Endoscopic Dacryocystorhinostomy With Ologen Implant

Objective: To compare the effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation.Background: Chronic dacryocystitis is an inflammatory disorder of the lacrimal sac that is mostly accompanied by partial or total nasolacrimal duct obstruction. Watering and discharge are the most common symptoms, however some cases can escalate to serious ocular and extraocular complications. It can result in severe ocular morbidity and loss of productivity at work, as it can temporarily obscure vision, prevent a person from concentrating on their task, and be socially uncomfortable. The goal of this research is to find a way to reduce recurrence after DCR surgery.Methods: We conducted a prospective controlled study to evaluate effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation. A total of 40 patients underwent primary endoscopic DCR surgery in Menoufia University Hospital from march 2020 till march 2021. A total of 20 cases did endoscopic DCR using ologen implant (group A) and the other 20 cases did endoscopic DCR using silicon tube (group B). Results: The success rate, which was evaluated by MUNK score and syringing test, was compared between both groups also rate of complications like epistaxis, implant complications and post surgery synechiae was compared. Success rates was 75% in ologen group and 85%in the other group. Epistaxis, infection and post sugery synechiae were statistically in significant between the two groups but implant complications was more in ologen group than the other group.Conclusion: Endoscopic DCR with ologen implantation is not superior to endoscopic DCR with silicon stenting due to the challenging ologen implantation procedure and the high cost relative to silicon stenting.

Differences in human and sheep platelet adherence, aggregation and activation induced by glass beads in a modified chandler loop-system

In human cardiovascular research, sheep in particular are used as a large animal model in addition to pigs. In these animals, medical products, developed and tested for human medical purposes, are almost exclusively used in interventional studies. Therefore, the extent to which platelets from human and ovine blood differ in terms of adherence, aggregation and activation after a 4- or 8-minutes exposure to glass was investigated. Testing was performed with platelet-rich plasma (PRP) and a modified Chandler loop system, with 4- and 8-minute blood-material exposure times corresponding to 20 and 40 test cycles, respectively, through the entire silicon tube loop of the test system. In sheep and human PRP, contact with the silicone tubing resulted in a decrease in platelet count after 4 minutes and 20 test cycles, respectively. Four more minutes (20 additional test cycles) caused a further decrease of the platelet count only in sheep PRP. When the silicon tube was partly filled with glass beads, these effects were more pronounced and stronger in sheep then in human PRP. The mean platelet volume, which was used as parameter for platelet aggregation, did not change over time in human PRP without glass exposure. With glass exposure in human and sheep PRP the mean platelet volume increased within 40 test cycles, but this increase was stronger in sheep than in human PRP. Regarding activation behavior, the activation markers CD62P and CD63 were detectable only in < 30% (sheep) and < 45% (human) of platelets, whereas after 8 min of glass exposure, the proportion of CD62P+ and CD63+ cells was more increased than before only in sheep. These results indicate that ovine platelets adhere more strongly to glass and show stronger aggregation behavior after glass contact than human platelets, but that ovine and human platelets differ only slightly in activability by glass.

Experimental Analysis of Hot Corrosion Behaviour of some Composite Coatings on Boiler Steel at Elevated Temperature

Hot corrosion is the main reason of failure of boiler tubes used at high temperature in thermal power plants. This paper is an attempt to investigate the effect of different composite coatings on boiler tube steel in corrosive environment of Na2SO4 – 60%V2O5 at 900°C for 50 cycles. The coatings have been deposited with high velocity oxy fuel process. The samples were exposed to hot corrosion in a Silicon tube furnace at 900°C for 50 cycles. The kinetics of corrosion behaviour were analysed by the weight gain measurements after each cycle. Corrosion products were analysed with weight change statistics, X-ray diffraction, and scanning electron microscopy. It is found that 100Cr3C2 composite coatings provided the higher resistance to corrosion as compared to other types of coatings. Cr carbide layer was formed on the surface and these layers provided the protection from hot corrosion.

Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

Lacrimal stenting versus three-snip punctoplasty for treatment of punctal stenosis or occlusion: An open-label, randomized clinical trial

Background: To compare the short-term anatomical and functional outcomes of, as well as patient satisfaction with, lacrimal stenting and three-snip punctoplasty for the treatment of punctal stenosis or occlusion. Methods: In this open-label, randomized clinical trial, we included 50 eyes of 30 patients diagnosed with punctal stenosis or occlusion. They were randomly allocated to two groups of 25 eyes each, using central telephone randomization. Group A underwent a lacrimal stenting procedure and was subdivided into two subgroups: Group A1 (13 eyes) received polyvinylpyrrolidone-coated perforated punctal plugs, and Group A2 (12 eyes) received closed intubation using a bicanalicular silicon tube. Group B included 25 eyes that underwent three-snip punctoplasty. All eyes were examined after 1 day, 1 week, 1 month, 3 months, and 6 months. Postoperative anatomical success assessing the punctum size, functional success using the fluorescein disappearance test, and patient satisfaction based on epiphora scoring were recorded. Results: Both study groups were comparable in terms of sex and age distribution. Compared to Group B, Group A had a significantly larger punctum size at one, three, and 6-month postoperatively (P = 0.009, 0.01, and 0.02, respectively). The difference in FDT results was significant between the two groups at all follow-up visits (P = 0.008, 0.0001, 0.003, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively). Likewise, patient satisfaction was significantly different between both groups at all follow-up visits (P = 0.007, 0.001, 0.005, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively). Conclusions: Lacrimal stenting is an effective method for the treatment of punctal stenosis or occlusion. Overall, the FDT results and patient satisfaction outcomes were significantly better. Keywords: punctal occlusion, punctal stenosis, epiphora, lacrimal stenting, closed intubation, bicanalicular silicon tube, perforated punctal plugs, three-snip punctoplasty, 3-snip punctoplasty

The Potential of AFX Iliac Extension in Abdominal Aortic Aneurysms with High Iliac Tortuosity

Background Recently, endovascular aortic aneurysm repair (EVAR) is the most common surgery for abdominal aortic aneurysm (AAA). However, iliac limb complications of EVAR often cause problems in patients with high iliac tortuosity. There is no difference of rate of iliac limb complication among EVAR devices, such as Excluder, Endurant, and Zenith in high iliac tortuosity. But there has been not reported about AFX. Objectives We studied AFX iliac extension as it is the only stent graft with an endoskeletal framework. This study aimed to evaluate the AFX iliac extension patency in a case in vitro and to use it in seven cases of AAA with high iliac tortuosity. Methods The silicon tube inserted in the AFX iliac extension was flexed at 30, 60, 90, and 120 degrees, and the lumen of the iliac extension was monitored using an underwater camera in the circulatory system. During the experiment, the Iwaki Bellows Pump (IWAKI CO., LTD., Tokyo, Japan) produced a pulsating flow. We used this in seven patients with AAA high iliac tortuosity cases between November 2018 and May 2019. Results If the silicon tube inserted in the AFX iliac extension was flexed at 60 and 120 degrees, the stent protruded into the lumen. However, the graft was dilated at all degrees. All seven patients with AFX iliac extension had no complications and a patent iliac artery. Conclusion The AFX iliac extension can reduce iliac limb complications in cases of high iliac tortuosity.

Repositioning of the Severe Prolapsed Silicone Tubes after Bicanalicular Nasal Intubation: A Novel Technique

Background. Bicanalicular nasal intubation is widely used in lacrimal drainage system surgery. Its common complication is lateral displacement or spontaneous prolapse. When the distal part of the silicone tubes cannot be seen in the nose endoscopically, either repositioning or removal could be a challenge. We developed a simple technique to reposition the severe prolapsed silicone tubes. Method. This retrospective study included 6 patients with severe prolapsed silicone tubes who had undergone bicanalicular nasal intubation between January 2017 and December 2019. We used a memory wire probe to pull a nylon suture through the lacrimal passage retrograde. Then, the nylon suture was cut into two lines. One line was coiled to the prolapsed tube and tied to another line. This nylon turned into a “lasso” to capture the silicone tube and then lock its knot. By pulling the nylon suture, the severe prolapsed silicone tube was repositioned to the nasal cavity. Results. Using this technique, we successfully repositioned severe prolapsed silicone tubes without any complication in 6 cases. Conclusions. Silicone tube reposition guiding by using a memory wire probe is an optional technique in the treatment of prolapse of silicone tubes, particularly if the distal part of the silicon tube was embedded in the lacrimal sac and cannot be seen in the nose by endoscopy. It is a feasible, minimally invasive, safe, and effective method, avoiding premature tube removal.

Long-Term Outcome of Sciatic Nerve Regeneration Using Bio3D Conduit Fabricated from Human Fibroblasts in a Rat Sciatic Nerve Model

Previously, we developed a Bio3D conduit fabricated from human fibroblasts and reported a significantly better outcome compared with artificial nerve conduit in the treatment of rat sciatic nerve defect. The purpose of this study is to investigate the long-term safety and nerve regeneration of Bio3D conduit compared with treatments using artificial nerve conduit and autologous nerve transplantation. We used 15 immunodeficient rats and randomly divided them into three groups treated with Bio3D ( n = 5) conduit, silicon tube ( n = 5), and autologous nerve transplantation ( n = 5). We developed Bio3D conduits composed of human fibroblasts and bridged the 5 mm nerve gap created in the rat sciatic nerve. The same procedures were performed to bridge the 5 mm gap with a silicon tube. In the autologous nerve group, we removed the 5 mm sciatic nerve segment and transplanted it. We evaluated the nerve regeneration 24 weeks after surgery. Toe dragging was significantly better in the Bio3D group (0.20 ± 0.28) than in the silicon group (0.6 ± 0.24). The wet muscle weight ratios of the tibial anterior muscle of the Bio3D group (79.85% ± 5.47%) and the autologous nerve group (81.74% ± 2.83%) were significantly higher than that of the silicon group (66.99% ± 3.51%). The number of myelinated axons and mean myelinated axon diameter was significantly higher in the Bio3D group (14708 ± 302 and 5.52 ± 0.44 μm) and the autologous nerve group (14927 ± 5089 and 6.04 ± 0.85 μm) than the silicon group (7429 ± 1465 and 4.36 ± 0.21 μm). No tumors were observed in any of the rats in the Bio3D group at 24 weeks after surgery. The Bio3D group showed significantly better nerve regeneration and there was no significant difference between the Bio3D group and the nerve autograft group in all endpoints.

Non-Endoscopic Endo-nasal Dacryocystorhinostomy in a Saddle shaped nose: A Case Report

Introduction: Non Endoscopic endo-nasal dacryocystorhinostomy retains the benefit of an Endo-nasal approach and can be done without using an expensive video endoscope or laser system. Case presentation: A 22 years old female presented with epiphora and medial canthal mass in her left eye, accompanied by discharge and recurrent conjunctival congestion since childhood. Physical examination revealed loss of height of the nose with discharge in her left eye, and am immobile and non-tender mass below the level of medial canthal tendon. On applying pressure over the lesion there was mucopurulent discharge from both the upper and lower punctum . The bridge of the nose was very flat and external dacryocystectomy was a challenge. A non-endoscopic endonasal dacryocystorhinostomy with silicon tube intubation was planned. During the procedure, the bone was lower than normal requiring more bone nibbling. Epiphora was resolved immediately after surgery. Conclusion: Non-Endoscopic endo-nasal dacryocystorhinostomy has the benefit of doing it through an endo-nasal approach without expensive and space consuming video-endoscope making more room for bone nibbling even in a narrow and deformed nasal cavity.