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Synthetic mesh.

Criteria of an ideal mesh.
#Surgery
US Criteria of Acute cholecystitis:

-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"

#Surgery
Recognizing  acute cholecystitis  on  US:

-The presence of gallstones, possibly impacted in the neck of the  gallbladder or cystic duct)  (Fig.  21-5)
-Thickening  of the gallbladder  wall  (>3  mm) (see  Fig.  21-5,  A)
-Pericholecystic fluid (fluid around the  gallbladder) (see  Fig.  21-5,  B)
- A positive sonographic Murphy sign  (A positive Murphy sign in this case is pain  that is  elicited  by compression of  the gallbladder with the US probe).

•In  the  presence  of  gallstones  and  gallbladder wall  thickening, US  has  a  positive  predictive  value  for  acute cholecystitis  as high  as 94%.

#Surgery
Types of sutures.
Plain catgut:

-Nature, absorbable.
-From the submucosal collagen of the sheep's intestine.
-Time of absorption: one week. (absorbed by phagocytosis)
-Uses: Its use is limited now because of severe reactions
-Used for ligating superficial blood vessels and SC fatty tissues.
Chromic catgut:

-Nature, absorbable.
-Like plain catgut, but it is modified by chromium salt solution to make it less irritant and to increase time of absorption to 3 weeks.
-It may be used in the presence of infection and cancer cases.
Dexon (polyglycolic acid):

-Synthetic,absorbable.
-Multifilamentous with good tensile strength.
-Time of absorption: 4 months.
-Used is general surgery, gynecological, soft tissue approximation, including use in ophthalmic procedures.
Dexon (polyglycolic acid):

-Synthetic,absorbable.
-Multifilamentous with good tensile strength.
-Time of absorption: 4 months.
-Used is general surgery, gynecological, soft tissue approximation, including use in ophthalmic procedures.
PDS (Polydioxanone synthetic smooth suture):

-Synthetic, absorbable.
-It is monofilamentous,so it is useful in suturing infected or contaminated wounds.
-Time of absorption: 6 months.
-intended for use ingeneral soft tissue approximation, including paediatric CV tissue, microsurgery and ophthalmic surgery.
Vicryl (polyglactin):

-Synthetic, absorbable.
-It is multifilamentous.
-Time of absorption: after 4 months.
-Used now: for gastrointestinal anastmosis.
-Vessels ligation in all surgical specialies.
-General soft tissues approximation.
Monocryl polyglecapron 25:

-Synthetic, absorbable.
-Monofilament with high tensile strength.
-Time of absorption: 3-4 months.
Surgical silk:

-Natural, non-absorbable.
-It is multifilamentous.
-Rich in protein material so it causes marked tissue reaction.
-If infection occurs, we remove sutures to allow improvement.
-Used in major blood vessels ligation and tendon repair. It's black.
Nylon (Ethilon):

-Synthetic, non-absorbable.
-It is polyamide.
-Mono-or multifilamentous with good tensile strength.
-Elicit minimal tissue reaction.
-Skin closure and herniorrhaphy.
-Time to absorb: year
s.
Prolene (Polypropylene):

-Synthetic, non-absorbable.
- Monofilamentous with good tensile strength,it has difficult knotting.
-Indicated for use in general soft tissue approximating and/or ligation, including use in cardiovascular, ophthalmic and neurosurgical procedures.
Polytetrafluroethylene (PTFE):

-Synthetic,non-absorbable.
-Minimal tissue response with good handling.
How to read a suture package.
Remember:

-Aaron's "هارون" sign: is a referred pain felt in the epigastriumupon continuous firm pressure over McBurney's point. It is indicative of appendicitis.

-Aaron's sign is named for Charles Dettie Aaron, an American 
gastroenterologist.


#Surgery
Remember:

-The only bone in the body whole surface of it is atricular surface is talus bone.

#Surgery
Remember:
In abdominal examination in a surgical case, Never forget to examine:

-Supraclavicular lymph glands
-Hernia orifices
-Femoral pulses
-Genitalia
-Bowel sounds
-Anal canal and rectum
.

#Surgery
This figure shows the opening of submandibular duct (Wharton's duct) on each side of the lingual frenulum, the openings are abnormally large on each side, this is considered to be a normal physiological variant.

#Salivary
#Surgery
Quick Notes
This figure shows the opening of submandibular duct (Wharton's duct) on each side of the lingual frenulum, the openings are abnormally large on each side, this is considered to be a normal physiological variant. #Salivary #Surgery
The submandibular duct (Wharton's duct) emerge from the medial aspect of the deep part, and passes forwards in the floor to open beside the base of the lingual frenulum.

#Surgery