of 20 patients were enrolled in this nonrandomized, first-in-human study. Ten patients received BEAR treatment and 10 received a hamstring autograft ACL reconstruction. The BEAR procedure was performed by augmenting a suture repair with a proprietary scaffold, the BEAR scaffold, placed in between the torn ends of the ACL at the time of suture repair. The BEAR scaffold is to our knowledge the only device that fills the gap between the torn ligament ends to have current Investigational Device Exemption approval from the Food and Drug Administration. Ten milliliters of autologous whole blood were added to the scaffold prior to wound closure. Outcomes were assessed at 3 months postoperatively. The outcomes measures included postoperative pain, muscle atrophy, loss of joint range of motion, and implant failure (designated by an International Knee Documentation Committee grade C or D Lachman test and/or an absence of continuous ACL tissue on magnetic resonance images). There were no joint infections or signs of significant inflammation in either group

  14. Development of flexural vibration inspection techniques to rapidly assess the structural health of rural bridge systems

    Treesearch

    Brian K. Brashaw; Robert Vatalaro; Xiping Wang; Kevin Sarvela; James P. Wacker

    2008-01-01

    Approximately 4,000 vehicle bridges in the State of Minnesota contain structural timber members. Recent research at the University of Minnesota Duluth Natural Resources Research Institute (UMD NRRI) has been conducted on vibration testing of timber bridges as a means of developing rapid in-place testing techniques for assessing the structural health of bridges. The...

  15. Evaluation of fleet management techniques for timber highway bridges

    Treesearch

    Brent M. Phares; Travis K. Hosteng; Justin Dahlberg; Michael A. Ritter

    2011-01-01

    The general condition of the nation's bridges presents a complex management issue when considering cost, safety, and time. Consequently, the management of those bridges can become an overwhelming task. The need for a management system that is specific to rural systems may help to improve the management of this significant number of bridges. Although individual...

  16. Open tension free repair of inguinal hernias; the Lichtenstein technique

    PubMed Central

    Sakorafas, George H; Halikias, Ioannis; Nissotakis, Christos; Kotsifopoulos, Nikolaos; Stavrou, Alexios; Antonopoulos, Constantinos; Kassaras, George A

    2001-01-01

    Background Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. Methods In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. Results Inguinal hernia was indirect in 55 % of cases (297 patients), direct in 30 % (162 patients) and of the pantaloon (mixed) type in 15 % (81 patients). Mean patient age was 53.7 years (range, 18 – 85). Follow-up was completed in 407 patients (80 %) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1 – 6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2 %). Postoperative neuralgia was observed in 5 patients (1 %). Conclusion Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994. PMID:11696246

  17. Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques

    PubMed Central

    Dewan, Ashvin K.; Gibson, Matthew A.; Elisseeff, Jennifer H.; Trice, Michael E.

    2014-01-01

    Articular cartilage defects have been addressed using microfracture, abrasion chondroplasty, or osteochondral grafting, but these strategies do not generate tissue that adequately recapitulates native cartilage. During the past 25 years, promising new strategies using assorted scaffolds and cell sources to induce chondrocyte expansion have emerged. We reviewed the evolution of autologous chondrocyte implantation and compared it to other cartilage repair techniques. Methods. We searched PubMed from 1949 to 2014 for the keywords “autologous chondrocyte implantation” (ACI) and “cartilage repair” in clinical trials, meta-analyses, and review articles. We analyzed these articles, their bibliographies, our experience, and cartilage regeneration textbooks. Results. Microfracture, abrasion chondroplasty, osteochondral grafting, ACI, and autologous matrix-induced chondrogenesis are distinguishable by cell source (including chondrocytes and stem cells) and associated scaffolds (natural or synthetic, hydrogels or membranes). ACI seems to be as good as, if not better than, microfracture for repairing large chondral defects in a young patient's knee as evaluated by multiple clinical indices and the quality of regenerated tissue. Conclusion. Although there is not enough evidence to determine the best repair technique, ACI is the most established cell-based treatment for full-thickness chondral defects in young patients. PMID:25210707

  18. The double-pulley technique for double-row rotator cuff repair.

    PubMed

    Arrigoni, Paolo; Brady, Paul C; Burkhart, Stephen S

    2007-06-01

    In an effort to maximize the area of footprint coverage, we developed the "double-pulley technique" for double-row rotator cuff repairs. Two suture anchors are inserted at the articular margin of the greater tuberosity (one anterior and one posterior). All 4 suture strands from each anchor are passed through a single medial point on the torn cuff. In this way, the 4 suture strands from the anteromedial anchor pass through 1 point in the cuff and the 4 strands from the posteromedial anchor pass through a different point in the cuff. A suture strand from 1 anchor is tied extracorporeally to a suture strand of the same color from the other anchor. The other ends of those 2 strands are then pulled, thereby delivering this extracorporeal knot into the joint and over the medial footprint. These 2 free suture strands are then tied together as a static knot. The procedure is repeated with the other sutures. This technique creates a double mattress suture medially, which compresses the intervening tendon bridge against its bone bed. We call this procedure the double-pulley technique because it uses the anchor eyelets as pulleys to deliver the extracorporeal knot into the shoulder. After the lateral row repair is performed, the rotator cuff footprint will be completely reconstituted.

  19. 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.

  20. 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.

  1. New techniques and technology to repair cerebrospinal fluid rhinorrhea.

    PubMed

    Paludetti, G; Sergi, B; Rigante, M; Campioni, P; Galli, J

    2004-06-01

    Cerebrospinal fluid rhinorrhea occurs as a result of abnormal communication between the subarachnoid space and the pneumatized portion of the skull base, the paranasal sinuses and the middle ear. Conservative measures may be sufficient in the management of cerebrospinal fluid rhinorrhea, but, in some cases, surgical treatment may be required. Transnasal endoscopic techniques are constantly being used in preference to the intra- and extracranial approaches. Recently, image guidance systems have been adopted in neurosurgery, skull base and paranasal sinus surgery. The present report refers to 4 cases of nasal cerebrospinal fluid rhinorrhea leak successfully treated with a transnasal endoscopic approach using various techniques and materials to close the bone defect, in 2 of which, the navigation system (Stealth Station Treon ENT Image Guidance System with Landmark X, Software, Medtronic, XOMED, Jacksonville, FL, USA) was also used. In all cases, correct localization and repair of the leak was achieved and no major complications occurred. Following a review of the literature, the Authors conclude that, at present, transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is the surgical treatment of choice when the techniques and materials are correctly used. Furthermore, preliminary findings indicate that it is possible to make routine use of the navigation systems and that this technology may be usefully employed, above all, in the management of cerebrospinal fluid leaks.

  2. Dental dam patch: an effective intraoral repair technique using cyanoacrylate.

    PubMed

    Liebenberg, W H

    1998-10-01

    Secondary dental dam retention is a critical component of successful dental dam isolation and relates to the provision of an effective seal at the dam/tooth junction. Restorative success can be compromised if this seal is inadvertently interrupted during the operative effort. One such periodic mishap is entanglement of the bur and the interdental dam strip during caries or restorative removal. This invariably results in a gaping interproximal defect in the dam. This article discusses the importance of optimum isolation as it relates to current "wet bonding" adhesive procedures, and introduces a repair technique using a patch of dental dam and cyanoacrylate.

  3. Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: effects of recurrence and repair technique.

    PubMed

    Snyder, C W; Graham, L A; Vick, C C; Gray, S H; Finan, K R; Hawn, M T

    2011-04-01

    To determine the effects of repair technique and hernia recurrence on patient-reported outcomes after incisional hernia repair. This cohort study included patients from sixteen Veteran's Affairs Medical Centers across the United States who underwent elective incisional hernia repair between 1997 and 2002. Technical details and outcomes (repair type and recurrence status) were determined by physician chart review. Patient satisfaction, chronic pain (McGill pain scale and visual analogue scale), and health-related quality of life (Short Form 36) were evaluated with a mailed survey at a median of five years after repair. Multivariable regression modeling was performed to evaluate the effect of repair type and recurrence status on patient-reported outcomes. Of 854 patients alive at the time of survey mailing, 371 responded (43.4%). Patients with active recurrence were more likely to be dissatisfied with their results (odds ratio (OR) 6.2, P < 0.0001), to have chronic sensory hernia site pain (OR 3.2, P = 0.01), to report disturbance from pain (OR 2.1, P = 0.04), and to have significantly worse quality of life on the Physical Function, General Health, and Physical Component Score domains. Repair technique with permanent mesh versus suture had no independent effect on patient satisfaction, chronic pain, or QOL. Recurrence has a substantial negative effect on patient-reported outcomes after incisional hernia repair, whereas the repair technique has no independent effect.

  4. 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

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

    PubMed

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

    2016-02-01

    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.

  6. Surgical technique for repair of complex anterior skull base defects.

    PubMed

    Reinard, Kevin; Basheer, Azam; Jones, Lamont; Standring, Robert; Lee, Ian; Rock, Jack

    2015-01-01

    Modern microsurgical techniques enable en bloc resection of complex skull base tumors. Anterior cranial base surgery, particularly, has been associated with a high rate of postoperative cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess, and pneumocephalus. We introduce simple modifications to already existing surgical strategies designed to minimize the incidence of postoperative CSF leak and associated morbidity and mortality. Medical records from 1995 to 2013 were reviewed in accordance with the Institutional Review Board. We identified 21 patients who underwent operations for repair of large anterior skull base defects following removal of sinonasal or intracranial pathology using standard craniofacial procedures. Patient charts were screened for CSF leak, meningitis, or intracranial abscess formation. A total of 15 male and 6 female patients with an age range of 26-89 years were included. All patients were managed with the same operative technique for reconstruction of the frontal dura and skull base defect. Spinal drainage was used intraoperatively in all cases but the lumbar drain was removed at the end of each case in all patients. Only one patient required re-operation for repair of persistent CSF leak. None of the patients developed meningitis or intracranial abscess. There were no perioperative mortalities. Median follow-up was 10 months. The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons.

  7. Surgical technique for repair of complex anterior skull base defects

    PubMed Central

    Reinard, Kevin; Basheer, Azam; Jones, Lamont; Standring, Robert; Lee, Ian; Rock, Jack

    2015-01-01

    Background: Modern microsurgical techniques enable en bloc resection of complex skull base tumors. Anterior cranial base surgery, particularly, has been associated with a high rate of postoperative cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess, and pneumocephalus. We introduce simple modifications to already existing surgical strategies designed to minimize the incidence of postoperative CSF leak and associated morbidity and mortality. Methods: Medical records from 1995 to 2013 were reviewed in accordance with the Institutional Review Board. We identified 21 patients who underwent operations for repair of large anterior skull base defects following removal of sinonasal or intracranial pathology using standard craniofacial procedures. Patient charts were screened for CSF leak, meningitis, or intracranial abscess formation. Results: A total of 15 male and 6 female patients with an age range of 26–89 years were included. All patients were managed with the same operative technique for reconstruction of the frontal dura and skull base defect. Spinal drainage was used intraoperatively in all cases but the lumbar drain was removed at the end of each case in all patients. Only one patient required re-operation for repair of persistent CSF leak. None of the patients developed meningitis or intracranial abscess. There were no perioperative mortalities. Median follow-up was 10 months. Conclusion: The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons. PMID:25722926

  8. 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

  9. Two-stitch technique for distal shaft hypospadias repair.

    PubMed

    Herman, Oscar; Heller, Lior; Dorenbaum, Arye; Westreich, Melvyn

    2002-02-01

    The authors present a new technique for distal shaft hypospadias repair using a flip flap fashioned with only two stitches. In raising the flap, the tissues lateral and proximal to the flap are undermined but there is no undermining beneath the flap. The flap is sutured up to the glans with two 4-0 Vicryl sutures. No sutures are placed at the lateral edges of the flap to create the "tube" of the neo-urethra, and no postoperative urinary drainage is used. Thirty-three children with distal shaft hypospadias underwent the "two-stitch" flip flap operation. The complications were one fistula and one case of urinary retention. The technique is an easy method for reconstructing distal penile hypospadias with a very low rate of complications and is suitable for an outpatient surgical setting.

  10. An attempt to describe a relationship between concrete deterioration quantities and bridge deck condition assessment techniques

    NASA Astrophysics Data System (ADS)

    Varnavina, Aleksandra V.; Sneed, Lesley H.; Khamzin, Aleksey K.; Torgashov, Evgeniy V.; Anderson, Neil L.

    2017-07-01

    This paper presents a study of the performance of four techniques - visual inspection, Ground Penetrating Radar (GPR), Ultrasonic Surface Wave (USW), and core control - that were used to assess condition of a concrete bridge deck. The bridge deck was then rehabilitated using hydrodemolition, and the concrete removed during hydrodemolition was assumed to be deteriorated. LiDAR measurements of concrete depth removal collected after hydrodemolition were used as ground truth. Comparisons of bridge deck condition assessment data and LiDAR concrete removal measurements were performed in this study. The comparisons attempt to find and describe a possible relationship between bridge deck assessment techniques and quantities of concrete deterioration.

  11. Precise Aircraft Guidance Techniques for NASA's Operation IceBridge

    NASA Astrophysics Data System (ADS)

    Sonntag, J. G.; Russell, R.

    2013-12-01

    We present a suite of novel aircraft guidance techniques we designed, developed and now operationally utilize to precisely guide large NASA aircraft and their sensor suites over polar science targets. Our techniques are based on real-time, non-differential Global Positioning System (GPS) data. They interact with the flight crew and the aircraft using a combination of yoke-mounted computer displays and an electronic interface to the aircraft's autopilot via the aircraft's Instrument Landing System (ILS). This ILS interface allows the crew to 'couple' the autopilot to our systems, which then guide the aircraft over science targets with considerably better accuracy than it can using its internal guidance. We regularly demonstrate errors in cross-track aircraft positioning of better than 4 m standard deviation and better than 2 m in mean offset over lengthy great-circle routes across the ice sheets. Our system also has a mode allowing for manual aircraft guidance down a predetermined path of arbitrary curvature, such as a sinuous glacier centerline. This mode is in general not as accurate as the coupled technique but is more versatile. We employ both techniques interchangeably and seamlessly during a typical Operation IceBridge science flight. Flight crews find the system sufficiently intuitive so that little or no familiarization is required prior to their accurately flying science lines. We regularly employ the system on NASA's P-3B and DC-8 aircraft, and since the interface to the aircraft's autopilot operates through the ILS, it should work well on any ILS-equipped aircraft. Finally, we recently extended the system to provide precise, three-dimensional landing approach guidance to the aircraft, thus transforming any approach into a precise ILS approach, even to a primitive runway. This was intended to provide a backup to the aircraft's internal landing systems in the event of a zero-visibility landing to a non-ILS equipped runway, such as the McMurdo sea ice runway

  12. Medial grasping sutures significantly improve load to failure of the rotator cuff suture bridge repair.

    PubMed

    Awwad, George E; Eng, Kevin; Bain, Gregory I; McGuire, Duncan; Jones, Claire F

    2014-05-01

    The suture bridge (SB) transosseous-equivalent rotator cuff repair reduces re-tear rates compared with single-row or other double-row constructs. However, failure rates continue to be high, especially in large and massive tears. The aim of this study was to assess the biomechanical performance of a new SB repair with use of a medial grasping suture compared with the traditional SB repair. Seven matched pairs of sheep infraspinatus tendons were randomly assigned to either SB or suture bridge with grasping suture (SBGS) repair. Each construct was subjected to cyclic loading and then loaded until failure under displacement control in a materials testing machine. Footprint displacement, ultimate load to failure, and mode of failure were assessed. The rotator cuff footprint displacement was less during tensile loading with the addition of the medial grasping suture. The ultimate load to failure was significantly greater for the SBGS repair group than for the SB repair group (334.0 N vs 79.8 N). The mode of failure was the tendon pulling off the footprint in all cases (type 1 tear). There were no failures in which the tendon tore at the medial row of anchors, leaving part of the tendon still on the footprint (type 2 tear). The addition of a medial grasping suture significantly improved the ultimate load to failure and reduced the footprint displacement of the SB rotator cuff repair in a biomechanical model. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  13. Structural basis for a novel mechanism of DNA bridging and alignment in eukaryotic DSB DNA repair.

    PubMed

    Gouge, Jérôme; Rosario, Sandrine; Romain, Félix; Poitevin, Frédéric; Béguin, Pierre; Delarue, Marc

    2015-04-15

    Eukaryotic DNA polymerase mu of the PolX family can promote the association of the two 3'-protruding ends of a DNA double-strand break (DSB) being repaired (DNA synapsis) even in the absence of the core non-homologous end-joining (NHEJ) machinery. Here, we show that terminal deoxynucleotidyltransferase (TdT), a closely related PolX involved in V(D)J recombination, has the same property. We solved its crystal structure with an annealed DNA synapsis containing one micro-homology (MH) base pair and one nascent base pair. This structure reveals how the N-terminal domain and Loop 1 of Tdt cooperate for bridging the two DNA ends, providing a templating base in trans and limiting the MH search region to only two base pairs. A network of ordered water molecules is proposed to assist the incorporation of any nucleotide independently of the in trans templating base. These data are consistent with a recent model that explains the statistics of sequences synthesized in vivo by Tdt based solely on this dinucleotide step. Site-directed mutagenesis and functional tests suggest that this structural model is also valid for Pol mu during NHEJ.

  14. Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

    PubMed

    Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

    2013-11-01

    Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  15. A simplified technique for giant inguinal hernia repair in infants.

    PubMed

    Banieghbal, B

    2008-06-01

    Repair of giant inguino-scrotal hernia (GISH) in male infants is a difficult operation, even in experienced hands. It requires an immaculate technique to avoid known complications such as tearing of the sac, injury to delicate testicular vessels and dividing of vas deferens. Moreover, a recurrence rate of 9% is noted in a number of reports. This article describes a new surgical maneuver to simplify the procedure. All GISH repaired by the author, over a 5-year period (October 2001-September 2006), were reviewed retrospectively. In total, 89 infants with 106 GISH underwent uni- or bilateral herniotomies. A standard inguinal incision is made and Scarpa's fascia is sharply opened; the external inguinal ring and the cord is identified. By gentle manipulation and blunt dissection, the spermatic cord together with the testis is exteriorized. The assistant applies gentle traction to the cord, which allows for easy identification of the inguinal sac and its subsequent separation from vas and vessels. Testis is replaced in the scrotum, hernial sac suture ligated at its base and the wound closed in layers. All cases were managed with the above approach. The average length of the procedure was 11 min for unilateral and 19 min for bilateral cases. Except for minimal scrotal swelling post-operatively, no other surgery-related complications were noted during or immediately after the operation. Testicular atrophy or iatrogenic undescended testes were not encountered in the follow-up period. Ipsilateral recurrent hernia was noted in one infant after 6 months which required re-operation with the same technique. In cases of GISH; dislocating the testis into the wound and applying a gentle stretch on the cord allows for a safe dissection of the hernial sac and subsequent herniotomy. This maneuver converts a difficult procedure into a relatively simple one.

  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 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

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

    PubMed

    Sekiya, Hidehiko; Kimura, Kentaro; Miki, Chitoshi

    2016-02-19

    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.

  19. Development of flexural vibration inspection techniques to rapidly assess the structural health of timber bridge systems

    Treesearch

    Xiping Wang; James P. Wacker; Robert J. Ross; Brian K. Brashaw; Robert Vatalaro

    2005-01-01

    This paper describes an effort to develop a global dynamic testing technique for evaluating the overall stiffness of timber bridge superstructures. A forced vibration method was used to measure the natural frequency of single-span timber bridges in the laboratory and field. An analytical model based on simple beam theory was proposed to represent the relationship...

  20. 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.

  1. The "bony Bankart bridge" procedure: a new arthroscopic technique for reduction and internal fixation of a bony Bankart lesion.

    PubMed

    Millett, Peter J; Braun, Sepp

    2009-01-01

    Arthroscopic treatment of bony Bankart lesions can be challenging. We present a new easy and reproducible technique for arthroscopic reduction and suture anchor fixation of bony Bankart fragments. A suture anchor is placed medially to the fracture on the glenoid neck, and its sutures are passed around the bony fragment through the soft tissue including the inferior glenohumeral ligament complex. The sutures of this anchor are loaded in a second anchor that is placed on the glenoid face. This creates a nontilting 2-point fixation that compresses the fragment into its bed. By use of the standard technique, additional suture anchors are used superiorly and inferiorly to the bony Bankart piece to repair the labrum and shift the joint capsule. We call this the "bony Bankart bridge" procedure.

  2. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques.

    PubMed

    Koprivanac, Marijan; Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

  3. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques

    PubMed Central

    Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A.; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes. PMID:28203540

  4. Hypospadias repair with the glanular-frenular collar (GFC) technique.

    PubMed

    Özbey, Hüseyin; Etker, Şeref

    2017-02-01

    In the normal human penis, the glans wings merge in the midline ventrally, but are separated by the 'septum glandis' in conjunction with the frenulum. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra, which has a special part known as the 'fossa navicularis'. This has inspired a hypospadias repair technique that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias. A total of 121 patients with varying degrees of hypospadias underwent surgery with the described technique: a Y-V plasty was used to dissect the inner foreskin, in a fashion that allowed for its ventral mobilization as a frenular mucosal collar. After tubularization of the proximal urethra, a partial spongioplasty was performed that extended up to the subcoronal level. The glans wings were approximated only at their outermost convexities, with a couple of subepithelial sutures, leaving a slit for the meatus. The cleft-like area between the split wings of the glans penis was filled with the terminal ends of the spongiosum and the dartos of the mucosal collar, which converged to form a septum and a neo-frenulum (glanular-frenular collar, GFC). The midline skin closure of the ventral collar and the circumferential foreskin closure was completed as usual. At a mean follow-up of 10 months, two patients developed urethral fistula (2%), six had meatal stenosis (5%), and two had glans dehiscence (2%) that resulted in meatal retraction. Overall, patients had a cosmetically satisfying appearance (Figure). Forty-one received secondary circumcision; the parents of 80 (66%) patients were satisfied with the final foreskin appearance obtained with this method. The split wings of the glans penis or so-called ventral cleft between the glans wings that accommodate the frenulum is part of normal anatomy. Hence, in hypospadias surgery, the approximated glans wings should allow for ventral support

  5. Repair of severed peripheral nerve: a superior anatomic and functional recovery with a new "reconnection" technique.

    PubMed

    Wikholm, R P; Swett, J E; Torigoe, Y; Blanks, R H

    1988-10-01

    The objective of this study was to use a quantitative functional and anatomic model to compare surgical repair of the rat sciatic nerve according to two techniques; standard epineurial repair and the recently reported "nerve reconnection technique" ("freeze-trim technique"). Functional recovery was evaluated using a functional index based on the measurements of the rats' footprints. Neuroanatomic experiments were conducted on the same animals to correlate functional recovery with regeneration of known motoneuron populations. The results of surgical repairs were also compared to those obtained from untreated sciatic nerve crush injuries. Functional recovery after epineurial repairs typically averaged 18%, whereas the mean recovery from the "nerve reconnection technique" was 71%. Crush injuries recovered to normal and reached a plateau much earlier than the surgical repairs. Retrograde horseradish peroxidase (HRP) labeling of motoneurons of the common peroneal nerve, a branch of the sciatic, revealed that there was a complex relationship between functional recovery and the number and distribution of motoneurons that regenerated axons distal to the repair site. The "nerve reconnection technique" greatly reduced the probability of axonal misdirection into the wrong distal branches at the repair site and brought an improvement of 300% to 400% in functional recovery over that found with epineurial repair. This technique of nerve repair may prove to be a valuable tool in reconstructive surgery.

  6. Simplified technique of mesh fixation during laparoscopic repair of abdominal ventral hernia.

    PubMed

    Piskun, G; Shaftan, G; Fogler, R

    1999-04-01

    The current techniques for intraperitoneal mesh fixation are complex and time-consuming. We present here a simple technique for the fixation of the mesh during laparoscopic intraperitoneal ventral hernia repair.

  7. Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique.

    PubMed

    Stahnke, Katharina; Nikulka, Constanze; Diederichs, Gerd; Haneveld, Hendrik; Scheibel, Markus; Gerhardt, Christian

    2016-05-01

    So far, recurrent rotator cuff defects are described to occur in the early postoperative period after arthroscopic repair. The aim of this study was to evaluate the musculotendinous structure of the supraspinatus, as well as bone marrow edema or osteolysis after arthroscopic double-row repair. Therefore, magnetic resonance (MR) images were performed at defined intervals up to 2 years postoperatively. Case series; Level of evidence, 3. MR imaging was performed within 7 days, 3, 6, 12, 26, 52 and 108 weeks after surgery. All patients were operated using an arthroscopic modified suture bridge technique. Tendon integrity, tendon retraction ["foot-print-coverage" (FPC)], muscular atrophy and fatty infiltration (signal intensity analysis) were measured at all time points. Furthermore, postoperative bone marrow edema and signs of osteolysis were assessed. MR images of 13 non-consecutive patients (6f/7m, ∅ age 61.05 ± 7.7 years) could be evaluated at all time points until ∅ 108 weeks postoperatively. 5/6 patients with recurrent defect at final follow-up displayed a time of failure between 12 and 24 months after surgery. Predominant mode of failure was medial cuff failures in 4/6 cases. The initial FPC increased significantly up to 2 years follow-up (p = 0.004). Evaluations of muscular atrophy or fatty infiltration were not significant different comparing the results of all time points (p > 0.05). Postoperative bone marrow edema disappeared completely at 6 months after surgery, whereas signs of osteolysis appeared at 3 months follow-up and increased to final follow-up. Recurrent defects after arthroscopic reconstruction of supraspinatus tears in modified suture bridge technique seem to occur between 12 and 24 months after surgery. Serial MRI evaluation shows good muscle structure at all time points. Postoperative bone marrow edema disappears completely several months after surgery. Signs of osteolysis seem to appear caused by bio-absorbable anchor

  8. [Application of three-dimensional printing technique in repair and reconstruction of maxillofacial bone defect].

    PubMed

    Yu, Dan; Liu, Jianhua; Zhu, Huiyong; Li, Zhiyong; Huang, Xu; Wei, Dong; Lin, Yi; He, Jianfeng; Zhao, Wenquan

    2014-03-01

    To explore the application of three-dimensional (3-D) printing technique in repair and reconstruction of maxillofacial bone defect. The related literature on the recent advance in the application of 3-D printing technique for repair and reconstructing maxillofacial bone defect was reviewed and summarized in the following aspects: 3-D models for teaching, preoperative planning, and practicing; surgical templates for accurate positioning during operation; individual implantable prosthetics for repair and reconstructing the maxillofacial bone defect. 3-D printing technique is profoundly affecting the treatment level in repair and reconstruction of maxillofacial bone defect. 3-D printing technique will promote the development of the repair and reconstructing maxillofacial bone defect toward more accurate, personalized, and safer surgery.

  9. Bridge stay cable condition assessment using vibration measurement techniques

    NASA Astrophysics Data System (ADS)

    Tabatabai, Habib; Mehrabi, Armin B.; Yen, Wen-huei P.

    1998-03-01

    In this paper, results of a research project sponsored by the Federal Highway Administration (FHWA) on a non-destructive method for measurement of stay cable forces in cable-stayed bridges are presented. This project included development and verification of specific analytical and experimental procedures for measurement of stay cable forces. In one set of procedures, a single laser vibrometer is used to measure low- level cable vibrations due to ambient (wind and traffic) excitation. The laser device allows rapid measurement of cable vibrations at distances of up to several hundred feet. Procedures are also developed for utilization of accelerometers attached to cables. Contact sensors are more appropriate when long-term remote monitoring is desired. Measured natural frequencies of vibration are related to cable tension through a mathematical formulation developed during the course of this study. This formulation includes the effects of cable sag-extensibility, bending stiffness, various boundary conditions, intermediate springs or dampers, etc. This method can also be used during construction in lieu of the 'lift off' method. The accuracy and effectiveness of this methodology was tested in the laboratory on a scaled model of a cable, and on two cable-stayed bridges. This ability to rapidly measure stay cable forces provides an opportunity for global condition assessment of these major structures.

  10. Repair vs replacement of direct composite restorations: a survey of teaching and operative techniques in Oceania.

    PubMed

    Brunton, Paul A; Ghazali, Amna; Tarif, Zahidah H; Loch, Carolina; Lynch, Christopher; Wilson, Nairn; Blum, Igor R

    2017-04-01

    To evaluate the teaching and operative techniques for the repair and/or replacement of direct resin-based composite restorations (DCRs) in dental schools in Oceania. A 14-item questionnaire was mailed to the heads of operative dentistry in 16 dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). The survey asked whether the repair of DCRs was taught within the curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability, expected longevity and recall systems. All 16 schools participated in the study. Thirteen (81%) reported the teaching of composite repairs as an alternative to replacement. Most schools taught the theoretical and practical aspects of repair at a clinical level only. All 13 schools (100%) agreed on tooth substance preservation being the main reason for teaching repair. The main indications for repair were marginal defects (100%), followed by secondary caries (69%). All 13 schools that performed repairs reported high patient acceptability, and considered it a definitive measure. Only three schools (23%) claimed to have a recall system in place following repair of DCRs. Most respondents either did not know or did not answer when asked about the longevity of DCRs. Repair of DCRs seems to be a viable alternative to replacement, which is actively taught within Oceania. Advantages include it being minimally invasive, preserving tooth structure, and time and money saving. However, standardised guidelines need to be developed and further clinical long-term studies need to be carried out. The decision between replacing or repairing a defective composite restoration tends to be based on what clinicians have been taught, tempered by experience and judgement. This study investigated the current status of teaching and operative techniques of repair of direct composite restorations in dental schools in Oceania. Copyright © 2017 Elsevier Ltd

  11. [Inguinal hernia repair by the tension free technique of Lichtenstein].

    PubMed

    Prywiński, S; Zomrowski, L; Kapała, A; Mackiewicz, Z

    1997-01-01

    Failure rate in standard groin hernia repair varies from 3 to 10%. Polypropylene mesh implantation based on Lichtenstein "tension free" method in 1986 year reduced the failure rate to less than 1%. From Feb. '95 to Dec.'96, 115 patients were operated on with 127 groin hernias repair. The average age of patients was 58 years 52 direct hernias, 74 indirect hernias and 1 pantaloon hernia have been diagnosed in examined material, 101 primary repairs and 26 repairs of recurrent hernia have been performed. The operations were performed in subarachnoid anaesthesia--66 patients, in general anaesthesia--11 patients in local anaesthesia--38 patients. After having opened the inguinal canal estimated the type of its wall defect. In case of direct hernia the sac usually was invaginated by absorbing suture. In case of indirect hernia sac was cut and peritoneal cavity left opened. The patch made of polypropylene monofilament mesh (size 6 x 8 cm) was sewn with "tension free" method under spermatic funiculus. As a complication 6 patients had haematomas in operating wounds. Four of the patients had wound infections. One of these patients was operated again and the patch was removed. The patients had no recurrence of hernia during the previous 10.6 months of observation. We haven't confirmed recurrence in examined material, yet it was too short time to estimate the efficiency of repair. The proposed way of groin hernia repair is easy and simple in every-day surgery practice.

  12. Preservation of the Pulmonary Valve During Early Repair of Tetralogy of Fallot: Surgical Techniques.

    PubMed

    Vida, Vladimiro L; Guariento, Alvise; Zucchetta, Fabio; Padalino, Massimo; Castaldi, Biagio; Milanesi, Ornella; Stellin, Giovanni

    2016-01-01

    During the last decade interest in preserving pulmonary valve (PV) function has stimulated a few surgeons to apply valve-sparing techniques in repairing tetralogy of Fallot (TOF), with the aim of preserving long-term right ventricular function. Since June 2007, we embarked upon a program for preserving PV function in selected patients during TOF repair. More recently, the introduction of more complex PV plasty techniques allowed us to further extend the applicability of PV preservation techniques. We believe that preservation of PV function during early repair of TOF, by combining different intraoperative surgical maneuvers, can be extended to almost all patients with classic TOF.

  13. Primary repair of infracardiac total anomalous pulmonary venous connection using a modified sutureless technique.

    PubMed

    Buitrago, Efren; Panos, Anthony L; Ricci, Marco

    2008-07-01

    Primary repair of infracardiac total anomalous pulmonary venous connection is associated with a significant risk of recurrent pulmonary venous obstruction. Herein we describe a technique of primary repair in which a modified sutureless anastomosis is constructed by suturing the left atrium to the posterior mediastinal pleura that surrounds the pulmonary venous confluence.

  14. 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

  15. Here are methods and techniques for choosing proper approaches to pipeline repair

    SciTech Connect

    Woods, J.W.

    1982-07-19

    This article discusses surface repair, underwater hyperbaric welding, and mechanical connectors vis-a-vis underwater pipelines. Recommends consideration of potential risk of damage to a particular line, and criticality of the pipeline to overall production continuity. Offers guidelines for the selection of an optimum repair method and a contingency plan. Concludes that the best method or technique for the repair of a particular underwater pipeline is that which best matches the urgency of repair given the particular characteristics of the line and that method in which the operator has confidence.

  16. 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) PMID:27218053

  17. New hot repair technique for coke oven wall

    SciTech Connect

    Mikoshi, Kazuhiro; Tsugita, Yasuhiro; Kikuchi, Akio; Okanishi, Kazuya

    1993-01-01

    The brick of coke-oven chamber walls is subjected to thermal and mechanical impact due to changes in temperature during coal carbonization and the lateral pressure applied at the time of coke pushing, and brick deterioration gradually progresses. Nippon Steel formerly repaired oven chamber wall brick by hot relaying at the Hirohata No. 2 Coke-Oven Battery and the Kamaishi No. 1 Coke-Oven Battery. In both cases the brick was relaid from the chamber end part (oven door). Therefore, if damage occurs in the middle part of the chamber, a large extent of brick relaying is necessary. The Hirohata No. 3 Coke-Oven Battery has recently been repaired by the boring method, in which only the brick of the middle part of coking chambers was hot-related. This report outlines the repair method newly adopted at that time.

  18. [Repair of lower extremity soft tissue defect with free musculo-cutaneous flaps bridging with healthy contralateral posterior tibial vessel].

    PubMed

    Chengde, Xia; Haiping, Di; Jidong, Xue; Yaohua, Zhao; Xiaoliang, Li; Qiang, Li; Xihua, Niu; Yonglin, Li; Hongkai, Lian

    2015-05-01

    To observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect. From February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting. All the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered. Appropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

  19. Symposium on the management of inguinal hernias: 4. The Shouldice technique: a canon in hernia repair

    PubMed Central

    Bendavid, Robert

    1997-01-01

    Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantages: the presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use. PMID:9194781

  20. Here are methods and techniques for choosing proper approaches to pipeline repair

    SciTech Connect

    Woods, J.W.

    1982-07-19

    This paper discusses methods most commonly used to repair underwater pipelines, as divided into 3 broad categories: surface repair, underwater hyperbaric welding, and mechanical connectors. Factors to be considered when selecting a repair method include potential risk of damage to a particular line, criticality of pipeline to overall production continuity, and worst possible damage that could occur. Suggests that final cost of efficient repair outweighs potential production revenue loss (especially in main transmission and even secondary lines) from a line out of service due to lack of planning. Conclusion is that the best method or technique for the repair of a particular underwater pipeline is that which best matches the urgency of repair given particular characteristics of the line and which can confidently be employed by the operator.

  1. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.

    PubMed

    Witt, Bryan L; Hyer, Christopher F

    2012-01-01

    to 10.71). The suture bridge technique is a viable option for Achilles tendon repair after surgical management of insertional Achilles tendinosis. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Biomechanical Evaluation of Flexor Tendon Graft With Different Repair Techniques and Graft Surface Modification

    PubMed Central

    Wu, Jingheng; Thoreson, Andrew R.; Reisdorf, Ramona L.; An, Kai-Nan; Moran, Steven L.; Amadio, Peter C.; Zhao, Chunfeng

    2016-01-01

    The purpose of this study was to investigate the biomechanical properties of modified repair techniques for flexor tendon reconstruction and the effects of surface modification using carbodiimide-derivatized synovial fluid plus gelatin (cd-SF-G), compared to the traditional repair techniques. The second and fifth digits from 16 canine forepaws were randomly divided into 4 groups: (1) traditional graft repairs (TGR group) including distal Bunnell repair and proximal Pulvertaft weave repair; (2) modified graft repairs (MGR group) including distal graft bony attachment repair and proximal step-cut repair; (3) group TGR coated with cd-SF-G (TGR-C group); and (4) group MGR coated with cd-SF-G (MGR-C group). Digit normalized work of flexion (nWOF), ultimate failure strength, and stiffness were measured. The nWOF in MGR group was significantly less than TGR group (p < 0.05). The nWOF in groups treated with cd-SF-G was significantly less than their untreated counterparts (p < 0.05). Ultimate load to failure of the MGR-C group was significantly greater than the TGR-C group (p < 0.05), but no significant difference in stiffness was found between these two groups. The modified techniques cannot only improve tendon gliding abilities but can also improve breaking strength. Additionally, surface modification with cd-SF-G significantly decreased the work of flexion. PMID:25665071

  3. Fact Sheet: Control Techniques Guidelines (CTG) for Shipbuilding and Ship Repair Facilities Operation (Surface Coating)

    EPA Pesticide Factsheets

    This page contains an August 1996 fact sheet with information regarding the CTG and Alternative Control Techniques (ACT) for Surface Coating at Shipbuilding and Ship Repair Facilities Operations. This document provides a summary of this guidance

  4. 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).

  5. Posterior compartment defect repair in vaginal surgery: update on surgical techniques.

    PubMed

    Ginger, Van Anh T; Kobashi, Kathleen C

    2007-09-01

    Posterior colporrhaphy has been the most common surgical technique for the repair of posterior compartment defects. Traditional posterior colporrhaphy involves plication of the levator ani, which may result in dyspareunia related to narrowing of the introitus. Current posterior compartment repairs either plicate the midline fascia or repair the specific site of fascial weakness. Despite insubstantial data, the use of grafts to reinforce posterior repairs has gained popularity. Grafts such as allografts, xenografts, and synthetic meshes have been used to reinforce the posterior wall. Complications include infection and erosion, as well as recurrence of prolapse. Minimally invasive techniques have been developed to recreate the apical support of the vaginal vault and repair the posterior prolapse. Properly conducted randomized prospective trials are needed to adequately assess these new approaches.

  6. Vehicle-bridge Interaction Analysis Based on the ANCF Quasi-conforming Plate Technique

    NASA Astrophysics Data System (ADS)

    Wang, Bingjian; He, Hua

    2017-06-01

    A new plate element is developed for analysis of plate structures in vehicle-bridge interaction analysis based on the combining of absolute nodal coordinate formulation (ANCF) and quasi-conforming technique (QCT). In order to simulate complex contact and large deformation during vehicle-bridge interaction (VBI) for the slender bridge, new curvature strains and explicit formulation of internal forces are developed for the shell elements of the bridge deck. The developed QCT_ANCF shell element is compared with the original ANCF element to verify its locking remedies. Compared with the original model, the new QCT_ANCF element shows better convergence and curvature continuity and is more accurate under the same number of elements. Numerical cases are analyzed using the QCT_ANCF element in comparison to analytical solutions and the original ANCF shell element. Meanwhile, there is less high frequency vibration in the velocity and acceleration curve by comparing with the original model. Furthermore, the vehicle-bridge interaction is parametrically analyzed using the new QCT_ANCF element under series of road roughness index and vehicle speeds. The impact factors based on the displacements and strains over the transverses of the bridge are investigated.

  7. New Surface-Treatment Technique of Concrete Structures Using Crack Repair Stick with Healing Ingredients.

    PubMed

    Ahn, Tae-Ho; Kim, Hong-Gi; Ryou, Jae-Suk

    2016-08-04

    This study focused on the development of a crack repair stick as a new repair method along with self-healing materials that can be used to easily repair the cracks in a concrete structure at the construction site. In developing this new repair technique, the self-healing efficiency of various cementitious materials was considered. Likewise, a crack repair stick was developed to apply to concrete structures with 0.3 mm or lower crack widths. The crack repair stick was made with different materials, such as cement, an expansive material (C12A₇), a swelling material, and calcium carbonate, to endow it with a self-healing property. To verify the performance of the crack repair stick for concrete structures, two types of procedures (field experiment and field absorption test) were carried out. As a result of such procedures, it was concluded that the developed crack repair stick could be used on concrete structures to reduce repair expenses and for the improved workability, usability, and serviceability of such structures. On the other hand, to evaluate the self-healing performance of the crack repair stick, various tests were conducted, such as the relative dynamic modulus of elasticity test, the water tightness test, the water permeability test, observation via a microscope, and scanning electron microscope (SEM) analysis. From the results, it is found that water leakage can be prevented and that the durability of a concrete structure can be improved through self-healing. Also, it was verified that the cracks were perfectly closed after 28 days due to application of the crack repair stick. These results indicate the usability of the crack repair stick for concrete structures, and its self-healing efficiency.

  8. New Surface-Treatment Technique of Concrete Structures Using Crack Repair Stick with Healing Ingredients

    PubMed Central

    Ahn, Tae-Ho; Kim, Hong-gi; Ryou, Jae-Suk

    2016-01-01

    This study focused on the development of a crack repair stick as a new repair method along with self-healing materials that can be used to easily repair the cracks in a concrete structure at the construction site. In developing this new repair technique, the self-healing efficiency of various cementitious materials was considered. Likewise, a crack repair stick was developed to apply to concrete structures with 0.3 mm or lower crack widths. The crack repair stick was made with different materials, such as cement, an expansive material (C12A7), a swelling material, and calcium carbonate, to endow it with a self-healing property. To verify the performance of the crack repair stick for concrete structures, two types of procedures (field experiment and field absorption test) were carried out. As a result of such procedures, it was concluded that the developed crack repair stick could be used on concrete structures to reduce repair expenses and for the improved workability, usability, and serviceability of such structures. On the other hand, to evaluate the self-healing performance of the crack repair stick, various tests were conducted, such as the relative dynamic modulus of elasticity test, the water tightness test, the water permeability test, observation via a microscope, and scanning electron microscope (SEM) analysis. From the results, it is found that water leakage can be prevented and that the durability of a concrete structure can be improved through self-healing. Also, it was verified that the cracks were perfectly closed after 28 days due to application of the crack repair stick. These results indicate the usability of the crack repair stick for concrete structures, and its self-healing efficiency. PMID:28773776

  9. A Simple Technique for Capsular Repair After Hip Arthroscopy

    PubMed Central

    Camp, Christopher L.; Reardon, Patrick J.; Levy, Bruce A.; Krych, Aaron J.

    2015-01-01

    Capsulotomy is typically performed during arthroscopic treatment for femoroacetabular impingement. As the frequency of hip arthroscopy continues to expand rapidly, increased attention is being paid to the implications of interportal capsulotomy and the need for repair. To minimize the risk of postoperative instability, capsular closure has been recommended to restore the anatomy and biomechanical function of the capsule. We present a reliable, efficient, and effective method for arthroscopic closure of the interportal capsulotomy after hip arthroscopy. PMID:26870655

  10. Combat Maintenance Concepts and Repair Techniques for Helicopter Airframe Structures

    DTIC Science & Technology

    1981-01-01

    helicopter airframe and to de- velop concepts for the assessment and repair of airframe combat damage. A computer model was developed to generate...random simulated hallistic strikes on the Black Hawk helicopter airframe. Random shotlines were generated with the model , and cases involving damage...Distribution of Ballistic Hits on Helicopters from Southeast Asia Combat Experience 23 Shotline Simulation Model 24 Conventions for Azimuth and

  11. Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study.

    PubMed

    Black, James C; Ricci, William M; Gardner, Michael J; McAndrew, Christopher M; Agarwalla, Avinesh; Wojahn, Robert D; Abar, Orchid; Tang, Simon Y

    2016-12-01

    Patellar tendon ruptures commonly are repaired using transosseous patellar drill tunnels with modified-Krackow sutures in the patellar tendon. This simple suture technique has been associated with failure rates and poor clinical outcomes in a modest proportion of patients. Failure of this repair technique can result from gap formation during loading or a single catastrophic event. Several augmentation techniques have been described to improve the integrity of the repair, but standardized biomechanical evaluation of repair strength among different techniques is lacking. The purpose of this study was to describe a novel figure-of-eight suture technique to augment traditional fixation and evaluate its biomechanical performance. We hypothesized that the augmentation technique would (1) reduce gap formation during cyclic loading and (2) increase the maximum load to failure. Ten pairs (two male, eight female) of fresh-frozen cadaveric knees free of overt disorders or patellar tendon damage were used (average donor age, 76 years; range, 65-87 years). For each pair, one specimen underwent the standard transosseous tunnel suture repair with a modified-Krackow suture technique and the second underwent the standard repair with our experimental augmentation method. Nine pairs were suitable for testing. Each specimen underwent cyclic loading while continuously measuring gap formation across the repair. At the completion of cyclic loading, load to failure testing was performed. A difference in gap formation and mean load to failure was seen in favor of the augmentation technique. At 250 cycles, a 68% increase in gap formation was seen for the control group (control: 5.96 ± 0.86 mm [95% CI, 5.30-6.62 mm]; augmentation: 3.55 ± 0.56 mm [95% CI, 3.12-3.98 mm]; p = 0.02). The mean load to failure was 13% greater in the augmentation group (control: 899.57 ± 96.94 N [95% CI, 825.06-974.09 N]; augmentation: 1030.70 ± 122.41 N [95% CI, 936.61-1124.79 N]; p = 0.01). This biomechanical

  12. A systematic review of comparison of upper eyelid involutional ptosis repair techniques: efficacy and complication rates.

    PubMed

    Chang, Suzie; Lehrman, Craig; Itani, Kamel; Rohrich, Rod J

    2012-01-01

    The most common form of blepharoptosis is involutional ptosis, commonly caused by the effect of progressive age on the levator aponeurosis. The treatment for this acquired ptosis is strictly surgical. For the plastic surgeon, the ideal lid ptosis repair provides the longest efficacy, the fewest complications and revisions, and, ultimately, the highest functional and cosmetic outcome for the patient. With over 100 different described techniques, there exists a need to make a comparison. A systematic review is considered a higher level of evidence because it is a review designed to be reproducible, with predetermined inclusion and exclusion criteria. To date, there has been no systematic review to study the efficacy and complication rates between different involutional lid ptosis repair techniques. A systematic search of the English literature published in the PubMed and Cochrane Central Register of Controlled Trials databases yielded trials on comparison of different adult upper lid involutional ptosis repair techniques regarding their efficacy and complication rates. Predetermined inclusion and exclusion criteria were used. : This systematic review revealed that there are no randomized, prospective, controlled comparison studies on involutional lid ptosis repair techniques. Although this systematic review revealed a lack of level I data in comparing the different ptosis repair techniques, it is important that the existing studies be reviewed and pooled to improve patient outcomes and to provide direction for future research. In the absence of higher level data studies, the authors propose a treatment algorithm for involutional ptosis repair. Therapeutic, IV.

  13. 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.

  14. Patch-augmented rotator cuff repair: influence of the patch fixation technique on primary biomechanical stability.

    PubMed

    Jung, Christian; Spreiter, Gregor; Audigé, Laurent; Ferguson, Stephen J; Flury, Matthias

    2016-05-01

    There is an ongoing debate about the potential of patch augmentation to improve biomechanical stability and healing associated with rotator cuff repair. The biomechanical properties of three different patch-augmented rotator cuff repair techniques were assessed in vitro and compared with a standard repair. Dermal collagen patch augmentation may increase the primary stability and strength of the repaired tendon in vitro, depending on the technique used for patch application. Forty cadaveric sheep shoulders with dissected infraspinatus tendons were randomized into four groups (n = 10/group) for tendon repair using a knotless double-row suture anchor technique. A xenologous dermal extracellular matrix patch was used for augmentation in the three test groups using an "integrated", "cover", or "hybrid" technique. Tendons were preconditioned, cyclically loaded from 10 to 30 N at 1 Hz, and then loaded monotonically to failure. Biomechanical properties and the mode of failure were evaluated. Patch augmentation significantly increased the maximum load at failure by 61 % in the "cover" technique test group (225.8 N) and 51 % in the "hybrid" technique test group (211.4 N) compared with the non-augmented control group (140.2 N) (P ≤ 0.015). For the test group with "integrated" patch augmentation, the load at failure was 28 % lower (101.6 N) compared with the control group (P = 0.043). There was no significant difference in initial and linear stiffness among the four experimental groups. The most common mode of failure was tendon pullout. No anchor dislocation, patch disruption or knot breakage was observed. Additional patch augmentation with a collagen patch influences the biomechanical properties of a rotator cuff repair in a cadaveric sheep model. Primary repair stability can be significantly improved depending on the augmentation technique.

  15. Environmental Assessment: 13th Street Bridge Emergency Repair and Retrofit Vandenberg Air Force Base California

    DTIC Science & Technology

    2003-06-23

    Striped skunk Expected Mephitis mephitis Mountain lion Expected Felis conco/or Bobcat Observed SRS 2003b Felis rufus Feral cat Observed...Z39-18 FINDING OF NO SIGNIFICAI"iT IMPACT AND FINDING OF NO PRACTICABLE ALTERNATIVE Emergency ~pair and Retrofit of the 13.,. Street Bridge at...EnvirormrenUJ.I Impact Analysis Process9 as amended by the interim change dated March 12, 2003, which adopted 32 CFR Part 989, the Air Force conducted an

  16. Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

    PubMed

    Feehan, Brendan P; Fromm, David S

    2017-05-01

    Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

  17. Biomechanical Performance of Medial Row Suture Placement Relative to the Musculotendinous Junction in Transosseous Equivalent Suture Bridge Double-Row Rotator Cuff Repair.

    PubMed

    Virk, Mandeep S; Bruce, Benjamin; Hussey, Kristen E; Thomas, Jacqueline M; Luthringer, Tyler A; Shewman, Elizabeth F; Wang, Vincent M; Verma, Nikhil N; Romeo, Anthony A; Cole, Brian J

    2017-02-01

    To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model. A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system. The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RCT group (100; P = .07) because 3 specimens failed in the MTJ group during cyclic loading. There were no significant differences between the 2 study groups with respect to biomechanical properties during the load to failure testing. In a cadaveric TOE-SB DR RCR model, medial row sutures through the MTJ results in a significantly higher rate of medial row failure. In rotator cuff tears with tendon tissue loss, passage of medial row sutures through the MTJ should be avoided in a TOE-SB RCR technique because of the risk of medial row failure. Copyright © 2016. Published by Elsevier Inc.

  18. A novel technique for repairing a large diaphragmatic defect with no costal attachments

    PubMed Central

    Tucker, Adam; Parissis, Harry

    2013-01-01

    Chronically ruptured diaphragms are difficult to diagnose. Often they are asymptomatic but convey a high risk for incarceration, and therefore surgical repair is mandatory. In the following case report, we present an abnormal 10×12 cm diaphragmatic defect whereby there was no anterior edge to the defect. This posed a challenge as to how to repair. We present a novel technique that facilitates sound solution through a thoracotomy approach. PMID:23598927

  19. A combined endovascular and open ''reverse hybrid'' technique for repair of complex juxtarenal inflammatory aortic aneurysms.

    PubMed

    Rigberg, David; Jimenez, Juan Carlos; Lawrence, Peter; Gelabert, Hugh

    2009-01-01

    Inflammatory abdominal aortic aneurysms (IAAA) can present significant challenges to surgeons, especially in the juxtarenal location where they may not be amenable to endovascular repair. The dense, inflammatory component of these lesions can encase adjacent structures including the duodenum, ureters, and inferior vena cava putting them at risk for injury during open exposure. We report a novel ''reverse hybrid'' technique using a combined endovascular and open approach for repair of large, juxtarenal IAAA's.

  20. 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

  1. Modification of Siepser sliding suture technique for iris repair and endothelial keratoplasty.

    PubMed

    Schoenberg, Evan D; Price, Francis W

    2014-05-01

    We describe a technique for closed-chamber iris repair that prevents knot and suture tail exposure into the anterior chamber. This modification of the Siepser sliding slipknot suture technique is particularly important in the setting of combined or future endothelial keratoplasty to prevent mechanical damage to donor endothelium during transplantation. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  2. 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.

  3. Hybrid repair of type A acute aortic dissections with the Lupiae technique: ten-year results.

    PubMed

    Esposito, Giampiero; Cappabianca, Giangiuseppe; Bichi, Samuele; Cricco, Antonio; Albano, Giovanni; Anzuini, Angelo

    2015-02-01

    Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. From 2003 to 2013, 89 patients with type A acute aortic dissections underwent replacement of the ascending aorta, the arch, and the rerouting of the neck vessels on the ascending aorta, creating a proximal Dacron landing zone for a completion with thoracic endovascular aortic repair if necessary. In-hospital mortality was 8.9%. In 16 patients, the false lumen healed spontaneously, whereas the remaining 65 patients underwent thoracic endovascular aortic repair. One patient died after thoracic endovascular aortic repair. Eighty patients were followed up. Complete thrombosis of the false lumen was obtained in 93.8% of patients. The median follow-up was 46 ± 35 months. Overall 8-year survival was 93.7% ± 5%, 100% for patients with spontaneously healed residual false lumen after just type A acute aortic dissection repair and 92.3% ± 7.7% for patients who underwent thoracic endovascular aortic repair after type A acute aortic dissection repair. In 10 years, 1 patient underwent a reoperation on the distal aorta (1.25%). The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex

    PubMed Central

    Kim, Kyung Soo

    2016-01-01

    Background Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Methods Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t-test or Wilcoxon signed rank tests. Results The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. Conclusions The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair. PMID:27747176

  5. Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial.

    PubMed

    Barber, F Alan

    2016-05-01

    To compare the structural healing and clinical outcomes of triple-loaded single-row with suture-bridging double-row repairs of full-thickness rotator cuff tendons when both repair constructs are augmented with platelet-rich plasma fibrin membrane. A prospective, randomized, consecutive series of patients diagnosed with full-thickness rotator cuff tears no greater than 3 cm in anteroposterior length were treated with a triple-loaded single-row (20) or suture-bridging double-row (20) repair augmented with platelet-rich plasma fibrin membrane. The primary outcome measure was cuff integrity by magnetic resonance imaging (MRI) at 12 months postoperatively. Secondary clinical outcome measures were American Shoulder and Elbow Surgeons, Rowe, Simple Shoulder Test, Constant, and Single Assessment Numeric Evaluation scores. The mean MRI interval was 12.6 months (range, 12-17 months). A total of 3 of 20 single-row repairs and 3 of 20 double-row repairs (15%) had tears at follow-up MRI. The single-row group had re-tears in 1 single tendon repair and 2 double tendon repairs. All 3 tears failed at the original attachment site (Cho type 1). In the double-row group, re-tears were found in 3 double tendon repairs. All 3 tears failed medial to the medial row near the musculotendinous junction (Cho type 2). All clinical outcome measures were significantly improved from the preoperative level (P < .0001), but there was no statistical difference between groups postoperatively. There is no MRI difference in rotator cuff tendon re-tear rate at 12 months postsurgery between a triple-loaded single-row repair or a suture-bridging double-row repair when both are augmented with platelet-rich plasma fibrin membrane. No difference could be demonstrated between these repairs on clinical outcome scores. I, Prospective randomized study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  6. 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.

  7. The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence.

    PubMed

    Kahle, Jason T; Highsmith, M Jason; Kenney, John; Ruth, Tim; Lunseth, Paul A; Ertl, Janos

    2017-06-01

    This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent. Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic. There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique. Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

  8. Comparison of the Suture Anchor and Transosseous Techniques for Patellar Tendon Repair: A Biomechanical Study.

    PubMed

    Lanzi, Joseph T; Felix, Justin; Tucker, Christopher J; Cameron, Kenneth L; Rogers, John; Owens, Brett D; Svoboda, Steven J

    2016-08-01

    Minimizing gap formation and maximizing the strength of patellar tendon repairs are 2 critical factors for successful healing of these injuries. The purpose of this study was to compare transosseous and screw-in anchor repair techniques to determine if there is a difference in gap formation and load to failure of the 2 constructs. The research hypotheses were that the anchor construct would have significantly less gap formation and would also have significantly greater load-to-failure strength. Controlled laboratory study. A total of 24 porcine specimens were randomly assigned into transosseous and 4.75-mm polyetheretherketone (PEEK) screw-in anchor repair groups. The repairs were then completed using 2 No. 2 FiberWire sutures, and each specimen was cyclically loaded on a tensile test machine to 250 N for a total of 1000 cycles. Gap formation was measured at 1, 10, 250, 500, and 1000 cycles. Each specimen was loaded to failure after 1000 cycles. Independent t tests were conducted. Statistically significant gap formation and load-to-failure differences were found between the 2 repair techniques. The mean gap in the anchor group (2.16 ± 1.81 mm) was significantly less than that seen in the transosseous group (5.71 ± 1.58 mm) (P < .001). The mean load to failure of the anchor group (669.9 ± 91.8 N) was significantly higher than that of the transosseous group (582.8 ± 92.6 N) (P = .03). The results support the 2 study hypotheses. These findings suggest that the 4.75-mm PEEK screw-in anchor construct may be superior to the transosseous technique for minimizing gap formation and improving load-to-failure strength after surgical repair of the patellar tendon. The use of the suture anchor technique in patellar tendon repair may support early load-bearing rehabilitation. © 2016 The Author(s).

  9. Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

    PubMed Central

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

  10. 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

  11. Cartilage repair surgery: outcome evaluation by using noninvasive cartilage biomarkers based on quantitative MRI techniques?

    PubMed

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

    2014-01-01

    New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. 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. 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.

  12. Triangular with Ala nasi (TAN) repair of unilateral cleft lips: a personal technique and early outcomes.

    PubMed

    Tan, Onder; Atik, Bekir

    2007-01-01

    The triangular flap repair is one of the most common techniques used in cleft lip surgery. However, inability to address the nasal deformity and loss of orbicularis wholeness accompanied with incomplete reorientation have been two major handicaps of the triangular repair. Therefore, we developed our personal technique, called the triangular with ala nasi (TAN) repair, including a perialar incision and a distinct approach to the skin and muscle. We applied the TAN technique to 32 consecutive (19 male and 13 female) patients with unilateral cleft. The mean age at repair was 2.5 (1-32) years. The cleft lip appeared completely and incompletely in 11 and 21 patients, respectively. The postoperative outcomes were assessed subjectively by Williams test and objectively by Lindsay-Farkas method.The mean follow-up time was 17.1 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. The recoveries of 79.1% and 86.2% on average, when compared with the noncleft side, were obtained postoperatively. With our technique, we aimed at combining the useful properties of the two popular techniques, Millard and Tennison-Randall. The TAN repair lengthens the vertical lip using a triangular flap, resulting in a nonlinear, zig-zag scar on the philtral ridge and forming a symmetrical cupid's bow, superiorities of the Tennison-Randall repair. On the other hand, our method also presents an excellent approximation of both the deep and superficial muscle groups and reduces the nasal deformity with a perialar incision, features of the Millard's technique.

  13. 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

  14. Muscle repair: platelet-rich plasma derivates as a bridge from spontaneity to intervention.

    PubMed

    Sánchez, Mikel; Anitua, Eduardo; Delgado, Diego; Sánchez, Pello; Orive, Gorka; Padilla, Sabino

    2014-10-01

    Muscle injuries account for between 10% and 55% of all sporting injuries. Although the skeletal muscle is a plastic organ capable of responding efficiently to environmental changes, the appropriate treatment of muscle injuries remains a daunting clinical challenge in sports medicine. There is considerable evidence to indicate that growth factors, such as transforming growth factor-β (TGFβ), hepatocyte growth factor (HGF) or insulin-like growth factor (IGF), and fibrin matrix are key in cellular events required for muscle repair and regeneration, namely myogenesis, angiogenesis and fibrogenesis. An innovative biological approach to the treatment of muscle injuries is the application of Plasma Rich in Growth Factors (PRGF) in intramuscular infiltrations. PRGF delivers growth factors, cytokines and adhesive proteins present in platelets and plasma, as well as other biologically-active proteins conveyed by the plasma, such as fibrinogen, prothrombin and fibronectin. This autologous, mimetic biomaterial embedded with a pool of growth factors acts as a smart dynamic scaffold, and should be applied taking into account a biological approach. A clinical trial is required to assess the functional repair outcome of PRGF infiltrations in muscle injuries.

  15. Bridging Plant and Human Radiation Response and DNA Repair through an In Silico Approach

    PubMed Central

    Nikitaki, Zacharenia; Pavlopoulou, Athanasia; Holá, Marcela; Donà, Mattia; Michalopoulos, Ioannis; Balestrazzi, Alma; Angelis, Karel J.; Georgakilas, Alexandros G.

    2017-01-01

    The mechanisms of response to radiation exposure are conserved in plants and animals. The DNA damage response (DDR) pathways are the predominant molecular pathways activated upon exposure to radiation, both in plants and animals. The conserved features of DDR in plants and animals might facilitate interdisciplinary studies that cross traditional boundaries between animal and plant biology in order to expand the collection of biomarkers currently used for radiation exposure monitoring (REM) in environmental and biomedical settings. Genes implicated in trans-kingdom conserved DDR networks often triggered by ionizing radiation (IR) and UV light are deposited into biological databases. In this study, we have applied an innovative approach utilizing data pertinent to plant and human genes from publicly available databases towards the design of a ‘plant radiation biodosimeter’, that is, a plant and DDR gene-based platform that could serve as a REM reliable biomarker for assessing environmental radiation exposure and associated risk. From our analysis, in addition to REM biomarkers, a significant number of genes, both in human and Arabidopsis thaliana, not yet characterized as DDR, are suggested as possible DNA repair players. Last but not least, we provide an example on the applicability of an Arabidopsis thaliana—based plant system monitoring the role of cancer-related DNA repair genes BRCA1, BARD1 and PARP1 in processing DNA lesions. PMID:28587301

  16. Bridging Plant and Human Radiation Response and DNA Repair through an In Silico Approach.

    PubMed

    Nikitaki, Zacharenia; Pavlopoulou, Athanasia; Holá, Marcela; Donà, Mattia; Michalopoulos, Ioannis; Balestrazzi, Alma; Angelis, Karel J; Georgakilas, Alexandros G

    2017-06-06

    The mechanisms of response to radiation exposure are conserved in plants and animals. The DNA damage response (DDR) pathways are the predominant molecular pathways activated upon exposure to radiation, both in plants and animals. The conserved features of DDR in plants and animals might facilitate interdisciplinary studies that cross traditional boundaries between animal and plant biology in order to expand the collection of biomarkers currently used for radiation exposure monitoring (REM) in environmental and biomedical settings. Genes implicated in trans-kingdom conserved DDR networks often triggered by ionizing radiation (IR) and UV light are deposited into biological databases. In this study, we have applied an innovative approach utilizing data pertinent to plant and human genes from publicly available databases towards the design of a 'plant radiation biodosimeter', that is, a plant and DDR gene-based platform that could serve as a REM reliable biomarker for assessing environmental radiation exposure and associated risk. From our analysis, in addition to REM biomarkers, a significant number of genes, both in human and Arabidopsis thaliana, not yet characterized as DDR, are suggested as possible DNA repair players. Last but not least, we provide an example on the applicability of an Arabidopsis thaliana-based plant system monitoring the role of cancer-related DNA repair genes BRCA1, BARD1 and PARP1 in processing DNA lesions.

  17. Nudging technique for scale bridging in air quality/climate atmospheric composition modelling

    NASA Astrophysics Data System (ADS)

    Maurizi, A.; Russo, F.; D'Isidoro, M.; Tampieri, F.

    2011-06-01

    The interaction between air quality and climate involves dynamical scales that cover an immensely wide range. Bridging these scales in numerical simulations is fundamental in studies devoted to megacity/hot-spot impacts on climate. The nudging technique is proposed as a bridging method that can couple different models at different scales. Here, nudging is used to force low resolution chemical composition models using a high resolution run on critical areas. A one-year numerical experiment focused on the Po Valley hot spot is performed using the BOLCHEM model to asses the method. The results show that the model response is stable to perturbation induced by the nudging and that, if a high resolution run is taken as a reference, there is an increase in model skills of low resolution run when the technique is applied. This improvement depends on the species and the season. The effect spreads outside the forcing area and remains noticeable over an extension about 9 times larger.

  18. 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.

  19. The Dycal try-in technique for Resin-bonded bridges.

    PubMed

    Poyser, Neil J; Briggs, Peter F A

    2004-09-01

    The resin-bonded bridge (RBB) is a predictable technique that has a useful place in modern day dentistry. Practitioners' main concerns, regarding this technique, are a lower survival rate when compared with conventional prostheses, and unpredictable aesthetics. Unfortunately, the minimal preparation and adhesive concepts used with RBBs complicates provisional cementation. Ideally, the RBB should be assessed as if it were the definitively bonded prosthesis. It is possible to achieve a good final aesthetic result as the grey shine-through of the metal wing can be eliminated by the use of opaque resin cements such as Panavia 21 OP. Ideally, the restoration should be assessed with an identical opaque try-in paste but, unfortunately, such a proprietary paste is not available. This paper describes the use of Dycal as a try-in paste for provisionally cementing a resin-bonded bridge and the benefits this offers.

  20. Arthroscopic repair of combined Bankart and SLAP lesions: operative techniques and clinical results.

    PubMed

    Cho, Hyung Lae; Lee, Choon Key; Hwang, Tae Hyok; Suh, Kuen Tak; Park, Jong Won

    2010-03-01

    To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

  1. Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

    PubMed Central

    Cho, Hyung Lae; Lee, Choon Key; Hwang, Tae Hyok; Park, Jong Won

    2010-01-01

    Background To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. Methods From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. Results VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. Conclusions In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first. PMID

  2. 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.

  3. Rectovaginal septal repair: case presentations and introduction of a modified reconstruction technique.

    PubMed

    Walfisch, A; Zilberstein, T; Walfisch, S

    2004-11-01

    Rectovaginal fistula are a relatively rare kind of anorectal fistulas. Spontaneous healing is rare and the rectal advancement flap repair is the most popular procedure with success rates ranging between 60% and 80%. We present a new technique for repairing damage in the rectovaginal septum that consists of placing a folded polyglycolic acid mesh (Dexon) between the levator ani muscle closure area and the vaginal wall. This absorbable mesh separates the suture lines on the vaginal and rectal walls, and induces fibrosis and healing. The technique was performed in four women suffering from a rectovaginal fistula due to different causes. It was successful in all cases.

  4. [Inguinal hernia repair: classification and the choice of adequate anaesthesia techniques].

    PubMed

    Antadze, A A; Rtveliashvili, N Z

    2008-01-01

    In spite of the great achievements in herniology, the problem of inguinal hernia is not solved. The adequate classification is a step to its proper treaty. The classification of the disease is presented in the article. The study confirms the benefits of local anaesthetic-based techniques over both general and spinal anaesthesia for inguinal hernia repair and presents new methods of treatment. The direct and indirect costs of anaesthesia for inguinal hernia repair are lowest when using local anaesthesia with or without sedation. Local anaesthesia-based techniques with conscious sedation fulfil all the requirements for the ideal ambulatory anaesthetic.

  5. 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

  6. Speed-Bridge arthroscopic reinsertion of tibial eminence fracture (complementary to the adjustable button fixation technique).

    PubMed

    Hardy, A; Casabianca, L; Grimaud, O; Meyer, A

    2017-02-01

    In comminuted fractures of the intercondyloid eminence of the tibial spine, the quality of the reduction and the arthroscopic fixation, notably adjustable suture button fixation, is sometimes disappointing with reduction defects of the anterior bone block. In the Speed-Bridge technique, the two traction sutures of the adjustable button fixation are replaced with two braided sutures of different colors. After the button is placed above the eminence, reduction is obtained by tightening the loop of the button. The accessory communitive fragments are then packed in the depression around the main fragment. A second row provides bone suturing for these accessory fragments; traction sutures of the button are attached anteromedially and laterally with knotless anchors to obtain a Speed-Bridge-type inverted-V bone suture. The Speed-Bridge arthroscopic reinsertion technique of the tibial eminence effectively completes the adjustable button bone suture technique for communitive fractures to obtain better reduction and good stability. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Umbilical cord sparing technique for repair of congenital hernia into the cord and small omphalocele.

    PubMed

    Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Musleh, Layla; Cozzi, Denis A

    2017-01-01

    Current repair of small omphaloceles and hernias into the umbilical cord is a straightforward procedure, whose repair may result in a suboptimal cosmetic outcome. We describe a novel repair technique retaining the umbilical cord elements in an attempt to improve the cosmetic appearance of the umbilicus. Eight neonates were consecutively treated more than a ten-year period. Size of the fascial defects ranged 1 to 3cm (median, 2). Present technique entails incision of the amniotic sac without its detachment from the skin, reduction of the extruded contents under direct vision, and closure of the abdominal wall defect by circumferential suturing of peritoneum and fascia around the base of the amniotic sac. The amniotic sac is then re-approximated and folded to create an umbilical stump, which is trimmed and left to shed naturally. All patients achieved a scarless abdomen with a normal appearing umbilicus in 6. The remaining 2 patients are awaiting surgery for persisting umbilical hernia repair and umbilicoplasty, respectively. Poor esthetic outcome was significantly associated with initial fascial defect ≥2.5cm in size (p=0.03). Present technique is a simple and cosmetically appealing repair for umbilical cord hernias and small omphaloceles, especially effective when the size of the fascial defect is less than 2.5cm. IV (Treatment Study). Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Biomechanical comparison of different suturing techniques in rabbit medial gastrocnemius muscle laceration repair.

    PubMed

    He, Min; Sebastin, Sandeep J; Gan, Aaron W T; Lim, Aymeric Y T; Chong, Alphonsus K S

    2014-09-01

    Skeletal muscle laceration is a common injury. Repair of disrupted delicate tissue is still a clinical challenge for surgeons. A few different muscle repair techniques have been reported. However, the best muscle repair technique has not been identified. The aim of the present study is to compare the biomechanical features of different repair techniques in muscles to identify the most effective one. New Zealand white rabbits (2.5-3 kg) were euthanized and medial gastrocnemius muscles were isolated. The muscles were completely transected with scalpels and then repaired by 3 different techniques, namely, (1) 2-strand mattress, (2) 4-strand Kessler (with epitendinous suture), and (3) Mason-Allen. To measure suture performance, the repaired specimens were mounted onto a mechanical testing machine Instron 5543. The muscles were loaded to failure at a constant speed of 60 mm/min. Data collected from Merlin v5.31 software were used to compute the biomechanical properties of each specimen. There was no significant difference in the mean maximum load of Kessler group (15.5 N) and Mason-Allen group (13.2 N), whereas the mean maximum load of the control (Mattress) group (4.4 N) was significantly smaller than the other 2 groups. Moreover, Kessler stitches were the stiffest among the 3. It is noteworthy that the mechanisms of failure were different: Kessler stitches were all pulled out longitudinally, whereas Mason-Allen stitches transmitted load across the laceration and ruptures occur at areas adjacent to the stitches, indicating that muscle is the weakest element in the biomechanical testing. Both Kessler and Mason-Allen stitches have shown better biomechanical features compared with the control group. Further study has to be done to compare the effect of these 2 techniques on muscle regeneration and scar formation in an in vivo model.

  9. 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.

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

    PubMed

    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.

  11. 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

  12. Minilaparoscopic Technique for Inguinal Hernia Repair Combining Transabdominal Pre-Peritoneal and Totally Extraperitoneal Approaches

    PubMed Central

    Loureiro, Marcelo P.; Bonin, Eduardo A; Claus, Christiano P.; Silva, Frederico W.; Cury, Antonio M.; Fernandes, Flavio A.M.

    2012-01-01

    Introduction: Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Materials and Surgical Technique: Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. Discussion: The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure. PMID:23484566

  13. Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

    PubMed

    He, Ze-yang; Chai, Ming-xiang; Liu, Yue-ju; Zhang, Xiao-ran; Zhang, Tao; Song, Lian-xin; Ren, Zhi-xin; Wu, Xi-rui

    2015-11-01

    The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  14. 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

  15. 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

  16. The surgical technique and early postoperative complications of the Gynecare Prolift pelvic floor repair system.

    PubMed

    Lucioni, Alvaro; Rapp, David E; Gong, Edward M; Reynolds, William S; Fedunok, Paula A; Bales, Gregory T

    2008-04-01

    The Gynecare Prolift pelvic floor repair system (GPS) comprises a synthetic mesh placed via a transvaginal, transobturator approach. We present our technique focusing on the safety and feasibility of the GPS. GPS candidates are evaluated in the office with a full history, physical examination, urinalysis and when appropriate, urodynamic evaluation. Patients were offered total vaginal vault prolapse repair or isolated anterior repair dependent of site of defect. Follow-up comprised a full history, physical examination, and global assessment of subjective satisfaction (2 and 6 weeks, 6 months postoperative). Concentration was placed on intraoperative and short-term postoperative complications and assessment of prolapse recurrence. GPS prolapse repair has been used in 12 patients for anterior or total vault prolapse. Mean postoperative follow-up time is 42 weeks. There were no major perioperative complications. De novo enterocele development was seen in one patient without any other incidence of recurrence. No incidence of mesh erosion or sexual dysfunction has been observed. The GPS is a safe and reproducible system for use in transvaginal repairs of vaginal vault prolapse. Long-term studies are needed to evaluate repair durability and for potential complications.

  17. 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

  18. 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.

  19. Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient.

    PubMed

    Mineta, Kazuaki; Suzue, Naoto; Matsuura, Tetsuya; Sairyo, Koichi

    2016-01-01

    Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.

  20. 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

  1. 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

  2. Repair or Reconstruction in Acute Posterolateral Instability of the Knee: Decision Making and Surgical Technique Introduction.

    PubMed

    Stannard, James P; Stannard, James T; Cook, James L

    2015-12-01

    Complex knee injury surgeons must frequently decide whether to repair or reconstruct an acute posterolateral corner (PLC) injury. If repair is not feasible or fails, reconstruction is often necessary. Several studies have found that reconstruction has better outcomes and lower failure rates. Careful studies of the anatomy of the corner have led to the development of "two-tailed" reconstruction techniques which are becoming widely used in the field. Repair should not be completely disregarded as there are times when it is necessary, especially when no donor allograft tissue is readily available or when aggressive postoperative rehabilitation will not be performed. Optimally, if the patient has high quality tissue available for repair, it is best to combine reconstruction with repair. The authors have developed a new PLC reconstruction technique which applies the functional anatomy that has been increasingly defined. We detail these methods here, which include the use of cortical button suspensory fixation and interference screw fixation of allografts in sockets. This allows for individual and sequential intraoperative tensioning of the grafts to obtain optimal knee stability and motion.

  3. 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.

  4. The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair.

    PubMed

    Vopat, Bryan G; Murali, Jothi; Gowda, Ashok L; Kaback, Lee; Blaine, Theodore

    2014-04-22

    Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthroscopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author's practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS) technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001). This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

  5. Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions.

    PubMed

    Spiegl, Ulrich J; Smith, Sean D; Todd, Jocelyn N; Coatney, Garrett A; Wijdicks, Coen A; Millett, Peter J

    2014-08-01

    Single- and double-row arthroscopic reconstruction techniques for acute bony Bankart lesions have been described in the literature. The double-row fixation technique would provide superior reduction and stability of a simulated bony Bankart lesion at time zero in a cadaveric model compared with the single-row technique. Controlled laboratory study. Testing was performed on 14 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. The quality of fracture reduction was measured with a coordinate measuring machine. To determine the biomechanical stability of the repairs, specimens were preconditioned with 10 sinusoidal cycles between 5 and 25 N at 0.1 Hz and then pulled to failure in the anteromedial direction at a rate of 5 mm/min. Loads at 1 mm and 2 mm of fracture displacement were determined. The double-row technique required significantly higher forces to achieve fracture displacements of 1 mm (mean, 60.6 N; range, 39.0-93.3 N; P = .001) and 2 mm (mean, 94.4 N; range, 43.4-151.2 N; P = .004) than the single-row technique (1 mm: mean, 30.2 N; range, 14.0-54.1 N and 2 mm: mean, 63.7 N; range, 26.6-118.8 N). Significantly reduced fracture displacement was seen after double-row repair for both the unloaded condition (mean, 1.1 mm; range, 0.3-2.4 mm; P = .005) and in response to a 10-N anterior force applied to the defect (mean, 1.6 mm; range, 0.5-2.7 mm; P = .001) compared with single-row repair (unloaded: mean, 2.1 mm; range, 1.3-3.4 mm and loaded: mean, 3.4 mm; range, 1.9-4.7 mm). The double-row fixation technique resulted in improved fracture reduction and superior stability at time zero in this cadaveric model. This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols

  6. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study

    PubMed Central

    de Araújo, Felipe Brandão Corrêa; Starling, Eduardo Simão; Maricevich, Marco; Tobias-Machado, Marcos

    2014-01-01

    OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven. PMID:25336820

  7. Repair technique for fractured implant-supported metal-ceramic restorations: a clinical report.

    PubMed

    Wady, Amanda Fucci; Paleari, André Gustavo; Queiroz, Thallita Pereira; Margonar, Rogerio

    2014-10-01

    The fracture of porcelain structures have been related in either natural dentition or implant-supported restorations. Techniques using a composite resin or indirect methods can be used. This article presents a porcelain fracture on implant-supported metal-ceramic restoration. IPS Empress e.max laminate veneer restoration was used to repair the fracture. With this technique, it was possible to restore aesthetics and function, combined with low cost and patient satisfaction.

  8. The adjustable slipknot technique for implanting neochordae in the repair of mitral valve prolapse.

    PubMed

    Yano, Mitsuhiro; Matsuyama, Masakazu; Nishimura, Masanori; Kawagoe, Katsuya

    2016-12-06

    The adjustable slipknot technique is a novel procedure for implanting neochordae. The neochorda acts like a lasso. The procedure facilitates accurate assessment of the length of the neochordae. We performed repairs for 30 of 31 (97.7%) patients using this technique. Less than mild residual regurgitation was observed in all patients at hospital discharge. © The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. 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

  10. Contact angle and contact angle hysteresis measurements using the capillary bridge technique.

    PubMed

    Restagno, Frédéric; Poulard, Christophe; Cohen, Céline; Vagharchakian, Laurianne; Léger, Liliane

    2009-09-15

    A new experimental technique is proposed to easily measure both advancing and receding contact angles of a liquid on a solid surface, with unprecedented accuracy. The technique is based on the analysis of the evolution of a capillary bridge formed between a liquid bath and a solid surface (which needs to be spherical) when the distance between the surface and the liquid bath is slowly varied. The feasibility of the technique is demonstrated using a low-energy perfluorinated surface with two different test liquids (water and hexadecane). A detailed description of both experimental procedures and computational modeling are given, allowing one to determine contact angle values. It is shown that the origin of the high accuracy of this technique relies on the fact that the contact angles are automatically averaged over the whole periphery of the contact. This method appears to be particularly adapted to the characterization of surfaces with very low contact angle hysteresis.

  11. 'Batman excision' of ventral skin in hypospadias repair, clue to aesthetic repair (point of technique).

    PubMed

    Hoebeke, P B; De Kuyper, P; Van Laecke, E

    2002-11-01

    In the hypospadiac penis the ventral skin is poorly developed, while dorsal skin is redundant. The classical Byars' flaps are a way to use the excess dorsal skin to cover the penile shaft. The appearance after Byars' flaps however is not natural. We use a more natural looking skin allocation with superior aesthetic results. The clue in this reconstruction is an inverted triangle shaped excision of ventral skin expanding over the edges of the hooded prepuce (which makes it look like Batman). After excision of the ventral skin it is possible to close the penile skin in the midline, thus mimicking the natural raphe. In case of preputial reconstruction the excised ventral skin makes the prepuce look more natural. The trend of further refining aesthetic appearance of the hypospadiac penis often neglects the penile skin reconstruction. A technique is presented by which the total penile appearances after surgery ameliorates due to better skin reconstruction.

  12. A new repair technique for penile paraffinoma: bilateral scrotal flaps.

    PubMed

    Jeong, J H; Shin, H J; Woo, S H; Seul, J H

    1996-10-01

    Although worldwide incidence is not well known, foreign-body injection is often attempted in order to increase the circumference of the penile shaft. Paraffin, Vaseline, and other materials are injected into the penile skin by the patient himself or by untrained persons who practice medicine fraudulently. Complications usually follow, such as penile deformity, skin necrosis, limited erectile function, and the inability to have intercourse. Definitive treatment of these patients includes the complete removal of skin and subcutaneous tissue infiltrated by the foreign material. Sometimes, complete removal of the foreign material may not be possible and may leave permanent foreign-body granuloma on the corpus cavernosum and/or corpus spongiosum. The remaining foreign material does not permit skin-graft coverage, which is a simple and effective method of resurfacing. In such cases, we tried a new technique comprised of bilateral scrotal flaps to provide for reliable and stable coverage. The scrotal skin, which has high elasticity, seems to be a good material for penile coverage, despite its hairy nature. In our experience, exclusively with Korean males, the scrotal hair has a low density and does not seem to cause serious problems, but patients with hirsute scrotal may be contraindicated. Since 1993, 17 patients with penile paraffinoma have been treated using the bilateral scrotal flap method. All 34 flaps survived completely and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful and without any major complications.

  13. Surgical Techniques for Repair of Peripheral Pulmonary Artery Stenosis.

    PubMed

    Mainwaring, Richard D; Hanley, Frank L

    2017-01-01

    Peripheral pulmonary artery stenosis is a rare form of congenital heart disease frequently associated with Williams and Alagille syndromes. Patients with this disease typically have systemic level right ventricular pressures secondary to obstruction at the lobar, segmental, and subsegmental branches. The current management of patients with peripheral pulmonary artery stenosis remains somewhat controversial. We have pioneered an entirely surgical approach to the reconstruction of peripheral pulmonary artery stenosis. This approach initially entailed surgical patch augmentation of all major lobar branches and effectively reduced right ventricular pressures by more than half. This was the first report demonstrating an effective approach to the disease. Over the past 5 years, we have gradually evolved the technique to extend the reconstruction's reach to include segmental and subsegmental branch stenoses. An important technical aspect of this approach entails division of the main pulmonary and separation of the branch pulmonary arteries to access the lower lobe branches. Pulmonary artery homograft patches are used to augment hypoplastic pulmonary artery branches. In addition, we perform a Heineke-Mikulicz type ostioplasty for isolated ostial stenoses. The technical details of the surgical approach to peripheral pulmonary artery stenosis are outlined in this article, and can also be used for other complex peripheral pulmonary artery reconstructions. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique.

    PubMed

    Anadol, Ziya A; Ersoy, Emin; Taneri, Ferit; Tekin, Ercüment

    2004-06-01

    Laparoscopic hernia repair has all the advantages of a tension free repair. This study compares the laparoscopic transabdominal preperitoneal (TAPP) approach with tension-free open hernia repair in terms of operative time, postoperative pain, hospital stay, complications, and cost. Open and TAPP repairs using polypropylene mesh were performed in two groups of 25 male patients. The difference in operative times between the groups was not significant. Mean pain scores (0-100) for the open group were 54.12 +/- 13.06 at 12 hours and 37.24 +/- 11.38 at 24 hours, significantly higher than the corresponding scores of 38.36 +/- 8.21 at 12 hours and 20.92 +/- 8.73 at 24 hours for the TAPP group (P < 0.05). The mean postoperative analgesic dose was 6.72 +/- 2.72 in the TAPP group, which was insignificantly lower than 7.52 +/- 2.00 in the open group. Mean hospital stay was 2.24 +/- 0.97 days in the open group and 1.52 +/- 0.51 in the TAPP group, which was significant (P < 0.05). Twenty patients (80%) in the TAPP group rated themselves highly satisfied with the surgery as compared to 11 patients (44%) in the open group (P < 0.05). There was no recurrence in either group during a mean followup period of 13.5 months (range, 8-28 months). Laparoscopic hernia repair was significantly more expensive than open (1100 US dollars versus 629 US dollars). TAPP repair is superior to open repair in terms of shorter hospital stay, lower postoperative pain, and better patient satisfaction. It is also safe, with no recurrence in a short-term period. This technique will be the operation of choice for the treatment of groin hernia after long-term results have been established in our center.

  15. [Comparative study between classical operations and Lichtenstein technique for hernia repair].

    PubMed

    Dima, R

    2012-01-01

    The aim of these study was to compare classical procedures in inguinal hernia repair (Postemski, Kimbarovski, Bassini, McVay) made in the Second Surgery Department of County Clinical Emergency Hospital Oradea with the operations in which was used the Lichtenstein technique in the same department, in a period of two years, with respect to recurrence rate, technical difficulty, convalescence and chronic pain. 217 operations were performed in classic way or using the Lichtenstein technique. Follow was performed at 1 month, 3, 6 and 12 months after surgery with a compliance of 80%. There was no significant difference in operating time between classic operations and tension free operations. The recurrence rates were significantly lower in the group operated by the Lichtenstein technique. The chronic pain was reported in both groups as mild or moderate. Lichtenstein hernia repair was easy to learn took the same time and resulted in fewer recurrences. It is possible to be used successfully in a general surgical unit.

  16. Femoral fracture repair using a locking plate technique in an adult captive polar bear (Ursus maritimus).

    PubMed

    Zimmerman, Dawn M; Dew, Terry; Douglass, Michael; Perez, Edward

    2010-02-01

    To report successful femoral fracture repair in a polar bear. Case report. Female polar bear (Ursus maritimus) 5 years and approximately 250 kg. A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.

  17. 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

  18. A new open anterior tension-free onlay patch technique for inguinofemoral hernia repair.

    PubMed

    Reyes-Devesa, Hugo Enrique; Martinez-Dejesús, Fermín; Martínez-Mier, Gustavo; Viñas-Dozal, Julio Cesar

    2005-07-01

    The high rate of misdiagnosed, coincident, or recurrent femoral hernias while or after mesh herniorrhaphy suggests its systematic search. We introduced a new open anterior tension-free mesh herniorrhaphy with a novel design. A description of the operative technique and patients demographics is presented. Two hundred sixty-eight hernias were repaired with this technique in a 5-year period. Two hundred twelve patients had a primary inguinal hernia. An unsuspected femoral hernia was discovered in 39 patients with a preoperatively diagnosed inguinal hernia. Operative time was 45 minutes, most patients were discharged in less than 24 hours, no recurrence has been noted, and minor complications were present. Most patients had minimal pain and returned to their normal activities within 10 days after surgery. This technique has the same advantages of open tension-free repairs, allows identification of femoral hernias, and protects a herniorrhaphy for recurrence.

  19. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development.

    PubMed

    Deprés-Tremblay, Gabrielle; Chevrier, Anik; Snow, Martyn; Hurtig, Mark B; Rodeo, Scott; Buschmann, Michael D

    2016-12-01

    Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. [Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence].

    PubMed

    Dorcaratto, Dimitri; Martínez-Vilalta, Miquel; Parés, David

    2010-05-01

    Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009. Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.

  1. 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.

  2. Thoracic endovascular aortic repair with visceral arteries intermittent clamp technique for descending thoracic aortic aneurysm with shaggy aorta.

    PubMed

    Igarashi, Takashi; Takase, Shinya; Satokawa, Hirono; Misawa, Yukitoki; Wakamatsu, Hiroki; Yokoyama, Hitoshi

    2013-10-01

    Aortic repair for severely atheromatous aneurysm remains a challenge. We used an intermittent clamp technique for all visceral arteries during thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm with a "shaggy aorta" to prevent systemic thromboembolism. In addition, we applied an extracorporeal circulation circuit to trap the thrombi during the endovascular repair. Postoperatively, no embolic complications were seen, and microscopic examination showed trapped plaques on the filter. We conclude that this technique is an option for preventing thromboembolism in aortic aneurysm repair in the context of a shaggy aorta when substantial concern of distal diffuse atheromatous emboli is raised based on clinical history or clear evidence on imaging.

  3. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique.

    PubMed

    Papadakis, Marios; Hübner, Gunnar; Bednarek, Marzena; Arafkas, Mohamed

    2017-03-01

    Perineal hernia is an uncommon complication following abdominoperineal rectum resection. Several surgical procedures have been proposed for perineal hernia repair, including perineal, laparoscopic and abdominal approaches. Repair techniques can be classified into primary suture techniques, mesh placements and repairs with autogenous tissue. We report a 68-year-old man with a perineal hernia, who underwent a pelvic floor reconstruction with a transperineal composite mesh and a gluteal fasciocutaneous rotation flap. We conclude that a combined approach with transperineal mesh reconstruction and gluteal fasciocutaneous flap could be an alternative choice in perineal hernia repair after abdominoperineal resection.

  4. Evaluation of skill-acquisition process in mitral valve repair techniques: a simulation-based study.

    PubMed

    Tavlasoglu, Murat; Durukan, Ahmet Baris; Arslan, Zekeriya; Kurkluoglu, Mustafa; Amrahov, Anar; Jahollari, Artan

    2013-01-01

    Increased patient awareness, duty-hour restrictions, escalating costs, and time constraints in the operating room have revolutionized surgical education. A bovine heart model was designed for training in mitral valve repair procedures. In this article, we aimed to share our experience with this model and to test the validity of simulation with respect to skill acquisition during the training course. After reviewing instructional video recordings of mitral valve repair techniques, 5 junior residents (first and second year) and 5 senior residents (year 4 or higher), who had no experience in mitral valve repair surgery previously, performed mitral valve repair techniques on bovine heart model in a three-month period. Nine different internet videos demonstrating surgical techniques were watched prior to performance in each case. Different text books were studied before the study course. Following repair in each case, the left ventricle of each bovine heart was statically pressurized, the coaptation depth was measured, and the regurgitation (if any) was scored. Each performance was recorded. At the end of the study, video records were evaluated in a blind fashion by 3 different surgeons experienced in mitral valve repair techniques. The monthly scores obtained were statistically analyzed. The mean coaptation depth values measured on a monthly basis were as follows: 2.75±0.63, 4.90±0.91, and 6.55±0.88 for the junior residents and 4.30±0.65, 5.45±0.68, and 7.00±0.64mm for the senior residents. Regurgitation scores noted were 2.20±0.52, 1.65±0.58, and 0.10±0.30 for the junior residents and 1.50±0.60, 0.65±0.67, and 0.70±0.65 for the senior residents During the study period, the practice improved in terms of the aforementioned parameters in both groups (p<0.05). This simulation model of mitral valve repair helped in skill acquisition on monthly basis in both resident groups. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc

  5. Preliminary Investigation of the Systematic Approach to the Repair Versus Replacement Decision-Making Process for Deteriorated Concrete Bridge Decks.

    DTIC Science & Technology

    1986-06-26

    Developing State Transportation Programs.............. 161 6.3 Bridge Management System ................... 163 6.4 Components of the Systematic Decision...144 Figure 6-1 Schematic of State Transportation Management and Bridge Management System .................................... 160 Figure 6-2...briefly highlights the general concepts associated with an overall bridge management system . Specifically, the chap- ter identifies the components or the

  6. A Simple, Effective, and Inexpensive Technique for Exposure of Papillary Muscles in Minimally Invasive Mitral Valve Repair: Wakka Technique.

    PubMed

    Tabata, Minoru; Hiraiwa, Nobuhiko; Kawano, Yuji; Nakatsuka, Daisuke; Hoshino, Satoshi

    2015-09-01

    Obtaining excellent exposure of the papillary muscles is challenging in minimally invasive mitral valve repair. We have developed a simple and effective technique using a sterile paper ruler. The ruler is cut to the proper length (8 to 12 cm) depending on the valve size, then rolled and sutured. The rolled ruler, 7 to 11 cm in circumference, is placed inside the mitral leaflets. This technique provides excellent exposure of the papillary muscles without damaging the leaflets and prevents chordal injury during artificial chordal implantation.

  7. Surgical repair of hip abductors. A new technique using Graft Jacket allograft acellular human dermal matrix.

    PubMed

    Rao, Biyyam M; Kamal, Tamer T; Vafaye, John; Taylor, Lee

    2012-10-01

    Avulsion of the abductors from the hip can be an infrequent but debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. This can result in intractable pain, limp, Trendelenberg lurch and instability of the hip. There have been various methods described for repairing or reconstruction of this abductor muscle complex including direct trans-osseous repair, muscle transfers, muscle and tendon sling, bone tendon allograft reconstruction and endoscopic repair techniques. In a prospective study at our institution we evaluated the results of a surgical technique in 12 patients using a trans-osseous repair of gluteus medius and minimus insertions augmented by a Graft Jacket allograft acellular human dermal matrix (Graft Jacket; Wright Medical Technology, Arlington, TN) over the anterior and anterolateral aspects of the greater trochanter. Diagnosis of hip abductor avulsions was made by evaluation of the history of presenting complaint, clinical examination and confirmed by ultrasound or MRI scans. Evaluation of results included pain scoring, gait evaluation, Trendelenberg test, and the Harris hip score. There was a significant improvement in pain (VAS mean values 8.25 to 2.33; p value < 0.0001), limp and gait along with abductor strength. The Trendelenberg test became negative in all but one. At the mean follow up of 22 months Harris hip scores improved from 34.05 to 81.26 (p value <0.0001). Overall this procedure appears to be safe and associated with high patient satisfaction, without the morbidity of any tendon or muscle transfers.

  8. PZT-based active damage detection techniques for steel bridge components

    NASA Astrophysics Data System (ADS)

    Park, Seunghee; Yun, Chung-Bang; Roh, Yongrae; Lee, Jong-Jae

    2006-08-01

    This paper presents the results of experimental studies on piezoelectric lead-zirconate-titanate (PZT)-based active damage detection techniques for nondestructive evaluations (NDE) of steel bridge components. PZT patches offer special features suitable for real-time in situ health monitoring systems for large and complex steel structures, because they are small, light, cheap, and useful as built-in sensor systems. Both impedance and Lamb wave methods are considered for damage detection of lab-size steel bridge members. Several damage-sensitive features are extracted: root mean square deviations (RMSD) in the impedances and wavelet coefficients (WC) of Lamb waves, and the times of flight (TOF) of Lamb waves. Advanced signal processing and pattern recognition techniques such as continuous wavelet transform (CWT) and support vector machine (SVM) are used in the current system. Firstly, PZT patches were used in conjunction with the impedance and Lamb waves to detect the presence and growth of artificial cracks on a 1/8 scale model for a vertical truss member of Seongsu Bridge, Seoul, Korea, which collapsed in 1994. The RMSD in the impedances and WC of Lamb waves were found to be good damage indicators. Secondly, two PZT patches were used to detect damage on a bolt-jointed steel plate, which was simulated by removing bolts. The correlation of the Lamb wave transmission data with the damage classified by in and out of the wave path was investigated by using the TOF and WC obtained from the Lamb wave signals. The SVM was implemented to enhance the damage identification capability of the current system. The results from the experiments showed the validity of the proposed methods.

  9. Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques

    PubMed Central

    Virk, Mandeep S.; Manzo, Richard L.; Cote, Mark; Ware, James K.; Mazzocca, Augustus D.; Nissen, Carl W.; Shea, Kevin P.; Arciero, Robert A.

    2016-01-01

    Background: The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature. Purpose: To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form–12 (SF-12) score were also compared. Results: A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06). Conclusion: The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair. Clinical Relevance: Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor). PMID:27570783

  10. Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques.

    PubMed

    Virk, Mandeep S; Manzo, Richard L; Cote, Mark; Ware, James K; Mazzocca, Augustus D; Nissen, Carl W; Shea, Kevin P; Arciero, Robert A

    2016-06-01

    The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature. To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair. Cohort study; Level of evidence, 3. Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form-12 (SF-12) score were also compared. A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06). The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair. Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor).

  11. Cartilage repair: third-generation cell-based technologies--basic science, surgical techniques, clinical outcomes.

    PubMed

    Hettrich, Carolyn M; Crawford, Dennis; Rodeo, Scott A

    2008-12-01

    The goal of all cartilage replacement techniques is the reformation of mature organized hyaline cartilage. However, currently cartilage repair techniques lead principally to production of fibrocartilage, which has material properties that are inferior to hyaline cartilage. Cell-based therapies such as autologous chondrocyte implantation hold promise for cartilage regeneration; however, these techniques still do not predictably result in hyaline cartilage formation. The newest, "third-generation techniques" have been developed to address the limitations of earlier techniques. These new procedures use 3 novel approaches: chondro-inductive or chondro-conductive matrix; use of allogeneic cells, both of which may allow a single-stage surgical approach; and techniques to mechanically condition the developing tissue before surgical application to improve the material properties and maturation of the implant. However, at this time there is very limited clinical data available on the nature and outcomes of these procedures.

  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. 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.

  14. High Performance ZVT with Bus Clamping Modulation Technique for Single Phase Full Bridge Inverters

    SciTech Connect

    Xia, Yinglai; Ayyanar, Raja

    2016-03-20

    This paper proposes a topology based on bus clamping modulation and zero-voltage-transition (ZVT) technique to realize zero-voltage-switching (ZVS) for all the main switches of the full bridge inverters, and inherent ZVS and/or ZCS for the auxiliary switches. The advantages of the strategy include significant reduction in the turn-on loss of the ZVT auxiliary switches which typically account for a major part of the total loss in other ZVT circuits, and reduction in the voltage ratings of auxiliary switches. The modulation scheme and the commutation stages are analyzed in detail. Finally, a 1kW, 500 kHz switching frequency inverter of the proposed topology using SiC MOSFETs has been built to validate the theoretical analysis. The ZVT with bus clamping modulation technique of fixed timing and adaptive timing schemes are implemented in DSP TMS320F28335 resulting in full ZVS for the main switches in the full bridge inverter. The proposed scheme can save up to 33 % of the switching loss compared with no ZVT case.

  15. Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial.

    PubMed

    Demetrashvili, Zaza; Pipia, Irakli; Loladze, David; Metreveli, Tamar; Ekaladze, Eka; Kenchadze, George; Khutsishvili, Kakhi

    2017-01-01

    The aim of this prospective randomized clinical study was to compare and analyze the results of two methods of treatment of incisional hernia: open retromuscular mesh repair and onlay technique. 180 patients who underwent open elective surgery for middle primary incisional hernia were randomized into two groups. The retomuscular mesh repair was used in the first group and the onlay technique - in the second group. Several preoperative and intraoperative factors, also wound complications (wound infection, hematoma, seroma) and hernia recurrence rate were determined and compared between the groups. The operative time was significantly longer in the retromuscular group compared with the onlay group (P < 0.001). In the retromuscular group 17 (22.1%) wound complications were observed, in the onlay group-39 (50.0%) wound complications. The difference was statistically significance (P < 0.001). Seroma was the most frequent postoperative wound complication, ranging from 16.9% to 41.0% among the groups, respectively (P = 0.0013). No significantly difference has been found between groups by wound infection and hematoma. 2 (2.6%) case of hernia recurrence was marked in retromuscular group and 4 (5.1%) case of hernia recurrence - in onlay group. But there was no statistically significantly difference between the two groups. Our research shows no significant difference in frequency of hernia recurrence between retromuscular mesh repair and onlay technique for treatment of incisional hernia. The usage of the retromuscular mesh repair is associated with significantly less wound complications than onlay technique. That can be considered as an advantage of retromuscular method, which makes it more preferential than onlay method. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Surgical repair of isolated triceps tendon rupture using a suture anchor technique: a case report

    PubMed Central

    MANCINI, FEDERICO; BERNARDI, GABRIELE; DE LUNA, VINCENZO; TUDISCO, COSIMO

    2016-01-01

    Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors. PMID:28217662

  17. Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population.

    PubMed

    Milchteim, Charles; Tucker, Scott A; Nye, Darin D; Lamour, Richard J; Liu, Wei; Andrews, James R; Ostrander, Roger V

    2016-07-01

    To report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. A retrospective analysis of patients who underwent primary and revision arthroscopic Bankart repairs using bioabsorbable anchors was performed. Outcome measures included recurrence of dislocation, American Shoulder and Elbow Scores (ASES), Rowe, visual analog scale (VAS), return to sports, and satisfaction scores. A total of 94 shoulders met the inclusion criteria. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 5 years (range, 3 to 8.3). The mean postoperative scores were as follows: ASES = 91.5/100; Rowe = 84.3/100; VAS = 0.8/10; satisfaction = 8.8/10. In those who attempted to return to sports, 82.5% were able to return to the same level of competition. Statistical analyses revealed a significant increase in risk of recurrence among high school and recreational athletes. No recurrences were observed among professional or college-level athletes. No significant difference in recurrence rates was observed in regards to age, time to surgery, type of athlete (collision v limited contact), repair of SLAP lesion, number of anchors, or revision surgery. Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as to limited access to postoperative physical therapy. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. One-flap Palatoplasty: A Cohort Study to Evaluate a Technique for Unilateral Cleft Palate Repair

    PubMed Central

    Cotrinal-Rabanal, Omar; Caceres-Nano, Evelyn

    2015-01-01

    Background: The 2-flap palatoplasty technique is actually the approach most commonly used in the United States for cleft palate repair. This is a one-time surgery that enables closure under minimal tension, lowering rates of subsequent fistula development. However, its primary disadvantage is potential detriment to maxillary growth (due to extent of dissection on both sides of the cleft and raw lateral surfaces). Since 2007, a surgical technique using only one mucoperiosteal flap from the noncleft side has been performed by us, reducing the extent of the surgery and its potential nondesirable effects over the palate. The purpose of this study is to evaluate the utility of this technique for unilateral cleft palate repair. Methods: This is a retrospective, simple-blinded cohort study between 2 groups of 120 patients each with unilateral cleft palate who were operated on using the 2-flap and 1-flap techniques by the Outreach Surgical Center Program Lima from 2007 to 2012. Data collection was accomplished by physical examination to evaluate the presence or absence of a fistula and to evaluate the presence of hypernasality. Postoperative bleeding was also studied. Results: We have observed no increase in the rate of fistulas and velopharyngeal insufficiency between these 2 studied groups (P = 0.801 and P = 1.000). Conclusions: Use of a 1-flap technique for unilateral cleft palate repair allowed us to achieve results comparable to those of a 2-flap technique in terms of postoperative fistula development and hypernasal speech. Additional studies are required to evaluate the effect of this technique on palatal growth. PMID:25973351

  19. Laser solder repair technique for nerve anastomosis: temperatures required for optimal tensile strength

    NASA Astrophysics Data System (ADS)

    McNally-Heintzelman, Karen M.; Dawes, Judith M.; Lauto, Antonio; Parker, Anthony E.; Owen, Earl R.; Piper, James A.

    1998-01-01

    Laser-assisted repair of nerves is often unsatisfactory and has a high failure rate. Two disadvantages of laser assisted procedures are low initial strength of the resulting anastomosis and thermal damage of tissue by laser heating. Temporary or permanent stay sutures are used and fluid solders have been proposed to increase the strength of the repair. These techniques, however, have their own disadvantages including foreign body reaction and difficulty of application. To address these problems solid protein solder strips have been developed for use in conjunction with a diode laser for nerve anastomosis. The protein helps to supplement the bond, especially in the acute healing phase up to five days post- operative. Indocyanine green dye is added to the protein solder to absorb a laser wavelength (approximately 800 nm) that is poorly absorbed by water and other bodily tissues. This reduces the collateral thermal damage typically associated with other laser techniques. An investigation of the feasibility of the laser-solder repair technique in terms of required laser irradiance, tensile strength of the repair, and solder and tissue temperature is reported here. The tensile strength of repaired nerves rose steadily with laser irradiance reaching a maximum of 105 plus or minus 10 N.cm-2 at 12.7 W.cm-2. When higher laser irradiances were used the tensile strength of the resulting bonds dropped. Histopathological analysis of the laser- soldered nerves, conducted immediately after surgery, showed the solder to have adhered well to the perineurial membrane, with minimal damage to the inner axons of the nerve. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fiber optic radiometer and thermocouple respectively, also rose steadily with laser irradiance. At 12.7 W.cm-2, the temperatures reached at the surface and at the interface were 85 plus or minus 4 and 68 plus or minus 4 degrees Celsius respectively

  20. [Cartilage repair and subchondral bone reconstruction based on three-dimensional printing technique].

    PubMed

    Zhang, Weijie; Lian, Qin; Li, Dichen; Wang, Kunzheng; Jin, Zhongmin; Bian, Weiguo; Liu, Yaxiong; He, Jiankang; Wang, Ling

    2014-03-01

    To investigate whether subchondral bone microstructural parameters are related to cartilage repair during large osteochondral defect repairing based on three-dimensional (3-D) printing technique. Biomimetic biphasic osteochondral composite scaffolds were fabricated by using 3-D printing technique. The right trochlea critical sized defects (4.8 mm in diameter, 7.5 mm in depth) were created in 40 New Zealand white rabbits (aged 6 months, weighing 2.5-3.5 kg). Biomimetic biphasic osteochondral composite scaffolds were implanted into the defects in the experimental group (n = 35), and no composite scaffolds implantation served as control group (n = 5); the left side had no defect as sham-operation group. Animals of experimental and sham-operation groups were euthanized at 1, 2, 4, 8, 16, 24, and 52 weeks after operation, while animals of control group were sampled at 24 weeks. Subchondral bone microstructural parameters and cartilage repair were quantitatively analyzed using Micro-CT and Wayne scoring system. Correlation analysis and regression analysis were applied to reveal the relationship between subchondral bone parameters and cartilage repair. The subchondral bone parameters included bone volume fraction (BV/TV), bone surface area fraction (BSA/BV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular spacing (Tb.Sp). In the experimental group, articular cartilage repair was significantly improved at 52 weeks postoperatively, which was dominated by hyaline cartilage tissue, and tidal line formed. Wayne scores at 24 and 52 weeks were significantly higher than that at 16 weeks in the experimental group (P < 0.05), but no significant difference was found between at 24 and 52 weeks (P > 0.05); the scores of experimental group were significantly lower than those of sham-operation group at all time points (P < 0.05). In the experimental group, new subchondral bone migrated from the surrounding defect to the centre, and subchondral bony plate formed at

  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. Anomalous Coronary Arteries and Myocardial Bridges: Risk Stratification in Children Using Novel Cardiac Catheterization Techniques.

    PubMed

    Agrawal, Hitesh; Molossi, Silvana; Alam, Mahboob; Sexson-Tejtel, S Kristen; Mery, Carlos M; McKenzie, E Dean; Fraser, Charles D; Qureshi, Athar M

    2017-03-01

    The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12-4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6-18.7) years and median weight 49.5 (11.4-142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

  3. Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis.

    PubMed

    DiBartola, Alex C; Everhart, Joshua S; Magnussen, Robert A; Carey, James L; Brophy, Robert H; Schmitt, Laura C; Flanigan, David C

    2016-06-01

    Compare histological outcomes after microfracture (MF), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS). Literature review using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library. Inclusion criteria limited to English language studies International Cartilage Repair Society (ICRS) grading criteria for cartilage analysis after ACI (autologous chondrocyte implantation), MF (microfracture), or OATS (osteochondral autografting) repair techniques. Thirty-three studies investigating 1511 patients were identified. Thirty evaluated ACI or one of its subtypes, six evaluated MF, and seven evaluated OATS. There was no evidence of publication bias (Begg's p=0.48). No statistically significant correlation was found between percent change in clinical outcome and percent biopsies showing ICRS Excellent scores (R(2)=0.05, p=0.38). Percent change in clinical outcome and percent of biopsies showing only hyaline cartilage were significantly associated (R(2)=0.24, p=0.024). Mean lesion size and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Most common lesion location and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Microfracture has poorer histologic outcomes than other cartilage repair techniques. OATS repairs primarily are comprised of hyaline cartilage, followed closely by cell-based techniques, but no significant difference was found cartilage quality using ICRS grading criteria among OATS, ACI-C, MACI, and ACI-P. IV, meta-analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. [Historic analysis of complex incisional hernia: to an understanding of the double prosthetic repair technique].

    PubMed

    Moreno-Egea, Alfredo; Aguayo-Albasini, José Luis

    2010-11-01

    The treatment of complex incisional hernias is, on occasions, a real social and professional, and still controversial, challenge. A multitude of techniques have been described over the years in an attempt to solve this problem. The social context and technological development of each period are essential to understand the continuous changes in the way of performing these techniques. This article caries out an historical review of the prosthetic treatment of incisional hernias, trying to understand and apply the basic principles of the treatment of all incisional hernias to the repair with a double mesh. Copyright © 2010 AEC. Published by Elsevier Espana. All rights reserved.

  5. Modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair.

    PubMed

    Kondoh, Haruhiko; Funatsu, Toshihiro; Taniguchi, Kazuhiro

    2013-01-01

    We present a modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair. After the proximal and distal anastomosis of a main tubular graft with four pre-sewn side branches, each visceral artery is cannulated and perfused with 25 °C blood (sum total, 800 mL/min). Then, each side branch is placed around the main graft, forming a gently curved loop around it. Finally, the orifice of each visceral artery is sutured to a side branch. This technique prevents kinking of the side branches and enables hemostasis to be secured with a clear view of all the suture lines.

  6. Surface-geophysical techniques used to detect existing and infilled scour holes near bridge piers

    USGS Publications Warehouse

    Placzek, Gary; Haeni, F.P.

    1995-01-01

    Surface-geophysical techniques were used with a position-recording system to study riverbed scour near bridge piers. From May 1989 to May 1993. Fathometers, fixed- and swept-frequency con- tinuous seismic-reflection profiling (CSP) systems, and a ground-penetrating radar (GPR) system were used with a laser-positioning system to measure the depth and extent of existing and infilled scour holes near bridge piers. Equipment was purchased commercially and modified when necessary to interface the components and (or) to improve their performance. Three 200-kHz black-and-white chart- recording Fathometers produced profiles of the riverbed that included existing scour holes and exposed pier footings. The Fathometers were used in conjunction with other geophysical techniques to help interpret the geophysical data. A 20-kHz color Fathometer delineated scour-hole geometry and, in some cases, the thickness of fill material in the hole. The signal provided subbottom information as deep as 10 ft in fine-grained materials and resolved layers of fill material as thin as 1 foot thick. Fixed-frequency and swept-frequency CSP systems were evaluated. The fixed-frequency system used a 3.5-, 7.0-, or 14-kHz signal. The 3.5-kHz signal pene- trated up to 50 ft of fine-grained material and resolved layers as thin as 2.5-ft thick. The 14-kHz signal penetrated up to 20 ft of fine-grained material and resolved layers as thin as 1-ft thick. The swept-frequency systems used a signal that swept from 2- to 16-kHz. With this system, up to 50 ft of penetration was achieved, and fill material as thin as 1 ft was resolved. Scour-hole geometry, exposed pier footings, and fill thickness in scour holes were detected with both CSP systems. The GPR system used an 80-, 100-, or 300-megahertz signal. The technique produced records in water up to 15 ft deep that had a specific conductance less than 200x11ms/cm. The 100-MHz signal penetrated up to 40 ft of resistive granular material and resolved layers as

  7. Nudging technique for scale bridging in air quality/climate atmospheric composition modelling

    NASA Astrophysics Data System (ADS)

    Maurizi, A.; Russo, F.; D'Isidoro, M.; Tampieri, F.

    2012-04-01

    The interaction between air quality and climate involves dynamical scales that cover a very wide range. Bridging these scales in numerical simulations is fundamental in studies devoted to megacity/hot-spot impacts on larger scales. A technique based on nudging is proposed as a bridging method that can couple different models at different scales. Here, nudging is used to force low resolution chemical composition models with a run of a high resolution model on a critical area. A one-year numerical experiment focused on the Po Valley hot spot is performed using the BOLCHEM model to asses the method. The results show that the model response is stable to perturbation induced by the nudging and that, taking the high resolution run as a reference, performances of the nudged run increase with respect to the non-forced run. The effect outside the forcing area depends on transport and is significant in a relevant number of events although it becomes weak on seasonal or yearly basis.

  8. Decoupled control techniques for dual flying capacitor bridge power supplies of large superconductive magnets

    SciTech Connect

    Ehsani, M.; Hozhabri, A.; Kustom, R.L.

    1986-01-01

    The dual flying capacitor (DFC) was developed in 1976 as a method of supplying efficient bilateral power to large superconductive magnets. This power supply concept uses a second superconductive coil for energy storage. Large reversible power demands of the load magnet are met by energy exchange between the storage and load coils, through the DFC bridge. This paper will show that the DFC circuit can be decomposed into two elementary single flying capacitor (SLC) circuits which can be controlled independently. The discovery of this decoupled control concept is the origin of several new control strategies which significantly improve the performance of DFC power supplies. Microcomputer controllers containing the decoupled control algorithm were tested on a DFC system simulator. The results show that time optimal load coil current and voltage control is now achievable by a robust bang-bang control technique. Furthermore, load coil current ripple and voltage spectrum can be independently controlled, while following an arbitrary reference signal. The DFC bridge, with the decoupled controllers, is a high performance power supply candidate for superconductive magnets of fusion reactors, particle accelerators and other systems.

  9. Anterior vaginal prolapse: review of anatomy and techniques of surgical repair.

    PubMed

    Weber, A M; Walters, M D

    1997-02-01

    To summarize the literature on anterior vaginal prolapse, focusing on vaginal anatomy, etiologic theories, and comparison of anterior colporrhaphy and paravaginal repair. We identified articles related to anterior vaginal prolapse through a MEDLINE search of English-language literature published from January 1966 through December 1995 and in bibliographies in gynecologic textbooks. We reviewed 80 articles published in peer-reviewed journals or textbooks and related to anterior vaginal prolapse. In addition, ten articles on operative procedures for urinary incontinence were studied. We abstracted and synthesized information from 31 papers that contained descriptions of and opinions on vaginal anatomy and etiology of vaginal prolapse. The vagina has three layers-mucosa, muscularis, and adventitia; there is no vaginal "fascia." Vaginal support is provided by the underlying levator ani muscles and by lateral connective-tissue attachments at the arcus tendineus fasciae pelvis or "white line." Anterior vaginal prolapse results from direct or indirect damage to the pelvic muscles or connective tissue or both. Forty-nine articles described surgical techniques for the correction of anterior vaginal prolapse, and 24 of them reported postoperative outcomes. Reported failure rates ranged from 0-20% for anterior colporrhaphy and 3-14% for paravaginal repair. No controlled studies compared different procedures performed primarily for correction of anterior vaginal prolapse. Dissection during anterior colporrhaphy splits vaginal muscularis, and repair involves plication of the muscularis and adventitia (not vaginal "fascia") in the midline, which may pull the lateral attachments further from the pelvic sidewall. Paravaginal repair restores the lateral attachments to the pelvic sidewall at the white line. Controlled studies that compare directly these two procedures for anterior vaginal prolapse repair are necessary to determine their relative effectiveness.

  10. Controlled, all-position, butterbead-temperbead welding technique for nuclear repairs

    SciTech Connect

    Clark, J.N.; Lambert, J.A.

    1986-02-01

    Sections III and XI of the ASME boiler and pressure vessel code describe a half-bead temper repair welding technique specifically designed for in-service BWR and PWR repair applications without postweld heat treatment. The method relies on deposition of two layers of weld beads. Prior to deposition of the second layer, half the first layer is ground away. As a result, the first layer HAZ is tempered or retransformed by the second layer heat input. It is on the basis of this tempering that a concession is granted to omit postweld heat treatment. The grinding stage is difficult to control, time consuming, and can involve long exposure of personnel to a radioactive environment. Consequently, there has been pressure to find a viable alternative to the half-bead technique. Much interest has been shown in the butterbead-temperbead technique, which is essentially the CEGB two-layer HAZ refinement technique. This does not require grinding of the first layer and achieves HAZ retransformation by increasing the heat input of the second layer. The elimination of the grinding stage considerably reduces repair time and, consequently, radiation exposure. The method has now been included as an acceptable alternative to the half-bead technique in section XI of the ASME code. The CEGB method has been used successfully in the U.K. power industry, mainly for prevention of stress relief cracking, but also to improve HAZ toughness for low temperature service. Two-layer HAZ refinement is achieved by retransformation of the first layer HAZ by the thermal field of the second layer.

  11. 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.

  12. Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique.

    PubMed

    Maciel, Gustavo Sasso Benso; Simões, Romeo Lages; do Carmo, Felipe Poubel Timm; Garcia, Julio William Rangel; Paulo, Danilo Nagib Salomão

    2013-01-01

    To analyze the results of bilateral inguinal hernia repairs by the Lichtenstein technique. We studied the charts of 59 patients who underwent elective simultaneous bilateral inguinal hernia repair between 2003 and 2007. We analyzed: gender, age, weight, operative time, length of hospital stay, Nyhus classification, complications in the immediate and late postoperative periods, and recurrence. These data were submitted to descriptive statistical analysis. Of the 59 patients, 95% were men. Age ranged from 40 to 60 years; weight, from 50 to 103 kg; operative time, from 60 to 80 minutes; and the length of stay, from one to six days. Thirty patients had type IIIB hernias; nine, type II; ten, type IIIA; seven, type IV; one, type II on the left and type IIIB on the right; one, type IIIA on the right and IIIB on the left; and one, type IIIA on the right and type II on the left. In the immediate postoperative period, pain was the most important manifestation, in 30.5% of subjects. In 94.92% of cases there were no complications. There were two cases of inguinodinia and one of burning pain in the surgical site. There was one recurrence 29 months after the procedure. Simultaneous bilateral inguinal hernia repair by Lichtenstein technique was safe and effective, with a low rate of complications, short hospital stay, and only one case of recurrence at an average of 48 months follow-up.

  13. Para-meatus skin incision with long channel technique for midshaft hypospadias repair without penile curvature.

    PubMed

    Su, Cheng; Yang, Tianyou; Zhang, Zhichong; Xu, Yeqing; Liang, Qifeng

    2012-05-01

    To report a new surgical technique for midshaft hypospadias repair without penile curvature. From September 2007 to October 2010, 21 patients, aged 13 months to 8.9 years, underwent single-stage hypospadias repair by 1 surgeon. The skin incision was created around the meatus, and a long channel beneath the urethral plate was created through the incision to the apex of the glans. The inner preputial flaps were tubularized into a neourethra, which was then transposed to the ventral channel through a ventrolateral tunnel beneath Buck's fascia. Most of the neourethra was covered by the intact soft tissue of the distal ventral penis. The proximal portion of the neourethra was covered by Buck's and dartos fascia around the skin incision, and the skin incision was closed longitudinally. The length of the urethral defect and channel and the postoperative complications were collected and analyzed. A total of 21 patients underwent single-staged hypospadias repair. The average length of the channel was 30 mm (range 25-35). The average length of the neourethra was 35 mm (range 30 to 40). The mean operative time was 60 minutes (range 50-70). The mean hospital stay was 12 days (range 10-14). With an average follow-up of 20 months (range 6-37), no postoperative complication was detected. This technique provides excellent short-term results for midshaft hypospadias without penile curvature and is a safe and simple solution. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Cell Seeding Densities in Autologous Chondrocyte Implantation Techniques for Cartilage Repair.

    PubMed

    Foldager, Casper Bindzus; Gomoll, Andreas H; Lind, Martin; Spector, Myron

    2012-04-01

    Cartilage repair techniques have been among the most intensively investigated treatments in orthopedics for the past decade, and several different treatment modalities are currently available. Despite the extensive research effort within this field, the generation of hyaline cartilage remains a considerable challenge. There are many parameters attendant to each of the cartilage repair techniques that can affect the amount and types of reparative tissue generated in the cartilage defect, and some of the most fundamental of these parameters have yet to be fully investigated. For procedures in which in vitro-cultured autologous chondrocytes are implanted under a periosteal or synthetic membrane cover, or seeded onto a porous membrane or scaffold, little is known about how the number of cells affects the clinical outcome. Few published clinical studies address the cell seeding density that was employed. The principal objective of this review is to provide an overview of the cell seeding densities used in cell-based treatments currently available in the clinic for cartilage repair. Select preclinical studies that have informed the use of specific cell seeding densities in the clinic are also discussed.

  15. Proposed technique for inguinal hernia repair with self-gripping mesh: avoiding fixation to undesired structures.

    PubMed

    Porrero, J L; Cano-Valderrama, O; Castillo, M J; Alonso, M T

    2015-10-01

    Self-gripping meshes have been developed to avoid fixing sutures during inguinal hernia repair. Operative time is shorter when using a self-gripping mesh than with conventional Lichtenstein repair. However, these meshes can be difficult to handle because they fix to undesired structures. The aim of this report is to describe a new technique to avoid this problem. Inguinal hernia dissection is made as usual. Once dissection is finished, a Parietex ProGrip(®) (Covidien, Dublin, Ireland) flat sheet mesh is cut depending on the size needed. A small split is made between the lower and medium third of the mesh to mark where the split for the spermatic cord will be. Using this mark, the upper third of the mesh is folded over the medium third, hiding the microgrips that make this a self-gripping mesh. In this way, only the lower third of the mesh has the microgrips exposed and the mesh can be fixed to the pubic bone and inguinal ligament without fixation to undesired structures. Once the lower third of the mesh is fixed, the split for the spermatic cord is completed and the upper part of the mesh is passed below the spermatic cord. Then, the mesh is unfolded to expose the microgrips again and the medium and upper third of the mesh are descended to its final position. This proposed technique for inguinal hernia repair with self-gripping mesh makes the surgery easier, avoiding mesh fixation to undesired structures.

  16. 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.

  17. Cartilage repair: synthetics and scaffolds: basic science, surgical techniques, and clinical outcomes.

    PubMed

    Kerker, Jordan T; Leo, Andrew J; Sgaglione, Nicholas A

    2008-12-01

    Symptomatic articular cartilage lesions have gained attention and clinical interest in recent years and can be difficult to treat. Historically, various biologic surgical treatment options have yielded inconsistent results because of the inferior biomechanical properties associated with a variable healing response. Improving technology and surgical advances has generated considerable research in cartilage resurfacing and optimizing hyaline tissue restoration. Biologic innovation and tissue engineering in cartilage repair have used matrix scaffolds, autologous and allogenic chondrocytes, cartilage grafts, growth factors, stem cells, and genetic engineering. Numerous evolving technologies and surgical approaches have been introduced into the clinical setting. This review will discuss the basic science, surgical techniques, and clinical outcomes of novel synthetic materials and scaffolds for articular cartilage repair.

  18. Evaluating Naturally Durable Wood Species for Repair and Rehabilitation of Above-Ground Components of Covered Bridges

    Treesearch

    Grant T. Kirker; Carol A. Clausen; A. B Blodgett; Stan T. Lebow

    2013-01-01

    More than 1,500 covered bridges remain in the United States. They are a unique part of our history; thus, replacement of bridge components is an equally important part of preserving this uncommon style of craftsmanship. The goal of this project was to evaluate seven wood species for their durability in above-ground field exposure. Chemical analysis was also conducted...

  19. 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.

  20. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients.

    PubMed

    Rigby, Ryan B; Cottom, James M; Vora, Anand

    2013-01-01

    Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the

  1. Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases.

    PubMed

    Zouari, M; Jallouli, M; Bendhaou, M; Zitouni, H; Mhiri, R

    2015-12-01

    Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair.

  2. A Modified Suture Bridge Technique for Application With Bone Anchors in Foot and Ankle Surgery.

    PubMed

    Walters, Jeremy; Correa, Christopher; Moss, Mark

    2015-01-01

    We present a suture bridge technique for reattachment of tendon or ligament to bone for use in foot and ankle surgery. The method is a simple, strong, and reproducible technique that could decrease the risk of irritation of the overlying cutaneous barrier and minimizes the likelihood of tendon strangulation when combined with soft tissue bone anchors. The present report serves as a guide to the use of this suture technique for reattachment of the Achilles tendon.

  3. The effect of triceps repair techniques following olecranon excision on elbow stability and extension strength: an in vitro biomechanical study.

    PubMed

    Ferreira, Louis M; Bell, Timothy H; Johnson, James A; King, Graham J W

    2011-07-01

    To determine the effect of two types of triceps repair techniques on elbow stability and extension strength in the setting of olecranon deficiency using a cadaveric model. Eight fresh-frozen cadaveric arms were tested in an elbow motion simulator, which produced active elbow extension by applying physiological loads to the tendons. Computed tomography-based surface models were used to determine cutting planes corresponding to sequential levels of olecranon resection. Both anterior and posterior triceps repairs were simulated for each level. Progressive sectioning of the olecranon increased elbow laxity for both active and passive extension (P < 0.001). Although the posterior repair resulted in greater laxity than the anterior repair for all but the 50% resection, this difference was small (less than 3°) and not statistically significant for either active (P = 0.2) or passive (P = 0.1) extension. Active extension produced less joint laxity than passive extension for both the anterior (P = 0.007) and posterior (P = 0.001) repairs. The posterior repair provided greater extension strength than the anterior repair at all applied triceps tensions and for all olecranon resections (P = 0.01). Both repairs reduced extension strength relative to the intact state (P < 0.01). Sequential olecranon excision decreased extension strength (P = 0.04); however, there were no differences between resection levels (P > 0.05). On average, there was a loss of extension strength of 24% and 30% for the posterior and anterior repairs, respectively. There was no significant difference in stability between repair techniques. Posterior repair of the triceps after olecranon excision would thus appear to be efficacious as a result of its higher triceps extension strength. However, clinical studies are needed to confirm these in vitro observations.

  4. Effect of subepineurial dehydroepiandrosterone treatment on healing of transected nerves repaired with the epineurial sleeve technique.

    PubMed

    Ayhan, Sühan; Markal, Nilgün; Siemionow, Krzysztof; Araneo, Barbara; Siemionow, Maria

    2003-01-01

    The epineurial sleeve technique for nerve repair is designed in part to protect a healing nerve from external humoral influences, but research suggests that the external factor dehydroepiandrosterone (DHEA) may actually improve nerve healing in crush injuries. To test the effect of DHEA, we injected it into the epineurial chambers created to repair transected rat sciatic nerves. In 18 control rats, the nerve was transected and repaired without DHEA treatment. Eighteen animals received subepineurial injections of propylene glycol vehicle, and 18 received subepineurial injections of about 0.2 ml DHEA. Walking-track analysis and toe-contracture measurements showed no significant differences among the three groups. At 12 weeks, the gastrocnemius muscles in the DHEA group were significantly heavier than those of untreated controls. At 6 and 12 weeks, DHEA-treated nerves had significantly more myelinated axons, larger average fiber diameter, and greater axonal cross-sectional areas in the proximal, middle, and distal sections. Myelin thickness did not differ between groups, except at 6 weeks between the DHEA and vehicle-treated groups. We conclude that subepineurial dehydroepiandrosterone treatment reduced the extent of denervation atrophy and induced an earlier onset of axonal regeneration.

  5. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case.

    PubMed

    Berezina, Tamara L; Fechtner, Robert D; Cohen, Amir; Kim, Eliott E; Chu, David S

    2015-01-01

    We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency. How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64.

  6. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case

    PubMed Central

    Berezina, Tamara L; Fechtner, Robert D; Cohen, Amir; Kim, Eliott E

    2015-01-01

    ABSTRACT We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency. How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64. PMID:26997836

  7. A novel technique for advancing the inferior labrum in a bankart repair.

    PubMed

    Adams, Brook A; Garrett, William H; Wright, Garth B; Khan, Maher W; Taylor, Jonathon B; Nord, Keith D

    2013-05-01

    Passing suture during a Bankart repair can be a difficult task. A key component of a Bankart repair involves shifting the anteroinferior capsule and labrum superiorly. This technical note describes a new technique of reaching the inferior aspect of the Bankart lesion from posterior. Typical suture passers push the tissue further away. Using a SutureLasso through the low posterolateral portal allows one to push the tissue from inferior toward the suture anchor, making it simpler to advance the capsulolabral complex. Three suture anchors are used in the anteroinferior quadrant. The lowest suture anchor is the critical anchor for advancing the capsule and labrum. The SutureLasso is placed into the axillary recess through the low posterolateral portal, and the nitinol wire is advanced through the capsule and labrum, retrieving the suture and pulling it back through the tissue for tying with a sliding locking knot. This ensures good superior advancement of the tissue and helps obtain an optimal arthroscopic result in Bankart repair. Additional anchors are placed, and suture passage for the middle and superior anchors is then completed from anterior. The advancement and restoration of the tissue tightness provide the optimal components for an excellent result.

  8. 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.

  9. A Dynamic Heart System to Facilitate the Development of Mitral Valve Repair Techniques

    PubMed Central

    Richards, Andrew L.; Cook, Richard C.; Bolotin, Gil; Buckner, Gregory D.

    2013-01-01

    Objective The development of a novel surgical tool or technique for mitral valve repair can be hampered by cost, complexity, and time associated with performing animal trials. A dynamically pressurized model was developed to control pressure and flowrate profiles in intact porcine hearts in order to quantify mitral regurgitation and evaluate the quality of mitral valve repair. Methods A pulse duplication system was designed to replicate physiological conditions in explanted hearts. To test the capabilities of this system in measuring varying degrees of mitral regurgitation, the output of eight porcine hearts was measured for two different pressure waveforms before and after induced mitral valve failure. Four hearts were further repaired and tested. Measurements were compared with echocardiographic images. Results For all trials, cardiac output decreased as left ventricular pressure was increased. After induction of mitral valve insufficiencies, cardiac output decreased, with a peak regurgitant fraction of 71.8%. Echocardiography clearly showed increases in regurgitant severity from post-valve failure and with increased pressure. Conclusions The dynamic heart model consistently and reliably quantifies mitral regurgitation across a range of severities. Advantages include low experimental cost and time associated with each trial, while still allowing for surgical evaluations in an intact heart. PMID:19224369

  10. Radiological and Clinical Evaluation of the Transosseous Cortical Button Technique in Distal Biceps Tendon Repair.

    PubMed

    Caekebeke, Pieter; Vermeersch, Nicolas; Duerinckx, Joris; van Riet, Roger

    2016-12-01

    One of the options to repair a ruptured distal biceps tendon to the radial tuberosity is by means of a transosseous cortical button. Although excellent functional outcomes have been reported, no studies have been performed to quantify the effect of the transosseous fixation technique on the radius. Our study evaluated the clinical outcome and radiological outcome of this technique. The main goal of this study was to evaluate the radiographic evolution of the bone tunnel in the radius. Patients with an acute distal biceps tendon rupture treated with a transosseous cortical button were invited to take part in the study. Fourteen patients were included in the final analysis. All patients were evaluated both clinically and by computed tomography scanning of the proximal radius after a minimum follow-up of 2 years. Outcomes were recorded using the visual analog scale score for pain, the Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand scores. Bone tunnel volume was measured with semiautomated computed tomography segmentation using image-processing software. There were no failures of fixation in the patient group examined. Elbow mobility, arm, and forearm circumference were symmetric for all patients. Average visual analog scale for pain was less than 2. Mean Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score were 2.3 and 97.6, respectively. Computed tomography images showed an average closure of the radial bony tunnel of 64% of the initial volume. Biceps tendon repair with cortical button fixation only shows partial tunnel closure. This could reduce the risk of potential complications due to osteolysis, such as radius fracture or hardware failure. Functional results were excellent and comparable to other fixation methods. The role of interference screws in transosseous cortical button techniques to strengthen the repair and to avoid osteolysis may therefore be questioned. Therapeutic IV. Copyright © 2016

  11. Double-V scrotoplasty for repair of congenital penoscrotal webbing: a hidden scar technique.

    PubMed

    McLeod, Daryl J; Alpert, Seth A

    2014-10-01

    Penoscrotal webbing (PSW) is a common reason for deferral of neonatal circumcision. Reports of successful procedures and outcomes in the literature are sparse. We have performed double-V scrotoplasty (DVS), a modification of a V-Y technique, in 138 patients with excellent results. We retrospectively reviewed the charts of boys who had undergone DVS for PSW since January 2009 by a single surgeon (S.A.A.). The indications, intraoperative findings, concomitant procedures, outcomes, and complications were recorded. A total of 138 DVSs were performed. Concomitant genital surgeries included 81 hidden penis repairs and 10 other (hernia, hypospadias, chordee, orchidopexy). The median age at the time of surgery was 9.6 months (6.1 months-9.8 years). Patients were evaluated about 1 month postoperatively. In seven cases (5%), minor skin separation occurred at the penoscrotal junction but all healed completely. Superficial skin infection occurred in one patient. None required reoperation and cosmetic results were subjectively excellent. PSW has been corrected in 138 patients without significant complications and with excellent results. This is the largest known peer-reviewed series evaluating a surgical technique for congenital PSW repair. We believe our technique is simple, reproducible, and, with no diverging suture lines lateral to the median raphe, improves cosmesis. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  12. Measurement of oxidatively induced DNA damage and its repair, by mass spectrometric techniques.

    PubMed

    Dizdaroglu, M; Coskun, E; Jaruga, P

    2015-05-01

    Oxidatively induced damage caused by free radicals and other DNA-damaging agents generate a plethora of products in the DNA of living organisms. There is mounting evidence for the involvement of this type of damage in the etiology of numerous diseases including carcinogenesis. For a thorough understanding of the mechanisms, cellular repair, and biological consequences of DNA damage, accurate measurement of resulting products must be achieved. There are various analytical techniques, with their own advantages and drawbacks, which can be used for this purpose. Mass spectrometric techniques with isotope dilution, which include gas chromatography (GC) and liquid chromatography (LC), provide structural elucidation of products and ascertain accurate quantification, which are absolutely necessary for reliable measurement. Both gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS), in single or tandem versions, have been used for the measurement of numerous DNA products such as sugar and base lesions, 8,5'-cyclopurine-2'-deoxynucleosides, base-base tandem lesions, and DNA-protein crosslinks, in vitro and in vivo. This article reviews these techniques and their applications in the measurement of oxidatively induced DNA damage and its repair.

  13. A novel modification of Bosworth's technique to repair zone I Achilles tendon ruptures.

    PubMed

    Pavan Kumar, Avadhanam; Shashikiran, Raviprakash; Raghuram, Choulapalle

    2013-03-01

    Zone I ruptures of the Achilles tendon and chronic ruptures in zone II with a gap of more than 6 cm are difficult to treat. We describe a technique that is very well suited to this type of rupture. Seventy-eight patients with chronic rupture of the Achilles tendon were operated on between January 1996 and December 2010. We used a modification of the Bosworth technique in which a strip of the gastrocnemius aponeurosis was taken, made into a tendon-like structure and passed through the calcaneum after making a drill hole; then it was sutured back to the proximal stump. The Leppilahti scoring system was used to evaluate these patients. Sixty-two patients had excellent results, 8 had good results, 4 had fair results, 2 had poor results, and 2 were lost to follow-up at the end of 1 year. Nearly all patients resumed work at 6 months postoperatively, had normal walking and stair climbing, and regained normal dorsiflexion. Our technique is ideally suited to zone I ruptures (where no distal stump is available for repair) and ruptures in zone II where end-to-end repair is not possible.

  14. Results of repair of iliac artery aneurysms with the sandwich technique

    PubMed Central

    Shutze, Ryan A.; Oglesby, Wes; Lee, Allen

    2017-01-01

    Patients undergoing endovascular repair (EVAR) of aortoiliac or iliac artery aneurysm may require sacrifice of one or both internal iliac arteries (IIAs). Until Food and Drug Administration–approved commercial grafts became available, endovascular IIA preservation was accomplished using the “sandwich” technique, but limited information is available regarding the results of this method. After obtaining institutional review board approval, we identified patients undergoing IIA preservation with the sandwich technique during EVAR at our institution. The patients have been followed prospectively since being identified to record patency rates and vascular symptoms or events. Twenty-four procedures were performed from 2011 through 2015 to treat iliac artery aneurysms. Fourteen of these procedures were done with concomitant EVAR using different endografts (Gore Excluder 11, Endologix AFX 2, Cook Zenith 1). Five were done to extend a previous EVAR that had developed a type Ib endoleak, 2 for an isolated external iliac artery aneurysm, 3 for an anastomotic aneurysm from a previous aortobiiliac graft, and 2 for isolated iliac aneurysm repair. There were 25 sandwich grafts (unilateral in 19, bilateral in 6). Contralateral embolization was performed in 5 cases. Immediate success rates were high, and patency rates were excellent at intermediate follow-up. Intraoperative type 3 endoleaks were not uncommon but usually resolved postoperatively. Endovascular IIA preservation is feasible with currently available devices using this technique. This procedure is recommended for preservation of the IIA during endovascular treatment of aortoiliac and iliac artery aneurysms when anatomy requires IIA preservation. PMID:28127120

  15. 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. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. JAG tearing technique with radiofrequency guide wire for aortic fenestration in thoracic endovascular aneurysm repair.

    PubMed

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

    2012-02-01

    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.

  18. 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.

  19. Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative "555 Technique".

    PubMed

    Gupta, Manish K; Muley, Kiran Kumar; Bethanbhatla, Murali Krishna; Nanavati, Juhil D; Manish, Kumar; Sarangi, Rathindra

    2017-03-01

    Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports. Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years). Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients. "555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

  20. Comparative radiographic analysis of changes in the abdominal wall musculature morphology after open posterior component separation or bridging laparoscopic ventral hernia repair.

    PubMed

    De Silva, Gayan S; Krpata, David M; Hicks, Caitlin W; Criss, Cory N; Gao, Yue; Rosen, Michael J; Novitsky, Yuri W

    2014-03-01

    Large ventral hernias are known to induce atrophic changes to the anterior abdominal wall musculature. We have shown that anterior component separation with external oblique (EO) release, with resultant reconstruction of the midline, results in hypertrophy of the rectus muscle (RM), internal oblique (IO), and transversus abdominis (TA). We aimed to compare and contrast the impact of posterior component separation with transversus abdominis release (TAR) and bridging laparoscopic ventral hernia repair (LVHR) on the muscles of the abdominal wall. Preoperative and at least 6-month postoperative CT scans were analyzed for patients undergoing TAR with midline reconstruction and LVHR without midline reconstruction. A change in the measured area of each abdominal wall muscle was used as the determinant of hypertrophy or atrophy. The areas of the RM, EO, IO, and TA were measured at the L3 to L4 level through the axial plane. Twenty-five consecutive patients with pre- and postoperative images were analyzed in each group. In the TAR group, the RA, EO, and IO demonstrated significant increases in area. In the LVHR group, no muscles demonstrated any significant changes. Similar to anterior component separation, hernia repair with TAR results in hypertrophy of the rectus abdominis muscle. In addition, we found that TAR was associated with hypertrophy of both external and internal oblique muscles. Bridging repair during LVHR, on the other hand, did not result in any significant changes in any of the abdominal muscles. Our findings provide clear radiologic evidence that re-creation of the midline by means of the TAR leads to improved anatomy of the abdominal wall, in addition to positive compensatory changes of the lateral abdominal wall musculature. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. 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

  2. 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

  3. Novel Repair Technique for Life-Extension of Hydraulic Turbine Components in Hydroelectric Power Stations

    NASA Astrophysics Data System (ADS)

    Hiramatsu, Yoichi; Ishii, Jun; Funato, Kazuhiro

    A significant number of hydraulic turbines operated in Japan were installed in the first half of the 20th century. Today, aging degradation and flaws are observed in these turbine equipments. So far, Japanese engineers have applied NDI technology of Ultrasonic Testing (UT) to detect the flaws, and after empirical evaluation of the remaining life they decided an adequate moment to replace the equipments. Since the replacement requires a large-scale field site works and high-cost, one of the solutions for life-extension of the equipments is introduction of repair services. We have been working in order to enhance the accuracy of results during the detection of flaws and flaws dimensioning, in particular focusing on the techniques of Tip-echo, TOFD and Phased-Array UT, accompanied by the conventional UT. These NDI methods made possible to recognize the entire image of surface and embedded flaws with complicated geometry. Then, we have developed an evaluation system of these flaws based on the theory of crack propagation, of the logic of crack growth driven by the stress-intensity factor of the crack tip front. The sophisticated evaluation system is constituted by a hand-made software and database of stress-intensity factor. Based on these elemental technologies, we propose a technique of repair welding to provide a life-extension of hydraulic turbine components.

  4. Repair techniques for acute distal biceps tendon ruptures: a systematic review.

    PubMed

    Watson, Jonathan N; Moretti, Vincent M; Schwindel, Leslie; Hutchinson, Mark R

    2014-12-17

    There is a lack of consensus regarding the optimal surgical approach and fixation method for distal biceps tendon ruptures. The purpose of this study was to conduct a systematic review comparing the results of the various surgical approaches and repair techniques for acute distal biceps tendon ruptures. We searched the MEDLINE, Cochrane, and Embase databases for all published randomized controlled trials, prospective cohort studies, or case series that involved primary repairs of acute distal biceps tendon ruptures with use of a cortical button, intraosseous screws, suture anchors, or bone tunnels for fixation. Exclusion criteria included case reports, cadaveric studies, repairs of partial ruptures, revision repairs, and multiple methods of fixation in the same patient. Statistical analysis was performed with use of the chi-square test. Twenty-two studies met the inclusion criteria. The total number of patients was 494 (498 elbows). The complication rate was 24.5% (122 of 498 elbows) overall, and it was 23.9% (seventy-eight of 327) for one-incision procedures and 25.7% (forty-four of 171) for two-incision procedures (p = 0.32). The complication rate was 26.4% (seventy-five of 284) for suture anchors, 20.4% (thirty-four of 167) for bone tunnels, 44.8% (thirteen of twenty-nine) for intraosseous screws, and 0% (zero of eighteen) for cortical button fixation. The complication rate for use of bone tunnels was significantly lower than that for intraosseous screws (p < 0.01). Similarly, the cortical button method proved superior to intraosseous screws (p = 0.01). The most common complication was lateral antebrachial cutaneous nerve neurapraxia (9.6% across all studies, 11.6% for one incision, and 5.8% for two incisions). The complication rate did not differ significantly between one and two-incision distal biceps repairs; however, the bone tunnel and cortical button methods had significantly lower complication rates compared with suture anchors and intraosseous screws

  5. 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

  6. Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

    PubMed

    Braun, Daniel; Nabauer, Michael; Orban, Mathias; Orban, Martin; Gross, Lisa; Englmaier, Andrea; Rösler, Diana; Mehilli, Julinda; Bauer, Axel; Hagl, Christian; Massberg, Steffen; Hausleiter, Jörg

    2017-02-03

    The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR). Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3±0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10±8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade ≥3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p<0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days. Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.

  7. Laparoscopic Mesh Versus Open Preperitoneal Mesh Versus Conventional Technique for Inguinal Hernia Repair

    PubMed Central

    Johansson, Bo; Hallerbäck, Bengt; Glise, Hans; Anesten, Bengt; Smedberg, Sam; Román, Jonas

    1999-01-01

    Objective To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects. Summary Background Data Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has been questioned. The laparoscopic technique must be thoroughly compared with the open procedures before its true place in hernia surgery can be defined. Methods Six hundred thirteen male patients aged 40 to 75 years were randomized to the conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. Results Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. Patients who underwent TAPP gained full recovery after 18.4 days, compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 14.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days for the conventional procedure (p = 0.04). They also had significantly less restriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were more common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP group were recorded after 1 year (p = n.s.). Conclusion The laparoscopic technique results in both shorter time to full recovery and shorter time to return to work, at the price of substantially increased costs. PMID:10450737

  8. Comparative Effectiveness of Two Ultrasound-Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair.

    PubMed

    Steffel, Lauren; Kim, T Edward; Howard, Steven K; Ly, Daphne P; Kou, Alex; King, Robert; Mariano, Edward R

    2016-01-01

    Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks ("double TAP" technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.

  9. [PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

    PubMed

    Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

    2016-02-01

    To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P<0.05); the score at 6 months after operation was significantly lower than that at other time points (P<0.05), but no significant difference was shown between the other time points (P>0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor

  10. [Repair in situ of parastomal hernia with modified sublay-keyhole technique].

    PubMed

    Fei, Yang; Li, Jiye; Yao, Sheng

    2011-09-01

    To investigate the procedure and the effectiveness of modified Sublay-Keyhole technique for repair in situ of parastomal hernia. Between October 2007 and March 2010, 11 patients with parastomal hernia underwent modified Sublay-Keyhole technique for repair in situ. There were 5 males and 6 females with an average age of 63 years (range, 55-72 years). The average body mass index was 28.2 (range, 23.5-32.5). All stomas in patients were permanent, including 6 end colostomies caused by abdominal perineal resection for rectal cancer, 2 end ileostomies secondary to total colon resection for ulcerative colitis, and 3 end ileostomies following ileal conduit for bladder resection. One patient underwent previous prothetic repair with polypropylene mesh. The average time from last operation to admission was 2.5 years (range, 1-4.5 years). According to classification criteria of George Eliot hospital, 3 cases were classified as grade 2b, 2 as grade 3a, 5 as grade 3b, and 1 as grade 4. The average longest diameter of hernia ring was 9.5 cm (range, 6-12 cm). Reconstructions of abdominal wall in all patients were performed successfully through modified Sublay-Keyhole technique. The average size of hernia ring was 75.5 cm2 (range, 30-112 cm2), and the average size of polypropylene mesh was 280.5 cm2 (range, 175-360 cm2). The average operative time was 165 minutes (range, 120-195 minutes) and the average postoperative hospitalization days were 11 days (range, 9-14 days). All patients achieved healing of incision by first intention with no abdominal wall infection. Seroma and hematoma occurred in 2 patients and 1 patient, respectively, and were cured by needle aspiration and pressure bandaging. All patients were followed up 26.3 months on average (range, 10-39 months). One case suffered from parastomal hernia recurrence at 11 months postoperatively because of suture loosening and too wide aperture in mesh; and re-sutures in both mesh aperture and myofascial dehiscence were given and

  11. The "open branch" technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm.

    PubMed

    Krajcer, Zvonimir; Echeverria, Angela

    2016-03-01

    Spinal cord ischemia (SCI) has been one of the most concerning complications after surgical and endovascular thoracoabdominal aortic aneurysm repair "Open Branch" is an innovative technique to reduce the incidence of SCI Further studies in a larger number of patients with varying pathologies are needed to confirm the advantages of this technique.

  12. Open repair for aortic occlusive disease: indication, techniques, results, tips and tricks.

    PubMed

    Tshomba, Y; Melissano, G; Apruzzi, L; Baccellieri, D; Negri, G; Chiesa, R

    2014-04-01

    The aim of this article was to review indications, techniques, and outcomes of a series of open repair for aortic occlusive disease. Between 1991 and 2013, 1071 patients (917 men, 154 women; mean age 62.6 years) underwent open repair for aortoiliac occlusive disease. According to TASC II classification, 123 patients (11.5%) had type B lesions, 343 (32%) type C, and 605 (56.5%) type D. Among type D lesions, 138 patients had Leriche's Syndrome with complete aortic occlusion. Nine hundred and eight aortobifemoral bypasses, 114 axillo-bifemoral bypasses, 42 aortic endarterectomies with patch aortoplasty, and 7 thoracobifemoral bypasses were performed. Associated endarterectomy of abdominal aorta was required in 191 patients (18.5%), of the femoral arteries in 297 (28.7%). Perioperatively mortality was 0.6%; perioperative morbidity included cardiac (3.4% of patients), respiratory (2.6%), as well as acute renal insufficiency (2.6%). There were 26 (2.5%) cases of intraoperative distal embolization, 9 (0.8%) of acute graft thrombosis and 9 (0.8%) of bleeding requiring surgical revision within the first 24 hours after surgery. Sixty-one groin complications were reported in 57 patients (5.3%). During a mean follow-up time of 74 months (range 1-264), calculated actuarial occlusion-free survival at 12, 24, and 36 months was 94.8%, 91.8% and 87.2%, respectively. The limb-salvage rate in patients with critical limb ischemia was 87.3%. There were 11 (1%) graft infections. Open repair is a ductile strategy and may be tailored according to the patient clinical condition and disease anatomy. Long-term patency is excellent with low perioperative mortality and reasonable morbidity rates.

  13. Pectoralis major tendon repair: a biomechanical study of suture button versus transosseous suture techniques.

    PubMed

    Thomas, William; Gheduzzi, Sabina; Packham, Iain

    2015-09-01

    Pectoralis major tendon avulsion injury benefits from surgical repair. The technique used and speed of rehabilitation in this demanding population remains subject to debate. We performed a biomechanical study comparing suture button (Pec Button™, Arthrex, Naples, FL) with a transosseous suture technique (FibreWire, Arthrex, Naples, FL). Freshly slaughtered porcine humeri were prepared to model a single transosseous suture or suture button repair. A static, tensile load to failure experiment and a cyclic, tensile load experiment to model standard (10,000 cycles) and accelerated rehabilitation (20,000 cycles) philosophies were tested. The mode of failure, yield and ultimate failure load, extension (clinical failure >10 mm) and the resistance to cyclic loading was measured. The mode of failure was suture fracture in all the static load experiments with 10/11 occurring as the suture passed through the button and 7/11 as the suture passed through the bone tunnels. There was a significant difference in yield load, favouring transosseous suture [p = 0.009, suture button (SB) 673.0 N (647.2-691.7 N), transosseous suture (TOS) 855.0 N (750.0-891.4 N)] and median extension, favouring suture button [p = 0.009, SB 8.8 mm (5.0-12.4 mm), TOS 15.2 mm (13.2-17.1 mm)]. 2/3 transosseous suture and 0/3 suture buttons failed before completing 20,000 cycles. The difference in mean number of cycles completed was non-significant. The difference in mean extension was 5.1 mm (SB 6.7 mm, TOS 11.7 mm). Both techniques show advantages. The difference in extension is likely to be more clinically relevant than load tolerated at failure, which is well above physiological levels. The findings do not support an accelerated rehabilitation model.

  14. Monitoring cracks and prestress-loss in PSC girder bridges using vibration-based damage detection techniques

    NASA Astrophysics Data System (ADS)

    Park, Jae-Hyung; Kim, Jeong-Tae; Ryu, Yeon-Sun; Lee, Jung-Mi

    2007-04-01

    In this study, a vibration-based method to simultaneously predict prestress-loss and flexural crack in PSC girder bridges is presented. Prestress-loss and flexural crack are two typical, but quite different in nature, types of damage which can be occurred in PSC girder bridges. The following approaches are implemented to achieve the objective. Firstly, two vibration-based damage detection techniques which can predict prestress-loss and flexural crack are described. The techniques are prestress-loss prediction model and mode-shape-based crack detection method. In order to verify the feasibility and practicality of the techniques, two different lab tests are performed. A free-free beam with external unbonded tendons is used to verify the feasibility of the prestress-loss prediction model. In additional, a PSC girder with an internal unbonded tendon is used to evaluate the practicality of the prestress-loss prediction model and the mode-shape- based crack detection method.

  15. 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

  16. Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report

    PubMed Central

    2013-01-01

    Introduction The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. Case presentation A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a ‘pop’ on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Conclusion Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps

  17. Augmented Repair of Acute Achilles Tendon Rupture Using an Allograft Tendon Weaving Technique.

    PubMed

    Huang, Xiaowei; Huang, Gan; Ji, Ying; Ao, Rong guang; Yu, Baoqing; Zhu, Ya Long

    2015-01-01

    Achilles tendon rupture is a common injury, especially in those who are physically active. Although open surgery is a widely used option for the treatment of acute Achilles tendon rupture, the optimal treatment is still disputed. In our study, 59 patients with unilateral, closed, acute rupture of the Achilles tendon were treated by open surgery using an allograft weave to augment the repair. All the surgeries were performed within 1 to 4 days after injury. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was recorded as 91.20 (range 88 to 95), 95.34 (range 92 to 98), and 98.27 (range 97 to 99) at the 3-, 6-, and 12-month follow-up visit, respectively. At the final follow-up visit, the mean difference between the mid-calf circumference of the injured and uninjured legs was 0.19 (range -0.03 to 1.50) cm (p = .43). At the final follow-up visit, the mean difference between the vertical distances from the plantar surface of the heel to the ground for the injured and uninjured lower extremities was 0.44 (range -0.03 to 0.5) cm (p = .17). Augmented repair using the allograft tendon weaving technique provided satisfactory tendon strength and functional outcomes and a timely return to the patients' activities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Final Environmental Assessment for the Grace Hopper Bridge Embankment Repairs at Joint Base Charleston Weapons Station, South Carolina

    DTIC Science & Technology

    2015-07-06

    other agricultural crops with minimum inputs of fuel, fertilizer, pesticides, and labor, and without intolerable soil erosion (7 United States Code...The continued erosion would cause sedimentation and reduced water quality in Goose Creek. Temporary repairs that would replace lost soil and rip-rap...10 3.3 Soils

  19. 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.

  20. One-stage total thoracic aortic repair for mega-aorta using frozen elephant trunk technique.

    PubMed

    Uchida, Naomichi; Katayama, Akira; Kuraoka, Masatsugu; Sueda, Taijiro

    2011-10-01

    We report the case of a 71-year-old female with mega-aorta extending from the ascending aorta to the descending aorta, who was successfully treated with a one-stage total thoracic aortic repair by the frozen elephant trunk technique using a stent-graft. We used a home-made frozen elephant trunk with four giant-turco Z-stents on the distal side that was inserted into the downstream descending aorta via an aortic arch guiding pull-through wire. The stent-graft was distally positioned at the level of the 12th thoracic vertebra after total arch replacement had been performed using a four-branch graft. The postoperative course was good, and there was no paraplegia or other complications. A postoperative computed tomography scan demonstrated complete thrombosis of the descending thoracic aneurysm without endoleak. In conclusion, the frozen elephant trunk was effective as a one-stage operation for mega-aorta.

  1. 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

  2. A minimally invasive "overwrapping" technique for repairing neglected ruptures of the Achilles tendon.

    PubMed

    Lui, Tun Hing

    2014-01-01

    About 10% to 25% of acute ruptures of the Achilles tendon go undiagnosed for some time beyond what would be optimal for repair and a return to optimal function. Managing these chronic or neglected ruptures is a surgical challenge, because the tendon ends retract and atrophy and could develop a short, fibrous distal stump. In the present report, a patient with a ruptured right Achilles tendon, neglected for approximately 10 years, is described. The chronically injured tendon was successfully treated by overwrapping the interposed scar at the rupture site. This minimally invasive technique restored tension to the tendon, a prerequisite for which was the presence of functional triceps surae, confirmed by identification of gross contraction of the muscle during tiptoeing. The procedure is contraindicated when the scar tissue is not intact and does not have sufficient laxity to allow adequate dorsiflexion of the ankle after overwrapping the tendon or when the triceps surae are nonfunctional.

  3. Early Experiences of Sandwich Technique to Preserve Pelvic Circulation during Endovascular Aneurysm Repair.

    PubMed

    Kim, Daehwan; Chung, Jung Kee; Park, Hyung Sub; Jung, In Mok; Lee, Taeseung

    2017-06-01

    To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9-1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.

  4. A novel suture technique for distal aorta-graft anastomosis in aortic aneurysm repair surgery: diagonal basting stitch.

    PubMed

    Cagli, Kerim; Cicek, Omer Faruk; Lafci, Gokhan

    2015-01-01

    We describe a novel suture technique of distal anastomosis between the graft and the aorta in ascending aortic aneurysm repair surgery. In this technique, the aortic graft is positioned inside the distal aortic lumen with an overlapping segment and circumferential or back wall part only diagonal basting stitches are performed without use of Teflon pledgets, strips, or bioadhesives. This new technique establishes a secure anastomosis line, shortens anastomosis time, and avoids the use of foreign materials.

  5. A New Local Flap Nipple Reconstruction Technique Using Dermal Bridge and Preoperatively Designed Tattoo

    PubMed Central

    Iwahira, Yoshiko

    2017-01-01

    Background: Nipple–areolar reconstruction is the final step in breast reconstruction. Reconstruction using local flaps and tattooing is useful in cases of bilateral reconstruction, a small nipple–areolar complex (NAC) as the donor site, and avoiding disturbance of the normal side and other body parts. However, this method can cause projection loss and color fading of the nipple. Moreover, the breast mound is reconstructed with an implant. Methods: We performed nipple–areolar reconstruction of 90 nipples using clover-designed flaps oriented at 120 degrees and tattooing after breast silicone implantation in 64 women. The tattoo was designed before flap operation and stained darker. Following donor site closure, a dermal flap was made as a bridge for nipple support. The nipple space was separated by the dermal flap from the breast mound and was filled with subcutaneous tissue. The size of the reconstructed nipple projection was measured postoperatively and 1 year later. The projection maintenance rate was calculated. Results: The heights of the nipple projection were 11.3 ± 1.8 mm (95% confidence interval [CI]: 10.9–11.7) just after the operation and 6.09 ± 2.4 mm (95% CI: 5.6–6.6) 1 year later. The actual range of nipple projection between these 2 heights was 5.2 ± 2.4 mm (95% CI: 4.7–5.7). The maintenance rate of the reconstructed nipple projection after 12 months was 54.1 ± 20.9 (95% CI: 49.7–58.5). The nipple color was maintained for over a year. Conclusions: Our nipple–areolar reconstruction technique could maintain the projection and color of the reconstructed nipple for a long period. Good outcomes were obtained in this implant-based breast reconstruction. PMID:28507843

  6. Multiple rib fracture in a neonatal foal using a nylon strand suture repair technique.

    PubMed

    Kraus, Beth M; Richardson, Dean W; Sheridan, Georgiana; Wilkins, Pamela A

    2005-01-01

    To report rib fracture repair using the Securos Cranial Cruciate Ligament Repair System (SCCLRS; Securos Veterinary Orthopedics, Charlton, MA) in a neonatal foal. Case report. A 1-day-old Standardbred foal with fracture of left ribs 2-9. Four days after admission the foal was anesthetized and rib fractures were repaired using open reduction and the SCCLRS. Rib fractures were successfully stabilized and the foal was discharged 7 days postoperatively without further complications. The SCCLRS provided a straightforward, effective method of rib fracture repair in neonatal foals. Effective rib fracture repair in neonatal foals can be achieved with the SCCLRS.

  7. Mitral valve repair by Alfieri's technique does not limit exercise tolerance more than Carpentier's correction.

    PubMed

    Frapier, Jean-Marc; Sportouch, Catherine; Rauzy, Valerie; Rouviere, Philippe; Cade, Stéphane; Demaria, Rolland G; Davy, Jean-Marc; Albat, Bernard

    2006-06-01

    The main goal of this study was to evaluate if the edge-to-edge mitral repair could be a limiting factor for exercise tolerance and to compare these results to those of classical techniques. Between 2000 and 2002, 54 consecutive patients were operated on for mitral valve regurgitation (MR). Twenty-five patients were operated with Alfieri's technique (group A) and 29 patients with Carpentier's technique (group C). The mean age was 63.9 years in group A and 63.8 years in group C (p = 0.98). After a mean follow-up of 16.2+/-12 months, survivor patients were seen at the outpatient clinic, by the same physician for a clinical evaluation, an echocardiogram at rest and at peak exercise, and received a cardiorespiratory exercise testing with maximal oxygen uptake (VO2 max) recording. Clinical status improved with 0% of the patients in class NYHA III or IV in either group postoperatively versus 77% preoperatively. There was no significant MR in 80% of cases in group A versus 89.6% in group C (p = 0.54). The mean mitral valve area was 2.5 and 2.9 cm2 in groups A and C, respectively (p = 0.018). The mitral gradient at rest was 3.8 and 3.3 mmHg (p = 0.31) and the mitral gradient at peak exercise was 8.5 and 9.7 mmHg (p = 0.22) in groups A and C, respectively. Cardiorespiratory exercise testing showed a mean VO2 max of 73.7+/-15% of normal value in group A versus 79.6+/-13.1% in group C (p = 0.18). Alfieri's technique has the same efficiency on improvement of MR and clinical status than classical repair. Despite a higher restriction of mitral valve area at rest in group A, gradient and mean VO2 max at peak exercise were similar in both groups.

  8. 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

  9. One and a half ventricle repair in association with tricuspid valve repair according to "peacock tail" technique in patients with Ebstein's malformation and failing right ventricle.

    PubMed

    Prifti, Edvin; Baboci, Arben; Esposito, Giampiero; Kajo, Efrosina; Dado, Elona; Vanini, Vittorio

    2014-05-01

    The aim of this study was to evaluate the outcome in a series of patients with Ebstein's anomaly and a failing right ventricle (RV) undergoing tricuspid valve (TV) repair and bidirectional Glenn cavopulmonary anastomosis (BDG). Between January 2006 and September 2013, 11 consecutive patients diagnosed with severe forms of Ebstein's anomaly and a failing RV underwent TV surgery and BDG. The mean age was 16.5 ± 7 years. Most frequently found symptoms were cyanosis, dyspnea, and arrhythmias. The azygos or hemiazygos veins were left open. The TV was repaired using the "peacock tail" technique, which consisted of total detachment of the anterior and posterior leaflets of the TV and rotation in both directions reimplanting them to the true annulus. The mean follow-up was 3.8 ± 2.4 years (range three months to six years). Hospital mortality was 9% (one patient). TV repair was possible in 10 patients. None of the patients had AV block postoperatively. At one year after surgery, the indexed RV and RA diameter were reduced significantly versus the preoperative data (p = 0.003 and p < 0.001). The mean TVR and indexed TV area were 1.2 ± 0.42 and 1.6 ± 0.6 (mm/m2), significantly lower than preoperatively (p = 0.001 and p = 0.008, respectively). The mean NYHA functional class, SaO2 , and cardiothoracic ratio were significantly improved. The peacock tail technique for TV repair in combination with BDG in patients with Ebstein's malformation and depressed RV function results in TV preservation, a low incidence of recurrent regurgitation, favorable functional status and RV function, and resolution of cyanosis. © 2014 Wiley Periodicals, Inc.

  10. The Kelly technique of bladder exstrophy repair: continence, cosmesis and pelvic organ prolapse outcomes.

    PubMed

    Jarzebowski, A C; McMullin, N D; Grover, S R; Southwell, B R; Hutson, J M

    2009-10-01

    The Kelly technique of radical soft tissue mobilization, an alternative to osteotomy and modern staged repair, has been used extensively at our tertiary referral center for bladder exstrophy in the last 2 decades. We present what is to our knowledge the first long-term followup of the Kelly technique in 31 patients treated at our institution. Patients admitted for bladder exstrophy at our institution since 1980 were identified and the medical charts were reviewed. Continence questionnaires were completed during followup appointments or by mail. Continence was defined as complete-dry greater than 3 hours during the day and night with 2 or fewer night wets per month and partial-dry 2 hours or more during the day and 3 or greater night wets per month, and/or stress incontinence. The degree of pelvic organ prolapse was assessed in females older than 12 years. Data were available on 31 Kelly patients, including 14 females, 4 to 25 years old and 13 patients, including 4 females, 2 to 29 years old treated with another staged technique. Of 30 Kelly patients without urinary diversion 21 (70%) were completely or partially continent. Of the 30 patients 17 voided spontaneously without clean intermittent catheterization or augmentation, of whom 12 (71%) were continent. Lower abdominal appearance was graded as abnormal in 11 of 12 male Kelly patients vs in 2 of 7 nonKelly males with pubic approximation (p = 0.01). Of the 12 females assessed none of 9 Kelly patients had prolapse, whereas 2 of 3 nonKelly patients had prolapse (p <0.05). The continence rate after the Kelly operation compares favorably with that in recent series. The abnormal appearance of the lower abdomen and bony pelvis in Kelly males may result from a lack of pubic approximation. Importantly pelvic organ prolapse may be decreased in women after the Kelly technique.

  11. A novel technique to repair a transverse sacral fracture in a previously fused lumbosacral spondylolisthesis

    PubMed Central

    Noh, Thomas; Chedid, Mokbel K.

    2016-01-01

    Background: Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbar-to-sacral instrumentation have been previously described. We report a new technique to repair a transverse Type-2 Roy-Camille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented high-grade L4-L5, L5-S1 spondylolisthesis. Case Description: A 64-year-old female who previously had an L4-L5, L5-S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months. She was found to have an S1-S2 transverse fracture caused by previous implantation of pedicle screws. She underwent repositioning of several failed right lumbar and sacral screws and then had bilateral S1-S2 screws placed directly across the fracture line. The patient had an unremarkable postoperative course. She discontinued most of her pain medications within 6 weeks postoperatively. In the months following surgery, she reported only minimal lower back pain and no radiculopathy with the last appointment 5 years postoperatively. Conclusions: We describe a novel technique to reduce an iatrogenic transverse type-2 Roy-Camille fracture at S1-S2 in a previously instrumented high-grade L4-L5, L5-S1 spondylolisthesis. The patient's fracture achieved adequate reduction and fusion with symptomatic relief. PMID:28028448

  12. 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.

  13. Review of In-Service Inspection and Repair Technique Developments for French Liquid Metal Fast Reactors

    SciTech Connect

    Baque, F.

    2005-04-15

    In-service monitoring of nuclear plants is indispensable for both the Operator and the Regulator. The notion of in-service monitoring ranges from the continuous monitoring of the reactor in operation to the thorough in-service reactor inspection during programmed shutdowns. However, the highly specific environment found in French liquid metal fast reactor plants - Phenix and Superphenix - makes monitoring and inspection complicated because of the use of a sodium coolant that is hot, opaque, and difficult to drain.The Commissariat a l'Energie Atomique, in collaboration with its traditional French partners, Electricite de France utilities and FRAMATOME/Novatome Engineering, decided to conduct a 6-yr research and development program (1994-2000) to explore this problem vis-a-vis Superphenix, as well as the possibilities of intervening within the reactor block or on components in a sodium environment. Furthermore, the safety reevaluation of Phenix, conducted between 1994 and 2003, represented an excellent 'test bench' during which the limits of inspection processes - applied to an integrated reactor concept - were surpassed using techniques such as fuel subassembly head scanning, ultrasonic examination of the core support, and visual inspection of the cover-gas plenum following a partial sodium draining. Repair techniques were investigated for cleaning of sodium wet structure surfaces, cutting of damaged parts, and welding in sodium aerosol atmosphere. Both conventional and laser processes were tested.

  14. 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

  15. Total extraperitoneal laparoscopic hernia repair: a modified technique associated with few complications and a low early recurrence rate.

    PubMed

    Kakkis, J L; Brunicardi, F C

    1996-10-01

    Laparoscopic hernia repairs have been demonstrated to be safe and effective, with less postoperative pain and earlier return to work than with open repairs. Modifications of the laparoscopic technique are evolving that attempt to reduce the overall complication rate while maintaining an effective repair. From January 1994 through July 1995, 67 inguinal hernias on 40 patients were repaired using the total extraperitoneal approach at UCLA Medical Center. Of the 67 hernias, four (6%) were pantaloon, 16 (24%) were indirect, and the remainder (70%) were direct. Three patients of 40 (7.5%) had complications that included seromas (two patients) and urinary retention (one patient). The early recurrence rate is zero, with a mean follow-up period of 6 months. The average time taken off from work was 2 days, with a range of zero to 10 days. Total extraperitoneal laparoscopic hernia repair is a modified technique associated with low early recurrence and few complications. In addition, earlier return to work results in less patient inconvenience, greater productivity, and reduction in medical disability expenses.

  16. 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.

  17. A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia.

    PubMed Central

    Fitzgibbons, R J; Salerno, G M; Filipi, C J; Hunter, W J; Watson, P

    1994-01-01

    OBJECTIVE: This study was done (1) to determine whether congenital indirect inguinal hernias in male pigs could be repaired by placing a polypropylene mesh prosthesis over the defect intra-abdominally, (2) to measure the incidence of adhesions between intra-abdominal viscera and the prosthesis with and without the adhesion barrier oxidized regenerated cellulose, (3) to determine the incidence of other complications, and (4) to assess the effect on fertility. SUMMARY BACKGROUND DATA: Several techniques for laparoscopic inguinal herniorrhaphy are currently being evaluated to determine whether there are advantages over conventional inguinal herniorrhaphy. Perhaps the most controversial is the intraperitoneal onlay mesh procedure (IPOM). Its advantage is its simplicity (in that the repair is accomplished by placing a prosthesis over the hernia defect intra-abdominally, avoiding a groin dissection). Its disadvantage is the potential for complications because the prosthesis is in contact with the intra-abdominal viscera. METHODS: In male pigs, polypropylene mesh alone or polypropylene mesh plus the adhesion barrier oxidized regenerated cellulose (composite prosthesis) was fixed to the peritoneum surrounding the hernia defect. In phase 1 (6-week follow-up), two groups of 13 pigs each underwent herniorrhaphy at laparotomy or laparoscopy. In phase 2 (7.1-month follow-up), 21 pigs underwent laparoscopic herniorrhaphy. RESULTS: All IPOM herniorrhaphies were successful. The prostheses adhered most frequently to the bladder, followed by small bowel, peritoneum, and cord structures. Prosthetic erosion into these organs was not observed. Laparoscopically placed prostheses in phases 1 and 2 had significantly less surface covered by adhesions (13% +/- 13% and 19% +/- 27%, respectively) and a lower adhesion tenacity grade (1.5 +/- 0.9 and 1.3 +/- 1.1, respectively) than those placed at laparotomy (44% +/- 27% and 2.5 +/- 0.7, respectively; p < 0.01). In phase 1, a histologic

  18. Fixation of posterior process fractures of the olecranon using a modified suture bridge technique: report of 2 cases.

    PubMed

    Cha, Soo Min; Shin, Hyun Dae; Kim, Kyung Cheon; Noh, Chang Kyun

    2014-12-01

    We encountered 2 patients with posterior process fractures of the olecranon and fixed the fragment using a modified suture bridge method without a metallic implant. The suture anchor was inserted distally through the fracture plane, and the small tip of proximal olecranon was reduced to the ulna. Computed tomography revealed bony union 4 and 5 months later. At the 1-year postoperative follow-up examination, the clinical outcomes were satisfactory in both patients. This suture bridge technique was reliable for small fragment fixation in posterior process fracture of the olecranon based on the tension band theory with no problems induced by metallic hardware. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. A new data assimilation technique based on ensemble Kalman filter and Brownian bridges: An application to Richards' equation

    NASA Astrophysics Data System (ADS)

    Berardi, Marco; Andrisani, Andrea; Lopez, Luciano; Vurro, Michele

    2016-11-01

    In this paper a new data assimilation technique is proposed which is based on the ensemble Kalman filter (EnKF). Such a technique will be effective if few observations of a dynamical system are available and a large model error occurs. The idea is to acquire a fine grid of synthetic observations in two steps: (1) first we interpolate the real observations with suitable polynomial curves; (2) then we estimate the relative measurement errors by means of Brownian bridges. This technique has been tested on the Richards' equation, which governs the water flow in unsaturated soils, where a large model error has been introduced by solving the Richards' equation by means of an explicit numerical scheme. The application of this technique to some synthetic experiments has shown improvements with respect to the classical ensemble Kalman filter, in particular for problems with a large model error.

  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. Percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population

    PubMed Central

    Van den Branden, B.J.L.; Post, M.C.; Swaans, M.J.; Rensing, B.J.W.M.; Eefting, F.D.; Plokker, H.W.M.; Jaarsma, W.; Van der Heyden, J.A.S.

    2010-01-01

    Background. Percutaneous mitral valve (MV) repair using the edge-to-edge clip technique might be an alternative for patients with significant mitral regurgitation (MR) and an unacceptably high risk for operative repair or replacement. We report the short-term safety and efficacy of this new technique in a high-risk population. Methods. All consecutive high-risk patients who underwent percutaneous MV repair with the Mitraclip® between January and August 2009 were included. All complications related to the procedure were reported. Transthoracic echocardiography for MR grading and right ventricular systolic pressure (RVSP) measurement were performed before, and at three and 30 days after the procedure. Differences in NYHA functional class and quality of life (QoL) index were reported. Results. Nine patients were enrolled (78% male, age 75.9±9.0 years, logistic EuroSCORE 33.8±9.0%). One patient developed inguinal bleeding. In one patient partial clip detachment occurred, a second clip was placed successfully. The MR grade before repair was ≥3 in 100%, one month after repair a reduction in MR grade to ≤2 was present in 78% (p=0.001). RVSP decreased from 43.9±12.1 to 31.6±11.7 mmHg (p=0.009), NYHA functional class improved from median 3 (range 3 to 4) to 2 (range 1 to 4) (p=0.04), and QoL index improved from 62.9±16.3 to 49.9±30.7 (p=0.12). Conclusion. In high-risk patients, transcatheter MV repair seems to be safe and a reduction in MR can be achieved in most patients, resulting in a short-term improvement of functional capacity and QoL. (Neth Heart J 2010;18:437–43.) PMID:20862239

  2. Arthroscopic Bankart repair and subscapularis augmentation: an alternative technique treating anterior shoulder instability with bone loss.

    PubMed

    Maiotti, Marco; Russo, Raffaele; Zanini, Antonio; Schröter, Steffen; Massoni, Carlo; Bianchedi, Diana

    2016-06-01

    This study presents the preliminary results of a new arthroscopic technique consisting of the association of 2 procedures, capsulolabral repair and subscapularis augmentation tenodesis, in the treatment of traumatic anterior shoulder instability with both glenoid bone loss and a Hill-Sachs lesion. Eighty-nine patients engaged in sports were enrolled in this retrospective case-series study with 2 to 5 years' follow-up. All patients underwent a computed tomography scan to assess the percentage of glenoid bone loss by the Pico method. A prior stabilization procedure had failed in 20 patients, who were then segregated into a different group. Visual analog scale (VAS), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess the results. Only 3 of 89 patients had a post-traumatic redislocation. The mean length of follow-up was 31.5 months (range, 25-60 months). The VAS, Rowe, and ASES scores showed significant improvements: The VAS score decreased from a mean of 3.1 to 0.5 (P = .0157), the Rowe score increased from 58.9 to 94.1 (P = .0215), and the ASES score increased from 68.5 to 95.5 (P = .0197). The mean deficit of external rotation was 6° with the arm at the side of the trunk, and the mean deficit was 3° with the arm in 90° of abduction. The described procedure is a reproducible and effective technique used to restore joint stability in patients engaged in sports who have incurred anterior recurrent shoulder dislocation associated with glenoid bone loss (<25%) and a Hill-Sachs lesion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. A Novel Bone Marrow Stimulation Technique Augmented by Administration of Ultrapurified Alginate Gel Enhances Osteochondral Repair in a Rabbit Model

    PubMed Central

    Baba, Rikiya; Momma, Daisuke; Matsuoka, Masatake; Hontani, Kazutoshi; Elmorsy, Sameh; Endo, Kaori; Todoh, Masahiro; Tadano, Shigeru; Iwasaki, Norimasa

    2015-01-01

    Cartilage injuries are a common health problem resulting in the loss of daily activities. Bone marrow stimulation technique, one of the surgical techniques for the cartilage injuries, is characterized by technical simplicity and less invasiveness. However, it has been shown to result in fibrous or fibrocartilaginous repair with inferior long-term results. This study focused on using ultrapurified alginate gel (UPAL gel) as an adjuvant scaffold in combination with a bone marrow stimulation technique. The objective of this study was to assess the efficacy of a bone marrow stimulation technique augmented by UPAL gel in a rabbit osteochondral defect model. To achieve this goal, three experimental groups were prepared as follows: defects without intervention, defects treated with a bone marrow stimulation technique, and defects treated with a bone marrow stimulation technique augmented by UPAL gel. The macroscopic and histological findings of the defects augmented by UPAL gel improved significantly more than those of the others at 16 weeks postoperatively. The combination technique elicited hyaline-like cartilage repair, unlike bone marrow stimulation technique alone. This combination procedure has the potential of improving clinical outcomes after use of a bone marrow stimulation technique for articular cartilage injuries. PMID:26414601

  4. 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 of...

  5. 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 of...

  6. 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 of...

  7. 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 of...

  8. 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 of...

  9. National Outcomes for Open Ventral Hernia Repair Techniques in Complex Abdominal Wall Reconstruction.

    PubMed

    Ross, Samuel W; Oommen, Bindhu; Huntington, Ciara; Walters, Amanda L; Lincourt, Amy E; Kercher, Kent W; Augenstein, Vedra A; Heniford, B Todd

    2015-08-01

    Modern adjuncts to complex, open ventral hernia repair often include component separation (CS) and/or panniculectomy (PAN). This study examines nationwide data to determine how these techniques impact postoperative complications. The National Surgical Quality Improvement Program database was queried from 2005 to 2013 for inpatient, elective open ventral hernia repairs (OVHR). Cases were grouped by the need for and type of concomitant advancement flaps: OVHR alone (OVHRA), OVHR with CS, OVHR with panniculectomy (PAN), or both CS and PAN (BOTH). Multivariate regression to control for confounding factors was conducted. There were 58,845 OVHR: 51,494 OVHRA, 5,357 CS, 1,617 PAN, and 377 BOTH. Wound complications (OVHRA 8.2%, CS 12.8%, PAN 14.4%, BOTH 17.5%), general complications (15.2%, 24.9%, 25.2%, 31.6%), and major complications (6.9%, 11.4%, 7.2%, 13.5%) were different between groups (P < 0.0001). There was no difference in mortality. Multivariate regression showed CS had higher odds of wound [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.5-2.0], general (OR 1.5, 95% CI: 1.3-1.8), and major complications (OR 2.1, 95%, CI: 1.8-2.4), and longer length of stay by 2.3 days. PAN had higher odds of wound (OR 1.5, 95%, CI: 1.3-1.8) and general complications (OR 1.7, 95%CI: 1.5-2.0). Both CS and PAN had higher odds of wound (OR 2.2, 95%, CI: 1.5-3.2), general (OR 2.5, 95%, CI: 1.8-3.4), and major complications (OR 2.2, 95%CI: 1.4-3.4), and two days longer length of stay. In conclusion, patients undergoing OVHR that require CS or PAN have a higher independent risk of complications, which increases when the procedures are combined.

  10. 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

  11. Analysis Techniques, Materials, and Methods for Treatment of Thermal Bridges in Building Envelopes

    DTIC Science & Technology

    2013-08-01

    example calculation is given for a roof composed of a steel bulb tee bridging through fiber glass insula- tion and covered by gypsum concrete and...fourth of a double pane glass window, 3-D geometry ....................................................... 71 42 Thermographic image of window frames in...greater than would be expected in a wall made up of planar layers such as gypsum wallboard, insulation, sheathing, and cladding. TBs often result from

  12. 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.

  13. 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.

  14. Experimental analysis of vehicle-bridge interaction using a wireless monitoring system and a two-stage system identification technique

    NASA Astrophysics Data System (ADS)

    Kim, Junhee; Lynch, Jerome P.

    2012-04-01

    Deterioration of bridges under repeated traffic loading has called attention to the need for improvements in the understanding of vehicle-bridge interaction. While analytical and numerical models have been previously explored to describe the interaction that exists between a sprung mass (i.e., a moving vehicle) and an elastic beam (i.e., bridge), comparatively less research has been focused on the experimental observation of vehicle-bridge interaction. A wireless monitoring system with wireless sensors installed on both the bridge and moving vehicle is proposed to record the dynamic interaction between the bridge and vehicle. Time-synchronized vehicle-bridge response data is used within a two-stage system identification methodology. In the first stage, the free-vibration response of the bridge is used to identify the dynamic characteristics of the bridge. In the second stage, the vehicle-bridge response data is used to identify the time varying load imposed on the bridge from the vehicle. To test the proposed monitoring and system identification strategy, the 180 m long Yeondae Bridge (Icheon, Korea) was selected. A dense network of wireless sensors was installed on the bridge while wireless sensors were installed on a multi-axle truck. The truck was driven across the bridge at constant velocity with bridge and vehicle responses measured. Excellent agreement between the measured Yeondae Bridge response and that predicted by an estimated vehicle-bridge interaction model validates the proposed strategy.

  15. Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study.

    PubMed

    de la Fuente, C; Carreño-Zillmann, G; Marambio, H; Henríquez, H

    2016-01-01

    To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared. A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond(®) suture to 4.5cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (α=.05), and the maximum resistances using the Student t test (α=.05). There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique. The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Sexual dysfunction after inguinal hernia repair with the Onstep versus Lichtenstein technique: A randomized clinical trial.

    PubMed

    Andresen, Kristoffer; Burcharth, Jakob; Fonnes, Siv; Hupfeld, Line; Rothman, Josephine Philip; Deigaard, Søren; Winther, Dorte; Errebo, Maj-Britt; Therkildsen, Rikke; Hauge, Dina; Sørensen, Fritz Søbæk; Bjerg, Jesper; Rosenberg, Jacob

    2017-06-01

    Sequelae after inguinal hernia repair include pain-related impairment of sexual function. Pain during intercourse can originate from the scar, scrotum, penis, or during ejaculation. The aim of this study was to investigate if the Onstep technique resulted in better results than the Lichtenstein technique regarding pain-related impairment of sexual function. This study was part of the randomized ONLI trial (NCT01753219, Onstep versus Lichtenstein for inguinal hernia repair). Separate reporting of pain-related impairment of sexual function was planned before the study start, with a separate sample size calculation. Participants were randomized to the Onstep or Lichtenstein technique for repair of their primary inguinal hernia and followed up at 6 months postoperative with the use of a questionnaire specific for pain-related impairment of sexual function. A total of 259 patients completed the 6-month follow-up, 129 in the Lichtenstein group and 130 in the Onstep group. Among the patients operated with the Onstep technique, 17 experienced pain during sexual activity 6 months after operation compared with 30 patients operated with the Lichtenstein technique (P = .034). Both subgroups that experienced pain during sexual activity had a median visual analog scale score of 0 with an interquartile range of 0 to 2 (P = .349). The Lichtenstein technique resulted in new pain in 14 patients, whereas the Onstep procedure gave new pain in 7 patients (P = .073). The Onstep technique was superior to the Lichtenstein technique in terms of pain during sexual activity 6 months after operation. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. 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

  18. Semitendinosus and gracilis free muscle-tendon graft for repair of massive rotator cuff tears: surgical technique.

    PubMed

    Gigante, Antonio; Bottegoni, Carlo; Milano, Giuseppe; Riccio, Michele; Dei Giudici, Luca

    2016-01-01

    Massive rotator cuff tears are difficult to treat surgically due to retraction, degeneration and fraying of the ends of torn tendons, severe fatty infiltration and atrophy of the respective muscles. Procedures developed to close the gap between the rotator cuff and the greater tuberosity of the humerus, such as soft tissue release may be inadequate for large tears. Human or porcine dermal allografts still have uncertain benefits, and tendon transfers seem to be associated with poor outcomes, donor site morbidity and altered mechanics. Reverse total shoulder arthroplasty has limited durability and is not indicated in young patients with high functional demands. We developed a new technique for repairing massive rotator cuff tears by semitendinosus and gracilis myotendinous grafting. This novel therapeutic option allows massive rotator cuff tears to be repaired using autologous material that is adequate and adaptable, making it possible to cover any width of defect. The technique is low-invasive and not technically demanding, with minimal donor site morbidity.

  19. 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

  20. 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

  1. 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

  2. Full-arch milled titanium implant bridge: technical report.

    PubMed

    Peché, Wendy-Ann; Van Vuuren, Ludwig Jansen; Park, Chae

    2011-09-01

    The manufacturing of full-arch fixed implant-supported bridges with the use of the traditional lost wax technique remains a technical challenge. Distortion of the alloy during casting and subsequent heating cycles during porcelain build-up causes numerous problems. Fracturing of porcelain on large restorations is difficult and costly to restore. The fitting problems can be eliminated by utilising CAD/CAM technology in the manufacturing of long-span or full-arch titanium bridges. Repair of damaged porcelain can be simplified with the use of discrete, individually-removable crowns on the bridge.

  3. Blepharoptosis repair through the small orbital septum incision and minimal dissection technique in patients with coexisting dermatochalasis.

    PubMed

    Jung, Younhea; La, Tae Yoon

    2013-02-01

    To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. The pre- and postoperative MRD1 averaged 1.1 ± 0.8 mm and 2.8 ± 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.

  4. Blepharoptosis Repair through the Small Orbital Septum Incision and Minimal Dissection Technique in Patients with Coexisting Dermatochalasis

    PubMed Central

    Jung, Younhea

    2013-01-01

    Purpose To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. Methods A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. Results The pre- and postoperative MRD1 averaged 1.1 ± 0.8 mm and 2.8 ± 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. Conclusions Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis. PMID:23372372

  5. [Repair of primary inguinal hernia: Lichtenstein versus Shouldice techniques. Prospective randomized study of pain and hospital costs].

    PubMed

    Porrero, José L; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuanbenito, Alfonso; Sánchez-Cabezudo, Carlos

    2005-02-01

    Hernia is one of the most widely studied processes, and the search for excellence has become the final aim. However, many controversies remain to be resolved. The objective of the present study was to analyze postoperative pain and costs using two techniques of primary inguinal hernia repair. We performed a prospective, randomized study of 54 patients who underwent surgical repair of inguinal hernia through either the Lichtenstein or the Shouldice technique between June 2001 and May 2002. The following variables were analyzed: age, location and type of hernia, evaluation of tolerance to local anesthesia, surgical technique, operating time, pain at days 1, 3 and 5 after surgery, analgesic consumption, days until driving could be resumed, days off work, and occupation. The patient groups were similar, with no significant differences in age, location or type of hernia. For Lichtenstein hernioplasty, operating time was lower (p < 0.01); pain evaluation showed no significant differences on days 1 and 3 after surgery but was higher on day 5 (p = 0.064). No significant differences were found in analgesic consumption, time before driving could be resumed, or days off work. Freelance patients returned to work earlier, independently of the surgical technique performed. The cost of the Lichtenstein technique was 235 euros compared with 180 euros for the Shouldice technique and this difference was statistically significant (p < 0.05). In the hands of expert surgeons, the Shouldice technique is the procedure of choice in the repair of primary hernias. The results are just as satisfactory as those obtained with Lichtenstein hernioplasty and hospital costs are lower.

  6. Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps.

    PubMed

    Archer, Jacob B; Sun, Hai; Bonney, Phillip A; Zhao, Yan Daniel; Hiebert, Jared C; Sanclement, Jose A; Little, Andrew S; Sughrue, Michael E; Theodore, Nicholas; James, Jeffrey; Safavi-Abbasi, Sam

    2016-03-01

    This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients' mean age was 33 years (range 11-79 years). The mean overall length of follow-up was 14 months (range 5-45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)--1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. Extensive anterior skull base

  7. 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 to

  8. Multilayer myofascial-mesh repair for giant midline incisional hernias: a novel advantageous combination of old and new techniques.

    PubMed

    Picazo-Yeste, Joaquín; Morandeira-Rivas, Antonio; Moreno-Sanz, Carlos

    2013-09-01

    The components separation technique has been proposed as the best solution when facing large abdominal wall defects. In counterpart, this sometimes comes at the price of high rates of wound complications and recurrence. Moreover, the components separation method alone seems insufficient for huge defects, in which it is impossible to reapproximate the rectus muscles without tension. For these cases, we illustrate a novel operation using a modified components separation technique. Twenty-eight patients with giant midline incisional hernias were treated with a combination of the components separation (bilateral sliding rectus abdominis advancement flaps), an autologous multilayer repair, and a retromuscular mesh reinforcement. Twenty-four (85%) patients have been analyzed. Transverse defect size ranged from 15 to 25 cm (average, 18.8 cm). Wound complications occurred in nine (37%) cases; three of them required drainage of a subcutaneous abscess. After a mean follow-up of 22 (range, 12-48) months, one (4%) recurrence was identified. Multilayer myofascial-mesh repair was associated with a low recurrence rate, and wound complications were managed without issues. This approach is a reliable technique for most surgeons and may constitute a new part of the armamentarium for the repair of challenging defects.

  9. 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.

  10. A laboratory comparison of a new arthroscopic transosseous rotator cuff repair to a double row transosseous equivalent rotator cuff repair using suture anchors.

    PubMed

    Kummer, Frederick J; Hahn, Michael; Day, Michael; Meislin, Robert J; Jazrawi, Laith M

    2013-01-01

    Because current instrumentation makes it possible to perform an arthroscopic transosseous rotator cuff repair, we performed a biomechanical comparison of a double-row transosseous equivalent rotator cuff repair using suture anchors to an arthroscopic, transosseous rotator cuff repair to determine if they provided similar fixation stability. Six pairs of shoulders were used. One of each pair had a standard double row, transosseous equivalent arthroscopic rotator cuff repair using a suture-bridge technique with suture anchors, and the other had an arthroscopic transosseous repair using an Xbox technique. The repairs were cycled at 150 N for 10,000 cycles with movement of the lateral cuff edge recorded and then tested to failure. The total cuff edge displacement at 10,000 cycles in the anchor group (transosseous equivalent repair) was 7.9 mm and 6.3 mm for the bone tunnel group (transosseous repair); these were not significantly different (p=0.19). The anchor group failed at an average of 309 N and the bone tunnel group at an average of 339 N (p=0.22). Biomechanical testing suggests that arthroscopic, transosseous rotator cuff repair using a Xbox suture configuration is similar in strength and stability to an arthroscopic transosseous equivalent suture-bridge repair. Both techniques demonstrated difficulty in maintaining the lateral position of the tendon.

  11. The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus.

    PubMed

    Cuéllar, Adrián; Cuéllar, Ricardo; Heredia, Jorge Díaz; Cuéllar, Asier; García-Alonso, Ignacio; Ruiz-Ibán, Miguel Angel

    2017-03-13

    To evaluate the risk of injury to the inferior lateral geniculate artery with two different techniques for lateral meniscus repair. Eight cadaveric knees were used. Inside-out sutures and an all-inside suture device were placed at the most lateral edge of the popliteal hiatus, and 15 and 30 mm anterior to this point. The minimum distances between the sutures and the inferior lateral geniculate artery were measured through a limited lateral arthrotomy. Artery penetration or collapse due to the sutures was also evaluated. The median distance between the sutures and the artery when inserted at the lateral edge of the popliteal hiatus was 1.5 mm (interquartile range: 1.3) for the inside-out technique and 1.5 mm (1.3) for the all-inside technique (differences not significant, n.s.). When the sutures were inserted 15 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.1) and 1.3 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). When the sutures were inserted 30 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.0) and 1.5 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). The artery was punctured with two of the inside-out sutures placed 15 mm from the popliteal hiatus, no puncturing occurred in the all-inside technique (n.s.). Tying of the inside-out sutures resulted in obliteration of the artery in four of eight sutures placed at 15 mm from the popliteal hiatus and three of eight sutures at 30 mm; no obliteration of the artery was found using the all-inside device (significant differences, p = 0.002). Although both all-inside and inside-out lateral meniscal repair techniques place sutures very close to the lateral geniculate artery, the inside-out technique is riskier as extra-articular knot tying can cause artery obliteration when suturing the part of the meniscus immediately lateral to the popliteal hiatus. Therefore, all-inside meniscal repair

  12. A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique

    PubMed Central

    Rossell-Perry, Percy

    2016-01-01

    Background: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. Materials and Methods: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. Results: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. Conclusions: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes. PMID:28216814

  13. 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

  14. Outcome of repair of chronic tear of the pectoralis major using corkscrew suture anchors by box suture sliding technique

    PubMed Central

    Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay

    2016-01-01

    AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949

  15. Primary Repair of Traumatic Distal Biceps Ruptures in a Military Population: Clinical Outcomes of Single- Versus 2-Incision Technique.

    PubMed

    Waterman, Brian R; Navarro-Figueroa, Lorenzo; Owens, Brett D

    2017-09-01

    To determine the success of distal biceps repair in a high-demand military population and to comparatively evaluate the perioperative risk profile, functional results, and adverse patient outcomes of a single- versus 2-incision technique within this high-risk group. Between 2007-2013, all military service members undergoing primary surgical repair for distal biceps rupture through the Military Health System were isolated. Patients with allograft tendon reconstruction, revision procedures, nonmilitary status, and/or follow-up of less than 24 month were excluded. Demographic data (age, limb dominance) and surgical variables (time to surgery, surgical technique) were extracted, and rates of perioperative complications, rerupture, reoperation, revision, and inability to return to preinjury function were recorded. Logistic regression analysis was performed to evaluate for prognostic risk factors, whereas the Fisher exact test was used for comparative analysis. A total of 290 patients met the inclusion criteria, including 44 (15.2%) with a delayed presentation; all patients were men, with an average age of 38.9 years (range, 20-61 years). A single-incision technique was performed in 75.4% (n = 214) versus a 2-incision technique in 24.6% (n = 70), and a cortical button was the predominant fixation construct (73.4%). Reruptures occurred in 7 patients (2.4%), and 3 individuals (1.0%) had significant elbow dysfunction postoperatively. When we compared the overall complication rates, the 2-incision technique (7.1%, n = 5) was not significantly different from the single-incision repair (16.4%, n = 35; P = .0732). Tobacco use was significantly associated with risk of rerupture (odds ratio, 4.86; P = .0423) or combined surgical and clinical failures (odds ratio, 5.64; P = .0091), whereas age, limb dominance, time to surgery, fixation construct, and surgical technique were not statistically significant (P > .05). Among active patients, a single-volar incision technique

  16. Endovascular repair of a ruptured subclavian artery aneurysm in a patient with Ehlers-Danlos syndrome using a sandwich technique.

    PubMed

    Desai, Sapan S; Codreanu, Maria; Charlton-Ouw, Kristofer M; Safi, Hazim; Azizzadeh, Ali

    2014-10-01

    We present the case of a type IV Ehlers-Danlos syndrome patient with a ruptured right subclavian artery aneurysm and associated arteriovenous fistula who underwent successful endovascular repair requiring simultaneous stent graft repair of the innominate artery using a sandwich technique. A 17-year-old man with known type IV Ehlers-Danlos syndrome developed right neck and shoulder swelling. CTA study demonstrated a 17 × 13-cm ruptured subclavian artery aneurysm with an associated internal jugular vein arteriovenous fistula. In the hybrid suite, a 7 mm × 15-cm stent graft (Viabahn, WL Gore & Associates, Flagstaff, AZ) was advanced from the right brachial approach into the innominate artery. A separate wire was placed into the right carotid artery via the right femoral approach (7 Fr), and a 7 mm × 10-cm stent graft (Viabahn) was advanced into the innominate artery. An additional 8 mm × 10-cm stent graft (Viabahn) was placed from the right brachial approach to obtain a distal-landing zone in the axillary artery. Complex vascular anatomy, in which graft seal creation may be challenging, does not exclude endovascular approaches as the sandwich technique can be utilized as a suitable alternative to open repair.

  17. A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair.

    PubMed

    Vourliotakis, George; Katsargyris, Αthanasios; Tielliu, Ignace F J; Zeebregts, Clark J; Verhoeven, Eric L G

    2015-02-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, the presence of the stiff guide wire does not always allow for an ideal apposition of the stent graft to the angulated common iliac artery vessel wall. We describe herein a modified technique for Gore Excluder limb-graft deployment with partial removal of the stiff wire in cases with difficult tortuous or narrow iliac arteries during endovascular abdominal aortic aneurysm repair. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. V-shaped double-row distal triceps tendon repair: a novel technique using unicortical button fixation.

    PubMed

    Scheiderer, Bastian; Lacheta, Lucca; Imhoff, Andreas B; Siebenlist, Sebastian

    2017-03-14

    This report was designed to present a novel technique combining suture anchor and unicortical button fixation for distal triceps tendon repair. For anatomical reinsertion of an acute distal triceps tendon rupture, two suture anchors and one unicortical button forming a V-shaped configuration were used. The operative approach is described in detail. Excellent clinical and functional results were achieved in the early postoperative phase. The patient reached full elbow range of motion and extension muscle strength (5/5) compared to the uninjured arm 12 weeks after surgery. Complications did not occur. This is the first report using unicortical button fixation in distal triceps tendon repair with promising preliminary results. Technical description, case report, Level V.

  19. Use of a Central Splitting Approach and Near Complete Detachment for Insertional Calcific Achilles Tendinopathy Repaired With an Achilles Bridging Suture.

    PubMed

    Gillis, Craig T; Lin, Jason S

    2016-01-01

    After 3 to 6 months of conservative management for insertional calcific Achilles tendinopathy, operative intervention might be warranted. Despite a success rate of 75% to 100% with surgery, no consensus has been reached on the amount of acceptable detachment of the Achilles tendon. The present case series reports on the results of a central splitting approach with 80% to 90% detachment of the Achilles insertion repaired with a double-row bridging suture device. A total of 14 patients (16 heels) for whom nonoperative management for insertional calcific Achilles tendinopathy had previously failed were enrolled in the present study they had undergone surgical management. The patients were followed up for a mean of 18 (range 11 to 25) months postoperatively and were evaluated using the American Orthopaedic Foot and Ankle Society Hind Foot scoring system, 36-item Short Form Health Survey questionnaire, and pre- and postoperative visual analog pain scale. The mean visual analog pain scale core had decreased 5.84 (range 1 to 9) points postoperatively (p < .001). The mean postoperative American Orthopaedic Foot and Ankle Society Hind Foot score was 87 ± 19.7 (range 52 to 105) points. One patient reported moderate pain with no limitation of activities. The mean 36-item Short-Form Health Survey score for physical functioning was 77.7 (range 30 to 100) points postoperatively in 11 patients. No patient reported incisional discomfort. All 14 patients (16 heels) reported being satisfied and had returned to their previous functional status. Thus, the central splitting Achilles approach with anchoring of the Achilles insertion using the double-row suture device is a safe and reasonable option in the operative treatment of insertional calcific Achilles tendinopathy.

  20. 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.

  1. Bomb Crater Repair Techniques for Permanent Airfields. Report 3. Series 4 Tests.

    DTIC Science & Technology

    1985-10-01

    reported herein. a. The performance of the 14-in. grout-limestone repair was very good in lane 1 and fair in lane 2. The numerous shrinkage cracks in the...Subbase, and Base-Course -Materials, MIL-STD-62., Method 104. Hutchinson, R. L., Roe C. L., and Denso R. 1!. 1981. "Field lest Eval- uation of

  2. 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.

  3. Primary achilles tendon repair with mini-dorsolateral incision technique and accelerated rehabilitation.

    PubMed

    Hrnack, Scott A; Crates, John M; Barber, F Alan

    2012-10-01

    No consensus exists for the best primary repair of acute Achilles tendon ruptures. Problems with wound healing and nerve damage can occur. Prolonged immobilization leads to stiffness and calf atrophy. This study assesses the clinical outcome of acute Achilles tendon repairs using a mini-dorsolateral incision followed by a rapid rehabilitation program. A consecutive series of acute Achilles tendon ruptures repaired using a mini-dorsolateral incision were reviewed with a minimum 12 months follow up. Fifteen patients with an average age of 44 (range, 32 to 60) years were followed an average of 45 (range, 14 to 72) months. Two modified, buried core high strength sutures were placed in each torn end of the Achilles tendon reinforced with a running circumferential whip-stitch. Ankle Hindfoot scores, single toe raises, calf circumference, and adverse events were recorded. An accelerated postoperative rehabilitation protocol was followed. Postoperative AOFAS Ankle Hindfoot scores averaged 98.3 [39 pain; 49.6 function; 9.3 alignment]. All patients could single heel raise. Eight of 15 demonstrated atrophy with an average calf circumference loss of 1.0 cm. The only postoperative complication was one case of superficial cellulitis successfully treated with oral antibiotics. There were no sural nerve injuries, wound break down, or re-ruptures at final followup. The repair of acute Achilles tendon ruptures through a minimal lateral incision provided excellent functional outcomes, avoided complications including sural nerve injury, and allowed a return to sports between 4 to 6 months.

  4. Superficial fascial system repair: an abdominoplasty technique to reduce local complications after caesarean delivery.

    PubMed

    Al-Benna, Sammy; Al-Ajam, Yazan; Tzakas, Elias

    2009-05-01

    Abdominal incision complications are a major source of morbidity after caesarean delivery. Repair of the superficial fascial system may avert local complications after caesarean delivery by minimising tension to the skin and increasing the initial biomechanical strength of wound which has the potential to decrease early wound dehiscence and as a by-product correct suprapubic bulging.

  5. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe.

    PubMed

    Wilhelm, A

    2011-12-01

    Anal fistula repair still remains challenging. Up to 30% of fistulas persist after surgery despite many improvements in surgical skills and technique. One major reason for surgical failure is a persistent fistula track or remnants of the fistula epithelium which could not be removed during surgery. To overcome this problem, a novel technique was developed using a newly invented radial emitting laser probe ("FiLaC™", Biolitec, Germany) to destroy the fistula epithelium and to simultaneously obliterate the remaining fistula track. In a pilot study, we operated on 11 patients with cryptoglandular anal fistula. All patients underwent previous surgery up to 6 times prior to definitive surgery. In the primary operation, the initial abscess was drained, the internal opening of the fistula identified and seton drainage placed. During fistula repair, we used the flap technique for conventional closure of the internal opening. The remaining fistula track was cleaned mechanically, the laser inserted into the track and energy applied homogeneously at a wavelength of 1,470 nm and 13 watt. While providing continuous retraction of the probe, the remaining epithelium was destroyed and the fistula track obliterated. The median follow-up was 7.4 months. Nine out of 11 fistulas showed primary healing (81.8%). Only one minor form of incontinence (limited soiling) was observed and no complications occurred. The use of a novel diode laser source and a radial emitting laser probe in addition to conventional surgery is a very promising new technique in sphincter-preserving anal fistula repair. The observed healing rate is high. Due to minimized trauma to the sphincter muscle, there are good short-term functional results without observable procedure-related complications.

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

    PubMed

    Vijayan, S; Bentley, G; Briggs, Twr; Skinner, Ja; Carrington, Rwj; Pollock, R; Flanagan, Am

    2010-07-01

    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.

  7. 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

  8. Arthroscopic double-pulley remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs.

    PubMed

    Koo, Samuel S; Burkhart, Stephen S; Ochoa, Eloy

    2009-11-01

    We present a modified arthroscopic technique used to treat anterior shoulder instability associated with mild glenoid bone loss and a large Hill-Sachs lesion. The procedure aims to convert a bony intra-articular defect into an extra-articular defect by insetting the infraspinatus into the Hill-Sachs lesion. The arthroscopic procedure is performed with the patient in the lateral decubitus position, and the same portals used for anterior instability repair are used for this technique. The sequence of steps involves placing and passing the glenoid anchors and sutures and then waiting to tie the anterior sutures until after the humeral suture anchors have been placed. The subacromial bursa is cleared; then 2 transtendon suture anchors are placed in the Hill-Sachs lesion. Next, the previously placed Bankart repair sutures are tied, and finally, the remplissage sutures are tied in the subacromial space over the infraspinatus by use of the transtendon double-pulley technique. This technique uses the eyelets of the 2 suture anchors as pulleys and creates a double-mattress suture.

  9. 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

  10. Barlow's Mitral Valve Disease: A Comparison of Neochordal (Loop) and Edge-To-Edge (Alfieri) Minimally Invasive Repair Techniques.

    PubMed

    da Rocha E Silva, Jaqueline G; Spampinato, Ricardo; Misfeld, Martin; Seeburger, Joerg; Pfanmüller, Bettina; Eifert, Sandra; Mohr, Friedrich W; Borger, Michael A

    2015-12-01

    Barlow's mitral valve (MV) disease remains a surgical challenge. We compared short- and medium-term outcomes of neochordal ("loop") versus edge-to-edge ("Alfieri") minimally invasive MV repair in patients with Barlow's disease. From January 2009 to April 2014, 123 consecutive patients with Barlow's disease (defined as bileaflet billowing or prolapse [or both], excessive leaflet tissue, and annular dilatation with or without calcification) underwent minimally invasive MV operations for severe mitral regurgitation (MR) at our institution. Three patients (2.4%) underwent MV replacement during the study period and were excluded from subsequent analysis. The loop MV repair technique was used in 68 patients (55.3%) and an edge-to-edge repair was performed in 44 patients (35.8%). Patients who underwent a combination of these 2 techniques (n = 8 [6.5%]) were excluded. The median age was 48 years, and 62.5% of patients were men. Concomitant procedures included closure of a patent foramen ovale or atrial septal defect (n = 19), tricuspid valve repair (n = 5), and atrial fibrillation ablation (n = 15). Follow-up was performed 24.7 ± 17 months postoperatively and was 98% complete. No deaths occurred perioperatively or during follow-up. Aortic cross-clamp time (64.1 ± 17.6 minutes versus 95.9 ± 29.5 minutes) and cardiopulmonary bypass (CPB) time (110.0 ± 24.2 minutes versus 146.4 ± 39.1 minutes) were significantly shorter (p < 0.001) in patients who received edge-to-edge repair. Although patients who underwent edge-to-edge repair received a larger annuloplasty ring (38.6 ± 1.5 mm versus 35.8 ± 2.7 mm; p < 0.001), the early postoperative resting mean gradients were higher (3.3 ± 1.2 mm Hg versus 2.6 ± 1.2 mm Hg; p = 0.007) and the mitral orifice area tended to be smaller in this group (2.8 ± 0.7 cm(2) versus 3.0 ± 0.7 cm(2); p = 0.06). The amount of residual MR was similar between groups (0.3 ± 0.6 versus 0.6 ± 1.0 for edge-to-edge versus loop procedures

  11. Estimation of load redistribution on a cable-stayed bridge using a combination of sensing techniques

    NASA Astrophysics Data System (ADS)

    Zonta, Daniele; Esposito, Paolo; Molignoni, Marco; Pozzi, Matteo; Zandonini, Riccardo; Wang, Ming; Zhao, Yang; Inaudi, Daniele; Posenato, Daniele; Glisic, Branko

    2012-04-01

    The motivation of this work is the installation of a monitoring system on a new cable-stayed bridge spanning the Adige River 10 km north of the town of Trento. This is a statically indeterminate structure, having a composite steel-concrete deck of length 260 m overall, supported by 12 stay cables, 6 per deck side. These are full locked steel cables of diameters 116 mm and 128 mm, designed for operational loads varying from 5000 to 8000 kN. The structural redundancy suggests that plastic load redistribution among the cables can be expected in the long term. To monitor such load redistribution, the owner decided to install a monitoring system to measure cable stress; the precision specified was of the order of few MPa. However no cable release or any form of on-site calibration involving tension change was allowed. The solution found was a combination of built-on-site electromagnetic and fiber-optic elongation gauges, these appropriately distributed on both the cables and the anchorages. We discuss how the set of gauges allows tension and elongation measurement with the appropriate precision, and compare the initial monitoring results with the tension estimates made using a non-destructive vibration test.

  12. Analysis of monitoring data from cable-stayed bridge using sensor fusion techniques

    NASA Astrophysics Data System (ADS)

    Zonta, Daniele; Bruschetta, Federico; Zandonini, Riccardo; Pozzi, Matteo; Wang, Ming; Zhao, Yang; Inaudi, Daniele; Posenato, Daniele; Glisic, Branko

    2013-04-01

    This paper illustrates an application of Bayesian logic to monitoring data analysis and structural condition state inference. The case study is a 260 m long cable-stayed bridge spanning the Adige River 10 km north of the town of Trento, Italy. This is a statically indeterminate structure, having a composite steel-concrete deck, supported by 12 stay cables. Structural redundancy, possible relaxation losses and an as-built condition differing from design, suggest that long-term load redistribution between cables can be expected. To monitor load redistribution, the owner decided to install a monitoring system which combines built-on-site elasto-magnetic and fiber-optic sensors. In this note, we discuss a rational way to improve the accuracy of the load estimate from the EM sensors taking advantage of the FOS information. More specifically, we use a multi-sensor Bayesian data fusion approach which combines the information from the two sensing systems with the prior knowledge, including design information and the outcomes of laboratory calibration. Using the data acquired to date, we demonstrate that combining the two measurements allows a more accurate estimate of the cable load, to better than 50 kN.

  13. Performance of weld repairs on service-aged 2{1/4}Cr-1Mo girth weldments utilizing conventional postweld heat treatment and temper-bead repair techniques

    SciTech Connect

    Gandy, D.W.; Viswanathan, R.; Findlan, S.J.

    1996-06-01

    Weld repair of service-damaged piping and header girth weldments has generated considerable interest within the fossil power plant arena over the past few years. The interest has stemmed in part from recent revisions to the National Board Inspection Code regarding welding repair of Cr-Mo steels and from the fact that many domestic utility power plants are nearing the end of their projected design life. EPRI is addressing a number of concerns expressed by utilities surrounding weld repair under a joint EPRI/utility program RP3484-01. The program is focused on procuring service-aged piping and header girth weldments, quantifying the level of damage associated with those weldments, performing weld repairs within the girth weldment region, testing the repair weldment mechanically and metallurgically, and comparing the increase or decrease in remaining life associated with the weld repair. This paper discusses four industry case histories along with two piping girth weld repairs performed under the EPRI program: (1) a repair performed with conventional postweld heat treatment and (2) a repair performed employing temper-bead welding repair technology.

  14. Defective dental restorations: to repair or not to repair? Part 2: All-ceramics and porcelain fused to metal systems.

    PubMed

    Blum, Igor R; Jagger, Daryll C; Wilson, Nairn H F

    2011-04-01

    With the increasing use of ceramics in restorative dentistry, and trends to extend restoration longevity through the use of minimal interventive techniques, dental practitioners should be familiar with the factors that may influence the decision either to repair or replace fractured metal-ceramic and all-ceramic restorations and, also, the materials and techniques available to repair these restorations. This second of two papers addresses the possible modes of failure of ceramic restorations and outlines indications and techniques in this developing aspect of restoration repair in clinical practice. The repair of metal-ceramic and all-ceramic restorations is a reliable low-cost, low-risk technique that may be of value for the management of loss or fracture of porcelain from a crown or bridge in clinical practice.

  15. Repair of an oroantral communication by a human amniotic membrane: a novel technique

    PubMed Central

    Bharani, Siva; Ambardar, Kalhan

    2015-01-01

    The amniotic membrane is the innermost layer of fetal membrane and is attached to the chorion in the placenta. This membrane has been used for nearly a century in varied fields such as ophthalmology, reconstructive surgery, and burn treatment. In this case report, we used a human amniotic membrane to repair an iatrogenic oroantral communication that occurred during the extraction of the patient's right upper second molar. A splint was given after the perforation was covered with human amniotic membrane and healing was clinically evaluated at various intervals. The outcome of the study revealed that the human amniotic membrane was an efficient graft material for repairing the defect caused by an iatrogenic oroantral communication following tooth extraction. PMID:26339578

  16. [Patient with Ebstein anomaly treated by Carpentier's technique tricuspid valve repair--a case report].

    PubMed

    Urbanowicz, Tomasz; Katarzyński, Sławomir; Jemielity, Marek

    2010-02-01

    Ebstein anomaly is a congenital tricuspid valve and right ventricle malformation characterised by posterior and/or septal leaflet deformation that are malpositioned. The target of surgical intervention is to restore tricuspid valve function with right ventricle preservation but also to decrease the risk of cardiac arrhythmias. We present a case of a 56-year-old female patient with type C Ebstein anomaly. She underwent successful procedure of tricuspid valve repair with biodegradable ring.

  17. Development and Evaluation of a Percutaneous Technique for Repairing Proximal Femora With Metastatic Lesions

    DTIC Science & Technology

    2006-05-01

    Hip Fracture ; Femur 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC... fracture load for the repaired femur divided by the measured fracture load for the contralateral intact femur [Task 1g]. The mean and standard...in the CT scan data of the intact femora, the FE-predicted fracture load of each femur in its altered state was directly compared to (divided by) the

  18. Development and Evaluation of a Percutaneous Technique for Repairing Proximal Femora with Metastatic Lesion

    DTIC Science & Technology

    2005-05-01

    Structural 10 Analysis; Bone; Bone Metastases; Pathological Fracture ; Hip 16. PRICECODE Fracture ; Femur 17. SECURITY CLASSIFICATION 18. SECURITY...proximal femur are a common and serious manifestation of breast cancer. These lesions can be painful and can lead to pathological fracture ...defined as the FE-predicted fracture load of the proximal femur before and after repair, divided by the FE-predicted fracture load of the intact model

  19. Tent-shape technique: another procedure to repair P2 of posterior leaflet of mitral valve.

    PubMed

    Kassem, Samer; Moasis, Ghassan A; Biglioli, Paolo

    2011-06-01

    In this report, we describe a new procedure to repair the prolapsing high mid-scallop of the mitral valve (MV) posterior leaflet (P2) with detailed consideration of the anatomy and physiology of the MV. A new artificial chord is implanted in the body of the P2 at the same height of non-prolapsing P1 and P3, and the remaining part of the prolapsing P2 is anchored to the artificial chord taking the shape of a tent.

  20. The comparison of histological results of experimentally created facial nerve defects repaired by 2 different anastomosis techniques: classic suture technique or tissue adhesives for nerve anastomosis?

    PubMed

    Gencer, Zeliha Kapusuz; Özkiriş, Mahmut; Saydam, Levent; Dağlioğlu, Y Kenan; Sakallioglu, Öner; Kuyucu, Yurdun; Polat, Sait; Kanmaz, Alper

    2014-03-01

    The objective of this study was to compare the histological regeneration characteristics of nerve fibers at the anastomosis lines performed by classic suture technique or a tissue adhesive (N-butyl-2-cyanoacrylate). The control group consisted of 7 rabbits. The 21 rabbits were randomly divided into 3 groups based on the harvesting week. In the study group following preparation of facial nerve bilaterally, a 0.5-cm segment of facial dorsal buccal nerve was resected, and the defect was repaired with a nerve graft, which was harvested from sural nerve of the same side by 8-0 nylon suture technique and by application of N-butyl-2-cyanoacrylate on the other side. Electron microscopic examination at consecutive second, fourth, and sixth days (corresponding to 4th, 8th, and 12th week in human subjects) revealed increased nerve degeneration findings in N-butyl-2-cyanoacrylate group when compared with microsuture repair technique. We conclude that N-butyl-2-cyanoacrylate is not an appropriate material for nerve anastomosis.

  1. 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.

  2. New technique for single-staged repair of aortic coarctation and coexisting cardiac disorder.

    PubMed

    Korkmaz, Askin Ali; Guden, Mustafa; Onan, Burak; Tarakci, Sevim Indelen; Demir, Ali Soner; Sagbas, Ertan; Sarikaya, Tugay

    2011-01-01

    The management of adults with aortic coarctation and a coexisting cardiac disorder is still a surgical challenge. Single-staged procedures have lower postoperative morbidity and mortality rates than do 2-staged procedures. We present our experience with arch-to-descending aorta bypass grafting in combination with intracardiac or ascending aortic aneurysm repair.From October 2004 through April 2010, 5 patients (4 men, 1 woman; mean age, 45.8 ± 9.4 yr) underwent anatomic bypass grafting of the arch to the descending aorta through a median sternotomy and concomitant repair of an intracardiac disorder or an ascending aortic aneurysm. Operative indications included coarctation of the aorta in all cases, together with severe mitral insufficiency arising from damaged chordae tendineae in 2 patients, ascending aortic aneurysm with aortic regurgitation in 2 patients, and coronary artery disease in 1 patient. Data from early and midterm follow-up were reviewed.There was no early or late death. Follow-up was complete for all patients, and the mean follow-up period was 34.8 ± 18 months (range, 18 mo-5 yr). All grafts were patent. No late graft-related sequelae or reoperations were observed.For single-staged repair of aortic coarctation with a coexistent cardiac disorder, we propose arch-to-descending aorta bypass through a median sternotomy as an alternative for selected patients.

  3. Discontinuous Brillouin strain monitoring of small concrete bridges: comparison between near-to-surface and smart FRP fiber installation techniques

    NASA Astrophysics Data System (ADS)

    Bastianini, Filippo; Rizzo, Andrea; Galati, Nestore; Deza, Ursula; Nanni, Antonio

    2005-05-01

    Brillouin fiber optic sensing is a promising technology for Structural Health Monitoring (SHM) whose diffusion is however at present reduced by the unavailability of proper sensor products and established installation techniques specifically aimed at the building industry. Due to its intrinsic distributed sensing capability, Brillouin systems can individually measure the deformation of any single segment of considerable lengths of single-mode fiber. In addition, Brillouin retains all the other typical advantages of Fiber Optic Sensors (FOS), such as harsh environment durability and electro-magnetic interference rejection. These advantages, especially considering that the required sensors are really low cost, make the system particularly attractive for periodical ("discontinuous") strain monitoring of unattended infrastructures that might be exposed to ageing and vandalism damages. Despite the high equipment cost, the technique can become economically convenient when the same initial investment can be amortized over a number of applications that can be monitored periodically using the same device. This work presents a comparison between two different Brillouin sensor installation techniques: Near-to-Surface Fiber (NSF) embedding and smart-FRP sensor bonding. Both systems have been experimented in the field on small Reinforced Concrete (RC) bridges subject to a diagnostic load test. The obtained results clearly highlight the advantages of the smart-FRP system, in terms of performance enhancements, installation cost, and time reduction.

  4. Application of Rapid Prototyping Technique and Intraoperative Navigation System for the Repair and Reconstruction of Orbital Wall Fractures

    PubMed Central

    Cha, Jong Hyun; Lee, Yong Hae; Ruy, Wan Chul; Roe, Young; Moon, Myung Ho

    2016-01-01

    Background Restoring the orbital cavity in large blow out fractures is a challenge for surgeons due to the anatomical complexity. This study evaluated the clinical outcomes and orbital volume after orbital wall fracture repair using a rapid prototyping (RP) technique and intraoperative navigation system. Methods This prospective study was conducted on the medical records and radiology records of 12 patients who had undergone a unilateral blow out fracture reconstruction using a RP technique and an intraoperative navigation system from November 2014 to March 2015. The surgical results were assessed by an ophthalmic examination and a comparison of the preoperative and postoperative orbital volume ratio (OVR) values. Results All patients had a successful treatment outcome without complications. Volumetric analysis revealed a significant decrease in the mean OVR from 1.0952±0.0662 (ranging from 0.9917 to 1.2509) preoperatively to 0.9942±0.0427 (ranging from 0.9394 to 1.0680) postoperatively. Conclusion The application of a RP technique for the repair of orbital wall fractures is a useful tool that may help improve the clinical outcomes by understanding the individual anatomy, determining the operability, and restoring the orbital cavity volume through optimal implant positioning along with an intraoperative navigation system. PMID:28913272

  5. Application of Rapid Prototyping Technique and Intraoperative Navigation System for the Repair and Reconstruction of Orbital Wall Fractures.

    PubMed

    Cha, Jong Hyun; Lee, Yong Hae; Ruy, Wan Chul; Roe, Young; Moon, Myung Ho; Jung, Sung Gyun

    2016-09-01

    Restoring the orbital cavity in large blow out fractures is a challenge for surgeons due to the anatomical complexity. This study evaluated the clinical outcomes and orbital volume after orbital wall fracture repair using a rapid prototyping (RP) technique and intraoperative navigation system. This prospective study was conducted on the medical records and radiology records of 12 patients who had undergone a unilateral blow out fracture reconstruction using a RP technique and an intraoperative navigation system from November 2014 to March 2015. The surgical results were assessed by an ophthalmic examination and a comparison of the preoperative and postoperative orbital volume ratio (OVR) values. All patients had a successful treatment outcome without complications. Volumetric analysis revealed a significant decrease in the mean OVR from 1.0952±0.0662 (ranging from 0.9917 to 1.2509) preoperatively to 0.9942±0.0427 (ranging from 0.9394 to 1.0680) postoperatively. The application of a RP technique for the repair of orbital wall fractures is a useful tool that may help improve the clinical outcomes by understanding the individual anatomy, determining the operability, and restoring the orbital cavity volume through optimal implant positioning along with an intraoperative navigation system.

  6. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.

    PubMed

    Hsu, Andrew R; Jones, Carroll P; Cohen, Bruce E; Davis, W Hodges; Ellington, J Kent; Anderson, Robert B

    2015-11-01

    Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with FiberWire in a Krackow fashion reinforced with absorbable sutures. Patient demographics were recorded along with medical comorbidities, activity at injury, time from injury to surgery, length of follow-up, return to baseline activities by 5 months, and postoperative complications. The most common activity during injury for both groups was basketball (PARS: 39%, open: 47%). A greater number of patients treated with PARS were able to return to baseline physical activities by 5 months compared with the open group (PARS: 98%, open: 82%; P = .0001). There were no significant differences (P > .05) between groups in rates of rerupture (P = 1.0), sural neuritis (P = .16), wound dehiscence (P = .74), superficial (P = .29) and/or deep infection (P = .29), or reoperation (P = .13). There were no deep vein thromboses (DVTs) or reruptures in either group. In the PARS group, there were no cases of sural neuritis, 3 cases (3%) of superficial wound dehiscence, and 2 reoperations (2%) for superficial

  7. Biomechanical in vitro validation of intramedullary cortical button fixation for distal biceps tendon repair: a new technique.

    PubMed

    Siebenlist, Sebastian; Lenich, Andreas; Buchholz, Arne; Martetschläger, Frank; Eichhorn, Stefan; Heinrich, Petra; Fingerle, Alexander; Doebele, Stefan; Sandmann, Gunther H; Millett, Peter J; Stöckle, Ulrich; Elser, Florian

    2011-08-01

    Extramedullary cortical button-based fixation for distal biceps tendon ruptures exhibits maximum load to failure in vitro but cannot restore the anatomic footprint and has the potential risk for injury to the posterior interosseous nerve. Double intramedullary cortical button fixation repair provides superior fixation strength to the bone when compared with single extramedullary cortical button-based repair. Controlled laboratory study. The technique of intramedullary cortical button fixation with 1 or 2 buttons was compared with single extramedullary cortical button-based repair using 12 paired human cadaveric elbows. All specimens underwent computed tomography analysis to determine intramedullary dimensions of the radial tuberosity as well as the thickness of the anterior and posterior cortices before biomechanical testing. Maximum load to failure and failure modes were recorded. For baseline measurements, the native tendon was tested for maximum load to failure. The intramedullary area of the radial tuberosity provides sufficient space for single or double intramedullary cortical button implantation. The mean thickness of the anterior cortex was 1.13 ± 0.15 mm, and for the posterior cortex it was 1.97 ± 0.48 mm (P < .001). We found the highest loads to failure for double intramedullary cortical button fixation with a mean load to failure of 455 ± 103 N, versus 275 ± 44 N for single intramedullary cortical button fixation (P < .001) and 305 ± 27 N for single extramedullary cortical button-based technique (P = .003). There were no statistically significant differences between single intramedullary and single extramedullary button fixation repair (P = .081). The mean load to failure for the native tendon was 379 ± 87 N. Double intramedullary cortical button fixation provides the highest load to failure in the specimens tested. Double intramedullary cortical button fixation provides reliable fixation strength to the bone for distal biceps tendon repair and

  8. Safety and Effectiveness of a Small Incision Lateral Eyebrow Ptosis Repair Technique Using a Frontalis Muscle Transposition Flap.

    PubMed

    Ganapathy, Preethi S; Chundury, Rao V; Perry, Julian D

    To evaluate the safety and effectiveness of a frontalis muscle transposition flap for treatment of lateral eyebrow ptosis. The charts of all patients undergoing frontalis muscle transposition flap eyebrow ptosis repair from December 2013 to September 2014 were reviewed. Charts with inadequate photographs were excluded. Charts were reviewed for demographics, preoperative and postoperative photographs, surgical technique, and complications. The following parameters were assessed on preoperative and postoperative photographs: corneal diameter, central brow height, and lateral brow height. Measurements were normalized to a standard corneal diameter of 11.5 mm. Statistical analysis was performed in conjunction with the Cleveland Health Institute Biostatistics Department. Forty-six total patients underwent frontalis muscle transposition flap eyebrow ptosis repair and the charts of 31 patients (53 cases) were reviewed. There were 20 female and 11 male patients. Average age was 69.1 ± 7.7 years (range: 50 - 86 years). There were 9 unilateral and 22 bilateral cases. Concomitant surgeries included upper blepharoplasty (33 cases), conjunctival-Mullerectomy blepharoptosis repair (3 cases), and intralesional tetracycline injection for festoons (3 cases). Average follow-up interval between surgery and the final postoperative photograph was 10.2 weeks (range: 6-26 weeks). Overall, lateral brow height increased postoperatively by 1.78 mm (p < 0.05). In patients that underwent frontalis muscle transposition flap alone, lateral brow height increased by 2.86 mm (p < 0.05). Scalp hypesthesia was documented in 10/31 patients, and resolved in 8/10 patients at last follow up. A frontalis muscle transposition flap effectively addresses lateral eyebrow ptosis repair through a small, relatively concealed incision. It produces temporary scalp hypesthesia in a significant number of patients, and long-term results remain unknown.

  9. Transition from a low- to a high-volume centre for bile duct repair: changes in technique and improved outcome

    PubMed Central

    Mercado, Miguel Ángel; Franssen, Bernardo; Dominguez, Ismael; Arriola-Cabrera, Juan Carlos; Ramírez-Del Val, Fernando; Elnecavé-Olaiz, Alejandro; Arámburo-García, Rigoberto; García, Artemio

    2011-01-01

    Background Improvements in bile duct injury repairs have been shown in centres with specialized surgeons. The aim of the present study was to demonstrate the temporal change in the pattern of referral, technical variation associated with repair and long-term outcome of bile duct injuries at a tertiary referral centre in Mexico City. Methods A retrospective case note review was performed. Patients were divided into two groups: group I (GI) 1990 to 2004 and group II (GII) 2005–2008, and appropriate statistical analysis undertaken. Results Over a 20-year period, 312 patients with iatrogenic bile duct injuries required surgical treatment (GI = 169, GII = 140 patients). All injuries were reconstructed using a Roux-en-Y hepaticojejunostomy. The proportion of patients who had undergone a laparoscopic cholecystectomy increased from 24% to 36% (P = 0.017) over the two time periods. In the second time period there was an increase in segment IV and V partial resections (P = 0.020), a reduction in the use of transanastomotic stents (42% to 2%, P = 0.001) and an increase in the proportion of patients requiring a neoconfluence (2% to 11%, P = 0.003). In the second time period, the number of patients requiring a hepatectomy during repair (2% to 1%, P = 0.001), a portoenterostomy (16% to 9%, P = 0.060) or a double-barrel hepatico-jejunostomy (5% to 1%, P = 0.045) significantly decreased. During follow-up, patients in the second time period had a reduction in the incidence of post-operative cholangitis (11% to 6%, P = 0.310) and the frequency of post-operative anastomotic stenoses (13% to 5%, P = 0.010). Mortality remained low throughout the series but was absent in the second group. Conclusions Changes in technique and growing experience of the multidisciplinary team improved operative and long-term results of bile duct injury repair. PMID:21999589

  10. 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.

  11. Technique for placement of a posterior prefabricated fiber-reinforced composite bridge.

    PubMed

    Arteaga, Sarita; Meiers, Jonathan C

    2006-01-01

    Fiber-reinforced composite (FRC) materials currently are used as alternatives for fixed restorations of edentulous areas within the posterior and anterior regions of the mouth. A chairside technique, using a prefabricated FRC framework, allows the clinician to offer the patient another fixed option for replacing a missing posterior tooth that is more time-efficient and cost-effective than other, more traditional approaches. Procedures that incorporate adhesive dentistry give dentists the ability to replace missing teeth and splint unstable teeth for periodontal or orthodontic purposes. This article demonstrates the sequence and chairside technique for placing a prefabricated FRC framework to restore a posterior edentulous area.

  12. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair.

    PubMed

    Wake, B L; McCormack, K; Fraser, C; Vale, L; Perez, J; Grant, A M

    2005-01-25

    The choice of approach to the laparoscopic repair of inguinal hernia is controversial. There is a scarcity of data comparing the laparoscopic transabdominal preperitoneal (TAPP) approach with the laparoscopic totally extraperitoneal (TEP) approach and questions remain about their relative merits and risks. To compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. We searched Medline Extra, Embase, Biosis, Science Citation Index, Cochrane Central Register of Controlled Trials (CENTRAL), Journals@ Ovid Full Text and the electronic version of the journal, Surgical Endoscopy. Recent conference proceedings by the following organisations were hand searched: Association of Endoscopic Surgeons of Great Britain & Ireland; International Congress of the European Association for Endoscopic Surgery; Scientific Session of the Society of American Gastrointestinal & Endoscopic Surgeons (SAGES); and the Italian Society of Endoscopic Surgery. In addition, specialists involved in research on the repair of inguinal hernia were contacted to ask for information about any further completed and ongoing trials, relevant websites were searched and reference lists of the all included studies were checked for additional reports. All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic TAPP with laparoscopic TEP for inguinal hernia repair were eligible for inclusion. Non-randomised prospective studies were also eligible for inclusion to provide further comparative evidence of complications and adverse events. Statistical analyses were performed using the fixed effects model and the results expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). The search identified one RCT which reported no statistical difference between TAPP and TEP when considering duration of

  13. Autologous collagen induced chondrogenesis (ACIC: Shetty-Kim technique) - A matrix based acellular single stage arthroscopic cartilage repair technique.

    PubMed

    Shetty, Asode Ananthram; Kim, Seok Jung; Shetty, Vishvas; Jang, Jae Deog; Huh, Sung Woo; Lee, Dong Hwan

    2016-01-01

    The defects of articular cartilage in the knee joint are a common degenerative disease and currently there are several established techniques to treat this problem, each with their own advantages and shortcomings. Autologous chondrocyte implantation is the current gold standard but the technique is expensive, time-consuming and most versions require two stage procedures and an arthrotomy. Autologous collagen induced chondrogenesis (ACIC) is a single-stage arthroscopic procedure and we developed. This method uses microfracture technique with atelocollagen mixed with fibrin gel to treat articular cartilage defects. We introduce this ACIC techniques and its scientific background.

  14. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis.

    PubMed

    Li, Dongxu; Fan, Qiang; Iwase, Tomoyuki; Hirata, Yasutaka; An, Qi

    2017-07-15

    Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation. A random-effect/fixed-effect model was used to summarize the estimates of mean difference/odds ratio with 95% confidence interval. Subgroup analysis stratified by region was performed. Fifteen publications involving 1034 patients were included. This meta-analysis demonstrated that (1) VSD size in the MP group was significantly smaller; (2) CBP time, ACC time, and hospital stay in the MP group experienced improvement; (3) Other postoperative outcomes showed no significant differences between two groups; and (4) The trends in China and other countries were close. The MP and TP techniques had comparable outcomes; however, the MP technique was performed with significantly shorter CBP and ACC times in patients with smaller VSDs. Given this limitation of data, the results of comparison of the two techniques in patients with larger VSDs remain unknown. Further studies are needed.

  15. Roy D. Bridges Bridge

    NASA Image and Video Library

    2003-08-06

    Incoming KSC Director James W. Kennedy (left) and departing KSC Director Roy D. Bridges Jr. (center) view the new sign on the NASA Causeway naming the bridge for Bridges who is leaving KSC to become the director of NASA's Langley Research Center, Hampton, Va. At right is the 45th Space Wing Commander Brig. Gen. J. Gregory Pavlovich. The bridge spans the Banana River on the NASA Causeway and connects Kennedy Space Center and Cape Canaveral Air Force Station.

  16. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged.

    PubMed

    Suri, Rakesh M; Burkhart, Harold M; Daly, Richard C; Dearani, Joseph A; Park, Soon J; Sundt, Thoralf M; Li, Zhuo; Enriquez-Sarano, Maurice; Schaff, Hartzell V

    2011-11-01

    Recent reports have shown that robotic mitral valve repair is effective in treating posterior leaflet disease; however, comparison with trans-sternal (open) valvuloplasty for all prolapse categories has not been performed. Moreover, data from the recently published EVEREST II trial infer that adverse event rates after mitral valve repair for degenerative disease are high. We therefore compared early outcomes of robotic versus open mitral valve repair for patients with mitral valve prolapse. Among 745 consecutive patients undergoing open or robotic mitral repair for degenerative disease, 95 propensity-matched pairs were identified. Leaflet prolapse categories were similar between groups. Complete mitral valve repair was performed using identical techniques. Median crossclamp and bypass times were longer in the robotic group but decreased significantly over time (P < .001). There were no conversions to open sternotomy, repair rate and early survival were 100%, dismissal mitral regurgitation grade was similar (P = 1.00), and all patients in the robotic group had mild or less mitral regurgitation at 1 month after repair. There were no differences in adverse events (5% open vs 4% robotic, P = 1.00). Patients in the robotic group had shorter postoperative ventilation time, intensive care unit stay, and hospital stay. Robotic mitral valve repair allows complete anatomic correction of all categories of leaflet prolapse using techniques identical to open approaches. Robotic repair effectively corrects mitral regurgitation, offers excellent freedom from adverse events, and facilitates rapid weaning from ventilation, translating into earlier hospital dismissal. Safety and efficacy after both open and robotic mitral valve repair are higher than recently reported in the EVEREST II trial and establish a benchmark against which nonsurgical therapies should be evaluated. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  17. Transperitoneal laparoscopic repair of vesicovaginal fistula for patients with supratrigonal fistula: comparison with open transperitoneal technique.

    PubMed

    Xiong, Yang; Tang, Yunhua; Huang, Fang; Liu, Longfei; Zhang, Xiangyang

    2016-09-01

    We investigated the treatment outcomes of laparoscopic vesicovaginal fistula repair (LVVFR) in patients with supratrigonal vesicovaginal fistula (VVF) in contrast with open transperitoneal vesicovaginal fistula repair (OVVFR). We analyzed 58 VVF repairs from June 2005 to July 2014, with 22 patients in the LVVFR group and 36 in the OVVFR group. Demographic parameters, operative variables, and perioperative outcomes were retrospectively collected and analyzed. The chi-square test, Fisher's exact test, Student's t test and the Mann-Whitney U test were used for statistical analysis. Patients in both groups had comparable preoperative characteristics. Significantly shorter hospital stay (5.6 vs. 13.2 days, p < 0.05) and less blood loss (52 vs. 103 ml, p < 0.05) were observed in LVVFR group. Patients in the LVVFR group achieved a higher overall VVF success rate (95.5 % vs. 83.3 %, p > 0.05) and recurrent VVF success rate (90.0 % vs. 75.0 %, p > 0.05) than OVVFR group, but it was not statistically significant. Patients who underwent OVVFR experienced more postoperative symptomatic bladder spasms (8.3 % vs. 4.5 %, p > 0.05), urinary tract infections (UTIs) (5.6 % vs. 0.0 %, p > 0.05), and stress urinary incontinence (SUI) (5.6 % vs. 4.5 %, p > 0.05), but fewer incidents of postoperative ileus (0.0 % vs. 4.5 %, p > 0.05) than the LVVFR group; differences were not significant. Judging from this initial trial, LVVFR should be recommended as the primary intervention to treat supratrigonal VVF patients in view of its reduced blood loss and hospital stay.

  18. Semitendinosus and gracilis free muscle-tendon graft for repair of massive rotator cuff tears: surgical technique

    PubMed Central

    GIGANTE, ANTONIO; BOTTEGONI, CARLO; MILANO, GIUSEPPE; RICCIO, MICHELE; DEI GIUDICI, LUCA

    2016-01-01

    Massive rotator cuff tears are difficult to treat surgically due to retraction, degeneration and fraying of the ends of torn tendons, severe fatty infiltration and atrophy of the respective muscles. Procedures developed to close the gap between the rotator cuff and the greater tuberosity of the humerus, such as soft tissue release may be inadequate for large tears. Human or porcine dermal allografts still have uncertain benefits, and tendon transfers seem to be associated with poor outcomes, donor site morbidity and altered mechanics. Reverse total shoulder arthroplasty has limited durability and is not indicated in young patients with high functional demands. We developed a new technique for repairing massive rotator cuff tears by semitendinosus and gracilis myotendinous grafting. This novel therapeutic option allows massive rotator cuff tears to be repaired using autologous material that is adequate and adaptable, making it possible to cover any width of defect. The technique is low-invasive and not technically demanding, with minimal donor site morbidity. PMID:27900313

  19. 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

  20. Core weave versus Krackow technique for Achilles tendon repair: a biomechanical study.

    PubMed

    Hong, Yuhwan; Hermida, Luis; White, Kacey L; Parks, Brent G; Camire, Lyn M; Guyton, Camire

    2010-12-01

    The Krackow stitch, commonly used for Achilles tendon repair, leaves the bulk of the stitch on the surface of the tendon as a possible nidus for adhesion. The proposed core weave stitch leaves a minimal amount of suture material on the tendon surface. The functional strength of the core weave stitch compared with the Krackow and the optimal number of throws, or stitches crossing the surface of the tendon, with this stitch are not known. Twenty-one matched pairs of fresh-frozen cadaveric Achilles tendons were transected and randomly assigned to receive a 4-stranded stitch, either Krackow or core weave, with three, five, or seven throws. The samples were cyclically loaded to 75, 125 and 175 N for 1000 cycles at each load until failure, defined as 5 mm of elongation. No significant difference in failure load was observed between the Krackow and core weave groups at any number of throws or within the groups based on number of throws. Failure load for the different number of throws in the Krackow group approached significance (p = 0.10), with higher failure load with three throws. Functional strength of the core weave stitch and the Krackow stitch did not differ between groups with three, five, and seven throws. There was no significant difference in strength based on throws in either group. The proposed core weave stitch provides functional strength similar to that of the Krackow stitch for tendon repair with reduced suture material on the tendon surface.

  1. A modified Chevrel technique for ventral hernia repair: long-term results of a single centre cohort.

    PubMed

    Mommers, E H H; Leenders, B J M; Leclercq, W K G; de Vries Reilingh, T S; Charbon, J A

    2017-08-01

    To evaluate the short- and long-term results after a modified Chevrel technique for midline incisional hernia repair, regarding surgical technique, hospital stay, wound complications, recurrence rate, and postoperative quality of life. These results will be compared to the literature derived reference values regarding the original and modified Chevrel techniques. In this large retrospective, single surgeon, single centre cohort all modified Chevrel hernia repairs between 2000 and 2012 were identified. Results were obtained by reviewing patients' medical charts. Postoperative quality of life was measured using the Carolina Comfort Scale. A multi-database literature search was conducted to compare the results of our series to the literature based reference values. One hundred and fifty-five patients (84 male, 71 female) were included. Eighty patients (52%) had a large incisional hernia (width ≥ 10 cm) according the definition of the European Hernia Society. Fourteen patients (9%) underwent a concomitant procedure. Median length-of-stay was 5 days. Within 30 days postoperative 36 patients (23.2%) had 39 postoperative complications of which 30 were mild (CDC I-II), and nine severe (CDC III-IV). Thirty-one surgical site occurrences were observed in thirty patients (19.4%) of which the majority were seroma (16 patients 10.3%). There was no hernia-related mortality during follow-up. Recurrence rate was 1.8% after a median follow-up of 52 months (12-128 months). Postoperative quality of life was rated excellent. The modified Chevrel technique for midline ventral hernias results in a moderate complication rate, low recurrence rate and high rated postoperative quality of life.

  2. 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.

  3. Evaluation of native hyaline cartilage and repair tissue after two cartilage repair surgery techniques with 23Na MR imaging at 7 T: initial experience.

    PubMed

    Zbýň, S; Stelzeneder, D; Welsch, G H; Negrin, L L; Juras, V; Mayerhoefer, M E; Szomolanyi, P; Bogner, W; Domayer, S E; Weber, M; Trattnig, S

    2012-08-01

    To compare the sodium normalized mean signal intensity (NMSI) values between patients after bone marrow stimulation (BMS) and matrix-associated autologous chondrocyte transplantation (MACT) cartilage repair procedures. Nine BMS and nine MACT patients were included. Each BMS patient was matched with one MACT patient according to age [BMS 36.7 ± 10.7 (mean ± standard deviation) years; MACT 36.9 ± 10.0 years], postoperative interval (BMS 33.5 ± 25.3 months; MACT 33.2 ± 25.7 months), and defect location. All magnetic resonance imaging (MRI) measurements were performed on a 7 T system. Proton images served for morphological evaluation of repair tissue using the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system. Sodium NMSI values in the repair area and morphologically normal cartilage were calculated. Clinical outcome was assessed right after MRI. Analysis of covariance, t-tests, and Pearson correlation coefficients were evaluated. Sodium NMSI was significantly lower in BMS (P = 0.004) and MACT (P = 0.006) repair tissue, compared to reference cartilage. Sodium NMSI was not different between the reference cartilage in MACT and BMS patients (P = 0.664), however it was significantly higher in MACT than in BMS repair tissue (P = 0.028). Better clinical outcome was observed in BMS than in MACT patients. There was no difference between MOCART scores for MACT and BMS patients (P = 0.915). We did not observe any significant correlation between MOCART score and sodium repair tissue NMSI (r = -0.001; P = 0.996). Our results suggest higher glycosaminoglycan (GAG) content, and therefore, repair tissue of better quality in MACT than in BMS patients. Sodium imaging might be beneficial in non-invasive evaluation of cartilage repair surgery efficacy. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. Long-term results of the single-patch repair technique for sinus venosus atrial septal defects.

    PubMed

    Temizkan, Veysel; Ugur, Murat; Alp, Ibrahim; Ucak, Alper; Yilmaz, Ahmet Turan

    2013-04-01

    Anomalous pulmonary venous drainage commonly accompanies sinus venosus atrial septal defects (SVASDs). Many techniques have been reported for avoiding postoperative complications, such as narrowing of the superior vena cava (SVC) or the pulmonary system, and arrhythmia. We perform a single V-Y pericardial patch plasty repair technique for SVASDs. The purpose of this study is to report on the long-term results of this surgical technique. We retrospectively analyzed patients who had a diagnosis of ASD and who underwent their operations between 2000 and 2010 at the Gulhane Military Medical Academy Haydarpasa Training Hospital. Thirty-nine of the patients had an anomalous pulmonary return, and the single pericardial patch technique had been performed in 32 of these patients. The mean (±SD) postoperative extubation time was 5 ± 1.6 hours. The mean drainage volume was 384 ± 137 mL. All patients were discharged from the hospital at a mean of 4.6 ± 1.1 days after their operation and were prescribed anticoagulants for 3 months. No perioperative or late-term mortality was observed. Patients were followed up for 6 months to 2 years. There were no residual shunts and no stenosis-related findings in the pulmonary venous system or the SVC. Use of the single pericardial patch plasty technique might lower complication rates in patients with SVASD, especially those who have not completed their growth.

  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. Potential inspection, maintenance and repair techniques for the OTEC (Ocean Thermal Energy Conversion) systems

    SciTech Connect

    Not Available

    1983-02-01

    One of the major post-installation considerations of the OTEC platforms is the performance of underwater inspection, maintenance and repair (IMR) during their 30-year design life. In order to assist in the conceptual development of an IMR program, this study was undertaken using the two OTEC candidate configurations as a baseline. The objectives of the study were: (1) conduct an inventory of underwater Non-Destructive Examination (NDE) devices including a description of their performance capabilities, dimensional data, the areas of the various structures where they are most applicable, and a narrative description of the level of performance attained to date; (2) and to conduct an inventory of NDE device deployment vehicles which also includes a description of their performance capabilities, dimensional data, areas of the platform where they are most applicable as now designed and a relative comparison of these vehicles as to their ability to deploy the devices described in (1) above.

  7. Potential inspection, maintenance and repair techniques for the OTEC (Ocean Thermal Energy Conversion) systems

    NASA Astrophysics Data System (ADS)

    1983-02-01

    One of the major post-installation considerations of the OTEC platforms is the performance of underwater inspection, maintenance and repair (IMR) during their 30-year design life. In order to assist in the conceptual development of an IMR program, this study was undertaken using the two OTEC candidate configurations as a baseline. The objectives of the study were: conduct an inventory of underwater Non-Destructive Examination (NDE) devices including a description of their performance capabilities, dimensional data, the areas of the various structures where they are most applicable, and a narrative description of the level of performance capabilities, dimensional data, the areas of the various structures where they are most appliable and a narrative description of the level of performance they have attained to date, and to conduct an inventory of NDE device deployment vehicles.

  8. 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

  9. Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection.

    PubMed

    Gao, Feng; Zeng, Qian; Lin, Fangming; Ge, Xiaohu

    2017-07-01

    To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

  10. Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique.

    PubMed

    De la Fuente, Carlos; Peña y Lillo, Roberto; Carreño, Gabriel; Marambio, Hugo

    2016-03-01

    Rupture of the Achilles tendon is a common injury during working years. Aggressive rehabilitation may provide better outcomes, but also a greater chance of re-rupture. To determine if aggressive rehabilitation has better clinical outcomes for Achilles tendon function, Triceps surae function, one-leg heel rise capacity and lower complication rate during twelve weeks after percutaneous Achilles tendon repair compared to conventional rehabilitation. Randomized controlled trial. Thirty-nine patients were prospectively randomized. The aggressive group (n=20, 41.4 ± 8.3 years) received rehabilitation from the first day after surgery. The conventional group (n=19, 41.7 ± 10.7 years) rested for 28 days, before rehabilitation started. The statistical parameters were the Achilles tendon rupture score (ATRS), verbal pain scale, time to return to work, pain medication consumption, Achilles tendon strength, dorsiflexion range of motion (RoM), injured-leg calf circumference, calf circumference difference, one-leg heel rise repetition and difference, re-rupture rate, strength deficit rate, and other complication rates. Mixed-ANOVA and Bonferroni's post hoc test were performed for multiple comparisons. Student's t-test was performed for parameters measured on the 12th week. The aggressive group with respect to the conventional group had a higher ATRS; lower verbal pain score; lower pain medication consumption; early return to work; higher Achilles tendon strength; higher one-leg heel rise repetitions; and lower one-leg heel rise difference. The re-rupture rate was 5% and 5%, the strength deficit rate was 42% and 5%, and other complications rate was 11% and 15% in the conventional and aggressive group, respectively. Patients with Dresden repair and aggressive rehabilitation have better clinical outcomes, Achilles tendon function and one-leg heel rise capacity without increasing the postoperative complications rate after 12 weeks compared to rehabilitation with immobilization and

  11. CDS, UX, and System Redesign - Promising Techniques and Tools to Bridge the Evidence Gap.

    PubMed

    McGinn, Thomas

    2015-01-01

    In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the "evidence gap." We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge. All of the articles in this issue explore, in some fashion, CDS systems and how we can best bring providers and their work environment to the evidence. We are at the very early stages of the science of usability. Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice. While the featured examples, techniques, and tools in the special issue are a promising start to improving usability and CDS, many of the papers highlight current gaps in knowledge and a great need for generalizable approaches. The great promise is for "learning" approaches to generate new evidence and to integrate this evidence in reliable, patient-centered ways at scale using new technology. Closing the evidence gap is a real possibility, but only if the community works together to innovate and invest in research on the best ways to disseminate, communicate, and implement evidence in practice.

  12. CDS, UX, and System Redesign – Promising Techniques and Tools to Bridge the Evidence Gap

    PubMed Central

    McGinn, Thomas

    2015-01-01

    Introduction: In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the “evidence gap.” We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge. About the Issue: All of the articles in this issue explore, in some fashion, CDS systems and how we can best bring providers and their work environment to the evidence. We are at the very early stages of the science of usability. Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice. While the featured examples, techniques, and tools in the special issue are a promising start to improving usability and CDS, many of the papers highlight current gaps in knowledge and a great need for generalizable approaches. The great promise is for “learning” approaches to generate new evidence and to integrate this evidence in reliable, patient-centered ways at scale using new technology. Closing the evidence gap is a real possibility, but only if the community works together to innovate and invest in research on the best ways to disseminate, communicate, and implement evidence in practice. PMID:26290894

  13. A novel sutureless technique for the repair of coronary sinus injuries

    PubMed Central

    Patrini, Davide; Adams, Benjamin; Lawrence, David; Roberts, Neil

    2015-01-01

    Coronary Sinus injury related to cardioplegia catheter insertion is a rare complication associated with significant morbidity and mortality risk. We describe a simple, safe and effective sutureless technique for the management of coronary sinus injury. This technique was developed in a porcine haemostatic workshop in Hamburg, Germany. PMID:26793359

  14. Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique.

    PubMed

    Stein, T; Buckup, J; Efe, T; von Eisenhart-Rothe, R; Hoffmann, R; Zimmermann, E; Welsch, F

    2015-03-01

    Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated. Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)]. The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic. Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.

  15. From mitochondrial ion channels to arrhythmias in the heart: computational techniques to bridge the spatio-temporal scales.

    PubMed

    Plank, Gernot; Zhou, Lufang; Greenstein, Joseph L; Cortassa, Sonia; Winslow, Raimond L; O'Rourke, Brian; Trayanova, Natalia A

    2008-09-28

    Computer simulations of electrical behaviour in the whole ventricles have become commonplace during the last few years. The goals of this article are (i) to review the techniques that are currently employed to model cardiac electrical activity in the heart, discussing the strengths and weaknesses of the various approaches, and (ii) to implement a novel modelling approach, based on physiological reasoning, that lifts some of the restrictions imposed by current state-of-the-art ionic models. To illustrate the latter approach, the present study uses a recently developed ionic model of the ventricular myocyte that incorporates an excitation-contraction coupling and mitochondrial energetics model. A paradigm to bridge the vastly disparate spatial and temporal scales, from subcellular processes to the entire organ, and from sub-microseconds to minutes, is presented. Achieving sufficient computational efficiency is the key to success in the quest to develop multiscale realistic models that are expected to lead to better understanding of the mechanisms of arrhythmia induction following failure at the organelle level, and ultimately to the development of novel therapeutic applications.

  16. 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.

  17. Roy D. Bridges Bridge

    NASA Image and Video Library

    2003-08-06

    From left, incoming KSC Director James W. Kennedy looks on as departing KSC Director Roy D. Bridges Jr. shakes hands with the 45th Space Wing Commander Brig. Gen. J. Gregory Pavlovich. The occasion is the unveiling of the new sign on the NASA Causeway naming the bridge for Bridges who is leaving KSC to become the director of NASA's Langley Research Center, Hampton, Va. The bridge spans the Banana River on the NASA Causeway and connects Kennedy Space Center and Cape Canaveral Air Force Station.

  18. 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.

  19. 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.

  20. 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.

  1. Extrafibrillar collagen demineralization-based chelate-and-rinse technique bridges the gap between wet and dry dentin bonding.

    PubMed

    Mai, Sui; Wei, Chin-Chuan; Gu, Li-Sha; Tian, Fu-Cong; Arola, Dwayne D; Chen, Ji-Hua; Jiao, Yang; Pashley, David H; Niu, Li-Na; Tay, Franklin R

    2017-07-15

    Limitations associated with wet-bonding led to the recent development of a selective demineralization strategy in which dentin was etched with a reduced concentration of phosphoric acid to create exclusive extrafibrillar demineralization of the collagen matrix. However, the use of acidic conditioners removes calcium via diffusion of very small hydronium ions into the intrafibrillar collagen water compartments. This defeats the purpose of limiting the conditioner to the extrafibrillar space to create a collagen matrix containing only intrafibrillar minerals to prevent collapse of the collagen matrix. The present work examined the use of polymeric chelators (the sodium salt of polyacrylic acid) of different molecular weights to selectively demineralize extrafibrillar dentin. These polymeric chelators exhibit different affinities for calcium ions (isothermal titration calorimetry), penetrated intrafibrillar dentin collagen to different extents based on their molecular sizes (modified size-exclusion chromatography), and preserve the dynamic mechanical properties of mineralized dentin more favorably compared with completely demineralized phosphoric acid-etched dentin (nanoscopical dynamic mechanical analysis). Scanning and transmission electron microscopy provided evidence for retention of intrafibrillar minerals in dentin surfaces conditioned with polymeric chelators. Microtensile bond strengths to wet-bonded and dry-bonded dentin conditioned with these polymeric chelators showed that the use of sodium salts of polyacrylic acid for chelating dentin prior to bonding did not result in significant decline in resin-dentin bond strength. Taken together, the findings led to the conclusion that a chelate-and-rinse conditioning technique based on extrafibrillar collagen demineralization bridges the gap between wet and dry dentin bonding. The chelate-and-rinse dental adhesive bonding concept differentiates from previous research in that it is based on the size

  2. 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

  3. Sutureless surgical techniques for arch aneurysm repair in a patient with Behçet's disease.

    PubMed

    Uchida, Naomichi; Takasaki, Taiichi; Takahashi, Shinya; Sueda, Taijiro

    2014-01-01

    In patients with vasculo-Behçet's disease, endovascular stent graft is a reasonable treatment from the viewpoint of prevention of an anastomotic pseudo-aneurysm. We report a case of total arch replacement combined with open stent grafting technique to the downstream aorta and graft inclusion into sino-tubular junction as sutureless surgical techniques for an arch aneurysm in a 42-year-old woman with Behçet's disease. Postoperative computed tomography (CT) showed that the aortic aneurysm had completely disappeared in 11 months after the operation. Open stent grafting technique was effective to prevent anastomotic pseudo-aneurysm formation.

  4. Treatment of Knee Arthrofibrosis and Quadriceps Insufficiency after Patellar Tendon Repair: A Case Report Including Use of the Graston Technique

    PubMed Central

    Black, Douglass W.

    2010-01-01

    Arthrofibrosis of the knee is a surgical complication that can limit range of motion, inhibit muscle activity, and decrease patient function. Optimal conservative treatment has not been well established in the literature, leaving a clinician with limited evidence for treatment planning. Described here is part of the rehabilitative course of care for a patient with arthrofibrotic limitations after a mid-substance patellar tendon repair with augmentation. Marked limitations in knee flexion range of motion and quadriceps activity were addressed using the Graston Technique to deal with soft-tissue adhesions; traditional physical therapy care was also provided. Clear improvement in range of motion and quadriceps activity and function was noted over the course of 5 treatments during 1 month. Treatment process and clinical reasoning are offered to promote understanding and to facilitate future inquiry. PMID:21589706

  5. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique.

    PubMed

    Black, Douglass W

    2010-06-23

    Arthrofibrosis of the knee is a surgical complication that can limit range of motion, inhibit muscle activity, and decrease patient function. Optimal conservative treatment has not been well established in the literature, leaving a clinician with limited evidence for treatment planning. Described here is part of the rehabilitative course of care for a patient with arthrofibrotic limitations after a mid-substance patellar tendon repair with augmentation. Marked limitations in knee flexion range of motion and quadriceps activity were addressed using the Graston Technique to deal with soft-tissue adhesions; traditional physical therapy care was also provided. Clear improvement in range of motion and quadriceps activity and function was noted over the course of 5 treatments during 1 month. Treatment process and clinical reasoning are offered to promote understanding and to facilitate future inquiry.

  6. In vitro tensile bond strength of denture repair acrylic resins to primed base metal alloys using two different processing techniques.

    PubMed

    Banerjee, Sarmistha; Engelmeier, Robert L; O'Keefe, Kathy L; Powers, John M

    2009-12-01

    Approximately 38% of removable partial denture (RPD) failures involve fracture at the alloy/acrylic interface. Autopolymerizing resin is commonly used to repair RPDs. Poor chemical bonding of repair acrylic to base metal alloys can lead to microleakage and failure of the bond. Therefore, ideal repair techniques should provide a strong, adhesive bond. This investigation compared the tensile bond strength between cobalt-chromium (Super Cast, Pentron Laboratory Technologies, Llc., Wallingford, CT) and nickel-chromium (Rexalloy, Pentron Laboratory Technologies, Llc.) alloys and autopolymerized acrylic resin (Dentsply Repair Material, Dentsply Int, Inc, York, Pa) using three primers containing different functional monomers [UBar (UB), Sun Medical Co., Ltd., Shiga, Japan: Alloy Primer (AP) Kuraray Medical Inc., Okayama, Japan; and MR Bond (MRB) Tokyuyama Dental Corp., Tokyo, Japan] and two processing techniques (bench cure and pressure-pot cure). One hundred and twenty eight base metal alloy ingots were polished, air abraded, and ultrasonically cleaned. The control group was not primed. Specimens in the test groups were primed with one of the three metal primers. Autopolymerized acrylic resin material was bonded to the metal surfaces. Half the specimens were bench cured, and the other half were cured in a pressure pot. All specimens were stored in distilled water for 24 hours at 37 degrees C. The specimens were debonded under tension at a crosshead speed of 0.05 cm/min. The forces at which the bond failed were noted. Data were analyzed using ANOVA. Fisher's PLSD post hoc test was used to determine significant differences (p < 0.05). Failure modes of each specimen were evaluated under a dissecting microscope. Significant differences in bond strength were observed between combinations of primers, curing methods, and alloys. Primed sandblasted specimens that were pressure-pot-cured had significantly higher bond strengths than primed sandblasted bench-cured specimens. The

  7. Myoblast transplantation in the porcine model: a potential technique for myocardial repair.

    PubMed

    Van Meter, C H; Claycomb, W C; Delcarpio, J B; Smith, D M; deGruiter, H; Smart, F; Ochsner, J L

    1995-11-01

    The use of transgenic cells transplanted in syngeneic rodents has shown modest success, but allogeneic and xenogeneic transplants have not been uniformly successful. To assess the feasibility of xenogeneic and allogeneic myoblast transplantation, we subjected seven adult swine to transplantation of murine atrial tumor cells (xenogeneic), neonatal porcine myocytes (allogeneic), and human fetal cardiomyocytes into the left ventricular wall. After general anesthesia, isolated cells were injected along the anterior and posterior walls of the porcine left ventricle. All the animals were immuno-suppressed and observed for 1 month after injection, at which time they were killed and analyzed. This report will present results primarily concerned with the success of human cell transfers. In all injected sites examined, the transplanted cells thrived within the host myocardium with no significant rejection. Transplant cells formed close associations with host myocytes that resembled nascent intercalated disks on electron microscopy. These cells also contained myofibrils and other cell architecture resembling the transplanted cell lines. Additionally, these cells appeared to produce an angiogenic influence resulting in the proliferation of the surrounding microvasculature. We believe that these findings indicate successful xenogeneic and allogeneic myoblast cell transplantation in a large animal model. These experiments set the stage for future studies to assess the ability of these cells to form a syncytium, contract, and potentially repair failed myocardium.

  8. Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair.

    PubMed

    Camarda, Lawrence; Pitarresi, Giuseppe; Lauria, Michele; Fazzari, Federico; D'Arienzo, Michele

    2017-07-03

    To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture-meniscus construct used during the transtibial pull-out repair technique. A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all specimens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500-1000 cycles) and ultimate load and modes of failure of the suture-meniscus construct were also recorded. There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6 ± 0.7 vs 1.4 ± 0.4 mm) and the 100th cycle (2 ± 0.7 vs 1.8 ± 0.4 mm). At 500 and 1000 cycles, the 2SS fixation technique resulted in significantly more displacement than the 3SS fixation technique (2.8 ± 0.6 vs 2.3 ± 0.5 mm; 3.1 ± 0.7 vs 2.5 ± 0.5 mm) (p < 0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500-1000 cycles). Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests. Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-operative immobilization time.

  9. Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

    PubMed Central

    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

  10. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    PubMed

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A

    2011-12-01

    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  11. [Molecular repair mechanisms using the Intratissue Percutaneous Electrolysis technique in patellar tendonitis].

    PubMed

    Abat, F; Valles, S L; Gelber, P E; Polidori, F; Stitik, T P; García-Herreros, S; Monllau, J C; Sanchez-Ibánez, J M

    2014-01-01

    To investigate the molecular mechanisms of tissue response after treatment with the Intratissue Percutaneous Electrolysis (EPI(®)) technique in collagenase-induced tendinopathy in Sprague-Dawley rats. Tendinopathy was induced by injecting 50 μg of type i collagenase into the patellar tendon of 24 Sprague Dawley rats of 7 months of age and weighting 300 g. The sample was divided into 4 groups: the control group, collagenase group, and two EPI(®) technique treatment groups of 3 and 6 mA, respectively. An EPI(®) treatment session was applied, and after 3 days, the tendons were analysed using immunoblotting and electrophoresis techniques. An analysis was also made of cytochrome C protein, Smac/Diablo, vascular endothelial growth factor and its receptor 2, as well as the nuclear transcription factor peroxisome proliferator-activated receptor gamma. A statistically significant increase, compared to the control group, was observed in the expression of cytochrome C, Smac/Diablo, vascular endothelial growth factor, its receptor 2 and peroxisome proliferator-activated receptor gamma in the groups in which the EPI(®) technique was applied. EPI(®) technique produces an increase in anti-inflammatory and angiogenic molecular mechanisms in collagenase-induced tendon injury in rats. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  12. Advances in autologous chondrocyte implantation and related techniques for cartilage repair.

    PubMed

    Foldager, Casper Bindzus

    2013-04-01

    Articular cartilage is a specialized tissue exhibiting low intrinsic capabilities of regeneration or healing after injury. Autologous chondrocyte implantation (ACI) and scaffold-supported ACI are often used for treatment of larger chondral defects (> 2 cm2). These utilize open surgery re-implantation of ex vivo cultured autologous chondrocytes harvested as a biopsy arthroscopically in a prior surgery. This two-step procedure is an advanced and expensive treatment that despite high expectations have failed to regenerate articular cartilage in a consistent and predictable fashion, and as many as 25% the operated of patients have dissatisfactory outcomes. The objective of the present thesis was to address and investigate methods for optimizing the steps involved in the ACI and scaffold-supported ACI treatment including chondrocyte culture environment, chondrocyte labeling and tracking, improved biomaterials, and cell seeding densities. We hypothesized that these areas were eligible for targeted optimization, which has been addressed in the five papers constituting the work performed in the present thesis. The first two studies address the in vitro cell expansion of chondrocytes before re-implantation. After validation of hypoxia-suitable housekeeping genes for quantitative gene expression analysis using previously validated algorithms (study 1) the effect of combined hypoxic- and 3D culture on human chondrocytes gene expression was investigated (study 2). An in vitro experiment was performed to determine the effect on gene expression of an intracellular superparamagnetic labeling agent for 1.5T MRI-tracking of alginate-embedded human chondrocytes (study 3). We further performed a literature study, reviewing the cell seeding densities of the implanted chondrocytes used in clinically available cell transplantation-based treatments for cartilage repair (study 4). Finally, we tested the addition of dermatan sulfate to a clinically approved methoxy-polyethen-glycol (MPEG

  13. Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas

    PubMed Central

    Malhotra, Amber; Patel, Kartik; Sharma, Pranav; Wadhawa, Vivek; Madan, Tarun; Khandeparkar, Jagdish; Shah, Komal; Patel, Sanjay

    2017-01-01

    Objective The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management. Methods This was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed. Results Thirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II. Conclusion The UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes. PMID:28832791

  14. Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas.

    PubMed

    Malhotra, Amber; Patel, Kartik; Sharma, Pranav; Wadhawa, Vivek; Madan, Tarun; Khandeparkar, Jagdish; Shah, Komal; Patel, Sanjay

    2017-01-01

    The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management. This was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed. Thirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II. The UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes.

  15. The "Open Branch" Technique: A New Way to Prevent Paraplegia After Total Endovascular Repair of Thoracoabdominal Aneurysm.

    PubMed

    Mangialardi, Nicola; Lachat, Mario; Esposito, Andrea; Puippe, Gilberte; Orrico, Matteo; Alberti, Vittorio; Fazzini, Stefano; Ronchey, Sonia

    2016-03-01

    Staged endovascular treatment of thoracoabdominal aortic aneurysms (TAAA) has been proved to be an effective strategy to reduce the risk of spinal cord ischemia (SCI). Several techniques have been described: some imply the staged coverage of the aorta, other the temporarily perfusion of the sac through a branch left unstented or a dedicated branch that will be occluded later. The aim of those is to facilitate the expansion of the collateral network that perfuses the spinal cord. However, each of them, have some disadvantages such as the need of two interventions of big magnitude and the risk of target vessel occlusion or endograft displacement. We describe a new technique to treat TAAA in a staged manner. The first step of our technique is the thoracoabdominal endograft deployment with the branching of all target vessels; one of these is branched with a bare stent inside which a covered stent will be placed in a second step, which can be perfomed under local anesthesia. We named this technique "open branch" (OB). Before insertion of the covered stent, a balloon is inflated inside the bare stent to simulate the complete sac exclusion to evaluate eventual neurological complication. Two patients with Crawford type II TAAA and one with a suprarenal aneurysm following the open repair of an infrarenal aortic aneurysm were treated. No cases of SCI were observed after the two procedures. Median interval time between the two procedures was 8, 6 weeks (4-16). Between the two steps, no aneurysm growth or rupture and no branch occlusion or endograft displacement was observed. These three cases of "OB" technique show that this is a safe and feasible alternative strategy to treat TAAA in a staged manner. © 2015 Wiley Periodicals, Inc.

  16. Editorial Commentary: Arthroscopic Rotator Cuff Repair--Infection Rate After Rotator Cuff Repair With Arthroscopic, Open, and Mini-open Techniques.

    PubMed

    Brand, Jefferson C

    2016-03-01

    In "Risk Factors for Infection After Rotator Cuff Repair," B. G. Vopat et al. report a lower rate of postoperative infection with an arthroscopic rotator cuff repair than with an open or mini-open approach. Although there were only 14 infections (infection rate of 0.77%), the reason for the preponderance of male patients, 13 of the 14 infections, needs further research to determine effective preventive strategies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Preservation treatment for wood bridge application

    Treesearch

    Jake Bigelow; Stan Lebow; Carol A. Clausen; Lowell Greimann; Terry J. Wipf

    2009-01-01

    Timber can often be a cost-effective construction material for new bridges. The durability of the bridge greatly depends on proper attention to construction details and fabrication, as well as proper preservative treatment before, during, and after construction. Material repair and replacement costs for bridges are a considerable expense for highway agencies. To...

  18. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique.

    PubMed

    Miller, Suzanne L; Webb, Gavin R

    2008-03-01

    Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the inferior gluteal nerve and artery to the inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. The

  19. Potential-scour assessments and estimates of scour depth using different techniques at selected bridge sites in Missouri

    USGS Publications Warehouse

    Huizinga, Richard J.; Rydlund, Jr., Paul H.

    2004-01-01

    The evaluation of scour at bridges throughout the state of Missouri has been ongoing since 1991 in a cooperative effort by the U.S. Geological Survey and Missouri Department of Transportation. A variety of assessment methods have been used to identify bridges susceptible to scour and to estimate scour depths. A potential-scour assessment (Level 1) was used at 3,082 bridges to identify bridges that might be susceptible to scour. A rapid estimation method (Level 1+) was used to estimate contraction, pier, and abutment scour depths at 1,396 bridge sites to identify bridges that might be scour critical. A detailed hydraulic assessment (Level 2) was used to compute contraction, pier, and abutment scour depths at 398 bridges to determine which bridges are scour critical and would require further monitoring or application of scour countermeasures. The rapid estimation method (Level 1+) was designed to be a conservative estimator of scour depths compared to depths computed by a detailed hydraulic assessment (Level 2). Detailed hydraulic assessments were performed at 316 bridges that also had received a rapid estimation assessment, providing a broad data base to compare the two scour assessment methods. The scour depths computed by each of the two methods were compared for bridges that had similar discharges. For Missouri, the rapid estimation method (Level 1+) did not provide a reasonable conservative estimate of the detailed hydraulic assessment (Level 2) scour depths for contraction scour, but the discrepancy was the result of using different values for variables that were common to both of the assessment methods. The rapid estimation method (Level 1+) was a reasonable conservative estimator of the detailed hydraulic assessment (Level 2) scour depths for pier scour if the pier width is used for piers without footing exposure and the footing width is used for piers with footing exposure. Detailed hydraulic assessment (Level 2) scour depths were conservatively estimated by

  20. 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)

  1. [Vacuum sealing drainage combined with discontinuous windowing technique for repairing large area exposed wound of Achilles tendon].

    PubMed

    Che, Yong-qi; Zhao, Jian-qiang; Zhai, Wei; Wang, Wen-liang; Wang, Jun-cheng; Kang, Xiang-hui

    2015-12-01

    To explore clinical effect of vacuum sealing drainage (VSD) combined with discontinuous windowing technique for repairing large area exposed wounds of Achilles tendon. From July 2009 to May 2014, 11 patients with large exposed wounds of Achilles tendon were treated, including 5 males and 6 females with an average age of 43 years old (aged from 7 to 65 years old). Among them, 4 cases were skin necrosis caused by heavy objects abrasion and contusion; 3 cases were caused by distal tibiofibula fractures; 3 cases were caused by bicycle-spoke injuries; 1 case was caused by diabetes. Areas of exposed Achilles tendon were from 6 cmx3 cm to 14 cmx5 cm without tendon rupture or bone exposed. After debridement, discontinuous fenestration on Achilles tendon was made by knife blade parallel with longitudinal axis of Achilles tendon, combined with Vacuum Sealing Drainage (VSD) treatment. After drainage treatment with one VSD cycle (5 to 7 days), abundant fresh granulation tissues were growing on all wounds and survived well after the second phase dermatoplasty. All patients were followed up for 12 to 24 months, the color of skin flap was good, the texture was soft without burst. At 3 to 4 months after operation, subcutaneous fat was appeared under the flap, the skin was sliding, movement of ankle joints was good. No delayed Achilles tendon rupture were occurred. Vacuum sealing drainage (VSD) combined with discontinuous fenestration is a simple, safe and effective method for repairing large area exposed wounds of Achilles tendon,which could minimize the secondary damage caused by wounds of skin flap grafting.

  2. Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents.

    PubMed

    Dierckman, Brian D; Ni, Jake J; Karzel, Ronald P; Getelman, Mark H

    2017-06-24

    This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair. This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist. Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p < 0.00056. Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. IV.

  3. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

    PubMed

    Shin, Sang-Jin; Jeong, Jae-Hoon; Jeon, Yoon Sang; Kim, Rag Gyu

    2016-12-01

    The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50 % of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50 % of the tendon's thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6 months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0 ± 10.3 to postoperative 92.6 ± 8.0), Constant score (61.2 ± 8.5-88.0 ± 5.3), VAS for pain (4.9 ± 2.6-0.6 ± 0.7) improved significantly after arthroscopic transtendon anatomic repair (p < 0.001). No patients had rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

  4. 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

  5. Estimation of dynamic, in vivo soft-tissue deformation: experimental technique and application in a canine model of tendon injury and repair.

    PubMed

    Bey, Michael J; Kline, Stephanie K; Baker, Andrew R; McCarron, Jesse A; Iannotti, Joseph P; Derwin, Kathleen A

    2011-06-01

    Outcomes after rotator cuff surgery are typically assessed with measures of strength, joint motion, or pain, but these measures do not provide a direct assessment of tissue function as healing progresses. To address this limitation, this manuscript describes biplane X-ray analysis as a technique for quantifying in vivo soft-tissue deformation. Tantalum beads were implanted in the humerus and infraspinatus tendon in a canine model of tendon injury and repair. Biplane X-ray images were acquired during treadmill trotting and tissue deformation was estimated from the three-dimensional bead positions. Changes over time were characterized by the mean, range, and normalized range (i.e., range/mean) of interbead distance. Intact tendon repair tissue demonstrated significant decreases over time in the mean (p = 0.003), range (p = 0.001), and normalized range (p = 0.001) of interbead distance. Failed tendon repair tissue demonstrated significant decreases over time in the range (p =  0.05) and normalized range (p = 0.04) of interbead distance. In an uninjured control, differences over time in the interbead distance parameters were not detected. This approach is a promising technique for estimating changes over time in soft-tissue deformation. These preliminary data indicate appreciable differences between normal tendons, intact repairs, and failed repairs. Copyright © 2010 Orthopaedic Research Society.

  6. 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

  7. Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique.

    PubMed

    Schliemann, Benedikt; Lenschow, Simon; Domnick, Christoph; Herbort, Mirco; Häberli, Janosch; Schulze, Martin; Wähnert, Dirk; Raschke, Michael J; Kösters, Clemens

    2017-04-01

    Dynamic intraligamentary stabilization (DIS) has been introduced for the repair of acute anterior cruciate ligament (ACL) tears as an alternative to delayed reconstruction. The aim of the present study was to compare knee joint kinematics after DIS to those of the ACL-intact and ACL-deficient knee under simulated Lachman/KT-1000 and pivot-shift tests. We hypothesized that DIS provides knee joint kinematics equivalent to an intact ACL. With the use of a robotic knee simulator, knee kinematics were determined in simulated Lachman/KT-1000 and pivot-shift tests at 0°, 15°, 30°, 60°, and 90° of flexion in eight cadaveric knees under the following conditions: (1) intact ACL, (2) ACL deficiency, (3) DIS with a preload of 60 N, and (4) DIS with a preload of 80 N. Statistical analyses were performed using two-factor repeated-measures analysis of variance. The significance level was set at a p value of <0.05. After DIS with a preload of either 60 N or 80 N, the anterior translation was significantly reduced in the simulated Lachman/KT-1000 and pivot-shift tests when compared to the ACL-deficient knee (p < 0.05). No significant differences were observed between the DIS reconstruction with a preload of 80 N and the intact ACL with regard to anterior laxity in either test. However, DIS with a preload of only 60 N was not able to restore knee joint kinematics to that of an intact knee in all degrees of flexion. DIS with a preload of 80 N restores knee joint kinematics comparable to that of an ACL-intact knee and is therefore capable of providing knee joint stability during ACL healing. DIS therefore provides a new technique for primary ACL repair with superior biomechanical properties in comparison with other techniques that have been described previously, although further clinical studies are required to determine its usefulness in clinical settings.

  8. 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.

  9. 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.

  10. Meningocele repair

    MedlinePlus

    ... Myelodysplasia repair; Spinal dysraphism repair; Meningomyelocele repair; Neural tube defect repair; Spina bifida repair ... If your child has hydrocephalus, a shunt (plastic tube) will be put in the child's brain to ...

  11. Conformal, planarizing and bridging AZ5214-E layers deposited by a 'draping' technique on non-planar III V substrates

    NASA Astrophysics Data System (ADS)

    Eliás, P.; Strichovanec, P.; Kostic, I.; Novák, J.

    2006-12-01

    A draping technique was tested for the deposition of positive-tone AZ5214-E photo-resist layers on non-planar (1 0 0)-oriented III-V substrates, which had a variety of three-dimensional (3D) topographies micromachined in them that consisted, e.g., of mesa ridges confined to side facets with variable tilt, inverted pyramidal holes and stubs confined to perpendicular side facets. All objects were sharp-edged. In each draping experiment, an AZ5214-E sheet was (1) formed floating on the water surface, (2) lowered onto a non-planar substrate and (3) draped over it during drying to form either self-sustained, or conformal, or planarizing layers over the non-planar substrates. The draping process is based on the depression of the glass transition temperature Tg of AZ5214-E material induced by penetrant water molecules that interact with AZ5214-E. During the process, the molecules are initially trapped under an AZ5214-E sheet and then transported out through the sheet via permeation. The water-AZ5214-E interaction modifies the stiffness κ of the sheet. The magnitude of the effect depends on temperature T and on partial water vapour pressure difference p(T, P, κ): the net effect is that Tg = f(C(T, P), p(T, P, κ)) is lowered as the concentration C of water increases with T and p, where P is the permeability of the sheet. The interaction depressed the Tg of the sheets as low as or lower than 53 °C for 6 µm thick sheets. At room temperature T < Tg, the sheet is glassy and too stiff to yield to adhesion and capillary forces. Consequently, it cannot conform to a 3D topography, and it can form a self-sustained, bridging layer over it. By contrast, at T ap or > Tg, the sheet becomes rubbery and mouldable by adhesion and capillary forces. As a result, it can either contour or planarize the topography depending on its geometry and thickness of the sheet.

  12. Soft tissue repair for tibialis anterior tendon ruptures using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation.

    PubMed

    Mao, Haijun; Xu, Guanyue

    2015-09-17

    Traumatic ruptures of the tibialis anterior tendon are rare but can cause substantial functional deficiencies. This study aimed to evaluate the feasibility of a surgery for soft tissue repair of traumatic rupture of the tibialis anterior tendon by using a plate and screw fixation repair in combination with the free anterolateral thigh flaps transplantation. Eight consecutive patients with anterior tibialis tendon ruptures who visited orthopedics departments from February 2008 to February 2012 were included in our study. The ruptured tendon was reconstructed with plate and screw fixation technique, and the tissue defects were repaired with anterolateral thigh free flaps. The complications and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. Postoperative manual strength test was performed using a 0 to 5 scale. All flaps survived without any complications. The average preoperative and postoperative AOFAS ankle-hindfoot scores of the patients were 51 and 95, respectively. Good ankle dorsiflexion strength against strong resistance was observed in eight ankles postoperatively (manual strength of one patient was 4/5, the others were 5/5), and a substantial improvement in strength was noted compared with the preoperative examination. Soft tissue repair for tibialis anterior tendon rupture using plate and screw fixation technique in combination with anterolateral thigh flaps transplantation is a feasible technique and yield satisfactory results.

  13. 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

  14. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears.

    PubMed

    Marchetti, Daniel Cole; Phelps, Brian M; Dahl, Kimi D; Slette, Erik L; Mikula, Jacob D; Dornan, Grant J; Bucci, Gabriella; Turnbull, Travis Lee; Singleton, Steven B

    2017-10-01

    To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged

  15. Structural Dynamic Response Compressing Technique in Bridges using a Cochlea-inspired Artificial Filter Bank(CAFB)

    NASA Astrophysics Data System (ADS)

    Heo, G.; Jeon, J.; Son, B.; Kim, C.; Jeon, S.; Lee, C.

    2016-09-01

    In this study, a cochlea-inspired artificial filter bank (CAFB) was developed to efficiently obtain dynamic response of a structure, and a dynamic response measurement of a cable-stayed bridge model was also carried out to evaluate the performance of the developed CAFB. The developed CAFB used a band-pass filter optimizing algorithm (BOA) and peakpicking algorithm (PPA) to select and compress dynamic response signal containing the modal information which was significant enough. The CAFB was then optimized about the El-Centro earthquake wave which was often used in the construction research, and the software implementation of CAFB was finally embedded in the unified structural management system (USMS). For the evaluation of the developed CAFB, a real time dynamic response experiment was performed on a cable-stayed bridge model, and the response of the cable-stayed bridge model was measured using both the traditional wired system and the developed CAFB-based USMS. The experiment results showed that the compressed dynamic response acquired by the CAFB-based USMS matched significantly with that of the traditional wired system while still carrying sufficient modal information of the cable-stayed bridge.

  16. Use of a new type of PTFE mesh in laparoscopic incisional hernia repair: the continuing evolution of technique and surgical expertise.

    PubMed

    Verbo, Alessandro; Petito, Luigi; Pedretti, Giorgio; Lurati, Massimo; D'Alba, Pierfrancesco; Coco, Claudio

    2004-01-01

    We present the results of our first 44 laparoscopic incisional hernia repairs. This study examines the effectiveness of this technique in patients presenting with a first-time or recurrent incisional hernia. From October 2001 to November 2002, a total of 45 consecutive patients underwent laparoscopic incisional hernia repair with a new form of expanded polytetrafluoroethylene (ePTFE) mesh. Patient data, preoperative, intraoperative, and postoperative records, were recorded and analyzed. Mean defect size was 84 cm2, mean mesh size was 311 cm2, mean surgical time was 65 minutes, and mean hospital stay was 2.25 days. Postoperative complications occurred in four patients (9.1%). The laparoscopic approach is a safe, effective, and relatively complication-free option in the management of first-time and recurrent incisional hernias. The use of modified ePTFE mesh with a dual surface in incisional hernia repair enables early tissue attachment, reduces adhesions, and could reduce the incidence of recurrences.

  17. Determination and compensation of series resistances during whole-cell patch-clamp recordings using an active bridge circuit and the phase-sensitive technique.

    PubMed

    Riedemann, Therese; Polder, Hans Reiner; Sutor, Bernd

    2016-10-01

    We present a technique which combines two methods in order to measure the series resistance (R S) during whole-cell patch-clamp recordings from excitable and non-excitable cells. R S is determined in the amplifier's current-clamp mode by means of an active bridge circuit. The correct neutralization of the electrode capacitance and the adjustment of the bridge circuit is achieved by the so-called phase-sensitive method: Short sine wave currents with frequencies between 3 and 7 kHz are injected into the cells. Complete capacitance neutralization is indicated by the disappearance of the phase lag between current and voltage, and correct bridge balance is indicated by a minimized voltage response to the sine wave current. The R S value determined in the current-clamp mode then provides the basis for R S compensation in the voltage-clamp recording mode. The accuracy of the procedure has been confirmed on single-compartment cell models where the error amounted to 2-3 %. Similar errors were observed during dual patch clamp recordings from single neocortical layer 5 pyramidal cells where one electrode was connected to the bridge amplifier and the other one to a time-sharing, single-electrode current- and voltage-clamp amplifier with negligible R S. The technique presented here allows R S compensation for up to 80-90 %, even in cells with low input resistances (e.g., astrocytes). In addition, the present study underlines the importance of correct R S compensation by showing that significant series resistances directly affect the determination of membrane conductances as well as the kinetic properties of spontaneous synaptic currents with small amplitudes.

  18. Two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging dialysis catheter.

    PubMed

    Yoon, William J; Lorelli, David R

    2015-01-01

    The purpose of this study is to report a novel two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging hemodialysis catheter in internal jugular vein (IJV) catheter-dependent patients with contralateral central venous occlusion. The first stage is to implant the ePTFE component and consists of: 1) performing two to three incisions in the upper arm ipsilateral to the preexisting IJV catheter, 2) tunneling the expanded polytetrafluoroethylene (ePTFE) component through these incision sites, and 3) placing the ePTFE component in the subcutaneous tissue without anastomosing it to the target artery. The preexisting IJV catheter is maintained to provide continuous dialysis access. The second stage is initiated in 4 weeks and includes: 1) thrombectomy and anastomosing the ePTFE component arterial end to the target artery, 2) insertion of the venous outflow component using the preexisting IJV catheter access site, and 3) connecting the venous outflow component to the ePTFE component in the standard fashion. The HeRO graft was successfully implanted in two stages without using a femoral bridging catheter. Immediate postimplant cannulatabilty was achieved upon completion of the second stage procedure. This novel two-stage HeRO implantation technique is simple, yet allows immediate cannulation upon completion of the second stage procedure while avoiding the need of a femoral bridging catheter in IJV catheter- dependent patients with contralateral central venous occlusion, and thus lowering the risk of infection related to a femoral bridging catheter.

  19. Repair of Double Head Pectoralis Major Tendon Avulsion into its Native Footprint Using Bi-cortical EndoButtons and Tendon Sliding Technique.

    PubMed

    Prabhu, Jagadish; Faqi, Mohammed Khalid; Alkhalifa, Fahad; Tayara, Bader Kamal; Awad, Rashad Khamis

    2017-01-01

    Injuries to the pectoralis major muscle are relatively infrequent. The mechanism of injury is usually an eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. We report a case that presented to us with a history of sudden pain in the left pectoral region while doing heavy bench press exercise. The patient sustained a type III D pectoralis muscle -tendon avulsion. Surgical repair was done through a bi-cortical tendon sliding technique using two cortical buttons. In this article we describe our modifications to the previously described surgical technique for the pectoralis major tendon repair using the EndoButton and tension - slide technique, aiming to overcome the possible complications.

  20. Repair of Double Head Pectoralis Major Tendon Avulsion into its Native Footprint Using Bi-cortical EndoButtons and Tendon Sliding Technique

    PubMed Central

    Prabhu, Jagadish; Faqi, Mohammed Khalid; Alkhalifa, Fahad; Tayara, Bader Kamal; Awad, Rashad Khamis

    2017-01-01

    Injuries to the pectoralis major muscle are relatively infrequent. The mechanism of injury is usually an eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. We report a case that presented to us with a history of sudden pain in the left pectoral region while doing heavy bench press exercise. The patient sustained a type III D pectoralis muscle –tendon avulsion. Surgical repair was done through a bi-cortical tendon sliding technique using two cortical buttons. In this article we describe our modifications to the previously described surgical technique for the pectoralis major tendon repair using the EndoButton and tension – slide technique, aiming to overcome the possible complications. PMID:28217216

  1. Three Bridge Fryer's Ford Bridge, Nimrod Bridge, and Ward's ...

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

    Three Bridge - Fryer's Ford Bridge, Nimrod Bridge, and Ward's Crossing Bridge - Fryer's Ford Bridge, Spanning East Fork of Point Remove Creek at Fryer Bridge Road (CR 67), Solgohachia, Conway County, AR

  2. Outcomes of digital zone IV and V and thumb zone TI to TIV extensor tendon repairs using a running interlocking horizontal mattress technique.

    PubMed

    Altobelli, Grant G; Conneely, Stacy; Haufler, Christina; Walsh, Maura; Ruchelsman, David E

    2013-06-01

    Biomechanical evidence has demonstrated that the running interlocking horizontal mattress (RIHM) repair for extensor tendon lacerations is significantly stronger, with higher ultimate load to failure and less tendon shortening compared with other techniques. We investigated the efficacy and safety of primary extensor tendon repair using the RIHM repair technique in the fingers followed by the immediate controlled active motion protocol, and in the thumb followed by a dynamic extension protocol. We conducted a retrospective review of all patients undergoing extensor tendon repair from August 2009 to April 2012 by single surgeon in an academic hand surgery practice. The inclusion criteria were simple extensor tendon lacerations in digital zones IV and V and thumb zones TI to TIV and primary repair performed using the RIHM technique. We included 8 consecutive patients with 9 tendon lacerations (3 in the thumb). One patient underwent a concomitant dorsal hand rotation flap for soft tissue coverage. We used a 3-0 nonabsorbable braided suture to perform a running simple suture in 1 direction to obtain a tension-free tenorrhaphy, followed by an RIHM corset-type suture using the same continuous strand in the opposite direction. Average time to surgery was 10 days (range, 3-33 d). Mean follow-up was 15 weeks (range, 10-26 wk). We applied the immediate controlled active motion protocol to all injuries except those in the thumb, where we used a dynamic extension protocol instead. Using the criteria of Miller, all 9 tendon repairs achieved excellent or good results. There were no tendon ruptures or extensor lags. No patients required secondary surgery for tenolysis or joint release. No wound complications occurred. The RIHM technique for primary extensor tendon repairs in zone IV and V and T1 to TIV is safe, allows for immediate controlled active motion in the fingers and an immediate dynamic extension protocol in the thumb, and achieves good to excellent functional outcomes

  3. Load to Failure and Stiffness: Anchor Placement and Suture Pattern Effects on Load to Failure in Rotator Cuff Repairs.

    PubMed

    Esquivel, Amanda O; Duncan, Douglas D; Dobrasevic, Nikola; Marsh, Stephanie M; Lemos, Stephen E

    2015-04-01

    Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen-crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. Controlled laboratory study. A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P < .05). According to study results, when choosing a repair technique, other factors such as number of sutures in the repair should be considered to judge the strength of the repair. Previous in vitro studies have shown the double-row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties.

  4. Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques.

    PubMed

    Kim, Sung-Jae; Jung, Min; Lee, Jae-Hoo; Kim, Chul; Chun, Yong-Min

    2014-12-17

    The purpose of this study was to compare the clinical outcomes and structural integrity after two techniques of arthroscopic anterosuperior rotator cuff repair: in continuity and disruption of the tear margin. This study included fifty-nine patients who underwent arthroscopic repair of an anterosuperior rotator cuff tear that was done either by disrupting the margin between the subscapularis and supraspinatus tears (Group A) or by performing the repair in continuity without disrupting the margin (Group B). Clinical outcomes were assessed on the basis of a visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder a