Bone lid technique versus standard technique for treatment of mandibular lesions.

BACKGROUND: Jaw lesions are frequent in the oral and maxillofacial areas. Different methods for enucleating jaw lesions in the oral and maxillofacial sites have been proposed, including the bone lid technique. PURPOSE: The aim of this study was to compare the clinical and radiographic results of the bone lid technique employing a piezoelectric surgery to the traditional technique in individuals with mandibular lesions. MATERIALS AND METHODS: A randomized controlled trial was conducted on 24 patients with mandibular lesions. They were randomly allocated into two groups (n = 12 for each group). Group I: the mandibular lesion was excised with bone lid technique using a piezoelectric device, followed by the fixation of the bony window after its repositioning. Group II: the lesion was excised with the traditional method using rotatory burs. Pain, soft tissue healing, bone exposure, bone lid integration, and the volume of the residual bone defect were all assessed clinically and radiographically after one week, one month, and six months. RESULTS: All patients in both groups showed adequate soft tissue healing except for one case in group I experienced wound dehiscence and bone lid exposure. The bone lid group reported significantly less pain than the usual approach at the 3rd and 7th days. After six months, the volume of bone defect filling was considerably higher in the bone lid group compared to the conventional group. CONCLUSION: The bone lid technique was an effective procedure in the management of mandibular lesions compared to the standard method. Besides, this technique provides better bone healing and reduces bone loss. TRIAL REGISTRATION: This clinical trial was registered at clinicaltrials.gov on 14/8/2023 and had registration number NCT05987930.

Comparison between head rotation and standard techniques for i-gel™ insertion: a randomized controlled trial.

BACKGROUND: This study evaluated the effect of head rotation on the first-attempt success rate of i-gel insertion, aiming to alleviate the effect of gravity on the tongue and reduce resistance between the device and the tongue. METHODS: Adult surgical patients were randomized to standard and head rotation technique groups. In the head rotation technique group, patients' heads were maximally rotated to the left before i-gel insertion. The primary endpoint was the first-attempt success rate. Secondary endpoints included the success rate within two attempts (using the allocated technique), time required for successful i-gel placement within two attempts, and success rate at the third attempt (using the opposite technique). RESULTS: Among 158 patients, the head rotation technique group showed a significantly higher first-attempt success rate (60/80, 75.0%) compared to the standard technique group (45/78, 57.7%; P = 0.021). The success rate within two attempts was similar between the groups (95.0% vs. 91.0%, P = 0.326). The time required for successful i-gel placement was significantly shorter in the head rotation technique (mean [SD], 13.4 [3.7] s vs. 16.3 [7.8] s; P = 0.030). When the head rotation technique failed, the standard technique also failed in all cases (n = 4), whereas the head rotation technique succeeded in five out of the seven patients where the standard technique failed. CONCLUSIONS: The head rotation technique significantly improved the first-attempt success rate and reduced the time required for successful i-gel insertion. It was effective when the standard technique failed. The head rotation technique may be an effective primary or alternative method for i-gel insertion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT05201339).

Biomechanical analysis of push-pull principle versus traditional approach in locking plates for proximal humeral fracture treatment.

INTRODUCTION: Proximal humerus fractures are usually treated with locking plates, which could present recurrence, screw penetration, joint varization. The push-pull principle was introduced to prevent these risks and showed promising results; a dedicated design was then developed and this feasibility study aims to compare the biomechanical performances of such dedicated push-pull plate with the traditional locking plate using finite elements. MATERIALS AND METHODS: The humerus geometry was obtained from Sawbone CT-scans; the geometries of a traditional locking plate and of the dedicated push-pull one were used. A fracture was added below the humeral head and the plates were virtually implanted. The wire pulling mechanism was simulated connecting the plate to the humeral head apex, considering two levels of tension. Three testing set-ups (axial, torsion and compression bending) were simulated. Stress distributions on bone, plate and screws were measured. RESULTS: Stress distribution on the distal humerus was similar for both plates. Stress distribution on the proximal humerus was more homogeneous for the push-pull model, showing less unloaded sections (up to 78%). The different levels of tension applied to the wire returned slight differences in terms of stress values, but the comparison with the traditional approach gave similar outcomes. CONCLUSIONS: More homogeneous stress distribution is found with the push-pull plate in all three testing set-ups, showing lower unloaded areas (and thus lower stress-shielding) compared to the traditional plate; the screws implemented returned to be all loaded in at least one of the set-ups, thus showing that they all contribute to plate stability.

Comparison of the Clinical Outcomes between All-inside and Standard Technique in Anterior Cruciate Ligament Reconstruction with 6-strand Hamstring Tendon Autograft.

OBJECTIVE: All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes. METHODS: From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied. RESULTS: At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016). CONCLUSION: The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.

Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management

The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

A questão da Psicanálise em Fabio Herrmann: crise em crise? / La cuestión del Psicoanálisis en Fabio Herrmann: ¿crisis en crisis? / The question of Psychoanalysis in Fabio Herrmann: crisis in Crisis?

O artigo expõe a ideia de Fabio Herrmann sobre a história da psicanálise como resistência à Psicanálise. Atribui a crise atual da Psicanálise à sua redução, depois de Freud, à clínica padrão de consultório, sustentada por uma teoria padrão.(AU)

El artículo expone la idea de Fabio Herrmann sobre la historia del psicoanálisis como resistencia al Psicoanálisis. Atribuye la actual crisis del Psicoanálisis a su reducción, después de Freud, a la clínica padrón de consultorio, la cual está soportada por una teoría padrón.(AU)

The paper deals with Fabio Herrmann’s idea on the history of psychoanalysis as resistance to Psychoanalysis. Herrmann attributes the contemporary crisis in Psychoanalysis to its reduction, after Freud, to the practice of a standard technique in the consulting room that is supported by a standard theory.(AU)

A questão da psicanálise em Fabio Herrmann: crise em crise? / La cuestión del psicoanálisis en Fabio Herrmann: ¿crisis en crisis? / The question of psychoanalysis in Fabio Herrmann: crisis in Crisis?

O artigo expõe a ideia de Fabio Herrmann sobre a história da psicanálise como resistência à Psicanálise. Atribui a crise atual da Psicanálise à sua redução, depois de Freud, à clínica padrão de consultório, sustentada por uma teoria padrão.

El artículo expone la idea de Fabio Herrmann sobre la historia del psicoanálisis como resistencia al Psicoanálisis. Atribuye la actual crisis del Psicoanálisis a su reducción, después de Freud, a la clínica padrón de consultorio, la cual está soportada por una teoría padrón.

The paper deals with Fabio Herrmann’s idea on the history of psychoanalysis as resistance to Psychoanalysis. Herrmann attributes the contemporary crisis in Psychoanalysis to its reduction, after Freud, to the practice of a standard technique in the consulting room that is supported by a standard theory.

Heart Transplantation. A Retrospective Analysis of the Long-Term Results

Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89: 23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD) -free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.

Heart Transplantation. A Retrospective Analysis of the Short and Intermediate Term Results / 대한구급학회지

BACKGROUND: Heart transplantation is still the best therapy for end-stage heart disease. However, the longterm outcome among different institutions vary. The current series is an assessment of the important factors which determine prognosis. METHODS: Between November of 1992 and September of 2000, 85 heart transplantations were performed at our institution. The standard technique was used in the first 57 patients (group I) where as in the latter 28 patients (group II), the Bicaval technique was utilized. The mean waiting time was approximately 4.7 months, and the causes in decreasing order were Dilated cardiomyopathy (n=69), Ischemic cardiomyopathy (n=10), Hypertrophic cardiomyopathy and others (n=6). The mean follow up was about 31 months. The immunosuppressive protocol comprised cyclosporin, Azathioprine (AZA), and prednisone. Later changes included induction with IL-2 receptor monoclonal antibody and changing AZA to mycophenolate mofetil. RESULTS: The mean donor ischemic time was 95.8 28.3 mins and the implantation time was 59.3 7.6 mins. There was a higher incidence of significant TR in group I along with a greater postoperative pacing requirement. There were 35 postoperative complications of which infectious events were most common (26). Of these, only 3 were early infections and the rest occurred late postoperatively. There were a total of 8 mortalities of which only one occurred early postoperatively and among the 7 late deaths, 3 were medically related and 4 were related to social factors. Only 5% of the patients had graft vascular disease. The overall 1YSR was 92% and the 5 YSR was 85%. CONCLUSIONS: The superior long term results of this current series was attributable to strong early immunosuppression, a homogenous population, and very low incidence of CMV infection.