Endoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel “purpose-made” prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to “mainstream”, first-line intervention.
Colon ; Constriction, Pathologic ; Drainage* ; Endosonography ; Hand ; Pancreatic Pseudocyst ; Phenobarbital ; Prostheses and Implants ; Self Expandable Metallic Stents ; Stents ; Ultrasonography

OBJECTIVE: To evaluate the immunogenicity of bovine jugular vein conduits (BJVCs) treated with different cross-linking methods. METHODS: The BJVCs were treated with glutaradehyde (GA), dye-mediated photooxidation (DMP) and polyepoxy compound (PC) (n = 10). The tissue homogenates obtained from BJVCs treated with PC, GA, DMP, and fresh BJVCs, were mixed with the complete Freand adjavant to form the emulsive antigen, which were used to immunize rabbits correspondently. The antibody concentrations to BJVCs in those rabbits' serum were measured by counter double immuno diffusion. The immunologic responses to the BJVCs in different groups were measured with Western blotting. RESULTS: The positive bands appeared when the sera of rabbits were immunized by fresh BJVCs reacted with antigens of fresh BJVCs, but no bands appeared when the sera of rabbits were immunized by fresh BJVCs reacted with those antigens of the BJVCs treated with GA, DMP, and PC in Western blotting. CONCLUSION The immunogenicity of BJVCs treated with PC, DMP, and GA can be reduced significantly and meet the clinical standard.
Animals ; Bioprosthesis ; Blood Vessel Prosthesis ; Cattle ; Cross-Linking Reagents ; Glutaral ; pharmacology ; Jugular Veins ; immunology ; Prostheses and Implants ; Rabbits ; Random Allocation

Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality. In the past decade, endovascular repair has become the preferred treatment because of its superior outcomes to open repair and medical therapy. The Valiant Captivia Thoracic Stent Graft System is a third-generation endovascular stent graft with advancements in minimally invasive delivery, conformability to the anatomy, and the minimization of adverse sequelae. Herein, this stent graft is briefly reviewed and its 3-year outcomes are presented. Freedom from all-cause and dissection-related mortality was 79.1% and 90.0%, respectively. The Valiant Captivia Stent Graft represents a safe, effective intervention for acute complicated TBAD. Continued surveillance is needed to verify its longer-term durability.
Aortic Aneurysm, Thoracic ; Aortic Rupture ; Blood Vessel Prosthesis ; Endovascular Procedures ; Extremities ; Freedom ; Humans ; Hypertension ; Mortality ; Risk Factors ; Self Expandable Metallic Stents

Bone Nails ; adverse effects ; Bone Plates ; adverse effects ; Hip Fractures ; physiopathology ; surgery ; therapy ; Humans ; Prostheses and Implants ; adverse effects

OBJECTIVES: The direct acoustic cochlear implant (DACI) is among the latest developments in the field of implantable acoustic prostheses. The surgical procedure requires a mastoidectomy and a posterior-inferior tympanotomy, with access to the facial recess at the level of the oval window, in a complex and lengthy surgical approach. Here, we report a new and considerably shorter surgical approach. METHODS: The new approach involves positioning of artificial incus above the oval window through the superior-anterior tympanotomy. We performed DACI placement in temporal bone specimens (n=5) to assess the feasibility of the new approach. RESULTS: The average time for the DACI implant in the temporal bones was only 112 minutes (range, 94 to 142 minutes) and there was little clinical risk associated with the procedure. Access was easy and drilling was minimal. CONCLUSION: Our approach simplified the surgical procedure and consequently reduced the time required for DACI placement.
Acoustics* ; Cochlear Implants* ; Incus ; Prostheses and Implants ; Temporal Bone*

OBJECTIVETo study the biomechanical characteristics of antegrade intramedullary fixation for metacarpal fractures.

METHODSFrom March to May 2008, both the 4th and 5th metacarpals from 25 formalin embalmed cadaver hands had three-point bending test after transverse osteotomy followed by randomly fixation with one of the following three methods: plate and screw, antegrade intramedullary K-wire, crossed K-wire. While, both the 2nd and 3rd metacarpals had torsional loading test after the same management as the 4th and 5th metacarpal had undergone.

RESULTSIn the three-point bending test, both the maximum bending moment (M(max)) and bending rigidity (EI) of the antegrade intramedullary K-wire were comparable with those of the plate and screw, and were significantly larger than those of the crossed K-wire. In the torsional loading test, the antegrade intramedullary K-wire had a statistically smaller maximum torque (T(max)) than the plate and screw, and had a comparable T(max) with the crossed K-wire; while, the torsional rigidity (GJ) of the intramedullary K-wire was statistically weaker than that of both the plate and screw and the crossed wire.

CONCLUSIONSOne single antegrade intramedullary K-wire can provide a satisfactory M(max) and EI for metacarpal fixation and shows relatively weak in the torsional loading test. The injured finger should be well protected to avoid torsional deformity in clinical practice.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Bone Wires ; Cadaver ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Metacarpal Bones ; injuries ; Osteotomy

BACKGROUND: To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS). METHODS: A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined. RESULTS: The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (+/- 3.5) and 2.3 (+/- 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm). CONCLUSIONS: With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.
Aged ; Aged, 80 and over ; Bone Plates ; *Bone Screws ; Bone Wires ; Female ; Fracture Fixation, Intramedullary/*methods ; Hip Fractures/radiography/*surgery ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

Amputation is an unpleasant affair, generating a very negative aura that must be consciously combated. For optimal care of amputation, the surgeon needs not only to be comprehensive trained in reconstructive surgery but also to be knowledgeable about prosthetics. The evolution of an artificial arm can be traced first from the cosmetic prosthesis, then to that with passive movements, and lastly to an artificial limb with active movement which made it possible to restore to some degree the lost function of the amputation limb. But the gap between basic requirement of function and cosmesis is still present in conventional prosthesis. Myoelectric prosthesis was introduced for upper extremity amputees since 1960 by Korbinski and his co-workers and was most exciting improvement in the field of prosthetics. Two patients of bilateral above-elbow and bilateral below-knee amputees with myoelectric prostheses and conventional prostheses were compared in their function, cosmesis and acceptability of patient. Myoelectric prosthesis shows not only favorable cosmesis but also excellent function in range of motion and coordination of mechanical joints. And myoelectric prosthesis provides superior pinch force and requires less energy expenditure than a body-powered conventional prosthesis. So, in spite of the high cost of the appliance and of continued maintenance and repair, improvement in comfort, cosmesis and function have had to good level of acceptance of patients. Further research will undoubtedly improve the appearance, function and durability of the present electrically powered myoelectric prosthesis, making them even more acceptable and useful to lower limb and upper limb amputees.
Amputation ; Amputees ; Artificial Limbs ; Energy Metabolism ; Epilepsy ; Extremities ; Humans ; Joints ; Lower Extremity ; Prostheses and Implants ; Range of Motion, Articular ; Upper Extremity

This review article presents the radiological options for management of malignant gastric outflow obstruction distal to the pylorus. We place these options in context with surgical and endoscopic alternatives and recommend their use, particularly in those institutions where endoscopic alternatives may not be readily available.
Duodenal Obstruction ; Pylorus* ; Self Expandable Metallic Stents ; Technology, Radiologic

OBJECTIVETo evaluate the biocompatibility of the super high molecular weight poly D,L-lactic acid (SHMW-PDLLA) implant.

METHODSThe SHMW-PDLLA plates were implanted into the SD-rats between the masseter and ramus of the mandible. The blood specimens were gained at 3, 6, 9, 12 months after the operation. The proteins, electrolyte, enzyme and other indices were tested by use of Beckman automatic biochemical analysis device. The soft tissue specimens around the SHMW-PDLLA plates were gained at 3, 6, 9, 12 months after the operation and the tissue reaction was observed with the pathological and haematological methods.

RESULTSThere were not any abnormal findings in the blood after the SHMW-PDLLA plates implanted in the body of SD-rats. The implanted SHMW-PDLLA plates were degraded gradually in 6 to 12 months after the operation. There was not any abnormal tissue reaction found to the soft tissue around the SHMW-PDLLA plates by histological and pathological observations.

CONCLUSIONSThe SHMW-PDLLA implant has a good biocompatibility to SD-rats.

Animals ; Biocompatible Materials ; chemistry ; Bone Plates ; Lactic Acid ; chemistry ; Mandible ; Molecular Weight ; Prostheses and Implants