Experience with the use of nylon fishing line for surgical sutures has been reported from several African countries. A recent publication suggested that fishing line and an injection needle may provide an atraumatic suture that is especially suitable for intracutaneous skin closures. This article provides further empirical support for such alternative technology. We describe a randomized, blinded clinical trial conducted in Butare (Rwanda) with 220 cutaneous wounds closed by intracutaneous sutures, with either the homemade suture or a commercial nylon thread (Ethilon). We compared the clinical outcomes as well as the costs of those two materials. There are no significant differences between the two sutures in terms of clinical findings or in the reported ease of use by the surgeons. The cost of a homemade atraumatic suture is US $0.07, which is less than one-thirtieth the cost of the commercial thread. The advantage of the commercial thread is the assurance of quality. We consider whether this quality assurance justifies the large price difference, and if the homemade suture should be recommended to surgeons in countries where the costs of surgical material often remain an obstacle for life-saving operations.

Objective: This study measures the effect of hyperthermia applied through a heatable stent in the esophagus in order to investigate whether this procedure offers a therapeutic option for tumor treatment. Material and Methods: Thermoplastic malleable stents, with the capacity to be heated after implantation, were placed endoscopically in the middle third of the esophagi of 30 pigs. After placement the stents were heated in vivo for 60 min at temperatures ranging from 43 to 52°C. Temperature was measured in the surrounding tissue at various distances from the stent, determining heat penetration. The esophagi were histologically examined after 7 days. Results: The maximal heating temperature tolerated in the esophagi without transmural necrosis was 46.5°C, when applied twice for 60 min with a pause of 48 h. With this procedure a tumor damaging temperature of 42.5°C was achieved at a maximum distance of 12 mm surrounding the stent. Conclusion: Application of hyperthermia through a heatable stent in the esophagus is feasible. The maximal depth of therapeutic temperature achieved by this procedure (12 mm) is not sufficient to heal esophageal cancer, but may be of palliative value.