Evaluation of FiberLoop sutures in locking and nonlocking tendon repair.

UNLABELLED: The FiberLoop suture has been developed as a double stranded, double-armed suture of FiberWire, but has not been previously studied. This is a comparison study of FiberLoop, FiberWire, and Ethibond. METHODS: Six groups of bovine tendons were randomly sorted for testing. They were cut and repaired using FiberWire, FiberLoop, and Ethibond with modified Kessler and modified Krackow repair techniques. A 4-0 core suture was used and tested to failure. RESULTS: Both FiberLoop and FiberWire were significantly stronger than Ethibond regardless of the repair technique used. There was no difference between the nonlocking and locking repair technique in any of the suture groups. However, the nonlocking technique failed by tissue pull through while the locking technique failed by suture breakage. CONCLUSIONS: The FiberLoop suture and the FiberWire suture were significantly stronger than the Ethibond suture. Additionally, this study shows that the 4-0 suture is of adequate strength to repair a tendon injury. The double-armed Fiberloop may translate into quicker tendon repairs without sacrificing strength.

Antegrade and retrograde endoscopy for treatment of esophageal stricture.

Total or near-total esophageal stricture results from multiple processes. Traditional treatment with wire cannulation followed by serial dilation is often contraindicated due to poor visualization and the risk of perforation. We seek to demonstrate that combined antegrade and retrograde endoscopy are useful for treatment of total or near-total esophageal strictures. The gastrostomy tube is removed and the tract dilated. A standard endoscope is passed retrograde to the stricture. An antegrade endoscope is advanced until transillumination across the stricture is visualized. A biopsy forceps or needle is used to traverse the stricture in an antegrade fashion. The tract is cannulated with a stiff wire that is then brought out through the gastrostomy site. The stricture is serially dilated. The gastrostomy tube is replaced, and a nasogastric tube is left across the stricture for 3 to 4 weeks. The endoscope is withdrawn and an 18 or 20 Fr gastrostomy tube is left in place. A total of three patients with total esophageal strictures were treated using combined antegrade and retrograde esophagoscopy. All three patients regained the ability to swallow secretions. Importantly, there were no instances of esophageal perforation. This technique has broader application, including combination with minilaparotomy for patients without retrograde access. Further research is needed to determine durability of stricture dilation.

Simultaneous pancreas-kidney transplantation utilizing a common arterial conduit: early experience and potential applications.

Simultaneous pancreas-kidney transplantation has gained acceptance as a therapeutic modality for patients with end-stage renal disease secondary to diabetes mellitus. In some instances, performing the procedure as conventionally described with renal revascularization from the left iliac vessels and pancreatic arterial inflow from the right iliac vessels may be difficult or undesirable. We describe our experience with an alternate operative technique utilizing a single arterial conduit to vascularize both organs. We believe that this technique may be of use in certain patients undergoing simultaneous pancreas-kidney transplantation.