Retrograde Esophageal Dilation in Children without the String

A new technique for retrograde esophageal dilation is presented, which does away with the indwelling string. The method utilizes a Teflon–coated arterial guide wire, which is passed through the gastrostomy and, under fluoroscopy, is directed up the esophagus and out the mouth. The wire is followed by the string and dilators. This method avoids both embarrassment caused by the string and occurrence of the usual complications.     

逆行球囊扩张治疗输尿管狭窄

目的：评价逆行球囊导管扩张治疗输尿管狭窄的效果。方法：采用逆行球囊导管对21例输尿管狭窄患者进行扩张治疗,其中结石导致的狭窄10例,输尿管开放手术后9例,盆腔放疗术后2例,扩张后留置双J管。结果：20例扩张成功,症状和肾积水缓解,肾功能不同程度改善,2例拔出双J管后发生再狭窄,肾积水无变化或加重需进一步治疗。结论：逆行球囊扩张治疗输尿管狭窄是一种安全有效、简便易行的方法,可以作为输尿管狭窄的首选治疗。     

Bacteremia after Esophageal Dilation: A Clinical and Experimental Study

Patients with esophageal stricture caused by caustic ingestion, reflux esophagitis, or esophageal anastomosis often require repeated dilation. These patients frequently have a short febrile course after dilation. After development of brain abscess following esophageal dilation in 1 patient, positive blood cultures were obtained in 4 patients immediately following esophageal dilation. Caustic strictures were produced in cats and esophageal dilations performed. Blood cultures were positive at one minute after dilation in 6 cats and at five minutes in 2 of those cats. The organism responsible in all clinical and three of four experimental examples was Staphylococcus aureus. It is suggested on the basis of this clinical and experimental data that patients undergoing esophageal dilation should have prophylactic coverage if they are immunosuppressed, if endocarditis prophylaxis is necessary, if they are infants, if they are diabetic, or if they had severe bacteremia following dilation.     

Balloon Dilation for Endosonographic Staging in Esophageal Cancer: A Phase 1 Clinical Trial

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Endoscopic-Assisted Correction of the Deviated Nose

The approach to nasal bone classic corrective rhinoplasty is an almost-blind technique, where the results depends on feeling by the surgeon's hand. To overcome these drawbacks, endoscopic-assisted corrective rhinoplasty and septoplasty were performed for 16 cases of deviated noses between January 1995 and May 1997. The average follow-up period was 18 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection, and septal deviation. The postoperative courses were satisfactory in most cases, with few complications. Compared with 28 cases of classic rhinoplasty, the patient satisfaction rate was high (87.5% in endoscopic-assisted rhinoplasty, 71.4% in classic rhinoplasty), and the complication and revision rate was low (0% in endoscopic assisted rhinoplasty, 14.3 and 7.1% in classic rhinoplasty). But extra time (about 40 min) and greater expense were required for endoscopic-assisted rhinoplasty. It appeared to us that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum, the cause of the deformity, and the immediate effect of the corrective measures used. The use of an endoscope in corrective rhinoplasty for deviated noses provides an expanded field of vision, direct manipulation of lesions, and better aesthetic and functional results.     

内镜辅助面部轮廓改形术

目的探讨内镜在面部轮廓改形中的应用价值。方法在内镜辅助下对58例面部轮廓缺陷求术者面部骨支架进行截骨改形,其中方形脸38例,颧骨复合体肥大12例,骨性歪鼻8例。结果手术时间40～86min,平均65min;术中出血量60～120ml,平均78ml。术后住院3～7d,平均4d。术后随访3～24个月,无一例出现截骨不对称、截骨不足、截骨过度、意外骨折、颏神经和面神经损伤、血管损伤、感染等并发症,面部轮廓改善满意。结论内镜辅助面部轮廓改形术有助于获得良好的手术效果,安全可行。     

内镜黏膜下注射糖皮质激素联合扩张术治疗早期食管癌内镜黏膜下剥离术后狭窄的初步探索

目的探讨内镜黏膜下注射糖皮质激素联合扩张术治疗早期食管癌内镜黏膜下剥离（endosc opicsubmucosal dissection,ESD）术后狭窄的疗效。方法回顾性分析2009年1月～2013年1月20例早期食管癌ESD术后狭窄患者资料,内镜黏膜下注射地塞米松5mg（用生理盐水稀释至8ml,分4点注射,每点2m1）联合扩张术（观察组）和单纯扩张术（对照组）各10例,随访6个月,比较2组再狭窄发生的时间。结果2组操作均成功,观察组再狭窄发生时间（41．2±8．9）d,对照组为（28．2±5．8）d（t=3．875,P=0．001）。结论内镜黏膜下注射糖皮质激素治疗早期食管癌ESD术后狭窄是安全且有效的,可延缓再狭窄时间。     

Endoscopic-Assisted Achilles Tendon Repair With Plantaris Tendon Augmentation

Six portals are made at the sides of the Achilles tendon. The plantaris tendon is harvested and retrieved to the distal-medial portal. The investing fascia of the Achilles tendon is released at the medial border of the tendon. The suture is passed through the tendon end through the medial portal and exits at the tendon surface and then the fascia and skin. The suture is retrieved at the tendon surface through the medial portal. The loops of the suture are retrieved through the proximal-medial, proximal-lateral, and lateral portals, and a loop of suture is then formed at the surface of the tendon and beyond the boundary of the tendon. The suture is passed through the tendon again in a deep-to-superficial direction within the loop and is retrieved through the proximal-medial portal. The suture is tensioned, and a locking stitch is formed. The loops of the suture are retrieved through the medial, lateral, and proximal-lateral portals. The suture is then passed through the tendon in a deep-to-superficial direction and is retrieved again through the proximal-medial portal, and the second locking stitch is formed. This is repeated 3 to 4 times over the medial side of the proximal tendon through the proximal-medial portal, and the suture is then passed to the proximal-lateral portal at the surface of the tendon. Locking stitches are then applied to the lateral side of the tendon. The same procedure is then repeated over the distal tendon with another suture. The tendon ends are approximated with the pair of sutures tied through the medial and lateral portals. The plantaris tendon is passed through the Achilles tendon with a pointed tendon passer through the proximal and distal portals. The plantaris tendon is then looped around the Achilles tendon and sutured to it.     

Clinical Remission in Endoscope-Guided Pneumatic Dilation for the Treatment of Esophageal Achalasia: 7-Year Follow-up Results of a Prospective Investigation

Background and Aims  

Prospective, long-term reports and predictors of outcome of endoscope-guided pneumatic dilation are lacking in the literature. The aim of this prospective 7-year follow-up study is to report the efficacy of endoscope-guided pneumatic dilation and determine the possible confounding factors related to remission.     

Retrograde cardioplegia

OBJECTIVE: This study was undertaken to compare the efficacy of retrograde cardioplegia for myocardial perfusion with that of antegrade cardioplegia at the same flow rate. METHODS: Colored microspheres were used in rat hearts to assess the capillary flow of cardioplegia solution. Myocardial perfusion was evaluated with magnetic resonance imaging in pig hearts. Phosphorus 31 magnetic resonance spectroscopy was used to determine the efficacies of the cardioplegic techniques in sustaining myocardial energy metabolism. RESULTS: At the same flow rate, the number of colored microspheres delivered to the capillaries by retrograde cardioplegia (15 +/- 1 microspheres/mm2) was significantly lower than that delivered by antegrade cardioplegia (29 +/- 2 microspheres/mm2). Furthermore, only 19% +/- 3% of the colored microspheres delivered to the capillaries by retrograde cardioplegia were found in the arteriolar portions of the capillaries, whereas most (80% +/- 3%) remained in the venular portions. Moreover, magnetic resonance images showed that contrast-enhanced signal-time courses obtained from different regions of the myocardium during retrograde cardioplegia varied significantly. Localized phosphorus 31 spectra showed that retrograde cardioplegia required a higher flow rate than did antegrade cardioplegia to sustain normal myocardial energy metabolism. CONCLUSIONS: We conclude that retrograde cardioplegia provides significantly less capillary flow than does antegrade cardioplegia. Its microvascular perfusion varies significantly among the various small areas of the myocardium. As a result, its efficacy in sustaining normal myocardial energy metabolism is lower than that of antegrade cardioplegia.