Background: Suture-less circumcision by Feracrylate glue creates a weak and non waterproob bond. Hence, there is wound dehiscence and delayed healing which favor infection in many patients. I am describing a new techn...Background: Suture-less circumcision by Feracrylate glue creates a weak and non waterproob bond. Hence, there is wound dehiscence and delayed healing which favor infection in many patients. I am describing a new technique for suture-less circumcision which is free from above limitations. Methods: In my center in the time span of 2 years, I did 51 cases of circumcision with Laser tissue welding technique (group A). Age range was 5 months to 21 years. During the same time span, in 56 patients circumcision was done by Feracrylate glue (group B). The age range was 3 months to 22 years. This group was kept as a control. Patients in both groups were randomly distributed. The technique of circumcision by Laser tissue welding is as follows. Patient is under short GA, the prepuce above the artery forceps is chopped off by scissors and bleeders are coagulated by bipolar cautery. Now, 0.9 ml 40% human albumin is taken in 1 ml syringe and mixed with 0.1 ml of 10% glutaraldehyde solution. The syringe is shaken vigorously to mix both the components. The skin and mucosa of penis are held by tooth forceps and a thin layer of this mixture is layered over it all around. Infrared Laser of 5 watts power and 850 nm illuminated over this bond for 60 seconds to polymerize it. Results: In group A, 2 (3.9%) patients developed partial wound gape, no patient had complete wound gape. 3 (5.88%) patients had grade 2 infections which settled with conservative treatment of oral antibiotics. In group B, 6 (10.71%) patients had partial wound gape and 8 (14.28%) patients had complete wound gapping. 11 (19.64%) patients developed grade 2 and 8 (14.28%) patients grade 3 wound infection. All these 19 patients’ post-operative antibiotics were started and given for 7 - 10 days. The Glutaraldehyde albumin mixture bond is already described in medical literature (Bioglue) for its use to seal coronary anastomosis after CABG operation, to seal sutures of cardiac surgery and for aortic dissection, etc. It is a surgical adhesive composed of purified bovine serum albumin (BSA) and glutaraldehyde and is already American FDA approved. It creates a flexible mechanical seal independently of the body’s clotting mechanism. In my technique, 0.9 ml of 40% human albumin is mixed with 0.1 ml 10% glutaraldehyde solution which costs only 50 cents which is a massive 1000 times cost reduction. Laser application polymerizes the glue and forms a waterproob bond in less than a minute. In my technique, percentage of glutaraldehyde used is only 10% compared to 50% in bioglue, hence it is non-toxic to the tissues. Conclusion: Suture-less circumcision by glutaraldehyde albumin glue enhanced Laser tissue welding is a safe, cheap and effective technique of performing circumcision. It is an important advance in circumcision surgery after a long time. The technique becomes a foundation for its vast application in other areas of surgery.展开更多
Objectives: Thrombocytopenia has been reported following implantation of Perceval suture-less aortic valve. However, the time course of thrombocytopenia and platelet recovery is unknown. In addition, the effect of thr...Objectives: Thrombocytopenia has been reported following implantation of Perceval suture-less aortic valve. However, the time course of thrombocytopenia and platelet recovery is unknown. In addition, the effect of thrombocytopenia on post-operative outcome is unknown. We sought to study this observation and correlate that with short-term outcome. Methods: This is a retrospective review of a prospectively collected database over a 3-year period of all isolated aortic valve replacements (70 patients) using bioprosthetic valves (sutured Magna and suture-less Perceval). All preoperative, intraoperative and postoperative variables were collected and analyzed. Platelets count and mean platelet volumes were collected and analyzed in respect to the type of valve used and their time course. Results: The cohort consisted of 70 consecutive patients of which 42 underwent Perceval suture-less valve (group Perceval) and 28 underwent bioprosthetic sutured valve (group Magna). There was no difference in platelets count and mean platelet volume at baseline. However, Perceval group had significant drop in platelet count from day 1 to day 3 post-operatively, followed by a gradual increase in platelet count until discharge. Mean platelet volume, however, was not different between the two types of valves. Postoperative outcomes were similar in the two groups with exception of intensive care and a hospital stay which were significantly shorter in Perceval group. Conclusion: Thrombocytopenia following Perceval suture-less valve is observed from day 1 postoperatively and it is a transient phenomenon. It does not correlate with worse clinical outcomes postoperatively. Larger studies are needed to elucidate the mechanism and its impact.展开更多
Background Total anomalous pulmonary venous connection （TAPVC） is the most important anomaly of the pulmonary veins. Many surgical techniques have been proposed to establish a widely patent connection between the co...Background Total anomalous pulmonary venous connection （TAPVC） is the most important anomaly of the pulmonary veins. Many surgical techniques have been proposed to establish a widely patent connection between the common pulmonary vein and the left atrium while avoiding post-repair pulmonary vein stenosis. However, for patients with hypoplastic common pulmonary vein, the traditional techniques may be limited by the vessel’s length and size. The anastomotic technique can cause trauma to the pulmonary venous endothelium. We propose a novel anastomotic technique for the primary surgical repair of supra-cardiac TAPVC where the venous incision is extended onto the vertical vein and a suture-less anastomosis is performed. Methods From January 2000 to December 2008, 143 patients were surgically treated for TAPVC at Guangdong Cardiovascular Institute, including 59 （41.2 %） cases of supracardiac type, 63 （44.1 %） of cardiac type, 6 （4.2 %） of infracardiac type, and 15 （10.5 %） of mixed type. Twenty one of 59 supracardiac TAPVC were undertaken with the extended anastomotic technique through the pericardial oblique sinus approach. This group included 9 boys and 12 girls. Aged at presentation ranged from 2 days to 13 years with a median of 4 months. Weight ranged from 2.3 kg to 25 kg with a median of 4.8 kg. Results There was no early or late mortality. One case failed to follow-up. The mean aortic cross-clamp time was 42.5 ± 6.4 minutes. The cardiopulmonary bypass time was 75.6 ± 7.2 minutes. Deep hypothermic circulatory arrest was not employed in any case. Intraoperative echocardiogram demonstrated a widely patent anastomosis between the common pulmonary vein and the left atrium. The velocities across the anastomosis were in the range of 0.50 to 0.75 m/s. Four cases required delayed sternal closure due to hemodynamic instability. The mean ICU stay was 8.7 ± 5.3 days with a mean period of artificial ventilation of 4.2 ± 2.9 days. The duration of follow up was 3.8 ± 1.8 years with one case lost to follow up. Assessments with transthoracic echocardiography showed the velocities across the anastomosis were in the range of 0.55 to 0.75 m/s. Conclusions Extended anastomosis with suture-less technique can be an effective method for primary repair of supracardiac TAPVC. TAPVC is the most important anomaly of the pulmonary veins.展开更多
文摘Background: Suture-less circumcision by Feracrylate glue creates a weak and non waterproob bond. Hence, there is wound dehiscence and delayed healing which favor infection in many patients. I am describing a new technique for suture-less circumcision which is free from above limitations. Methods: In my center in the time span of 2 years, I did 51 cases of circumcision with Laser tissue welding technique (group A). Age range was 5 months to 21 years. During the same time span, in 56 patients circumcision was done by Feracrylate glue (group B). The age range was 3 months to 22 years. This group was kept as a control. Patients in both groups were randomly distributed. The technique of circumcision by Laser tissue welding is as follows. Patient is under short GA, the prepuce above the artery forceps is chopped off by scissors and bleeders are coagulated by bipolar cautery. Now, 0.9 ml 40% human albumin is taken in 1 ml syringe and mixed with 0.1 ml of 10% glutaraldehyde solution. The syringe is shaken vigorously to mix both the components. The skin and mucosa of penis are held by tooth forceps and a thin layer of this mixture is layered over it all around. Infrared Laser of 5 watts power and 850 nm illuminated over this bond for 60 seconds to polymerize it. Results: In group A, 2 (3.9%) patients developed partial wound gape, no patient had complete wound gape. 3 (5.88%) patients had grade 2 infections which settled with conservative treatment of oral antibiotics. In group B, 6 (10.71%) patients had partial wound gape and 8 (14.28%) patients had complete wound gapping. 11 (19.64%) patients developed grade 2 and 8 (14.28%) patients grade 3 wound infection. All these 19 patients’ post-operative antibiotics were started and given for 7 - 10 days. The Glutaraldehyde albumin mixture bond is already described in medical literature (Bioglue) for its use to seal coronary anastomosis after CABG operation, to seal sutures of cardiac surgery and for aortic dissection, etc. It is a surgical adhesive composed of purified bovine serum albumin (BSA) and glutaraldehyde and is already American FDA approved. It creates a flexible mechanical seal independently of the body’s clotting mechanism. In my technique, 0.9 ml of 40% human albumin is mixed with 0.1 ml 10% glutaraldehyde solution which costs only 50 cents which is a massive 1000 times cost reduction. Laser application polymerizes the glue and forms a waterproob bond in less than a minute. In my technique, percentage of glutaraldehyde used is only 10% compared to 50% in bioglue, hence it is non-toxic to the tissues. Conclusion: Suture-less circumcision by glutaraldehyde albumin glue enhanced Laser tissue welding is a safe, cheap and effective technique of performing circumcision. It is an important advance in circumcision surgery after a long time. The technique becomes a foundation for its vast application in other areas of surgery.
文摘Objectives: Thrombocytopenia has been reported following implantation of Perceval suture-less aortic valve. However, the time course of thrombocytopenia and platelet recovery is unknown. In addition, the effect of thrombocytopenia on post-operative outcome is unknown. We sought to study this observation and correlate that with short-term outcome. Methods: This is a retrospective review of a prospectively collected database over a 3-year period of all isolated aortic valve replacements (70 patients) using bioprosthetic valves (sutured Magna and suture-less Perceval). All preoperative, intraoperative and postoperative variables were collected and analyzed. Platelets count and mean platelet volumes were collected and analyzed in respect to the type of valve used and their time course. Results: The cohort consisted of 70 consecutive patients of which 42 underwent Perceval suture-less valve (group Perceval) and 28 underwent bioprosthetic sutured valve (group Magna). There was no difference in platelets count and mean platelet volume at baseline. However, Perceval group had significant drop in platelet count from day 1 to day 3 post-operatively, followed by a gradual increase in platelet count until discharge. Mean platelet volume, however, was not different between the two types of valves. Postoperative outcomes were similar in the two groups with exception of intensive care and a hospital stay which were significantly shorter in Perceval group. Conclusion: Thrombocytopenia following Perceval suture-less valve is observed from day 1 postoperatively and it is a transient phenomenon. It does not correlate with worse clinical outcomes postoperatively. Larger studies are needed to elucidate the mechanism and its impact.
文摘Background Total anomalous pulmonary venous connection （TAPVC） is the most important anomaly of the pulmonary veins. Many surgical techniques have been proposed to establish a widely patent connection between the common pulmonary vein and the left atrium while avoiding post-repair pulmonary vein stenosis. However, for patients with hypoplastic common pulmonary vein, the traditional techniques may be limited by the vessel’s length and size. The anastomotic technique can cause trauma to the pulmonary venous endothelium. We propose a novel anastomotic technique for the primary surgical repair of supra-cardiac TAPVC where the venous incision is extended onto the vertical vein and a suture-less anastomosis is performed. Methods From January 2000 to December 2008, 143 patients were surgically treated for TAPVC at Guangdong Cardiovascular Institute, including 59 （41.2 %） cases of supracardiac type, 63 （44.1 %） of cardiac type, 6 （4.2 %） of infracardiac type, and 15 （10.5 %） of mixed type. Twenty one of 59 supracardiac TAPVC were undertaken with the extended anastomotic technique through the pericardial oblique sinus approach. This group included 9 boys and 12 girls. Aged at presentation ranged from 2 days to 13 years with a median of 4 months. Weight ranged from 2.3 kg to 25 kg with a median of 4.8 kg. Results There was no early or late mortality. One case failed to follow-up. The mean aortic cross-clamp time was 42.5 ± 6.4 minutes. The cardiopulmonary bypass time was 75.6 ± 7.2 minutes. Deep hypothermic circulatory arrest was not employed in any case. Intraoperative echocardiogram demonstrated a widely patent anastomosis between the common pulmonary vein and the left atrium. The velocities across the anastomosis were in the range of 0.50 to 0.75 m/s. Four cases required delayed sternal closure due to hemodynamic instability. The mean ICU stay was 8.7 ± 5.3 days with a mean period of artificial ventilation of 4.2 ± 2.9 days. The duration of follow up was 3.8 ± 1.8 years with one case lost to follow up. Assessments with transthoracic echocardiography showed the velocities across the anastomosis were in the range of 0.55 to 0.75 m/s. Conclusions Extended anastomosis with suture-less technique can be an effective method for primary repair of supracardiac TAPVC. TAPVC is the most important anomaly of the pulmonary veins.
