Developing and validating an implantable suture tension sensor.

Introduction: Suture tension has a direct influence on the sutured tissue. For abdominal wall closure, suture tension should be optimal without causing tissue necrosis, which can result in surgical site infection or incisional hernia. The purpose of the present study is to evaluate a device that can measure suture tension in-situ and in real-time. Materials and methods: A cheap, commercially available analog-to-digital converter was used, in conjunction with a force sensing resistor. A sensor probe housing was designed and 3D-printed. In order to test the sensor, a mechanical, computer controlled human abdominal wall model called the AbdoMAN was used. Results: An implantable suture tension sensor was developed, keeping cost-effectiveness in mind. This sensor can translate tension in the suture into a downward force, applied to the force sensing resistor. The sensor's raw readout was characterized using a set of weights, from which a formula correlating the readout to a specific force, was derived. Preliminary validation was successfully performed using the AbdoMANmodel, which showed a progressive rise in suture tension when the intra-abdominal pressure was artificially increased over time. Conclusion: The implantable suture tension sensor appeared to be capable of recording real time changes in suture tension, and the. validation process of this sensor has been initiated. With the information from devices like this, a much better understanding of the issues at play in the development of incisional hernia can be gained.

[Long-term consequences of esophageal atresia; esophageal and lung abnormalities in adulthood]. / Langetermijngevolgen van slokdarmatresie.

Esophageal atresia is a rare congenital anomaly. Due to increased survival rates, the population of adults born with this malformation is growing. These patients turn out to have an increased risk to develop Barrett's esophagus, esophageal carcinoma or lung abnormalities like bronchiectasis. This is illustrated by three cases: a 42-year-old man with an irresectable esophageal squamous cell carcinoma; a 23-year-old man with a Barrett's esophagus without any reflux complaints; and a 51-year-old women with a reflux esophagitis and extensive bronchiectasis due to a combination of gastroesophageal reflux with chronic aspiration and a reduced sputum clearance because of a history of tracheomalacia. It is important for healthcare providers to be aware of these risks and the possible absence of symptoms, in order to detect abnormalities at an early stage and improve quality of life of these patients.

Aortic Customize: an in vivo feasibility study of a percutaneous technique for the repair of aortic aneurysms using injectable elastomer.

OBJECTIVE: This study aimed to test a percutaneous technique for aneurysm-sac filling by means of in situ polymerisation in an in vivo model. DESIGN: Aortic Customize is a new endovascular treatment concept for aortic aneurysms: a non-cross-linked liquid elastomer is injected to fill the aneurysm sac around a balloon-catheter. With this method, a compliant elastomer mould with a patent lumen is created. MATERIAL: The formulation used in the experiments consisted of a two-component addition-cure liquid-silicone formulation, based on vinyl-terminated polydimethylsiloxane (PDMS). METHODS: The concept of aneurysm-sac filling was tested in vivo in porcine experiments (n = 3). RESULTS: In vivo porcine experiments with the sac-filling application showed successful exclusion of the created aneurysms with patent lumens and absence of endoleaks. The aneurysms were excluded successfully in the in vivo model, injecting elastomer through a 7-French catheter, filling up the entire aneurysm sac. CONCLUSIONS: These in vivo experiments demonstrate that the principle of aneurysm-sac filling by means of in situ curing is feasible, excluding the aneurysm and creating a new lumen. Further long-term animal experiments must be done prior to consideration of clinical application.

The acute compartment syndrome of the lower leg: a difficult diagnosis?

Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Under these circumstances, intra-compartmental pressure measurement can be of great assistance. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.

[The treatment of colorectal liver metastases: good 5 year survival chance after partial liver resection at the Rotterdam University Hospital, 1984/1999]. / De behandeling van colorectale levermetastasen: goede 5-jaarsoverlevingskans na partiële leverresectie in het Academisch Ziekenhuis Rotterdam, 1984/'99.

OBJECTIVE: To evaluate the results of partial liver resection in patients with liver metastases. DESIGN: Retrospective. METHOD: All of the patients who underwent a partial liver resection at the Rotterdam University Hospital during the period June 1984-August 1999 due to one or more metastases of a colorectal carcinoma were traced in the computerised hospital archive. Data concerning the primary tumour, the diagnostics carried out, the liver resection carried out and the clinical outcome after the operation were analysed using the statistical software SPSS. The actuarial survival was determined according to the Kaplan-Meier method. RESULTS: In total 163 patients underwent an operation: 108 men and 55 women, with a mean age of 58 years (range: 32-77). Postoperative morbidity occurred in 34 patients (21%), mostly infections and gall leakage. During the hospital admission 10 patients died (6%). In the follow-up period, mean 30.2 months (median: 23.8) there was a recurrence of colorectal carcinoma in 82 of the patients (50%). The actuarial 5-year survival chance was 37%. The only statistically significant unfavourable prognosis factor for survival, was a larger tumour volume in the liver at the time of the hepatectomy.