An improved technique for a stapled transabdominal esophagojejunostomy.

BACKGROUND: In the performance of a stapled transabdominal esophagojejunostomy there are two main technical problems involved and related to a difficult surgical exposure. One is the placement of the purse-string suture and the second is the insertion of the anvil of the circular intraluminal stapler into the distal esophagus. METHODS: These technical difficulties can be overcome by opening just the anterior wall of the esophagus at the anastomosis level, leaving the posterior wall intact. RESULTS: The integrity of the posterior wall avoids retraction of the mucosa, allowing the esophagus to remain opened for the placement of a through and through purse-string suture under direct vision. It also acts as a conduit for the insertion of the anvil of the circular intraluminal stapler. CONCLUSIONS: The technique described herein avoids stay sutures, purse-string instruments, and forceful instrumental dilatation of the distal esophagus, making these very important operative steps much easier, safer, and more reliable.

Q angle: effects of isometric quadriceps contraction and body position.

The quadriceps femoral angle (Q angle) has been linked with several knee disorders, but Q-angle measurement procedures have not been standardized. The purpose of this study was to examine the effects of isometric quadriceps contraction in the standing and supine positions on the Q angle. The Q angles of the right knees of 30 men and 30 women were measured goniometrically during four test conditions: 1) quadriceps relaxed in standing, 2) quadriceps contracted in standing, 3) quadriceps relaxed in supine, and 4) quadriceps contracted in supine. The pelvic widths were also measured as the distance between the anterior superior iliac spines in standing and supine. A two-way multivariate analysis of variance showed a significant difference between genders (p < 0.001) and among the four test conditions (p < 0.001) (N = 60). Separate one-way analyses of variance (ANOVAs) with two grouping factors (contraction and position) showed significant effects of contraction (p < 0.001) for both men and women, but no significant effect of positions. A dependent t-test showed that the pelvic width differed between standing and supine for both men and women (p < 0.001). The results showed that isometric quadriceps contraction affects the Q angle with the subjects standing or supine, even though the pelvic width differed significantly between the two positions. Clinicians and researchers should consider the results of this study in order to standardize procedures for measuring the Q angle.