Red Rubber Catheter Research Articles

Linear and discrete foreign body small intestinal obstruction outcomes, complication risk factors, and single incision red rubber catheter technique success in cats.

To compare survival and report perioperative complications in cats undergoing surgery for small intestinal (SI) linear (LFBO) and discrete (DFBO) foreign body obstructions (FBO). To report success of a red rubber catheter technique (RRCT) to remove LFBOs. Retrospective study. Client-owned cats (n = 169). Medical records of cats undergoing surgery for SI FBO from a veterinary teaching hospital between February 2012 and January 2023 were classified as LFBO, DFBO, or both linear and discrete FBO (BFBO). Signalment and perioperative data were collected. Preoperative hypoalbuminemia (LFBO: n = 1/6; DFBO: n = 5/6) and septic peritonitis (LFBO: n = 2/4; DFBO: n = 0/4; BFBO: n = 2/4) were rare. Intraoperative hypotension did not differ between LFBOs and DFBOs (p = .4756). RRCT was successful in 20/24 attempts of LFBO removal. Three cats were euthanized intraoperatively (LFBO: 1; DFBO: 1; BFBO: 1). Postoperatively, two cats (DFBO) experienced intestinal dehiscence and two cats (DFBO) died or were euthanized. Survival to discharge (p = 1.0000) and postoperative complications (p = .1386) did not differ between LFBOs and DFBOs. Postoperative complications and survival did not differ between cats with LFBOs and DFBOs. Intestinal dehiscence secondary to FBO in cats is rare. A RRCT can be successful in many cats with LFBOs. Cats with LFBOs and DFBOs have similar postoperative complication rates and survival to discharge when preoperative septic peritonitis is not present. Intestinal dehiscence is rare, which is important when discussing surgical prognosis with owners. A RRCT can be considered to remove LFBOs when there is concern for multiple enterotomies.

A mismanaged case of post herpetic nasal stenosis: a salvage story

Acquired nasal stenosis is due to loss of vestibular lining because of scar contracture or direct injury to the lobule-ala-columella complex. We present a patient of Herpes zoster mismanagement with scarring of the right nasal cavity who was treated by placing a stent to achieve nasal patency. A 47-year-old male, previously diagnosed to have Herpes zoster, presented with complaints of right nasal obstruction, discolouration of skin and burning sensation over the right cheek and nose. He had applied an herbal paste given by quacks which led to scarring and hypopigmentation over the face. He tried peeling the scab off which resulted in a skin contracture and right nasal obstruction. Local examination revealed multiple erythematous hypopigmented plaques over the right maxillary region, scarring over the right lateral aspect of the dorsum, ala and tip and a skin contracture causing stenosis of the right anterior nares. The stenosed area was excised and diagnostic nasal endoscopy showed collapse of the ala and the vestibular region in the right nasal cavity. A red rubber catheter was used as a stent and sutured in place at the ala. Postoperatively, nasal cavity patency was maintained. Herpes zoster is usually self-limiting and treatment with analgesics suffices. Antiviral medication and corticosteroids may alleviate severe pain. However, mismanagement of the lesions by taking local herbal paste and medicines can lead to exacerbation of the lesions and complications like nasal stenosis.

Urethral catheterization of small female cats and dogs weighing less than ten kilograms: the two-catheter technique.

To provide a video tutorial on how to perform an alternate method for urethral catheterization, the 2-catheter technique. Small female cats and dogs that are too small for concurrent digital palpation (generally < 10 kg). A larger red rubber catheter (18 Fr in dogs, and 10 Fr in cats) is gently fed into the vaginal canal and reflected dorsally, then a smaller urethral catheter can be introduced ventrally, angling downwards at a 45° angle, into the urethral orifice for urinary catheterization. The 2-catheter method is a useful alternative in petite female cats and dogs to improve rates of successful catheterization. The inability to perform concurrent digital palpation in petite female dogs and cats can make urinary catheterization more challenging due to the inability to palpate locoregional anatomic landmarks and without the added manipulation of the catheter tip during placement. Using a second, larger catheter to occlude the vaginal canal similarly to how a finger would during digital palpation can aid in successful catheterization in this challenging subset of veterinary patients.

Percutaneous Pigtail Catheter Drainage of Spontaneous Intestinal Perforation in Premature Infants

IntroductionPeritoneal drainage is an established management strategy for spontaneous intestinal perforation (SIP) in premature infants. We sought to evaluate the safety and efficacy of percutaneous pigtail catheter placement as an alternative to drain insertion via a lower quadrant incision. MethodsPatients less than 32 weeks gestational age who underwent peritoneal drain placement for SIP at two neonatal intensive care units between 2011 and 2022 were identified. Incisional drainage (ID) or percutaneous pigtail catheter drainage (PD) was used based upon the usual practices of the surgeons. ID (n = 19) was performed via a 5-mm right lower quadrant incision into which a one-fourth–inch Penrose or red rubber catheter was placed. PD (n = 18) was accomplished using a Seldinger technique by which a 6.0 or 8.5 F pigtail catheter was passed through the left lower quadrant. Demographics and physiological parameters at the time of drainage were recorded and short-term and long-term outcomes were evaluated. ResultsThirty seven infants were identified. There were no differences in demographics or physiological derangement between the groups. Patients who underwent ID had more frequent stool drainage, a greater transfusion requirement, and a longer time to full feedings (60.6 v 37.7 d, P = 0.04). Incisional hernias (n = 3, 16%) only developed after ID. The duration of drain placement, length of stay, and time to resolution of pneumoperitoneum were similar with ID and PD as was the incidence of premature drain dislodgement and subsequent laparotomy. ConclusionsPercutaneous drain placement provided effective drainage in infants with SIP and was associated with more rapid feeding advancement and no incidence of incisional hernia.

Telescoping Nasal Intubation for Carotid Endarterectomy: A Case Series.

Systemic anticoagulation is a relative contraindication for performing nasal intubation due to the risk of hazardous bleeding. However, nasal intubation may sometimes be the only way to facilitate surgical exposure. There are currently no recommendations in the literature to safely perform nasal intubation in anticoagulated patients. This case series describes 4 patients, all receiving systemic anticoagulation for carotid endarterectomy, who received nasal intubation using a telescoping approach. None of them had any epistaxis. Telescoping the endotracheal tube using a red rubber catheter may be an effective and safe method for nasal intubation when there is a high risk of epistaxis.

A Cost-Effective, Adjustable, Dynamic Subcortical Stimulation Device – Technical Note

ABSTRACT Brain mapping and neuromonitoring remain the gold standard for identifying and preserving functional neuroanatomic regions during safe, maximal brain tumor resection. Subcortical stimulation (SCS) can identify white matter tracts and approximate their distance from the leading edge of an advancing resection cavity. Dynamic (continuous) devices permitting simultaneous suction and stimulation have recently emerged as time-efficient alternatives to traditional static (discontinuous) techniques. However, the high cost, fixed cap size, and fixed tube diameter of commercially available suction devices preclude universal adoption. Our objective is to modify available suction devices into monopolar probes for subcortical stimulation mapping. We describe our technique using a novel, cost-effective, dynamic SCS technique as part of our established neuromonitoring protocol. We electrified and insulated a conventional variable suction device using an alligator clip and red rubber catheter, respectively. We adjusted the catheter’s length to expose metal on both sides, effectively converting the suction device into a monopolar stimulation probe capable of cortical and subcortical monopolar stimulation that does not differ from commercially available discontinuous or continuous devices. We fashioned a dynamic SCS suction probe using inexpensive materials compatible with all suction styles and sizes. Qualitative and quantitative analysis in future prospective case series is needed to assess efficacy and utility.

Endoscope-Guided Marble Foreign Body Removal Technique in an Inland Bearded Dragon (Pogona vitticeps)

Abstract A 1-yr-old intact female inland bearded dragon (Pogona vitticeps) was presented approximately 24 h after observed ingestion of a marble. Orthogonal whole-body radiographs with and without contrast revealed a spherical radiopaque foreign body within the gastric lumen and no passage of contrast material beyond the foreign body, suggestive of pyloric outflow obstruction. The complete blood count showed mild basophilia, and plasma biochemical analysis revealed a moderately elevated creatine kinase. The bearded dragon was placed under general anesthesia, and a rigid endoscope was used to visualize the foreign body at the level of the pylorus. The marble foreign body was suctioned and removed orally using a red rubber catheter and a Luer-lock syringe. The patient recovered uneventfully from the procedure and was sent home with sucralfate and omeprazole after 2 days of hospitalization. This report provides a novel, nonsurgical method for removing smooth spherical foreign bodies from the proximal gastrointestinal tract of bearded dragons. The technique may apply to various small-to-medium–sized reptiles or amphibians that present with spherical foreign bodies.

V05-05 REPAIR OF ENTERO-CONDUIT FISTULA USING ROBOT-ASSISTED LAPAROSCOPY

You have accessJournal of UrologyCME1 May 2022V05-05 REPAIR OF ENTERO-CONDUIT FISTULA USING ROBOT-ASSISTED LAPAROSCOPY Aeen Asghar, David Strauss, and Daniel Eun Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a case highlighting surgical management of an entero-conduit fistula (ECF), with robot-assisted laparoscopy (RAL). The patient is a 71-year-old male with a history of non-invasive high-grade urothelial carcinoma (UC) of the left distal ureter who underwent a RAL distal ureterectomy and ureteroneocystostomy and subsequent left RAL completion nephroureterectomy and eventual RAL radical cystoprostatectomy (RC) and intracorporeal ileal conduit (IC) diversion due to recurrence despite an induction course of intravesical BCG. Most recently, he developed metastatic disease to his right lung and underwent robot-assisted right lobectomy. Currently, the patient is disease-free. Nearly two years after RC, he presented with food particles and air per his urostomy. He also had a positive poppy seed test. Initially, pouchoscopy identified a pinpoint ECF tract at the proximal end of the IC. A 6-month trial of conservative management was unsuccessful with multiple episodes of pyelonephritis of his solitary right kidney requiring prophylactic antibiotics. Here, we demonstrate our approach to RAL ECF repair. METHODS: We began with pouchoscopy, which revealed a larger ECF, able to be cannulated by a 5 Fr open-ended catheter. Injection of contrast highlighted the ECF. A simultaneous pouchogram revealed reflux to the solitary right kidney. Access was obtained using a 5mm optical trocar without difficulty. We noted no significant intra-abdominal adhesions despite his past surgeries. Four 8mm robotic ports and a 5mm assistant port were used as outlined in the video. The ureteral anastomosis was easily identified, and further dissection revealed the ECF in proximity to the bowel-bowel anastomosis staple line. We upsized the left 8 mm robotic port to 12 mm to use a 45 mm robotic stapler. The ECF tract was stapled and oversewn using 4-0 silk sutures. Omentopexy and interposition flap was performed by mobilizing the omentum and fixating it in between the bowel and IC using 4-0 silk sutures to prevent recurrence. RESULTS: Operative console time was 98 minutes with 25 mL of blood loss. He was discharged on the same day. The red rubber catheter, which was secured to the IC, was removed at his 2-week post-operative visit. He remains symptom-free at the time of his 6 month follow up visit. CONCLUSIONS: First-line treatment of ECF is conservative management, with surgical repair reserved for rare failure. This case shows the feasibility of RAL ECF repair and revisions for urinary diversion-related complications. Additionally, it highlights a potential benefit of RAL given minimal adhesion development despite multiple prior major intra-abdominal surgeries done using the robotic approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e517 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar More articles by this author David Strauss More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Technique for Witzel Tunnel Catheter Drainage of the Biliary and Pancreatic Anastomosis of a Whipple Procedure

Introduction: Stenting the pancreatic and biliary anastomoses in a Whipple procedure has been shown to lower the rate of anastomotic leak. Method: We have identified a combined biliary and pancreatic ductal external drainage catheter/stent to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the hepatico-jejunostomy. The silastic feeding tube is then advanced into the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. The combined tubes then exits the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. Results: Our technique offers several advantages. It’s a more durable way of stenting the two anastomoses and prevents stent migration. It provides an opportunity to study the two anastomosis via contrast administration. The witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several IR/endoscopic interventions. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter/stent system has many theoretical advantages.

A Stepwise Approach to Lefort Colpocleisis

Study Objective The objective of this educational video is to describe the technique and required equipment for performing a LeFort partial colpocleisis using surgical footage as well as a low-cost surgical model. Design Educational surgical video. Setting Canadian academic medical centre. Patients or Participants This educational video was created using surgical footage as well as a low cost, reproducible surgical model. Interventions Using surgical footage and low-cost surgical model, we demonstrate a LeFort partial colpocleisis in six steps. (1) Proper patient positioning, (2) mark rectangular resection area, (3) dissect and resect vaginal epithelium, (4) place red rubber catheter to allow for lateral channels, (5) reduce prolapse using sequential pursestring sutures, (6) perineorrhaphy. Measurements and Main Results N/A. Conclusion Conclusion: Pelvic organ prolapse affects the quality of life of many patients, and one in nine will require corrective surgery by the age of 80. LeFort partial colpocleisis is a highly successful, minimally invasive surgical approach that is indicated in patients with pelvic organ prolapse who are no longer having vaginal intercourse and/or have comorbidities that prohibit a more extensive procedure. This video provides a stepwise approach to performing a LeFort partial colpocleisis. The objective of this educational video is to describe the technique and required equipment for performing a LeFort partial colpocleisis using surgical footage as well as a low-cost surgical model. Educational surgical video. Canadian academic medical centre. This educational video was created using surgical footage as well as a low cost, reproducible surgical model. Using surgical footage and low-cost surgical model, we demonstrate a LeFort partial colpocleisis in six steps. (1) Proper patient positioning, (2) mark rectangular resection area, (3) dissect and resect vaginal epithelium, (4) place red rubber catheter to allow for lateral channels, (5) reduce prolapse using sequential pursestring sutures, (6) perineorrhaphy. N/A. Conclusion: Pelvic organ prolapse affects the quality of life of many patients, and one in nine will require corrective surgery by the age of 80. LeFort partial colpocleisis is a highly successful, minimally invasive surgical approach that is indicated in patients with pelvic organ prolapse who are no longer having vaginal intercourse and/or have comorbidities that prohibit a more extensive procedure. This video provides a stepwise approach to performing a LeFort partial colpocleisis.

Use of Retrograde Intubation as an Alternative Maneuver to Secure a Difficult Airway in a Spiny Soft-Shell Turtle (Apalone spinifera)

A spiny soft-shell turtle (Apalone spinifera) underwent coelioscopy after a 6 month history of anorexia and persistent leukocytosis. A laryngeal mass obstructed the glottis and prevented standard orotracheal intubation. Use of a red rubber catheter through a midventral cervical tracheostomy facilitated orotracheal intubation and maintenance by inhalant anesthesia. This method of intubation should be considered as an option for intubation in the chelonian if access to the glottis is impaired.

CORRELATION BETWEEN POSITION OF RED RUBBER CATHETER ON X RAY AND GAP LENGTH IN TYPE C ESOPHAGEAL ATRESIA (EA)

BACKGROUND AND AIM: Gap length is important determinant for feasibility of primary repair in atresia and also for the preparedness and prognosis of delayed or staged operative procedures. A diagnostic plain radiograph with a red rubber catheter in situ might provide reliable information regarding the gap length without involving additional risk and cost. The present study was conducted to assess the gap length between the two esophageal pouches by preoperative plain radiography with in situ red rubber catheter in upper esophageal pouch and to know the correlation between position of red rubber catheter and measured gap length between upper and lower pouch. METHODOLOGY: Out of all patients admitted and diagnosed as gross's type C EA during September 2018 to November 2019 were included in the present study. The data regarding clinical history, general and systemic examination, pre-operative investigations including plain radiograph with in situ red rubber catheter and intraoperative measured gap length were recorded. Statistically correlation assessed between position of red rubber catheter and intraoperatively measured gap length among patients with type c EA. RESULTS: Total 283 patients were included in the present study. Radiologically position of red rubber catheter was found at level of T2, T3 and T4 in 18.7%, 55.5% and 25.8% respectively. A correlation was found between the preoperative radiological assessments of position of red rubber catheter with intra operatively measured gap length in this study and association between these two variable were found statistically signicant (r=-0.66, P=0). CONCLUSION: The preoperatively radiographic position of upper pouch should be assessed carefully to predict the gap width and it helps in preparedness of surgical management of the patients.

A Simple Technique to Facilitate Sheath Irrigation of Septic Flexor Tenosynovitis

Septic flexor tenosynovitis is an aggressive hand infection that requires expedient attention. We describe the use of readily available red rubber catheters and arthroscopy tubing in operative irrigation of septic flexor tenosynovitis. The advantage of this technique over more open or invasive techniques is its simplicity, minimally invasive and tissue sparing nature, and rapid flow of fluid within the tight flexor sheath.

A technique for witzel tunnel catheter drainage of the biliary and pancreatic anastomosis of a Whipple procedure

Presenter: Mridul Pansari MD | Florida Atlantic University Background: Stenting of the pancreatic and biliary anastomoses of a Whipple procedure has been shown to lower the rate of anastomotic leak in several retrospective and prospective studies. We describe here a combined biliary and pancreatic ductal external drainage catheter we have used successfully in our pancreatico-duodenectomy operations. Methods: We have identified a combined biliary and pancreatic ductal external drainage catheter / stent which we construct on the operating table to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the choledocho or hepatico- jejunostomy. The silastic feeding tube is then advanced well into the lumen of the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. Multiple small extra openings are cut into both tubes at their distal segments to facilitate ductal drainage. The combined tubes then exeunt the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. The tube is secured to the skin externally with a heavy nylon suture. The pediatric feeding tube is then secured to the outer part of the red rubber catheter with benzoin and three ¼ inch steri-strips. Both catheters are connected to separate external drainage bags. We perform our pancraetico- jejunostomy with a single layer of interrupted 3-0 silk suture and our bile duct anastomosis with a single layer of 4-0 or 5-0 PDS or Maxon suture. Two 10 mm Jackson Pratt drains are then placed in the right upper quadrant. Results: There are several theoretical advantages that our procedure offers. First, it diverts the pancreatic fluid and bile, decreasing it's flow through the respective anastomosis which helps in the healing of the anastomosis. Secondly, our technique is a more durable way of stenting the two anastomoses and prevent the migration of the stents. The pediatric feeding tube has three areas of resistance that prevents its migration. The fenestration in the external portion, the fenestration in the internal portion and the mucosal stitch that is placed to hold it in place. The red rubber catheter is kept in place by the Witzel tunnel itself. Third advantage is that it provides an opportunity to study the two anastomosis via contrast administration. Fourth, the witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several wire based treatments in a Seldinger fashion, should a leak be identified in the post operative period. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter / stent system has many theoretical advantages.

Initial experience with transanal proctectomy in children

BackgroundThe use of transanal proctectomy may have particular advantages for pediatric patients with small pelvic working space. We report short-term outcomes of transanal completion proctectomy (taCP) during surgery for inflammatory bowel disease. MethodsAll patients (age≤19) underwent taCP from January 1, 2018 to December 31, 2019. Prior total abdominal colectomy (TAC) was performed using a single-incision technique. At operation, patients underwent single-incision laparoscopy with taCP. Patient demographics, pre and perioperative details, and postoperative complications were abstracted. ResultsSeven patients (n = 6) with a median age of 18 years [Range: 13–19] were included in this initial series. All patients had a prior TAC with end-ileostomy with taCP occurring a median of 6 [Range: 3–89] months after TAC. Six of 7 had a diagnosis of ulcerative colitis (UC) while 1 patient had Crohn's colitis. For patients with UC, taCP was part of an ileal pouch-anal anastomosis with the majority (n = 4) proceeding as a modified-two stage and the remaining (n = 2) a three-stage approach. Single-incision laparoscopy through the prior ileostomy site was used in all IPAA patients. Median operative time was 226 [Range: 150–264] minutes with no conversions to more invasive technique. Median hospital length of stay (LOS) was 5 [Range: 2–8] days.In-hospital complications occurred in two patients who had watery diarrhea that prolonged LOS but resolved postdischarge. One patient was readmitted for bowel obstruction that resolved with placement of red rubber catheter at the ileostomy site.Of the 4 patients with a functioning ileal pouch, 1 patient reported 6–10 bowel movements per day, while 3 others reported ≤5 bowel movements per day. Half (n = 2) reported 1–2 nocturnal bowel movements at their first postoperative visit. No patients reported soiling or leakage, though one patient had a single episode of incontinence. ConclusionIn this pilot series, transanal proctectomy was effective and safe. Future work should compare traditional MIS completion proctectomy to taCP for applications in pediatric inflammatory bowel disease. Type of study: Case series. Level of Evidence: IV.

Pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs.

To determine the pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs. 6 healthy adult dogs. Each dog received a single dose of trazodone (approx 8 mg/kg) per rectum. Trazodone tablets were crushed into a powder, mixed with 5 mL of tap water, and injected into the rectum via a red rubber catheter. Sedation scores were assigned, and blood samples were collected for determination of plasma trazodone concentration at predetermined times before and after drug administration. Pharmacokinetic parameters were estimated by noncompartmental analysis. Plasma trazodone concentration remained below the detection limit for 1 dog even though it became moderately sedate. Median (interquartile [25th to 75th percentile] range [IQR]) maximum plasma trazodone concentration and volume of distribution and clearance corrected for bioavailability were 1.00 μg/mL (0.66 to 1.40 μg/mL), 10.3 L/kg (7.37 to 14.4 L/kg), and 639 mL/kg/h (594 to 719 mL/kg/h), respectively. Median time to maximum plasma trazodone concentration and elimination half-life were 15 minutes (range, 15 to 30 minutes) and 12 hours (IQR, 7.99 to 12.7 hours), respectively. All dogs became mildly or moderately sedate, and the extent of sedation was maximal at a median of 30 minutes (IQR, 30 to 60 minutes) after trazodone administration. No adverse effects were observed. Rectal administration of trazodone may be a viable option for sedation and treatment of anxiety in dogs for which administration of sedatives and anxiolytics by other routes is contraindicated. Further research is necessary to better elucidate the pharmacokinetics and efficacy of trazodone following rectal administration and determine optimal dosing.

Kluth type I3 and intra-abdominal variants of esophageal atresia: A case series

Background: Esophageal atresia (EA) encompasses a group of congenital anomalies (one in 2500 live births) comprising an interruption in the continuity of the esophagus combined with or without a persistent communication with the trachea. It is confirmed by passing no. 10 sterile, blunt‑tipped red rubber catheter into the esophagus, which gets failed to pass beyond 10 cm. Case Series: We describe two male neonates in whom the infant feeding tube could be passed to 18-20 cm in the upper esophageal pouch. A babygram with a blunt-tipped soft red rubber catheter in situ confirmed the esophageal atresia (EA) with the long upper pouch in the first case and EA with obstruction at the gastroesophageal junction in the second one. Conclusion: The importance of recognizing rare Kluth variants of EA is stressed. A low threshold for performing a red rubber catheter test is stressed.

Endoscopic Wedge Excisions with CO2 Laser for Subglottic Stenosis.

Endoscopic Wedge Excisions with CO2 Laser for Subglottic Stenosis.

Retrospective evaluation of urinary indwelling catheter type in cats with urethral obstruction (January 2014 to December 2014): 91 cases.

To investigate the influence of urinary catheter type on recurrence rate (rUO) in cats with urethral obstruction. Retrospective study. Two private referral hospitals. Ninety-one cats diagnosed with urethral obstruction treated with a 3.5-Fr Argyle (AR) or 3.5-Fr red rubber (RR) indwelling catheter presenting in 2014. One hundred sixty-six cats were identified using diagnostic code search with 91 cats meeting inclusion criteria. All were treated with IV fluids, buprenorphine, prazosin, and an indwelling urethral catheter with a closed collection system. Catheter groups did not differ statistically in baseline characteristics, medication treatment, or catheterization time. Follow-up was available for 91 cats at 24hours, 86 cats at 7 days, and 84 cats at 30 days. There was no statistical difference in rUO between cats with different catheter types at any time in this retrospective study. No difference in rUO was found in cats treated for urethral obstruction with a 3.5-Fr AR or RR catheter, however, due to the retrospective nature of this study the inability to detect a difference may be due to the small sample size of this study. Recurrent urethral obstruction in this study at 30 days was 11%.

Novel Passage of Dermis-Fat Graft for Augmentation of Vermilion Deficiency Following Cleft Lip Repair.

Despite timely repair of cleft lip, secondary deformities such as vermilion notching or "whistle deformity" often require further surgical treatment. The use of dermis-fat graft for soft tissue augmentation of the upper lip is an established technique. We propose an innovation on this technique, by which the dermis-fat graft can be placed reliably and with minimal dissection by use of a soft red rubber sheath to protect the Keith needle while delivering the graft through the submucosal pocket in the dry vermilion, thereby avoiding the needle inadvertently catching soft tissue inside the pocket. We recommend using an 8F red rubber catheter, cutting the catheter to be just shorter than a 2.5-inch Keith needle. This provides a sheath through which the Keith needle can be passed within the submucosal vermilion tunnel. We believe this to be much more reliable for vermilion augmentation than other techniques, including fat injection, and makes graft inset more predictable, faster, and simpler.