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O presente artigo apresenta uma invenção desenvolvida para auxílio à redução e ao controle da obesidade, embasado no controle do fluxo de alimentos no esôfago. Neste novo método proposto, um dispositivo colocado no esôfago diminui seu raio efetivo, reduzindo, por consequência, a velocidade e o fluxo com que o alimento pode ser consumido. A base do método é um dispositivo denominado módulo de látex, com formato aproximadamente cilíndrico, que é aplicado no esôfago. Este módulo contém um lúmen central, com diâmetro consideravelmente menor que o diâmetro do esôfago, que limita a passagem de alimento pelo órgão. Na concepção do método e do módulo, buscou-se realizar o controle de fluxo alimentar através do esôfago, sem causar agressões ao tecido, e sem comprometer a digestão e absorção dos alimentos. Desenvolvido a partir do látex natural, extraído da seringueira Hevea brasiliensis, tal módulo foi avaliado quanto a características construtivas e mecânicas, aplicabilidade, facilidade de remoção, eficácia na redução de fluxo, peso e danos ao esôfago. O módulo foi posicionado no esôfago por meio de vídeo-endoscopia em um cão piloto e manteve-se no local por sete dias, nos quais foi acompanhado por meio de radiografias sucessivas até a sua retirada, momento em que foi avaliada a integridade da mucosa esofágica. Os resultados apresentados demonstram que o método proposto é uma nova possibilidade de controle e redução da obesidade em pessoas e animais.

This work introduces a device to aid in the treatment of obesity by controlling the flow of substances in the esophagus. In the method proposed, a device placed in the esophagus reduces its effective radius, thus reducing the flow and speed in which the food can be consumed. The basis of the method is a nearly cylindrical latex module, which is applied in the esophagus. The module’s central lumen diameter is considerably smaller than the diameter of the esophagus. This limits the rate of food passage through the esophagus. The device was designed in such a way that it could control the food flow through the esophagus without causing aggression to its internal tissue and without compromising the digestion and absorption of food. The device was built using natural latex from the rubber tree Hevea brasiliensis, and was evaluated according to its construction, mechanical properties, applicability, effectiveness in reducing food flow, weight, and damage to the esophagus. The module was placed in the esophagus by means of video-endoscopy and remained in place for seven days, where in it was accompanied by successive radiographies until its with drawal by video-endoscopy, when we were able to examine the integrity of the esophagus wall. The results presented in this paper show that the proposed method is a new possibility for the treatment of obesity in humans and animals.

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O tratamento cirúrgico do paciente com estenose traqueobrônquica exige uma avaliação individualizada em razão da complexidade de sua origem, sendo a traqueoplastia considerada a modalidade ideal. As causas mais comuns de estenose são devidas à intubação traqueal e ao desenvolvimento de neoplasias e estas condições são justamente as que mais se beneficiam com o tratamento endoscópico quando a correção cirúrgica não está indicada. Na atualidade, os meios endoscópicos incluem a aplicação de diversos tipos de laser e sondas de dilatação, habitualmente com o uso de broncoscópio rígido, e emprego de radioterapia e órteses, separadamente ou em associação. Basicamente, as órteses são de dois tipos: metálicas e de silicone. As metálicas têm sua indicação mais freqüente para os casos de traqueomalacia e estenoses por compressão neoplásica extrínseca. Nos casos de obstrução da via aérea por inflamação aguda, restrita à sua luz ou sem envolvimento mais profundo da parede traqueobrônquica, ou em presença de neoplasia endoluminal, é recomendável a órtese de silicone. Embora em algumas situações essas diversas formas de tratamento possam ser intercambiáveis, não costumam ser a regra. Portanto, a estratégia terapêutica visando à resolução mais eficaz da estenose traqueobrônquica baseia-se na seleção dos métodos empregados desde o primeiro tratamento

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The Mentor inflatable penile prosthesis is a hydraulic device that was introduced in May 1983 for the treatment of erectile dysfunction. Since its introduction further technical modifications and improvements have been made on the product. From the onset the reliability, function and cosmetic effect of this physiological device have been excellent. The modifications have served to improve the ease of operation and to increase further the reliability as demonstrated by our progressive decrease in the incidence of mechanical failures. From May 1983 to November 1986 we implanted 137 Mentor inflatable penile prostheses. Our over-all mechanical failure rate was 7.3 per cent. As a result of the modifications, however, the mechanical failure rate decreased to 3.1 per cent during the last 38 months of that period when 129 (94 per cent) of the prostheses were implanted, and during the last 24 months of that period when 86 (63 per cent) of the prostheses were implanted the mechanical failure rate was only 1.2 per cent.

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A new material has been used as tendon and ligament prosthesis on animals. The long-term clinical results obtained after ACL and Achilles tendon replacement suggest an adequate tolerance and a function of the prosthesis.

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An alternative method for electrically joining two rigid terminals within the flexible encapsulant of a prosthesis was sought after welded platinum wires suffered fatigue failure when implanted. The advantage of using spring clips is discussed and fatigue tests to compare spring-clips, made for one of two gold alloys, with welded Platinum or Pt/Ir wires are described. Some physical properties of the superior gold alloy are tabulated.

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A description is given of a prosthesis for replacement of tumour-destroyed diaphyseal bone in the lower extremity. It can be used in a salvage procedure and as an alternative to intramedullary nailing or plating procedures. The method is not complicated provided that mechanically sound devices are used and technical errors are avoided. The operation time is short and the patients can be mobilized early.

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Use of an antireflux prosthesis (Angelchik prosthesis) in the surgical treatment of symptomatic gastroesophageal reflux has increased steadily during the past several years. This report describes a patient in whom this device broke away from its insertion site at the cardioesophageal junction and migrated through the abdominal cavity to the pelvis. Variable abdominal and pelvic symptoms accompanied this passage, and abdominal roentgenograms identified the final pelvic location. Breakaway was caused by avulsion of the tie straps from the prosthesis. Four additional cases of migratory antireflux prostheses are reported briefly. Physicians should be aware that bizarre and otherwise unexplained abdominal pain in patients with this device may result from dislocation and migration of the prosthesis through the abdominal cavity. Abdominal roentgenograms are diagnostic and define the extent of migration.

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Harrington rods are now well accepted as surgical implants for the correction of scoliosis and in general have proven to be effective in this role. However a number of the rods have been observed to break. The purpose of this note is to outline a simple approach to the redesign of rods which will significantly reduce the incidence of broken rods. By means of a straight-forward stress analysis the propensity to fail of an existing rod is evaluated and two new designs proposed which offer a considerably improved resistance to failure during a patient's lifetime.

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Every surgeon who is involved in prostatic surgery should have a good knowledge of the anatomy and the physiology of the urinary bladder and the sphincter system in male. The cause and the treatment of postprostatectomy incontinence is discussed in detail. The expectancy time in postprostatectomy incontinence is recommended to be long enough (1-1 1/2 years) because this harmful complication of 1-2 degree leaks in 85% within a year. So far the operative treatment of 2-3 grade postoperative incontinence is limited to the use of Scott prosthesis where the success rate varies according to different authors from 60 to 85% in 5 years observation time.

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A review of 102 total ankle arthroplasties performed during a four-year period revealed that complications occurred in 41%. 22% with impingement of various types 6.9% with loosening and 2.9% with deep sepsis. The best results were obtained in patients with rheumatoid arthritis and those with posttraumatic osteoarthritis who were older than 60 years of age. Total ankle arthroplasty currently should not be considered in patients with posttraumatic osteoarthritis who are younger than 60 years old. Arthrodesis remains the only acceptable method of treatment in these individuals. Total ankle arthroplasty seems indicated in patients who have significant ankle joint disability secondary to rheumatoid arthritis and in elderly patients with disabling posttraumatic degeneration whose physical demands are limited.

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