Abstract: Some aspects of the present invention are directed to unique products and methods for treating fistulae and other passageways and openings in the body. In some preferred forms, an inventive construct will include an elongate graft body that incorporates a plurality of sheet or sheet-like segments. The plurality of sheet or sheet-like segments, in some arrangements, will be stacked in a generally longitudinal direction along the length of the plug body, and optionally, the segments will be received over one or more elongate elements. Elongate elements of this sort can take a variety of forms including a suture, wire, filament, or other relatively thin-bodied elongate member, although in some forms, an elongate element will be or include a somewhat heftier structure such as a biodegradable or non-biodegradable three-dimensional body.

Abstract: A device for inserting a medical apparatus into a living body includes a handle and an elongated sheath extending from the handle to a distal end configured for insertion to a target location in the living body in combination with a clasp positioned within a distal portion of the elongated sheath and configured to temporarily attach to an endoscopic device and a spring retention mechanism movable from a first resting configuration maintaining a first closed position of the clasp to a second compressed configuration moving the clasp to an open position. A withdrawal mechanism is movable from a first resting configuration in which the distal end of the elongated sheath extends distally over a distal end of the endoscopic device to a second retracted configuration in which the distal end of the elongated sheath is moved proximally of the distal end of the endoscopic device.

Abstract: The disclosure pertains to a handle assembly for a left atrial appendage occlusion device delivery system and methods of use therefor. The handle assembly includes a leadscrew mechanism for smooth, low backlash control of a delivery catheter for the left atrial appendage occlusion device and manipulation segments which allow one hand operation of the handle assembly.

Abstract: This disclosure is directed to an aperture occlusion device and a method for occluding an aperture, including a perimembranous ventricular septal defect. The aperture occlusion device includes a wire frame element. The wire frame forms geometric shapes that include an occluder region and a securing region. The occluder region and the securing region are separated by an attachment region including a waist. The occluder region and securing region can include membranous coverings. The device can be attached to a delivery hub. The wires forming the occluder region and securing region can have a shape-memory capability such that they can be collapsed and distorted in a sheath during delivery, but resume and maintain their intended shape after delivery.

Abstract: The present disclosure relates to a surgical anchoring apparatus for use during a minimally invasive surgical procedure. The surgical anchoring apparatus includes a body member and a dilator element at least partially positionable therein. The body member includes a grip segment adapted for manual engagement by a user and an expandable section having a plurality of expandable segments and a plurality of cam surfaces. The grip segment resiliently transitions between a first or normal state and a second state in which the grip segment is at least partially inverted. The expandable section's cam surfaces are configured to engage a distal end of the dilator element upon its insertion such that the expandable section may transition from an initial condition to an expanded condition in which the body member is secured or anchored within an incision in tissue.

Abstract: The application relates to a hand access laparoscopy device having a gelcap, a retainer, a sleeve and a retention ring. The gelcap includes gel that is bonded to a cap. The cap includes an inner cylindrical wall to which the gel in bonded, thereby providing a sealing area between the device and the wound in a body wall. By securing the gel to the inner cylindrical wall, the thickness of the gel and corresponding cap is minimized along with the overall footprint of the device. With the gel thickness reduced and able to be substantially flush, the “doming” phenomenon produced by insufflation of a patient's abdomen is reduced.

Abstract: A colored suture includes an elongate woven braid of filaments including one or more ends made of an ultra high molecular weight polyethylene (UHMWPE). The suture also includes second and third ends which can be colorable or dyeable before or after incorporation into the elongate woven braid. This invention provides surgeons with improved recognition of suture ends in surgery by construction of a bi-colored co-braid with at least two ends of different color schemes or patterns braided into a UHMWPE construction. One of the colored ends runs continuously from one end of the suture to the other end. The other colored end can be colored only on one half of the end. This provides a suture with two distinguishable ends, while still maintaining a continuous line of color along the length of the suture.

Abstract: Systems, devices, and methods for cutting a filament or suture having an extrudable inner core member are provided. In one exemplary embodiment, a device includes a compression element to compress an inner core away from a knot disposed at a distal end of the suture, and a cutting element disposed within a portion of the compression element to cut the inner core after it has been compressed. As a result, an amount of extrudable inner core that extends distally beyond the knot is minimized without negatively impacting the integrity of the knot. In other embodiments, the compression and cutting elements are separately provided as two different devices. The actions of compressing and cutting can be performed using a variety of techniques, including those known to those skilled in the art. Methods for clamping the inner core and then cutting a portion of the inner core are also provided.

Abstract: A surgical suturing device comprises a cartridge having a needle and suture. An elongate shaft has a proximal end and a distal end. An actuator is connected to the proximal end of the elongate shaft. A pair of jaws is connected to the distal end of the elongate shaft. The jaws have a closed position adapted to receive and retain the cartridge, and wherein the jaws are latched in the closed position. The jaws also have a partially opened position adapted to release the cartridge wherein the jaws are biased by a spring from the first opened position towards the closed position. The jaws also have and a fully opened position spaced apart further than the partially opened position, wherein spring does not bias the jaws towards the closed position.

Abstract: An apparatus and method for minimally invasive suturing is disclosed. A suturing device for minimally invasive suturing includes proximal section having a proximal end, a distal end, and a longitudinal axis therebetween; a suture head assembly extending from the distal end of the proximal section; a suturing needle having a pointed end and a blunt end, the suturing needle capable of rotating about an axis approximately perpendicular to a longitudinal axis of the proximal section, wherein the pointed end of the suturing needle is positioned within the suture head assembly prior to and after rotation of the suturing needle; and an actuator extending from the proximal end of the proximal section to actuate a drive mechanism having a needle driver for engaging and rotating the suturing needle.

Abstract: A method of making a packaged antimicrobial suture having improved shelf life. The method comprising the steps of providing an inner package having a source of antimicrobial agent, providing an adsorbent material effective to adsorb a portion of the antimicrobial agent over time, positioning a suture within the inner package, the suture comprising one or more surfaces, covering the inner package with an outer package having an inner surface and subjecting the suture, the inner package and the inner surface of the outer package to time, temperature and pressure conditions sufficient to vapor transfer an effective amount of the antimicrobial agent from the antimicrobial agent source to the suture and the inner package, thereby substantially inhibiting bacterial colonization on the suture and the inner package, wherein the packaged antimicrobial suture exhibits improved shelf life.

Abstract: A method for applying and maintaining compression with a staple includes piercing a material with deformable ends of staple legs. The legs enter the material until the material applies a pre-set compressive force within a pre-defined compression range to a compression device disposed at least partly between the legs. The compression device has a compression resistor connected to a compression surface. The compression surface is movably disposed with respect to the bridge. Movement of the compression surface towards the bridge is resisted with a force imparted by the compression resistor. The legs are deformed to maintain at least some of the compressive force between the material and the compression device. Forces greater than the pre-set force are absorbed with the compression resistor. The pre-set compressive force to the material is maintained within the pre-defined compression range throughout a state change of the material.

Abstract: In one embodiment, a medical device includes an elongate member and a tissue anchor. The elongate member defines a lumen. The elongate member has a retention member disposed within the lumen. The tissue anchor has a first arm portion, a second arm portion, and a base portion extending between the first arm portion and the second arm portion. The tissue anchor has a first configuration and a second configuration. The first arm portion is substantially linear when the tissue anchor is in its first configuration and the first arm portion is non-linear when the tissue anchor is in its second configuration. The tissue anchor is biased to its second configuration. The tissue anchor is configured to be disposed within the lumen defined by the elongate member such that the retention member engages the tissue anchor to help retain the tissue anchor in its first configuration.

Abstract: An exemplary surgical apparatus may include an end effector; a shaft extending proximally from the end effector, the shaft including an articulation region; and a handle including at least one button, where actuation of the button causes said the effector to articulate through a discrete increment relative to the shaft.

Abstract: A medical instrument having a tool assembly attachable to a distal end of the medical instrument is disclosed. The tool assembly includes a pair of opposing tissue engaging surfaces for clamping tissue therebetween. The medical instrument also includes a housing having a fixed handle and a movable handle mounted to the housing and selectively movable relative to the fixed handle from a first position in spaced relation relative to the fixed handle to a second position closer to the fixed handle to actuate the clamping of tissue. The instrument further includes a selectively activatable drive assembly including a power source and a motor which is operatively coupled to the movable handle, wherein upon actuation the motor actuates the pair of opposing tissue engaging surfaces. The drive assembly also includes a controller configured to variably control the rate at which the motor actuates the pair of opposing tissue engaging surfaces in response to the force exerted on the movable handle.

Abstract: An apparatus for closing a surgical incision comprises left and right base panels, a plurality of closure components, and a plurality of left and right axial supports coupled to the respective base panels. The closure components couple the left and right base panels to each other laterally and have left and right ends coupled to the respective base panels. The closure components are positioned laterally across the left and right panels, the left axial supports are disposed between pairs of left closure component ends, the right axial supports are disposed between pairs of right closure component ends, and the left and right axial supports are offset from one another such that a serpentine arrangement of consecutive closure components and axial supports is formed. The apparatus can be made of antimicrobial materials or materials impregnated with antimicrobial agents. A flexible adhesive cover can be provided over the apparatus when in use.

Abstract: Surgical instruments and their methods of use are disclosed. In some embodiments, the surgical instrument may include a handle and an elongated shaft assembly extending distally from the handle. The surgical instrument may also include a fastener deployment system for deploying fasteners from the elongated shaft assembly including a reciprocating driveshaft disposed within the elongated shaft assembly. The driveshaft may include an internal channel and at least one guide surface shaped and arranged to maintain an orientation of at least one fastener in the channel of the driveshaft. In other embodiments, the fastener deployment system may include a follower disposed within the elongated shaft assembly for displacing one or more fasteners within the elongated shaft assembly towards a distal fastener deployment position.

Abstract: An improved distal end for a ligating band dispenser having a transverse groove or ridge profile that promotes rolling of the bands. In one embodiment, the ligating bands and the transverse grooves or ridges are dimensioned such that the width of the bands when stretched on the support surface is substantially the same as the pitch of the transverse grooves or ridges. Having the width of the bands when stretched on the support surface be substantially the same as or less than the pitch of the transverse grooves or ridges allows the bands to fit within the grooves, which helps insure that the bands are sufficiently held back by the ridge crests to induce a rolling action. In addition, the transverse grooves or ridges may also be dimensioned such that the height of the ridge crests is sufficiently high to insure that the bands are sufficiently held back by the ridge crests to induce a rolling action.

Abstract: An embolic coil configured in such a manner that the risk that a stretch preventing wire breaks is very small even if the embolic coil is wound to a diameter smaller than the diameter of a secondary shape of the coil imparted thereto and also in such a manner that the embolic coil has excellent deliverability. An embolic coil is configured in such a manner that a stretch preventing wire and a coil, a part or the whole of said coil being coarsely wound, are affixed to each other at at least two different points. The portion of the stretch preventing wire which is located between the two different portions is provided with a portion to which a stretchable shape has been imparted.

Abstract: Elongate implant structures can be introduced into an airway system to a target airway axial region, often to apply lateral bending and/or compression forces against the lung tissue from within the airways for an extended period of time. Structures or features of the implants may inhibit tissue reactions that might otherwise allow portions of the device to eventually traverse through the wall of the airway. The devices may enhance the area bearing laterally on the tissue of a surrounding airway lumen wall. Embodiments may have features which increase the device friction with the airway to allow the device to grip the surrounding airway as the device is deployed. An appropriate adhesive may be introduced around the device in the lung. Hydrophilic material may inhibit biofilm formation, or features which induce some tissue ingrowth (stimulation of tissue growth) may enhance implanted device supported.

Abstract: The present invention relates to solid pharmaceutical compositions comprising the phosphatidylinositol 3-kinase inhibitor compound 4-(trifluoromethyl)-5-(2,6-dimorpholinopyrimidin-4-yl)pyridin-2-amine or a pharmaceutically acceptable salt thereof, sodium stearyl fumarate, and optionally at least one additional pharmaceutically acceptable carrier. The present invention also relates to the processes for their preparation and to their use as medicaments for the treatment of cancer.

Abstract: A cutting implement includes a V-shaped blade portion that defines an aperture through which a quadriceps tendon may pass as a doctor harvests the tendon through a minimally invasive procedure.

Abstract: Tissue removal probes comprise an elongated member, a drive shaft rotatably disposed within the member, and a rotatably tissue removal element mounted to the distal end of the drive shaft. One tissue removal element comprises a plurality of tissue-cutting filaments affixed at proximal and distal ends of the tissue removal element. The cutting filaments may have optional hinge points that allow the distal end of the tissue removal element to be inverted, thereby transforming the tissue removal element from a tissue-cutting device to a tissue-grasping device. Another tissue removal element may have a blunted tip to prevent distal tissue trauma and an irrigation port to provide irrigation fluid to the removed tissue and/or tissue removal element. Another tissue removal element has a proximal and distal spiral grooves that are oppositely pitched, so that removed tissue can be collected in the middle of the tissue removal element.

Abstract: A surgical tool lifts an overlying layer of skin away from underlying bone to prepare the bone to accommodate a convex element of an implantable device. The tool includes a lifting shell for insertion between the skin and the bone so as to lift the skin away from bone. A tool base supports the lifting shell and is supported by the bone. A drill template opening in the tool base provides access for preparing the bone to accommodate the convex element.

Abstract: Apparatus and methods for spinal surgery include a retractor with an elongated body extending along a longitudinal axis between a distal end and an opposite proximal end. The retractor defines a passage between the distal and proximal ends and a window opening into the passage adjacent to the distal end. The apparatus also includes a guide member extending laterally from the proximal end of the retractor and the guide member includes a body extending along an arc. The body defines a number of trajectories each intersecting the window of the retractor. The apparatus further includes an instrument removably mounted to the guide member and the instrument is movable along the guide member and securable to the guide member in any one of the number of trajectories so that the instrument can be moved along the selected trajectory through the window.

Abstract: A method of intraoperatively selecting between a partial knee arthroplasty and total knee arthroplasty includes mounting a patient-specific three-dimensional surface of a convertible patient-specific guide in a unique position mating to a corresponding surface of a distal femoral bone. The convertible patient-specific guide includes an anterior portion and a distal portion a patellofemoral guide. One of a total knee arthroplasty and a partial knee arthroplasty is selected intraoperatively. If total knee arthroplasty is selected, first and second covers are removed from corresponding first and second distal guiding bore. First and second distal pins through the first and second distal guiding bores are registered on the bone. If partial knee arthroplasty is selected, the anterior portion is severed and removed along a frangible groove and the distal portion is used as a patellofemoral guide.

Abstract: Methods and devices are provided for performing minimally invasive surgical procedures. In one embodiment, a surgical device is provided that includes an elongate shaft having a distal portion configured to be movable between a first configuration in which the distal portion of the shaft is substantially straight or linear and a second configuration in which the distal portion of the shaft is bent at a compound angle. The shaft's distal portion can be configured to be articulated in a wide range of compound angles and can be configured to be selectively locked in a fixed position anywhere within that range.

Abstract: An endoscopic surgical instrument for removing tissue or bone, the instrument comprising (1) a generally tubular component (2) a cutting device which is housed in the distal end member and part of which protrudes beyond the window in the distal member, and (3) a means for operating the cutting device. The tubular component comprises a distal end member containing a cutting device, a proximal member, and between the distal member and the proximal member a hollow, generally tubular intermediate member which deforms elastically when the angle between the distal member family proximal member is changed. The intermediate member can for example be composed of a nickel titanium alloy, and/or can be slotted, and/or can be in the form of an accordion, and/or be in the form of a coil.

Abstract: A transducer stack (10) includes rings (16) of piezo-electric ceramic alternating with metal electrodes (18) along a threaded central shaft (32) extending from a titanium back plate (20). A spacer or threaded element (14) threaded on to the shaft (32) holds the ceramic rings (16) and electrodes (18) in compression against the back plate (20). The transducer stack (10) is mountable eccentrically to a horn (12) of an ultrasonically-vibratable tool, away from an axis of an elongate waveguide (56) extending from the horn (12). The transducer stack (10) may vibrate in a flexural mode perpendicular to the waveguide (56), generating torsional mode ultrasonic vibrations in the horn (12) and waveguide (56), or in a flexural mode parallel to the waveguide (56), generating longitudinal mode ultrasonic vibrations in the horn (12) and waveguide (56).

Abstract: A rotatable thrombectomy wire for breaking up thrombus or other obstructive material comprising an inner core composed of a flexible material and an outer wire surrounding at least a portion of the inner core. The outer wire has a sinuous shaped portion at a distal region. The inner core limits the compressibility of the outer wire. The outer wire is operatively connectable at a proximal end to a motor for rotating the wire to macerate thrombus.

Abstract: An inflow access cannula system for allowing an instrument to access a surgical site, the system including an inflow access cannula including distal and proximal ends and a central lumen extending therebetween, and an instrument adapter for releasable connection to the cannula, the adapter including a lumen communicating with the central lumen, the adapter further including a port and a fluid passageway connecting the port with the lumen of the adapter, and a spacer for spacing the proximal portion of the instrument from the distal end of the cannula, such that when the distal portion of an instrument extends within the central lumen and the proximal portion of the instrument is disposed in the lumen, in engagement with the spacer, fluid can flow into the port, along the fluid passageway, into the lumen and through the central lumen.

Abstract: There is provided an apparatus (10) and method for establishing and maintaining in selectively arrestable manner manuary access to a sufflated body cavity of a patient through a fenestration formed in the patient's body tissue during a minimally invasive surgical procedure. The apparatus (10) generally comprises a seal section (100) and a sheath section (200) coupled thereto. The seal section (100) includes an endless loop portion (110) that defines an opening (120). The sheath section (200) includes a mouth portion (210), an outer glove portion (230), and a pliable intermediate portion (220) extending therebetween. The outer glove portion (230) defines a plurality of extensions to accommodate the digits of a user's hands which are truncated so that they each terminate at a digit opening.

Abstract: Exemplary insertion tools for facilitating insertion of an electrode array into a bodily orifice include a stylet assembly having a stylet configured to be inserted into a lumen of the electrode array, a slide assembly configured to at least partially house the stylet assembly, and a handle assembly configured to engage at least a portion of the slide assembly. The slide assembly may be configured to selectively disengage from the handle assembly. The stylet assembly may be configured to selectively disengage from the slide assembly while the stylet is still inserted into the lumen of the electrode array. Corresponding systems and methods are also described.

Abstract: A tunneling tool for implanting a medical device into body tissue is described. The tunneling tool comprises a first leg and a second leg. An intermediate portion of the second leg is shaped to nest a medical device therein. A hub connects the first and second distal leg ends together. A sheath providing a lumen extends from the hub to an open end distal of the first and second legs. The first and second legs are manipulatable to separate the hub and the sheath into two portions, a first split portion connected to the first leg and a second split portion connected to the second leg. When a medical device is nested in the tunneling tool, breaking the tunneling tool apart enables the first and second split portions to be removed from body tissue, leaving the implanted medical device behind.

Abstract: A shielded bladed obturator is provided with a shield lockout that prevents retraction of a shield to expose a blade for cutting. The shield lockout in one aspect has a rotational switch interacting with a longitudinal extending shield to lock and unlock the shield. A blade exposure and coverage system is also provided.

Abstract: A surgical device for treating shoulder dystocia having a first arm having a proximal portion, a distal portion and a first curved surface, a second arm having a proximal portion, a distal portion and a second curved surface and a shoulder engagement section positioned at least between the distal portion of the first and second arms and connecting the first and second arms. The engagement section has an atraumatic surface and is configured to contact and press down on the baby to reposition the baby upon manipulation of the first and second arms.

Abstract: An exfoliation includes a unit handle which is hollow and has a handle proximal end and a handle distal end, and has an air receiving port in the handle distal end and an air discharge port in the handle proximal end; an abrasion rim adjacent to the air receiving port having an abrasive surface; an air passageway in fluid communication with the air receiving port and the air discharge port; and with vacuum mechanism in fluid communication with the air passageway for drawing an air stream into the air receiving port, passing the air stream through the air passageway and discharging the air stream from the air discharge port. The unit preferably additionally includes a debris gathering chamber in fluid communication with the air passageway for collecting and retaining debris particles in the air stream.

Abstract: The current request reports an external fixation device to stabilize bone fractures with adaptable configuration during different stages of surgery or during treatment, through the generation of six degrees of freedom among the bone fragments. The device comprises numerous press-connector means, numerous cylindrical bars, numerous osteosynthesis screws and optionally from one to several rigid rings and one or more extension elements that permit generating diverse stable configurations to treat bone fractures.

Abstract: A ratcheting strut comprising: (a) a ratchet box including a through passage; (b) a first tube sized to extend at least partially through the passage, the first tube including ratchet teeth that engage corresponding ratchet teeth of the ratchet box; (c) a second tube mounted to the ratchet box in parallel with the first tube, the second tube operatively coupled to a second fixation adapter; and (d) a threaded rod operatively coupled to a nut and a first fixation adapter, the threaded rod repositionably mounted to the first tube, where the nut is operatively coupled and repositionable with respect to the first tube.

Abstract: An implant assembly can include an implant configured to be coupled to at least one bone part. The implant can include an implant body that defines at least one unsmooth surface. The assembly can further include a cap configured to be coupled to the implant body such that the cap overlies the at least one unsmooth surface. The cap can include a shell that defines a cavity that is configured to receive at least a portion of the implant body such that the shell flexes relative to the implant body as the cavity receives the at least a portion of the implant body to thereby couple the cap to the implant. The cap defines an outer surface that is curved.

Abstract: A cross connector assembly is provided. In one embodiment, the cross connector is configured to engage a pair of rods in a spinal implant assembly. In an exemplary embodiment, the cross connector assembly includes at least one elongated top member having a pair of hooked-shaped ends and a pair of sliding members configured to slideably engage the at least one elongated top member. The cross connector may further include an upper fastener and a lower fastener engaged with the upper fastener configured to translate upon rotation of the upper fastener and engage the sliding members, biasing them from a first position to a second position.

Abstract: An interspinous process implant comprising an elongated body defining a longitudinal axis and an interior cavity. The implant includes engagement members movable between a first position stowed within the interior cavity and a second position deployed from the interior cavity. Each engagement member includes a central hub defining a hub axis perpendicular to the longitudinal axis of the body. Each central hub has an inwardly extending crank pin. The crank pins are radially offset from the hub axis and circumferentially spaced apart from one another. The implant also include an elongated drive shaft mounted for axial movement within the interior cavity and includes a distal actuation portion having upper and lower yokes positioned to cooperate with the crank pins. Upon axial movement of the drive shaft the crank pins translate through respective arcuate paths about the hub axis, causing corresponding rotational movement of the engagement members about the hub axis.

Abstract: An intramedullary bone fixation device is disclosed herein. The device includes a first longitudinally extending member, a second longitudinally extending member, and a coupling member. The first longitudinally extending member includes a connector end and a bone engagement end opposite the connector end. The second longitudinally extending member includes a connector end and a bone engagement end opposite the connector end. The coupling member is configured to engage the connector ends of the respective longitudinally extending members, thereby coupling the first longitudinally extending member to the second longitudinally extending member. The device may be provided in an kit form at least partially unassembled. The device may be delivered into a fracture and fully assembled within the fracture or adjacent bone via percutaneous or minimally invasive surgical procedures. The device, on account of its configuration and assembly, may be considered modular in some cases.

Abstract: The present invention provides an intramedullary nail having a body with a transverse bore extending through the body and having an area of enhanced stress distribution on at least the lateral side of the transverse bore. In one exemplary embodiment, the intramedullary nail includes a cutout adjacent to the transverse bore, such as an oblique cutout, that enhances the stress distribution of the intramedullary nail in the region around the lateral opening of the transverse bore. In one exemplary embodiment, the cutout includes a ramp portion or area that defines the lateral opening of the transverse bore. In other exemplary embodiments, the cutout includes a runout or a substantially flat portion that defines the lateral opening of the transverse bore.

Abstract: An orthopedic screw system includes a screw with a locking head that can both lockingly engage in a fixed angle threaded screw hole to secure a plate to a bone without compression, and non-lockingly engage at a compression screw hole to provide compression between the plate and the bone. The structure of the system is particularly well adapted to plates and screw of small dimensions, such as screws smaller than 3.5 mm and is capable of providing high compressive force, on the order of 120 lbs of axial load, without significant plastic deformation between the screw and plate. Further, the screw holes are structured for arrangement in tight clusters on the bone plate, thereby facilitating a compact design on the bone plate.

Abstract: A bone anchor compatible for use with a neural integrity monitoring systems includes a bone-engaging portion extending between a first end portion and a second end portion. The first end portion includes a resorbable non-electrically conductive polymer defining an insulated region. The second end portion includes a conductive region having reduced electrical resistance relative to the insulated region. The insulated region is contiguous with the conductive region. Methods of use are disclosed.

Abstract: An apparatus for distributing the load caused by the insertion of a fastening device into bony tissue is disclosed. In one embodiment, the apparatus comprises a crown having a plurality of protrusions. The protrusions may have any desired physical properties, and function to obtain purchase in the bony tissue. Preferably, the crown includes an opening that is selectively engageable with a spherical head of the fastening device. The opening preferably comprises a spherical curvature that allows the surfaces of the spherical head and the opening to maintain flush contact, even when the fastening device is inserted into the bony tissue at a non-orthogonal angle. When the fastening device is inserted into the bony tissue, the crown distributes the load over a wider section of the bone, allowing the bone to maintain its structural integrity.

Abstract: A method includes inserting a first surgical device into an exposed first end of a first bone until a trailing end of the first surgical device is disposed adjacent to the first end of the first bone. A second surgical device is inserted into an exposed first end of a second bone while the first surgical device remains disposed within the first bone. A first portion of an implant is advanced into the second bone while being engaged with a passageway defined by the implant such that the implant is guided by the second surgical device. The second surgical device is removed from the second bone and from its engagement with the implant. The first bone is repositioned such that the first surgical device is aligned with the passageway defined by the implant, and the first bone is forced into engagement with a second portion of the implant.

Abstract: A catheter-based device tracks over a guidewire which has been placed from a first blood vessel into a second blood vessel. The distal tip of the catheter is advanced into the second vessel while a proximal member remains in the first vessel. Matching blunt tapered surfaces on each of the distal tip and the proximal member are clamped together, with adjacent walls of each vessel between them, after which a known, controlled pressure is applied between the two surfaces. Heat energy is then applied to the blunt surfaces for approximately 1-30 seconds to weld the walls of the two vessels together. After coaptation of the vessel walls, the heat is increased to then cut through the vessel walls to create a fistula of the desired size.

Abstract: Methods and apparatus are provided for treating contrast nephropathy, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such neuromodulation may effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.