In Microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to cover the coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting nerve regeneration. This article presents a 32-year-old patient who experienced complete transection of the median nerve at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. Nerve regeneration was followed-up for 18 months and evaluated with the Rosé n and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the median nerve.

Background & Aim: Replacement of a fractured metal-ceramic restoration is not possible in some cases.combination of different surface treatments and repair systems have been recommended for this purpose. The present study assessed the shear bond strength of three intra-oral metal-ceramic repair systems.Materials & Methods: In this in vitro study, 30 cylindrical metal specimens and 30 porcelain specimens were fabricated. The specimens were embedded in a ring, after surface treatment, the specimens received one of the following repair systems including Ultradent, Ivoclar Vivadent and Clearfil Multi-Purpose according to the manufacturers’instructions. The specimens were stored in incubator then thermal cycled. The shear bond strength of the specimens and failure types was determined. The data were analyzed.Results: On porcelain substrate, the mean and standard deviation of shear bond strength using Ultradent, Clearfil and Ivoclar Vivadent repair systems were 12.16 (±4.59), 10.19 (±4.18) and 12.68 (±4.89) while the rates were 14.32 (±3.15), 24.66 (±3.25) and 13.32 (±3.83) in the metal substrate. The bond strength of Clearfil system was significantly higher than others in the metal substrate (both: p<0.0001) while no other significant differences was noted in the paired comparisons. all metal specimens showed adhesive failures while the porcelain specimens demonstrated more cohesive failures.Conclusion: Although, replacement of the fractured metal-ceramic restorations is the ideal treatment modality, in the porcelain substrate all repair systems can be used. Clearfil repair system was associated with higher bond strength in the metal substrate.

Background: Varicocelectomy is considered as standard treatment for male infertility for clinical varicocele. The aim of this study is to address the effects of varicocelectomy on semen parameters, chromatin packaging, and pregnancy outcome.Materials and Methods: This retrospective study was carried out between June 2006 and February 2011 on 145 infertile men with grade II or III varicocele. Microsurgical varicocelectomy was performed as part of patient management. Sperm count, motility, morphology, and chromatin packaging were assessed with a Makler counting chamber, light microscopy, Papanicoulaou and chromomycin A3 (CMA3) staining, respectively. In addition, we assessed spontaneous clinical pregnancy and miscarriage rates.Results: The percentages of spontaneous cumulative pregnancies post-surgery were 33.1% (3 months), 42.06% (6 months), 46.2% (9 months), 48.9% (12 months), and 55.8% (after 12 months).Percentages of spontaneous cumulative miscarriage post-surgery were 2.46% (3 months), 4.93% (6 months), 4.93% (9 months), 6.17% (12 months), and 6.17 % (after 12 months). Both sperm parameters improved and the percentage of sperm protamine deficiency decreased significantly after varicocelectomy.Conclusion: These results confirm that varicocelectomy improves sperm parameters and chromatin packaging, thereby improving the chance of pregnancy. Positive aspects of this study include the large number of patients studied, duration of follow up, one surgeon who performed all of the surgeries, and type of surgery (microsurgery). The spontaneous pregnancy results also suggest that if pregnancy is not achieved within twelve months post-surgery, an alternative approach such as assisted reproductive technology (ART) treatment should be considered.

The diabetic foot is frequently susceptible to extensive infections and for its management a lot of tissue should be sacrificed. Vessel obliteration of the main arterial trunks associated with diabetic microangiopathy in most cases lead to major segmental amputations.Classics techniques of tissue revascularization using by-pass techniques are usually not effective in these pathologic conditions. Therefore, for well-selected cases (based on clinical examination, Doppler, angiography), the free tissue transfer may represent an alternative to amputation.The authors report the case of a diabetic patient who sustained a free transfer for plantar coverage, including the long-term postoperative improvement during 44 months. The final result stimulates us to consider the free tissue transfer as a viable solution for defect coverage in the diabetic foot.

Introduction: This study aimed to evaluate the effect of oral hygiene instruction programs on the knowledge, attitude, performance, and DMFT index in pregnant women. Materials & Methods: In this clinical trial, 120 pregnant women in Fereydoun Shahr (Isfahan Province) were selected by cluster sampling method. The subjects were randomly divided into intervention and control groups. Educational intervention was conducted through four 2-hour sessions in the field of oral health in four groups with 11 subjects and two groups with eight subjects in the intervention group. The data of both groups were collected before, four weeks and three months after the intervention. The data were analyzed with SPSS 21, using independent-samples t-test, chi-squared test, and repeated measurements (α = 0. 05). Results: Of 120 subjects, 60 were in the control group, with the remaining 60 in the intervention group. After the educational intervention, after three months, the means of knowledge scores in the control and intervention groups were 8. 02 ± 1. 70 and 14. 15 ± 1. 05, respectively. The mean attitude scores were 30. 45 ± 3. 76 and 36. 00 ± 2. 33, and the mean performance scores were 35. 17 ± 3. 53 and 41. 43 ± 2. 40 in the control and intervention groups, respectively. Furthermore, the means of PI were 3. 28 ± 0. 81 and 2. 95 ± 0. 75 in the control and intervention groups, respectively. A repeated measure design was used to study the effect of time, group, interaction between the groups, and time on knowledge, attitude, performance, and DMFT index. The results showed a significant increase in the knowledge, attitude and performance of mothers in the intervention group compared to the control group. Evaluation of the DMFT index showed that time and group interaction was significant concerning decayed and filled teeth. Conclusion: The results showed that the educational program had a significant effect on improving the knowledge, attitude, and oral health parameters of pregnant women.

Cerebrovascular diseases comprise a major subspecialty in neurological surgery. Current education curriculums lack the necessary training modalities for teaching the microvascular techniques, to neurosurgery residents. We have included a 1-month micro-lab and animal lab rotation for senior residents, which can be added to their current educational program. Necessary equipment for this rotation includes an operating microscope Zeiss S8, Microsurgical instruments, and animal anesthesia equipment are used to perform revascularization techniques on the aorta of a rat model (average-sized Sprague-Dawley weighing 200-250 gram). This rotation was included in previous curriculums as micro-lab. Evaluation of microvascular surgical skills following the addition of animal models to this skill lab is suggested to be considered as a part of OSCE in board certification in future studies. The addition of animal models to micro-lab rotations, provides a better understanding of tissue consistency while dealing with a microvascular surgery procedure, for neurological surgery residents.