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Anterior Surface (anterior + surface)
Selected AbstractsResection and reconstruction of retrohepatic vena cava without venous graft during major hepatectomiesJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2007Marcel Autran C. Machado MD Abstract Background Progress in liver surgery has enabled hepatectomy with concomitant venous resection for liver malignancies involving the inferior vena cava (IVC). The authors describe an alternative technique for IVC reconstruction without the need of graft. Methods Parenchymal transection is performed from anterior surface of the liver down to the anterior or left lateral surface of the IVC using combination of two techniques reported elsewhere. IVC is clamped above and below the tumor and the liver in continuity with an invaded segment of IVC is removed en bloc. A transverse anastomosis of IVC is performed starting with running suture on the posterior wall followed by the anterior wall. Results This approach has been successfully employed in eight consecutive patients with IVC involvement. The procedures performed were 5 right hepatectomies, 1 right posterior sectionectomy, 1 right trisectionectomy, and 1 left trisectionectomy. Two patients needed total vascular exclusion (TVE) for 11 and 10 min, respectively. Blood transfusion was necessary in three patients. Pathologic surgical margins were free in all cases. No postoperative mortality was observed. Conclusion This technique of IVC reconstruction precludes the use of graft and minimizes the use of TVE decreasing ischemic damage to the remnant liver. J. Surg. Oncol. 2007;96:73,76. © 2007 Wiley-Liss, Inc. [source] Tibial Bone KPro technique and long term resultsACTA OPHTHALMOLOGICA, Issue 2009J TEMPRANO The operation is performed in three stages. The first stage consists in preparing the eye to receive and maintain the keratoprosthesis. For this purpose the anterior surface of the eye is cleaned and regularized, eliminating fibrous tissue and the entire epithelium. Subsequently we obtain a 2 x 3 cm graft of buccal mucosa from the inferior lip comprising the entire mucosal and submucosal thickness. The graft is sutured to cover the anterior pole of the eye to promote revitalization. The second stage consists in preparing the keratoprosthesis. A 10 mm disk of tibial bone from the superior part of the medial face of the tibia is obtained using a crown drill. The posterior part of the piece of bone obtained is then cut with a chisel to obtain a thickness of 3 mm. Subsequently the obtained disk of bone is cleaned and a central opening of 3.5 mm is performed to introduce in this opening a PMMA optic cylinder, 9 mm in length, 3.5 mm in diameter in its narrow portion, 4 mm in the wider portion. Fixation is achieved with cyanoacrylate. This is left to dry and then it is introduced into a palpebral pocket of the inferior lid of the patient. The pocket is closed with sutures and the piece is left in place for three months. For the third stage we remove the keratoprosthesis device from the palpebral pocket and if it is found to be in perfect conditions we dissect the buccal mucous membrane which is covering the cornea and perform a central window with a 4.5 mm trephine to remove the transparent or cataractous lens and perform a total iridectomy. The posterior portion of the optic cylinder is introduced into the anterior chamber. The prosthesis is sutured to the anterior pole of the eye with non-absorbible sutures. Finally the buccal mucosa is replaced, covering the entire area. One point of blepharorraphy is applied. Long term results. We started to use this technique in 1988 and after 21 years of experience we have 80% of anatomically perfect results. In 20 % of the cases the prosthesis extruded due to total or partial resorption of the bone. It has to be emphasized that these were cases without any other possibility of treatment. We did 143 cases during these years. The longest follow-up of a prosthesis "in situ" is 19 years. The earliest extrusion was after one year. The complications are the same as for OOKP (glaucoma, retinal detachment, vitritis, extrusion) The functional results depend on the conditions of the retina and the optic nerve. There were many cases with 20/20 vision. The mean value of retention of the prosthesis is 15 years. [source] Comparison of anterior chamber depth measurements taken with the Pentacam, Orbscan IIz and IOLMaster in myopic and emmetropic eyesACTA OPHTHALMOLOGICA, Issue 4 2009Canan Asli Utine Abstract. Purpose:, This study determined to assess the degree of agreement between anterior chamber depth (ACD) measurements obtained using three different devices and to analyse the relationship between ACD and spherical equivalent (SE) refraction. Methods:, In this cross-sectional study, 42 eyes of 42 patients with a mean SE of , 4.69 ± 4.61 D (range 0.00 D to , 14.88 D) were analysed. Measurements of ACD between the corneal epithelium and the anterior surface of the crystalline lens, obtained using the Pentacam, Orbscan IIz and IOLMaster, were compared. The relationships between SE and ACD measurements obtained with different devices were also investigated. The results were analysed using Bland,Altman analyses, single-sample t -test and Pearson's correlation test. Results:, Orbscan ACD measurements were an average of 0.05 mm less than Pentacam measurements (p = 0.01). IOLMaster measurements were an average of 0.06 mm less than Orbscan measurements (p < 0.001). None of the ACD values measured by any of the devices were correlated with increasing SE (p > 0.05 for all). There was a weak positive correlation between SE and the difference in ACD measurements with Pentacam and Orbscan (p = 0.04); however, the differences between Pentacam and IOLMaster ACD measurements and Orbscan and IOLMaster ACD measurements seemed to be independent of SE (p = 0.17 and p = 0.54, respectively). Conclusions:, The ACD in clinically normal eyes is measured differently by various non-ultrasonic devices. However, the observed mean error between these modalities is too small to create any noticeable difference in refractive outcome. No significant relationship was found between SE and ACD measurements obtained by Pentacam, Orbscan or IOLMaster. [source] Ocular manifestations in liver transplant recipients with familial amyloid polyneuropathyACTA OPHTHALMOLOGICA, Issue 5 2008Ola Sandgren Abstract. Purpose:, To evaluate postoperative ocular involvement in Swedish liver transplant (LT) recipients with familial amyloid polyneuropathy (FAP). Methods:, Routine ophthalmological examinations were performed in 48 LT recipients, with particular attention given to amyloid deposition in the anterior segment and the vitreous body. Medical records were scrutinized for information regarding neurological impairment at the time of the LT. The diagnosis was secured in all cases by examining for amyloid deposits in biopsy specimens and positive genetic testing for amyloidogenic transthyretin (ATTR) Val30Met mutation. Results:, Six patients (12.5%) developed vitreous opacities within the post-LT observation period. The first opacities were seen 40 months after transplantation, 8 years after the onset of systemic disease. Four patients (8%) developed secondary glaucoma, the first of which was observed 18 months after the procedure and 6.5 years after the onset of disease. Sixteen patients (33%) developed deposits on the anterior surface of the lens. Scalloped pupillary margins were noted in 10 patients (21%). Conclusion:, The prevalence of eye complications increases with time after LT and regular follow-up is necessary, especially to disclose the development of glaucoma , a complication with insidious symptoms of which patients are normally unaware. [source] An anatomical study of the muscles that attach to the articular disc of the temporomandibular jointCLINICAL ANATOMY, Issue 8 2009Kosuke Matsunaga Abstract The masticatory muscles are generally described as the muscles that originate from the cranium and insert on the mandible. Some of the masticatory muscles also insert into the articular disc of the temporomandibular joint. Although there are numerous reports of studies on the attachment of the fibers to the disc, most reports discuss only one muscle. We have shown that the masticatory muscles are not simply a group of clearly independent muscles, but that these muscles contain various transitional muscle bundles among the major muscles. From this point of view, we carried out minute dissection of the collective muscles and muscle bundles surrounding the temporomandibular joint. We dissected 40 head halves of 20 Japanese cadavers (10 males, 10 females: average 79.6 yr). After complete removal of the bony elements, the structures surrounding the temporomandibular joint were investigated en-block. In all specimens, the superior surface of the upper head of lateral pterygoid and the midmedial muscle bundle were attached to the disc. In some specimens, the discotemporal bundle, zygomaticomandibularis, and masseter were attached to the anterior surface of the disc. The total vector of these muscles pulls the disc anteriorly. In contrast, the vector of the muscles to the condylar processes of the mandible pulls the mandible medially. From these observations, it seems that the fibers, which attach to the disc act to steady the disc against the masticatory movement. Clin. Anat. 22:932,940, 2009. © 2009 Wiley-Liss, Inc. [source] Fresh-frozen vs. embalmed bone: is it possible to use formalin-fixed human bone for biomechanical experiments on implants?CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2009Ayhan Cömert Abstract Purpose: As formalin is an extremely reactive electrophilic chemical that reacts with tissues, the purpose of this study was to explore whether formalin fixation could potentially alter the mechanical properties of bone tissue and have an effect on the primary stability measurements of implants. Material and methods: ,3.3 × 8 mm, ,4.1 × 8 mm, and ,4.8 × 8 mm implants were placed on sockets prepared into the anterior surface of the radius of two fresh-frozen human cadavers. The insertion torque of each implant was quantified using a strain-gauged torque-wrench connected to a data acquisition system at a sample rate of 10 KHz, and resonance frequency analysis measurements were also undertaken for each implant. The cadavers were then subjected to embalment with 10% formalin for 3 months, and the same experiments were undertaken on the contra lateral radius of the cadavers. Results: The insertion torques before and after chemical fixation were similar for ,3.3 mm (P>0.05), and higher values were obtained for ,4.1 mm and ,4.8 mm implants after chemical fixation (P<0.05). The resonance frequency analysis values before and after chemical fixation were similar for all implants (P>0.05). Conclusions: Implants have higher insertion torque values in formalin-fixed bone than fresh-frozen human bone, but similar implant stability quotients in both cases. The insertion torque technique can detect the difference between formalin-fixed and fresh-frozen human bone, but resonance frequency analysis cannot. [source] | ||||||||||