Multicenter prospective randomized controlled clinical trial comparing the pocket-creation method with and without single-clip traction of colonic endoscopic submucosal dissection.

BACKGROUND: The pocket-creation method (PCM) was developed to overcome the technical difficulties of endoscopic submucosal dissection (ESD), although opening the pocket remains challenging. We developed a novel technique of PCM with single-clip traction (PCM-CT), which uses a reopenable clip as a traction device to maintain stability during the procedure. No prospective study has compared the efficacy of PCM-CT and PCM. This study aimed to investigate the effectiveness of PCM-CT vs. PCM in a randomized controlled trial. METHODS: This randomized controlled clinical trial was conducted at four Japanese institutions. Patients with superficial colorectal neoplastic lesions were included following Japanese guidelines for colorectal cancer. Seven moderately experienced endoscopists performed the ESD procedures using either PCM-CT or PCM. RESULTS: 100 patients were enrolled in the study. Compared with PCM, PCM-CT achieved significantly faster mean (SD) dissection speed (21.4 [10.8] vs. 27.0 [14.5] mm2/min [95%CI 0.5 to 10.7], P = 0.03), and reduced the mean procedure time (81.8 [57.9] vs. 64.8 [47.6] minutes [95%CI -38.2 to 4.3], P = 0.12) and pocket-opening time (37.8 [33.0] vs. 30.0 [28.9] minutes [95%CI -20.2 to 4.6], P = 0.22). En bloc and R0 resection rates were not significantly different between the two groups (100% vs. 100%, P >0.99; 100% vs. 96%, P = 0.50, respectively). No significant differences were observed in adverse events between the two groups. CONCLUSION: ESD facilitated by the novel PCM-CT method appeared to be significantly faster than PCM. Both methods achieved high R0 resection rates.

Development of a novel multipoint traction device for gastric and colorectal endoscopic submucosal dissection and evaluation of its efficacy and safety.

BACKGROUND: Proper traction allows safer and easier endoscopic submucosal dissection; however, single-point traction may not be sufficient. In this study we assessed the safety, efficacy, and feasibility of our newly developed multipoint traction device. METHODS: During an ex vivo study using a Konjac training model, two experts and two trainees resected 80 mock lesions of 20-mm diameter by performing endoscopic submucosal dissection with and without multipoint traction. The primary outcome was the success rate of the procedure involving traction. The secondary outcomes were the submucosal dissection time, dissection speed, and perforation during endoscopic submucosal dissection. During the in vivo study, to clarify the initial clinical outcomes, we used data from the electronic medical record of patients at our institution who underwent gastric and colorectal endoscopic submucosal dissection, which was performed by experts with our newly developed multipoint traction device, from March to December 2022. RESULTS: The ex vivo study indicated that all traction procedures were successful. Higher resection speeds were observed with endoscopic submucosal dissection with traction than without traction (P < 0.001). Perforations were not observed. During the first in vivo clinical study, traction was feasible during 20 gastric and colorectal endoscopic submucosal dissection procedures. No adverse events occurred. CONCLUSIONS: Our multitraction device can increase the submucosal dissection speed and simplify endoscopic submucosal dissection techniques, thus safely reducing technical challenges. The application of this device for endoscopic submucosal dissection could lead to safer and more efficient procedures. Clinical registration UMIN Clinical Trials Registry, Japan (registration number UMIN000053384).

Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients.

PURPOSE: Abdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns. METHODS: Four tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation. RESULTS: Ten patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4-22) in GOC and 5 days (range 4-11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4-22). CONCLUSION: Traction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

Postoperative Intermaxillary Elastic Traction Contributes to the Stability of Absorbable Plates Fixation for Bilateral Mandibular Fracture.

The use of absorbable plates can be challenging for mandibular fractures involving bilateral dentition. Chewing and mouth opening movements may cause loosening or breakage of absorbable materials, leading to displacement of bone segments and resulting in malocclusion. The use of absorbable materials for bilateral mandibular fracture surgery itself raises concerns for surgeons. Timely intermaxillary elastic traction is essential for these patients after surgery to maintain correct occlusion. The surgical approaches were performed with intraoral mandibular sulcus incisions. During the surgery, intermaxillary fixation screws were implanted and steel wires were used for intermaxillary ligation and fixation to restore the occlusal. After the fractured segments were sequentially reduced, they were fixed with inion 2.0 absorbable plates. The patient underwent intermaxillary elastic traction for 1 week. Elastic mask was used to assist in stabilizing the position of the jawbone and maintaining occlusion. After discharge, the patient continued traction at home for 3 weeks before removing the intermaxillary fixation screws. The patient recovered well after surgery without any complications. The postoperative occlusal relationship is good. Postoperative CT showed good reduction of the fractured segments. For the case reported in this article, elastic traction was promptly implemented after surgery. We emphasize that restoring occlusion is always the treatment goal for jawbone fractures. We believe that keeping the intermaxillary fixation screws for a month is a wise choice to be prepared for unexpected needs.

Traumatic vertebral artery dissection associated with cervical neck traction devices.

Cervical arterial dissection (CAD) is a common cause of stroke in young people which can be classified as either spontaneous or traumatic. The primary initial symptoms are headache, neck pain, and dizziness. Recently, a 57-year-old woman experienced a severe headache after using a cervical neck traction device. Radiological examination of the head and neck revealed right vertebral artery dissection, which emphasizes the importance of recognizing that using cervical neck traction devices increases the risk of traumatic vertebral artery dissection.

Pins and Rubber Band Traction System Combined with Internal Fixation for Intra-articular Fractures of the Proximal Interphalangeal Joints.

Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20-81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°-106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°-90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic).

Energia interfacial para fratura entre novas zircônias de diferentes translúcidez e o cimento resinoso / Interfacial energy to fracture between between new zirconia of different translucency and resin cement

O objetivo do presente estudo foi determinar a energia interfacial para fratura e a distribuição de tensões usando espécimes Brazil-nuts. Esses espécimes foram usinados em zircônia de alta translucidez (Vita YZ HT, Vita Zahnfabrik), super translucidez (Vita YZ ST, Vita Zahnfabrik) e extra translucidez (Vita YZ XT, Vita Zahnfabrik) usando uma máquina de alta precisão, de forma que apresentaram um defeito de forma elíptica no centro de cada hemi-disco totalmente padronizado. As superfícies de cimentação foram preparadas com tratamentos de superfície (jateamento com partícula de óxido de alumínio e aplicação de silano), em seguida seguirão o protocolo de cimentação com cimento resinoso com metacriloiloxi-decil-dihidrogenofosfato (MDP). Os espécimes cimentados foram armazenados em água destilada em estufa 37 °C por 7 dias, em seguida, metade dos espécimes foi ensaiada e a outra metade foi colocada em envelhecimento térmico em uma com banhos de 5- 55 °C (sendo ensaiada logo após o término do envelhecimento). O teste de energia interfacial para fratura (EIF ou tenacidade à fratura interfacial) foi realizado em uma máquina de ensaios universal usando um teste de compressão com a interface adesiva do espécime posicionada em cinco ângulos diferentes (0°, 5°, 15°, 25° e 30°), pois dessa forma foi possível mensurar a EIF em pura tração, puro cisalhamento e em modos mistos de falha. Todas as interfaces foram observadas após a fratura para determinação dos padrões de falha e crescimento de trinca na interface adesiva. Foi realizada também a análise da distribuição de tensões nesses espécimes com o método de elementos finitos (FEA). Foi realizado o teste de normalidade Kolmogorov- Smirnov, Shapiro-Wilk e o Teste de Levene (95%), que concluíram que os dados não apresentam comportamento normal e não são homocedásticos (p=0,000). Desta forma, foi realizado o teste Kruskal-Wallis e post hoc Teste de Dunn, ambos com nível de significância de 5%. Entretanto, não houve diferença estatisticamente significante entre os materiais não envelhecidos (p0=0,485, p10=0,8580, p20=0,4027, e p30=0,650) e envelhecidos (p0=0,6976, p10=0,3505, p20=0,7565, e p30=0,1469). Adicionalmente, foi aplicado o Teste de Mann-Whitney, também com nível de significância de 5%, para comparar cada um dos grupos quanto ao fator envelhecimento; essa análise mostrou diferença estatisticamente significante entre os materiais envelhecidos e não envelhecidos em cada um dos ângulos usados (p>0,05). De acordo com o FEA, o carregamento compressivo de espécimes Brazil-nut em diferentes inclinações permitiu a predominância de tensões de tração ou cisalhamento, conforme o ângulo de posicionamento da interface adesiva. Pode ser concluído que, os valores de energia interfacial para fratura sob tensões predominantemente de cisalhamento são maiores do que quando as amostras estão submetidas somente à tensões de tração. Todas zircônias translúcidas cimentadas com cimento resinoso possuem energia para fratura semelhantes e o envelhecimento térmico afeta negativamente essas interfaces(AU)

The objective of the present study will determine the interfacial energy to fracture and stress distribution using the Brazil-nut specimens. These specimens will be milled in high translucent zirconia (Vita YZ HT, Vita Zahnfabrik), super translucent (Vita YZ ST, Vita Zahnfabrik) and extra translucent (Vita YZ XT, Vita Zahnfabrik) using a high precision machine, so that there will be an elliptical shape defect in the center of each hemi-disk. The cementing surfaces will be prepared with surface treatment (sandblasting with aluminum oxide particles), after that a cleaning, application of Silane, drying and application of resin cement with MDP will hold the cementing protocol. The cemented specimens will be stored in a stove with distilled water at a temperature of 37°C for 7 days after the adhesive cementation, after that the specimens will be aged in a thermal cycling bath machine with temperature varying within 5-55° C and will be tested shortly after the aging. The interfacial energy to fracture test (IEF or interfacial fracture toughness) will be held in a universal testing machine using a compression test with the adhesive interface of the specimen placed in five different angles (0°, 5°, 15°, 25° and 30°) this way it will be possible to measure the IEF in its pure form of tensile, pure shear and mixed modes of failure. All interfaces will be observed after the fracture to determine the patterns of failure and crack growth in the adhesive interface. Also, there will be held the stress distribution analysis in these specimens with the finite element method. The data obtained will be discussed in front of the relevant literature. Kolmogorov-Smirnov, Shapiro-Wilk and Levene Test normality test (95%) were preformed, these concluded that the data do not present normal behavior and are not homocdatic (p=0.000). Thus, the Kruskal-Wallis test and dunn's post hoc test were performed, both with a significance level of 5%. However, there was no statistically significant difference among the non-aged materials (p0=0.485, p10=0.8580, p20=0.4027, and p30=0.650) and aged materials (p0=0.6976, p10=0.3505, p20=0.7565, and p30=0.1469) were analyzed. Additionally, the Mann- Whitney Test was applied, also with a significance level of 5% to compare each of the groups regarding the aging factor. Thus, there was a statistically significant difference between aged and non-aged materials at each angle (p>0.05). According to FEA, the compressive loading of Brazil-nut specimens at different inclinations allowed the predominance of tensile or shear stresses, according to the positioning angle of the adhesive interface. It can be concluded that the values of interfacial energy to fracture under predominantly shear stresses are higher than when the samples are subjected only to tensile stresses. All translucent zirconia resin cement-bonded have similar interfacial energy to fracture, and thermal aging negatively affects these interfaces(AU)

Percutaneous Transhepatic Release of an Impacted Lithotripter Basket and Its Fractured Traction Wire Using a Goose-Neck Snare: a Case Report

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.

Dinamômetro tracionador de dispositivos dentários / Dental Apploances tensile dynamometer

A dental appliances tensile dynamometer was developed remove direct bonded orthodontic brackets from the tooth, without necessity of extracting this late; this means that the essay is realized with the dental organ resting in its alveolus of a living patient. The apparatus basically consists of a metalic tube, containing a fixed blade (or a S-like structure) tied to a metalic wire. When the wire is conected to the bracket, the dynamometer is pulled, the blade is submitted to a tensile effort which is dected by two extensometers that send electric pulses to a plotter or to a micro-computer, already calibrated to quantify the traction force value necessary to remove the bracket. It is possible to use this dynamometer in many other situations, as to verify the bond strength of dental adhesives to the various dental tissues, or to quantify the necessary force to extract a teeth from is socket

Cirugía laparoscópica sin neumoperitoneo / Laparoscopic surgery without pneumoperitoneum

Presentamos nuestra experiencia en 17 procedimientos de cirugía laparoscópica sin neumoperitoneo. La aplicación de esta técnica ha implicado fabricar elementos de tracción de la pared abdominal como alambres y tractor regulable. Se han realizado 11 colecistectomías, 2 procedimientos urológicos y 4 ginecológicos. El análisis de este procedimiento ha demostrado tener una morbilidad menor que la técnica con neumoperitoneo, y una disminución considerable en los otros

Tracción transoperatoria para la corrección del plano transverso de la escoliosis idiopática. Reporte preliminar / Transoperative traction for transversal plane correction of idiopathic scoliosis. Preliminary report

La corrección quirúrgica de la escoliosis idiopática es tema de controversia, en cuanto a su efectividad en el plano transverso. La deformidad no ocurre por rotación sino por desplazamiento ventrolateral de la columna. Pensamos que con un nuevo instrumento, siguiendo la técnica de Cotrel-Dubousset y con la experiencia del Dr. Luque, en México, se logrará la corrección en todos los planos. Los pacientes tratados tenían una escoliosis idiopática operaron 8, aquí mostramos la evaluación postoperatoria de 2, siete meses después de la cirugía, donde se logró la disminución de la escoliosis costal y la medialización de las vértebras en los planos sagital, coronal y transverso, se espera que la modificación será mayor además de la ausencia de complicaciones postquirúrgicas

Luxación dorsal del atlas y ventral del axis. Comunicación de un caso y revisión de la literatura / Traumatic dorsal dislocation of the atlas without neural involvement in a three year old girl. A case report and review of bibliography

Se presenta el caso de una niña de tres años y tres meses de edad quien a consecuencia de una caida sufrió luxación dorsal del atlas y ventral del axis sin fracturas. Lesión sumamente rara. Se hace la revisión bibliográfica al respecto, discutiéndose primordialmente os factores causales predisponentes.