A Comparative Study of Using Collagen Patch or Fat Plug in Myringoplasty for Small Tympanic Membrane Perforations.

One of the most common problems in otorhinolaryngology is perforation of tympanic membrane. Although many small perforations heal spontaneously over time, some may remain persistent due to infection or some other causes. In the past years so many grafts have been used with good success rate. In this prospective study of 60 patients with small tympanic membrane perforations, we have compared newer biomaterial collagen patch and conventional fat plug as office procedures in treatment. According to our study, both groups had a significantly equal success rates & the rate of healing & complete closure at the end of 1 & 2 months follow up. The hearing improvement in A-B gap during follow up of both groups were compared with pre-op A-B gap & showed a significant p value. This showed that both collagen patch & fat plug groups had a significant improvement in hearing following procedure. In our study quadrant of perforation does not correlate with the amount of hearing & healing rates were comparatively better in anterior quadrant than posterior quadrant. Infective causes were more & the failure rates were also high for such cause in both groups.

Superficial palmar branch of the radial artery in a fibromuscular tunnel: a case report.

The radial artery usually passes on the radial side of the wrist lateral to the wrist to enter the anatomical snuff box and dorsum of the hand. If the radial artery passes anterior to the wrist, it usually enters the carpal tunnel, and in such cases, it may lead to the compression of the median nerve within the carpal tunnel. During the routine dissection, we found a case of the unusual radial arterial branch that passed anterior to the wrist yet outside the carpal tunnel. The artery passed within a tunnel formed by the fibromuscular fibers of thenar muscles arising from the anterior aspect of the transverse carpal ligament. Knowledge of the course and distribution of the variant superficial palmar branch of radial artery are of importance to the surgeons operating around the wrist, radiologist interpreting angiograms, and orthopedists managing trauma to the wrist.

Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study.

INTRODUCTION: Tibialis posterior tendon insufficiency in adult acquired flat foot deformity (AAFFD) is treated by reinforcing the posterior tibial tendon (PTT) using grafts from flexor hallucis longus (FHL) and flexor digitorum longus (FDL). The communication between FHL and FDL will influence the length of the graft that can be harvested from FHL and FDL. In this study, we aim to study the patterns of communications between FHL and FDL tendons and the location of Master Knot of Henry (MKH) and point of division of FDL tendons in Indian population. MATERIALS AND METHODS: In this observational descriptive study, 36 formalin-fixed cadavers were sourced from Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India, and JIPMER, Puducherry, India, during the period of 2017-19. Various parameters of the foot to locate the MKH and point of division of FDL tendons and various types of communications between FHL and FDL were observed. RESULTS: Among the various types of communications between FHL and FDL tendons, type I was present in 61.76% of cases, type II in 2.94% of cases, type III in 7.35% of cases, type IV in 14.70% of cases, type V in 8.82% of cases, type VI in 0% of cases, type VII in 1.47% of cases and an unusual type in 2.94% of cases. CONCLUSION: In the present study done in Indian population, we found that type I variety is present more commonly followed by type IV. FHL and FDL tendon grafts can be lengthened based on the communications between them. In type I variety, the communication can be severed at the FDL end to lengthen the tendon graft for harvest.

Anatomical variations of the principal nutrient pedicle for iliac crest graft: the ilio-lumbar artery.

PURPOSE: The purpose of this study is to observe the origin, course, length, diameter and termination of the ilio-lumbar artery (ILA) and its variations in south Indian population. MATERIALS AND METHODS: The study was carried out in 34 sides in 19 cadavers (R-18, L-16) used for routine dissection for undergraduate students during the period of 2017-2018 in Department of Anatomy, JIPMER, Puducherry. On each side of the pelvis, the origin, length, diameter, course of the ILA and its relations to the surrounding anatomical structures was observed and documented. RESULTS: Out of 34 formalin-fixed pelvis halves of human cadavers, the ILA originated from the common iliac artery (CIA), the trunk of the internal iliac artery (IIA) and posterior division of IIA in around 0%, 61.76%, and 38.23% of the cases, respectively. In all the cadavers, the ILA passes in between the obturator nerve anteriorly and the lumbosacral trunk posteriorly and ILA terminates by giving iliac and lumbar arteries medial to the psoas major muscle. CONCLUSIONS: In our study, we observed that the mean distance between the origin of ILA and the bifurcation of the CIA is significantly less than the study done previously. The knowledge about the variations in the origin, course, length, diameter, and termination of ILA is very important to the surgeon to avoid iatrogenic injury during surgeries in lumbosacral region and moreover, it will be easy to access the ILA for clamping or embolization. A similar study can be done with more sample size in different population to increase the knowledge base regarding ILA anatomy.

Investigation on environmental factors of waste plastics into oil and its emulsion to control the emission in DI diesel engine.

Rapid depletion of conventional fossil fuel resources, their rising prices and environmental issues are the major concern of alternative fuels. On the other hand waste plastics cause a very serious environmental dispute because of their disposal problems. Waste plastics are one of the promising factors for fuel production because of their high heat of combustion and their increasing availability in local communities. In this study, waste plastic oil (WPO) is tested in DI diesel engine to evaluate its performance and emission characteristics. Results showed that oxides of nitrogen (NOx) emission get increased with WPO when compared to diesel oil. Further, the three phase (O/W/O) plastic oil emulsion is prepared with an aid of ultrasonicater according to the %v (10, 20 & 30). Results expose that brake thermal efficiency (BTE) is found to be increased. NOx and smoke emissions were reduced up to 247ppm and 41% respectively, when compared to diesel at full load condition with use of 30% emulsified WPO.

Green technology effect of injection pressure, timing and compression ratio in constant pressure heat addition cycle by an eco-friendly material.

Present energy strategies focus on environmental issues, especially environmental pollution prevention and control by eco-friendly green technologies. This includes, increase in the energy supplies, encouraging cleaner and more efficient energy management, addressing air pollution, greenhouse effect, global warming, and climate change. Biofuels provide the panorama of new fiscal opportunities for people in rural area for meeting their need and also the demand of the local market. Biofuels concern protection of the environment and job creation. Renewable energy sources are self-reliance resources, have the potential in energy management with less emissions of air pollutants. Biofuels are expected to reduce dependability on imported crude oil with connected economic susceptibility, reduce greenhouse gases, other pollutants and invigorate the economy by increasing demand and prices for agricultural products. The use of neat paradise tree oil and induction of eco-friendly material Hydrogen through inlet manifold in a constant pressure heat addition cycle engine (diesel engine) with optimized engine operating parameters such as injection timing, injection pressure and compression ratio. The results shows the heat utilization efficiency for neat vegetable oil is 29% and neat oil with 15% Hydrogen as 33%. The exhaust gas temperature (EGT) for 15% of H2 share as 450°C at full load and the heat release of 80J/deg. crank angle for 15% Hydrogen energy share.

Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers.

INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers. METHODS: Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1-4). They were asked to perform the PC or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared. RESULTS: There were no significant differences between the FLS and VBLaST© scores for either the PC or the ligating loop task. Experts' scores were significantly higher than the scores for novices on both trainers. CONCLUSION: This study showed that the subjects' performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Although concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.

Validation of the VBLaST peg transfer task: a first step toward an alternate training standard.

BACKGROUND: The FLS trainer lacks objective and automated assessments of laparoscopic performance and requires a large supply of relatively expensive consumables. Virtual reality simulation has a great potential as a training and assessment tool of laparoscopic skills and can overcome some limitations of the FLS trainer. This study was carried out to assess the value of our Virtual Basic Laparoscopic Surgical Trainer (VBLaST(©)) in the peg transfer task compared to the FLS trainer and its ability to differentiate performance between novice, intermediate, and expert groups. METHODS: Thirty subjects were divided into three groups: novices (PGY1-2, n = 10), intermediates (PGY3-4, n = 10), and experts (PGY5, surgical fellows and attendings, n = 10). All subjects performed ten trials of the peg transfer task on each simulator. Assessment of laparoscopic performance was based on FLS scoring while a questionnaire was used for subjective evaluation. RESULTS: The performance scores in the two simulators were correlated, though subjects performed significantly better in the FLS trainer. Experts performed better than novices only on the FLS trainer while no significant differences were observed between the other groups. Moreover, a significant learning effect was found on both trainers, with a greater improvement of performance on the VBLaST(©). Finally, 82.6% of the subjects preferred the FLS over the VBLaST(©) for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the user interface for the VBLaST(©). CONCLUSION: This study demonstrated that the VBLaST(©) reproduced faithfully some aspects of the FLS peg transfer task (such as color, size, and shape of the peg board, etc.) while other aspects require additional development. Future improvement of the user interface and haptic feedback will enhance the value of the system as an alternative to the FLS as the standard training tool for laparoscopic surgery skills.

The added value of virtual reality technology and force feedback for surgical training simulators.

Laparoscopic surgery requires more specialized training of the surgeons than traditional open surgery. The Virtual Basic Laparoscopic Surgical Trainer (VBLaST) is being developed as a virtual version of the Fundamentals of Laparoscopic Skills (FLS) trainer. This study assessed the current haptic and virtual reality (VR) technology of a virtual peg transfer task of the VBLaST, based on the subjective preference of surgeons and their objective task performance measures. Twenty-one surgical residents, fellows and attendings performed a peg-transfer task in the FLS and the VBLaST. Each subject performed 10 trials on each simulator. Results showed that subjects performed significantly better on the FLS than on the VBLaST. Subjects showed a significant learning effect on both simulators, but with an accelerated improvement on the VBLaST. Even so, 81% of the subjects preferred the FLS over the VBLaST for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the haptic interface. Despite the subjective preference for the physical simulator, the performance results indicate an added value of VR and haptics in surgical training, which is expected to be demonstrated in more surgically relevant tasks such as suturing and knot-tying.