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Chronically implanted IUDs consisting of silk suture threads induced decidualization in regions of the uterus remote from the suture site in ovariectomized mice treated with a regimen of progesterone and oestrogen which sensitizes the uterus to a decidual stimulus. In these conditions the IUDs did not inhibit decidualization induced by instilled oil, although they did so in pregnant animals of the same strain. Varying the dose of progesterone and oestrogen did not produce conditions in which IUD's inhibited oil-induced decidualization in ovariectomized mice and progesterone treatment did not prevent IUDs inhibiting decidualization in pregnant animals. However, when ovariectomized mice, sensitized as before, were primed repeatedly with oestrogen to simulate continuing oestrous cycles after IUD insertion, the IUD's inhibited oil-induced decidualization. This involved the premature loss of instilled oil from the uterine lumen and was associated with heavy infiltration of leucocytes into the luminal epithelium. Numbers of leucocytes free in the uterine lumen did not appear to be critical. It appears that contact between the oil and the luminal epithelial surface must be sustained for some length of time to induce a decidual reaction; brief contact is not sufficient to trigger the response.

SINCE its introduction in 1952 by Jones and Smith 1 sphincteroplasty has been widely used for stenosis of duodenal papilla and to form a wide opening at the distal end of the common duct to provide for stones descending from the intrahepatic ducts in case of hepatolithiasis. Placement of hemostats or sutures at the duodenal papilla before its division is recommended, because of the ease of securing choledochal mucosa to include it in the interrupted suture with the duodenal mucosa. Difficulty is often encountered in inserting mosquito hemostats as recommended by Jones z or putting a needle accurately in the orifice of the duodenal papilla. Therefore, split tip bougie* was fashioned out of the urethral bougie as shown in Fig. 1. The exact dimension of the bougie is shown in Fig. 2. After choledochotomy, the bougie is inserted into the distal common bile duct via choledochotomy opening until firm resistance is felt. Duodenotomy is made on the duodenal wall just opposite to the tip of the bougie inserted. A small curved non-cutting needle with a braided silk suture is inserted into the orifice via a slit on the tip of the bougie at 10 to 12 o'clock position and tied (Fig. 3). The papilla is divided between

Acute obstructive cholangitis developed secondary to a common duct stone formed around a silver hemostatic clip, introduced at cholecystectomy two years previously, that had migrated from a long cystic duct remnant. Stone formation around a silk suture is well known, and silver clips in the area of the porta hepatis may constitute a similar hazard.

It is a well-known fact that in pulmonary tuberculosis patients treated by resection, the quality of the suture material used for closing the bronchial stump plays an important role in the pathogenesis of postoperative bronchopleural fistula. Of 426 cases treated surgically and in whom silk suture thread was used, 23 developed bronchopleural fistula, whereas none of the 220 cases sutured with nylon monofilament developed the abnormality. Statistical analysis of 100 surgical cases with silk thread suture and of 100 cases with nylon monofilament suture showed that the two groups had no marked differences as to background factors. However, as compared with the silk-thread suture group, the nylon-monofilament suture group revealed more consistently favorable postoperative bronchoscopic findings. Experimental studies with dogs showed a similar lack of complications when the monofilament suture material was used, as contrasted to twisted multifilament material. As surgical operations were conducted in hospital by the same surgical personnel using the same procedures, it can be said that, to insure prevention of complications, the suture material for bronchial stump closure should be of non-irritating nature and preferably of monofilament strength and quality, such as nylon monofilament.

To the Editor. —We read with interest the correspondence by Jordan and Anderson 1 describing the technique for prevention of prolapse of silicone stents following dacryocystorhinostomy surgery. As this is a fairly common and inconvenient occurrence in the postoperative period, we immediately adopted their technique to secure the stents at the time of dacryocystorhinostomy. As Jordan and Anderson recommended, we used a 4-0 silk suture to secure the two arms of the silicone loop to each other with a square knot placed below the internal common punctum. In the first 17 patients in whom this additional step was taken, there were no prolapsed tubes. Interestingly, however, three patients developed the unusual complaint of a foul odor noted respectively at 3, 5, and 8 weeks postoperatively. One patient described the odor as smelling "like a dirty diaper in my nose." We had never previously heard this complaint among several hundred patients

A new technique for continous long term intravenous alimentation in unrestrained rats has been developed. The model involves the use of the intravenous tubing set which was constructed from the barrel of a 1 ml syringe-cylinder with flanges sutured to the rat’s skin. After inserting the silicone catheter into the jugular vein the free end was exited at the intraauricular area and passed through the intravenous tubing set. The tubing was then connected with a silk suture to the top of the cage. This prohibits twisting of the system and allows unrestrained movement of the rat in the cage with a rotation of 6–8 turns in either direction. The metabolic cage was constructed from an inverted 4-liter glass jug with the base removed. A floor and root were fashioned from coarse wire screen. Urine and feces were easily separated and collected through the neck of the jug. This new “proxy” set was tested and compared with the standard swivel assembly parameters in rats infused by either method. However, the cost of the new set (excluding pump) was almost 90 times less than its commercially available counterpart. This self constructed approach should bring small animal research within the economic means of the most investigators.

The surgeon performing microsurgical intracapsular cataract surgery currently is concerned more with the incision and its closure than with the removal of the lens.

A technique is described to mark the longitudinal aspect of a saphenous vein in situ in the leg, using a silk suture inserted superficially in the perivascular connective tissue of the vein. The method prevents twisting of the vein when it is inserted in the heart and also provides the surgeon with a simple measure of real graft length.

• Flaccid eyelids commonly have a history of gradual onset of epiphora, which is aggravated by cold weather and wind. The natural history starts in middle age; as age increases, flaccidity increases. When the flaccid eyelids are surgically improved by a lateral canthal tendonesis, epiphora is greatly diminished. The surgical technique of tenodesis is accomplished by making an 18-mm skin incision at the lateral canthus. The pretarsal and preseptal portions of the orbicular muscle are mobilized, and the raphe is incised. The lateral canthal tendon is dissected and a 2-0 black silk suture is orthopedically placed so it pulls the tendon into a drilled hole near Whitnall's orbital tubercle. Cautery is applied to the cut ends of the upper and lower mobilized muscle. The pretarsal and preseptal muscles are resected 5 mm. The skin is approximated and the 2-0 suture is tied over a button and left in place for six weeks.

• False aneurysm formation is a well-recognized late complication of prosthetic graft insertion. Despite the fact that other etiologic factors may be involved, the behavior of the suture material remains of central importance. In a retrospective review of 1,330 peripheral vascular cases, we found 26 cases involving a total of 39 false aneurysms, or an incidence of 2% (26/1,330). Twenty-four of these were directly attributable to failure of the monofilament plastic suture or silk suture material. Braided Dacron suture was used in the original anastomosis in another seven cases, and in these instances the false aneurysms were not related to suture failure but were associated with such factors as previous endarterectomy, failure of arterial wall, and chronic hypertension. None of the 39 aneurysms was secondary to infection or trauma. These results emphasize the importance of using a braided, nonabsorbable suture material to ensure the continued integrity of an anastomosis involving prosthetic grafts. ( Arch Surg 114:412-415, 1979)

A silk suture in the urinary bladder of rats induces tumorous growths of urothelia. Whether these tumorous growths are due to initiation or due to promotion by the suture remains unknown. A 3-O silk suture was therefore placed in the bladders of rats for 4 or 8 weeks. After removal of the suture and a period of recovery, the bladders of these and sham-operated control rats were exposed to N -methyl- N -nitrosourea (MNU) in order to examine whether the effects of the suture were reversible following its removal from the bladder. In addition, the bladder mucosa was exposed to either MNU or Ringer's solution followed by placement of the silk suture in the bladder wall in order to examine promotor activity of the suture. The tumor incidence induced by MNU was little influenced by the prior temporary placement of the suture in the bladder wall, thus indicating a reversibility of the effects of the suture. The placement of the silk suture in the bladder wall that had a prior exposure to MNU resulted in a significant incidence of invasive tumors. All these results are consistent with the fact that a silk suture in the bladder acts as a promotor but not as an initiator.

LOWER-LID lag with rounding of the lateral canthus is especially common in patients wearing an ocular prosthesis over many years. This technique utilizes the lower lid as a sling. The lateral canthus is revised by the same procedure. Excellent results have been obtained for eight months. This is a preliminary report, since any procedure that is going to be proved effective must be followed up for over two to three years. Method A lateral canthotomy is performed. The lower arm of the lateral canthal tendon is cut at its periosteal insertion (Fig 1). This releases the lower lid and allows it to be freely rotated. A 4-0 silk suture is placed in the cut end of the canthal tendon and the lid is brought up over the upper lid to determine the amount of shortening which is necessitated. This point is marked on the lid margin. Scissors are used to

Objective: To compare the effects of verapamil on the contralateral kidney affected by unilateral ureter obstruction. Material & method: The right ureter of oryctalagus cuniculus rabbits, were obstructed surgically with silk suture material, and kept alive for 14 days. One group was obstructed without other treatment, one group was given verapamil from day 7 until day 14 of the obstruction. One group was obstructed and given verapamil from day 0 through day 14. One group was given a sham operation as a control group. The contralateral kidney of all groups were harvested and processed with ApopTag. The increase of apoptotic tubular cells compared to the control group was then analyzed between each group. Results: The highest increase in apoptotic cells was in the obstructed group without verapamil, but increased significantly compared to control (p

It may seem presumptuous, and it may really be presumptuous, to write on the technique of ileal conduit surgery for an audience of highly trained urologists who competed successfully in an active residency training program and who have, as a group, pursued distinguished careers. On the other hand, though the mortality of the ileal conduit operation is below 2% in patients operated upon for benign disease, morbidity figures, particularly those reflecting long-term complications, remain quite variable. As an example, persistent infection is reported in some series in upward of 60% of conduits in patients with normal upper tracts. In my patients, this figure is about 10 in a comparable group. James Holland, reviewing “high” ileal conduits—those attached directly to the renal pelvis—found that only 40% remained infected in the postoperative period, a surprisingly good result when one considers that this form of diversion is elected most often in patients with extreme hydronephrosis(9). These better results are probably directly related to operative technique and since the technique to be described, albeit with many digressions, evolved at Brady over the years 1955–1962, it seems a particularly apt subject for description and review in a Festschrift piece written to honor Dr. William W. Scott on his twenty-fifth anniversary as Chariman of the Division of Urolgy at Johns Hopkins.

The characteristics of silk as a surgical suture have been known for many years and need not be reviewed extensively, as excellent summaries are available. 1-4 Silk granuloma and extrusion have been attributed to simple foreign-body reaction, excessively large sutures, infection, allergy, or the dye or coating on the suture. 5 Recently Bahnson, Spencer and Bennett 6 described persistent staphylococcal infection about silk sutures used in 5 operations on the heart and great vessels. A second major procedure was necessary to remove the infected silk, after which the patients promptly recovered. Disturbing reports such as this stimulate the continued search for a better surgical suture. Several of the new synthetic suture materials have been found to incite less tissue reaction than silk, and Teflon has been noted to be especially innocuous. 7-9 Although the degree of tissue reaction is certainly not the underlying cause of all suture complications, these would

INJURY to the invisible subendocardial conduction system during surgical closure of congenital defects in the ventricular septum is an uncommon but extremely grave complication.1 , 2 Impalement of these delicate fibers with a needle or enclosure by a silk suture invariably results in complete, irreversible heart block. Recent anatomic and histologic studies indicate that in the presence of a high defect, the bundle of His arises from a normally placed atrioventricular node and penetrates the membranous septum adjacent to the margin of the defect. From this position, the right bundle branch proceeds downward in an arc along the posteroinferior rim at varying . . .

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THE INJECTION of various dyes has long been used as an adjunct to excision of lesions such as pilonidal sinuses and thyroglossal duct cysts. The usefulness has been somewhat variable, particularly where spillage of the dye stains adjacent tissues and sometimes confuses rather than assists the operation. Forrest and Robinson 1,2 described the use of methylene blue injected into the parotid duct as a technical adjunct to operations for removal of tumors of the parotid gland. They reported that the dye stained the normal gland but not the tumor and that spillage did not occur. The present report concerns a further trial of this method. Method At the time of operation, after endotracheal intubation, the duct is visualized, dilated, and cannulated with a polyethylene tube (PE 90). The catheter is threaded in 1.5 cm and anchored to the buccal mucosa with a silk suture. The end of the catheter with

OVER the past several years, the following sclerectomy operation has been evolved in New Orleans, based on Allen's cyclodialysis modification. 1 After preparation, anesthesia and akinesia, a superior rectus bridle suture is placed and secured. An 8 mm curving flap of conjunctiva and Tenon's is created and folded over the cornea. The limbus is cleaned with a Tooke blade. With a No. 67 Beaver blade, a radial groove is made from the anterior most limit of the limbus and extending posterior for 3 to 4 mm (Figure, A ). One 7-0 black silk suture is passed across the groove, drawn up in the center, and cut. The ends are used to apply traction to gape the groove, which is then deepened down to the choroid (Figure, B ). Cautery is used for hemostasis only if scleral bleeding obscures the groove. Using a cyclodialysis spatula, the sclera is separated from the underlying choroid

A SIMPLE canalicular rod technique has proved effective for correcting stenosis of the ampullary portion of the common canaliculus. Technique Inject the stenosed area of the canaliculus with lidocaine. Pass a probe (Bowman's No. 1 or No. 2) through the upper and the stenosed common canaliculus and into the opening of the lacrimal sac (Fig 1). When the probe is withdrawn, test patency by lavaging saline through the upper and the lower channels. The fluid which is flushed through both passages should flow freely into the nose. Insert a stainless steel canalicular rod (with a 4-0 surgical silk suture swaged to one end) through the upper canaliculus. The distal end of the rod should extend through the previously obstructed portion of the canaliculus and rest on the medial wall of the lacrimal sac. The proximal end of the rod should lie within the upper canaliculus, and only the suture should

One hazard that has not been stressed sufficiently in connection with the use of the rubber dam in operative dentistry is the danger of a patient’s ingesting or inhaling the rubber dam clamp when he is lying in a supine position. A 6-year-old girl swallowed a clamp; it was recovered successfully after an esophagoscopy was performed. This incident led us to develop a method that would help prevent the problem of inhalation or ingestion of a rubber dam clamp. Dental floss or heavy black silk suture material is ligated to each clamp and is allowed to hang from the patient’s mouth. If a clamp should fall into the pharynx, it can be retrieved by pulling on the ligature. This technique is recommended to all operative dentists, especially to those working with children.

IRIS retraction in round pupil cataract cryooextraction by a surgeon, operating without the aid of another surgeon, can present problems such as iris adhesions to the cryoextractor. The delivery can be facilitated by the use of a 6-0 black silk suture threaded through a peripheral iridectomy at the 12 o'clock position and used for retraction. Iris retraction with a suture has been described before, 1 but apparently has not been popularized. This method is particularly useful during cryoextraction. The corneal flap is lifted by the nurse assistant with a preplaced or postplaced suture. The surgeon grasps the iris adjacent to the peripheral iridectomy with iris forceps, and the needle and silk are threaded through the iridectomy entering at the posterior border of the iris and exiting from the anterior border (Fig 1). Traction on the suture is applied by the surgeon with one hand (Fig 2) while the cryoextractor is

{Received 1st March 1965) Summary. Unilateral cryptorchidism has been produced in prepubertal rats by abdominal fixation of an undescended testis and in adult rats by transplantation of a previously descended testis from the scrotal sac into the abdominal cavity. The incorporation of l-lysine-U-14C into protein of slices of both types of experimentally induced cryptorchid testes 30 days following the surgical procedure has been found to be markedly greater than that observed for slices of contralateral, scrotal testes of the same animal. It has long been known that cryptorchidism leads to severe spermatogenic damage. In addition, the undescended testis has been reported to be over thirty times more likely to become malignant as compared to a normal, scrotal testis (Campbell, 1942). For these reasons, our laboratory has initiated studies on the metabolism of mammalian testicular tissue beginning with an investiga¬ tion of the incorporation of 14C-labelled lysine into rat testicular protein. It was initially found that the incorporation of L-lysine-U-14C into protein of slices of cryptorchid testes which were experimentally-induced in adult rats was much greater than that observed for slices of scrotal testes obtained from the same animal (Davis, Morris 8c Hollinger, 1964). The present experiments were designed to explore further this finding, as well as to investigate the physiological significance of inducing cryptorchidism by transplanting a previously descended adult testis from the scrotal sac into the abdominal cavity. Unilateral cryptorchidism was experimentally produced in two groups of male Sprague-Dawley rats. The first group (five animals) consisted of prepubertal rats which were 20 days of age and in which the testes had not yet begun their descent. Abdominal fixation of the undescended testis was carried out by performing a midline abdominal incision under ether anaesthesia and suturing the right testis to the dorsolateral abdominal wall, thereby preventing its normal descent. A fine 6-0 surgical silk suture was passed just under the

Background: The closure of the periodontal flaps post-surgery is a necessity for attainment of a primary union between the flap margins and the establishment of a healthy dentogingival junction. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds to overcome the problems associated with conventional suture materials like silk. Objective: The present study was carried out to assess the healing of the periodontal flaps when closed with the conventional silk sutures and N-butyl cyanoacrylate. Materials and Methods: The study was carried out on 24 patients who needed flap surgical procedure for pocket therapy. Results: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a period of 21 days to 6 weeks, the sites treated with both the materials showed similar healing patterns. Conclusion: It can be concluded that cyanoacrylate aids in early initial healing.

Six polyvinyl chloride and six polyethylene angioplasty balloons were inflated six times each under laboratory conditions. Outside diameter of the balloons was measured on initial and final inflations; volume was measured by water displacement at each inflation. In addition, three balloons in either group were constricted with a silk suture around the midportion. Balloons were then intentionally ruptured and the rupture site recorded. The diameters of the polyvinyl chloride balloons increased over six inflations, while they remained relatively constant for the polyethylene balloons. Rupture sites were in the area of the balloon that had the greatest outside diameter, and the tears were longitudinal.

A sterile calcified granuloma on the external surface of a right ventriculotomy in an 8-year-old boy was identified four years after closure of a ventricular septal defect. He had no symptoms, but a systolic ejection murmur was identified and disappeared after resection of the lesion. Sensitivity to silk suture material is suggested by the operative findings and a history of multiple silk suture sinuses developing in his uninfected original thoracotomy incision.

Upper abdominal pains lasting 12 years after cholecystectomy, were improved in an 82-year-old woman following the rejection of indigestable silk surgical sutures induced by combined therapy of acupuncture, moxibustion and low-power laser beam irradiation directed to an old post-cholecystectomy scar. An inflammatory reaction followed by granulation tissue mass was developed. Embedded in the granulation tissue were the above mentioned silk sutures which finally were expelled through the skin at the operation scar. A surgical procedure suggested to the patient, in case of acupuncture therapy failure, was obviously avoided. Serratia-marcescens infection of the expelled material was bacteriologically defined.

For many years rhinoplastic surgeons have been confronted with the problem of preventing a widening or a weblike distortion of the septolabial angle following the classic procedure for shortening the nose, i. e. (1) transsection of the membranous septum down to the anterior nasal spine of the maxilla, (2) reduction of the septum and upper lateral cartilages and (3) reattachment of the columella to the septum. In carrying out step 3 overcorrection is essential to compensate for the subsequent inevitable contraction due to cicatrization of the transfixed membranous septum. With this in mind, Jacques Joseph, of Berlin, in 1898 devised the septocolumellar suture to raise the tip of the nose, 1 and this method became the standard practice in rhinoplasty and is meticulously followed at the present time. A heavy silk suture is passed through the septal cartilage and the columella in an oblique fashion, so that when the suture is

A NEW TYPE of lid retraction suture for ocular surgery has been used as follows: one needle of a double-armed 4-0 silk suture is passed along the conjunctival surface of the lid to pierce the entire thickness of the lid, to appear 1 mm above the level of the upper margin of the tarsal plate, and emerging through the skin at the junction of the inner and middle thirds of the length of the lid (Fig 1). The second needle is carried out in the same manner at the junction of the middle and outer thirds of the lid, leaving the loop of the suture partly embracing the conjunctival surface of the middle third of the lid (Fig 1). The loop is carried across the lid margin, pulled to the desired level, and attached together with the previously passed sutures down to the towels with a hemostat (Fig 2). If

I should like to recommend the following corneoscleral suture with modified conjunctival flaps. A conjunctival incision is made along the limbus from 11 to 1 o'clock (figure, A ). This part of the conjunctiva is then undermined From 1 to 3 o'clock a conjunctival flap 3 mm. wide is prepared. A similar one is made from 11 to 9 o'clock (figure, B ). 2. A single-armed 000000 silk suture is knotted double. The needle is then introduced into the conjunctiva above 12 o'clock, about 5 mm. from the limbus, from without in. A vertical bite is then taken in the episclera 2 mm. above the limbus, the needle emerging as close as possible to the limbus. The needle is then reintroduced through the conjunctiva 2 mm. above the free border and brought out. This needle is then cut off. The suture is now anchored above in the episclera and outside the conjunctive.

A silk suture placed in the lumen of one uterine horn of rats before mating prevented pregnancy in that horn although normal implantation occurred in the unoperated horn. The suture did not interfere with fertilization or the tubal transport of ova, nor did it induce a decidual reaction; it appeared to prevent pregnancy by causing failure of implantation.

Ferguson1 was able to produce uniformly in rabbits gastric ulcers which persisted from 2 to 8 months or longer. He incised the anterior wall of the stomach and at the point of incision removed a piece of mucosa and then closed the stomach by a silk suture, the rabbits being kept on a diet of hay, oats and carrots. It occurred to us that this observation provided a method of studying the effect of diet on the healing of this experimental gastric ulcer.In our first series of rabbits we found that if a lesion was made in the posterior wall of the stomach in which no silk suture was present and one in the anterior wall in which a silk suture was present and the rabbits placed on the stock diet of hay, oats and carrots, that the posterior lesion healed in 30 days, but the anterior lesion did not. This showed that the silk suture was a factor in delaying healing and that in the absence of the silk, diet played no role in delaying healing.Anterior lesions of the Ferguson type were made in 29 rabbits. Twelve were...

In Reply. —We would like to thank Drs Kersten and Kulwin for their suggestions. We agree with their assertion that a silk suture represents more of nidus for infection than does a polypropylene suture. Therefore, we have also switched to monofilament suture to secure the two arms of the silicone stent. However, one of our patients had an extrusion after we switched to a monofilament suture and we believe that the suture must be tied tightly and is probably less secure than the silk suture. In addition, the monofilament suture may "cheesewire" through the stent if it is tied too tightly in these cases. We have had some patients with or without silk sutures complain of a malodorous discharge from the nose with a silicone stent in place. In many cases we believe that this is the result of an allergy to the silicone and it is usually relieved by

To the Editor. —In retinal detachment surgery, we use an O black silk suture as a stay suture under each of the four rectus muscles. Normally, the surgeon ties a knot at the end of the suture. This makes the suture into somewhat of a loose ring when it is not held tautly. This can cause difficulty when the surgeon handles the suture, especially if he grasps only one arm of it. In this case, the suture will slip or slide and act as a loose ring under the muscle (Fig 1). Because of the slippage, it will be temporarily ineffective for holding the muscle. This situation can be avoided by tying an additional knot in the middle of the suture. This will prevent all slippage when the suture is grasped anywhere distal to the middle knot and will assure that neither of the arms of the suture will slip

Congenital cardiac anomalies, including a large interatrial septal defect, were repaired surgically in a 14-year-old girl. After an asymptomatic period of 20 weeks she began to have recurrent fever. Vigorous antibiotic treatment had only temporary effects. Reoperation showed that the original defects had been corrected but that one end of a silk suture was hanging free in the lumen of the right atrium and harboring Pseudomonas aeruginosa in pure culture. Removal of the suture was followed by uneventful recovery, ultimate resumption of full activity, and a satisfactory adolescence.

The use of fine milliner's needles and silk, as advocated by Kocher, Halsted and Cushing, entails the threading of numerous needles. This task is tedious, time consuming and often difficult, especially when medium, heavy and braided silks are used. The method described here is presented because of its simplicity. A piece of wire is selected according to the size of needle and thread to be used. The accompanying table gives the best corresponding sizes of wire, needles, and suturing materials. The ends of a piece of wire approximately 3 cm. long are grasped in a needle holder to form a loop. A fine silk suture is passed through the loop and pulled tight to shape the end of the wire so that it will readily pass through the eye of a needle. As many as twelve needles can be threaded onto this doubled wire. The suture material is passed through

About three years ago1I described a case of intraperitoneal rupture of the urinary bladder in which operation was performed seventy-seven hours after the receipt of injury. The patient made a good recovery and was entirely free from any bladder symptoms subsequently. Four years after the operation the man died of pneumonia and the bladder was removed at the post-mortem examination. There were no adhesions along the suture line. The scar of the rupture is represented by a thin line 2¼ inches in length. At the time of the operation the rent easily admitted four fingers. An additional point of interest is the fact that a careful search failed to reveal any trace of the continuous silk suture used at the operation. Coal-Mine Accidents. —The risk of coal mining is greatest during the winter months, when the liability of serious mine explosions is increased by the drying

Doctor Wallace M. Dennison's excellent discussion of "The Pierre Robin Syndrome," Pediatrics, 36:336, did not mention a very effective and easy method of preventing airway obstruction. Oeconomopoulos described the placement of a heavy silk suture through the base of the tongue and through the anterior alveolar ridge. We have found this to be most effective.

Previous Studies The difficulty in maintaining patency of anastomoses of arteries less than 3 mm in outside diameter was shown by Shumacker in 1948.15Seidenberg,14in 1958, presented a method which gave a higher percentage of patency in such arteries. Since that time, further study of the techniques of anastomosis of arteries of 1-2 mm in size has given increasingly good results. Various methods of anastomosis have been tried, and the results may be grouped as follows: Suture Methods. —Chase, Schwartz, and Rob2,3have reported their good results in vessels of 1-2 mm by the use of 7-0 silk suture or fine wire in a classical end-to-end suture method, using a four-power binocular loupe. Jacobson and Suarez10reported consistent patency in such vessels using a binocular microscope with magnifications up to 40 diameters. Variations of the classical suture technique have included the use of an electrically

The conventional method of repairing severed nerves is by the use of silk sutures, which are introduced ideally through the connective tissue sheath of the nerve. Actually it is very difficult to avoid the inclusion of some nerve fibers in each suture, and these fibers may be strangulated when the threads are tied. This is especially true of small nerves with delicate connective tissue sheaths. A further objection to silk suture of nerves is that, when the threads are tied, there tends to occur some knuckling of fibers with disturbance of the longitudinal organization of nerve fiber pattern at the suture site. The knuckling of nerve fibers is very striking when pronounced retraction of the nerve sheaths has occurred, so that when the sutures are passed through the sheaths (which often do not come back over the bundles) and then tied, the stumps become pressed against one another and a

Although there have been extensive tests made of the retention or loss of tensile strength of various synthetic fabrics used as arterial grafts, no controlled experiments have been reported of the strength of the anastomotic bond between synthetic graft and host vessel. Such an investigation was deemed important because of the occasional late development of partial disruption at the suture line between graft and host vessel with formation of a false aneurysm. It has been postulated that such disruptions occur from the failure of a strong bond to develop between graft and host, which gives way completely when silk suture weakens and finally breaks. This study was planned to determine the strength of the anastomotic bond in experimental animals and in man many months after grafting, and to determine if the strength of this bond was dependent on the residual tensile strength of suture material. Methods A. Animal Experiments. —Teflon

The record of attempts to cure urinary incontinence in the female is an interesting illustration of the inability of most men to go straight to the point in working on any problem involving a part of the human body. The real importance of the condition, in its possibilities of discomfort and even disability to the individual, is well shown by the long array of procedures which have been advocated to help this distressing trouble. Until a few years ago, no satisfactory method of cure for incontinence in the female was known; all of the methods were more or less futile, many of them ridiculous, and some of them even dangerous. Contractile collodion has been painted over the meatus. Radial cauterization, as in a redundant rectal mucous membrane, has been used. Paraffin has been injected under the mucous membrane to make a permanent pressure against the canal. A sterile silk suture

The attempt to localize retinal lesions is not new. In 1882, von Graefe1described his method of localizing a retinal cysticercus cyst. He also invented a new type of ophthalmoscope to be used in such cases. His method embodied several principles that are in use today. Accurate localization of a retinal tear is a difficult procedure. The reason is obvious. One is working with many variable factors, e. g., the cooperation of the patient, the possible movement of the detached retina containing the tear, the length of the globe and the surgeon's judgment in estimating distance. No method, therefore, is free from error. At the present time various methods are employed. Schoenberg,2in a recent article, described the method that Gonin employs. He locates the retinal tear with the ophthalmoscope, and ascribes it to a meridian corresponding to the hour hand of the clock. A black silk suture