Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy

BACKGROUND/AIMS: Primary repair of a large hiatal hernia is associated with a published recurrence rate of up to 10%; anecdotal rates even higher than this have been reported to the authors. The use of prosthetic material in the repair of other abdominal wall defects has often produced better results than primary repair. We wanted to compare laparoscopic primary repair of large hiatus hernias with laparoscopic primary repair reinforced with prosthetic. METHODS: Thirty-one patients with symptomatic gastroesophageal reflux and a hiatal defect 8 cm or greater were randomized to Nissen fundoplication with posterior cruroplasty (n = 16) or Nissen cruroplasty, and onlay of polytetrafluoroethylene (PTFE) mesh (n = 15). All patients underwent preoperative esophagogastroduodenoscopy (EGD) and barium esophagography. After posterior cruroplasty with interrupted nonabsorbable suture, the mesh reinforcement group had an onlay of PTFE placed around the hiatus. A radial slit with 3 cm 'keyhole' (to accommodate the esophagus) was cut into the PTFE. The prosthetic was stapled to the diaphragm, and the two leaves of the slit were stapled to each other. All patients underwent EGD at 3 months and all had esophagrams every 6 months postoperatively. Follow-up ranged from 12 to 36 months. RESULTS: Length of hospital stay was equal in both groups (2 days). The average cost to the patient with PTFE was USD 1,050 higher than to the patient with primary repair. There were 2 complications (1 pneumonia, 1 urinary retention) in the PTFE group, and 1 complication (pneumothorax) in the primary repair group. There were 3 recurrences (18.8%) in the primary group (p = 0.08, chi(2) test). CONCLUSION: The use of PFTE reinforcement for primary repair of large hiatal hernias may result in a lower rate of recurrent herniation compared to primary repair alone. Copyright Copyright 1999 S.Karger AG, Basel     

Ethanol flush for the prevention of catheter occlusion

Catheter occlusion by lipid material has been associated with the use of compounded nutrient solutions containing lipid. We have studied the incidence of catheter occlusion when either a saline or an ethanol flush has been used prior to the application of a heparin lock following an overnight infusion of such nutrients. Lipid occlusion occured in 13 of 23 catheters when a saline flush preceeded the application of a heparin lock, whereas the use of a 20% ethanol solution before the application of the heparin lock resulted in only 2 occlusoins in 28 catheters (p < 0.001). In addition there was significantly longer catheter survival in the ethanol group (p < 0.01). It is concluded that an ethanol flush may significantly reduce the incidence of catheter occlusion during the use of lipid mixes.     

Volunteers for biomedical research. Recruitment and screening of normal controls.

We examined the process of accruing healthy control subjects for biomedical research on brain function. Of 1670 responders to newspaper advertising, 23.1% were uninterested when learning more about the studies, and 50.9% of those remaining were found by structured telephone screening to meet exclusionary criteria for having a history of psychiatric, neurologic, or medical disease that might affect brain function. Of 312 volunteers passing the telephone screening who came to an in-person evaluation by a physician and agreed to participate, 49.7% were found to meet exclusionary criteria, and only 157 were admitted to the study. This underscores the importance of attending to the issue of screening and assessment of "normal volunteers." Alternative strategies should be considered for enriching the pool.     

Implementation of an On-Line lsokinetic Analysis System

A cost effective and efficient means of obtaining torque, work, and power measurements for a large group of subjects was needed. As a solution to this problem, an Apple 111 microcomputer was interfaced to a Cybex II isokinetic dynamometer. This system provided instantaneous values for the three parameters listed above as well as additional options for filekeeping and data manipulation. Intraclass reliability coefficients for the parameters of torque, work, and power ranged from r = 0.991 to r = 0.999. It was concluded that a microcomputer support system is, in view of its time saving qualities and relative cost, an economical and efficient means of providing meaningful information for clinical analysis of patients. J Orthop Sports Phys Ther 1982;4(1):36-38.     

Oligonucleotide-directed mutagenesis as a general and powerful method for studies of protein function.

We have used oligonucleotide-directed mutagenesis to make a specific change in the beta-lactamase (EC 3.5.2.6) (ampicillin resistance) gene of the plasmid pBR322. Evidence suggests that the active site for this enzyme may include a serine-threonine dyad (residues 70 and 71). By priming in vitro DNA synthesis with a chemically synthesized 16-base oligodeoxyribonucleotide, we have inverted the Ser-Thr dyad to Thr-Ser and thereby generated a mutant with an ampicillin-sensitive phenotype. This "double-mismatch" method is relatively simple and also very general because detection of mutants is at the level of DNA and involves only colony hybridization. Accordingly, the procedure can be applied to any DNA sequence and does not depend on the phenotype of the mutant.