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Urothelial and Urethral Cancer
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Ibrahim Jubber, Karl H. Pang, James W.F. Catto
Lymphatic drainage − important in the extent of pelvic lymph node dissection (PLND) (Figure 24.6).External iliac.Obturator.Internal iliac (hypogastric).Common iliac.Presacral.Abdominal (paracaval, iteraaortocaval, para-aortic).
Quality of Life and Survivorship in Head and Neck Cancer
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Debate continues around the importance of obturation or free tissue transfer on HRQoL for the maxillectomy defect.70 Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.
Nasal Septal Perforations
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The principle of obturation is to cover the inflamed mucosal margin. In 2002, Meyer13 cited the use of septal obturators in the management of perforations. Inert sheeting (usually silastic) was placed to prevent drying and encourage epithelialization over the cartilage/bony septum to create a mature mucosal edge. Evidence suggests that patients do derive benefit from the use of nasal obturators, but opinion on their usage and effectiveness is divided. Facer and Kern,14 in a retrospective study of 73 patients, reported 72.8% of obturators remained in place, but 27.4% of buttons were removed or were extruded. Brain4 described the long-term outcome of 102 patients with medium or large holes (1 cm perforations or larger). He described a good result in 44.4 and 32.4%, respectively. The main benefit from obturation appears to be the control of whistling and epistaxis. Often, crusting and nasal discomfort remain a problem.6,15 The feeling of obstruction is improved when crusting is reduced, but the bulk effect of an obturator may increase blockage, particularly in anterior perforations with a narrow nasal valve. Poorly tailored silastic may irritate the mucosa, particularly with anterior holes close to the membranous septum. Patient interference and movement of the mobile membranous septum against the edge of the obturator can lead to granuloma formation. It is often for these reasons that patients request removal of the obturator.
Cervical nerve root variant: report of two cases under the cervical endoscopy and review of clinical literature
Published in British Journal of Neurosurgery, 2023
Bin Sun, Changgui Shi, Huiqiao Wu, Ying Zhang, Nicholas Tsai, Zeng Xu, Xiao-Dong Wu, Wen Yuan
She underwent posterior cervical endoscopic keyhole surgery at the right C6-7. After a skin incision of 7 mm was made at the medial junction of the inferior and superior facet joint, an obturator (6.9 mm outer diameter) was introduced. The tip of the obturator was placed at the marked point (Figure 1) under fluoroscopic guidance. The back wall of the nerve root canal and the medial margin of the facet joint were palpated with the obturator. An oblique-type working channel was introduced on the obturator and the endoscope was introduced. We used 3-mm drills and bone punches to resect the bone at the medial joint segment. The inferior part of lamina was resected until the superior pedicle of lower adjacent vertebra was probed and similarly the superior part of lamina was resected until the inferior pedicle of upper adjacent vertebra was probed. Then the endoscopic cannula was advanced into the canal tilted from medial to lateral direction. Additional decompression was performed by undercutting the posterior wall of C7 foramen from medial to lateral until a probe could pass the foramen freely. Osteophyte of Luschka’s joint was exposed and drilled flat. No disc herniation was found. The anomalous right C7 root was found. Two branches originated from the proximal trunk of the C7 root. Both exited through the C6-7 foramen. The sheath of the cephalad white branch was inadvertently incised during exploration and the nerve fibres were observed (Figure 2).
Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan
Published in Journal of Obstetrics and Gynaecology, 2022
Hirotaka Sato, Shota Otsuka, Hirokazu Abe, Sachiyuki Tsukada
Surgeries were performed at Hokusuikai-Kinen Hospital by a trained urologist. Briefly, two pieces of polypropylene mesh (GYNEMESH PS; Ethicon, Somerville, NJ) were used for LSC. In patients with a uterus, supracervical hysterectomy was typically performed. When uterus preservation was required, the anterior mesh strip was Y-shaped and penetrated through the broad ligament. Then, posterior dissection of the levator ani muscles was performed bilaterally, and posterior mesh was fixed to the levator ani muscles using non-absorbable sutures (Tefdesser II; Kono Seisakusyo, Chiba, Japan). Anterior dissection of the bladder neck was performed. The anterior mesh was fixed to the vaginal wall using non-absorbable sutures, and the anterior and posterior mesh pieces were then sutured together bilaterally to the cervical stump and uterosacral ligaments using non-absorbable sutures. Subsequently, the peritonea overlying the sacrum were dissected. The parietal end of one piece of mesh was then fixed to the sacral promontory using non-absorbable sutures. Peritoneal closure was performed above the mesh pieces using absorbable sutures (Monocryl; Ethicon). All reoperations for SUI were performed with a tension-free vaginal tape obturator (TVT-O).
Development of an algorithm for effective design of respirator half-masks and encapsulated particle filters
Published in International Journal of Occupational Safety and Ergonomics, 2022
Serhii Cheberyachko, Yurii Cheberyachko, Mykola Naumov, Oleg Deryugin
As a result of the performed work, the algorithm for designing and manufacturing filter masks of the dust respirator, which consists of several stages, was worked out and improved. In the first stage, the dimensions of faces of potential consumers were defined, and then the dimensions obtained were applied to a 3D head model on which the contour of a half-mask obturator was constructed. We paid attention to the difficulties that were associated with different thickness and elasticity of different parts of the face, which could affect the obturator design to ensure uniformity of clamping forces and minimal impact on blood circulation in the soft tissues of the worker’s face. Then, we selected the appropriate dust respirator structure (number of particle filter layers, needed respiration valve) depending on the concentration and properties of aerosols and operating conditions and the type of particle filter material depending on the characteristics of harmful aerosols (diameter of aerosol particles, toxicity, hazard class). This process was described in detail by Makowski and Okrasa [23] and by Hayashi and Tokura [24]. It should be noted that the modern development level of particle filter materials allows for a high degree of air purification.