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We report a case of conjunctival erosion due to ligature suture knot exposure following Aurolab aqueous drainage device (AADI) implantation. A 48-year-old man, a known case of primary angle-closure glaucoma, had failed trabeculectomy with mitomycin-C and Ahmed glaucoma valve (AGV) in the right eye. The right eye had a large posterior AGV bleb with hypertropia and limitation of extraocular movement on downward gaze and uncontrolled intraocular pressure (IOP). An inferonasal AADI was performed uneventfully. At the 1-month postoperative visit, a small conjunctival erosion was noted over the ligature (6-0 vicryl) suture knot. However, there was no leak. Two weeks later, there was hypotony and a leak was noted at the site of the absorbed ligature. Immediate surgical repair was performed by re-ligature of the AADI tube with 8-0 vicryl and the ligature knot was placed under the scleral patch graft and the conjunctival defect was sutured. Early intervention helped in successfully healing the conjunctival erosion, reversal of the hypotony and well-controlled IOP. Adequate covering of the entire subconjunctival tube including its ligated part by a patch graft may prevent this complication.

The objective of this article is to compare the occurrence of hemorrhagic complications in student-performed feline ovarian pedicle ligations using the traditional suture pedicle double-ligation (PDL) to the suture-less auto-ligation (AL) techniques, and to describe the stepwise method of teaching the AL technique to students. A total of 287 cats underwent an ovariohysterectomy (OHE) performed by a fourth-year veterinary student trained by veterinary faculty to perform the AL technique beginning with a low-fidelity model and progressing to live patient surgeries. Students performed the AL and PDL techniques on 146 and 141 cats respectively. Hemorrhagic complications occurred in 4 of 146 cats (2.7%) in the AL group and 8 of 141 (5.7%) in the PDL group and were not found to be significantly different ( p = 0.2496). This article demonstrates that novice surgeons can safely perform the AL technique on feline ovarian pedicles without significantly increasing complications compared to the traditionally taught method when a stepwise training program is implemented. Additionally, this technique has been shown to be safe, effective, and more efficient when performed by experienced veterinary surgeons. 1 Veterinary institutions should consider including the AL technique in their core curricula as a standard method for feline ovarian pedicle ligation. Doing so will facilitate the development of more proficient entry-level practitioners who are better able to serve their patients, clients, employers, humane societies, and their communities by using a more efficient and safe feline ovariohysterectomy technique.

Periodontitis is a disease that affects a wide group of people, and there has been an increased interest in the research of finding useful materials that help reduce inflammation and the further loss of tissue. In this study, we have tested a boron-containing compound (BCC) Calcium Fructoborate (CaFB) and Boric Acid (BA) hydrogels on the gingival level on Wistar rats. First, we have induced the periodontal disease at the lower incisors, we have applied the hydrogels and after a week, we have euthanized the rats. Next, the oral soft tissue reaction was clinically and then histologically investigated. Our study has shown good clinical response of the oral tissue, and we have noticed lower levels of inflammation on the experimental groups treated with the BCCs hydrogels. Despite the generally good response of the biological structures to the presence of BA and CaFB on periodontal level, more scientifically proved information is needed to obtain the desired biological responses in all clinical situations.

Made available in DSpace on 2021-06-25T11:13:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 This study evaluated the influence of Doxycycline (DOX) and Low-Intensity Laser (LIL) (InGaAlP diode laser) as scaling and root planing (SRP) adjuvants in the treatment of periodontitis induced in rats. The rats received periodontal disease induction, and after 7 days, the ligature was removed, and the animals were divided into groups/treatments: NT—receive no treatment; SRP—submitted only to SRP; DOX—submitted to SRP and DOX irrigation; LIL—submitted to SRP and LIL irradiation; and DOX + LIL—submitted to SRP treatments, DOX irrigation and LIL irradiation. The animals were sacrificed at 7, 15 and 30 days, and then, the analyses were performed. A lower concentration of Alpha-glycoprotein acid and Complement 3 was observed in the DOX + LIL group compared to all the other groups in all the periods, and for Complement 4 at 15 and 30 days (P

Background pneumovesicoscopic approach gives new possibilities for endovideosurgical correction of congenital ureteral and bladder pathology. Aim To increase the efficiency of ureteral reimplantation in patients with vesicoureteral reflux (VUR), obstructive megaureter and bladder pathology by using pneumovesicoscopic access. Materials and methods For the period 2014 - 2020 a total of 52 children aged from 10 months up to 15 years (median 2.5 years) were treated. In all patients, pneumovesicoscopic ureteral reimplantation according to the Cohen technique was performed, and in six cases bilateral procedure was done. 30 patients with obstructive megaureter (32 ureters) were treated, and intravesical suturing with ureteral plication was performed in 9 patients. Reimplantation for grade 3-5 VUR was performed in 22 patients (26 ureters), in combination with excision of the bladder diverticulum was done in 3 patients, while 3 children were undergone to simultaneous excision of the ureterocele. An original technique for fixation of the mobilized dilated ureter with a ligature to the bladder neck is proposed to simplify its intravesical suturing according to the Starr technique. Results The mean operation time was 142 (83-235 minutes). Conversion to open surgery was required in 1 (1.9%) child during the learning curve. The length of stay was 5-6 days, with an average of 5.21 days. According to ultrasound data, after 1, 3, 6 months there was a decrease in the size of the collecting system and ureter in all cases. At cystography after 6-12 months, VUR was detected in 3 (5.7%) children: in 2 (9%) patients with grade 3-5 VUR and in 1 (3.3%) patient with obstructive megaureter and ureteral suturing. Conclusion Pneumovesicoscopic access for ureteral reimplantation in patients with VUR, obstructive megaureter, bladder diverticulum and ureterocele has proven its efficiency and reliability with a minimal complication rate (5.7%). Our proposed method of fixing the mobilized ureter with a ligature to the bladder neck helps to simplify the suturing of the ureter and to shorten the operation time.

Introduction. In recent years a link between periodontitis and cardiovascular diseases has been proposed. Oxidative stress has been found to be involved in their pathophysiology. Objectives. The aim of this study was to demonstrate that a wire ligature placed around the first mandibular molars of the rat causes inflammation in the periodontium and lipid deposits in the aorta, via oxidative stress. Methods. Twenty male Wistar rats were divided randomly into two groups of 10: Control group and Periodontitis group. An orthodontic wire ligature was placed around the cervix of the first mandibular molar and was kept in place for 4 weeks. Clinical attachment loss was determined to assess the gingival recession. Aorta was harvested after 4 weeks and the malondialdehyde (MDA) levels in the aorta tissue homogenate were determined. Lipid deposits were evaluated using Oil Red staining and immunofluorescence under confocal microscopy. Total lipid deposits in the aorta were assessed using a computer morphometry system. Results. Significant gingival recession was observed in the Periodontitis group in comparison with the Control group. Increased MDA levels were present in the aorta in the ligatured rats in comparison with the Control group. Significant lipid deposits were observed in the aorta of the Periodontitis group as opposed to the Control group. Conclusions. The affixing of an orthodontic wire ligature produces gingival recession, increased oxidative stress and lipid deposits in the rat descending aorta.

OBJECTIVE The aim: The aim of the research was to study the features of the ultrastructure of the skin of white rats 60 and 90 days after modeling of portal hypertension. PATIENTS AND METHODS Materials and methods: The investigations were performed on male white nonlinear rats. The animals of the first (control) group underwent a sham operation. In rats of the second group, portal hypertension was simulated by applying a ligature to the portal vein. 60 and 90 days after the start of the experiment, a biopsy was taken from the anterior abdominal wall for electron microscopy research. RESULTS Results: It was shown that skin in intact animals (control group) was of typical structure before beginning of experiment and 60 and 90 days after a sham operation. 60 days after the start of the experiment, we found severe edema of the basal and spinous layer of the epidermis, breakdown of intercellular contacts, edema of endotheliocytes, their perivascular edema, leukocytes infiltration, edema of mitochondria and lysosomes. 90 days after the start of the experiment, ultrastructural changes in the skin were more pronounced. Ultrastructural changes of microvessels were characterized by narrowed lumen. Endothelial cells had significant edema. CONCLUSION Conclusions: Тhe data obtained should be taken into account when performing surgical interventions to prevent complications in the formation of the scar.

Objective. To improve the efficacy of endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature. Materials and methods. In 2017-2020 yrs period the analysis of efficacy of endoscopic hemostasis was done in 160 patients, ageing 40-85 yrs old, for the ulcer gastro-duodenal hemorrhage. The patients were distributed into two groups: the main - 80 patients, in whom high-frequency biological welding electro-ligature was performed, and a control one - 80 patients, in whom monopolar thermal argon-plasm coagulation was conducted. Results. In the main Group a primary hemostasis was achieved in 77 (96.3%) patients. Early recurrence of hemorrhage have occurred in 3 (3.8%) patients. In a control Group a primary hemostasis was achieved in 66 (82.5%) patients. Recurrence of the hemorrhage have occurred in 14 (17.5%) patients. Conclusion. Endoscopic hemostasis for the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, is achieved due to the impedance action of modulated signal of a high-frequency current as well as the adaptive system of automatic guidance of the welding process and a contact between special endoscopic probe, owing a concave electrode, with bleeding vessel, leading to its complete obliteration. Application of welding electro-ligature for endoscopic hemostasis in the ulcer gastro-duodenal hemorrhage, using high-frequency biological welding electro-ligature, guarantees more secure residual hemostasis, than application of monopolar thermal argon-plasm coagulation, peculiarly in hemorrhage from vessels owing 2 - 4 mm diameter. As a result, the hemorrhage recurrence rate have had reduced down to 3.8% (in the control Group - 18.0%).

Introduction: Plaque induced periodontitis is the second most common oral disease worldwide after dental caries. Documents from animal experiments proved that NSAIDs can reduce the inflammation and the rate of resorption of alveolar bone thus, stabilize the periodontal condition. In the last 10 years, diode laser also has been highly recommended as a treatment modality for periodontal inflammatory diseases due to its anti-inflammatory effect, ability to accelerate the healing process and its pain reduction ability. Materials and Methods: 84 albino rats were divided into 4 groups. Group I is the negative control group which did not subjected to any procedure, group II is the positive control group which is subjected to ligature induced periodontitis but did not take any treatment, group III is the diode laser group which is subjected to ligature induced periodontitis and treated by diode laser irradiation after removal of the ligature and group IV is the ibuprofen group which is subjected to ligature induced periodontitis and treated by ibuprofen syrup for 4 days after removal of the ligature. Results: inflammatory cell count was measured in all specimens stained by H&E and area fraction was measured in all specimens stained by MMP-1 immuno histochemical marker. Total amount of inflammatory cells and MMP-1 decreased by time with a significant difference between treatment groups and positive control group. Conclusion: Diode laser irradiation showed greater and faster reduction in inflammation than ibuprofen.

Background Cholecystectomy is a common elective procedure for cholecystic diseases, including cholecystitis and cholelithiasis. Common bile duct injury is a major complication in both open and laparoscopic cholecystectomy (LC). The number of cholecystectomies performed has increased due to popularization and application of the laparoscopic technique, which has led to an increase in the number of bile duct injuries. Case summary A 65-year-old man presented to the General Surgery Department with a complaint of repeated right upper quadrant pain for 2 years that had worsened over the previous day. The patient had a history of gallstones and hypertension. A LC was performed; it was found that a biliary stricture of 53 h duration was caused by a ligature injury of the common bile duct during the LC. Another laparoscopic exploration was performed, and the stricture was released. Conclusion LC is a common surgical procedure, but if a complication occurs, it is important for the surgeon to consider another exploratory surgery.

Aim. To demonstrate the advantages of laparoscopic surgery in patients with colorectal cancer compared to traditional surgical intervention. Methods. A retrospective analysis of 40 patients treatment (the main group) in the Department of abdominal Oncology of the Kursk Regional Oncology Center for the period 20172019, who had a pronounced violation of the passage through the intestine due to stenosing by the tumour, was conducted. As a control group, 30 people who underwent open surgery in the volume of a colostomy for the period 20172019 was taken. Results. According to the average duration of surgical intervention, the groups significantly differed (p 0.05), the average duration of surgery in the laparoscopic group was less 40.513.6 min, with laparotomy 54.518.5 min. The volume of blood loss during the operation was greater in the control group and reached 7540 ml against, 10.55.5 ml the differences were statistically significant (p 0.05). The average length of stay in hospital in the laparoscopic group was 41 days, which is significantly less than in patients who underwent laparotomy 114 days (p 0.05). Postoperative complications occurred in 10% of patients in the control group: seroma of the median wound in 2 patients, ligature fistula in 1 patient. There were no postoperative fatalities in both groups. Conclusion. The comparison of methods of surgical intervention showed that the results of laparoscopic operations are much better than traditional open operations in patients with colorectal cancer since they significantly reduce the duration of the rehabilitation period, accompanied by minor blood loss.

IntroductionCatastrophic hemorrhage is the leading cause of preventable trauma deaths in the military and civilian populations. The use of tourniquets by first responders (medical and nonmedically trained) is supported and has the potential to save lives if applied correctly.AimsWe sought to examine the use of 5 tourniquets: 1 improvised and 4 commercially available tourniquets to investigate the time taken to stop simulated bleeding and to secure the device; evidence of rebleeding when the “blood pressure” was restored and to gain qualitative feedback on their application.Materials and MethodsFour commercially available tourniquets (Combat Application Tourniquet [C-A-T], Special Operations Forces Tactical Tourniquet - Wide (SOFTT-W), stretch, wrap, and tuck tourniquet [SWAT-T], and the Tourni-key) and an improvised tourniquet (tie & wooden spoon) were tested on a complex silicone simulation model used to replicate catastrophic hemorrhage from a blast injury with above traumatic knee amputation (SAM 4.1 Trauma Simulation Ltd, UK). To limit the user variability, the same investigator applied each tourniquet and each was tested 3 times. No ethical approval was required to conduct this study.ResultsNone of the devices took longer than 1 minute to secure. The C-A-T and SOFTT-W were quickest to occlude and secure. Although the Tourni-key took longer statistically, this was unlikely to be a clinically important difference. Compared to the others, the SOFTT-W rebled on 2 out of 3 applications. The improvised tourniquet had an obvious ligature effect because of its narrowness, followed by the Tourni-key. This effect was least evident with the SWAT-T; however, particular care was needed to ensure it was safely secured as it was slippery when wet.ConclusionsAll tourniquets tested were effective and swift to apply. The Tourni-key’s antipinch card seems helpful in reducing local pain under the windlass. Reinspection for rebleeding is important and should be routinely performed irrespective of the device. The width of the SWAT-T may be beneficial, thereby, reducing the risk of crush injury.

Ligature strangulation causes death due to neck compression without suspension. However, suicidal ligature strangulation is rare. The suicide of a 32-year-old man is presented. After a dispute, the man was found outdoors with a lashing belt around his neck which had been pulled tight with a ratchet. Conjunctival petechiae were found, but hemorrhages in the soft tissues were not observed. The hyoid bone and larynx did not show fractures or hemorrhage. Other injuries as well as signs of defence were not observed. The differentiation between homicidal and suicidal ligature strangulation can be difficult and requires careful investigation and collaboration by police and forensic pathologists.

Arteriovenous fistulae are abnormal direct communications between artery and venous system. It rarely occurs in superficial temporal vessel and is usually caused by trauma. Clinical manifestation includes pulsatile mass, headache, hemorrhage and tinnitus. Angiography is standard diagnostic modality and surgical removal of the pulsating mass with ligature of the feeding vessel is definitive treatment. The authors describe the case of a 35-year-old female patient who developed a pulsatile tortuous mass, extending from the left preauricular area to the left scalp after sustaining thorn injury (extremely rare penetrating injury). The treatment done was a complete surgical removal of the pulsatile mass and ligature of the feeding superficial temporal artery.

A large number of experimental studies has demonstrated that angiotensin II (Ang II) is involved in key events of the inflammatory process. This study aimed to evaluate the role of Ang II type 1 (AT1) and Ang II type 2 (AT2) receptors on periodontitis. Methods: Experimental periodontitis was induced by placing a 5.0 nylon thread ligature around the second upper left molar of AT1 mice, no-ligature or ligature (AT1-NL and AT1-L), AT2 (AT2-NL or AT2-L) and wild type (WT-NL or L). Alveolar bone loss was scanned using Micro-CT. Cytokines, peptides and enzymes were analyzed from gingival tissues by Elisa and RT-PCR. Results: The blockade of AT1 receptor resulted in bone loss, even in healthy animals. Ang II receptor blockades did not prevent linear bone loss. Ang II and Ang 1-7 levels were significantly increased in the AT2-L (p < 0.01) group compared to AT2-NL and AT1-L. The genic expression of the Mas receptor was significantly increased in WT-L and AT2-L compared to (WT-NL and AT2-NL, respectively) and in AT1-L. Conclusions: Our data suggest that the receptor AT1 appears to be important for the maintenance of bone mass. AT2 receptor molecular function in periodontitis appears to be regulated by AT1.

Aims: To compare the incidence of intra-operative haemorrhage from ovarian vessels during ovariectomy (OV) and ovariohysterectomy (OVH) in dogs and cats performed by inexperienced surgeons using surgeon's and constrictor knots to ligate the ovarian pedicles.Methods: All client-owned female dogs (n = 51) and cats (n = 102) that presented for OV or OVH at two referral clinics in Belgium and France from January to June 2019 were included. Surgeries were performed by inexperienced surgeons under the supervision of diplomates or residents of the European College of Veterinary Surgeons. During routine and emergency OV or OVH one pedicle of each animal was ligated using a constrictor knot and the other with a surgeon's knot, the side assigned randomly. Time taken to perform each knot and the number of ligatures that resulted in intraoperative haemorrhage from the ovarian vessels were recorded. Body condition score (BCS) was recorded for 33 dogs and 22 cats.Results: The median time taken to perform constrictor knots in dogs (81 seconds), was longer than for surgeon's knots (69 seconds; p = 0.005). In cats, the median time taken to perform constrictor knots (109 seconds) was also longer than for surgeon's knots (90.5 seconds; p = 0.02).The number of dogs that had intra-operative haemorrhages from pedicles ligated with constrictor knots (2/102; 3.9%) was less than those ligated with surgeon's knots (10/102; 19.6%; p = 0.027). The median BCS of dogs that experienced haemorrhage (n = 8; median 5/9, min 3/9, max 7/9) was higher (p = 0.019) than that of dogs that did not experience haemorrhage (n = 25; median 4/9, min 3/9, max 8/9).There was no evidence (p = 1.0) of a difference in the proportion of cats that experienced intra-operative haemorrhage from pedicles ligated with constrictor knots (3/44; 6.8%) and those ligated with surgeon's knots (2/44; 4.5%). Two-thirds of the haemorrhages with constrictor knots were caused by pedicle rupture during tightening.Conclusions: The rate of intraoperative haemorrhage from the ovarian pedicle was lower when a constrictor knot was used compared to a surgeon's knot in dogs but not in cats. While the constrictor knot was more time consuming to tie this is not likely to have a clinical impact. Use of this knot by inexperienced surgeons in dogs may help to reduce the risk of intraoperative haemorrhage during OVH/OV.

Aims: The present study aimed to investigate the efficacy of local use of propolis (PRO) as a monotherapy or adjunctive therapy to scaling and root planning (SRP) in the treatment of ligature-induced periodontitis (LIP) in rats by evaluating inflammatory markers and oxidative stress. Settings and Design: The present study was carried out at Hawler Medical University, College of Dentistry, and the animals used in the study were rats that were housed in an animal facility at the College of Medicine. The experimental part of the study was carried between December 2016 and August 2017. Subjects and Methods: In total, 125 rats were equally divided into 5 groups of 25 animals: the control group (C) with no experimental periodontitis or treatment (gp1), LIP treated by local irrigation with a vehicle (dimethyl sulfoxide + physiological saline solution) group (gp2); LIP treated by SRP with vehicle irrigation group (gp3); LIP treated by local irrigation with 10% PRO extract group (gp4); and LIP treated by SRP with 10% PRO extract irrigation group (gp5). Experimental periodontitis was induced by placing a silk ligature around the cervix of the mandibular incisor for 4 weeks. After removal of the ligature, SRP was performed in gp3 and gp5. Five rats from each group were euthanized on days 0, 3, 7, 14, and 21 after local treatment. Intracardiac blood samples were obtained for analysis of the inflammatory cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) and oxidative stress, which were represented by the expression of serum malondialdehyde (MDA). Statistical Analysis Used: Data were analyzed statistically by analysis of variance followed by Tukey's test (P < 0.05). Results: Gp5 demonstrated significantly lower IL-1β, TNF-α, and MDA serum levels than the other treatment groups at all experimental time points (P < 0.05). No significant differences were found when PRO was used as a monotherapy (P > 0.05). Conclusions: Local use of a PRO extract was effective as an adjunctive treatment with SRP in a rat model of experimental periodontitis via anti-inflammatory and antioxidative activities.

Mesenchymal stem cells (MSCs) are often used in the experimental studies of the enhancement of damaged nerve regeneration. The aim of this work was to study the effect of subperineural transplantation of MSCs on the regenerating fibers of a damaged sciatic nerve in rats using immunohistochemical detection of peripherin. The suspension bone marrow-derived mesenchymal stem cells(5x104 cells in 5 μl of medium) from Wistar-Kyoto rat was transplanted into the rat sciatic nerve damaged by ligature application (40 s). 5 μl of culture medium was injected subperineurally into the animals in the control group following the ligature application. Two months after the operation, peripherin-immunopositive nerve fibers were counted and measured on transverse sections of the distal segment of the recipient's nerve. Morphometric analysis of regenerating fibers was performed using the ImageJ software (NIH, USA). It showed that the average thickness of nerve fibers in animals of the experimental group was increased. A study of the thickness of the nerve fibers of the distal segment of the damaged nerve showed that in animals treated with MSCs, the percentage of larger diameter fibers was higher in comparison with the control group.

Here, we studied the effect of the Gly-Pro peptide on the reactivity and adaptive potential during the stimulation of the parasympathetic nervous system by carbachol under the conditions of successive combined effects of three stressors: immobilization, surgical intervention, and the injection procedure. Consistent combined effect of the surgical intervention in the form of the ligature application to the pyloric stomach, the immobilization, and the saline injection procedure under the carbachol allowed to identify 4 typer of responses. These types were characterized by different combinations of corticosterone contents, and separate leukocyte subpopulations. All responses were accompanied by the stress development, as indicated by the adaptation intensity index. The most prominent stress reactions were observed in animals after the immobilization and surgery, and the combined effects of saline and carbachol injections. Through the modulation of the parasympathetic link of the autonomic nervous system, and probably the direct effect on the adrenal glands, Gly-Pro changed the corticosterone levels, individual leukocyte subpopulations, and the adaptation intensity index under multicomponent stress. In the case of the simultaneous peptide and carbachol administration, it apparently activated the resistant (resistance, counteraction) pathway of adaptation, and in the case when it was administered before carbachol, – the tolerance (endurance, patience) pathway.

Introduction. In recent years a link between periodontitis and cardiovascular diseases has been proposed. Oxidative stress has been found to be involved in their pathophysiology. Objectives. The aim of this study was to demonstrate that a wire ligature placed around the first mandibular molars of the rat causes inflammation in the periodontium and lipid deposits in the aorta, via oxidative stress. Methods. Twenty male Wistar rats were divided randomly into two groups of 10: Control group and Periodontitis group. An orthodontic wire ligature was placed around the cervix of the first mandibular molar and was kept in place for 4 weeks. Clinical attachment loss was determined to assess the gingival recession. Aorta was harvested after 4 weeks and the malondialdehyde (MDA) levels in the aorta tissue homogenate were determined. Lipid deposits were evaluated using Oil Red staining and immunofluorescence under confocal microscopy. Total lipid deposits in the aorta were assessed using a computer morphometry system. Results. Significant gingival recession was observed in the Periodontitis group in comparison with the Control group. Increased MDA levels were present in the aorta in the ligatured rats in comparison with the Control group. Significant lipid deposits were observed in the aorta of the Periodontitis group as opposed to the Control group. Conclusions. The affixing of an orthodontic wire ligature produces gingival recession, increased oxidative stress and lipid deposits in the rat descending aorta.

Absztrakt: Bevezetés: Arteficiális arterio-venosus fisztula okozta steal szindróma és következményes distalis ischaemia az arterio-venosus fisztula (AVF) sebészet egyik legsúlyosabb szövődménye, mely a műtétek 1–8%-ában fordul elő. A szövődményt hagyományosan nehéz kezelni anélkül, hogy a fisztulát elvesztenénk. Kezelési opciók között van a fisztula ligaturája, a fisztula szűkítése (banding), distalis revascularisatio az AVF áthidalásával és az anastomosis alatti arteria ligaturájával (distal revascularisation with interval ligation – DRIL), az arteriás beáramlás proximalizálása (proximalisation of the arterial inflow – PAI) és az arteriás beáramlás distalizációja (revision using distal inflow – RUDI). Egy 45 éves fiatal nő esetét mutatjuk be, akinek 5 hónappal a bal oldali cubitalis AVF kialakítását követően necrosist okozó ischaemiája alakult ki a bal felső végtagján. AVF megtartása érdekében az ischaemia megszüntetésére RUDI-műtétet végeztünk, melyhez v. basilica interpositumot használtunk fel. A beavatkozás eredményeként ischaemiás panaszai megszűntek, dialízisét megszakítani nem kellett, újabb vasculáris hozzáférés kialakítása nem vált szükségessé. Az arteriás beáramlás distalizációja (RUDI) könnyen kivitelezhető, jó eredményeket biztosító eljárás, melynek kivitelezéséhez a vena basilica graft felhasználása igen kézenfekvő megoldás.

Objective. To estimate the efficacy of first procedure of endoscopic ligature for the varicose esophageal veins in children, suffering portal hypertension in accordance to data of endoscopic examination. Materials and methods. Endoscopic ligature of the varicose esophageal veins was performed in 24 patients, suffering portal hypertension, aiming at prophylaxis of hemorrhage from the varicose veins. Results. Reduction of the varicose veins degree after first ligature procedure was observed in 14 (58.33%) children, eradication of the varicose veins - in 5 (20.83%) of them. In 1 (4.17%) patient a complication (hemorrhage) have occurred in a moment of a ligature application. In 2 (8.33%) patients a hemorrhage from the varicose veins of stomach have occurred. Conclusion. Endoscopic ligature constitutes a secure and effective prophylactic method for hemorrhage from the esophageal varicose in children, suffering portal hypertension, and permits to control the varicose degree on stages of the portal hypertension treatment. Even after first procedure of endoscopic ligature the esophageal varicose degree have had reduced at average (p < 0.05). After endoscopic ligature the hemorrhage occurrence risk have reduced: p=0.05, and the risks ratio constitutes 0.14 (95% CI 0.04-0.56).

Made available in DSpace on 2019-10-06T16:45:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-09-01 This work aims to study an alternative technique of cecectomy in roosters using inhalation anesthesia for subsequent use in digestibility experiments. A total of 30 adult chickens of Leghorn breed were used with an average age of 27 wk. The birds were preoxygenated, and the anesthetic induction was performed using isoflurane diluted in oxygen. After proper muscle relaxation, endotracheal intubation was performed using a Murphy catheter and kept in anesthesia under mechanical ventilation with a constant monitoring of electrocardiography variables, heart rate, oxyhemoglobin saturation, and body temperature during the surgical procedure. An incision of approximately 3 cm was made between keel and cloaca in order to expose and extirpate the cecum followed by a simple ligature. The opening of the peritoneal cavity was closed in 2 ways: Sultan suture technique was used for closing the abdominal wall and modified Cushing intradermic continuous points for closing the skin. The time for anesthesia induction and preoperational period noted to be 10 ± 2 min. Surgical procedures completed in 7 ± 1.5 min. No intraoperatively and postoperatively harm observed in animals. Water was immediately provided after the birds returned to cages and feed offered after 24 h of surgery. In remaining birds, no abnormalities were observed during and after the experimental period (3 mo). The present study describes a promising update on cecectomy technique regarding anesthesia induction and surgical procedures in roosters using potential drugs and safer surgical materials without any trans- and postoperative complications. Brazil University (Universidade Brasil), Campus Fernandópolis School of Agricultural and Veterinarian Sciences São Paulo State University (Unesp) Aquaculture Center of Unesp São Paulo State University (Unesp) School of Agricultural and Veterinarian Sciences São Paulo State University (Unesp) Aquaculture Center of Unesp São Paulo State University (Unesp)

Purpose To evaluate current views on comparing delayed ligature of the dorsal venous complex (D-DVC) with standard ligature of the dorsal venous complex (S-DVC) for safety, urinary control and oncological outcomes during laparoscopic radical prostatectomy. Methods A comprehensive searching of PubMed, Web of science, Embase and the Cochrane Library was made and then we performed a meta-analysis, including all randomized controlled trials (RCTs) and retrospective studies, to evaluate the two different techniques. Results Two RCTs and six retrospective studies containing 1822 cases (222 cases from RCTs and 1600 cases from retrospective studies) were identified. Although D-DVC was related to more blood loss (WMD: 7.30 mL; 95% CI, 2.43 to 12.16; p = 0.003), the blood transfusion rate between the two groups showed no significant difference (OR = 1.93; 95% CI, 0.55 to 6.73; p = 0.31), and patients in the D-DVC group could benefit from a shorter operative time (WMD: −30.83 min; 95% CI, −53.32 to −8.35; p = 0.007). Positive apical margin events were significantly less in the D-DVC group (OR = 0.39; 95% CI, 0.22 to 0.71; p = 0.002). As for urinary control, there were no differences in continence rates after 3 months (OR = 1.64; 95% CI, 0.98 to 2.73; p = 0.06) and 12 months (OR = 1.00; 95% CI, 0.63 to 1.57; p = 0.99) of follow-up. However, there was a significantly higher continence rate after 6 months of follow-up in the D-DVC group (OR = 1.46; 95% CI, 1.02 to 2.11; p = 0.04). Conclusions Standard and delayed approaches to DVC are equally safe and result in similar urinary control. The delayed approach could decrease the positive apical margin rate. However, further large-scale prospective studies are needed to investigate and compare the prognosis and long-term functional outcomes between the two approaches.

Made available in DSpace on 2019-10-06T17:07:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-06-01 Aim: This study evaluated the effects of topical green tea extract solution (GTE) as adjuvant therapy to mechanical debridement for the treatment of experimental periodontitis (EP). Material and methods: We used 120 male rats (Rattus norvegicus albinus – Wistar), divided into the following four groups: NEP (sham) (n = 30): no experimental periodontitis (NEP), only simulation of EP by installation and removal of a ligature; EP (n = 30): EP induction by ligature; SRP (n = 30): EP, scaling and root planing (SRP), and irrigation with physiological saline solution; SRP/GT (n = 30): EP, SRP, and irrigation with GTE. Histologic analysis and immunohistochemistry were performed for detection of interleukin (IL)1ß, tumor necrosis factor-alpha (TNF-α), IL-10, and anti-tartrate resistant acid phosphatase (TRAP) in the furcation area. The percentage of bone in the furcation (PBF) was considered the primary variable and evaluated at 14, 22, and 37 days. The data from the histological analysis and the IL- 1B, TNF- A, and IL-10 were submitted to a Kruskal-Wallis variance test and Dunn's posttest (p ≤ 0.05). The histometric data and TRAP were submitted to analysis of variance (ANOVA) and Tukey's posttest (p ≤ 0.05). Results: The SRP/GT group showed lower inflammatory process, lower immunolabeling pattern of IL-1ß and TNF-α, and greater immunolabeling pattern of IL-10 compared with the EP and SRP groups at 22 days. Fewer TRAP-positive multinucleated osteoclasts were observed in all periods in the SRP/GT group (5.22 ± 0.65; 7.33 ± 0.80; 8.55 ± 1.15) compared with the SRP group (30.67 ± 8.55; 13.22 ± 0.77; 13.87 ± 0.77). Higher PBF was observed in all periods in the SRP/GT group (74.65 ± 7.14; 76.61 ± 5.36; 79.24 ± 3.75) compared with the SRP group (61.60 ± 9.48; 54.84 ± 9.06; 53.25 ± 9.66). Conclusion: GTE adjuvant to SRP reduced inflammation, osteoclastic activity, and alveolar bone loss in EP. São Paulo State University (UNESP) School of Dentistry Department of Surgery and Integrated Clinic – Periodontics Division São Paulo State University (UNESP) School of Dentistry Department of Basic Science – Histology Division São Paulo State University (UNESP) School of Dentistry Department of Surgery and Integrated Clinic – Periodontics Division São Paulo State University (UNESP) School of Dentistry Department of Basic Science – Histology Division

Made available in DSpace on 2019-10-06T16:21:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-05-01 Background/Objective: The beneficial effects of sub-antimicrobial dose doxycycline (SDD) associated with nonsurgical periodontal therapy are well documented. Recently, the effects of SDD on metalloproteinases have been investigated in the treatment of hypertension. The aim of this study was to evaluate the effects of SDD on ligature-induced periodontitis in spontaneously hypertensive rats (SHR). Methods: Fifty-four adult male rats were divided into three groups: SHR-C, SHR-L and SHR-L-DOX (C - Control; L – Ligature). In group SHR-L-DOX, animals were treated with daily 5 mg/kg SDD administration. In L groups, a ligature remained around mandibular first molars for the first 10 days. Each group was divided for euthanasia at 10 or 21 days. Microtomographic and histometric analyses were performed. Osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP) assay and gene expression of 84 inflammatory mediators by polymerase chain reaction (PCR) array. Results: Group SHR-L-DOX presented reduced systolic blood pressure when compared with group SHR-L at both 10 and 21 days (p < 0.05). Group SHR-L-DOX showed decreased bone and attachment loss in comparison with group SHR-L at both 10 and 21 days (p < 0.05). SDD treatment reduced the amount of TRAP-positive cells at 10 days (p < 0.05). Group SHR-L-DOX showed a downregulated inflammatory genes profile in comparison with SHR-L at 10 and 21 days. Conclusion: SDD therapy exerted systemic modulatory effect on inflammation with reduced periodontal tissue destruction in hypertensive rats. Department of Oral Surgery and Periodontology School of Dentistry of Ribeirao Preto University of Sao Paulo Department of Morphology Stomatology and Physiology School of Dentistry of Ribeirao Preto University of Sao Paulo Dental School of Araçatuba Univ Estadual Paulista – UNESP Department of Basic Sciences Dental School of Araçatuba Univ Estadual Paulista – UNESP Department of Basic Sciences

Despite a thousand-year history of anal fistula treatment, long-term outcomes have not been optimal, which encourages us to explore new surgical approaches. One of the methods of surgical treatment of anal fistulas is the use of ligature (Seton) in its different modifications. This review analyzes the literature data on the use of different modifications of seton treatment of anal fistulas. The analysis of publications showed the great interest in the use of the method, yet there is neither clear scheme nor systematic approach to applying it in clinical practice. Further study, as well as randomized researches, are required to find the optimal treatment and improve surgery results of using seton when dealing with anal fistula.

BACKGROUND Ischemic osteonecrosis of the femoral head produces necrotic cell debris and inflammatory molecules in the marrow space, which elicit a chronic inflammatory repair response. The purpose of this study was to determine the effects of flushing out the necrotic cell debris and inflammatory proteins on bone repair in a piglet model of ischemic osteonecrosis. METHODS Osteonecrosis of the femoral head of the right hindlimb was induced in 12 piglets by tying a ligature tightly around the femoral neck. One week after the surgery, 6 animals were treated with a percutaneous 3-needle bone washing procedure and non-weight-bearing (NWB) of the right hindlimb (wash group). The total saline solution wash volume was 450 mL per femoral head. Serial wash solutions were collected and analyzed. The remaining 6 animals were treated with NWB only (NWB group). At 8 weeks after the surgery, the femoral heads were assessed using radiography, micro-computed tomography (micro-CT), and histological analysis. In addition, we compared the results for these piglets with our published results for 6 piglets treated with multiple epiphyseal drilling (MED) plus NWB without bone washing (MED group). RESULTS Necrotic cells and inflammatory proteins were present in the bone wash solution collected 1 week after ischemia induction. The protein and triglyceride concentrations decreased significantly with subsequent washing (p < 0.005). At 8 weeks after ischemia induction, the wash group had a significantly higher bone volume than the MED or NWB group (p < 0.0001). Histological bone-formation measures were also significantly increased in the wash group compared with the MED group (p = 0.002) or NWB group (p < 0.0001) while macrophage numbers were significantly decreased in the wash group. CONCLUSIONS The percutaneous 3-needle procedure flushed out cell debris and inflammatory proteins from the necrotic femoral heads, decreased osteoclasts and macrophages, and increased bone formation following induction of ischemic osteonecrosis. CLINICAL RELEVANCE We believe that this is the first study to investigate the concept of washing out the necrotic femoral head to improve bone healing. The minimally invasive procedure may be useful to improve the necrotic bone environment and bone repair following ischemic osteonecrosis.

Made available in DSpace on 2022-04-29T08:31:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: The present study aimed to compare two different models of orthodontic tooth movement (OTM) in rats by evaluating tooth movement efficiency and periodontal tissues remodelling. Design: Fifteen animals were randomly distributed into 3 groups: control group (untreated); ligature appliance (LA) as experimental OTM using a closed coil spring fixed around maxillary first molar by steel ligature; occlusal appliance (OA) as experimental OTM using a closed coil spring attached on the occlusal surface of the maxillary first molar. After 15 days, all animals were euthanized, and the maxilla of each animal was collected for qPCR, micro-computed tomography, and histological analyses. Results: Interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha gene expressions were significantly upregulated in the animals of the LA group as compared to the other groups. No significant difference was observed in tooth displacement between both methods. The LA group presented higher linear bone loss and lower values of bone volume fraction, bone mineral density, trabecular number and increased values of trabecular separation compared to the other groups. The birefringent collagen content in the tension side of the periodontal ligament contained significantly lower collagen content in the LA group than in the control group. Furthermore, on the pressure side, the collagen content was significantly lower in the LA and OA groups than in the control group. Conclusions: The OA group presented little or no deleterious effect on periodontal tissues compared to the LA group, suggesting its use may be more reliable for OTM induction in rats for 15 days. Department of Diagnosis and Surgery School of Dentistry at Araraquara São Paulo State University - UNESP Department of Periodontology and Operative Dentistry University Medical Center of the Johannes Gutenberg University Department of Morphology Genetics Orthodontics and Pediatric Dentistry School of Dentistry at Araraquara São Paulo State University - UNESP Department of Diagnosis and Surgery School of Dentistry at Araraquara São Paulo State University - UNESP Department of Morphology Genetics Orthodontics and Pediatric Dentistry School of Dentistry at Araraquara São Paulo State University - UNESP FAPESP: 2017/07137-2

Background: Self-strangulation with a vehicle-assisted ligature is reported to be very uncommon suicidal method. Related cases are rarely published, and many of them report massive injuries to neck organs, and even complete decapitation. Case presentation: We report an unusual case of self-strangulation where a body was found dead inside a car with a rope around his neck and tied to an electric pole behind the car. The rope didn’t break while the car moved away, and no decapitation was associated. The manner of death was determined as suicide based on a complete criminal investigation supported by a detailed crime scene investigation and autopsy. Conclusion: This case is reported for its originality due to the unusual method of suicide employed by the victim, and because it was not related to decapitation.

Background Chronic constriction injury (CCI) is a model of neuropathic pain induced by four loose ligatures around the sciatic nerve. This work aimed to investigate the sensory, affective, cognitive, and motor changes induced by an adaptation of the CCI model by applying a single ligature around the sciatic nerve. Methods Mechanical allodynia was measured from day 1 to day 28 postsurgery by the von Frey test. The beam walking test (BWT) was conducted weekly until 28 days after surgery. Anxiety- and depression-like behaviors, and cognitive performance were assessed through the open field (OF), forced swimming (FS), and novel object recognition (NOR) tests, respectively, 21 days after surgery. Results The two CCI models, both Bennett and Xie’s model (four ligatures of the sciatic nerve) and a modification of it (one ligature), induced mechanical allodynia, increased immobility in the FS, and reduced recognition index in the NOR. The exploratory behavior and time spent in the central part of the arena decreased, while the defensive behavior increased in the OF. The animals subjected to the two CCI models showed motor alterations in the BWT; however, autotomy was observed only in the group with four ligatures and not in the group with a single ligature. Conclusions Overall these results demonstrate that our adapted CCI model, using a single ligature around the sciatic nerve, induces sensory, affective, cognitive, and motor alterations comparable to the CCI model with four ligatures without generating autotomy. This adaptation to the CCI model may therefore represent an appropriate and more easily performed model for inducing neuropathic pain and study underlying mechanisms and effective treatments.

Made available in DSpace on 2022-04-28T19:49:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Universidade Federal do Pará Background: Hydronephrosis is the dilation of the pelvis and renal calyxes due to post-renal obstruction. The obstruction is often associated with extraluminal masses, blood clots and ureter ligation in castration procedures. Ureter ligation is reported as a malpractice. The renal function is reestablished if ligation is rapidly undone, but not for obstructions longer than four weeks. Often, clinical signs are results from months to years after the castration, when nephrectomy is the best therapeutic option. This paper aims to report a case of asymptomatic unilateral hydronephrosis in a 10-year-old dog caused by chronic ureter occlusion with Nylon 3.0 suture during an elective procedure. Case: A 10-year-old female pinscher dog, spayed 3 years ago was admitted at the Surgery Department of the Veterinary Hospital of the Federal University of Jataí (HV-UFJ). The animal was taken for periodontal treatment. In the physical and laboratory examination (complete blood count, hepatic and renal biochemical tests) no significant and noteworthy alterations were found. Ultrasonographic examination showed no changes in the topography and echotexture of the left kidney, however the right kidney was not visualized, with an anechoic structure suggestive of advanced and severe hydronephrosis. Therefore, exploratory laparotomy was proposed to identify the observed structure, with the periodontal treatment considered for a later time. So, a retroumbilical incision was made, followed by linea alba and the removal of simple isolated suture remaining from previous surgical procedure. In the cavity, the viscera were isolated and the left kidney was identified, observing preserved anatomy. On the other hand, the right kidney had altered topography and morphology, being exposed after release of adhesions in adjacent structures. The right renal artery and vein were dissected and a double ligature was made. Then, the right ureter was dissected, observing marked dilatation in the proximal portion and the presence of local ligation with Nylon 3.0. Right ureterectomy and right nephrectomy were performed. After nephrectomy, the capsule was ruptured, observing dark fluid in it and absence of tissue compatible with renal parenchyma. The material was preserved in 10% formaldehyde and sent for histopathological examination. Histopathology revealed risk of rupture of the renal capsule due to the advance of renal degeneration and complete absence of parenchyma. However, contrary to the severity of the histopathological, surgical and ultrasonographic findings, the patient did not present clinical signs at the time of diagnosis. Discussion: In the intraoperative evaluation, the cause of the hydronephrosis was verified to be in fact the ligation of the ureter, which may have been accidental or due to the malpractice of the veterinarian surgeon. Other possible causes such as adhesions and granulomas were ruled out because the Nylon 3.0 suture was found in the proximal portion of the right ureter. It is believed that the patient may have presented clinical signs of hydronephrosis that may have been confused by the tutors as postoperative complications, changes that if identified and performed in time, could have avoided the occurrence or worsening of hydronephrosis and subsequent nephrectomy. Clinically, the bitch did not show clinical signs presented in the literature as consistent with hydronephrosis such as polyuria, polydipsia, abdominalgia, external fistula and anorexia. Therefore, it is believed that this case is one of the first reports of the occurrence of severe hydronephrosis without typical clinical manifestations of hydronephrosis. This fact raises a warning about the thorough monitoring in the postoperative period by owners and veterinarians, in addition to highlighting concerns regarding the occurrence of medical malpractice versus surgical accidents. Veterinary Hospital Universidade Federal de Jataí (UFJ), Jataí, GO Post-Graduation Department in Animal Science Universidade Federal de Jataí (UFJ), Jataí, GO Veterinary Medicine Department Universidade Federal de Jataí (UFJ), Jataí, GO Department of Nephrology and Urology Universidade Estadual Paulista - Júlio de Mesquita Filho (Unesp), SP Department of Nephrology and Urology Universidade Estadual Paulista - Júlio de Mesquita Filho (Unesp), SP

Objectives The purpose of this systematic review was to determine the potential interest of parathyroid hormone (PTH) as an adjunct to periodontal treatment based on studies performed in rodents. Materials & methods Electronic databases (MEDLINE, Web of Science) were searched up to December 2019. Studies assessing the impact of PTH administration in experimental periodontitis in rodents have been identified. Results Amongst the 247 identified articles, 10 met the inclusion criteria and were included in this systematic review. Experimental periodontitis was mainly induced by ligature placement or surgically with a dental bur. All studies considered bone healing after PTH administration at different frequencies as primary outcome. Results showed that an intermittent administration of PTH promoted bone healing and neovascularization. Nevertheless, a decrease of soft tissue inflammation was also observed. Conclusion Intermittent administration of PTH appears to enhance significantly periodontal healing and to promote alveolar bone regeneration. However, due to the risk of side effects, the development of scaffolds allowing its local and time-controlled delivery is of importance.

Introduction: Ventriculo-peritoneal shunt malfunction is a common neurosurgical presentation, which may occur as a result of shunt disconnection at the level of the valve. Previous studies assessing ligatures have suggested that the constrictor knot is stronger in securing a ligature compared to the surgeon's knot. Our study compared the ability of each knot to secure shunt tubing to the valve.Methods: A medtronic shunt valve was secured to a peritoneal catheter using the surgeon's knot versus constrictor's knot. The weight and subsequent force (N) required to pull off the shunt tubing at the knot site were recorded.Results: The mean pull-off force was 11.7 N for the surgeon knot, and 8.9 N for the constrictor knot. There was significant difference in favour for the surgeon's knot compared to the constrictor knot.Conclusions: The surgeon's knot is significantly stronger than the constrictor knot for securing a peritoneal catheter to a CSF shunt valve.

Submitted by Luana Priscila Costa (luana@reitoria.unesp.br) on 2020-09-28T19:37:32Z No. of bitstreams: 1 moraes_rm_preprint_sjc_live.pdf: 719766 bytes, checksum: a9e3b89c126b7e394531c62ad32351b9 (MD5) Approved for entry into archive by Luana Priscila Costa (luana@reitoria.unesp.br) on 2020-09-28T19:43:17Z (GMT) No. of bitstreams: 1 moraes_rm_preprint_sjc_live.pdf: 719766 bytes, checksum: a9e3b89c126b7e394531c62ad32351b9 (MD5) Made available in DSpace on 2020-09-28T19:43:17Z (GMT). No. of bitstreams: 1 moraes_rm_preprint_sjc_live.pdf: 719766 bytes, checksum: a9e3b89c126b7e394531c62ad32351b9 (MD5) Previous issue date: 2020-09-08 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective Lactobacillus reuteri is reported as a beneficial adjunct to conventional periodontitis treatment or as monotherapy for gingivitis in several clinical trials. However, probiotics are not free from the risk of adverse effects. We investigated the effects of live and heat-killed (paraprobiotic) L. reuteri during the development of ligature-induced periodontitis in rats. Methods Thirty-two male rats were divided into four groups—control group: healthy rats, LIP group: rats with ligature induced periodontitis, LIP/PRO group: rats with periodontitis that received live L. reuteri, LIP/PARA group: rats with periodontitis that received heat-killed L. reuteri. Treatment was administered for 30 days prior to ligation and continued for 14 days until euthanasia. The hemimandibles were removed and submitted to radiographic analysis, microcomputerized microtomography (μCT) and histomorphometric analysis. Results Radiographic analysis revealed that pro- and paraprobiotics enhanced the percentage of mesial bone support. The μCT analysis showed that paraprobiotic treatment increased bone volume and trabecular number while decreasing total bone porosity and trabecular separation. Live probiotic led to higher trabecular thickness. In the histomorphometric analysis, paraprobiotics significantly prevented furcation bone loss and collagen breakdown, although both pro- and paraprobiotics similarly reduced mesial bone loss. There were no significant differences in attachment loss or the number of tartrate-resistant acid phosphatase -positive cells across treatments. Conclusions Although viable and heat-killed bacteria reduced mesial alveolar bone loss and ameliorated furcation microarchitecture parameters, paraprobiotics presented the most pronounced results preventing periodontitis development. This can contribute to the future use of paraprobiotics in the prevention and treatment of periodontitis. Preprint Universidade Estadual Paulista Julio de Mesquita Filho - Unesp FAPESP: 2016/06946-1 FAPESP: 2017/26461-5

Objective: The publication of a prospective [1] and several retrospective [2,3] studies describing a worse prognosis in patients affected with early-stage cervical cancer who underwent a minimally invasive radical hysterectomy has raised a high concern in what measures should be undertaken in order to revert these results. Potential strategies [4] to prevent tumor spillage have been previously proposed. Methods: In this video, we describe nine strategies that should be addressed in future trials regarding this procedure. Results: These strategies are: 1. Fallopian tubes should be coagulated prior to start the surgery. 2. All sentinel lymph nodes and lymphadenectomy specimens should be obtained without lymph nodes fragmentation. 3. All surgical specimens should be extracted within a containment bag. 4. Uterine manipulators must never be used. 5. Prior to vaginal section, a closed knotted ligature should be placed around the vagina, proximal to the section line, and the remaining vaginal cavity profusely washed. 6. Once the vagina is opened, the surgical specimen should be extracted vaginally within a specimen retrieval bag. 7. After surgery, the pelvic cavity is profusely washed with physiological serum, and the vagina should be washed with iodopovidone diluted to 10% [5]. 8. Port-site metastasis prevention measures should be performed. 9. Every action made to prevent tumor spillage should be recorded in the surgical report. Conclusion: As there is a biological rationale in these measures that would prevent tumor spillage and seeding, there is a need of prospectively exploring them within appropriate studies in order to determine their own oncological outcome.

Objective Rodent models such as mice and rats are often used in investigations of the oral cavity in the fields of periodontology and dental anesthesiology. When various treatments are performed in the oral cavity, it is very important to secure the visual field while keeping the animal's mouth fully opened, in order to ensure the consistency of experimental procedures. Therefore, we developed a standardized gag conforming to various degrees of oral cavity size of different aged rats. Design The gag was composed of a rectangular incisor-opening frame constructed from a stainless steel wire with retractors and a dial to alter the opening amounts. Wistar rats (n = 5) aged 4, 8, and 12 weeks were used to evaluate the suitability of the gag in oral cavity. As tests for application of gag in intraoral experiments, the ligature placement around the molars, drug injection into the gingiva, measurement of gingival blood flow rate, and installation of stimulation an electrode for somatosensory-evoked potentials into the molar were performed. Results Adjusting the opening dial enabled both the maintenance of open state and more favorable intraoral observation compared with tweezers as a control device in all different types of rats. Furthermore, our gag made it possible to facilitate the insertion of diverse instruments into the oral cavity and to achieve various experimental purposes. The stainless-steel gag can also be autoclaved and dry-heat sterilized. Conclusion It was revealed that our mouth gag can be widely applied to various oral experiments in different old aged rats.

Introduction: Lepidium sativum, commonly known as garden cress is a herb that is native to Egypt and West Asia. Its seeds are rich source of proteins, dietary fiber, omega-3 fatty acids, iron, other essential nutrients and phytochemicals. Garden cress is widely used in folk medicine for the treatment of many diseases. Periodontitis is defined as an inflammatory bacterial-induced disease that damages the soft tissue and gradually destroys the periodontal ligaments and supporting alveolar bone. Periodontitis can cause teeth to loosen or lead to tooth loss. Different methods, such asbiomechanical measurements, surgical approaches are used to treat periodontitis. Objective: to evaluate histologically and ultra-structurally the possible effect of garden cress therapy on alveolar bone healing in rats with ligature induced periodontitis. Materials and Methods: Fortyfive adult male Sprague–Dawley rats of 6 months old (200-250 grams in weight) was used in this study. They were divided into 3 equal groups: group A; (control group), group B; (ligature induced periodontitis) and group C :( ligature induced periodontitis with garden cress administration). Ligature was removed after 11 days. Garden cress was applied after ligature removal systemically by using oral gavage. Rats were sacrificed after six weeks from the ligature removal. Mandibles were dissected out and were prepared for histological and scanning electron microscopic evaluation. Results: After 6 weeks the specimens of group B (periodontitis group) showed alveolar bone loss, while in group C (garden cress group) showed relative restoration of alveolar bone. Results of scanning electron microscope revealed an irregular & porous bone surface of group B, while Group C showed relative smooth and regular alveolar bone. Conclusion: Garden Cress systemic administration accelerates alveolar bone healing and enhances bone formation in periodontal diseases.

Introduction Laparoscopic surgery is considered safe and effective for a gastric submucosal tumors, and reduced-port surgery (RPS) is being increasingly performed to treat these tumors. Herein, we present laparoscopic RPS with the cowboy technique for the removal of gastric submucosal tumors. Materials and surgical technique A single-port access device was inserted at the naval (three 5-mm trocars), and a 5-mm trocar was inserted in the left lateral abdominal wall. A ligature was placed at the neck of the tumor, the loop was then tightened, and the knot was finally secured-a process referred to as the cowboy technique. This technique enables complete surgical excision and can be used for exophytic submucosal tumors of the stomach. Four patients underwent RPS with this technique, and the outcomes were good. Discussion Our cowboy technique enables the safe full-thickness excision of gastric submucosal tumors with exophytic growth and is very useful in performing RPS.

Introduction Laparoscopic splenectomy started to be more popular and nowadays it is the first choice for splenectomy in children. The main advantages of laparoscopic splenectomy over open approach are the shorter hospital stay, low complications and the cosmetic results despite the main concern of long operative time and the intra operative bleeding. Aim The aim of this study was to report our experience with laparoscopic splenectomy in children's with hematological diseases using ligasure regarding vascular control safety, efficacy and complications rate. Methods A retrospective study was carried out at Queen Rania Al-Abdullah Hospital for Children over the period from January 2017 to February 2019. Total number of 18 patients with hematological diseases underwent laparoscopic splenectomy using ligasure. Demographic data, complications and outcomes were collected to assess the advantages of ligasure usage for vascular control safety. Results Out of 18 patients underwent laparoscopic splenectomy using ligasure (10 with spherocytosis, 4 with immune thrombocytopenic purpura [ITP], 3 with sickle cell anemia, 1 with hemangioma), from which number, 8 patients were males and 10 were females. Mean age was 6.7 years (ranges from 4.3 to13.7 years). Mean operative time was 107 minutes (ranges from 70-180 minutes). There was no conversion to open splenectomy and no mortality. Intra operative blood loss was insignificant. Conclusion Laparoscopic splenectomy using ligature is safe with excellent results in decreasing operative time, less complications and decrease incidence of intraoperative bleeding.

BACKGROUND Two operative procedures are currently advocated to stimulate the necrotic femoral head healing in children with Legg-Calve-Perthes disease: transphyseal neck-head tunneling (TNHT) and multiple epiphyseal drilling (MED). The purpose of this study was to compare the bone healing and physeal function after treatment with TNHT or MED in a piglet model of ischemic osteonecrosis. METHODS Eighteen piglets were induced with osteonecrosis by surgically placing a ligature tightly around the right femoral neck. One week later, the piglets were assigned to 1 of 3 treatment groups (n=6/group): (1) local nonweight bearing only (NWB), (2) TNHT plus NWB, or (3) MED plus NWB. The unoperated left femoral heads were used as normal controls. The animals were euthanized at 8 weeks after osteonecrosis induction. Histologic, histomorphometric, radiographic, microcomputed tomography (CT), and calcein-labeling assessments were performed. Statistical analysis included a 1-way ANOVA. RESULTS Micro-CT analyses showed higher femoral head bone volume in the MED group compared with the TNHT and the NWB groups (P

There is no standard method for closure of an appendiceal stump during laparoscopic appendectomy. This study compares stump closure using a stapler with closure using an Endoloop ligature. The charts of all patients who underwent laparoscopic appendectomy at a single tertiary care center over a two-year period were reviewed for demographics, comobidities, operative details and costs, and outcomes. There were 325 patients who underwent a laparoscopic appendectomy. The majority, 250 (77%), underwent stump closure with a stapler. They were equivalent in demographics and postoperative complication rates. Cases using an Endoloop were slightly faster in terms of procedure time and room time, and less expensive in terms of operative supply cost. The price difference is not explained by time saved in the operating room and more likely by the equipment price.

Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.

We present a unique case of suicidal hanging. The deceased was a 31-year-old male who was found hanging from a tree in a dense thicket, with his lower limbs in contact with the ground (partial suspension). There was an apparatus similar to a facial mask placed around his nose and mouth. A strong chemical smell was emanating from the apparatus, which was identified as chloroform (Formyl trichloride/CHCl3). A ligature with a soft cloth beneath it was around his neck. A ligature mark was present around the neck. The decedent’s blood alcohol levels were 112 mg/dl. The blood and stomach contents were negative for chloroform. A complete death investigation, including scene investigation and complete autopsy examination, confirmed the cause of death as hanging. The manner of death was suicide. This case highlights how the deceased had used several methods whilst committing suicide to minimize pain, including the inhalation of chloroform, which would have also resulted in the inability to engage in protective actions during the act.

Aim. To determine the efficacy of brand new industrial synthetic material for surgical treatment of patients with complicated anal fistulae and advantages of its use for ligature method of chronic paraproctitis treatment. Methods. Between 2010 and 2017, 175 patients (average age 47 years) with extra- and transsphincteric fistula were treated with a ligature. The study group consisted of 67 patients treated with rubber seton, comparison group included 108 patients treated with nylon ligature. Results. The results of clinical use of two seton types for the treatment of rectal fistulae are presented. Rubber thread with circular section as seton was proved to be inexpensive and effective material, advantages of which result from its physical properties. Thus, dissection of muscle tissue due to rubber elasticity becomes more efficient due to the greater reserve of compression than in case of rigid nylon seton, and that reduces the number of contractions. In addition, physical properties of the material, such as its high surface wettability, offer good drainage, and homogeneity of the material not absorbing the fluids, in turn, provides avoidance of the «wick effect» with the spread of infection into the wound. So, the treatment of anorectal fistulae with ligature with the use of rubber seton demonstrates the best therapeutic results and is preferable for patients. Conclusion. Use of rubber seton in treatment of complicated anal fistulae allows reducing hospital stay, provides better drainage of the surgical wound, and reducing the number of complications and required contractions, thus, minimizing the associated pain syndrome.

Examination of skeletonised remains for the cause and manner of death is a highly challenging task for forensic experts. We report an unusual case of postmortem decapitation following hanging with the presence of a well-preserved ligature mark in the partially skeletonised body. Careful death scene investigation, interpretation of circumstantial evidence and meticulous autopsy provided information on the cause and manner of death.