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Background Ventricular septal defect (VSD) is the most common congenital heart defect in children and adults. Until recently, open-heart surgical closure has traditionally been considered the mainstay of intervention for the majority of VSDs. The development of a trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices that can safely and effectively close these defects was welcomed by cardiologists, patients, and their families making trans-catheter device closure an attractive and feasible alternative. Objective We aim to evaluate the intermediate and long-term follow-up outcome of patients who underwent percutaneous trans-catheter closure of isolated ventricular septal defects. Patients and Methods This study is an exploratory pilot single-tertiary center study. The study included 25 patients who have successfully undergone percutaneous ventricular septal closure in the cardiac catheterization unit of the cardiology department at Ain Shams university Hospitals in the period from June 2015 till June 2018. The follow up protocol includes detailed history taking, clinical examination, and full 2D echocardiography with additional circumferential and radial strain imaging by speckle tracking technique (STE), resting and Holter electrocardiograms. Results A significant increase in growth parameters were noticed during 6.3 month mean follow up time, with an overall mean weight increase by 10% and an overall mean height increase by 6.2%. Sequential echocardiographic follow-up showed highly significant decrease in LV dimensions and volumes, circumferential LV strain values, pulmonary to systemic circulation (Qp:Qs) ratio, RVSP and mPAP. Significant complications occurred in (12%) of patients: symptomatic/significant Brady-arrhythmia (Complete heart block) that required permanent pacemaker implantation (4%), significant residual shunt causing hemolytic anemia requiring re-intervention (4%) and significant valvular regurgitation (Severe Tricuspid Regurgitation) (4%) Conclusion The development of a VSD trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices is an attractive and feasible procedure with high success rates

Background: Given appropriate case selection and capability, many acute lacerations can be managed in the primary care setting. An understanding of the basic pathophysiology, assessment and management principles is essential. Objective: The aim of this article is to provide a basic framework for assessing and managing simple acute lacerations. Discussion: The aim of assessment is initially to decide whether the laceration is suitable for office-based treatment, and then whether it requires formal surgical closure with sutures or staples. Two non-surgical techniques for skin closure in amenable wounds are described. A companion article in this issue provides details of surgical closure techniques and wound aftercare.

Introduction. Few randomized controlled studies have been conducted comparing a small to large fascial bite technique, yet recommendations have been made to standardize small bite closures. However, large scale randomized controlled trials require considerable effort and may benefit from a pilot study. Methods. This multi-center randomized controlled pilot study of adult patients undergoing median laparotomy incision investigated the feasibility of studying the outcomes between small and large surgical closure techniques. Results. Fifty of 100 planned patients consented, 32 patients completed surgery and 19 patients completed the one-year ultrasound. Enrollment was 2.7 versus 8 patients per month pre/post addition of study coordinator. Clinical results are summarized for feasibility demonstration purposes, but not analyzed for hypothesis testing. The total cost of the pilot study was $19,152.50 and took 22 months from first surgery to final one-year ultrasound. Conclusions. This feasibility assessment demonstrates the complexity of planning a large scale randomized trial evaluating small and large bite surgical closure technique. To expand this pilot study to a full scaled sample size study would require dedicated personnel and large grant funding.

Enterocutaneous fistulas are a rare occurrence after placement of a PEG tube. The key risk factor for their development is the time the PEG tube is in situ, giving time for the fistula tract to mature. Enterocutaneous fistulae are traditionally treated with parenteral nutrition or surgical management. We present a case of a 69-year-old woman who underwent surgical closure of an enterocutaneous fistula with a fibrin plug. The fistula recurred on post-operative Day 5, and the patient was placed on thickened fluids to increase the viscosity of the fluid exiting the fistula tract. This approach decreased the output and lead to subsequent closure of the fistula by outpatient follow up at 4 weeks. This case demonstrates an application of Poiseuille’s law to closure of fistula tracts.

Objective To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Methods Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Results Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either “always or usually” versus “rarely or never” reapproximate the rectus muscles (38.4% versus 43.3%, p = 0.39), and close parietal peritoneum (42.5% versus 46.9%, p = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, p = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, p Conclusion Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques.

The rotator interval is a triangular space located between the subscapularis and supraspinatus tendons in the anterosuperior region of the shoulder. Within its borders lie the superior glenohumeral and coracohumeral ligaments, the long head of biceps tendon, and capsule. From a biomechanical standpoint, the rotator interval contributes to shoulder stability and maintains normal glenohumeral translation, and helps maintain stability of the long head of the biceps. Multiple studies have described various surgical closure techniques and the associated outcomes on overall function; still the optimal surgical technique is a source of debate. The primary objectives of this chapter are to review the anatomy and biomechanics of the rotator interval, its components and their function, and surgical treatment of the rotator interval as related to stiffness.