Long-term degeneration renders central tracts refractory to penetration by regenerating optic fibers

We have examined time-dependent changes in the ability of degenerating central pathways in the goldfish to be penetrated by regenerative axons. We have found that when a tract has degenerated for 2–5 weeks it is readily penetrated by regenerating optic fibers. However, tracts which degenerated for any longer than 6 weeks, before being exposed to the regenerating fibers, were only sparsely penetrated by them. We conclude that over a period of no less than 6 weeks, degenerating central tracts in the goldfish change their character and become relatively refractory to penetration by regenerating axons.     

Complications of Intrathoracic Nissen Fundoplication

This report details our experience with 30 patients who had Nissen fundoplication. Six underwent transabdominal Nissen fundoplication, and 10 had transthoracic Collis-Nissen with the gastric wrap in a subdiaphragmatic position. Ten patients had a transthoracic Nissen with the wrap in a supradiaphragmatic position. Four patients had a transthoracic Thal-Nissen procedure.In 1 of 4 patients with a Thal-Nissen procedure, intrathoracic rupture of the stomach with gastrobronchial fistula developed and necessitated left lower lobectomy. Four of 10 patients in whom the gastric wrap was left in the chest experienced severe complications: in 1 patient a lesser curvature ulcer developed and required hemigastrectomy; 1 patient had herniation of the fundoplication with gastric outlet obstruction and required operation for its correction; 2 patients had intrathoracic rupture of the gastric wrap and ultimately died. The 6 patients with transabdominal Nissen and the 10 with transthoracic Collis-Nissen with wrap placed in the abdomen did well. This experience severely condemns the practice of leaving the fundoplication above the diaphragm.