Impact of stapler versus manual closure techniques on pharyngocutaneous fistula development post-total laryngectomy: A systematic review and meta-analysis.

Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34-0.95, p = 0.03). Subgroup analysis found that stapling's protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09-0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06-0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.

[Application of double-layer soft tissue suture closure technique in the surgical treatment of patients with mandible medication-related osteonecrosis of the jaw of early and medium stages].

OBJECTIVE: To investigate the clinical application effect of double-layer soft tissue (DLST) suture closure technique in patients with mandible medication-related osteonecrosis of the jaw (MRONJ) of early and medium stages resulted in application of anti-bone-resorptive drugs. METHODS: Early to medium stage mandible MRONJ patients who underwent surgical treatment in the fourth ward of Peking University School and Hospital of Stomatology from October 2021 to September 2022 were included. Clinical information of the patients were collected, including primary disease, concomitant disease, medication regimen (drug type, duration of medication), MRONJ stage, clinical symptoms, imaging manifestations, etc. During surgery, after using marginal mandibulae resection to remove the necrotic bone, the wound was closed using DLST closure technique. Regular post-operative follow-up was performed to evaluate the therapeutic effect and complications of the DLST technique, the pain score and functional status of the patiens were evaluated. RESULTS: This study totally included 13 patients, 12 women and 1 man, aged (66.69±13.14) years. Seven patients had osteoporosis, 2 had lung cancer, 3 had breast cancer and 1 had prostate cancer among their primary diseases; 7 had no concomitant diseases, 2 had diabetes mellitus, 2 had cardiovascular disease and 1 had dry syndrome. Intravenous zoledronic acid were used in 9 patients, the average duration was (37.7±20.0) months, and other drugs, such as letrozole tablets were taken in 7 patients at the same time; Denosumab injection was used in 3 patients for an average of (10.3±11.9) months; Alendronate sodium tablets were taken in 5 patients for an average of (55.20±27.20) months, and prednisone acetate tablets or acarbose tablets were taken to varying degrees in 2 patients. The average post-operative follow-up was 11.9 months (9 to 17 months), and all the 13 patients were cured without complications, such as pus overflow and so forth. The pre-operative score of Karnofsky performance status (KPS) in the patients was 68.46±14.05, and the post-operative score was 82.31±15.36, and the difference was statistically significant (P < 0.05). The pre-operative score of visual analogue scale (VAS) in the patients was 5.77±0.73 and the post-operative score was 0.38±0.51, and the difference had statistical significance (P < 0.001). CONCLUSION: The double-layer soft tissue suture closure technique can achieve good clinical results in patients with MRONJ of the mandible using anti-bone-resorptive drugs alone, and can provide clinical treatment ideas for MRONJ patients with more complicated drug use.

Periostin/Bone Morphogenetic Protein 1 axis axis regulates proliferation and osteogenic differentiation of sutured mesenchymal stem cells and affects coronal suture closure in the TWIST1+/- mouse model of craniosynostosis.

BACKGROUND AND OBJECTIVE: The pathogenesis of coronal suture craniosynostosis is often attributed to the dysregulated cellular dynamics, particularly the excessive proliferation and abnormal osteogenic differentiation of suture cells. Despite its clinical significance, the molecular mechanims of this condition remain inadequately understood. This study is dedicated to exploring the influence of the Periostin/Bone Morphogenetic Protein 1 (BMP1) axis on the growth and osteogenic maturation of Suture Mesenchymal Stem Cells (SMSCs), which are pivotal in suture homeostasis. METHODS: Neonatal TWIST Basic Helix-Loop-Helix Transcription Factor 1 heterozygous (TWIST1+/-) mice, aged one day, were subjected to adenoviral vector-mediated Periostin upregulation. To modulate Periostin/BMP1 levels in SMSCs, we employed siRNA and pcDNA 3.1 vectors. Histological and molecular characterizations, including hematoxylin and eosin staining, Western blot, and immunohistochemistry were employed to study suture closure phenotypes and protein expression patterns. Cellular assays, encompassing colony formation, 5-ethynyl-2'deoxyuridine, and wound healing tests were conducted to analyze SMSC proliferation and migration. Osteogenic differentiation was quantified using Alkaline Phosphatase (ALP) and Alizarin Red S (ARS) staining, while protein markers of proliferation and differentiation were evaluated by Western blotting. The direct interaction between Periostin and BMP1 was validated through co-immunoprecipitation assays. RESULTS: In the TWIST1+/- model, an upregulation of Periostin coupled with a downregulation of BMP1 was observed. Augmenting Periostin expression mitigated craniosynostosis. In vitro, overexpression of Periostin or BMP1 knockdown suppressed SMSC proliferation, migration, and osteogenic differentiation. Periostin knockdown manifested an inverse biological impact. Notably, the suppressive influence of Periostin overexpression on SMSCs was effectively counteracted by upregulating BMP1. There was a direct interaction between Periostin and BMP1. CONCLUSION: These findings underscore the significance of the Periostin/BMP1 axis in regulating craniosynostosis and SMSC functions, providing new insights into the molecular mechanisms of craniosynostosis and potential targets for therapeutic intervention.

Atypical sagittal suture craniosynostosis: pathological considerations for early closure of the anterior part of the sagittal suture.

Sagittal suture synostosis is one of the most common craniosynostoses and is often diagnosed by characteristic narrow and long skull shape, scaphocephaly. However, some patients with sagittal suture synostosis do not present with typical scaphocephaly, making early diagnosis difficult. In this study, five cases of characteristic skull deformity showing a narrowing of the cranium posterior to the coronal suture on computed tomography (CT) are presented. The three older children presented with papilledema and intellectual disability and a closed sagittal suture on CT. The two infant cases were diagnosed with the characteristic cranial deformities with aggravation of the deformity over time, but sagittal suture closure was not evident on CT. All patients underwent cranial remodeling surgery. In the two infant cases, the histopathological findings showed that the anterior part of the sagittal suture was firmly fused with fibrous tissue without bony fusion. These findings suggested that narrowing of the cranium posterior to the coronal suture might be due to functional fusion of the anterior portion of the sagittal suture prior to bony fusion. In an infant presenting with such a deformity that shows aggravation of the deformity over time, surgical treatment should be considered.

Age estimation by evaluating median palatine suture closure using postmortem CT.

This study sought to develop an age-estimation formula to evaluate the extent of median palatine suture (MP) closure using postmortem computed tomographic (PMCT) images. The PMCT images of 634 Japanese subjects (mean age, 54.5 years; standard deviation [SD], 23.2 years) with known age and sex were examined. The degree of suture closure of the MP, anterior median palatine suture (AMP), and posterior median palatine suture (PMP) was measured and scored (suture closure score, SCS), and a single linear regression analysis was conducted with age at death. On the analysis, SCS of MP, AMP, and PMP showed a significant correlation with age (p < 0.001). The correlation coefficient of MP was higher (0.760, male; 0.803, female; and 0.779, total) than that of AMP (0.726, male; 0.745, female; and 0.735, total) or PMP (0.457, male; 0.630, female; and 0.549, total). The regression formula and standard error of estimation (SEE) of MP were calculated as Age = 100.95 × SCS + 20.51 (SEE 14.87 years) for male subjects, Age = 91.93 × SCS + 26.65 (SEE 14.12 years) for female subjects, and Age = 95.17 × SCS + 24.09 (SEE 14.59 years) for the total, respectively. In addition, another 50 Japanese subjects were randomly selected to validate the age-estimation formula. In this validation, the actual age of 36 subjects (72%) was within the estimated age ± SEE. This study showed that the age estimation formula using PMCT images of MPs was potentially useful for estimating the age of unidentified corpses.

Prophylactic mesh reinforcement for midline incisional hernia prevention: systematic review and updated meta-analysis of randomized controlled trials.

BACKGROUND: Incisional hernia (IH) is a common complication after abdominal surgery. Prevention of IH is matter of intense research. Prophylactic mesh reinforcement (PMR) has been shown to be promising in the minimization of IH risk after elective midline laparotomy. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PMR vs. primary suture closure (PSC). Risk ratio (RR) and standardized mean difference (MD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference. RESULTS: Fourteen RCTs (2332 patients) were included. Overall, 1280 (54.9%) underwent PMR while 1052 (45.1%) PSC. Postoperative follow-up ranged from 12 to 67 months. The incidence of IH was reduced for PMR vs. PSC (13.4% vs. 27.5%). The estimated pooled IH RR for PMR vs. PSC is 0.38 (95% CI 0.24-0.58; p < 0.001). Stratified subgroup analysis according to mesh location shows a risk reduction for intraperitoneal (RR = 0.65; 95% CI 0.48-0.89), preperitoneal (RR = 0.18; 95% CI 0.04-0.81), retromuscular (RR = 0.47; 95% CI 0.24-0.92) and onlay (RR = 0.24; 95% CI 0.12-0.51) compared to PSC. The seroma RR was higher for PMR (RR = 2.05; p = 0.0008). No differences were found for hematoma (RR = 1.49; p = 0.34), surgical site infection (SSI) (RR = 1.17; p = 0.38), operative time (OT) (MD = 0.27; p = 0.413), and hospital length of stay (HLOS) (MD = -0.03; p = 0.237). CONCLUSIONS: PMR seems effective in reducing the risk of IH after elective midline laparotomy compared to PSC in the medium-term follow-up. While the risk of postoperative seroma appears higher for PMR, hematoma, SSI, HLOS and OT seems comparable.

Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial.

The reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.

[Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. / Prophylaxe von parastomalen, perinealen und Narbenhernien in der kolorektalen Chirurgie.

This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave's syndrome: an Italian single center case series study.

BACKGROUND: Boerhaave's syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. METHODS: Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. RESULTS: Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions. CONCLUSIONS: To our knowledge, this is the largest case series reporting laparoscopic management of BS. We show that laparoscopy is a safe and feasible approach associated with a shorter length of hospital stay when compared with clinical series in which thoracic approach had been chosen. Of note, laparoscopic management would be easily adopted by surgical centers treating benign gastro-esophageal junction entailing a proper management more widely.

The morphometrics and typology of the skull in the Ghanaian local dog of non-descript breed (Canis lupus familiaris) / Morfometría y tipología del cráneo en el perro local de Ghana de raza no definida (Canis lupus familiaris)

The shape of the head is considered the most important criterion in determining the standard breeds of dogs. It is of much significance to study the skull typology of the Ghanaian local dog in order to establish a template of its identification as a breed and to generate data which could be useful in the comparative anatomy of the skulls of dogs. A total of twenty skulls of adult dogs of two age groups were used in this study. 31 parameters were measured and 6 skull indices were calculated on their basis. The group of skulls from older fully grown dogs showed higher values in all parameters. Results of the current study will provide baseline reference data on skull parameters of local dolichocephalic dogs. More importantly, results obtained could be useful in veterinary applied anatomy and clinical practice in areas including forensic medicine, plastic or cosmetic maxillofacial surgery, neurosurgery of the cranium, acupuncture, nerve block and other clinical manipulations involving the head.

La forma de la cabeza se considera el criterio más importante para determinar las razas estándar de perros. Es relevante estudiar la tipología del cráneo del perro local de Ghana para establecer una plantilla de su identificación como raza y generar datos que puedan ser útiles en la anatomía comparativa de los cráneos de perros. En este estudio se utilizaron un total de veinte cráneos de perros adultos de dos grupos de edad. Se midieron 31 parámetros y se calcularon 6 índices de cráneo sobre la base de ellos. El grupo de cráneos de perros mayores completamente desarrollados mostró valores más altos en todos los parámetros. Los resultados del estudio actual proporcionarán datos de referencia sobre los parámetros del cráneo de los perros dolicocefálicos locales. Más importante aún, los resultados obtenidos podrían ser útiles en la anatomía veterinaria aplicada y la práctica clínica en áreas que incluyen medicina forense, cirugía plástica o cosmética maxilofacial, neurocirugía del cráneo, acupuntura, bloqueo nervioso y otras manipulaciones clínicas que involucran la cabeza.

Cranial suture closure as an age indicator: A review.

Cranial suture closure has been recognized for over a century as a useful trait for age estimation. Although this indicator has become a standard feature of age assessment protocols in skeletal remains, serious questions have been raised about its reliability. This article attempts to provide a comprehensive review of cranial suture closure as an age indicator from several perspectives, including its anatomy and history, as well as issues relating to validation, statistics, and the potential of technological advancements to improve outcomes. We further suggest a path forward for the use of cranial suture closure as an estimator of age. Although its unreliability has been widely reported, cranial suture closure still appears to have value as an aging method, and it is hoped that the information contained in this article can serve as a stepping stone toward more effective use of this indicator. The cranium is often more durable than other skeletal elements in both archaeological and forensic circumstances, so maximizing the effectiveness of cranial indicators is an important goal. It is hoped that recent advancements in technology and in analytical approaches to the cranial sutures could breathe some new life into this feature as an indicator of age.

Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report.

BACKGROUND: Spontaneous esophageal rupture is a rare but serious disease with high mortality. Conservative treatment and endoscopic therapy have been reported, but surgical treatment is still a basic modality of therapy. In addition to thoracotomy, recent studies have reported treatment with thoracoscopic surgery and laparoscopic transhiatal repair. In this study, we report a patient who underwent laparoscopic transhiatal suture closure for spontaneous esophageal rupture with favorable postoperative course. We also discuss indication for laparoscopic surgery for spontaneous esophageal rupture. CASE PRESENTATION: A 70-year-old man visited our hospital with chief complaints of epigastric pain and vomitus niger. He was diagnosed with spontaneous esophageal rupture in the left wall of the lower esophagus by computed tomography and upper gastrointestinal (GI) series. At 11 h after the onset of symptoms, we performed laparoscopic transhiatal suture closure and lavage drainage. We performed transhiatal esophageal replacement using the 5-hole approach. We observed a perforation of 2 cm in diameter at the site of the rostral portion approximately 4 cm from the esophageal hiatus. All layers were closed with three stitches using 3-0 absorbable sutures. No perforation was observed in the thoracic cavity. The total operative time was 178 min, and total bleeding was 2 ml. He had no postoperative complications and was discharged on day 15 after the procedure. He received continuous proton pump inhibitor therapy as an outpatient. Healing cicatrization was found at the site of rupture by esophagogastroscopy. The patient was advised to improve his lifestyle and has shown no signs of recurrence over 2 years from the date of surgery. CONCLUSIONS: Simple closure of all the layers using laparoscopic transhiatal simple closure was useful in the treatment of esophageal rupture as a less invasive approach for patients who meet the following conditions: stable general condition, intrathoracic perforation, and the perforation site is identified as the lower esophagus by pre-operative examination.

Assessing the accuracy of cranial and pelvic ageing methods on human skeletal remains from a modern Greek assemblage.

The present study tests the accuracy of commonly adopted ageing methods based on the morphology of the pubic symphysis, auricular surface and cranial sutures. These methods are examined both in their traditional form as well as in the context of transition analysis using the ADBOU software in a modern Greek documented collection consisting of 140 individuals who lived mainly in the second half of the twentieth century and come from cemeteries in the area of Athens. The auricular surface overall produced the most accurate age estimates in our material, with different methods based on this anatomical area showing varying degrees of success for different age groups. The pubic symphysis produced accurate results primarily for young adults and the same applied to cranial sutures but the latter appeared completely inappropriate for older individuals. The use of transition analysis through the ADBOU software provided less accurate results than the corresponding traditional ageing methods in our sample. Our results are in agreement with those obtained from validation studies based on material from across the world, but certain differences identified with other studies on Greek material highlight the importance of taking into account intra- and inter-population variability in age estimation.

Age estimation approaches using cranial suture closure: A validation study on a Thai population.

Cranial suture closure, one of the most commonly used age estimation methods, for decades, however, is often viewed with caution and its reliability is still debated. Few methods of estimating age using the skeleton, especially cranial suture, have been tested on Thais. This study aims to test the traditional aging techniques using cranial suture closure on Thai individuals in order to identify the error rate of each method when applied to a Thai sample. Meindl and Lovejoy (1985), Acsádi and Nemeskéri (1970), and Mann (1991) methods were applied to 175 Thai dry crania. Bias and inaccuracy in the Meindl and Lovejoy, Acsádi and Nemeskéri, and Mann methods resulted in overestimation in young adults and underestimation in older individuals with an inaccuracy range of approximately 13-22 years. The Mann method approached 100% in predicting age in older males, but the method did not fare as well on Thai females. The results confirm inter-population variation does exist. Additionally, differences in age composition between populations used to develop the methods and Thais may lead to an increase in error. This study indicates that these three aging methods should be used in conjunction with other techniques. Further research which develops specific methods for Thais might give better results for age estimation.

Calvarial bone development and suture closure in Dicer-deficient mice.

OBJECTIVE: To evaluate whether lack of Dicer during calvaria development would lead to dysmorphology of calvaria and suture closure in mice. MATERIALS AND METHODS: A conditional Dicer deficient under Osx promoter mouse was employed in this study. The 4- and 10-week-old conditional Dicer-deficient mice control littermates and Osx-cre transgenic mice were studied for calvarial bone morphology and suture closure. Dry skull, microcomputed tomography (µCT), histological and gene expression studies were investigated to evaluate the effect of Dicer deficiency on calvarial bone morphology and their related genes during calvaria development. RESULTS: The results elucidated that complete suture closure was observed in 10-week-old conditional Dicer-deficient mice while incomplete closure suture was observed in age-matched Osx-cre control mice. The µCT and histological sections demonstrated complete fusion of posterior frontal suture and dysmorphic calvarial bones in Dicer deficient mice compared to the ones in their littermates and age-matched Osx-cre control mice. Gene expression study demonstrated significantly increased expression of suture and calvarial bone-related genes, that is Tgf-beta family, Bmp3, Msx2, Alx4, Runx2 and Osx in Dicer-deficient mice during suture closure time. CONCLUSIONS: The results suggest mature miRNAs are important for suture closure and calvarial morphology during calvaria development.

The developing temporal bone: computed tomography measurements and assessment of suture closure from birth to 18 years of age.

PURPOSE: To describe the normal CT appearance of the developing temporal bone in children from birth to 18 years of age. METHODS: Two hundred and six temporal bone CTs of children from 0.14 to 18.95 years were retrospectively selected and reviewed. Temporal bones were measured in a standardized slice orientation using the length of the basal turn of the cochlea, the length and width of the petrous bone, the coronal extent, trailing edge and anterior-posterior dimension of the temporal bone and the angle between petrous bone's length and the midsagittal line in the axial plane showing the basal turn of the cochlea in its greatest extent. Two sutures, two synchondroses and three fissures of the temporal bone were evaluated and graded. RESULTS: Chosen measurements and calculations demonstrate an increase of values from 0 to 18 years with the greatest increase occurring during the first 2 years of life. The angle between the basal turn of the cochlea and the midsagittal line shows a large variability. Logarithmic trend lines illustrate larger measurements of males as compared to females. The ratio of the basal turn of the cochlea and the length of the petrous bone is about 1:4.1 (f/m) during the first year of life and about 1:6.1 (f)/1:6.8 (m) from 17 years onwards. Results of suture closure are described using box-and-whisker plots. CONCLUSIONS: The developing temporal bone grows the most during the first 2 years of life. Knowledge of changing proportions and suture closure is essential for evaluation of temporal bone CT of children.

Application of modified reverse panoramic radiograph on lambdoid suture for age estimation.

BACKGROUND: Cranial suture closure has long been recognized as a character of human development related to aging. For this reason, it has been utilized for various forensic and archaeological studies to determine the age of an unidentified/or skeletonized individuals. Various cadaveric studies have established the role of lambdoid suture in age estimation, but not routinely practiced. The objective is to establish if any correlation exists between individual's age and lambdoid sutures closure status (ectocranially) in mortals through modified reverse panoramic radiograph (RPRg). METHODS: Total number of 85 subjects, 25 years and beyond were included in the study, and divided into four groups with an age interval of 10 years. Assessment of lambdoid suture closure was done according to Frederic Rating Scale on modified RPRg. Data obtained was subjected to statistical analysis using Spearman's correlation test. RESULTS: A significant difference was observed between the age group and suture closure. Correlation coefficient of 0.570 was obtained, and was interpreted as a good correlation between the age and suture closure status with a P value of <0.001. CONCLUSIONS: Lambdoid suture can be very effective and practical tool for age assessment in mortals through modified RPRg (ectocranially).

The effect of factors other than age upon skeletal age indicators in the adult.

CONTEXT: Estimation of adult age from skeletal remains is problematic due to the weak and variable relationship between age indicators and age. OBJECTIVES: To assess the proportion of variation in age indicators that is associated with factors other than age and to attempt to identify what those factors might be. METHODS: The paper focuses on frequently used adult bony age markers. A literature search (principally using Web of Science) is conducted to assess the proportion of variation in age indicators associated with factors other than age. The biology of these age markers is discussed, as are factors other than age that might affect their expression. RESULTS: Typically, ∼60% of variation in bony age indicators is associated with factors other than age. Factors including inherent metabolic propensity to form bone in soft tissue, vitamin D status, hormonal and reproductive factors, energy balance, biomechanical variables and genetic factors may be responsible for this variation, but empirical studies are few. CONCLUSION: Most variation in adult skeletal age markers is due to factors other than age; dry bone study of historic documented skeletal collections and high resolution CT scanning in modern cadavers or living individuals is needed to identify these factors.

[Infections associated with percutaneous arterial closure devices: medico-legal issues]. / Les implications médico-légales des infections sur les systèmes de fermeture percutanée artérielle.

Percutaneous suture closure devices have reduced the time needed for manual compression and hospital stays, but several meta-analysis emphasized a higher risk of vascular damages compared to manual compression. Two cases of infections on percutaneous suture closure devices were analyzed; which had medico-legal issues. Beyond the medical point of view, the patient's complaints, the way lawyers and medical experts have examined the cases were analyzed and resulted in physicians and hospitals being sentenced. Rather than stigmatizing those devices, we just want to invite cardiologists not to underestimate this serious risk. Before using those devices, physicians should balance the risk-benefit ratio, follow prevention guidelines, and most of all, be aware of any single signs of emerging infection to detect and treat them early, and thus reduce the severity of infections thanks to a targeted antibiotic treatment adapted to the antibiogram and an active role of vascular surgeons.

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure.

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 ± 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 ± 11.2 d) and the traditional secondary suturing group (36.2 ± 15.3 d) (P < 0.05). Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time.