AN EVALUATION OF AUTOMATIC SUTURE WITH UKL-60 AND UKL-40 DEVICES BY PULMONARY RESECTION.
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The authors have developed a double-barreled tack suture procedure for carotid endarterectomy with minimal modification of a conventional needle holder. With this method surgeons can make two stitches simultaneously by using two needles threaded with double-armed suture material, which are held tightly in a parallel fashion in the jaws of a modified needle holder. This method is very effective in preventing the buckling of the intimal wall of the arterectomized distal internal carotid artery. Also, it reduces the tack suture time markedly compared with the conventional tack suture method.
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OBJECTIVE: Incontinence is one of the drawbacks of radical prostatectomy. The causes of post-operative incontinence are sphincter deficiency (SD) and bladder dysfunction (BD). SD seems to be the main cause of incontinence and long time to continence. We present a surgical modification of the anatomical radical retropubic prostatectomy consisting in the reconstruction of the posterior aspect of the striated urethral sphincter in order to obtain a quick recovery of continence postoperatively. MATERIALS AND METHODS: Caudal retraction of the urethro-sphincteric complex after apical dissection of the prostate often occurs. Furthermore posterior fibrous raphe interruption can cause shortening of anatomical and functional urethral length and affect continence. In order to avoid caudal retraction of the sphincteric complex, after completing vesico-urethral anastomosis, the posterior emicircumference of the striated sphincter is fixed to the posterior aspect of the bladder one centimeter cranially and posteriorly to the urethro-vesical anastomosis. The rabdosphincter is sutured separately from the urethro-vesical suturing. This technical modification makes it possible to obtain an anatomical length of the urethra of about a centimeter more than with the standard technique, replacing it in a more anatomical position. Furthermore, this technique provides the new posterior platform for the urethro-sphincteric complex. Twenty-four patients with clinical organ confined disease and age range 54-74 years (mean 64 years) underwent Walsh's anatomical radical retropubic prostatectomy with reconstruction of the rabdosphincter (group A). Catheter was removed 7 to 11 days postoperatively. Early continence was assessed objectively with the number of pads per day as follows: 0-1 mini pad = continent; 1-2 pads per day = mild incontinence; 2 or more pads per day = severe incontinence. Continence was evaluated at 3 days and one month after catheter removal. Group A compared to 21 patients (group B) who underwent standard anatomical RPP (historical control group). RESULTS: In group A 16/24 patients (66.7%) and 19/24 patients (79.2%) were continent respectively at three days after removal of the catheter and after one month; mild incontinence (1-2 pads/day) was present in 6/24 patients (25%) and 3/24 (12.5%) respectively, 2/24 patients (8.3%) suffered from severe incontinence after 3 days and one month. In group B 7/21 patients (33%) were continent at hospital discharge, 11/21 (52%) after one month. CONCLUSIONS: Careful reconstruction of the posterior aspects of the rabdosphincter shortens time to continence after RRP.
A method for the differentiation of motor and sensory nerve fibres of mixed peripheral nerves is presented. This method is based on the different content of acetylcholinesterase in motor and sensory nerve axons. The median and ulnar nerves of 13 human cadavers were biopsied at the wrist within three hours post mortem. All specimens were stained after the method of KARNOVSKY. The axons of the motor nerve fibres with their high content of acetylcholinesterase thus were marked. In all the examined ulnar nerves the motor fibres were found in the ulnar part. They were different in size and figure. In the median nerves only 1 to 3 motor fascicles were found, which are localized in the palmar and radial section of the nerve. These motor fibres represent only a little part of the whole cross section of the median nerve. As a consequence of this method of differentiation between motor and sensory fibres the surgery of peripheral mixed nerves may be influenced.
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