wound therapy (NPWT) device (Variant I) provides suitable and preferable cosmetic outcome unlike unsatis- factory cosmetic outcome from the implementation of the incision and wound gauze package only (Variant II). Reduction in the number of dressing changes for Variant I benefits both the nurse who takes care of the wound and the patient with the condition in terms of decrease time as well as the pain experienced during dressing is reduced producing a better outcome for the patient. The primary closure system provides better satisfaction compared to the traditional incision and gauze package technique. Better outcome as a result of patient satisfac- tion provides relief to patient . Also as has been reported by some authors, the primary closure system with subsequent connection to the NWPT prevents the patient from acquiring any secondary infection. Improved re- covery rate implies reduction in hospitalisation and hospital cost. Administration of antibiotics only in the treatment of some abscesses is sometimes inadequate, hence the need for incision and drainage . Incision and drainage often seen as an out-patient procedure is usually carried out in management of abscess or boil to release pus. This procedure may require treatment of the area with antibiotics and aseptically making an incision to allow the pus to drain through the incision. However, because of the possibility of infection, the patient should be treated with antibiotics. The use of the primary closure has been recommended to be beneficial due to its cost effectiveness and not associated with further wound complication. Thus basically this method utilizes negative pressure that promotes wound granulation similar to that obtained from the use of VAC developed by Argenta and Morykwas . The primary wound closure and drainage has been reported to promote faster wound healing and reducing hospital stay. It is also reported to be a safe procedure. A study by Vosa et al. (2012) revealed the implementation of the primary wound closure system is safe and feasible and most importantly does not compromise on mortality thus, giving high survival rates for patients .
left to heal by open healing (secondary intention). Advo- cates of this technique state that reduced wound tension facilitates trouble free healing without recurrence if all sinus tracts are fully excised . Alternatively, the wound may be closed to heal by primary closure, either by mid- line closure techniques (with the wound lying within the natal cleft)  or other techniques (where the wound is placed out with the midline) . In this study, we used excision and partially closure as a novel minimally inva- sive approach for management of pilonidal disease.
Five years later McGregor and Jackson 4 extended the range of the flap, noting that an undelayed flap will generally reach as far back as the ear. Bakamjian 5 stated that the externally transferred flap will reach the orbit and zygoma and the nasopharynx internally. The Bakamjian flap, as it was commonly termed, became the workhorse flap for cutaneous defects of the face and neck Daniel and coworkers 6 identified three main vascular contributions to the Background and objective: Deltopectoral flap is a two staged flap requiring skin graft of the donor site. This study was conducted to evaluate the possibility of primary closure of the deltopectoral flap-donor site without skin grafting.
The trial is a double blinded randomized controlled inter- national multi centre trial comparing traditional closure with running slowly absorbable suture to closure with the aid of prosthetic mesh. A total of 11 centers have agreed to participate in the trial which are located in three different countries (The Netherlands, Germany and Austria). A total number of 460 patients will be included. Patients will be randomized in three groups per-operatively to either re- ceive primary closure, or mesh supported closure either in a sublay or onlay position. Patients will be kept unaware of the procedure until the endpoint of the trial was assessed. Outpatient clinic controls will be done by surgeons or sur- gical residents blinded for the procedure. Results will be stratificated by center and operation indication.
Medline and Scopus databases were used to search rele- vant studies since initiation to November 2013. Search terms used were ( “ delayed primary closure ” OR “ delay pri- mary closure ” OR “ delayed closure ” OR “ delay closure ” OR “ primary closure ” OR “ wound closure ” ) AND ( “ surgical wound infection ” [Mesh] OR “ superficial surgical site in- fection ” OR “ wound infection ” OR “ superficial SSI ” ) with limited to randomised controlled trials (RCTs), English, and human for Medline; English, medicine, article, article in press for Scopus. List of references of previous meta- analyses and all eligible studies were also explored for eligibility.
Two cases had bile leak through the drain that was inserted in the hepatorenal pouch, one in the primary closure (1/12) and one in the T-tube group (1/7). There were no manifestations of neither local nor general peritonitis. The bile leak in the patient with primary closure was minimal, started second post-operative day and stopped with conservative treatment on the ifth day while that with T-tube was moderate, started third post-operative day and stopped with conservative treatment on the ninth day. No patient was in need for re-operation (Table 1).
Mean healing time was significantly shorter in patients treated more recently by primary intention in comparison with historical patients (28 vs 81 days). The only complication observed was a small superficial abscess that developed around a non-absorbable stitch 10 months after closure in a patient treated by primary closure. Conclusions: According to our results, fast healing can be safely obtained by closure of a clinically healthy wound, despite growth of multidrug resistant organisms, even in immune-compromised patients.
Primary wire closure has traditionally been the preferred method of closure for median sternotomy incisions, and more than 40 different closure techniques have been suggested for optimizing sternal stability [7, 8]. Several studies have investigated their effectiveness, and others have examined the biomechanical properties of the different methods [9–12]. Additionally, studies have shown that in patients with wound instability, dehiscence, or DSWI, re-entry into the chest and rewiring of sternot- omy incisions increase the risk of perioperative mortality [13, 14]. As such, rigid fixation with sternal plating has recently begun to be used for sternal closure in such patients. Early clinical, cadaveric, and biomech- anical studies show sternal plating to be a reliable method for stabilizing the sternum in complicated cases [15–17]. For example, Fawzy et al., in a human cadaveric model, showed that it required signifin- cantly increased intrathoracic pressure to cause a 2.0 mm separation in wires with one sternal plate reinforcement vs. wires alone. They concluded that adding a single sternal plate to primary closure im- proves the strength of the sternum . Additionally, Snyder et al. showed that postoperative length of stay was significantly shorter in patients who had sternot- omy closure with sternal plates .
Baseline characteristics of the patients were described. Predictors were compared between SSI and non-SSI using chi-square (or exact test) and Student’s t test (or Mann-Whitney U test) for categorical and continuous data, respectively. Variables with p value less than 0.10 would be included in multivariable analysis. For adjust- ing purpose, type of wound closure (i.e., delayed primary or primary closure) was included in the multivariable analysis. Forward stepwise logistic regression was applied to identify predictors that significantly associated with SSI (p value < 0.05) and thus should be kept in a final parsimonious model.
These wounds have been handled in a traditional manner with late primary closure or second intention, a situation that constitutes a real physical and psychological pain for those who suffer from it, due to the doubling of their hospital stay associated with the delay in healing of wounds, increased morbidity and mortality and prolonging their early incorporation into the family, work or school environment, constituting a very high cost for society [16,17].
Previous studies conducted at different centers in Singapore revealed contradictory evidence for the risk of progression to primary angle closure glaucoma (PACG) following prior APAC after laser peripheral iridotomy (LPI). An initial study conducted at the National University Hospital (NUH) between 1990 and 1994 revealed that a majority (58.1%) of these Asian eyes required additional treatment with ocular hypotensive medication, and 32.7% of patients required filtration surgery after an APAC episode. 5
Clinical studies showed that the amount of blood loss depends on the operation technique, the surgeon's expe- rience and the timing of cleft closure [6,16]. Scheune- mann and Stellmach, for example, described an average blood loos of 32–50 ml in their patient group during an unilateral cheiloplasty. Cheiloplasty in combination with the repair of the nasal floor was associated with an average blood loss of 49–60 ml and confirmed on palatoplasty with a blood loss of about 87–129 ml . Another inves- tigation by Reinisch described an average blood loss of 30 ml during cheiloplasty .
This stage is characterized by sudden and severe elevation of IOP as a result of total closure of the angle. This stage presents with rapidly progressive impairment of vision associated with periocular pain and congestion. Nausea and vomiting may occur in severe cases. On examination during acute stage shows a ciliary flush, elevated IOP, odematous cornea with epithelial vesicles. Anterior chamber is shallow with peripheral irido corneal contact which is best detected by directing a narrow slit beam on to the limbus at an angle of 90 0 . The pupil is vertically oval, fixed in semi dilated position, unreactive to both light and accommodation. Subsequent examination after corneal oedema has cleared shows aqueous flare and cells, dilated and congested blood vessels on iris, odematous hyperemic optic disc.
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Eyes with APAC that responded to medical treatment but had other signs suggesting CACG showed a better response to trabeculectomy with decline in IOP in about 87.5% of cases. In this study, these eyes did not receive LPI prior to the trabeculectomy. There are still insufficient data to determine whether an eye with APAC and signs of CACG is better treated with primary LPI or a primary trabeculec- tomy. The indication for performing trabeculectomy surgery may include those that had an acute on chronic type of presentation, where there was already extensive damage to the optic nerve and/or the persistence of high IOP after other treatments such as LPI.
Results: The mean IOP was 19.46(±7.05) mmHg and mean CCT was 508.07(±33.26) μ m. The mean IOP for primary open angle glaucoma (POAG), ocular hypertension (OHT), normal tension glaucoma (NTG), pseudoexfoliative glaucoma (PXG) and primary chronic angle closure glaucoma (PCAG) patients was 19.22 mmHg, 21.39 mmHg, 14.33 mmHg, 33.25 mmHg and 14.75 mmHg respectively. The mean CCT values were 502.24 μ m (POAG), 524.32 μ m (OHT), 500.75 μ m (NTG), 579.00 μ m (PXG) and 530.25 μ m (PCAG). Age of the patient and glaucoma surgery had an influence on corneal thickness. A positive relationship was found between CCT and IOP (p < 0.001). Conclusions: The mean CCT of Ethiopian glaucoma patients is thin in comparison to other ethnic groups and patients with OHT have thicker corneas than POAG patients. Hence determination of CCT for each patient is necessary in the up-to-date glaucoma management.
Craniosynostosis is the premature closure of cranial sutures. Primary, or congenital, craniosynostosis is often sporadic but may be associated with genetic or chromosomal abnormalities. Secondary craniosynostosis presents after gestation, and can occur in metabolic bone diseases, including rickets. We describe the first reported cases of primary craniosynostosis in 2 unrelated, term infants with X-linked hypophosphatemic rickets (XLH). The diagnosis of XLH in both patients was confirmed by genetic testing. At the time craniosynostosis was detected, the patient in the first case did not have any other clinical features of XLH. The second patient developed clinical findings of craniosynostosis, followed by rickets. These are the earliest reported cases of craniosynostosis in XLH and demonstrate that craniosynostosis may be a presenting feature of this disease.
were performed using chi-square or Fisher’s exact test appropriately. For diabetes, a further two-group comparison was done to assess the two-group differences. Abbreviations: AGIS, Advanced Glaucoma Intervention Study; SD, standard deviation; bpm, beats per minute; BP, blood pressure; mmHg, millimeter of mercury; CDR, cup-to- disc ratio; IOP, intraocular pressure; HVF, Humphrey visual field; MD, mean deviation; PSD, pattern standard deviation; PACG, primary angle-closure glaucoma; POAG, primary open-angle glaucoma; NA, not applicable; NTG, normal-tension glaucoma; LogMar, logarithm of the minimum angle of resolution; ANOVA, analysis of variance.
Glaucoma is the second leading cause of blindness worldwide. It is a relatively common eye disease charac- terized by the pathological loss of retinal ganglion cells resulting into progressive loss of sight and related changes in the retinal nerve fiber layer and optic nerve head . Glaucoma affects 70 million people worldwide and by the year 2020, this number is estimated to rise to around 79.6 million . Glaucoma can be classified as primary or secondary based on the etiology and aqueous humor dynamics . Primary glaucoma (PG) is one of the most common optic neuropathies and further classi- fied as primary open angle glaucoma (POAG) and pri- mary angle closure glaucoma (PACG) on the basis of gonioscopy (anterior chamber anatomy) and their spe- cific etiology.
Chen et al. (2015) evaluated the risk of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in depression patients with long-term use of selective serotonin reuptake inhibitors. The au- thors used data from the National Health Insurance Re- search Database in Taiwan and identified 26,186 patients with newly diagnosed depression and without preexist- ing glaucoma. The authors divided the patients into two cohorts. The first cohort included 13,093 patients with one year of serotonin reuptake inhibitors use. The second was a comparison cohort which included 13,093 patients who had never used serotonin reuptake inhibitors. All cohorts included patients > 20 years. The authors used the Kaplan-Meier method for evaluating the incidence of open-angle and angle-closed glaucoma between serotonin reuptake inhibitors and the comparison cohorts. For cal- culating the differences between the curves, the authors used a long-rank test. It was revealed that the incidence of open-angle and angle-closure glaucoma between the serotonin reuptake inhibitors and comparison cohorts had non-significant differences (long-rank test P = 0.52 for open-angle glaucoma, P = 0.32 for angle-closure glau- coma). Also, the authors concluded that the incidence of open-angle glaucoma in the serotonin reuptake inhibitors cohort was non-significantly higher than that in the com- parison cohort (1.51 vs 1.39 per 1000 person-years), with an adjusted hazard ratio of 1.07 (95% CI = 0.82–1.40). The inci- dence of angle-closure glaucoma in the serotonin reuptake inhibitors was non-significantly lower than that in the comparison cohorts (0.95 vs 1.11 per 1000 person-years), with an adjusted hazard ratio of 0.85 (95% CI = 0.62–1.18). The authors concluded that the risk of primary open-angle and primary closed-angle glaucoma in the Chinese ethnic population in Taiwan does not depend on the long-term use of serotonin reuptake inhibitors (3).
difficult cases may not have been evenly distributed across all resident classes. More junior residents may preferentially get assigned LPI procedures that are perceived as more straightforward, leaving the more difficult cases for the senior residents. The decrease in mean power usage across resident classes may perhaps be even more pronounced among patients randomized to residents of varying experi- ence. The decreasing total power use among residents of increasing seniority suggests that a learning curve is present, though whether this learning curve is sufficiently aggressive remains to be seen. With proper supervision and standard- ized training, it might be reasonable to expect residents to be performing LPIs using total powers comparable to mean powers reported in the literature for Caucasian and non-Caucasian eyes at a much earlier stage in training. The learning curve might be shortened with standardization of power per shot depending on the thickness of the iris (based on color or ethnicity) or with a lower threshold to increase power per shot if the laser setting is not effective. Increased observation of junior residents may help them to improve laser aim and focusing to decrease rate of ineffective laser shots. Standardizing iridotomy size might also be beneficial to prevent early closure of the iridotomy or an unnecessarily large iridotomy.