A simplified, improved techniqe for the Collis gastroplasty for dilatable esophageal strictures.

A safe, simple, effective and fast gastrophasty for the dilatable strictured esophagus has proved sound in dogs and feasible and effective in twenty-five patients. Several of the patients who had been operated upon elsewhere had recurrences. Postoperative follow-up studies of the 25 patients operated upon have revealed freedom from substernal pain, dysphagia, aspiration and bleeding in the upper part of the gastrointestinal tract. Encouraged by the success of the surgical techinique in patients with stricture of the esophagus, we have recently applied the same technique in the repair of hiatal hernia without stricture.     

A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone

Several techniques are described for fixation of Vancouver B1 femoral shaft fractures after total hip arthroplasty. Twenty-four femurs were scanned by dual x-ray absorptiometry scanned and matched for bone mineral density. Femurs were implanted with a cemented simulated total hip prosthesis with a simulated periprosthetic femur fracture distal to the stem. Fractures were fixed with Synthes (Paoli, Pa) 12-hole curved plates and 4 different constructs proximally. Each construct was loaded to failure in axial compression. Constructs with locking and nonlocking screws demonstrated equivalent loads at failure and were superior in load at failure compared with cables. Cable constructs failed proximally. No proximal failures occurred in specimens fixed with screws and cables. A combination of locked or nonlocked screws and supplemental cable fixation is recommended for the treatment of Vancouver B1 periprosthetic femur fractures.     

The influence of alendronate on osseointegration of nanotreated dental implants in New Zealand rabbits

Objectives: Growing clinical demands for stronger and faster bone bonding to the implant have motivated the development of methods enhancing osseointegration. Lately, the application of bisphosphonates (bis) in order to optimize bone healing has become a topic of great interest. N‐containing bis, such as alendronate (ALN), are the more potent drugs of this class. It was the aim of this study to determine the effect of ALN on the osseointegration of a well‐documented nanotreated implant system in a rabbit femoral condyle model. Material and methods: Thirty‐two adult female New Zealand White rabbits received one implant (3.25 mm in diameter and 10 mm in length) in their left femoral condyle, a week after they were ovariectomized. Half of them were saline treated (control, group A) and the other half were ALN treated (group B). Rabbits from both groups were euthanized after 6 and 12 weeks, respectively. Results: The specimens were evaluated histologically and histomorphometrically. Upon histological evaluation, no obvious differences were found between the control and the treatment group. Implants showed good integration into the bone tissue surrounding them. There were also no statistically significant differences in bone‐to‐implant contact and the amount of bone tissue in the immediate neighborhood of the implant at both healing periods. Conclusions: The systemic administration of ALN was not found to affect histological osseointegration of implants in animals with a hormonal status resembling that of postmenopausal healthy women. Further research will be needed to investigate this approach.     

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors,and association with intraoperative disseminated intravascular coagulation‐like thromboelastographic qualities: a single‐center retrospective study

This study describes the risk of thrombotic and hemorrhagic complications, both intraoperatively, and up to 1 month following visceral transplantation. Data from 48 adult visceral transplants performed between 2010 and 2017 were retrospectively studied [32 multivisceral (MVTx); 10 isolated intestine; six modified‐MVTx]. Intraoperatively, intracardiac thrombosis (ICT)/pulmonary embolism (PE) occurred in 25%, 0% and 0% of MVTx, isolated intestine and modified MVTx, respectively, and was associated with 50% (4/8) mortality. Preoperative portal vein thrombosis (PVT) was a significant risk factor for ICT/PE (P = 0.0073). Thromboelastography resembling disseminated intravascular coagulation (DIC) (r time <4 mm combined with fibrinolysis or flat‐line) was statistically associated with occurrence of ICT/PE (P < 0.0001). Compared to subgroup without ICT/PE, occurrence of ICT/PE was associated with an increased demand for all blood product components both overall, and each surgical stage. Hyperfibrinolysis (56%) was identified as cause of bleeding in MVTx. Incidence of postoperative thrombotic event at 1 month was 25%, 30% and 17% for MVTx, isolated intestine and modified MVTx, respectively. Incidence of postoperative bleeding complications at 1 month was 11%, 20% and 17% for MVTx, isolated intestine and modified MVTx. In conclusion, MVTx recipients with preoperative PVT are at an increased risk of developing intraoperative life‐threatening ICT/PE events associated with DIC‐like coagulopathy.     

Spontaneous esophageal hematoma diagnosed by computed tomography

An 82-year-old woman with acute chest pain was found to have an elongated mass inseparable from the esophagus on CT examination. Hyperdense areas within the mass indicated the diagnosis of spontaneous hematoma of the esophageal wall. She recovered completely without treatment.