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BACKGROUND Post-cholecystectomy transected bile ducts (TBDs) are not amenable to standard endoscopic management. Combined ERCP and endosonography (CERES) including EUS-guided hepaticoenterostomy enhance therapeutic biliary endoscopy. CERES treatment of post-cholecystectomy TBDs is evaluated. METHODS Among 165 consecutive patients who underwent ERCP for post-cholecystectomy bile duct injury (Amsterdam A/B/C/D grades [%] = 47/30/7/16) between January 2009-November 2020 at a tertiary-care center, 10/26 (38%) with TBDs (6 female; 32-92 years old) underwent CERES before attempted endoscopic repair (staged CERES, n = 7) or surgical repair (preoperative CERES, n = 1), or as destination therapy (definitive CERES, n = 2). Short-term clinical success rate, final clinical success rate and comprehensive complication index (CCI) were retrospectively determined. Additionally, number of follow-up procedures, adverse events, recurrences, final patency grades and definitive cure rate were determined in patients with staged CERES. RESULTS Index CERES (hepaticogastrostomy, 60%; hepaticoduodenostomy, 40%) achieved bile leak and jaundice resolution in 10 patients (100% short-term clinical success rate). Overall, 9/10 patients maintained good/excellent biliary drainage over a median 3.2 years without any unplanned percutaneous/surgical procedures (90% final clinical success rate; median CCI = 8.7). Staged CERES using recanalization (n = 6) or diversion (n = 1) strategies achieved Grade A patency in 5/7 (71%) patients after a median of 2 follow-up procedures over a median 12-month treatment period; 2 failed recanalization patients were salvaged by indefinite hepaticoenterostomy stent or elective surgery, respectively. Among staged CERES, 2 treatment-related cholangitis occurred (29%) and 2 recurring strictures (29%) developed over a median 8.4 year follow-up; recurring strictures were endoscopically remodeled (n = 1) or indefinitely stented (n = 1); final Grade A/B biliary patency was achieved in 5/7 (71%) and definitive cure in 4/7 (57%). CONCLUSIONS CERES controls acute symptoms in selected post-cholecystectomy TBD patients allowing subsequent staged endoscopic therapy. Definitive cure or long-term biliary drainage is possible in most cases and elective surgery can be facilitated in the remainder.

EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS. Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan–Meier method. During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3–100%, SEMS group 95% CI 83.2–100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups. EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven.

Development research has been carried out in order to solve a practical industrial problem: to counteract axial displacement (axial drift or axial creep) of workpieces during the welding process. Solutions found in the literature generally provide adequate results; however, they are mechanically complex with high purchase and maintenance costs. A mechanically simple and inexpensive solution is proposed in this paper. Axial drift is measured with a low-cost custom-built contact displacement sensor. This sensor can measure axial drift without calibration or set-up operations. It is highly robust in order to function correctly in industrial conditions. A pneumatic cylinder moves the idle turning roll along a rail, modifying the longitudinal position of the idle turning roll in order to counteract axial drift. The position of the idle turning roll is controlled by a control algorithm, which consists of a set of rules. Tests were carried out in order to validate the proposed solution, which can be applied to existing turning rolls thereby significantly reducing costs.

Currently, the face can be reshaped with minimally invasive procedures. This report describes how the midface can be suspended by increasing the projection of the malar area, decreasing the nasolabial fold depth, and improving the jaw definition using 3-0 polypropylene sutures with absorbable cones (Silhouette Sutures). Preoperative skin marks were made to indicate the four points on each side of the face where the sutures would exit through the skin: 1 cm lateral to the middle of the nasolabial fold, at the corner of the mouth, and on the line from the lateral corner of the lips to the angle of the mandible. The sutures were inserted through a 1.5-cm incision positioned in the temporal area. After insertion of the needle, the sutures were fixed to a small polypropylene mesh over the deep temporal fascia. A total of 316 patients were treated between January 2007 and December 2009. The results over a mean follow-up period of 18 months were good, with high patient satisfaction. All the complications experienced by 42 patients (13.3%) were minor and temporary including temporal area pain (7%), visible dermal pinching (3.5%), hematoma (1.3%), asymmetry (0.6%), and suture palpability (0.3%). There were no infections. Face-lifts were performed for 257 women with a mean age of 47 years and 59 men with a mean age of 49.5 years. This procedure can be performed for various age groups to rejuvenate and reshape the middle face. Men whose scars cannot be easily hidden due to baldness are good candidates as well. The technique led to stable results and only minor, temporary complications, with a high level of satisfaction among patients and surgeons. The longevity of the results beyond the mean follow-up period of 18 months needs to be determined.

Breasts represent femininity and any change of shape may affect their appearance. Breast ptosis may be caused by several factors, including significant weight loss, pregnancy, long breastfeeding periods, and involution of the postmenopausal breast tissue. Breast ptosis may be associated with breast hypoplasia; thus, in case of a mastopexy with or without the use of implants being indicated, several considerations have to be taken into account: the wishes of the patient, age of the patient, degree of ptosis, parenchymal volume, covering tissue, quality of the tissue, pocket implant, shape and content of the implant, and resulting scars.

Breast augmentation is one of the most regularly performed interventions requiring reoperation in aesthetic surgery. For this reason, it involves a greater chance for complications. In this report, the authors aim to provide young plastic surgeons with guidelines based on their experience for responding to each of these complications, to explain the causes and ways of avoiding them, and to show how they can be treated when they occur.

Tramadol (1RS, 2RS)-2-[(dimethylamino)-methyl]-1-(3-methoxyphenyl)-cyclohexanol) is an atypical centrally acting analgesic agent with weak opioid receptor affinity that, like some antidepressants, enhances the extraneuronal concentrations of the monoamine neurotransmitters, noradrenaline and serotonin, by interfering with their re-uptake and release mechanisms.The present study was undertaken to evaluate the potential role of 5-HT(1A) receptors and opioids receptors in the analgesic effect of tramadol in neuropathic pain. With this aim, the effect of either a selective 5-HT(1A) receptor antagonist (WAY-100635, N-2-[4-(2-methoxyphenyl-1-piperazinyl]ethyl]-N-2-pyridinylcyclohexane carboxamide) or a selective 5-HT(1A) receptor agonist (8-OH-DPAT, 8-hydroxy-2-(di-n-propylamine) tetralin hydrobromide) or an opioid receptor antagonist (naloxone; naloxone hydrochloride dihydrate) was investigated in combination with tramadol by means of the cold-plate test in the chronic constriction injury model in rats.The results showed that WAY-100635 (0.8 mg/kg) significantly enhanced the antiallodynic effect of non-effective doses of tramadol (5-10 mg/kg). In contrast, 8-OH-DPAT (0.5 mg/kg) counteracted the antiallodynic effect of an effective dose of tramadol (22 mg/kg). Naloxone (0.5 mg/kg) partially counteracted the antiallodynic effect of tramadol (22 mg/kg).These findings suggest the involvement of opioid and 5-HT(1A) receptors in the antinociceptive effect of tramadol and support the idea that the combination of tramadol with compounds having 5-HT(1A) antagonist properties could be a new strategy to improve tramadol-induced analgesia in neuropathic pain.

Mature leaves of dwarf elder (Sambucus ebulus L.) contain the non-toxic type 2 ribosome-inactivating protein ebulin 1 (Girbes et al., 1993b, J. Biol. Chem. 268: 18195–18199). We have now found that the green fruits of dwarf elder contain both free and polymerized forms of ebulin (ebulin f) and a new homo-dimeric D-galactose-binding lectin (SELfd). Polymerized material containing ebulin and lectin is composed of aggregates of variable relative molecular mass, some of them being close to 250 000. These aggregate forms are maintained in part by reducible disulphide bridges and reconstitute from reductant-free dialyzed material previously reduced with 2-mercaptoethanol. Direct incubation of free ebulin f with the free SELfd did not lead to polymerization, thus indicating that polymerization triggers some kind of substantial and perhaps catalyzed change in the structure of these proteins. Ebulin-containing polymerized material reacts with anti-ebulin f antibodies. Our results indicate that ebulin f is a fruit-form of ebulin 1. In contrast to green fruits, mature fruits lack both polymerized material and ebulin f, thus indicating some kind of reserve role for them in green fruits. Polymerization of ebulin and the dimeric lectin may represent a novel means of storing the non-toxic type 2 ribosome-inactivating proteins and lectins found in highly metabolic tissues, such as green fruits.

The characteristics of devices with gate oxide short defects are investigated for both n-MOS and p-MOS transistors. Experimental results obtained from real and design induced gate oxide shorts are presented analyzing the defect-induced conduction mechanisms that determine the transistor behavior. It is shown that three variables (defect location, transistor type and gate polysilicon doping type) influence the characteristics of a defective device. Of interest is the prediction and observation of a particular gate oxide short type that can cause latchup. An electrical model is proposed and compared with experimental data. Such a model is developed to be used in electrical CAD environments without introducing a penalty in the simulation time.

Between June 1990 and June 1992 we carried out 56 breast operations: 18 reductions, 32 mastopexies, and 6 implant changes. The surgical techniques used in all cases basically consisted of three phases: the periareolar incision, the creation of the superior pedicle with two medial and lateral flaps, and the "anchoring," crossed by both flaps in order to hold up the mammary gland. The diameter of the "doughnut" of skin that we had to deepidermize varied between 5 and 15 cm, thus raising the nipple-areola complex by as much as 10 cm. The volume of tissue removed from the hypertrophic breast ranged from 70 to 520 g. In 24 of the 32 mastopexies, the use of a silicone implant was necessary in order to provide greater volume, texture, and better mammary contour. In these cases the size of the prostheses varied between 120 and 300 cc. All patients completed the postop followup in the normal way. Only three patients suffered a slight dehiscence of the periareolar suture, which was solved within a few days of the operation by means of a Friedreich. The periareolar cutaneous pleats and the hardness of the breast gradually disappeared, as predicted, within a period of 3-4 months; afterward the breast looked perfectly natural.

The resection of the columella and nasal depressor muscles is a simple operation to perform and one which allows an improvement in the facial physiognomy of many patients. This operation can be done alone or in conjunction with the classic rhinoplasty, thus achieving an improvement in the aesthetics of the smile. It has also been proved, contrary to common belief, that the action of these muscles has no connection with physiological breathing mechanisms.