Orofacial clefts are extremely common birth defects. Orofacial clefts affect a multitude of different areas including feeding, speech, proper tooth development, as well as personality. There are many causes associated with the many different presentations of the birth defect. There have been a multitude of different surgical procedures over time that have dealt with the complications associated with repairing the various clefts. There is no current accepted standard for orofacial cleft repair. In more recent times the focus of the various orofacial clefts procedures have gone from a major procedure where survival was the objective to a more streamline procedure with a man goal of restoring normal human anatomy. Presurgical nasoalveolar molding (PNAM) is more recent procedure that takes advantage of the malleability and rapid growth of facial tissue during the first months of life. This procedure uses a custom acrylic plate that brings the right and left halves of the cleft closer together. This procedure is currently not accepted by all because the long-term effects are unclear. The aim of this study is to point out the short term successes of the PNAM procedure, compare our results to current published studies, and suggest further study that should be completed. A case report was completed on the first five months of treatment on a bilateral cleft lip/ cleft palate case. The case report followed the patient from birth through the first cleft lip closure surgery. The notes taken at weekly appliance adjustment appointments will be reviewed for information on progress as well as behavior and parent involvement. Pictures were also reviewed in order to review progress as well as surgical procedure. After review of the appointment notes and various pictures from throughout the process it was deemed that this PNAM procedure was a success. It was found that there was an overall increase in symmetry in facial structure as well and an increase in facial tissue. After reviewing pictures of the surgical procedure it can be concluded that the overall process was made easier by the PNAM procedure. It is concluded that the PNAM procedure is extremely successful in the short term but in order to receive more concrete results more cases must be reviewed with future follow-ups in order to see consistent long-term results.

No description available.

Master of Science / Department of Clinical Sciences / James D. Lillich / Objective - To compare the biomechanical characteristics of the currently recommended (CR) technique and a less invasive (LI) surgical approach for arthrodesis of the proximal interphalangeal joint (PIPJ). Additionally, to describe a technique for cartilage removal and disruption of the subchondral bone. Study design - Randomized paired limb design for biomechanical comparison. Cartilage removal and subchondral bone disruption was accomplished using an orthopedic drill bit. Sample Population – 76 cadaver limbs. Methods - Cadaver PIPJs were drilled using a 3.5mm, 4.5mm or 5.5mm drill bit. Articular surfaces were digitally photographed and analyzed. Other paired PIPJs were arthrodesed using either the CR or the LI surgical technique. Implants consisted of a 3-hole DCP and two 5.5mm transarticular screws. Constructs were tested to failure in dorso-palmar/plantar and latero-medial in single cycle 3-point bending. The maximum load and yield load was measured and composite stiffness was calculated and statistically compared. Results - The LI technique had significantly greater mean yield load (11.3 ± 2.8 kN vs. 7.68 ± 1.1 kN, P=0.008) and mean maximum load (13.5 ± 3.1 kN vs. 10.1 ± 1.94 kN, P= 0.02) under latero-medial bending. Under dorso-palmar/plantar bending there was no statistical difference between the surgical approaches (P=0.5). The 4.5mm drill bit removed 42% ± 7.3 of the cartilage and disrupted subchondral bone. The LI technique had a decreased surgical time (19 ± 3 min.) when compared with the CR (31 ± 3 min.) technique. Conclusion – The LI technique results in a stronger composite as measured in 3-point bending, loaded to failure. Clinical Relevance – The LI surgical technique may be considered for clinical cases requiring arthrodesis of the PIPJ as there is no reduction in composite strength.

Há uma tendência mundial para a substituição de animais vivos por métodos alternativos ou substitutivos, reduzindo o número destes para uso didático especificamente. A elaboração de métodos variados para realização de aulas de Cirurgia mantém a educação atualizada e sincronizada com o desenvolvimento de práticas de ensino contribuindo para o pensamento ético. Alguns destes métodos substitutivos são: utilização de cadáveres formolizados, modelos sintéticos, como espumas e bexigas de látex, vísceras e músculos de cadáveres de animais, vídeos ilustrativos, modelos virtuais, suturas em tecidos, preparação de peças anatômicas, dentre outros. A habilidade cirúrgica se desenvolve por meio de repetição de exercícios, razão pela qual, muitas instituições estão adotando simuladores e outros modelos de treinamento nos Programas de Graduação e Residência médico-veterinária, permitindo a repetição dos exercícios de forma individualizada. No presente estudo, utilizou-se o Líquido de Larssen Larssen modificada (Silva et al.,2004) - que permite a reutilização de corpos por até quatro vezes, com o objetivo de se avaliar a preservação de características organolépticas de cadáveres e de suas vísceras, utilizados no ensino de Técnica Cirúrgica, comparando a preservação dos corpos com e sem heparinização dos mesmos. Para tanto, foram obtidos 14 corpos de cães, cedidos de forma consensual pelos proprietários, que foram eutanasiados devido doenças graves ou vieram a óbito de forma natural. Em sete cadáveres, no momento da eutanásia, utilizou-se heparinização em volume de 5 mL por via venosa e nos demais sete corpos não. Os animais de ambos os grupos foram preservados em câmara fria (-12 graus °C a -8 graus °C) e retirados 20 horas antes do treinamento de alunos em técnica cirúrgica dos sistemas digestório, articular, urinário, respiratório e do globo ocular. Para o treinamento, foram utilizados residentes médicos-veterinários e alunos do quinto ano da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ/USP). Ao final de cada treinamento, eles responderam a um questionário que avaliou, de forma empírica, a consistência, coloração, odor e textura dos órgãos abordados, e, assim, comparar os métodos de preservação, bem como a eficiência do treinamento. Após a análise dos resultados constatou-se que, diante das condições do experimento, não houve diferença significativa entre os grupos preservados com ou sem heparina; verificou-se eficiência no treinamento cirúrgico, elucidando, desenvolvendo e capacitando os participantes em habilidades motoras fundamentais para a formação do cirurgião veterinário. Conclui-se que o treinamento cirúrgico torna-se fundamental e deve ser implementado nas instituições de ensino, sugerindo- que se faça a conscientização e educação por parte dos proprietários no tocante a doar seus animais para o ensino médico. / There is a global trend to replace live animals for alternative or substitute methods, reducing the number of these specifically for educational use. The development of various methods for surgery classes keeps updated and synchronized education with the development of teaching practices contributing to ethical thinking. Some of these substitutive methods are: use of fixation cadavers, synthetic models, such as foam and latex bladders, guts and muscles of animal carcasses, illustrative videos, virtual models, sutures in tissues, preparation of anatomical parts, among others. Surgical skill is developed through repetition exercises, which is why many institutions are adopting simulators and other training models in undergraduate programs and medical-veterinary residence, allowing the repetition of individualized exercises. In the present study, we used the liquid Larssen - modified Larssen (Silva et al., 2004) - which allows reuse bodies up to four times, in order to evaluate the organoleptic preservation of corpses and its viscera, used in the Surgical Technique teaching, comparing the preservation of bodies with and without heparin them. Therefore, we obtained 14 bodies of dogs, assigned by consensus by the owners, who were euthanized due to serious illness or death came naturally. In seven cadavers at the time of euthanasia was used heparinization volume of 5 ml intravenous and not in other seven bodies. The animals of both groups were preserved in cold storage (-12 degrees ° C to -8 degrees C) and withdrawn 20 hours before the training dea students in surgical technique of the digestive system, joint, urinary, respiratory ear and eye. For training, medical-veterinary residents were used and fifth graders at the Faculty of Veterinary Medicine and Animal Science of the University of São Paulo (FMVZ / USP). At the end of each training, they completed a questionnaire that assessed, empirically, consistency, color, odor and texture of the covered bodies, and thus compare preservation methods and the training efficiency. After analyzing the results it was found that, given the experimental conditions, there was no significant difference between the groups preserved with or without heparin; it was found efficiency in surgical training, clarifying, developing and enabling key participants in motor skills for forming a veterinary surgeon. We conclude that surgical training is fundamental and must be implemented in educational institutions, sugerindo- that make awareness and education by the owners with respect to donate their animals for medical education.

O aprendizado e o ensino da cirurgia veterinária envolvem o desenvolvimento de habilidades que podem ser obtidas em laboratórios, por meio de vários modelos já disponíveis, incluindo o treinamento em cadáveres. Nestes, quando comparados aos procedimentos em animais vivos, duas limitações são notadas e frequentemente mencionadas, e referem-se às alterações de consistência dos tecidos e à ausência de sangramento durante o treinamento cirúrgico. Este trabalho foi focado na superação destas questões, por meio da realização da simulação de circulação sanguínea em cadáveres adequadamente preservados, permitindo aos usuários do sistema a possibilidade de treinamento cirúrgico em um modelo mais próximo do animal vivo, viabilizando também o aprendizado e a prática da hemostasia. Depois de desenvolvido o sistema, o mesmo foi utilizado por estudantes de Medicina Veterinária com distintos níveis de experiência, que avaliaram todo o método por meio de questionário, ressaltando também os pontos positivos e negativos observados. Concluiu-se que é possível realizar a simulação de sangramento em cadáveres quimicamente preservados, e que tal sistema foi bem aceito por quem o utilizou, sendo mais uma alternativa para melhor preparar estudantes para as experiências em animais vivos que necessitem de intervenções cirúrgicas. / Veterinary surgery demands skills acquisition and refinement that can be obtained in laboratories using several available models, including training on cadavers. Those, when compared to live animal procedures, two limitations are noted and often mentioned, and are due to tissue consistency alterations and absence of bleeding during surgical training. This work was focused on overcoming these issues, by performing blood flow simulation in properly chemically preserved cadavers, giving users of this system the possibility of surgical training in a model closer to live animal, also enabling learning and practice of hemostasis. After developed the system, it was used by veterinary students with distinct experience levels, evaluating the whole method through a questionnaire, emphasizing positive and negative aspects. It was concluded that bleeding simulation in chemically preserved cadavers is possible, and that such a system was well accepted by those who used it, being an alternative to better prepare students for experiments on live animals that require surgical interventions.

Outcomes from surgery are dependent upon technical performance, as demonstrated by the variability that exists in outcomes achieved by different surgeons following surgery for rectal cancer. It is possible to improve such outcomes by focused training and the adoption of specific surgical techniques, such as the total mesorectal excision (TME) training programme in Stockholm which reduced local recurrence rates of cancer by 50%. It is generally accepted that good surgical technique is the enactment of a series of positive surgical actions, and the avoidance of errors. However, the constituents of good surgical technique for rectal cancer have not yet been studied in sufficient detail to identify the specific associations between individual steps and their consequences. In this study the ergonomic principles of human reliability analysis (HRA) were applied to video recordings of rectal cancer surgery. A system of error definition and identification was developed, utilising a bespoke software solution designed for the project. Calculation of optimal camera angles and position was determined in a virtual operating theatre. Analysis of synchronised footage from multiple camera views was performed, through which over 6,000 errors were identified across 14 procedural tasks. The sequences of events contributing to these errors are reported, and a series of error reduction mechanisms formulated for rectal cancer surgery.

Colonoscopy is the current standard for colorectal cancer screening. This procedure requires improvement since it causes patient pain and can even result in injury. Novel colonoscopy devices have to be evaluated to gain information about their performance. At the preclinical stage of the device development the evaluation is typically performed in laboratory experiments. For these experiments an artificial environment is required which can recreate the anatomical and biomechanical features of the colon. A colonoscopy simulator for the evaluation of colonoscopy devices was developed within the ERC funded CoDIR project (Colonic Disease Investigation by Robotic Hydrocolonoscopy). The here developed simulator had to provide a colon phantom with realistic biomechanical properties as well as a sensor setup to measure signals which can be used to quantify the performance of devices which are tested within the simulator. Related literature was reviewed and possible tissue mimicking materials were selected. The suitability of the selected materials was evaluated by testing the frictional and elastic properties of the materials and subsequently comparing the results to those of colon tissue. PVA cryogel was selected as the most suitable material as it exhibits comparable elasticity and coefficients of friction. The tissue mimicking materials were mould casted into phantoms which were designed to represent the anatomical features of the colon. A simulator environment was developed which integrates the phantom as well as force and pressure sensors into a functional system. The sensors measure mesenteric forces and intraluminal pressures which can be related to the performance of tested devices. The simulator allows the arrangement of the sensors and the phantoms in an adjustable, modular approach. The simulator environment was successfully applied in the evaluation of a novel colonoscopy device. The results indicate that PVA cryogels exhibit unique mechanical properties which can be compared to those of colon tissue. The developed colonoscopy simulator provides a promising tool which can aid the development of novel colonoscopy devices.

<p>Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. </p><p>PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)</p><p>Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346).</p><p>Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.</p>

Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18) Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346). Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.

Há uma tendência mundial para a substituição de animais vivos por métodos alternativos ou substitutivos, reduzindo o número destes para uso didático especificamente. A elaboração de métodos variados para realização de aulas de Cirurgia mantém a educação atualizada e sincronizada com o desenvolvimento de práticas de ensino contribuindo para o pensamento ético. Alguns destes métodos substitutivos são: utilização de cadáveres formolizados, modelos sintéticos, como espumas e bexigas de látex, vísceras e músculos de cadáveres de animais, vídeos ilustrativos, modelos virtuais, suturas em tecidos, preparação de peças anatômicas, dentre outros. A habilidade cirúrgica se desenvolve por meio de repetição de exercícios, razão pela qual, muitas instituições estão adotando simuladores e outros modelos de treinamento nos Programas de Graduação e Residência médico-veterinária, permitindo a repetição dos exercícios de forma individualizada. No presente estudo, utilizou-se o Líquido de Larssen Larssen modificada (Silva et al.,2004) - que permite a reutilização de corpos por até quatro vezes, com o objetivo de se avaliar a preservação de características organolépticas de cadáveres e de suas vísceras, utilizados no ensino de Técnica Cirúrgica, comparando a preservação dos corpos com e sem heparinização dos mesmos. Para tanto, foram obtidos 14 corpos de cães, cedidos de forma consensual pelos proprietários, que foram eutanasiados devido doenças graves ou vieram a óbito de forma natural. Em sete cadáveres, no momento da eutanásia, utilizou-se heparinização em volume de 5 mL por via venosa e nos demais sete corpos não. Os animais de ambos os grupos foram preservados em câmara fria (-12 graus &deg;C a -8 graus &deg;C) e retirados 20 horas antes do treinamento de alunos em técnica cirúrgica dos sistemas digestório, articular, urinário, respiratório e do globo ocular. Para o treinamento, foram utilizados residentes médicos-veterinários e alunos do quinto ano da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ/USP). Ao final de cada treinamento, eles responderam a um questionário que avaliou, de forma empírica, a consistência, coloração, odor e textura dos órgãos abordados, e, assim, comparar os métodos de preservação, bem como a eficiência do treinamento. Após a análise dos resultados constatou-se que, diante das condições do experimento, não houve diferença significativa entre os grupos preservados com ou sem heparina; verificou-se eficiência no treinamento cirúrgico, elucidando, desenvolvendo e capacitando os participantes em habilidades motoras fundamentais para a formação do cirurgião veterinário. Conclui-se que o treinamento cirúrgico torna-se fundamental e deve ser implementado nas instituições de ensino, sugerindo- que se faça a conscientização e educação por parte dos proprietários no tocante a doar seus animais para o ensino médico. / There is a global trend to replace live animals for alternative or substitute methods, reducing the number of these specifically for educational use. The development of various methods for surgery classes keeps updated and synchronized education with the development of teaching practices contributing to ethical thinking. Some of these substitutive methods are: use of fixation cadavers, synthetic models, such as foam and latex bladders, guts and muscles of animal carcasses, illustrative videos, virtual models, sutures in tissues, preparation of anatomical parts, among others. Surgical skill is developed through repetition exercises, which is why many institutions are adopting simulators and other training models in undergraduate programs and medical-veterinary residence, allowing the repetition of individualized exercises. In the present study, we used the liquid Larssen - modified Larssen (Silva et al., 2004) - which allows reuse bodies up to four times, in order to evaluate the organoleptic preservation of corpses and its viscera, used in the Surgical Technique teaching, comparing the preservation of bodies with and without heparin them. Therefore, we obtained 14 bodies of dogs, assigned by consensus by the owners, who were euthanized due to serious illness or death came naturally. In seven cadavers at the time of euthanasia was used heparinization volume of 5 ml intravenous and not in other seven bodies. The animals of both groups were preserved in cold storage (-12 degrees &deg; C to -8 degrees C) and withdrawn 20 hours before the training dea students in surgical technique of the digestive system, joint, urinary, respiratory ear and eye. For training, medical-veterinary residents were used and fifth graders at the Faculty of Veterinary Medicine and Animal Science of the University of São Paulo (FMVZ / USP). At the end of each training, they completed a questionnaire that assessed, empirically, consistency, color, odor and texture of the covered bodies, and thus compare preservation methods and the training efficiency. After analyzing the results it was found that, given the experimental conditions, there was no significant difference between the groups preserved with or without heparin; it was found efficiency in surgical training, clarifying, developing and enabling key participants in motor skills for forming a veterinary surgeon. We conclude that surgical training is fundamental and must be implemented in educational institutions, sugerindo- that make awareness and education by the owners with respect to donate their animals for medical education.