Pathfinders in oncology from the end of the 19th century to the first description of Ewing sarcoma.

During the period 1884 to 1922, the only option in cases of operable cancers was radical surgery, and only a minority of patients were cured. Sporadic attempts were made to treat inoperable cancer patients with bacterial toxins; however, with the discovery of x-ray and radium, the era of radiation treatment as an alternative to surgery began. The discovery of transmissible cancers and experimental growth of cancer cells offered new information and not only led to a better understanding of the cellular composition of cancers but also yielded important information that ultimately paved the way to chemotherapy. These efforts also advanced the understanding of the pathogenesis of tumors and induced new clinical and pathologic classifications and subspecializations. It is important to emphasize that many of the initiatives and discoveries made in Europe in the second half of the 19th century were first put into clinical practice in the United States during the first 2 decades of the 20th century, including the use of x-ray and radium for irradiation and as diagnostic tools. All things considered, the progress made between 1884 and 1922 came about through the hard work of many eminent individuals; however, there were 7 foresighted pathfinders (3 surgeons, 2 pathologists, 1 internist, and 1 physicist) who-despite their widely diverse backgrounds, personalities, and expertise-made remarkable contributions to oncology to an extent that is still felt today.

Suture of a stab wound of the heart.

Over many centuries, from the early writings of Galen, 'the father of Medicine', wounds of the heart were considered fatal and outside the remit of surgery. With the advent of anaesthesia, (ether was introduced by William Morton in 1846) and of antiseptic surgery, (Joseph Lister's first publication was in 1867), there was an explosion in the surgery of the abdominal cavity, the chest, the skull and the limbs, yet the heart was considered by the surgical fraternity to be the 'no-go' area of the body. Theodor Billroth, Professor of Surgery in Vienna and himself a pioneer of modern surgery, (he performed the first successful partial gastrectomy for carcinoma of the stomach in 1881), wrote "the surgeon who would attempt to suture a wound of the heart should lose the respect of his colleagues". In London, Stephen Paget, in 1896, wrote: "No new method and no new discovery can overcome the natural difficulties that attend a wound of the heart. It is true that suture has been vaguely proposed as a possible procedure and has been done in animals but I cannot find that it has ever been attempted in practice". (In fact, the heart is an amazingly tough and efficient pump that goes on working, year after year, without ever stopping for a service!).

The past and present of liver suture.

Since the first attempts at resecting parts of diseased livers in the late nineteenth century, hemorrhage has been the main obstacle for surgeons. One of the first hemostasis techniques in liver resection was liver suture. The idea of suturing the liver in order to perform resection was proposed by a team of Russian and Polish surgeons from Kharkiv University in today's Ukraine. The liver suture became widely popular and has been used in various forms throughout the surgical world. Further into the twentieth century, it has lost much of its popularity; however, over more than 100 years of existence it has seen several peaks in interest. Currently, it is still being used by some liver surgeons as it is one of the cheapest ways of obtaining a bloodless liver parenchyma transection.

The history of barbed sutures.

Ligatures have been used for millennia to close wounds. Sterilization and synthetic polymers that degrade in a commensurate fashion with wound healing have been the most significant improvements in these age-old devices. However, the constricting loop of a traditional suture and subsequent ischemia ("approximate, don't strangulate") still account for the most common cause of wound dehiscence-necrosis. Inspired by the quill of the North American porcupine, I envisioned a bidirectional array of barbs that could secure tissue without relying on constricting loops. One set of barbs could anchor the other. In this article, I document the development process of these barbed sutures from concept to patent to manufacture and US Food and Drug Administration approval. Knotless, strong, and easy to place, barbed sutures could foreseeably supplant conventional sutures, particularly as endoscopic procedures become more common. They also offer the intriguing potential to suspend ptotic tissues without surgical intervention.

Barbed sutures in breast reconstruction.

Postoperative closure techniques in breast reconstruction have remained largely unchanged over the past 75 years, despite recent use of adhesives and subcuticular staples and the advent of self-anchoring barbed sutures. In this article, the author discusses the applications for barbed sutures in breast reconstruction and describes specific techniques. Innovations in barbed suture material are also described, and the author's personal experiences are presented in comparison with traditional suturing techniques.

New and emerging uses of barbed suture technology in plastic surgery.

Barbed sutures first received US Food and Drug Administration approval for soft tissue approximation in 2005 and early adopters readily embraced this device to develop new techniques. It has become apparent that the advantages are more than just "skin deep." Superficial and deep fascia, cartilage, tendon, joint capsule, and fibrous periprosthetic capsules can also be manipulated. Barbed sutures have revolutionized our approach to facial rejuvenation and body contouring by enhancing our ability to quilt and powerfully lift tissue. The elimination of surgical drains and shorter surgical times has made this a true boon for plastic surgeons as well as many other surgical specialists. This article summarizes some of the current and evolving applications of this exciting new tool.

Breve historia de las suturas mecánicas en la cirugía mundial y argentina / Brief history of mechanical sutures in global surgery and Argentina

Las suturas mecánicas son instrumentos que se utilizan en cirugía para permitir secciones de tejidos de manera rápida y segura. Su invención co- rresponde a los húngaros Victor Fischer y Hümer Hültl. En este artículo se describe su evolución a lo largo de la historia de la cirugía y se detalla su incursión en la cirugía argentina.

The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives.

During a laparoscopic appendectomy, the closure of the appendiceal stump is an important step because of postoperative complications from its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis, and sepsis is feared and unwanted. The tactical modification of the appendiceal stump closure with a single endoligature, replacing the invaginating suture, adjusted very well to laparoscopic appendectomy, and nowadays is the procedure of choice, whenever possible. Among the alternatives that do not make use of an invaginating suture, studies advocate the use of an endostapler, endoligature (endo-loop), metal clips, bipolar endocoagulation, and polymeric clips. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.

The history and evolution of sutures in pelvic surgery.

The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool.

[Jaboulay, vascular surgeon at Lyon]. / Jaboulay, chirurgien vasculaire a Lyon.

Mathieu Jaboulay was an excellent surgeon. He was the first to come up with the principles of vascular surgery as he made a surgical anastomosis between two arteries of a dog by an eversion circular suture. In 1902, he implemented a suture between an artery and a vein in an arteritis by obliteration. Jaboulay also tried the graft of an animal kidney on the crease of a human elbow in 1906. Jaboulay was an initiator for Alexis Carrel.

Los primeros neurocirujanos de América: pre y postoperatorio en las trepanaciones Incas / The first neurosurgeons of America: Pre and post operative issues in the Inca trepanations

Las trepanaciones o craneotomías encontradas en America latina, fueron realizadas por culturas preincaicas y posteriormente por los Pueblos que fueron instruidos por ellos, durante su expansión del Tahuantinsuyo. En el presente trabajo se analizan aspectos del pre y postoperatorio, así como también del entorno, materiales de craneoplastías, elementos de sutura, etc.Se ensayan interpretaciones a la luz de nuevos hallazgos de la Neurocirugía y mi renovado interés por el tema.

The trepanation craniotomias found in americas or latino, were made by pre incaicas cultures and subsequently by People wo were educated by them, during their expansión of Tahuantinsuyo.In this paper we analyze aspects of pre and post operative periods, as well as the environment, craneoplasty materials,elements of suture, and so on. We rehearse interpretations in light of new findings of Neurosurgery and renewed interest in the topic.

Evolution of staples and clips for vascular anastomoses.

Because of the development of less invasive surgical techniques, there is an increasing demand for vascular anastomosing techniques that require less exposure of the operating field. This paper reviews the most important representatives of staples, clips, and other mechanical devices for vascular anastomosing described over the last five decades. This report is organized in three parts: (1) the history of clipping and stapling devices, (2) development of the Vessel Closure System (VCS) clips, and (3) current and potential status of mechanical vascular anastomotic devices. A Medline literature search was conducted and publications on the use of staples and/or clips for the creation of vascular anastomoses identified with extensive cross-referencing. The first literature description of a mechanical vascular stapling device was by Gudov in 1950. This and other reports from the Soviet Union stimulated brisk, competitive development of vascular anastomotic devices in Europe, North America, and Japan. Fasteners included staples, penetrating pin-rings, or toothed stainless steel clips, none of which gained acceptance because of their complexity and inability to facilitate end-to-side anastomoses. A more convenient and less traumatic anastomotic system (VCS Clip applier system) was introduced into clinical practice in 1995. This system differs from staples in that it is non-penetrating. A wide variety of reports have described the advantages, both technical and biological, that clips provide over conventional needle-and-suture, particularly for the construction of vascular access for hemodialysis. A steady evolution of mechanical vascular anastomotic devices has sought to eliminate the technical and biological disadvantages of conventional suturing. Although the conventional hand-sewn, overcast non-absorbable suture remains the "gold" standard, newer techniques such as the non-penetrating arcuate-legged VCS clips are gaining acceptance as a useful addition to the vascular surgeons' armamentarium.