Salpingoscopy: systematic use in diagnostic laparoscopy.

Science.gov (United States)

Marconi, G; Auge, L; Sojo, E; Young, E; Quintana, R

1992-04-01

To evaluate the importance of salpingoscopy together with laparoscopy in the diagnosis of tubal pathology. Salpingoscopy was performed as a complementary method in patients who were subjected to diagnostic laparoscopy. The relationship between the salpingoscopy and (1) the patient's previous history of tubal disease and (2) laparoscopic diagnoses was evaluated. Private patients referred to the Instituto de Fertilidad, Buenos Aires. Forty-two patients undergoing a diagnostic laparoscopy during the evaluation of their fertility or as a follow-up of previous therapy. Salpingoscopy was performed, using a colpomicrohysteroscope. We evaluated alterations in major and minor folds and their vascularization, the presence of microadhesions, and cellular nuclei dyed with methylene blue in the tubal lumen. Fifty percent of the patients who had no previous history of tubal disease presented with endosalpingeal alterations, and in 37% of the normal laparoscopies the salpinx had unilateral or bilateral salpingoscopic abnormalities. Salpingoscopy is a useful method to evaluate oviducts, before assuming their normality, and consideration of these women for assisted reproductive technology.

Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy.

Science.gov (United States)

Soliman, Ahmed M; Du, Ella Xiaoyan; Yang, Hongbo; Wu, Eric Q; Haley, Jane C

2017-06-01

Hysterectomy and laparoscopy are the two most common surgical options used to treat women with endometriosis, yet the disease may still recur. This study aimed to determine the long-term retreatment rates among endometriosis patients in the United States who received either hysterectomy or laparoscopy. Patients aged 18-49 years with endometriosis who underwent hysterectomy or laparoscopy were identified in the Truven Health MarketScan claims database (2004-2013). The retreatment rate up to 8 years after the initial surgery was estimated using Kaplan-Meier survival analysis. The relative risk of retreatment among patients with hysterectomy versus laparoscopy was assessed using a Cox proportional hazard model. A total of 24,915 patients with endometriosis who underwent hysterectomy and 37,308 patients with endometriosis who underwent laparoscopy were identified. The estimated retreatment rates were 3.3%, 4.7%, and 5.4% in the 2nd, 5th, and 8th year following hysterectomy, respectively, while the rates following laparoscopy were 15.8%, 27.5%, and 35.2%, respectively. The hazard ratio of retreatment was 0.157 (95% confidence interval [CI]: 0.146-0.169) comparing hysterectomy to laparoscopy. In the sensitivity analysis, which expanded the definition of retreatment by including medical treatments, the retreatment rate increased by a factor of 11-14 for the hysterectomy cohort and by a factor of 2-4 for the laparoscopy cohort, and the hazard ratio of retreatment rate for hysterectomy versus laparoscopy was 0.490 (95% CI: 0.477-0.502). Our study results indicated that the disease retreatment rate after laparoscopy is high among patients with endometriosis; even hysterectomy does not guarantee freedom from retreatment.

Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study).

Science.gov (United States)

Brenkman, H J F; Gertsen, E C; Vegt, E; van Hillegersberg, R; van Berge Henegouwen, M I; Gisbertz, S S; Luyer, M D P; Nieuwenhuijzen, G A P; van Lanschot, J J B; Lagarde, S M; de Steur, W O; Hartgrink, H H; Stoot, J H M B; Hulsewe, K W E; Spillenaar Bilgen, E J; van Det, M J; Kouwenhoven, E A; van der Peet, D L; Daams, F; van Sandick, J W; van Grieken, N C T; Heisterkamp, J; van Etten, B; Haveman, J W; Pierie, J P; Jonker, F; Thijssen, A Y; Belt, E J T; van Duijvendijk, P; Wassenaar, E; van Laarhoven, H W M; Wessels, F J; Haj Mohammad, N; van Stel, H F; Frederix, G W J; Siersema, P D; Ruurda, J P

2018-04-20

Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3-4b, N0-3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. NCT03208621 . This trial was registered prospectively on June 30, 2017.

Laparoscopy After Previous Laparotomy

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Zulfo Godinjak

2006-11-01

Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

Prognostic significance of diagnostic laparoscopy for spontaneous fertility

NARCIS (Netherlands)

Mol, B. W.; Swart, P.; Bossuyt, P. M.; van der Veen, F.

1999-01-01

OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact

Laparoscopy and hysteroscopy in a Tertiary Hospital: A 4 year review

African Journals Online (AJOL)

or hysteroscopy in AKTH within the study period were retrieved from the operation record book; their case files were retrieved, studied and recorded in a ... Key words: Anaesthesia; hysteroscopy; laparoscopy. Introduction. Laparoscopy and ... local anaesthesia with sedation may also be used for office laparoscopy.[3].

Use of laparoscopy in trauma at a level II trauma center.

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Barzana, Daniel C; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

2011-01-01

Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010. Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries. Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.

Laser laparoscopy in the treatment of polycystic ovarian disease

Science.gov (United States)

Mutrynowski, Andrzej; Zabielska, Renata

1996-03-01

A polycystic ovaries disease occurs in the case of women with anovulatory cycles as the result of neurohormonal disorders. Patients with this disease suffer from infertility and many symptoms, such as: irregular menstrual bleeding, hirsutism, obesity. The paper presents a method of the carbon dioxide laser laparoscopy in the polycystic ovary disease treatment. The study included 96 women operated on (carbon dioxide laser laparoscopy) in the II Clinic Of Obstetric and Gynecology in Warsaw. Each woman measured her body temperature in order to evaluate her menstrual cycle and had vaginal USG examination or a cytohormonal one before laparoscopy and within 6 months after the surgery. Performing the laparoscopy the operator punctured each ovary in at least 15 points using the carbon dioxide laser. The patients were followed-up for 6 months. The Chi test was used to make the statistic analysis. Comparing the percent of ovulatory cycles and regular ones before and after surgery we noticed that the differences were statistically relevant. Eighty-five patients (88%) had regular cycles and in 88 cases (92%) there was a diphasic curve of the body temperature after the laparoscopy. Fourteen percent of infertile women with polycystic ovary disease conceived.

Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women

International Nuclear Information System (INIS)

Sakar, Mehmet N.; Atay, Ahmet E.; Gul, T.; Celik, Y.

2008-01-01

Objective was to compare tuboperitoneal factors of infertile women hysterosalpingography (HSG) and laparoscopy. In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Out of 82 infertile women, pathological findings were observed in 45.1% by HSG and 54.9% had no pathological findings. On laparoscopic evaluation, however, pathological findings were observed in 65.85% and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45(44.4%) patients who had had no pathological findings by HSG and no pathological findings were detected by laparoscopy in 3 of the 37 (8.1%) patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3% and positive predictive value was 92% with a 55% predictive value and the accuracy ratio was 72%. Laparoscopy is a superior method for the result of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis and other pathologies. Therefore, these 2 methods are not alternative but complementary. (author)

Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study

International Nuclear Information System (INIS)

Rutten, Marianne J; Pijnenborg, Johanna MA; Schreuder, Henk WR; Schutter, Eltjo MJ; Spijkerboer, Anje M; Wensveen, Celesta WM; Zusterzeel, Petra; Mol, Ben Willem J; Kenter, Gemma G; Buist, Marrije R; Gaarenstroom, Katja N; Van Gorp, Toon; Meurs, Hannah S van; Arts, Henriette JG; Bossuyt, Patrick M; Ter Brugge, Henk G; Hermans, Ralph HM; Opmeer, Brent C

2012-01-01

Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence

Role of laparoscopy in evaluation of chronic pelvic pain

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Hebbar Shripad

2005-01-01

Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.

[Ten years experience with laparoscopy in the state women's clinic of Nurenberg].

Science.gov (United States)

Stark, G; Heise, P; Bischoff, R

1979-03-15

During the period from 1968--1977 2400 laparoscopies were performed. Of these 10.7% were for diagnostic purposes only, in 3.6% of the cases laparoscopy was combined with biopsie and in 85.7% with tubal sterilization. Deaths or serious bleedings did not occur, laparotomies were not necessary. Total insignificant complications amounted to 1.6% (1.3% small bleedings which did not necessitate an operation and in 0.3% clinical signs of peritonitis, these disappeared after 3 to 15 days). In 0.7% laparoscopy was interrupted because of poor vision. Nine of 2055 women became pregnant after sterilization (4.5 pregnancies/1000 sterilizations). In 2 cases the ligamentum rotundum was coagulated, in 7 cases recanalization was histologically confirmed. Until Oct. 1975 coagulation was unipolar, afterwords bipolar. In 45.3% the patients had undergone an operation before, like Ceasarian section, gallbladder operation, appendectomy or umbilical hernia operation. Patients with longitudinal incision, with preceding peritonitis or ileus were excluded from laparoscopy. Laparoscopy was performed by all assistents during their last year of clinical instruction. Their first 30 laparoscopies were done under control, every assistent performed about 100 laparoscopies.

A structured four-step curriculum in basic laparoscopy

DEFF Research Database (Denmark)

Strandbygaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde

2014-01-01

The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component.......The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component....

Does laparoscopy still has a role in modern fertility practice?

Directory of Open Access Journals (Sweden)

Ahmad Mahran

2017-12-01

Full Text Available Background: More than 3 decades after the introduction of in vitro fertilization (IVF and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%, tubal factor (30%, uterine cause (4%, and endometriosis (2.7%. No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%. Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%. Sixty cases (10% had intrauterine insemination and sixty four cases (10.7% underwent in vitro fertilization (IVF / intracytoplasmic sperm injection (ICSI treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%. The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant followed by women with polycystic ovary syndrome (27.8%. Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy.

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Fransen, Sofie Af; Broeders, Epm; Stassen, Lps; Bouvy, Nd

2014-07-01

Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained

Laparoscopy to evaluate scrotal edema during peritoneal dialysis.

Science.gov (United States)

Haggerty, Stephen P; Jorge, Juaquito M

2013-01-01

Acute scrotal edema is an infrequent complication in patients who undergo continuous ambulatory peritoneal dialysis (CAPD), occurring in 2% to 4% of patients. Inguinal hernia is usually the cause, but the diagnosis is sometimes confusing. Imaging modalities such as computed tomographic peritoneography are helpful but can be equivocal. We have used diagnostic laparoscopy in conjunction with open unilateral or bilateral hernia repair for diagnosis and treatment of peritoneal dialysis (PD) patients with acute scrotal edema. TECHNIQUE AND CASES: Three patients with acute scrotal edema while receiving CAPD over the span of 7 years had inconclusive results at clinical examination and on diagnostic imaging. All patients underwent diagnostic laparoscopy that revealed indirect inguinal hernia, which was concomitantly repaired using an open-mesh technique. Diagnostic laparoscopy revealed the etiology of the scrotal edema 100% of the time, with no complications, and allowed concomitant repair of the hernia. One patient had postoperative catheter outflow obstruction, which was deemed to be unrelated to the hernia repair. Diagnostic laparoscopy is helpful in confirming the source of acute scrotal edema in CAPD patients and can be performed in conjunction with an open-mesh repair with minimal added time or risk.

The role of laparoscopy in the multimodality treatment of colorectal cancer.

Science.gov (United States)

Hartley, J E; Monson, J R T

2002-10-01

Ten years after the first reports of laparoscopic techniques in colorectal surgery the precise role for these approaches in future colorectal practice as still to be defined. However, it seems most unlikely that the application is going to disappear. Laparoscopic colectomy is undoubtedly a complex. time-consuming procedure and it is clear that the technique is intolerant of difficult cases and will likely remain thus. Therefore. the potential advantages of laparoscopy do not as yet appear to be attainable across the board in colorectal resection. Such generalized advantage may, however, be tantalizingly close. Although many studies have failed to show major benefits for laparoscopy in terms of postoperative recovery, it must be remembered that most of these have been of insufficient statistical power to settle the issue. What is clear to all involved in the field is that very many patients do gain major benefit from the minimally invasive approach. The challenge for the future lies in developing the technology to such a point that these benefits for patients are more reproducible. The requirement for a significant abdominal incision to deliver an intact specimen represents a significant hurdle in this regard. The importance of pathological staging for colorectal cancer at present mandates retrieval of an intact specimen. It is of course possible that radiological staging may develop to such a point that surgeons need only remove the lesion with minimal attention to lymphadenectomy. Alternatively, new adjuvant therapies may arrive that, by virtue of increased efficacy and low side-effect profiles, may be applicable to all but the earliest lesions. Finally, increasing health awareness and application of screening programs may lead to a preponderance of large polyps and preinvasive lesions for which a more limited resection may be appropriate. Obviously these scenarios remain almost entirely speculative. However, the trend towards less invasive local therapy for

The concept of laparoscopy-assisted pancreatobiliary EUS (LAP-EUS).

Science.gov (United States)

Ramesh, Jayapal; Christein, John; Varadarajulu, Shyam

2013-05-01

While laparoscopy-assisted endoscopic retrograde cholangiopancreatography can be performed for the diagnosis and management of pancreaticobiliary diseases in patients with Roux-en-Y (RY) anatomy; the technical feasibility of performing laparoscopy-assisted endoscopic ultrasound (EUS) is unknown. In this report, we describe the technique for performing laparoscopy-assisted EUS in two patients with RY gastric bypass anatomy who presented with obstructive jaundice, abnormal liver function tests, and dilated biliary tree. While the examination was normal in one patient, EUS-guided fine needle aspiration of pancreatic head mass revealed adenocarcinoma in the other. Laparoscopic assisted EUS examination including FNA is feasible in Roux-en-Y surgical anatomy.

Development of urologic laparoscopy in Germany, Austria, and Switzerland: a survey among urologists.

Science.gov (United States)

Imkamp, Florian; Herrmann, Thomas R W; Stolzenburg, Jens U; Rassweiler, Jens; Sulser, Tullio; Zimmermann, Uwe; Dziuba, Sebastian; Kuczyk, Markus A; Burchardt, Martin

2014-12-01

Laparoscopy introduction has dramatically changed urology. Novel techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES), might also have substantial influence. This 2012 survey evaluated present laparoscopy use, its appraisal among urologic surgeons, laparoscopy training, and use of new techniques. Results were compared to the previous surveys, demonstrating the 10-year development of laparoscopy. A detailed questionnaire regarding demographic data, laparoscopy use, attitudes concerning laparoscopy, and novel techniques was send to 424 departments in Germany, Austria, and Switzerland. Procedures performed in 25 indications were quantitatively evaluated. The response rate was 63 % (269). Eighty-six percent of the respondents reported performing laparoscopy, compared to 54 % in 2002. Only 16 % expected economic advantages with laparoscopy, whereas 67 % expected shorter hospitalization. Seventy percent of responders anticipated comparable functional and oncological results between laparoscopic procedures and open surgery. Slow learning curves (81 %) and insufficient training facilities (32 %) were reported to impair laparoscopic surgery. On average, laparoscopic and non-laparoscopic surgical teams consisted of 2.5 and 3.5 members, respectively. LESS procedures were performed at 15 % of institutions. Twenty-two percent of respondents considered NOTES techniques valuable for future urology. Few indications (laparoscopic prostatectomies or nephrectomies) were performed frequently in specialized centers, and the rapidly increasing procedure numbers observed between 2002 and 2007 had dropped to a mild accretion. The results demonstrate broad acceptance of laparoscopy in German urologic surgery, depict the need for structured training facilities, and indicate limited impact of novel techniques (LESS and NOTES). The survey demonstrates the 10-year development of urologic laparoscopy and the broad acceptance

SmartSIM - a virtual reality simulator for laparoscopy training using a generic physics engine.

Science.gov (United States)

Khan, Zohaib Amjad; Kamal, Nabeel; Hameed, Asad; Mahmood, Amama; Zainab, Rida; Sadia, Bushra; Mansoor, Shamyl Bin; Hasan, Osman

2017-09-01

Virtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand-eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in laparoscopy, i.e. SmartSIM, which has been developed using a generic open-source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy-to-fabricate custom-built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graphical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning. Copyright © 2016 John Wiley & Sons, Ltd.

Selective use of diagnostic laparoscopy in patients with suspected appendicitis

NARCIS (Netherlands)

van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.

2000-01-01

BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of

THE ROLE OF LAPAROSCOPY IN BLUNT ABDOMINAL TRAUMA: DIAGNOSTIC, THERAPEUTIC OR BOTH?

Science.gov (United States)

Mosai, F

2017-09-01

The use of laparoscopy in blunt abdominal trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. But the feasibility of using laparoscopy for therapeutic intervention in these patients has been debated. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted. A retrospective analysis of a prospectively collected data was done. All adult patients who presented with abdominal trauma and were offered laparoscopic surgery at DGMAH from 2012 to 2015 were reviewed. Data was retrieved from our departmental database and analysed using descriptive statistics. A total of 318 patients were reviewed and 35 patients had blunt abdominal trauma and were included in the study. All the patients were offered laparoscopy. The median age was 30, with 91% of our patients being males. The highest injury severity score calculated was 38. At least 77% of the patients were managed using laparoscopy. This includes 43% who had both diagnostic and therapeutic intervention and 34% had only diagnostic laparoscopy. Eight patients were converted to open surgery mainly due to active bleeding and complex injuries. We did not have any non-therapeutic laparotomies, with no documented procedure related morbidity and mortality. The positive outcomes seen from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients. A conversion to open surgery should not be regarded as a failure but rather as a sign of mature and sound clinical judgement acknowledging the limitations of laparoscopy and/or the surgeon.

Rasmussen's model of human behavior in laparoscopy training.

Science.gov (United States)

Wentink, M; Stassen, L P S; Alwayn, I; Hosman, R J A W; Stassen, H G

2003-08-01

Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS. Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior. Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior. In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.

LEARNING CURVES OF LAPAROSCOPY – BARRIERS TO ADOPTION: A MNJIO EXPERIENCE!

Directory of Open Access Journals (Sweden)

Ramesh Maturi

2016-06-01

Full Text Available BACKGROUND Laparoscopy has been a new entry in the field of surgery with an active history of around just two decades. Today, it is in a position to challenge the conventional surgery which is in use since ages. It is making rapid inroads into various disciplines of surgery. Rapid improvements in optics, along with improvements in energy devices and mechanical stapling devices gave a fillip to acceptance of laparoscopy by the majority of surgeons. Also accumulating data and evidence has started influencing the sceptical, mobilising them to jump into the bandwagon. Barriers to adoption of new techniques, resistance to learning are common to human nature and it is necessary to have a systematic overview of the issues that might crop, so as to be prepared to overcome the problems of accepting laparoscopy into established centres of surgery. AIMS This publication is a reflection of our experience, our trials and tribulations in taking forward the laparoscopy program at our institution. This publication will give an overview of the steps involved in initiation of laparoscopy and aspires to be a source of answers, for day-to-day issues that crop during the process of learning laparoscopy. METHODS AND MATERIALS Just the way, executing laparoscopic surgery is a team effort, incorporating laparoscopy program in an institution is also a team effort where the members of team extend beyond the operating room. Involvement and co-operation of individuals across departments is a must along with benevolent seniors and a proactive administration. So we collated data by interviewing all the stakeholders of laparoscopy program, analysed observations of the faculty from the operating room and reviewed literature on the world wide web. Opinions of the administrators about their perceptions and the issues faced by the junior staff of the department were taken into consideration. Patients were interviewed before and after laparoscopic surgery. CONCLUSIONS Success at

Laparoscopy Assisted versus Open Distal Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer: Design and Rationale of a Phase II Randomized Controlled Multicenter Trial (COACT 1001).

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Nam, Byung Ho; Kim, Young-Woo; Reim, Daniel; Eom, Bang Wool; Yu, Wan Sik; Park, Young Kyu; Ryu, Keun Won; Lee, Young Joon; Yoon, Hong Man; Lee, Jun Ho; Jeong, Oh; Jeong, Sang Ho; Lee, Sang Eok; Lee, Sang Ho; Yoon, Ki Young; Seo, Kyung Won; Chung, Ho Young; Kwon, Oh Kyoung; Kim, Tae Bong; Lee, Woon Ki; Park, Seong Heum; Sul, Ji-Young; Yang, Dae Hyun; Lee, Jong Seok

2013-09-01

Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. NCT01088204 (international), NCCCTS-09-448 (Korea).

Laparoscopy in the acute abdomen.

Science.gov (United States)

Navez, Benoit; Navez, Julie

2014-02-01

Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary. Copyright © 2013 Elsevier Ltd. All rights reserved.

Role of diagnostic laparoscopy in chronic abdominal conditions with uncertain diagnosis

Directory of Open Access Journals (Sweden)

Amandeep S Nar

2014-01-01

Full Text Available Introduction: Laparoscopy has proved to be an important tool in the minimally invasive exploration of selected patients with chronic abdominal disorders, whose diagnosis remains uncertain, despite exploring the requisite laboratory and imaging investigations like ultrasonography, computed tomography (CT scan, and the like. Materials and Methods: Diagnostic Laparoscopy was conducted on 120 patients, admitted to the Departments of Surgery and Gynecology, Dayanand Medical College and Hospital, Ludhiana, with an uncertain diagnosis after four weeks of onset of symptoms. Conclusion: With laparoscopy providing tissue diagnosis, and helping to achieve the final diagnosis without any significant complication and less operative time, it can be safely concluded that diagnostic laparoscopy is a safe, quick, and effective adjunct to non-surgical diagnostic modalities, for establishing a conclusive diagnosis, but whether it will replace imaging studies as a primary modality for diagnosis needs more evidence.

Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

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Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

2017-10-01

The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

Laparoscopy in small bowel obstruction - current status - review.

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Szeliga, Jacek; Jackowski, Marek

2017-12-01

Acute small bowel obstruction (SBO) is an urgent medical condition. Its diagnosis is based mainly on a clinical examination followed by confirmatory simple routine radiological examinations such as plain X-ray of the abdominal cavity or computed tomography (CT). However, a real surgical challenge is not a decision whether to perform a surgery, but a decision when and how to perform it. To determine the place of laparoscopy in contemporary management of acute SBO based on the current literature. A review of the literature based on the Medline database and including mainly the period of 2013-2017 was performed. With regard to SBO, laparoscopy is a technique showing its advantages resulting from a minimally invasive approach. However, SBO is still a condition where the use of laparoscopy is limited mainly to selected cases such as SBO caused by single adhesions or foreign bodies. A basic limitation of using this technique is advanced and complicated SBO and lack of sufficient technical skills of the surgeon.

Laparoscopy in unexplained abdominal pain: surgeon's perspective

International Nuclear Information System (INIS)

Abdullah, M.T.; Waqar, S.H.; Zahid, M.A.

2016-01-01

Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Results: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Conclusion: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients. (author)

Intraoperative verification of hysterosalpingography and laparoscopy in cases of oviductal infertility

International Nuclear Information System (INIS)

Cislo, M.; Murawski, M.; Popiela, A.

1993-01-01

There has been made an analysis of 45 cases of women's oviductal infertility qualified to surgical treatment. In search of these reasons of infertility these patients underwent hysterosalpingographic examination and 24 of them additionally, diagnostic laparoscopy with chromoturbation. Positive intraoperative verification of HSG and laparoscopy, as a confirmation of tubal obstruction, they obtained at 40 women (88.9%) that made possible to carry out microsurgical operations in them. Such a big percentage of correct diagnoses make sure, that both HSG and laparoscopy are indispensable for proper qualification of a patient to microsurgical treatment of oviductal infertility. (author)

[Indications for laparoscopy in an internal medicine department in Dakar as indicated by echotomography].

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Aubry, P; Vergne, R; Oddes, B; Delanoue, G; Larregle, B; Seurat, P L

1984-01-01

A real time ultrasonography was set up in a senegalese hospital, resulting in a decrease of laparoscopy indications. Laparoscopy is given up for the diagnosis of liver abcess, jaundice and "abdominal masses". It must no more be included in the first step check up for hepatocellular carcinoma, because ultrasonography and cytology after puncture are enough to confirm the diagnosis. Laparoscopy remains essential for peritoneal diseases. Hepatic needle biopsy under laparoscopy control remains necessary to ensure with certainty the diagnosis of cirrhosis and especially chronic hepatitis, provided that no countraindications are found.

The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management.

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Tabassum, Meher; Atmuri, Kiran

2017-01-01

Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant) in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

THE ROLE OF LAPAROSCOPY IN DISCOVERING THE CAUSES OF CHRONIC PELVIC PAIN

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Jadranka Domazet Fink

2003-12-01

Full Text Available Background. The aim of this study was to assess the share of organic changes in patients with chronic pelvic pain (CPP as well as evaluate the need for invasive CPP diagnostics – laparoscopy.Methods. The data for the analysis were gathered retrospectively from the descriptions of 287 CPP patients who were treated at the Clinic of Gynaecology in Ljubljana from 1993 to 1999. In this analysis the share of laparoscopically established organic causes of CPP was assessed and the findings of invasive (laparoscopy and non-invasive diagnostics (clinical status and ultrasound were compared.Results. Out of 287 patients, 272 underwent laparoscopy, 7 underwent laparotomy while 8 were only observed. As regards organic CPP causes, an organic cause was established in 70.7% patients through laparoscopy. The most frequently observed phenomena were adhesions, namely in 97 (35.7% patients, endometriosis in 68 (25.0% and pelvic varices in 29 (10% patients.By comparing the results of invasive and non-invasive diagnostics it was established that up to three times more organic changes – a possible cause of CPP – can be discovered through laparoscopy than through the use of non-invasive diagnostics methods.Conclusions. Laparoscopy is considered to be the most reliable method of diagnostics and detection of organic causes of CPP. An adequate psychological treatment within a multidisciplinary approach is necessary in patients in whom an organic cause of CPP can not be discovered in their genital tract.

Predicting opportunities to increase utilization of laparoscopy for colon cancer.

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Keller, Deborah S; Parikh, Niraj; Senagore, Anthony J

2017-04-01

Despite proven safety and efficacy, rates of minimally invasive approaches for colon cancer remain low in the USA. Given the known benefits, investigating the root causes of underutilization and methods to increase laparoscopy is warranted. Our goal was to develop a predictive model of factors impacting use of laparoscopic surgery for colon cancer. The Premier Hospital Database was reviewed for elective colorectal resections for colon cancer (2009-2014). Patients were identified by ICD-9-CM diagnosis code and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes. An adjusted multivariate logistic regression model identified variables predictive of use of laparoscopy for colon cancer. A total of 24,245 patients were included-12,523 (52 %) laparoscopic and 11,722 (48 %) open. General surgeons performed the majority of all procedures (77.99 % open, 71.60 % laparoscopic). Overall use of laparoscopy increased from 48.94 to 52.03 % over the study period (p colon cancer laparoscopically. Colorectal surgeons were 32 % more likely to approach a case laparoscopically than general surgeons (OR 1.315, 95 % CI [1.222, 1.415], p characteristics that can be identified preoperatively to predict who will undergo surgery for colon cancer using laparoscopy. However, additional patients may be eligible for laparoscopy based on patient-level characteristics. These results have implications for regionalization and increasing teaching of MIS. Recognizing and addressing these variables with training and recruiting could increase use of minimally invasive approaches, with the associated clinical and financial benefits.

Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery.

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Liliana, Mereu; Alessandro, Pontis; Giada, Carri; Luca, Mencaglia

2011-01-01

The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach.

Development and validation of a theoretical test in basic laparoscopy

DEFF Research Database (Denmark)

Strandbygaard, Jeanett; Maagaard, Mathilde; Larsen, Christian Rifbjerg

2013-01-01

for first-year residents in obstetrics and gynecology. This study therefore aimed to develop and validate a framework for a theoretical knowledge test, a multiple-choice test, in basic theory related to laparoscopy. METHODS: The content of the multiple-choice test was determined by conducting informal...... conversational interviews with experts in laparoscopy. The subsequent relevance of the test questions was evaluated using the Delphi method involving regional chief physicians. Construct validity was tested by comparing test results from three groups with expected different clinical competence and knowledge.......001). Internal consistency (Cronbach's alpha) was 0.82. There was no evidence of differential item functioning between the three groups tested. CONCLUSIONS: A newly developed knowledge test in basic laparoscopy proved to have content and construct validity. The formula for the development and validation...

The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management

Directory of Open Access Journals (Sweden)

Meher Tabassum

2017-01-01

Full Text Available Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

Minimally Invasive Surgical Staging in Early-stage Ovarian Carcinoma: A Systematic Review and Meta-analysis.

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Bogani, Giorgio; Borghi, Chiara; Leone Roberti Maggiore, Umberto; Ditto, Antonino; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Lopez, Carlos; Sabatucci, Ilaria; Scaffa, Cono; Indini, Alice; Ferrero, Simone; Lorusso, Domenica; Raspagliesi, Francesco

Few studies investigated the efficacy and safety of minimally invasive surgery for the treatment of early-stage epithelial ovarian cancer (eEOC). In this context, we aimed to review the current evidence comparing laparoscopy and the laparotomic approach for staging procedures in eEOC. This systematic review was registered in the International Prospective Register of Systematic Reviews. Overall, 3065 patients were included: 1450 undergoing laparoscopy and 1615 undergoing laparotomic staging. Patients undergoing laparoscopy experienced a longer (but not statistically significant) operative time (weighted mean difference [WMD] = 28.3 minutes; 95% confidence interval [CI], -2.59 to 59.2), a lower estimated blood loss (WMD = -156.5 mL; 95% CI, -216.4 to -96.5), a shorter length of hospital stay (WMD = -3.7 days; 95% CI, -5.2 to -2.1), and a lower postoperative complication rate (odds ratio [OR] = 0.48; 95% CI, 0.29-0.81) than patients undergoing laparotomy. The upstaging (OR = 0.81; 95% CI, 0.55-1.20) and cyst rupture (OR = 1.32; 95% CI, 0.52-3.38) rates were similar between groups. Laparoscopic staging is associated with a shorter time to chemotherapy than laparotomic procedures (WMD = -5.16 days; 95% CI, -8.68 to -1.64). Survival outcomes were not influenced by the route of surgery. Pooled data suggested that the minimally invasive surgical approach is equivalent to laparotomy for the treatment of eEOC and may be superior in terms of perioperative outcomes. However, because of the low level of evidence of the included studies, further randomized trials are warranted. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

Laparoscopy and computed tomography imaging in advanced ovarian tumors: A roadmap for prediction of optimal cytoreductive surgery

OpenAIRE

Ahmed Samy El-Agwany

2018-01-01

Introduction: Comprehensive staging laparotomy and cytoreductive surgery followed by chemotherapy has been the standard of care in advanced ovarian cancer. Neoadjuvant chemotherapy is an alternative in inoperable advanced cases. To select patients amenable for successful cytoreduction, major determinants including CT imaging and laparoscopy could be of value. There is no general accepted model for selection and reproducibility of techniques are a major challenge due to different clinical prac...

Implementation of a Cross-specialty Training Program in Basic Laparoscopy

DEFF Research Database (Denmark)

Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette

2015-01-01

BACKGROUND AND OBJECTIVES: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the ...... laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up....

Analisis Strategi Pemasaran Produk Laparoscopy di Rumah Sakit PKU Muhammadiyah YOGYAKARTA

OpenAIRE

Mudayana, Ahmad Ahid

2010-01-01

Background : Complexity of hospital marketing strategy that have social function needed research to analyses marketing strategy have been applied by PKU Muhammadiyah Yogyakarta hospital, especially to promote Laparoscopy Product. Marketing strategy of the segmentation, targeting and positioning. The aim of the research to analyses marketing strategy of PKU Muhammadiyah Yogyakarta to promote Laparoscopy product.Method : This was descriptive research using qualitative method. The subject was di...

Laparoscopic Stephen-Fowler stage procedure: appropriate management for high intra-abdominal testes.

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Agrawal, Amit; Joshi, Milind; Mishra, Pankaj; Gupta, Rahul; Sanghvi, Beejal; Parelkar, Sandesh

2010-03-01

The length of testicular vessels is the main length-limiting factor to bring down the testes in the scrotum. Fowler and Stephen proposed the division of testicular vessels, high and as far from the testes as possible to maintain collateral blood supply, to treat high intra-abdominal testes. Cortesi introduced the diagnostic laparoscopy and Jorden first did the laparoscopic orchiopexy for nonpalpable testes. We had done Fowler-Stephen staged orchiopexy for high intra-abdominal testes, in which both stages were done laparoscopically. In total, 17 testes of 13 patients had undergone laparoscopic staged Fowler-Stephen orchiopexy. The decision to perform a staged Fowler-Stephen orchiopexy was based on the distance of the testis from the deep inguinal ring on laparoscopy. If distance was more than 2.5 cm, then we proceeded to a laparoscopic staged Fowler-Stephen orchiopexy. In the first stage, testicular vessels were cauterized by bipolar diathermy. Laparoscopic second-stage Fowler-Stephen procedure was done 6 months after the first stage. Patients were regularly followed, and the success of the procedure was assessed by the size of the testes and the position in the scrotum. Testicular vascularity was assessed by color Doppler ultrasonography. There was no testicular atrophy on second stage and on follow-up. All testes were in the scrotum with good size on follow-up. There was no complication related to laparoscopy. In cases of high intra-abdominal testes, the staged Fowler-Stephen procedure should be the procedure of choice. This procedure yields a high success rate. Transaction of vessels by bipolar diathermy is a very safe, cost-effective method.

Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience.

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Fagotti, A; Vizzielli, G; Fanfani, F; Costantini, B; Ferrandina, G; Gallotta, V; Gueli Alletti, S; Tortorella, L; Scambia, G

2013-11-01

To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC). All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis. Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had a high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RTperformance status (p=0.016) maintained an independent association with the PFS. Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications. © 2013.

Role of laparoscopy in peritonitis.

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Sangrasi, Ahmed Khan; Talpu, K Altaf Hussain; Kella, Nandlal; Laghari, Abdul Aziz; Rehman Abbasi, Mujeeb; Naeem Qureshi, Jawaid

2013-07-01

Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Laparoscopic management is feasible, safe and effective surgical option for

Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions ...

African Journals Online (AJOL)

the necessary hematological, biochemical, radiological, and ascitic fluid analysis, gastrointestinal .... In this aspect, diagnostic laparoscopy clearly scores above the imaging studies. ... abdominal pain and depression. Epidemiologie findings in ...

Current status of pediatric minimal access surgery at Sultan Qaboos ...

African Journals Online (AJOL)

Keywords: current status, laparoscopy, minimal access surgery, thoracoscopy. Departments of ... Materials and methods ... procedures, the open technique was used for the creation ... operated for bilateral inguinal herniotomy had recurrence.

Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

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Shu S

2015-08-01

Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

Diagnostic Laparoscopy for Trauma: How Not to Miss Injuries.

Science.gov (United States)

Koto, Modise Z; Matsevych, Oleh Y; Aldous, Colleen

2018-05-01

Diagnostic laparoscopy (DL) is a well-accepted approach for penetrating abdominal trauma (PAT). However, the steps of procedure and the systematic laparoscopic examination are not clearly defined in the literature. The aim of this study was to clarify the definition of DL in trauma surgery by auditing DL performed for PAT at our institution, and to describe the strategies on how to avoid missed injuries. The data of patients managed with laparoscopy for PAT from January 2012 to December 2015 were retrospectively analyzed. The details of operative technique and strategies on how to avoid missed injuries were discussed. Out of 250 patients managed with laparoscopy for PAT, 113 (45%) patients underwent DL. Stab wounds sustained 94 (83%) patients. The penetration of the peritoneal cavity or retroperitoneum was documented in 67 (59%) of patients. Organ evisceration was present in 21 (19%) patients. Multiple injuries were present in 22% of cases. The chest was the most common associated injury. Two (1.8%) iatrogenic injuries were recorded. The conversion rate was 1.7% (2/115). The mean length of hospital stay was 4 days. There were no missed injuries. In the therapeutic laparoscopy (TL) group, DL was performed as the initial part and identified all injuries. There were no missed injuries in the TL group. The predetermined sequential steps of DL and the standard systematic examination of intraabdominal organs were described. DL is a feasible and safe procedure. It accurately identifies intraabdominal injuries. The selected use of preoperative imaging, adherence to the predetermined steps of procedure and the standard systematic laparoscopic examination will minimize the rate of missed injuries.

Evaluation of Staged Fowler-Stephens Orchiopexy for the High ...

African Journals Online (AJOL)

The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open (67cases) or laparoscopic orchiopexy (11 cases) was performed. Only 65 patients were available for ...

The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology.

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Alsulaimy, Mohammad; Punchai, Suriya; Ali, Fouzeyah A; Kroh, Matthew; Schauer, Philip R; Brethauer, Stacy A; Aminian, Ali

2017-08-01

Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included. Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.

A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer.

Science.gov (United States)

Leake, Pierre-Anthony; Cardoso, Roberta; Seevaratnam, Rajini; Lourenco, Laercio; Helyer, Lucy; Mahar, Alyson; Law, Calvin; Coburn, Natalie G

2012-09-01

Despite improved preoperative imaging techniques, patients with incurable or unresectable gastric cancer are still subjected to non-therapeutic laparotomy. Diagnostic laparoscopy (DL) has been advocated by some to be essential in decision-making in gastric cancer. We aimed to identify and synthesize findings on the value of DL for patients with gastric cancer, in this era of improved preoperative imaging. Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We calculated the change in management and avoidance of laparotomy based on the addition of DL and laparoscopic ultrasound (LUS). The accuracy, agreement (kappa), sensitivity, and specificity of DL in assessing tumor extent, nodal involvement, and the presence of metastases with respect to the gold standard (pathology) were also calculated. Twenty-one articles were included. DL showed moderate to substantial agreement with final pathology for T stage, but only fair agreement for N stage. For M staging, DL had an overall accuracy, sensitivity, and specificity ranging from 85-98.9%, 64.3-94%, and 80-100%, respectively. The use of DL altered treatment in 8.5-59.6% of cases, avoiding laparotomy in 8.5-43.8% of cases. LUS provided additional benefit in 5.8-7.2% of cases. Despite evolving preoperative imaging techniques, diagnostic laparoscopy continues to be of substantial value in staging patients with gastric cancer and in avoiding unnecessary laparotomy. The current data support DL for all patients with advanced gastric cancer.

Gynaecological laparoscopy courses in the United Arab Emirates

African Journals Online (AJOL)

EB

gynaecological procedures having advantages over open surgery. Objective: To ... Models used may be useful for training gynaecological laparoscopy in developing countries. The long ... coordination and force needed to handle the tissues.2.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

Science.gov (United States)

Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

Comparison of hysterosalpingograms with laparoscopy in the ...

African Journals Online (AJOL)

Introduction: The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. Methods: We conducted a comparative cross sectional study on 208 medical files of infertile women ...

Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review.

Science.gov (United States)

Kyle, Esther B; Maheux-Lacroix, Sarah; Boutin, Amélie; Laberge, Philippe Y; Lemyre, Madeleine

2016-01-01

The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.

Malignant peritoneal cytology in stage I endometrial adenocarcinoma: the effect of progesterone therapy (a preliminary report).

Science.gov (United States)

Piver, M S; Lele, S B; Gamarra, M

1988-01-01

From February 1982-June 1986, 25 consecutive patients with surgical stage I endometrial adenocarcinoma (no evidence of metastasis at surgery or occult cervical or adnexal involvement on histopathologic review) and malignant peritoneal cytologic washings were treated with progesterone therapy. Twenty-two patients have undergone a second look laparoscopy and repeat cytologic washings, one of those also underwent a third look laparoscopy. Two patients refused second look laparoscopy, and in a third patient laparoscopy was medically contraindicated; all three have no evidence of disease (NED) at 15, 46, and 64 months respectively and are off therapy. Of the 22 patients who underwent second look laparoscopy, 21 (95%) had no macroscopic evidence of recurrent endometrial carcinoma and repeat negative peritoneal cytology; 1 patient (5%) had persistent malignant peritoneal cytology but was NED at third look laparoscopy one year later. All 25 patients are off progesterone therapy and remain clinically NED from 12-64 months. Although progesterone therapy for malignant peritoneal cytology resulted in a 100% reversal of malignant peritoneal cytology to normal in the 22 patients who underwent second or third look laparoscopy and all 25 patients remain clinically NED, the true value of progesterone therapy can only be ascertained by a randomized trial of progesterone versus no therapy.

ROLE OF DIAGNOSTIC LAPAROSCOPY IN EVALUATION AND TREATMENT OF CHRONIC ABDOMINAL PAIN IN CHILDREN.

Science.gov (United States)

Talat, Nabila; Afzal, Muhammad; Ahmad, Sarfraz; Rasool, Naima; Wasti, Arsalan Raza; Saleem, Muhammad

2016-01-01

Chronic abdominal Pain in children is a very common cause of hospital admission. Many of them are discharged without a diagnosis even after battery of investigations. Laparoscopy plays a significant role in diagnosis and management of many causes of acute and chronic abdominal pain. The purpose of this study was to determine the efficacy of laparoscopy as an efficient diagnostic and management tool in children with chronic abdominal pain. A descriptive, prospective case series was collected in the department of Paediatric surgery Mayo's Hospital Lahore, over the period of 5 years between Jan 2007-Dec 2013. The data of consecutive 50 patients, who were admitted in the department with the diagnosis of chronic abdominal pain, was recorded. All patients who had 2-3 admissions in hospital for last 2 months and failed to establish a definitive diagnosis after clinical examination and base line investigations underwent laparoscopy. The details of associated symptoms, finding of laparoscopy, laparoscopic procedures done, definitive diagnosis, histopathology, complications and relief of symptoms were collected and analysed and results were evaluated using SPSS-17. Out of 50 patients studies, 27/50 (54%) were male, 23/50 (46%) were female. Age ranged from 2-12 years, with the mean age of 7.24 year. Tuberculosis abdomen, adhesions, mesenteric lymphadenitis, appendicitis and cholecystitis were the final diagnosis. Five abdomens were found normal on laparoscopy. Complete pain relief was achieved in 30/50 (60%), reduced intensity of pain was gained in 12/50 (24%) cases while 16% (8/50) still complained of pain. Laparoscopy is an efficient diagnostic and treatment tool in children with chronic unexplained abdominal pain. It avoids serial examinations; prolong admission, battery of investigations and unnecessary surgeries.

An unusual case of intra-abdominal testicular torsion: Role of laparoscopy

Directory of Open Access Journals (Sweden)

Alfonso Papparella

2013-01-01

Full Text Available The authors report a case of intra-abdominal testicular torsion, where laparoscopy has been useful for diagnosis and surgical management. A boy was presented with a left impalpable testis. Laparoscopy revealed a twisted spermatic cord at the inlet pelvis, which ended in a testicular remnant located in the sub-umbilical area. After orchiectomy, the pathologist confirmed testicular atrophy. Diagnosis of intra-abdominal testicular torsion should be considered in patients with impalpable testis and abdominal pain, but could not be excluded in those with no symptoms.

Single access laparoscopic nephrectomy

Directory of Open Access Journals (Sweden)

Jay D Raman

2008-01-01

Full Text Available Laparoscopic nephrectomy has assumed a central role in the management of benign and malignant kidney diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions each at least 1-2 cm in length. Each incision carries morbidity risks of bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single access or keyhole surgery, which utilizes magnetic anchoring and guidance system (MAGS technology or articulating laparoscopic instruments. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing for the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series demonstrate feasibility as well as safe and successful completion of keyhole nephrectomy. Future work is necessary to improve existing instrumentation, increase clinical experience, assess benefits of this surgical approach, and explore other potential applications for this technique.

Competitive and Allelopathic Effects of Wild Rice Accessions (Oryza longistaminata) at Different Growth Stages.

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Shen, Shicai; Xu, Gaofeng; Clements, David Roy; Jin, Guimei; Zhang, Fudou; Tao, Dayun; Xu, Peng

2016-01-01

The competitive and allelopathic effects of wild rice (Oryza longistaminata) accessions on barnyard grass at different growth stages determined by days after sowing (0, 30, 60 and 90 days) were studied in greenhouse pot experiments. Wild rice accession RL159 exhibited the greatest height and tillering. The weed suppression rates of wild rice accessions OL and F1 on barnyard grass were significantly higher than for other rice accessions, with the lowest being O. sativa cultivar RD23. The highest suppression rates of OL and F1 were 80.23 and 73.96% at barnyard grass growth stages of 90 days and 60 days. At a 90 growth stage, wild rice accessions RL159 and RL169 caused 61.33 and 54.51% inhibition in barnyard grass growth, respectively. Under the same conditions, the competitive inhibition rates of OL, F1, RL159, RL169 and RL219 against barnyard grass were markedly lower than their weed suppressive effects, but were relatively similar for RD23. The allelopathic inhibition of OL and F1 on barnyard grass was significantly higher than other rice accessions. The highest allelopathic rates of OL and F1 were 60.61 and 56.87% at the 0 day growth stage. It is concluded that wild rice accessions OL and F1 exhibited the highest allelopathic activity along with moderate competitive ability against barnyard grass; wild rice accession RL159 had the highest competitive ability and moderate allelopathic activity on barnyard grass. Thus, the three wild rice accessions OL, F1 and RL159 could be used as ideal breeding materials for cultivated rice improvement.

Successful resuscitation after carbon dioxide embolism during laparoscopy

DEFF Research Database (Denmark)

Burcharth, Jakob; Burgdorf, Stefan; Lolle, Ida

2012-01-01

to another hospital, where she received hyperbaric oxygen treatment. The patient was discharged 14 days after surgery without any sequelae. It is important that the general surgeon suspects VAE during laparoscopy whenever the patient develops sudden and unexplained severe hypotension or cardiac arrest during...

Laparoscopy can be used to diagnose peritoneal tuberculosis

DEFF Research Database (Denmark)

Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas

2014-01-01

and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...... peritoneal tuberculosis....

Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy

International Nuclear Information System (INIS)

Stefansson, T.; Univ. Hospital, Uppsala; Nyman, R.; Nilsson, S.; Ekbom, A.; Univ. Hospital, Uppsala; Paahlman, L.

1997-01-01

Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.)

Three-dimensional versus two-dimensional vision in laparoscopy

DEFF Research Database (Denmark)

Sørensen, Stine D; Savran, Mona Meral; Konge, Lars

2016-01-01

were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS: Three hundred and forty articles were screened for eligibility, and 31 RCTs were included...... through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS: A systematic search of the literature...... in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71 %) showed a reduction in performance time, and 12 out of 19...

A randomised trial comparing laparoscopy with laparotomy in the ...

African Journals Online (AJOL)

time to normal activity, total hospital costs,[8] shorter hospital stay and quicker recovery in ... with laparoscopy in the surgical management of women with REP in any setting. ..... Regression analysis accounting for the learning curve shows that.

Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

Science.gov (United States)

Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim

2015-06-01

The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.

Application of artificial tactile sensing approach in kidney-stone-removal laparoscopy.

Science.gov (United States)

Afshari, Elnaz; Najarian, Siamak; Simforoosh, Nasser

2010-01-01

Artificial tactile sensing is a novel method for obtaining different characteristics of a hard object embedded in a soft tissue. In this regard, artificial palpation is one of the most valuable achievements of artificial tactile sensing that can be used in various fields of medicine and more specifically in surgery. In this study, considering the present problems and limitations in kidney-stone-removal laparoscopy, a new application will be presented for artificial tactile sensing approach. Having imitated surgeon's palpation during open surgery and modeled it conceptually, indications of stone existence that appear on the surface of kidney (due to exerting mechanical load) were determined. A number of different cases were created and solved by the software. Using stress distribution contours and stress graphs, it is illustrated that the created stress patterns on the surface of kidney not only show the existence of stone inside, but also its exact location. In fact, the reliability and accuracy of artificial tactile sensing method in detection of kidney stone during laparoscopy is demonstrated by means of finite element analysis. Also, in this paper, the functional principles of tactile system capable of determining the exact location of stone during laparoscopy will be presented.

Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy.

Science.gov (United States)

Magrina, Javier F; Cetta, Rachel L; Chang, Yu-Hui; Guevara, Gregory; Magtibay, Paul M

2013-05-01

Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy. Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction. For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival. Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions. Copyright © 2013 Elsevier Inc. All rights reserved.

Laparoscopy Improves Short-term Outcomes After Surgery for Diverticular Disease

Science.gov (United States)

RUSS, ANDREW J.; OBMA, KARI L.; RAJAMANICKAM, VICTORIA; WAN, YIN; HEISE, CHARLES P.; FOLEY, EUGENE F.; HARMS, BRUCE; KENNEDY, GREGORY D.

2012-01-01

BACKGROUND & AIMS Observational studies and small randomized controlled trials have shown that the use of laparoscopy in colon resection for diverticular disease is feasible and results in fewer complications. We analyzed data from a large, prospectively maintained, multicenter database (National Surgical Quality Initiative Program) to determine whether the use of laparoscopy in the elective treatment of diverticular disease decreases rates of complications compared with open surgery, independent of preoperative comorbid factors. METHODS The analysis included data from 6970 patients who underwent elective surgeries for diverticular disease from 2005 to 2008. Patients with diverticular disease were identified by International Classification of Diseases, 9th revision codes and then categorized into open or laparoscopic groups based on Current Procedural Terminology codes. Preoperative, intraoperative, and postoperative data were analyzed to determine factors associated with increased risk for postoperative complications. RESULTS Data were analyzed from 3468 patients who underwent open surgery and 3502 patients who underwent laparoscopic procedures. After correcting for probability of morbidity, American Society of Anesthesiology class, and ostomy creation, overall complications (including superficial surgical site infections, deep incisional surgical site infections, sepsis, and septic shock) occurred with significantly lower incidence among patients who underwent laparoscopic procedures compared with those who received open operations. CONCLUSIONS The use of laparoscopy for treating diverticular disease, in the absence of absolute contraindications, results in fewer postoperative complications compared with open surgery. PMID:20193685

The efficacy of virtual reality simulation training in laparoscopy

DEFF Research Database (Denmark)

Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S

2012-01-01

Background. Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past decade. Objective. To review randomized controlled trial...

[Diagnostic laparoscopy in acute abdomen].

Science.gov (United States)

Keller, R; Kleemann, M; Hildebrand, P; Roblick, U J; Bruch, H-P

2006-11-01

Acute abdomen is not a disease in itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 h. All strategies for the management of acute abdomen underline the need for an interdisciplinary approach to diagnosis and therapy. This requires focused and intelligent use of efficient diagnostic procedures. Diagnostic laparoscopy may be a key to solving the diagnostic dilemma of unspecific acute abdomen. Furthermore, it allows not only direct inspection of the abdominal cavity but also surgical intervention, if needed. In particular the rate of negative laparotomies can be reduced.

Results of the surgical treatment of non-advanced megaesophagus using Heller-Pinotti's surgery: Laparotomy vs. Laparoscopy

Directory of Open Access Journals (Sweden)

Luiz Roberto Lopes

2011-01-01

Full Text Available INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients and laparoscopy (26 patients. Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05. An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%. Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.

Role of laparoscopy in evaluation of abdominal pain

International Nuclear Information System (INIS)

Masud, M.; Adil, M.; Gondal, Z.I.; Aquil, A.

2017-01-01

Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain. Study Design: Prospective study. Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013. Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21. Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20- 70 years with mean age of 50 +- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 (29.09%) patients, cholecystitis with biliary sludge in 14 (12.72%), pelvic inflammatory disease in 12 (10.90%), ovarian cyst in 11(10%), adhesions in 10(9.09%), intestinal tuberculosis in 8 (7.27%), mesenteric lymphadenitis in 7 (6.36%), lymphoma in 4 (3.63%), ectopic pregnancy in 3 (2.7%), CA gallbladder in 2 (1.81%), meckels diverticulum in 2 (1.81%), endometriosis in 2 (1.81%) and crohns disease in 1 (0.9%) patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed. Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations. (author)

Value of diagnostic and therapeutic laparoscopy for patients with blunt abdominal trauma: A 10-year medical center experience.

Science.gov (United States)

Lin, Heng-Fu; Chen, Ying-Da; Chen, Shyr-Chyr

2018-01-01

Laparoscopy has been used for the diagnosis and treatment for hemodynamically stable patients with penetrating abdominal trauma. This study evaluated whether diagnostic and therapeutic laparoscopy can be used as effectively in select patients with blunt abdominal trauma. All hemodynamically stable patients undergoing operations for blunt abdominal trauma over a 10-year period (2006-2015) at a tertiary medical center were included. Patients undergoing laparotomy were categorized as group A. Patients who underwent laparoscopy were categorized as group B. The clinical outcomes of the 2 groups were compared. There were 139 patients in group A and 126 patients in group B. Group A patients were more severely injured (mean injury severity score of 23.3 vs. 18.9, P .05). Laparoscopy is a feasible and safe tool for the diagnosis and treatment of hemodynamically stable patients with blunt abdominal trauma who require surgery.

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis.

Science.gov (United States)

Islam, J; Clarke, D; Thomson, S R; Wilson, D; Dawood, H

2014-06-01

The incidence of abdominal tuberculosis is much higher in an HIV-positive cohort. The use of laparoscopy in the diagnostic work-up of suspected abdominal tuberculosis is underutilized and its use and efficacy in the context of HIV co-infection has never been examined. A prospective clinical audit of the use of diagnostic laparoscopy was conducted in patients with clinically suspected abdominal tuberculosis but histologically or microbiologically unconfirmed tuberculosis at any site. From January 2008 to June 2010, 81 patients underwent diagnostic laparoscopy; 34 were male and 47 were female, with a mean age of 33 years, and 77 % were HIV-positive. Fifty-five patients (68 %) had positive histology or culture for tuberculosis. In 15 patients (19 %), histology revealed non-specific inflammation, no pathology was found in one patient, and no specimen was taken from one patient. Eighty percent of peritoneal deposits and 77 % of lymph nodes were positive for tuberculosis, whereas 35 % of ascitic fluid cultures were positive. In nine patients (11 %) an alternative diagnosis was found; nine patients (11 %) had conversion to laparotomy. There was no procedure-related death. Nine patients (11 %) died during the 2-month follow-up period. Diagnostic laparoscopy avoids the morbidity and mortality of laparotomy in chronically ill patients, and reduces the rate of misdiagnosis of other abdominal conditions and unnecessary long-term therapy. Diagnostic laparoscopy and tissue sampling is a viable and reliable strategy in patients with suspected abdominal tuberculosis.

Laparoscopy has a therapeutic role in the management of abdominal trauma: A matched-pair analysis.

Science.gov (United States)

Chakravartty, Saurav; Sarma, Diwakar R; Noor, Muhammad; Panagiotopoulos, Spyros; Patel, Ameet G

2017-08-01

Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL). This group was matched with 25 similar patients undergoing laparotomy (LT). Matching of the two cohorts was based on patient characteristics, severity of injuries, haemodynamic compromise and radiological findings. Peri-operative outcomes were compared. Patient characteristics were similar in TL and LT patients for age (median 33 vs. 26 years), gender distribution and clinical presentation. Injury severity score was also similar with a median of 16 in both groups (major trauma = ISS>15, normal range 0-75). Types of injuries included; hollow viscus [bowel repair = 10 (TL) vs. 16 (LT)] and solid organs [5(TL) vs. 2 (LT)]. Median operating time was similar in both groups; 105(TL) compared to 98 (LT) minutes. Post-operative complications (1 vs. 10, p = 0.02), analgesia requirements, specifically opiate use (34 vs. 136 morphine equivalents, p = 0.002) and hospital stay (4 vs. 9 days, p = 0.03) were significantly lower in the laparoscopy group. Abdominal trauma in haemodynamically stable patients can be managed effectively and safely with laparoscopy by experienced surgeons. Major benefits may include lower morbidity, reduced pain, and shorter length of hospital stay. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Diagnostic and therapeutic value of laparoscopy for small bowel blunt injuries: A case report.

Science.gov (United States)

Addeo, Pietro; Calabrese, Daniela Paola

2011-01-01

Small bowel injuries after blunt abdominal trauma represent both a diagnostic and a therapeutic challenge. Early diagnosis and prompt treatment are necessary in order to avoid a dangerous diagnostic delay. Laparoscopy can represent a diagnostic and therapeutic tool in patients with uncertain clinical symptoms. We report the case of a 25-year-old man, haemodynamically stable, admitted for acute abdominal pain a few hours after a physical assault. Giving the persistence of the abdominal pain and the presence of free fluids at the computed tomography examination, an exploratory laparoscopy was performed. At the laparoscopic exploration, an isolated small bowel perforation was found, 60 cm distal from the ligament of Treitz. The injury was repaired by laparoscopic suturing and the patient was discharged home at postoperative day 3 after an uneventful postoperative course. Laparoscopy represents a valuable tool for patients with small bowel blunt injuries allowing a timely diagnosis and a prompt treatment.

Chronic pelvic pain: how does noninvasive imaging compare with diagnostic laparoscopy?

Science.gov (United States)

Tirlapur, Seema A; Daniels, Jane P; Khan, Khalid S

2015-12-01

Chronic pelvic pain (CPP) has an annual prevalence of 38/1000 in the UK, with coexisting pathologies often present. Diagnostic laparoscopy has long been the gold standard diagnostic test, but with up to 40% showing no abnormality, we explore the value of noninvasive imaging, such as pelvic ultrasound and MRI. A literature review from inception until January 2015 of the following databases: PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and System for Information on Grey Literature in Europe were performed to identify published studies assessing the usefulness of ultrasound, MRI, and laparoscopy in the diagnosis of CPP. Three studies (194 women) addressed their comparative performance in patients with endometriosis, showing the sensitivity of ultrasound ranged between 58 and 88.5%; MRI was 56-91.5% and in the one study using histology as its reference standard, the sensitivity of laparoscopy was 85.7%. Noninvasive imaging has the additional benefit of being well tolerated, safer, and cheaper than surgery. CPP, by nature of its multifactorial causation, can be difficult to manage and often requires a multidisciplinary team. Ultrasound and MRI may provide information about the presence or lack of abnormality, which would allow general practitioners or office gynaecologists to initiate treatment and think about surgery as a second-line investigative tool.

Efficacy evaluation of laparoscopy assisted ultrasound guided radiofrequency ablation in the treatment of hepatocellular carcinoma beneath the diaphragm

Directory of Open Access Journals (Sweden)

Song WANG

2017-06-01

Full Text Available Objective To explore the feasibility, safety and efficacy of laparoscopy assisted ultrasound guided radiofrequency ablation (RFA in the treatment of hepatocellular carcinoma (HCC beneath the diaphragm. Methods Twenty- three consecutive patients with solitary HCC beneath the diaphragm were treated by laparoscopy assisted ultrasound guided RFA in the Chinese PLA General Hospital from January 2013 to March 2016. We observed the perioperative complications and followed- up long-term effect. Results All the 23 patients successfully underwent laparoscopy assisted ultrasound guided radiofrequency ablation. No serious complications such as massive hemorrhage, biliary fistula and severe pleural effusion, hemopneumothorax occurred in the patients during perioperative period. CT examination 2-3 days after the operation revealed that the tumor was completely covered by the ablation area. Besides, the survival condition was satisfactory during follow-up period of 9-38 months. Conclusion Laparoscopy-assisted ultrasound-guided radiofrequency ablation is effective and safe for HCC beneath the diaphragm. DOI: 10.11855/j.issn.0577-7402.2017.05.16

Laparoscopy-like operative vaginoscopy: a new approach to manage mesh erosions.

Science.gov (United States)

Billone, Valentina; Amorim-Costa, Célia; Campos, Sara; Rabischong, Benoĭt; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

2015-01-01

Mesh erosion through the vagina is the most common complication of synthetic mesh used for pelvic organ prolapse repair. However, conventional transvaginal mesh excision has many technical limitations. We aimed at creating and describing a new surgical technique for transvaginal removal of exposed mesh that would enable better exposition and access, thus facilitating optimal treatment. A step-by-step video showing the technique. A university tertiary care hospital. Five patients previously submitted to pelvic organ prolapse repair using synthetic mesh, presenting mesh erosion through the vagina. Mesh excision using a laparoscopy-like operative vaginoscopy in which standard laparoscopic instruments are used through a single-incision laparoscopic surgery port device placed in the vagina. In all cases, a very good exposure of the mesh was achieved, a minimal tissue traction was required, and the procedures were performed in a very ergonomic way. All the patients were discharged on the same day of the surgery and had a painless postoperative course. So far, there have been no cases of relapse. This seems to be a simple, cheap, and valuable minimally invasive technique with many advantages in comparison with the conventional approach. More cases and time are necessary to access its long-term efficacy. It may possibly be used for the management of other conditions. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Treatment Patterns, Complications, and Health Care Utilization Among Endometriosis Patients Undergoing a Laparoscopy or a Hysterectomy: A Retrospective Claims Analysis.

Science.gov (United States)

Surrey, Eric S; Soliman, Ahmed M; Yang, Hongbo; Du, Ella Xiaoyan; Su, Bowdoin

2017-11-01

Hysterectomy and laparoscopy are common surgical procedures used for the treatment of endometriosis. This study compares outcomes for women who received either procedure within the first year post initial surgery. The study used data from the Truven Health MarketScan claims databases from 2004 to 2013 to identify women aged 18-49 years who received an endometriosis-related laparoscopy or hysterectomy. Patients were excluded if they did not have continuous insurance coverage from 1 year before through 1 year after their endometriosis-related procedure, if they were diagnosed with uterine fibroids prior to or on the date of surgery (i.e., index date), or if they had a hysterectomy prior to the index date. The descriptive analyses examined differences between patients with an endometriosis-related laparoscopy or hysterectomy in regard to medications prescribed, complications, and hospitalizations during the immediate year post procedure. The final sample consisted of 24,915 women who underwent a hysterectomy and 37,308 who underwent a laparoscopy. Results revealed significant differences between the cohorts, with women who received a laparoscopy more likely to be prescribed a GnRH agonist, progestin, danazol, or an opioid analgesic in the immediate year post procedure compared to women who underwent a hysterectomy. In contrast, women who underwent a hysterectomy generally had higher complication rates. Index hospitalization rates and length of stay (LOS) were higher for women who had a hysterectomy, while post-index hospitalization rates and LOS were higher for women who had a laparoscopy. For both cohorts, post-procedure complications were associated with significantly higher hospitalization rates and longer LOS. This study indicated significantly different 1-year post-surgical outcomes for patients who underwent an endometriosis-related hysterectomy relative to a laparoscopy. Furthermore, the endometriosis patients in this analysis had a considerable risk of

Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.

Science.gov (United States)

Tokas, Theodoros; Gözen, Ali Serdar; Avgeris, Margaritis; Tschada, Alexandra; Fiedler, Marcel; Klein, Jan; Rassweiler, Jens

2017-10-01

Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (psystem nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. The study was conducted in a pelvi trainer and no patients were recruited. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

On the Performance of One Stage Massive Random Access Protocols in 5G Systems

DEFF Research Database (Denmark)

Mahmood, Nurul Huda; Pratas, Nuno; Jacobsen, Thomas

2016-01-01

use case. Smart utility meters, automated sensors in farms, and vehicle tracking nodes for logistics monitoring are all examples of emerging mMTC devices. Ensuring efficient mechanisms to access the wireless channel for such a massive number of densely deployed devices is a key challenge posed by m......MTC applications. A framework for the comparative analysis of the one-stage massive access protocol with respect to important performance metrics for mMTC services is proposed in this paper. The proposed framework allows us to determine the scenarios where the relative simple one-stage protocol can sufficiently...

Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

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Deepak Dubey

2011-01-01

Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

Laparoscopy for bowel obstruction--a contradiction? Results of a multi-institutional survey in Germany.

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Zimmermann, M; Hoffmann, M; Laubert, T; Bruch, H P; Keck, T; Benecke, C; Schlöricke, E

2016-05-01

The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals. To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care. Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %. This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

The frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases

International Nuclear Information System (INIS)

Sattar, Z.; Iqbal, M.

2014-01-01

Introduction: Diagnostic laparoscopy allows the visual examination and documentation of intra-abdominal organs in order to detect any pathology. It is an important tool for final minimally invasive exploration of patients with abdominal tuberculosis, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. Objective: To determine the frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases of peritoneal tuberculosis. Study Design: Cross sectional survey. Setting: The study was conducted in all the four Surgical Wards on surgical floor of Mayo Hospital Lahore. Duration of Study with Dates: Six months (1st July 2009 to 31st December 2009). Material and Methods: 35 Patients aged between 13-60 years with clinical suspicion of peritoneal tuberculosis were selected. The patients underwent the procedure accordingly. Per operative diagnosis of peritoneal tuberculosis made on the basis of presence of any or all of the operative (laparoscopic) findings such as multiple peritoneal adhesions, fibrous bands, whitish peritoneal tubercles, omental thickening and ascites. Diagnosis was confirmed with histopathology of peritoneal tissue biopsy. Also the biochemical analysis and culture sensitivity of ascetic fluid was routinely performed if any ascites is present. Results: Out of 35 patients, 40% were males and 60% females with mean age of 24.91+-6.69 years. The Laparoscopic findings of peritoneal tuberculosis were whitish peritoneal tubercles (57.2%) peritoneal adhesions (28.6%), ascites (17.2%), omental thickening (14.3%), fibrous bands (11.4%) and swollen edematous appendix (5.7%). Eighty percent were labeled with diagnosis of peritoneal tuberculosis on basis of diagnostic laparoscopy. These patients were confirmed to have peritoneal tuberculosis on histopathology of tissue biopsy. Conclusion: Diagnostic laparoscopy is useful in patients with suspected peritoneal

Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

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Ai-Yun Shen

2016-10-01

Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

Large Conization and Laparoendoscopic Single-Port Pelvic Lymphadenectomy in Early-Stage Cervical Cancer for Fertility Preservation

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Polat Dursun

2013-01-01

Full Text Available Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.

Intraperitoneal Dexamethasone As A New Method for Relieving Postoperative Shoulder Pain after Gynecologic Laparoscopy

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Zahra Asgari

2012-01-01

Full Text Available Background: In this study, we tried to show the efficacy of Intraperitoneal dexamethasoneon relieving shoulder pain after gynecologic laparoscopy.Materials and Methods: In this double-blind randomized clinical trial, 63 patients who werecandidates for gynecologic laparoscopy were included. At the end of the procedure patientsrandomly received 16 mg dexamethasone (n=31 or placebo (n=32 intraperitoneally. Visualanalogue scale (VAS was used for clinical evaluation of pain severity during 24 hours afterlaparoscopy . A physician, who was not aware whether patients were treated with drug or placebo,evaluated the patients.Results: The severity of pain in the dexamethasone group within 0, 2, 4, 8, 12, 24 hoursafter procedure was significantly less than in the placebo group (p<0.001. The averageconsumption of opioids as analgesic/ sedative in the placebo group was more than thedexamethasone group (p=0.025.Conclusion: Findings of this study show that the prescription of 16 mg of dexamethasone(single dose in the peritoneal cavity may significantly reduce the severity of painafter Laparoscopy in comparison with placebo and may decrease the need for narcoticsas pain relief (Registration Number: IRCT201105306640N1.

The role of laparoscopy in the management of urachal anomalies in ...

African Journals Online (AJOL)

Objectives Management for urachal anomalies (UAs) is controversial. Although traditional treatment of UAs has been surgical excision, recent literature report also a conservative approach. We reviewed our experience to define the role of laparoscopy in the management of UAs in children. Patients and methods From July ...

Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes.

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Angioni, Stefano; Pontis, Alessandro; Sedda, Federica; Zampetoglou, Theodoros; Cela, Vito; Mereu, Liliana; Litta, Pietro

2015-01-01

Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy-BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.

Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair.

Science.gov (United States)

Nishihara, Yuichi; Isobe, Yoh; Kitagawa, Yuko

2017-12-01

A realistic simulator for transabdominal preperitoneal (TAPP) inguinal hernia repair would enhance surgeons' training experience before they enter the operating theater. The purpose of this study was to create a novel physical simulator for TAPP inguinal hernia repair and obtain surgeons' opinions regarding its efficacy. Our novel TAPP inguinal hernia repair simulator consists of a physical laparoscopy simulator and a handmade organ replica model. The physical laparoscopy simulator was created by three-dimensional (3D) printing technology, and it represents the trunk of the human body and the bendability of the abdominal wall under pneumoperitoneal pressure. The organ replica model was manually created by assembling materials. The TAPP inguinal hernia repair simulator allows for the performance of all procedures required in TAPP inguinal hernia repair. Fifteen general surgeons performed TAPP inguinal hernia repair using our simulator. Their opinions were scored on a 5-point Likert scale. All participants strongly agreed that the 3D-printed physical simulator and organ replica model were highly useful for TAPP inguinal hernia repair training (median, 5 points) and TAPP inguinal hernia repair education (median, 5 points). They felt that the simulator would be effective for TAPP inguinal hernia repair training before entering the operating theater. All surgeons considered that this simulator should be introduced in the residency curriculum. We successfully created a physical simulator for TAPP inguinal hernia repair training using 3D printing technology and a handmade organ replica model created with inexpensive, readily accessible materials. Preoperative TAPP inguinal hernia repair training using this simulator and organ replica model may be of benefit in the training of all surgeons. All general surgeons involved in the present study felt that this simulator and organ replica model should be used in their residency curriculum.

Laparoscopy vs robotics in surgical management of endometrial cancer: comparison of intraoperative and postoperative complications.

Science.gov (United States)

Seror, Julien; Bats, Anne-Sophie; Huchon, Cyrille; Bensaïd, Chérazade; Douay-Hauser, Nathalie; Lécuru, Fabrice

2014-01-01

To compare the rates of intraoperative and postoperative complications of robotic surgery and laparoscopy in the surgical treatment of endometrial cancer. Unicentric retrospective study (Canadian Task Force classification II-2). Tertiary teaching hospital. The study was performed from January 2002 to December 2011 and included patients with endometrial cancer who underwent laparoscopic or robotically assisted laparoscopic surgical treatment. Data collected included preoperative data, tumor characteristics, intraoperative data (route of surgery, surgical procedures, and complications), and postoperative data (early and late complications according to the Clavien-Dindo classification, and length of hospital stay). Morbidity was compared between the 2 groups. The study included 146 patients, of whom 106 underwent laparoscopy and 40 underwent robotically assisted surgery. The 2 groups were comparable in terms of demographic and preoperative data. Intraoperative complications occurred in 9.4% of patients who underwent laparoscopy and in none who underwent robotically assisted surgery (p = .06). There was no difference between the 2 groups in terms of postoperative events. Robotically assisted surgery is not associated with a significant difference in intraoperative and postoperative complications, even when there were no intraoperative complications of robotically assisted surgery. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy.

Science.gov (United States)

Xiao, Meizhu; Gao, Huiqiao; Bai, Huimin; Zhang, Zhenyu

2016-09-01

The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally

Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

DEFF Research Database (Denmark)

Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten

2017-01-01

INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...

Hybrid (laparoscopy + stent treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS

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Maciej Michalik

2016-12-01

Full Text Available Introduction : Celiac trunk (CT compression syndrome caused by the median arcuate ligament (MAL is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT – the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT. Aim: To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome. Material and methods : Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin. Results : In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation. Conclusions : The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.

Hybrid (laparoscopy + stent) treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS)).

Science.gov (United States)

Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Majda, Kaja; Gutowski, Piotr

2016-01-01

Celiac trunk (CT) compression syndrome caused by the median arcuate ligament (MAL) is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT - the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT. To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome. Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin. In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation. The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.

A three-stage heuristic for harvest scheduling with access road network development

Science.gov (United States)

Mark M. Clark; Russell D. Meller; Timothy P. McDonald

2000-01-01

In this article we present a new model for the scheduling of forest harvesting with spatial and temporal constraints. Our approach is unique in that we incorporate access road network development into the harvest scheduling selection process. Due to the difficulty of solving the problem optimally, we develop a heuristic that consists of a solution construction stage...

Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve.

Science.gov (United States)

Padin, Esther Mariño; Santos, Raquel Sánchez; Fernández, Sonia González; Jimenez, Antonia Brox; Fernández, Sergio Estevez; Dacosta, Ester Carrera; Duran, Agata Rial; Artime Rial, Maria; Dominguez Sanchez, Ivan

2017-10-01

3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.

[Diffuse Malignant Peritoneal Mesothelioma with Secondary Liver Invasion Diagnosed Using Laparoscopy - A Case Report].

Science.gov (United States)

Yasuda, Hiroshi; Okumura, Satoshi; Toyoda, Shou; Yamamoto, Kansuke; Mizumura, Naoto; Itou, Aya; Ogawa, Masao; Kawasaki, Masayasu; Kameyama, Masao

2018-03-01

A 69-year-old man with right upper quadrant abdominal pain and fever was referred to our hospital. He had a history of asbestosis exposure. Computed tomography(CT)revealed a mass at the right subhepatic space, and an antibiotic was administered after a diagnosis of an abdominal abscess. However, the patient did not respond to the treatment, and finally, exploratory laparoscopy was performed. A sheet of combined white nodules surrounding the right lobe of the liver was found, and the mass was continuous with the covering particles. Biopsy of the mass and immunohistochemical examination was performed. The resulting diagnosis was diffuse epithelial malignant peritoneal mesothelioma(MPM). Postoperative systematic chemotherapy of pemetrexed and cisplatin was administered. Laparoscopy was useful to evaluate the distribution of the MPM, which led to adequate therapeutic determination.

Endometriosis: frequency and correlation between symptomatology and disease stage

International Nuclear Information System (INIS)

Mehmud, G.; Akhtar, T.; Sadia, S.

2007-01-01

To determine the frequency of endometriosis in general gynecological and infertile women presenting to hospital and to correlate symptomatology and stage of disease. Fifty patients with diagnosis of endometriosis on laparoscopy were included in the study. The degree of pain symptoms was graded according to 1-4 point verbal rating scale designed by Biberoglu and Behrman. Endometriosis was staged according to Revised American Fertility Society (R-AFS) scoring on laparoscopy. Correlation coefficient-Spearman rank order correlation test was applied to analyze data. The frequency of endometriosis in infertile women was 24% (33) and in women with general gynecological complaints, it was 23% (17). There was a significant positive correlation between chronic pelvic pain and R-AFS scoring. Increasing severity of pelvic pain was also positively correlated with presence of endometrioma and complete obliteration of pouch of Douglas. No correlation between dysmenorrhoea and R-AFS scoring could be detected. Dysmenorrhoea was strongly and positively correlated with the presence of superficial implants. Dyspareunia was found to have positive correlation with R-AFS score and also with complete obliteration of pouch of Douglas. The frequency of endometriosis in infertile women was 24% (33) and in women with general gynecological complaints, it was 23% (17). Chronic pelvic pain and dyspareunia had strong positive correlation with R-AFS score while dysmenorrhoea had no such correlation. (author)

Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery.

LENUS (Irish Health Repository)

O'Riordan, J M

2013-08-01

Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.

Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

Science.gov (United States)

Spruit, Edward N; Kleijweg, Luca; Band, Guido P H; Hamming, Jaap F

2016-01-01

Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed.

Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

Directory of Open Access Journals (Sweden)

Edward N. eSpruit

2016-05-01

Full Text Available AbstractDetermining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. 24 trainees (control group without prior experience received a three week laparoscopic skills training utilizing four basic and one advanced training task. 28 trainees (experimental group received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a two month retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity and trainee characteristics are discussed.

Exploring Teacher Pedagogy, Stages of Concern and Accessibility as Determinants of Technology Adoption

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Burke, Paul F.; Schuck, Sandy; Aubusson, Peter; Kearney, Matthew; Frischknecht, Bart

2018-01-01

This research examines how the pedagogical orientations of teachers affect technology adoption in the classroom. At the same time, the authors account for the stage of concern that teachers are experiencing regarding the use of the technology, their access to the technology and the level of schooling at which they teach.The authors' investigation…

Laparoscopy in Urology Practice at a Tertiary Care Centre

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Quddus, M. B.; Mahmud, S. M.

2014-01-01

Objective: To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Study Design: Case series / observational study. Place and Duration of Study: The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Methodology: Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. Results: There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +- 10.9 years. The mean operative time was 216 A +- 100 minutes and mean length of hospital stay was as 2.7 A +- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% (2/28) blood transfusion. Conclusion: There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy. (author)

Performance Variables and Professional Experience in Simulated Laparoscopy: A Two-Group Learning Curve Study

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Luursema, J.M.; Rovers, Maroeska M.; Groenier, Marleen; van Goor, Harry

2014-01-01

Objective Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate

Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study

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Luursema, J.M.; Rovers, M.M.; Groenier, M.; Goor, H. van

2014-01-01

OBJECTIVE: Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate

Role of laparoscopy and ultrasound in the management of “impalpable testis” in children

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Iskandar Rahardjo Budianto

2014-10-01

Conclusions: Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.

Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy?

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Marano, Alessandra; Giuffrida, Maria Carmela; Giraudo, Giorgio; Pellegrino, Luca; Borghi, Felice

2017-04-01

Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases. Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded. A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance. Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.

Highly immersive virtual reality laparoscopy simulation: development and future aspects.

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Huber, Tobias; Wunderling, Tom; Paschold, Markus; Lang, Hauke; Kneist, Werner; Hansen, Christian

2018-02-01

Virtual reality (VR) applications with head-mounted displays (HMDs) have had an impact on information and multimedia technologies. The current work aimed to describe the process of developing a highly immersive VR simulation for laparoscopic surgery. We combined a VR laparoscopy simulator (LapSim) and a VR-HMD to create a user-friendly VR simulation scenario. Continuous clinical feedback was an essential aspect of the development process. We created an artificial VR (AVR) scenario by integrating the simulator video output with VR game components of figures and equipment in an operating room. We also created a highly immersive VR surrounding (IVR) by integrating the simulator video output with a [Formula: see text] video of a standard laparoscopy scenario in the department's operating room. Clinical feedback led to optimization of the visualization, synchronization, and resolution of the virtual operating rooms (in both the IVR and the AVR). Preliminary testing results revealed that individuals experienced a high degree of exhilaration and presence, with rare events of motion sickness. The technical performance showed no significant difference compared to that achieved with the standard LapSim. Our results provided a proof of concept for the technical feasibility of an custom highly immersive VR-HMD setup. Future technical research is needed to improve the visualization, immersion, and capability of interacting within the virtual scenario.

A Sense of Touch in Laparoscopy : Using Augmented Haptic Feedback to Improve Grasp Control

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Westebring-van der Putten, E.P.

2011-01-01

Laparoscopy is Minimally Invasive Surgery (MIS) that is conducted in the belly alcove and which enables instruments, which enter the body through small incisions, to manipulate tissue. The possible complications arising during laparoscopic surgery are partly caused by improper grasp control on the

Bladder Involvement in Stage I Endometriosis.

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Brady, Paula C; Missmer, Stacey A; Laufer, Marc R

2017-08-01

Endometriosis-the ectopic implantation of endometrial-like tissue-affects 10% of adolescent females and adults. Bladder involvement, causing dysuria and hematuria, occurs in a very small number of endometriosis patients. The patient presented at age 12 years with dysuria and pelvic pain. Laparoscopy revealed stage I endometriosis. Postoperatively, she reported persistent dysuria and passage of tissue in her urine. Cystoscopy showed diffuse erythema; urine cytology revealed glandular and spindle cells suggestive of endometriosis. She was transitioned from oral contraceptives to an intranasal gonadotropin-releasing hormone agonist, with symptom resolution. Intravesicular endometriosis coinciding with stage I disease supports a mechanism of endometriosis dissemination other than direct bladder infiltration. Patients with endometriosis who complain of urinary symptoms warrant assessment, because intravesicular bladder involvement cannot be excluded using pelviscopy. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Laparoscopy-assisted micropercutaneous choledocholithotripsy with holmium laser in a cholecystectomized patient: an initial report.

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Gökçen, Kaan; Atabey, Mustafa; Gökçen, Pınar; Gökçe, Gökhan

2017-12-01

We present a novel minimally invasive technique, laparoscopy-assisted micropercutaneous choledocholithotripsy, for choledocholithiasis that cannot be treated with other endoscopic techniques. This technique includes standard laparoscopic exploration of the common bile duct, combined with an all-seeing needle and holmium laser lithotripsy. As is known, an all-seeing needle is used in micropercutaneous nephrolithotomy for middle-sized renal stones. In this technique, an all-seeing needle was inserted into the dilatated common bile duct under laparoscopic vision and then a lithotripsy procedure was performed with a holmium laser behind the biliary stent. A cholecystectomized female patient with a 21-mm stone in the common bile duct who previously underwent an unsuccessful endoscopic retrograde cholangiopancreatography procedure was operated on in our service with laparoscopy-assisted micropercutaneous choledocholithotomy without a T-tube. This novel procedure was completed uneventfully and the patient was discharged without any complications. In the future, this procedure will hopefully be a treatment modality in choledocholithiasis that cannot be treated by other minimally invasive techniques.

Reusable single-port access device shortens operative time and reduces operative costs.

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Shussman, Noam; Kedar, Asaf; Elazary, Ram; Abu Gazala, Mahmoud; Rivkind, Avraham I; Mintz, Yoav

2014-06-01

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review.

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Wong, Jacqueline M K; Bortoletto, Pietro; Tolentino, Jocelyn; Jung, Michael J; Milad, Magdy P

2018-01-01

To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted. Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data. A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30-0.36). Bladder injury (0.24%, 95% CI 0.22-0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07-0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2-2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9-1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3-45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7-29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47-76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3-61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75-95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2-41.7). The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively

Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System.

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Wingate, Jonathan T; Etzioni, Ruth; Macdonald, Dusten M; Brand, Timothy C

2016-10-01

The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population. Published by Elsevier Inc.

Making or breaking climate targets : The AMPERE study on staged accession scenarios for climate policy

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Kriegler, Elmar; Riahi, Keywan; Bauer, Nico; Schwanitz, Valeria Jana; Petermann, Nils; Bosetti, Valentina; Marcucci, Adriana; Otto, Sander; Paroussos, Leonidas; Rao, Shilpa; Arroyo Currás, Tabaré; Ashina, Shuichi; Bollen, Johannes; Eom, Jiyong; Hamdi-Cherif, Meriem; Longden, Thomas; Kitous, Alban; Méjean, Aurélie; Sano, Fuminori; Schaeffer, Michiel; Wada, Kenichi; Capros, Pantelis; P. van Vuuren, Detlef|info:eu-repo/dai/nl/11522016X; Edenhofer, Ottmar

2015-01-01

This study explores a situation of staged accession to a global climate policy regime from the current situation of regionally fragmented and moderate climate action. The analysis is based on scenarios in which a front runner coalition - the EU or the EU and China - embarks on immediate ambitious

The efficacy of virtual reality simulation training in laparoscopy: a systematic review of randomized trials.

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Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S; Soerensen, Jette Led

2012-09-01

Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past decade. To review randomized controlled trials regarding VR training efficacy compared with traditional or no training, with outcome measured as surgical performance in humans or animals. In June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were searched using the following medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Controlled trials. All randomized controlled trials investigating the effect of VR training in laparoscopy, with outcome measured as surgical performance. A total of 98 studies were screened, 26 selected and 12 included, with a total of 241 participants. Operation time was reduced by 17-50% by VR training, depending on simulator type and training principles. Proficiency-based training appeared superior to training based on fixed time or fixed numbers of repetition. Simulators offering training for complete operative procedures came out as more efficient than simulators offering only basic skills training. Skills in laparoscopic surgery can be increased by proficiency-based procedural VR simulator training. There is substantial evidence (grade IA - IIB) to support the use of VR simulators in laparoscopic training. © 2012 The Authors  Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Single-access laparoscopic low anterior resection with vertical suspension of the rectum.

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Uematsu, Dai; Akiyama, Gaku; Narita, Maiko; Magishi, Akiko

2011-05-01

Single-access laparoscopic surgery was first introduced for colectomy and later adapted for anterior resection. During single-access laparoscopic pelvic procedures, such as total mesorectal excision, it is often difficult to obtain an adequate operative field. By suspending the rectum vertically, we were able to execute a total mesorectal excision with single-access laparoscopy. We describe here the use of this new procedure to treat rectal cancer. The selected 7 patients (1 male and 6 female) with stage II or III rectal cancer underwent the procedure. Single-port access to the abdomen was provided by a 3.0-cm incision at the right iliac fossa. The descending mesocolon was dissected by use of a medial approach, and a columnar magnet was placed on the surface of the abdominal wall to restore triangulation. The inferior mesenteric artery was skeletonized and the superior rectal artery divided during lymph node dissection. The total mesorectal excision extended to the pelvic floor and the rectum was vertically retracted with a suspending bar in collaboration with an extracorporeal magnet tool. The rectum was then transected below the reflection of the peritoneum. Intracorporeal anastomosis was performed with the double-stapling technique. Two pelvic drains were inserted through the single incision and the anus, respectively, for all patients. A defunctioning ileostomy was not created in any patient. Median total surgical time was 205 minutes (range, 175-245 min). Intraoperative blood loss was minimal in all patients (range, 1-20 mL). None of the cases required conversion to open surgery or addition of a second port. The only preoperative or postoperative complication occurred in one patient with clinical anastomotic leakage. Low anterior single-access laparoscopic resection seems safe and feasible when the rectum is suspended like a swing to ensure an adequate operative field.

Safety of laparoscopy versus laparotomy in early-stage endometrial cancer : a randomised trial

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Mourits, M.J.E.; Bijen, C.B.; Arts, H.J.; Ter Brugge, H.G.; van der Sijde, R.; Paulsen, L.; Wijma, J.; Bongers, M.Y.; Post, W.J.; van der Zee, A.G.; de Bock, G.H.

Background The standard surgery for early-stage endometrial cancer is total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy, which is associated with substantial morbidity. Total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy is less invasive and is assumed to

Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair

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Ferdinand Köckerling

2017-05-01

Full Text Available IntroductionThe guidelines of the international hernia societies recommend posterior repair in laparo-endoscopic technique for recurrent inguinal hernia after open anterior mesh repair and, conversely, open anterior repair for recurrence after laparo-endoscopic primary repair. Even when these guidelines are followed, already 1 year after repair a re-recurrence rate of 1–2% must be expected, with that rate rising further in the subsequent years. Accordingly, increasingly more patients with re-recurrence after anterior and posterior mesh implantation must be treated, which constitutes a problem that to date has been investigated in only very few studies. Hence, there are no well-founded recommendations. This paper now presents a number of case reports aimed at identifying the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment.Patients and methodsBased on three case reports the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment is presented below.ResultsIn all the three cases described explorative laparoscopy played a key role as decision tool when deciding how best to treat re-recurrence after anterior and posterior inguinal hernia repair. In one case severe adhesions after robotic prostatectomy and in another case correct placement of the mesh in the posterior plane, adhesions from the cecum to the groin region and no definitive finding of a re-recurrence resulted in an open repair. In the third case, an insufficient laparoscopic posterior mesh placement made the re-recurrent TAPP procedure relatively easy.ConclusionExplorative laparoscopy is an important decision tool for re-recurrent inguinal hernia treatment to minimize the risks of the procedure for the patients.

The poor quality of information about laparoscopy on the World Wide Web as indexed by popular search engines.

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Allen, J W; Finch, R J; Coleman, M G; Nathanson, L K; O'Rourke, N A; Fielding, G A

2002-01-01

This study was undertaken to determine the quality of information on the Internet regarding laparoscopy. Four popular World Wide Web search engines were used with the key word "laparoscopy." Advertisements, patient- or physician-directed information, and controversial material were noted. A total of 14,030 Web pages were found, but only 104 were unique Web sites. The majority of the sites were duplicate pages, subpages within a main Web page, or dead links. Twenty-eight of the 104 pages had a medical product for sale, 26 were patient-directed, 23 were written by a physician or group of physicians, and six represented corporations. The remaining 21 were "miscellaneous." The 46 pages containing educational material were critically reviewed. At least one of the senior authors found that 32 of the pages contained controversial or misleading statements. All of the three senior authors (LKN, NAO, GAF) independently agreed that 17 of the 46 pages contained controversial information. The World Wide Web is not a reliable source for patient or physician information about laparoscopy. Authenticating medical information on the World Wide Web is a difficult task, and no government or surgical society has taken the lead in regulating what is presented as fact on the World Wide Web.

Transumbilical single-site laparoscopy takes the advantage of ultraminilaparotomy in managing an extremely large ovarian cyst

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Hsuan Su

2012-11-01

Conclusion: This application not only provides both advantages of ultraminilaparotomy and laparoscopy but it also overcomes the limitations of both approaches. Therefore, it is the surgical approach of choice for a patient bearing an extremely large ovarian cystic tumor.

Modern Technologies In Ectopic Pregnancy Diagnostics On Hospital Stage

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L.V. Kaushanskaya

2009-12-01

Full Text Available The present research provides analysis of results of preoperative examination of 680 patients with ectopic pregnancy depending on the range of surgical treatment. It has been shown that in case of progressive ectopic pregnancy the diagnostic significance of concentrations of human chorionic gonadotropin, transvaginal examination and laparos-copy depends on the duration of pregnancy. When the term of ectopic pregnancy is 3-4 weeks monitoring of p chorionic gonadotropin in blood serum (99.5%, transvaginal examination (58% and laparoscopy (78.5% are more informative. When the term of ectopic pregnancy is more than 4 weeks there is a high diagnostic value of monitoring p-subunit of chorionic gonadotropin (99.5%, transvaginal examination (68% and laparoscopy (99,5%. The research has proved that pregnancy period of 3-4 weeks is optimal for laparoscopy and other operations

Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

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Hao, Zhang; Zhenya, Shen; Lei, Wang

2014-10-01

To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

Video-assisted laparoscopy for the detection and diagnosis of endometriosis: safety, reliability, and invasiveness

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Schipper E

2012-07-01

Full Text Available Erica Schipper,1 Camran Nezhat21Center for Minimally Invasive and Robotic Surgery, Palo Alto, CA; 2Obstetrics/Gynecology and Surgery, Stanford University Medical Center, Palo Alto, CA, USAAbstract: Endometriosis is a highly enigmatic disease with multiple presentations ranging from infertility to severe pain, often causing significant morbidity. Video-assisted laparoscopy (VALS has now replaced laparotomy as the gold standard for the diagnosis and management of endometriosis. While imaging has a role in the evaluation of some patients, histologic examination is needed for a definitive diagnosis. Laboratory evaluation currently has a minor role in the diagnosis of endometriosis, although studies are underway investigating serum markers, genetic studies, and endometrial sampling. A high index of suspicion is essential to accurately diagnose this complex condition, and a multidisciplinary approach is often indicated. The following review discusses laparoscopic diagnosis of endometriosis from the pre-operative evaluation of patients suspected of having endometriosis to surgical technique for safe and adequate laparoscopic diagnosis of the condition and postsurgical care.Keywords: endometriosis, video-assisted, laparoscopy, diagnosis

causes of infertility in females: evaluated by diagnonstic laparoscopy at a tertiary care centre

International Nuclear Information System (INIS)

Siraj, A.; Naseer, S.; Khan, S.

2015-01-01

Objective: To determine the frequency of various causes of infertility through diagnostic laparoscopy. Study Design: Cross sectional comparative study. Place and Duration of Study: The study was conducted in gynaecology/obstetrics department unit I of Military Hospital Rawalpindi from May 2011 - May 2012. Patients and Methods: A total of 50 patients were recruited in the study through outpatient clinic, 32 out of 50 had primary infertility and 18 had secondary infertility. Diagnostic laparoscopy was performed under general anesthesia and findings were recorded. Result: The mean age of patients was 26.4 years. Out of 50 patients 20 (40%) had polycystic ovaries, 15 (30%) had tubal blockage, 7 (14%) had endometriosis and 2 (4%) had fibroids while 6(12%) were found to have normal pelvis and no pathology was detected. Conclusion: polycystic ovaries was found major cause of infertility in this study group, followed by tubal factor infertility either secondary to pelvic inflammatory disease or otherwise, both these causes are treatable to variable extent and fertility can be resumed if managed properly. (author)

Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases.

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Dai, L N; Chen, C D; Lin, X K; Wang, Y B; Xia, L G; Liu, P; Chen, X M; Li, Z R

2015-10-01

Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. Ureteral fibroepithelial polyps are rare but rather

Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer.

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Tan, Hung-Jui; Meyer, Anne-Marie; Kuo, Tzy-Mey; Smith, Angela B; Wheeler, Stephanie B; Carpenter, William R; Nielsen, Matthew E

2015-03-15

Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers. With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation. During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care. © 2014 American Cancer Society.

Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy.

Science.gov (United States)

Soliman, Amr A; Shaalan, Waleed; Abdel-Dayem, Tamer; Awad, Elsayed Elbadawy; Elkassar, Yasser; Lüdders, Dörte; Malik, Eduard; Sallam, Hassan N

2015-12-01

To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Near-Infrared Fluorescence Laparoscopy of the Cystic Duct and Artery in Pigs : Performance of a Preclinical Dye

NARCIS (Netherlands)

Schols, Rutger M.; Lodewick, Toine M.; Bouvy, Nicole D.; van Dam, Dieuwertje A.; Meijerink, Wilhelmus J. H. J.; van Dam, Gooitzen M.; Dejong, Cornelis H. C.; Stassen, Laurents P. S.

2014-01-01

Background: Near-infrared fluorescence laparoscopy after intravenous indocyanine green (ICG) administration has been proposed as a promising surgical imaging technique for real-time visualization of the extrahepatic bile ducts and arteries in clinical laparoscopic cholecystectomies. However,

Sexual Function and Body Image are Similar after Laparoscopy-Assisted and Open Ileal Pouch-Anal Anastomosis

DEFF Research Database (Denmark)

Kjaer, Mie Dilling; Laursen, Stig Borbjerg; Qvist, Niels

2014-01-01

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is performed in patients with ulcerative colitis and familial adenomatous polyposis where the majority of patients are sexually active. Laparoscopic surgery is becoming the preferred technique for most colorectal interventions, and we examined posto...... better body image among laparoscopy-treated women, the two surgical techniques seem equal with respect to postoperative sexual function....... postoperative sexual function and body image compared to those after open surgery IPAA. METHODS: Patients treated with IPAA in the period from October 2008 to March 2012 were included. Evaluation of sexual function, body image, and quality of life was performed using the Female Sexual Function Index (FSFI......), the International Index of Erectile Function (IIEF), the Body Image Questionnaire (BIQ), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). RESULTS: We included 72 patients (38 laparoscopy-assisted and 34 open). Response rate was 74 %. There were no differences in demographics, functional outcome...

3D straight-stick laparoscopy versus 3D robotics for task performance in novice surgeons: a randomised crossover trial.

Science.gov (United States)

Shakir, Fevzi; Jan, Haider; Kent, Andrew

2016-12-01

The advent of three-dimensional passive stereoscopic imaging has led to the development of 3D laparoscopy. In simulation tasks, a reduction in error rate and performance time is seen with 3D compared to two-dimensional (2D) laparoscopy with both novice and expert surgeons. Robotics utilises 3D and instrument articulation through a console interface. Robotic trials have demonstrated that tasks performed in 3D produced fewer errors and quicker performance times compared with those in 2D. It was therefore perceived that the main advantage of robotic surgery was in fact 3D. Our aim was to compare 3D straight-stick laparoscopic task performance (3D) with robotic 3D (Robot), to determine whether robotic surgery confers additional benefit over and above 3D visualisation. We randomised 20 novice surgeons to perform four validated surgical tasks, either with straight-stick 3D laparoscopy followed by 3D robotic surgery or in the reverse order. The trial was conducted in two fully functional operating theatres. The primary outcome of the study was the error rate as defined for each task, and the secondary outcome was the time taken to complete each task. The participants were asked to perform the tasks as quickly and as accurately as possible. Data were analysed using SPSS version 21. The median error rate for completion of all four tasks with the robot was 2.75 and 5.25 for 3D with a P value performance time for completion of all four tasks with the robot was 157.1 and 342.5 s for 3D with a P value 3D robotic systems over 3D straight-stick laparoscopy, in terms of reduced error rate and quicker task performance time.

Comparison between hysterosalpingographic findings and lesions observed by laparoscopy and laparotomy

International Nuclear Information System (INIS)

Brolin, I.; Lannering, B.; Ortskrankenhaus, Goeteborg

1980-01-01

Laparoscopy andor laparotomy had been performed in 91 patients also examined by hysterosalpingography (HSG) during two years. The comparison of the radiological and the operative findings shows, that total occlusion and hydrosalpinx are radiological signs of adhesions in the pelvis. A depot of contrast medium remaining around the fimbriated end of the oviduct is also a sign of adhesions. More than half of the patients with adhesions surrounding the oviducts and/or endometriosis had however normal hysterosalpingograms. Thus, the radiological examination, hysterosalpingography, has a low sensitivity rate concerning pelvic abnormalities. (orig.) [de

Esophageal - Gastric Anastomosis in Radical Resection of Esophageal Cancer under Thoracoscopy Combined with Laparoscopy

International Nuclear Information System (INIS)

Hao, Z.; Lei, W.; Zhenya, S.

2014-01-01

Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)

Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

Directory of Open Access Journals (Sweden)

Yan Lin

2018-05-01

Full Text Available Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i the odds of mastectomy versus breast conserving surgery (BCS; ii the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence. The spatial scan statistic method was used to identify geographic areas with significantly higher likelihood of experiencing mastectomy. The study found that geographic accessibility to radiation therapy facilities was negatively associated with the likelihood of receiving mastectomy after adjustment for other covariates, but not associated with radiation therapy use among patients receiving BCS. Compared with patients travelling less than 30 minutes to a radiation therapy facility, patients travelling more than 90 minutes were about 1.5 times more likely to receive mastectomy (odds ratio, 1.51; 95% confidence interval, 1.08-2.11 and patients travelling more than 120 minutes were 1.7 times more likely to receive mastectomy (odds ratio, 1.70; 95% confidence interval, 1.19-2.42. The study also identified a statistically significant cluster of patients receiving mastectomy who were located in south-eastern South Dakota, after adjustment for other factors. Because

Laparoscopy shows superiority over endoscopy for early detection of malignant atrophic papulosis gastrointestinal complications: a case report and review of literature.

Science.gov (United States)

Toledo, A E; Shapiro, L S; Farrell, J F; Magro, C M; Polito, J

2015-11-02

The malignant form of atrophic papulosis (Köhlmeier-Degos disease) is a rare thrombo-occlusive vasculopathy that can affect multiple organ systems. Patients typically present with distinctive skin lesions reflective of vascular drop out. The small bowel is the most common internal organ involved, resulting in considerable morbidity and mortality attributable to ischemic microperforations. Determination of the presence of gastrointestinal lesions is critical in distinguishing systemic from the benign, cutaneous only disease and in identifying candidates for treatment. We describe an 18 year old male who first presented with cutaneous atrophic papulosis but became critically ill from small bowel microperforations. He had an almost immediate and dramatic response to treatment. Prior to his presentation with acute abdomen he had upper and lower endoscopy showing areas of nonspecific patchy erythema. At laparotomy, innumerable characteristic lesions with central pearly hue and erythematous border were seen. PubMed was used for a literature search using the keywords malignant atrophic papulosis, Degos disease, endoscopy, laparoscopy and laparotomy. This search yielded 200 articles which were further analyzed for diagnostic procedures and findings. Among the 200 articles we identified only 11 cases in which endoscopy was performed. Results of endoscopy and laparotomy in our patient with malignant atrophic papulosis were compared to those in the literature. Endoscopy of the gastrointestinal tract has shown gastritis and non-specific inflammation whereas laparoscopy shows white plaques with red borders on the serosal surface of the small bowel and the peritoneum. From personal communications with other physicians worldwide, we identified three additional unpublished cases in which endoscopy revealed only minimal changes while laparoscopy showed dramatic lesions. From our experience the endoscopic findings are often subtle and nonspecific, whereas laparascopy or laparotomy

Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial).

NARCIS (Netherlands)

Wind, J.; Hofland, J.; Preckel, B.; Hollman, M.W.; Bossuyt, P.M.M.; Gouma, D.J.; Berge Henegouwen, M.I.; Fuhring, J.W.; Dejong, C.H.C.; Dam, R.M. van; Cuesta, M.A.; Noordhuis, A.; Jong, D. de; Zalingen, E. van; Engel, A.F.; Goei, T.H.; Stoppelaar, I.E. de; Tets, W.F. van; Wagensveld, B.A. van; Swart, A.; Elsen, M.J.L.J. van den; Gerhards, M.F.; Wit, L.Th. De; Siepel, M.A.M.; Geloven, A.A.W. van; Juttmann, J.-W.; Clevers, J.C.; Bemelman, W.A.

2006-01-01

BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst

Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial)

NARCIS (Netherlands)

Wind, Jan; Hofland, Jan; Preckel, Benedikt; Hollmann, Markus W.; Bossuyt, Patrick M. M.; Gouma, Dirk J.; van Berge Henegouwen, Mark I.; Fuhring, Jan Willem; Dejong, Cornelis H. C.; van Dam, Ronald M.; Cuesta, Miguel A.; Noordhuis, Astrid; de Jong, Dick; van Zalingen, Edith; Engel, Alexander F.; Goei, T. Hauwy; de Stoppelaar, I. Erica; van Tets, Willem F.; van Wagensveld, Bart A.; Swart, Annemiek; van den Elsen, Maarten J. L. J.; Gerhards, Michael F.; de Wit, Laurens Th; Siepel, Muriel A. M.; van Geloven, Anna A. W.; Juttmann, Jan-Willem; Clevers, Wilfred; Bemelman, Willem A.

2006-01-01

BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst

Measurement of distances between anatomical structures using a translating stage with mounted endoscope

Science.gov (United States)

Kahrs, Lueder A.; Blachon, Gregoire S.; Balachandran, Ramya; Fitzpatrick, J. Michael; Labadie, Robert F.

2012-02-01

During endoscopic procedures it is often desirable to determine the distance between anatomical features. One such clinical application is percutaneous cochlear implantation (PCI), which is a minimally invasive approach to the cochlea via a single, straight drill path and can be achieved accurately using bone-implanted markers and customized microstereotactic frame. During clinical studies to validate PCI, traditional open-field cochlear implant surgery was performed and prior to completion of the surgery, a customized microstereotactic frame designed to achieve the desired PCI trajectory was attached to the bone-implanted markers. To determine whether this trajectory would have safely achieved the target, a sham drill bit is passed through the frame to ensure that the drill bit would reach the cochlea without damaging vital structures. Because of limited access within the facial recess, the distances from the bit to anatomical features could not be measured with calipers. We hypothesized that an endoscope mounted on a sliding stage that translates only along the trajectory, would provide sufficient triangulation to accurately measure these distances. In this paper, the design, fabrication, and testing of such a system is described. The endoscope is mounted so that its optical axis is approximately aligned with the trajectory. Several images are acquired as the stage is moved, and threedimensional reconstruction of selected points allows determination of distances. This concept also has applicability in a large variety of rigid endoscopic interventions including bronchoscopy, laparoscopy, and sinus endoscopy.

Planned second-look laparoscopy in the management of acute mesenteric ischemia

Science.gov (United States)

Yanar, Hakan; Taviloglu, Korhan; Ertekin, Cemalettin; Ozcinar, Beyza; Yanar, Fatih; Guloglu, Recep; Kurtoglu, Mehmet

2007-01-01

AIM: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI). METHODS: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS: The average time of admission to the hospital after the initiation of symptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6). CONCLUSION: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis. PMID:17659674

High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease.

Science.gov (United States)

Bristow, Robert E; Chang, Jenny; Ziogas, Argyrios; Randall, Leslie M; Anton-Culver, Hoda

2014-02-01

To characterize the impact of hospital and physician ovarian cancer case volume on survival for advanced-stage disease and investigate socio-demographic variables associated with access to high-volume providers. Consecutive patients with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Disease-specific survival analysis was performed using Cox-proportional hazards model. Multivariate logistic regression analyses were used to evaluate for differences in access to high-volume hospitals (HVH) (≥20 cases/year), high-volume physicians (HVP) (≥10 cases/year), and cross-tabulations of high- or low-volume hospital (LVH) and physician (LVP) according to socio-demographic variables. A total of 11,865 patients were identified. The median ovarian cancer-specific survival for all patients was 28.2 months, and on multivariate analysis the HVH/HVP provider combination (HR = 1.00) was associated with superior ovarian cancer-specific survival compared to LVH/LVP (HR = 1.31, 95%CI = 1.16-1.49). Overall, 2119 patients (17.9%) were cared for at HVHs, and 1791 patients (15.1%) were treated by HVPs. Only 4.3% of patients received care from HVH/HVP, while 53.1% of patients were treated by LVH/LVP. Both race and socio-demographic characteristics were independently associated with an increased likelihood of being cared for by the LVH/LVP combination and included: Hispanic race (OR = 1.72, 95%CI = 1.22-2.42), Asian/Pacific Islander race (OR = 1.57, 95%CI = 1.07-2.32), Medicaid insurance (OR = 2.51, 95%CI = 1.46-4.30), and low socioeconomic status (OR = 2.84, 95%CI = 1.90-4.23). Among patients with advanced-stage ovarian cancer, the provider combination of HVH/HVP is an independent predictor of improved disease-specific survival. Access to high-volume ovarian cancer providers is limited, and barriers are more pronounced for patients with low socioeconomic status, Medicaid insurance, and racial minorities. Copyright © 2013

CAPABILITIES OF VIDEO-ASSISTED LAPAROSCOPY IN THE DIAGNOSIS AND TREATMENT OF PERFORATION OF THE SMALL INTESTINE AND MECKEL’S DIVERTICULUM (2 CLINICAL OBSERVATIONS

Directory of Open Access Journals (Sweden)

I. I. Kirsanov

2016-01-01

Full Text Available BACKGROUND Misdiagnosis of acute appendicitis reaches 40%. Video laparoscopy allows the correct diagnosis to be establishedin 98.1%, and identify the other disease excluding the initial diagnosisin 1.6%, as well as to determine the optimal surgical approach and perform minimally invasive surgery, if possible.MATERIAL Clinical observation of 2 cases of perforation of the small intestine.CONCLUSION The use of laparoscopy in acute surgical disease of abdominal organs allows to establish the correct diagnosis and properly provide a therapy with a minimal surgical trauma.

Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution.

Science.gov (United States)

Moulton, Laura; Jernigan, Amelia M; Carr, Caitlin; Freeman, Lindsey; Escobar, Pedro F; Michener, Chad M

2017-11-01

Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery. The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice. A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ 2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development. A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m 2 , respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and

Input and output for surgical simulation: devices to measure tissue properties in vivo and a haptic interface for laparoscopy simulators.

Science.gov (United States)

Ottensmeyer, M P; Ben-Ur, E; Salisbury, J K

2000-01-01

Current efforts in surgical simulation very often focus on creating realistic graphical feedback, but neglect some or all tactile and force (haptic) feedback that a surgeon would normally receive. Simulations that do include haptic feedback do not typically use real tissue compliance properties, favoring estimates and user feedback to determine realism. When tissue compliance data are used, there are virtually no in vivo property measurements to draw upon. Together with the Center for Innovative Minimally Invasive Therapy at the Massachusetts General Hospital, the Haptics Group is developing tools to introduce more comprehensive haptic feedback in laparoscopy simulators and to provide biological tissue material property data for our software simulation. The platform for providing haptic feedback is a PHANToM Haptic Interface, produced by SensAble Technologies, Inc. Our devices supplement the PHANToM to provide for grasping and optionally, for the roll axis of the tool. Together with feedback from the PHANToM, which provides the pitch, yaw and thrust axes of a typical laparoscopy tool, we can recreate all of the haptic sensations experienced during laparoscopy. The devices integrate real laparoscopy toolhandles and a compliant torso model to complete the set of visual and tactile sensations. Biological tissues are known to exhibit non-linear mechanical properties, and change their properties dramatically when removed from a living organism. To measure the properties in vivo, two devices are being developed. The first is a small displacement, 1-D indenter. It will measure the linear tissue compliance (stiffness and damping) over a wide range of frequencies. These data will be used as inputs to a finite element or other model. The second device will be able to deflect tissues in 3-D over a larger range, so that the non-linearities due to changes in the tissue geometry will be measured. This will allow us to validate the performance of the model on large tissue

Sealed Orifice Laparoscopic or Endoscopic (SOLE) Surgery: technology and technique convergence for next-step colorectal surgery.

LENUS (Irish Health Repository)

Cahill, R A

2012-02-01

The new avenue of minimally invasive surgery, referred to as single-incision\\/access laparoscopy, is often presented as an alternative to standard multiport approaches, whereas in fact it is more usefully perceived as a complementary modality. The emergence of the technique can be of greater use both to patients and to the colorectal specialty if its principles can be merged into next-stage evolution by synergy with more conventional practice. In particular, rather than device specificity, what is needed is convergence of capability that can be applied by the same surgeon in differing scenarios depending on the individualized patient and disease characteristics. We detail here the global applicability of a simple access device construct that allows the provision of simple and complex single-port laparoscopy as well as contributing to multiport laparoscopic and transanal resections in a manner that is reliable, reproducible, ergonomical and economical.

Video-assisted laparoscopy for the detection and diagnosis of endometriosis: safety, reliability, and invasiveness

OpenAIRE

Schipper, Erica; Nezhat, Camran

2012-01-01

Erica Schipper,1 Camran Nezhat21Center for Minimally Invasive and Robotic Surgery, Palo Alto, CA; 2Obstetrics/Gynecology and Surgery, Stanford University Medical Center, Palo Alto, CA, USAAbstract: Endometriosis is a highly enigmatic disease with multiple presentations ranging from infertility to severe pain, often causing significant morbidity. Video-assisted laparoscopy (VALS) has now replaced laparotomy as the gold standard for the diagnosis and management of endometriosis. While imaging h...

Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model.

Science.gov (United States)

Dageforde, Leigh Anne; Bream, Peter R; Moore, Derek E

2012-09-01

The Hemodialysis Reliable Outflow (HeRO) dialysis access device is a permanent tunneled dialysis graft connected to a central venous catheter and is used in patients with end-stage dialysis access (ESDA) issues secondary to central venous stenosis. The safety and effectiveness of the HeRO device has previously been proven, but no study thus far has compared the cost of its use with tunneled dialysis catheters (TDCs) and thigh grafts in patients with ESDA. A decision analytic model was developed to simulate outcomes for patients with ESDA undergoing placement of a HeRO dialysis access device, TDC, or thigh graft. Outcomes of interest were infection, thrombosis, and ischemic events. Baseline values, ranges, and costs were determined from a systematic review of the literature. Total costs were based on 1 year of post-procedure outcomes. Sensitivity analyses were conducted to test model strength. The HeRO dialysis access device is the least costly dialysis access with an average 1-year cost of $6521. The 1-year cost for a TDC was $8477. A thigh graft accounted for $9567 in a 1-year time period. The HeRO dialysis access device is the least costly method of ESDA. The primary determinants of cost in this model are infection in TDCs and leg ischemia necessitating amputation in thigh grafts. Further study is necessary to incorporate patient preference and quality of life into the model. Copyright © 2012 Elsevier Inc. All rights reserved.

Single-port (OctoPort) assisted extracorporeal ovarian cystectomy for the treatment of large ovarian cysts: compare to conventional laparoscopy and laparotomy.

Science.gov (United States)

Chong, Gun Oh; Hong, Dae Gy; Lee, Yoon Soon

2015-01-01

To evaluate single-port assisted extracorporeal cystectomy for treatment of large ovarian cysts and to compare its surgical outcomes, complications, and cystic content spillage rates with those of conventional laparoscopy and laparotomy. Retrospective study (Canadian Task Force classification II-2). University teaching hospital. Twenty-five patients who underwent single-port assisted extracorporeal cystectomy (group 1), 33 patients who underwent conventional laparoscopy (group 2), and 25 patients who underwent laparotomy (group 3). Surgical outcomes, complications, and spillage rates in group 1 were compared with those in groups 2 and 3. Patients characteristics and tumor histologic findings were similar in the 3 groups. The mean (SD) largest diameter of ovarian cysts was 11.4 (4.2) cm in group 1, 9.7 (2.3) cm in group 2, and 12.0 (3.4) cm in group 3. Operative time in groups 1 and 2 was similar at 69.3 (26.3) minutes vs 73.1 (36.3) minutes (p = .66); however, operative time in group 1 was shorter than in group 3, at 69.3 (26.3) minutes vs 87.5 (26.6) minutes (p =.02). Blood loss in group 1 was significantly lower than in groups 2 and 3, at 16.0 (19.4) mL vs 36.1 (20.7) mL (p < .001) and 16.0 (19.4) mL vs 42.2 (39.7) mL (p = .005). The spillage rate in group 1 was profoundly lower than in group 2, at 8.0% vs 69.7% (p < .001). Single-port assisted extracorporeal cystectomy offers an alternative to conventional laparoscopy and laparotomy for management of large ovarian cysts, with comparable surgical outcomes. Furthermore, cyst content spillage rate in single-port assisted extracorporeal cystectomy was remarkably lower than that in conventional laparoscopy. Copyright © 2015. Published by Elsevier Inc.

Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

Science.gov (United States)

Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

2014-03-01

Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

Directory of Open Access Journals (Sweden)

Tanya Nazemi

2006-02-01

Full Text Available PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access DatabaseTM and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI, incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05, the median operative time was significantly shorter compared to the robotic method (p = 0.02. Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.

Anesthetic management for laparoscopy surgery in a patient with residual coarctation of aorta and mild aortic stenosis

Directory of Open Access Journals (Sweden)

Renu Sinha

2011-01-01

Full Text Available Perioperative management of patients with congenital heart disease is a challenge for the anesthesiologist. We present successful anesthetic management for diagnostic laparoscopy and cystectomy for tubo-ovarian mass in a case of residual coarctation of the aorta along with bicuspid aortic valve and mild aortic stenosis.

Unexpected findings at diagnostic laparoscopy: caecal incarceration with concurrent appendicitis in a patient with bilateral broad ligament defects

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Onida, S; Lynes, K; Whitehouse, PA

2010-01-01

Internal herniations through broad ligament defects are very rare. We present the first report of the triad of broad ligament defect, internal herniation of the caecum and appendicitis. A 36-year-old woman with phocomelia presented with right iliac fossa pain and vomiting. The patient had no previous history of trauma or surgery. Abdominal ultrasound showed a small amount of free fluid. At laparoscopy, bilateral broad ligament defects were found, with herniation of the caecum and an inflamed appendix through the right-sided defect. A laparoscopic salpingo-oophorectomy was required for reduction of the herniated bowel, and an appendicectomy was performed. Broad ligament defects may be congenital or acquired. In this case, in light of the limb abnormality and absence of previous surgery, a congenital aetiology is more likely. Ultrasound scan is not reliable and, although computed tomography may be of help, a diagnostic laparoscopy is the best investigation. PMID:20566032

Long-Term Follow-Up of a Controlled Trial of Laser Laparoscopy for Pelvic Pain

OpenAIRE

Jones, Kevin D.; Haines, Patricia; Sutton, Christopher J. G.

2001-01-01

Background and Objectives: The purpose of this study was to assess the long-term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis. Methods: We conducted a long-term follow-up of 56 patients who had participated in a randomized, double-blind controlled study at a tertiary referral center for the laparoscopic treatment of endometriosis. The patients had pelvic pain, minimal-to-moderate endometriosis, and underwent laser laparoscopy. We asked patients wheth...

Laparoscopy in the management of pediatric vesicoureteral reflux

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Atul A Thakre

2007-01-01

Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

Take-home training in a simulation-based laparoscopy course

DEFF Research Database (Denmark)

Thinggaard, Ebbe; Konge, Lars; Bjerrum, Flemming

2017-01-01

efficient method of training. Our aim was to investigate how box trainers are used in take-home training to help guide the design of take-home training courses. METHODS: This study was designed using a mixed methods approach. Junior doctors participating in a laparoscopy curriculum, which included...... practising at home on box trainers, were invited. Quantitative data on training patterns was collected from logbooks. Qualitative data on the use of box trainers was retrieved from focus groups and individual interviews. RESULTS: From logbooks, we found that 14 out of 18 junior doctors mixed their training......BACKGROUND: Simulation training can prepare trainees for clinical practice in laparoscopic surgery. Training on box trainers allows for simulation training at home, which studies have shown to be a feasible method of training. However, little research has been conducted into how to make it a more...

Diagnostic methods in finding out the causes of infertility, results of HSG examination and laparoscopy in infertile women examined at the Gynecological Ward of the City Hospital

International Nuclear Information System (INIS)

Kwasniewski, S.; Kukulski, P.; Szymanski, J.; Kwasniewska, A.

1993-01-01

The paper presents diagnostic methods and the results of hysterosalpingography (HSG) and laparoscopy examination, with special attention being drawn to the usefulness of these methods in finding out the causes of infertility. 51 patients with primary and second infertility were examined. HSG and laparoscopy make it possible to diagnose correctly the cause of infertility. They also enable adequate and early classification of patients for further diagnosis and treatment at highly specialized centers dealing with the problems of infertility. (author)

Unique features of prune belly syndrome in laparoscopic surgery.

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Saxena, Amulya K; Brinkmann, Olaf A

2007-08-01

The aim of this study was to evaluate the laparoscopic abdominal access modifications in children with prune belly syndrome undergoing a first stage Fowler-Stephens procedure. Eleven consecutive boys underwent a transperitoneal laparoscopic bilateral first stage Fowler-Stephens procedure. Patient age ranged from 1.5 to 3 years (mean age 2.2 years). In these patients, the floppy abdominal wall required a modified approach with regard to access technique, insufflation pressures, and work port stabilization methods. Duration of the procedures and intraoperative technical challenges encountered were prospectively documented. Mean operative time was 40 minutes (range 30 to 75 minutes), and all procedures were completed without any complications. Forceful insertion of ports was not possible, and all ports were introduced under complete open access. Larger volumes of carbon dioxide were used in the initial part of our series, when the ports were not sutured to the abdominal wall. An abdominal pressure of 8 mmHg was maintained in all patients and was considered optimal for the procedures. Short laparoscopy instruments (240 mm) were unsuitable for the procedures and had to be replaced by longer instruments (310 mm or 430 mm). Technical modifications are required to the approach in laparoscopic abdominal access to overcome the challenges posed by the floppy abdominal wall in prune belly patients. Open access, suture fixation of the optic and work ports, use of threaded sleeve ports, and use of proper length of laparoscopy instruments are valuable modifications to overcome the technical hurdles posed by these patients.

Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

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Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

2017-06-01

An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

Comparison of scanning scintigraphy and laparoscopy-biopsy data in the diagnosis of liver diseases. First results based on 35 cases

International Nuclear Information System (INIS)

Guillet, Robert.

1976-01-01

The liver is implicated in many functions, particularly the bile function, metabolic phenomena concerning glucids, lipids, proteids and coagulation, certain enzyme functions and cleansing processes involving a liver uptake stage followed by a biliary or urinary excretion stage. In view of the complexity of this metabolism it is obviously difficult to investigate the liver functions as a whole by a single set test. Furthermore the analysis of information supplied by scintigraphy implies rather complex technology, especially as these data are not always expressed in a universal form which clinicians can interpret directly. This can raise a barrier between the records and the doctor causing errors to appear not only in the interpretation but also in the indication of what method and products should be used. One of the aims of our future research is to demonstrate the inadequacy of a standard method using a single procedure and only one radioactive substance in hepatobiliary diseases of different mechanisms. To begin with therefore we should like to establish the advantages and limits of 99m technetium in the scanning scintigraphy morphological exploration of the liver, taking laparoscopy as a basis by comparison. We shall then attempt to define the criteria which in our opinion would allow a more rational use of liver scintigraphy in our medical care unit [fr

Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis.

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Uccella, Stefano; Bonzini, Matteo; Palomba, Stefano; Fanfani, Francesco; Ceccaroni, Marcello; Seracchioli, Renato; Vizza, Enrico; Ferrero, Annamaria; Roviglione, Giovanni; Casadio, Paolo; Corrado, Giacomo; Scambia, Giovanni; Ghezzi, Fabio

2016-01-01

To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. Retrospective case-control study (Canadian Task Force classification II-1). Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. Laparoscopic or open surgical treatment for endometrial cancer. A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI obese women in the laparoscopic group. Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors.

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Jedy-Agba, Elima; McCormack, Valerie; Olaomi, Oluwole; Badejo, Wunmi; Yilkudi, Monday; Yawe, Terna; Ezeome, Emmanuel; Salu, Iliya; Miner, Elijah; Anosike, Ikechukwu; Adebamowo, Sally N; Achusi, Benjamin; Dos-Santos-Silva, Isabel; Adebamowo, Clement

2017-07-01

Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.

Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy?

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Alborzi, Saeed; Motazedian, Shahdokht; Parsanezhad, Mohammad E

2003-05-01

To evaluate the chance of adhesion formation after laparoscopic salpingo-ovariolysis and determine the efficacy of early second-look laparoscopy (SLL). Prospective, randomized study (Canadian Task Force classification I). Shiraz University hospitals. Ninety women with mean duration of infertility of 7.2 years. Operative laparoscopy, with early SLL with adhesiolysis in 46 (group 1) and no SLL in 44 women (group 2). Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification. Separation of newly reformed adhesions was performed at the time of SLL. Patients were followed for a year after operation without other infertility treatment. At the time of operation in group 1, adnexal adhesions were graded as severe (class D) in 19 women, moderate (class C) in 31, mild (class B) in 28, and minimal (class A) in 14. Respective figures in group 2 were 10, 30, 34, and 14. After salpingo-ovariolysis these figures were 12, 10, 20, and 50 in group 1 and 6, 14, 17, and 51 in group 2. In group 1 in whom early second-look laparoscopy was performed, at the start of the operation these figures were 17, 20, 21, and 34, and after operation 12, 8, 20, and 52, respectively. There were 11 term pregnancies in group 1 and 15 in group 2. No women with severe adhesions in either group conceived. In group 1, chances of term pregnancy were 18.75% for those with moderate adhesions, 35.71% for women with mild adhesions, and 42.86% in patients with minimal adhesions. Respective figures in group 2 were 26.67%, 41.18%, and 57.14%. The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2%. Although separation of these adhesions could be performed more easily at the time of early SLL, the chance of pregnancy did not increase compared with that in patients who did not undergo SLL.

Summary Stage 2018 - SEER

Science.gov (United States)

Access this manual of codes and coding instructions for the summary stage field for cases diagnosed January 1, 2018 and forward. 2018 version applies to every site and/or histology combination, including lymphomas and leukemias. Historically, also called General Staging, California Staging, and SEER Staging.

Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

DEFF Research Database (Denmark)

Thorup, J M; Cortes, Dina; Visfeldt, J

1999-01-01

Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate...

Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach.

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Kosuga, Toshiyuki; Hiki, Naoki; Nunobe, Souya; Noma, Hisashi; Honda, Michitaka; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

2014-06-01

Laparoscopy-assisted total gastrectomy (LATG) is commonly performed for early gastric cancer (EGC) in the upper stomach; however, the incidence of anastomotic complications remains high, and postoperative nutritional status is not satisfactory. This study aimed to evaluate the feasibility and nutritional impact of a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG). This was a retrospective study of 167 patients with EGC in the upper stomach. Of these, 57 patients underwent LAsTG, while 110 patients underwent LATG. Postoperative change in body weight, and serum concentration of albumin (Alb) and total protein (TP) were compared between the LAsTG and LATG groups. Analysis of covariance (ANCOVA) was used to assess the influence of potential confounding factors. Frequency of anastomotic complications was significantly higher in the LATG group (16.3 %) than in the LAsTG group (5.3 %, P = 0.040). Postoperative recovery of body weight at 12 months after surgery was significantly better in the LAsTG group (89.8 ± 1.4 %) than in the LATG group (82.1 ± 1.0 %, P nutritional status.

Laparoscopy-Assisted Billroth I Gastrectomy for Ectopic Pancreas in the Prepyloric Region

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Yueh-Tsung Lee

2012-11-01

Full Text Available Ectopic pancreatic tissue is an uncommon developmental anomaly. The condition mostly occurs in the gastrointestinal tract and is usually asymptomatic. It rarely causes symptoms of inflammation, bleeding and perforation, and has potential for malignant change. Though it is an uncommon condition, cases of ectopic pancreas have been reported worldwide. Preoperative diagnosis of ectopic pancreas is challenging because of its nonspecific symptoms and signs. Owing to the revolution of minimally invasive surgery, submucosal tumors of the stomach can be resected by laparoscopic techniques. We have earlier reported on a case of ectopic pancreas in the stomach treated by robotics-assisted laparoscopic wedge resection. Herein, we report a case of ectopic pancreas in the prepyloric region of the stomach. A 44-year-old female presented with a two-week history of epigastralgia with radiation to the back. She received endoscopy check-up which disclosed a mass in the stomach. By endoscopic findings, a submucosal lesion in the prepyloric region with umbilical folding on the mucosa was identified. The umbilical folding on the mucosa hint the orifice of the duct of ectopic pancreas into the gastric mucosa suggestive of ectopic pancreas. Contrast-enhanced abdominal computed tomography showed a 5 cm cystic mass with heterogeneous content. To sum it up, the patient was diagnosed as ectopic pancreas in the stomach. She underwent laparoscopy-assisted antrectomy with Billroth I anastomosis (excision of the antrum and prepyloric region with reconstruction of gastrointestinal continuity by gastroduodenostomy and had an uneventful hospitalization course. The histopathology of the resected tumor demonstrated ectopic pancreatic tissue in the gastric wall. To the best of our knowledge, excision of gastric ectopic pancreas using laparoscopy-assisted antrectomy with Billroth I anastomosis has never been reported in the literature.

Surgeons’ muscle load during robotic-assisted laparoscopy performed with a regular office chair and the preferred of two ergonomic chairs

DEFF Research Database (Denmark)

Dalager, T.; Jensen, P. T.; Winther, T. S.

2018-01-01

associated with poor ergonomics and musculoskeletal pain. The ergonomic condition in the robotic console is partially dependent upon the chair provided, which often is a regular office chair. Our study quantified and compared the muscular load during robotic-assisted laparoscopy using one of two custom built...

Occult microscopic endometriosis: undetectable by laparoscopy in normal peritoneum.

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Khan, Khaleque Newaz; Fujishita, Akira; Kitajima, Michio; Hiraki, Koichi; Nakashima, Masahiro; Masuzaki, Hideaki

2014-03-01

Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (Pendometriosis due to the presence of adhesions in

Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation.

Science.gov (United States)

Sills, E Scott; Palermo, Gianpiero D

2016-07-01

We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.

Summary Staging Manual 2000 - SEER

Science.gov (United States)

Access this manual of codes and coding instructions for the summary stage field for cases diagnosed 2001-2017. 2000 version applies to every anatomic site. It uses all information in the medical record. Also called General Staging, California Staging, and SEER Staging.

Should laparoscopy and dye test be a first line evaluation for infertile women in southeast Nigeria?

Science.gov (United States)

Ikechebelu, J I; Mbamara, S U

2011-01-01

Laparoscopy and dye test is an important investigation in the evaluation of infertile women which has been underutilised in our practice. This review is aimed at determining whether the findings of this procedure are substantial enough to make it a first line evaluation for infertile women. A review of the laparoscopic findings in infertile women who presented for evaluation and treatment at a private fertility centre was carried out. A total of 253 day-case laparoscopy and dye test procedures were reviewed, 115 (45.0%) were done for primary infertility, 137 (54.5%) for secondary infertility and 1 (0.4%) for primary amenorrhoea and infertility. The mean period of infertility was 4.5 years with a range of 2-10 years and the women were aged between 19 and 52 years. Analysis of the result showed that 100 (39.5%) women had normal patent tubes while 153 (60.4%) had tubal pathologies like bilateral tubal occlusion in 97 (38.3%) and unilateral tubal occlusion in 56 (22.1%) women. Pelvic adhesion of varying degrees of severity was present in 108 (42.7%) women. Bilateral tubal occlusion was more common in nulliparous women and those aged between 30-39 years. One or both ovaries were normal (functional) in 189 (74.7%) women. Altogether, only 43 (17.0%) women were "normal" (had patent tubes, functional ovary and no pelvic adhesion). Additional pelvic pathology was present in 142 (56.1%) women. The commonest was uterine fibroid (leiomyomata) of various sizes in 100 (39.5%) of the women, followed by ovarian cyst in 56 (22.2%) and endometriosis in 11 (4.4%) women. Other pathologies observed include uterine abnormalities and unruptured ectopic pregnancy. Only 16 (37.2%) of the 43 "normal" women had no additional pelvic pathology. The high prevalence o tuboperitoneal factor and additional pelvic pathology in these infertile women reveal the importance of laparoscopic evaluation. We recommend the use of laparoscopy and dye test as a first line investigation in our environment to

Death during laparoscopy: can 1 gas push out another? Danger of argon electrocoagulation.

Science.gov (United States)

Sezeur, Alain; Partensky, Christian; Chipponi, Jacques; Duron, Jean-Jacques

2008-08-01

We report the death of a young man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst. The report analyzes the very particular mechanism of a gas embolism, which caused death here. This analysis leads us to recommend a close attention on the use of argon coagulators during laparoscopy. The aim of this article is to draw surgeons' attention to the conclusions of a court-ordered expert assessment intended to elucidate the mechanisms responsible for the death of a 20-year-old man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst.

Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

Science.gov (United States)

Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian

2014-01-01

The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

Science.gov (United States)

2018-04-05

Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. NCT02179112.

Important predictors of response determined by surgical staging prior to triple modality therapy for esophageal cancer

International Nuclear Information System (INIS)

Suntharalingam, M.; Vines, E.; Slawson, R.; Doyle, A.; Schuetz, J.; Greenwald, B.; Sonnet, J.; Krasna, M.

1997-01-01

Purpose/Objective: Since 1992, the University of Maryland has routinely performed preoperative surgical staging including thoracoscopy and laparoscopy on patients undergoing concurrent chemoradiation followed by surgical resection for esophageal carcinoma. We have performed an analysis of the pathologic pretreatment data in an attempt to identify possible predictors of response and outcome. Materials: Patients underwent thoracoscopy and laparoscopy in order to determine resectability of the primary lesion and pathologic nodal status prior to therapy. To date, 32 patients have completed triple modality therapy (28 men, 4 women, median age 59). Patients received 50.4 Gy in 1.8 Gy fractions in conjunction with two cycles of 5-FU (1 gm/m2) and Cisplatin (100 mg/m2) on days 1 and 28. Radiotherapy fields were determined by the extent of disease discovered at time of surgical staging. Ivor Lewis esophagectomy was performed 4 to 6 weeks after completion of chemo/RT. The median follow up is 24.8 months (range 4-49 mo.) Sixteen patients had squamous cell ca and 16 had adenocarcinoma. Univariate and multivariate analysis was performed in order to determine the influence of age, KPS, T stage, Lymph Nodes status and histology, on the likelihood of achieving a pathologic complete response and disease free survival. Results: Twenty-eight have undergone preoperative staging (2 refused, 2 medical contraindications.) All 32 patients are valuable for response to therapy and are included in the analysis. The three year cause specific and disease free survival is 46% and 41% respectively with a median CSS of 23 months and DFS of 19 months. The overall complete response rate assessed by histologic and immunohistologic evaluation at the time of esophagectomy is 31%. The DFS at 32 months is 72% (median not reached) for these patients versus 24% for those with residual disease at the time of surgery. The most significant predictor for the likelihood of achieving a pathologic CR was the

[Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery].

Science.gov (United States)

Fernández de Bustos, A; Creus Costas, G; Pujol Gebelli, J; Virgili Casas, N; Pita Mercé, A M

2006-01-01

Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy-assisted surgery. to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance. prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4), pT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment

Influence of promoting blood circulation to remove blood stasis combined with laparoscopy on serum MCP-1, RANTES, oxidative stress and hormones in infertile patients with endometriosis

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Xiao-Sha Zhang

2017-11-01

Full Text Available Objective: To observe the influence of promoting blood circulation to remove blood stasis combined with laparoscopy on serum MCP-1, RANTES, oxidative stress and hormones in infertile patients with endometriosis. Methods: A total of 60 infertile patients with endometriosis were randomly divided into observation group (30 cases and control group (30 cases. Observation group: promoting blood circulation to remove blood stasis combined with laparoscopy; control group: patients were treated only by laparoscopy. Recording and comparing the levels of MCP-1, RANTES, oxidative stress and hormones before and after treatment. Results: (1 Before treatment, there was no statistically significant difference in the serum MCP-1, RANTES, AOPP, MDA, SOD, levels between the two groups. After treatment, compared with the same group before treatment, the serum RANTES, AOPP, MDA levels of the two groups were significantly lower, the serum SOD level of the two groups were significantly higher, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. (2 Before treatment, there was no statistically significant difference in the serum FSH, LH, E2, P, PRL levels between the two groups. After treatment, compared with the same group before treatment, the serum FSH, LH, P, PRL levels of the two groups were significantly higher, the serum E2 level of the two groups were significantly lower, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. Conclusion: Promoting blood circulation to remove blood stasis combined with laparoscopy for infertile patients with endometriosis can reduce the levels of serum MCP-1, RANTES, oxidative stress, hormones and be beneficial to protect their uterine function.

Role of Laparoscopy in the Management of Acute Surgical Abdomen Secondary to Phytobezoars.

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Sheikh, Abu Baker; Akhtar, Aisha; Nasrullah, Adeel; Haq, Shujaul; Ghazanfar, Haider

2017-06-17

A bezoar is a collection of indigestible material found in the alimentary canal, which can cause mechanical obstruction of the gastrointestinal tract. Phytobezoar is a variant composed of mostly plant material and indigestible fiber. Phytobezoar is a rare cause of small bowel obstruction (SBO) and happens more commonly in patients with risk factors predisposing to impaired gastrointestinal motility. We present a rare case of SBO secondary to phytobezoar in a 60-year-old female patient with type 2 diabetes. There was no prior history of any abdominal surgery. The abdominal computed tomography (CT) scan was inconclusive. Laparoscopy was found to be an effective diagnostic and therapeutic procedure in this patient.

Laparoscopia na decisão da estratégia terapêutica para o casal infértil Laparoscopy in the decision of treatment strategy for the infertile couple

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Nuno Ricardo Goçalves Baptista Pereira

2010-09-01

laparoscopia revelou obstrução bilateral. Em 15 casos (65,2% em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI. RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%, 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%, and 16 cases of pelvic inflammatory disease (18.6%. Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%, revealed unilateral obstruction in 21 cases (25.3% and bilateral obstruction in 17 cases (20.5%. The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%. HSG sensitivity was

SURGICAL TREATMENT OF ADNEXAL MASSES IN PREGNANCY – THE ROLE OF LAPAROSCOPY MANAGEMENT

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Suzana Peternelj-Marinšek

2002-04-01

Full Text Available Background. The aim of this retrospective study was to find the incidence and type of adnexal masses in pregnancy, reliability of preoperative ultrasound examination and the effect of the surgical approach used, duration of pregnancy at the time of surgery, and the effect of emergency or planned surgery on the outcome of pregnancy. The obtained results and the data from literature were to provide the basis of the guidelines for the management of pregnant women with adnexal masses.Methods. In the study we enrolled 42 women, who underwent a surgery in pregnancy for adnexal masses. All surgeries were performed at the Department of Obstetrics and Gynecology in the period 1 January 1993–31 August 2000. The course of pregnancy was followed by 28 February 2001. The data were obtained from the records kept at the Department and from the questionnaire sent to the women. Statistical analysis was done using Chi-square test. Statistical significance was set at P ≤ 0.05.Results. We found the incidence of adnexal masses in pregnancy, requiring surgical treatment, to be 1/1034 deliveries. There were 6 (14.3% borderline malignant and malignant ovarian tumours, the incidence being 1/7239 deliveries. Preoperative ultrasound examination was not reliable enough to differentiate neither between benign and malignant adnexal masses, nor between adnexal masses and leiomyomas. Forty-two surgeries were made, 21 by laparoscopy and 21 by laparotomy. The size of removed tumours ranged between 4 and 30 cm (mean 9.4 cm, the most frequent type was mature cystic teratoma (n = 12. There were no differences in the outcome of pregnancy between the laparoscopy and laparotomy approach, between emergency and planned surgery, and between laparotomy performed by the 23rd and after the 23rd gestational week. Hemorrhagic shock due to heterotopic pregnancy lead to 1 spontaneous abortion. There were 2 preterm deliveries in the 37th week, 2 babies had intrauterine growth retardation

Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis.

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Di Saverio, Salomone; Vennix, Sandra; Birindelli, Arianna; Weber, Dieter; Lombardi, Raffaele; Mandrioli, Matteo; Tarasconi, Antonio; Bemelman, Willem A

2016-12-01

Modern management of severe acute complicated diverticulitis continues to evolve towards more conservative and minimally invasive strategies. Although open sigmoid colectomy with end colostomy remains the most commonly used procedure for the treatment of perforated diverticulitis with purulent/faeculent peritonitis, recent major advances challenged this traditional approach, including the increasing attitude towards primary anastomosis as an alternative to end colostomy and use of laparoscopic approach for urgent colectomy. Provided an accurate patients selection, having the necessary haemodynamic stability, pneumoperitoneum is established with open Hasson technique and diagnostic laparoscopy is performed. If faeculent peritonitis (Hinchey IV perforated diverticulitis) is found, laparoscopy can be continued and a further three working ports are placed using bladeless trocars, as in traditional laparoscopic sigmoidectomy, with the addition of fourth trocar in left flank. The feacal matter is aspirated either with large-size suction devices or, in case of free solid stools, these can be removed with novel application of tight sealing endobags, which can be used for scooping the feacal content out and for its protected retrieval. After decontamination, a sigmoid colectomy is performed in the traditional laparoscopic fashion. The sigmoid is fully mobilised from the retroperitoneum, and mesocolon is divided up to the origin of left colic vessels. Whenever mesentery has extremely inflamed and thickened oedematous tissues, an endostapler with vascular load can be used to avoid vascular selective ligatures. Splenic flexure should be appropriately mobilised. The specimen is extracted through mini-Pfannenstiel incision with muscle splitting technique. Transanal colo-rectal anastomosis is fashioned. Air-leak test must be performed and drains placed where appropriate. The video shows operative technique for a single-stage, entirely laparoscopic, washout and sigmoid colectomy

Is the aptitude of manual skills enough for assessing the training effect of students using a laparoscopy simulator?

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Zielke, Andreas

2005-12-01

Full Text Available Background: The aim of this study was to determine if students are suitable candidates to assess the learning effect through a virtual reality laparoscopy simulator (LapSim®. Materials and methods: 14 medical students in their final year without any previous experience with a virtual reality simulator were recruited as subjects. In order to establish a "base line" all subjects were instructed into the "clip application" task - a basis module of the laparoscopy simulator - at the beginning of the study. They were then randomized into two groups. Group A (n=7 had parameter adjusted to an easy level of performance, while group B (n=7 was adjusted to a difficult level. In both levels, errors simulated clinically relevant situations such as vessel rupture and subsequent bleeding. Each participant had to repeat the clip application task ten times consecutively. Results: The mean time for completion ten repetitions was 15 min pro participant in group A and 20 min in group B. From the first to the fifth repetition group A improved significantly the task completion time from 238.9 s to 103.3 s (p<0.007 consecutively and also improved the error score from 312 to 177 (p<0.07. At the tenth repetition they increased the task completion time from 103.3 s to 152.2 s (p<0.09 and increased their error score from 177 to 202 (p=0.25. From the first to the fifth repetition group B also improved the task completion time from 131.6 s to 104.5 s (p<0.31 consecutively and improved the error score from 235 to 208 (p<0.32 but at the tenth repetition they increased the task completion time from 104.5 s to 142.4 s (p<0.45 and clearly increased their error score from 208 to 244 (p<0.38. Conclusion: These results suggest that medical students, who lack clinical background, may be not suitable candidates for assessing the efficiency of a training model using a laparoscopy simulator. If medical students are appointed for such studies, they should receive didactic sessions in

Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

International Nuclear Information System (INIS)

Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.

2005-01-01

Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension

Worldwide access to treatment for end-stage kidney disease: a systematic review.

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Liyanage, Thaminda; Ninomiya, Toshiharu; Jha, Vivekanand; Neal, Bruce; Patrice, Halle Marie; Okpechi, Ikechi; Zhao, Ming-hui; Lv, Jicheng; Garg, Amit X; Knight, John; Rodgers, Anthony; Gallagher, Martin; Kotwal, Sradha; Cass, Alan; Perkovic, Vlado

2015-05-16

End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden. We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030. In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438-5·431 million) in our conservative model and 9·701 million (8·544-11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432,000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899-7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million [1·571-3·014 million]). The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies. Australian National Health and Medical Research Council. Copyright © 2015 Elsevier Ltd. All rights reserved.

Storage, access, and retrieval of endoscopic and laparoscopic video

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Bellaire, Gunter; Steines, Daniel; Graschew, Georgi; Thiel, Andreas; Bernarding, Johannes; Tolxdorff, Thomas; Schlag, Peter M.

1999-05-01

The system presented here enhances documentation and data- secured, second-opinion facilities by integrating video into DICOM3.0. Digital stereoscopic video sequences (DSVS) are especially in demand for surgery (laparoscopy, microsurgery, surgical microscopy, second opinion, virtual reality). Therefore DSVS are also integrated into the DICOM video concept. We present an implementation for a medical video server extended by a DICOM interface. Security mechanisms conforming with DICOM are integrated to enable secure internet access. Digital (stereoscopic) video sequences relevant for surgery should be examined regarding the clip length necessary for diagnosis and documentation and the clip size manageable with today's hardware. Methods for DSVS compression are described, implemented, and tested. Image sources relevant for this paper include, among others, a stereoscopic laparoscope and a monoscopic endoscope. Additionally, an approach is presented to analyze the motion of the endoscopic camera for future automatic video- cutting.

Strategic Accessibility Competition

OpenAIRE

Bacchiega, Emanuele; Randon, Emanuela; Zirulia, Lorenzo

2010-01-01

We analyze the effect of competition in market-accessibility enhancement among quality-differentiated firms. Firms are located in regions with different ex-ante transport costs to reach the final market. We characterize the equilibrium of the two-stage game in which firms first invest to improve market accessibility and then compete in prices. Efforts in accessibility improvement crucially depend on the interplay between the willingness to pay for the quality premium of the median consumer an...

Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy

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Mwaffaq Heis

2011-12-01

Full Text Available Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. Design: Descriptive retrospective study. Setting: A university hospital in the north of Jordan. Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD age was 31.5 (5.91 years. Mean (SD duration of infertility was 4 (3.44 years. Infertility was reported as primary and secondary by 119 (42.3 % and 162 (57.6 %, respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 % were referred for laparoscopy. Eight (17.3% of them were treated with unilateral salpingectomy and 28 (60.8% with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2% women, and 3 (6.7% women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7% conceived within 1 - 11 months after the hysterosalpingography. Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.

Use of a multimedia module to aid the informed consent process in patients undergoing gynecologic laparoscopy for pelvic pain: randomized controlled trial.

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Ellett, Lenore; Villegas, Rocio; Beischer, Andrew; Ong, Nicole; Maher, Peter

2014-01-01

To determine whether providing additional information to the standard consent process, in the form of a multimedia module (MM), improves patient knowledge about operative laparoscopy without increasing anxiety. Randomized controlled trial (Canadian Task Force classification I). Two outpatient gynecologic clinics, one in a private hospital and the other in a public teaching hospital. Forty-one women aged 19 to 51 years (median, 35.6 years) requiring operative laparoscopy for investigation and treatment of pelvic pain. Following the standard informed consent process, patients were randomized to watch the MM (intervention group, n = 21) or not (control group, n = 20). The surgeon was blinded to the group assignments. All patients completed a knowledge questionnaire and the Spielberger short-form State-Trait Anxiety Inventory. Six weeks after recruitment, patients completed the knowledge questionnaire and the State-Trait Anxiety Inventory a second time to assess knowledge retention and anxiety scores. Patient knowledge of operative laparoscopy, anxiety level, and acceptance of the MM were recorded. The MM intervention group demonstrated superior knowledge scores. Mean (SE) score in the MM group was 11.3 (0.49), and in the control group was 7.9 (0.50) (p <.001) (maximum score, 14). This did not translate into improved knowledge scores 6 weeks later; the score in the MM group was 8.4 (0.53) vs. 7.8 (0.50) in the control group (p = .44). There was no difference in anxiety levels between the groups at intervention or after 6 weeks. Overall, patients found the MM acceptable, and 18 women (86%) in the intervention group and 12 (60%) in the control group stated they would prefer this style of informed consent in the future. Use of an MM enhances the informed consent process by improving patient knowledge, in the short term, without increasing anxiety. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Laparoscopy rol in acute cases of lower abdomen in women. Review of the last 10 years in the British Hospital Gynecology Service

International Nuclear Information System (INIS)

Scasso, J; Scasso, S; Laufer, J; Alves, J; Sierra, I; Varela, S

2011-01-01

Acute lower abdominal episodes in women are the most frequent cause of consultation at the emergency room. The role of laparoscopy as a diagnostic and therapeutic tool, especially in women, has been well established. It allows the visualization of the entire abdominal cavity as well as the diagnosis delays and its complications in the evolution

An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK.

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Murray, A C; Markar, S; Mackenzie, H; Baser, O; Wiggins, T; Askari, A; Hanna, G; Faiz, O; Mayer, E; Bicknell, C; Darzi, A; Kiran, R P

2018-01-08

Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.

[Operative laparoscopy in the management of perforated peptic ulcer].

Science.gov (United States)

Schirru, Angelo; Cavaliere, Davide; Caristo, Ilario; Bianchi, Massimo; Cosce, Umberto; Mariani, Federica; Scarimbolo, Monica; Cavaliere, Paolo

2004-01-01

The aim of this retrospective study was to assess the feasibility, safety and efficacy of the laparoscopic approach in the management of perforated peptic ulcers. From January 1997 to December 2002, all patients referred to our community hospital for abdominal surgical emergencies were routinely managed by laparoscopic surgery. A review was carried out on 39 consecutive patients suffering from perforated peptic ulcers with or without generalised peritonitis. The study population comprised 24 male and 15 female patients, aged 30 to 94 years (mean age: 62 +/- 18). Laparoscopic repair was attempted in all patients. Laparoscopy afforded the correct diagnosis in all cases. Laparoscopic peritoneal washout (irrigation and suction of the entire abdominal cavity) with simple suture of the perforation proved successful in 34 patients. An additional omental patching was performed in 15 of these cases. Conversion to conventional open surgery was necessary in 5 patients. The morbidity and mortality rates were 13% and 10%, respectively. The mean operative time was 77 minutes (range: 40-120) and the mean hospital stay 9 days (range: 3-22). Laparoscopic repair of perforated ulcers is technically feasible but requires sound experience in laparoscopic abdominal emergencies. This study shows that the mini-invasive procedure is safe and effective, offering a valid alternative to traditional laparotomy.

Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.

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Vaghadia, H; McLeod, D H; Mitchell, G W; Merrick, P M; Chilvers, C R

1997-01-01

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.

Single Incision Laparoscopic Surgery for a Large Endometriotic Cyst

African Journals Online (AJOL)

In the last decade, laparoscopy has become the standard treatment for many gynecological conditions.[1,2] Today, laparoscopy is hailed as the standard approach in the surgical treatment of benign adnexal pathology.[1,2] Attempts to minimize access-related injuries and complications resulted in development of single port ...

Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis

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Aneta Słabuszewska-Jóźwiak

2015-05-01

Laparoscopy is a vital therapeutic method. Operative laparoscopy is an efficient method for treating infertility related to endometriosis, and the procedure seems to be the most effective particularly at stage III rAFS. The period for expectant management after a surgical procedure should last 6 months.

Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy.

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Kwon, A-Hon; Yanagimoto, Hiroaki; Matsui, Yoichi; Imamura, Atsushi

2006-08-01

An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincterotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.

Joint Hybrid Backhaul and Access Links Design in Cloud-Radio Access Networks

KAUST Repository

Dhifallah, Oussama Najeeb

2015-09-06

The cloud-radio access network (CRAN) is expected to be the core network architecture for next generation mobile radio systems. In this paper, we consider the downlink of a CRAN formed of one central processor (the cloud) and several base station (BS), where each BS is connected to the cloud via either a wireless or capacity-limited wireline backhaul link. The paper addresses the joint design of the hybrid backhaul links (i.e., designing the wireline and wireless backhaul connections from the cloud to the BSs) and the access links (i.e., determining the sparse beamforming solution from the BSs to the users). The paper formulates the hybrid backhaul and access link design problem by minimizing the total network power consumption. The paper solves the problem using a two-stage heuristic algorithm. At one stage, the sparse beamforming solution is found using a weighted mixed 11/12 norm minimization approach; the correlation matrix of the quantization noise of the wireline backhaul links is computed using the classical rate-distortion theory. At the second stage, the transmit powers of the wireless backhaul links are found by solving a power minimization problem subject to quality-of-service constraints, based on the principle of conservation of rate by utilizing the rates found in the first stage. Simulation results suggest that the performance of the proposed algorithm approaches the global optimum solution, especially at high signal-to-interference-plus-noise ratio (SINR).

Diagnostic value and timing of serum antichlamidial antibody level evaluation during infertility workup among infertile women in whom tubal factor was detected with diagnostic laparoscopy

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Serkan Kahyaoğlu

2012-03-01

Full Text Available OBJECTIVES: With normal hysterosalpingography (HSG results, selecting suitable candidates for the laparoscopic treatment of probable pelvic adhesions following previous pelvic inflammatory disease, it would be wise to investigate serum antibody screening against chlamidia trachomatis. It is worth to evaluate whether it is useful to detect a negative antichlamidial antibody disease for cancelling laparoscopy for a while with abnormal HSG findings. These two subjects have been investigated in study. MATERIAL AND METHODS: For detecting diagnostic value of serum antichlamidial antibody, in our infertility clinic, postoperative blood samples of 80 patients who were hospitalized for diagnostic laparoscopy to investigate infertility ethiology between May 2004 and November 2005 have been tested with microelisa method for antichlamidial IgM and IgG antibodies. HSG films of the patients performed at least one year were evaluated. Venous blood was drawn from these patients during postoperative early period for studying serum IgM and IgG antibodies of chlamidia trachomatis and the results were compared with operative findings. RESULTS: According to the antichlamidial antibody levels 60 (75% patients have not been infected with chlamidia and 20 (25% patients have been infected previously. When the patients were divided to two groups; normal and abnormal; based on preoperative HSG films; 18 (30% of the 60 patients with abnormal HSG films and 2 (10% of the 20 patients with normal HSG films had positive antichlamidial antibody levels respectively. CONCLUSION: The relationship between chlamidia trachomatis infection and tubal infertility has been demonstrated among 85% of patients with positive antichlamidial antibody levels and 46.7% of patients with negative levels who had tubal passage defects detected during diagnostic laparoscopy.

[Increased oxidized LDL cholesterol levels in peritoneal fluid of women with advanced-stage endometriosis].

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Polak, Grzegorz; Mazurek, Diana; Rogala, Ewelina; Nowicka, Aldona; Derewianka-Polak, Magdalena; Kotarski, Jan

2011-03-01

Proinflammatory and prooxidative environment in the peritoneal cavity may be involved in the pathogenesis of endometriosis. Imbalance between reactive oxygen species levels and the antioxidant capacity leads to oxidation of low-density lipoproteins (LDL). The importance of oxidized LDL (Ox-LDL) in the development of atherosclerosis is well recognized. The aim of our study was to evaluate for the presence of ox-LDL in the peritoneal fluid (PF) of women with and without endometriosis. A total of 60 women who underwent laparoscopy were divided into groups: endometriosis sufferers with minimal to mild (n 20) and moderate to severe (n 20) stages, and the reference group (n 20) with functional follicle ovarian cysts. Oxidized LDL levels were determined in the PF using enzyme immunoassay Oxidized LDL levels were detectable in all peritoneal fluid samples. Significantly increased levels of ox-LDL were observed in PF of women with stage III/IV endometriosis compared to the reference group (p = 0.03). However peritoneal fluid ox-LDL concentrations did not differ significantly between patients with minimal/mild and women with moderate/severe stage of the disease (p = 0.2). No significant difference in the PF ox-LDL concentrations was also found between women with stage I/II endometriosis and patients with follicle cysts (p = 0.3). Increased peritoneal fluid ox-LDL levels observed in women with advanced-stage endometriosis suggest the important role of oxidative stress in the pathogenesis of the disease.

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

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Chao, Tiffany E; Mandigo, Morgan; Opoku-Anane, Jessica; Maine, Rebecca

2016-01-01

Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than

39% access time improvement, 11% energy reduction, 32 kbit 1-read/1-write 2-port static random-access memory using two-stage read boost and write-boost after read sensing scheme

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Yamamoto, Yasue; Moriwaki, Shinichi; Kawasumi, Atsushi; Miyano, Shinji; Shinohara, Hirofumi

2016-04-01

We propose novel circuit techniques for 1 clock (1CLK) 1 read/1 write (1R/1W) 2-port static random-access memories (SRAMs) to improve read access time (tAC) and write margins at low voltages. Two-stage read boost (TSR-BST) and write word line boost (WWL-BST) after the read sensing schemes have been proposed. TSR-BST reduces the worst read bit line (RBL) delay by 61% and RBL amplitude by 10% at V DD = 0.5 V, which improves tAC by 39% and reduces energy dissipation by 11% at V DD = 0.55 V. WWL-BST after read sensing scheme improves minimum operating voltage (V min) by 140 mV. A 32 kbit 1CLK 1R/1W 2-port SRAM with TSR-BST and WWL-BST has been developed using a 40 nm CMOS.

Evaluation of surgical staging prior to combined modality therapy for esophageal cancer

International Nuclear Information System (INIS)

Suntharalingam, M.; Vines, E.; Echo, D. van; Greenwald, B.; Krasna, M.

1996-01-01

OBJECTIVE: Historically, patients with esophageal cancer have had a poor outcome despite aggressive treatment approaches. Recently chemo/RT followed by surgical resection has shown a significant improvement in survival in this patient population. The success of this aggressive approach has been predicated on accurate definition of disease extent and appropriate patient selection. We have performed pre-treatment surgical staging (thoracoscopy and laparoscopy) on 38 pts. referred for management of their localized esophageal cancer. The purpose of this report is to compare the results of clinical (CT, MRI, EGD, EUS) vs. surgical staging. The data gathered prospectively will also be used to identify potential predictors for disease-free survival. METHODS: Thirty-eight pts. were treated with combined modality therapy prior to a planned surgical resection. Patients received 50.4 Gy in 1.8 Gy fractions in conjunction with 5 FU (1 Gm/m2) and Cisplatin (100 mg/m2) on days 1 and 28. Patients were evaluated 4 to 6 wks. after completion of therapy for consideration of Ivor-Lewis esophagectomy. Of the original 38 pts., 4 are awaiting surgery, 3 died prior to resection, 2 pts. progressed through chemo/RT, and 1 refused. To date, 28 pts. are available for analysis with a median follow up of 21.5 months. This group included 16 pts. with squamous cell and 12 with adenocarcinoma. RESULTS: Twenty-five of the 28 pts. taken to surgery have undergone pre treatment surgical staging (2 refused, 1 medically unfit). Evaluation of tumor status revealed noninvasive staging to be accurate 56% of the time. Five pts. were converted from T 2 to T 3 , 1 from T 3 to T 4 and 3 T 4 tumors were found to be T 3 . Using the surgical findings at time of staging, 6 pts. were found to have T 2 tumors, 16 had T 3 tumors, and 3 had T 4 tumors. Clinical lymph node status was confirmed in 15 patients (60%). Six went from N+ to N 0 and 4 pts. thought to be N 0 were N+. Eight patients had evidence of positive

Randomized comparison of surgical stress and the nutritional status between laparoscopy-assisted and open distal gastrectomy for gastric cancer.

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Aoyama, Toru; Yoshikawa, Takaki; Hayashi, Tsutomu; Hasegawa, Shinichi; Tsuchida, Kazuhito; Yamada, Takanobu; Cho, Haruhiko; Ogata, Takashi; Fujikawa, Hirohito; Yukawa, Norio; Oshima, Takashi; Rino, Yasushi; Masuda, Munetaka

2014-06-01

Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer may prevent the development of an impaired nutritional status due to reduced surgical stress compared with open distal gastrectomy (ODG). This study was performed as an exploratory analysis of a phase III trial comparing LADG and ODG for stage I gastric cancer during the period between May and December of 2011. All patients received the same perioperative care via fast-track surgery. The level of surgical stress was evaluated based on the white blood cell count and the interleukin-6 (IL-6) level. The nutritional status was measured according to the total body weight, amount of lean body mass, lymphocyte count, and prealbumin level. Twenty-six patients were randomized to receive ODG (13 patients) or LADG (13 patients). The baseline characteristics and surgical outcomes were similar between the two groups. The median IL-6 level increased from 0.8 to 36.3 pg/dl in the ODG group and from 1.5 to 53.3 pg/dl in the LADG group. The median amount of lean body mass decreased from 48.3 to 46.8 kg in the ODG group and from 46.6 to 46.0 kg in the LADG group. There are no significant differences between two groups. The level of surgical stress and the nutritional status were found to be similar between the ODG and LADG groups in a randomized comparison using the same perioperative care of fast-track surgery.

Improving the safety of room air pneumoperitoneum for diagnostic laparoscopy.

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Ikechebelu, J I; Okeke, C A F

2008-06-01

Laparoscopic examination is a useful investigation in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including Nitrous Oxide (N2O), Carbondioxide (CO2), Helium, Xenon andAir. This was a prospective study in a private fertility centre in Nnewi, Nigeria aimed at reducing the morbidities inherent in the use Room Air pneumoperitoneum for diagnostic laparoscopy. This was sequel to an earlier study, which revealed that women who had Room Air pneumoperitoneum had a higher port wound infection rate, abdominal discomfort (feeling of retained gas in the abdomen) and shoulder pain with resultant delayed return to normal activity than women who had Co2 pneumoperitoneum. This study demonstrated that the use of soda lime to purify the Room Air and a low pressure suction pump to evacuate the air after the procedure significantly reduced the wound infection rate and virtually eliminated the abdominal discomfort and shoulder pain associated with Room Air pneumoperitoneum. This was followed by early return to normal activity. Therefore, use of Room Air for pneumoperitoneum is safe and affordable. It is recommended for low resource settings.

Soave transanal one-stage endorectal pull-through in the treatment of Hirschsprung′s disease of the child above two-year-old: A report of 20 cases

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Amine Ksia

2013-01-01

Full Text Available Background: The definitive treatment of Hirschsprung′s disease is the removal of the aganglionic bowel by a pull-through surgery. In most cases, this surgery is performed in infancy or in the neonatal period as presentation in older children and adulthood is uncommon. Materials and Methods: It is a retrospective study of 20 patients above two-year-old who underwent a transanal Soave one-stage endorectal pull-through procedure for Hirschsprung′s disease between January 2002 and December 2010. Results: Twenty patients were recruited in this study. Fourteen were males and six were females. Patient ages ranged from 2 to 14 years (median age: five years and three months. All patients presented with persistent constipation and abdominal distension. Two of them had an intestinal obstruction that required colostomy. Ten patients (50% had a recto-sigmoid Hirschsprung′s disease. All patients were operated on using a Soave one-stage endorectal pull-through procedure. The laparoscopy was necessary during the pull-through in three cases. The average duration of the intervention was 240 minutes. That represents almost the double of the duration of the same procedure in newborns and infants in our department (130 minutes. Early postoperative complications included one case of anastomosis leakage and one case of intussusception. Late postoperative complications were perineum irritation in five cases (25%, anal stenosis in four cases (20% and enterocolitis in one case (5%. None of our patients developed fecal incontinence. Soiling was reported in four cases (20%. There was no death. Conclusion: Soave transanal one-stage endorectal pull-through is safely feasible in children of more than two years of age. Laparoscopy may be necessary whenever there are difficulties in the pull-through.

Laparoscopy-assisted hydrostatic in situ reduction of intussusception: A reasonable alternative?

Directory of Open Access Journals (Sweden)

V. V. S. S. Chandrasekharam

2011-01-01

Full Text Available Aim: To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance. Materials and Methods: This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI. Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced. Results: Eleven patients [age 7.8 (±2.8 months] were operated over a period of 1 year. Ten (90.9% patients had ileocolic intussusception, which got completely reduced, but one (9% had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6 min. No patient had bowel ischemia and there were no intra- or postoperative complications. Conclusions: LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.

Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

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Sánchez-Margallo, F. M.; Tapia-Araya, A.; Díaz-Güemes, I.

2015-01-01

Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien, USA) was placed at the umbilical area through a single 3 cm incision. Three cannulae were introduced in the multiport device through the access channels and laparoscopic ovariohysterectomy was performed using a 5-mm sealing device, a 5-mm articulating grasper and a 5-mm 30° laparoscope. The mean total operative time was 52.66±15.20 minutes and the mean skin incision during surgery was 3.09±0.20 cm. Of the nine cases examined, in the one with an ovarian tumour, the technique was converted to multiport laparoscopy introducing an additional 5-mm trocar. No surgical complications were encountered and intraoperative blood loss was minimum in all animals. Clashing of the instruments and reduced triangulation were the main limitations of this technique. The combination of articulated and straight instruments facilitated triangulation towards the surgical field and dissection capability. One month after surgery a complete wound healing was observed in all animals. The present data showed that ovariohysterectomy performed with a single-port access is technically feasible in dogs. The unique abdominal incision minimises the abdominal trauma with good cosmetic results. PMID:26568831

Impact of nutritional status on outcomes in laparoscopy-assisted gastrectomy.

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Nagata, Tomoyuki; Nakase, Yuen; Nakamura, Kei; Sougawa, Akira; Mochiduki, Satoshi; Kitai, Shozo; Inaba, Seishiro

2017-11-01

There is a high morbidity rate after digestive surgery in patients with nutritional disorders such as high body mass index and depletion of skeletal muscle. The ratio of psoas muscle area to trunk area was defined as the Psoas and All trunk Ratio (PandA Ratio) and used as an index of the balance between muscle and adipose tissue. This ratio was determined in 77 patients undergoing laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Patients were classified into groups with and without postoperative complications. Clinicopathological factors were compared between the groups, and relationships of PandA Ratio with other nutritional indices were examined. PandA Ratios were also analyzed in males and females in each Clavien-Dindo grade. Complications developed in 22 patients (28.6%) after LAG. The PandA Ratio was significantly lower in patients with complications in univariate (2.76 ± 0.22% versus 3.66 ± 0.14%, P = 0.0009) and multivariate (P = 0.0064) analyses. A low PandA Ratio was also associated with more severe complications in males. Measurement of the areas of the psoas muscle and trunk on CT is useful for evaluation of the balance between skeletal and adipose tissue. The PandA Ratio derived from these measurements is a predictor of the clinical course after LAG in males. Copyright © 2017 Elsevier Inc. All rights reserved.

The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer.

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Nicklin, James; Janda, Monika; Gebski, Val; Jobling, Thomas; Land, Russell; Manolitsas, Tom; McCartney, Anthony; Nascimento, Marcelo; Perrin, Lewis; Baker, Jannah F; Obermair, Andreas

2012-08-15

Surgical staging in early-stage uterine cancer is controversial. Preoperative serum CA-125 may be of clinical value in predicting the presence of extra-uterine disease in patients with apparent early-stage endometrial cancer. Between October 6, 2005, and June 17, 2010, 760 patients were enrolled in an international, multicentre, prospective randomized trial (LACE) comparing laparotomy with laparoscopy in the management of endometrial cancer apparently confined to the uterus. Of these, 657 patients with endometrial adenocarcinoma had a preoperative serum CA-125 value recorded. Multiple cross-validation analysis was undertaken to correlate preoperative serum CA-125 with stage of disease (Stage I vs. Stage II+) after surgery. Patients' median preoperative serum CA-125 was 14 U/ml. A cutoff point of 30 U/ml was associated with the smallest misclassification error, and using this cutoff, 98 patients (14.9%) had elevated CA-125 levels. Of those, 36 (36.7%) had evidence of extra-uterine disease. Of the 116 patients (17.7%) with evidence of extra-uterine disease, 31.0% had an elevated CA-125 level. On univariate and multivariable logistic regression analysis, only preoperative CA-125 level, but no other preoperative clinical characteristics were found to be associated with extra-uterine spread of disease. Utilizing a cutoff point of 30 U/ml achieved a sensitivity, specificity, positive predictive value and negative predictive value of 31.0, 88.5, 36.7 and 85.7%, respectively. Elevated CA-125 above 30 U/ml in patients with apparent early-stage disease is a risk factor for the presence of extra-uterine disease and may assist clinicians in the management of patients with clinical Stage I endometrial cancer. Copyright © 2011 UICC.

Laparoscopy-assisted percutaneous endoscopic gastrostomy using a "Funada-kit II" device.

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Takahashi, Toshiaki; Miyano, Go; Shiyanagi, Satoko; Lane, Geoffrey J; Yamataka, Atsuyuki

2012-09-01

We aimed at assessing the effect of using a "Funada-kit II" device during laparoscopy-assisted percutaneous endoscopic gastrostomy (Lap-PEG), by reviewing 29 cases of Lap-PEG we performed from 2001 to 2011. We started using the "Funada-kit II" (CREATE MEDIC CO., Kanagawa, Japan) device with two parallel needles to puncture the stomach and assist suturing the anterior gastric wall to the anterior abdominal wall during Lap-PEG in 2011 (F-PEG). By introducing a loop through the lumen of one needle which allows placement of a suture introduced through the lumen of the other needle. Once repeated, the stomach can be pexied at two points, approximately 2 cm apart. We compared Lap-PEG (n = 23) with F-PEG (n = 6) where the mean ages and weights at surgery and sex ratios were similar. All cases were uneventful without intraoperative complications, although one postoperative wound infection occurred in a Lap-PEG case. There were no differences in the duration of analgesia, time taken to commence tube feeding, and return to full feeding. However, mean operating time was significantly shorter in F-PEG (28.1 min) versus Lap-PEG (46.1 min) p < 0.05. As per results F-PEG would appear to be as safe as Lap-PEG, but much quicker.

Efficacy of virtual computerized tomography laparoscopy for retroperitoneoscopic nephrectomy

International Nuclear Information System (INIS)

Shigeta, Masanobu; Kadonishi, Yuichi; Yasumoto, Hiroaki; Mita, Koji; Usui, Tsuguru; Marukawa, Kazushi

2004-01-01

Retroperitoneoscopic nephrectomy is less invasive than open nephrectomy, and is an alternative surgical procedure for renal tumors and upper urothelial tumors. We evaluated the efficacy of virtual computerized tomography laparoscopy (VCTL) as a navigator for retroperitoneoscopic nephrectomy to ascertain the correct anatomy of the renal hilum pre-operatively under the retroperitoneoscopic view. Seventy-three kidneys with localized renal tumors (n=44), upper urothelial tumors (n=23), or benign renal disease (n=6) underwent multidetector-row CT. VCTL was carried out by the volume-rendered technique. The findings were compared with those of real retroperitoneoscopy. After the operation, each operator scored 1 to 5 in evaluating the usefulness of virtual retroperitoneoscopy (score 5 indicated very useful). The percentages of renal arteries depicted by VCTL compared with those noted during real surgery were 93% for kidneys with renal tumors, 100% for upper urothelial tumors and 83% for benign renal disease. Two renal arteries of 2 kidneys were not detected by virtual imaging. These were about 1 mm in diameter and directly branched from the aorta, however retroperitoneoscopic nephrectomy was performed uneventfully. VCTL depicted all the renal veins. The anatomy of the renal hilum seen on VCTL and real retroperitoneoscopy was identical, without the minor angle deviation caused by drawing the kidney during the operation. The average score for the usefulness of VCTL was 4.1, ranging from 3 to 5. The accurate surgical anatomy of the renal hilum could be predicted in almost all patients pre-operatively. VCTL is an excellent navigator for retroperitoneoscopic nephrectomy. (author)

Laparoscopy training in surgical education: the utility of incorporating a structured preclinical laparoscopy course into the traditional apprenticeship method.

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De Win, Gunter; Van Bruwaene, Siska; Aggarwal, Rajesh; Crea, Nicola; Zhang, Zhewen; De Ridder, Dirk; Miserez, Marc

2013-01-01

To investigate whether preclinical laparoscopy training offers a benefit over standard apprenticeship training and apprenticeship training in combination with simulation training. This randomized controlled trial consisted of 3 groups of first-year surgical registrars receiving a different teaching method in laparoscopic surgery. The KU LEUVEN Faculty of Medicine is the largest medical faculty in Belgium. Thirty final-year medical students starting a general surgical career in the next academic year. Thirty final-year medical students were randomized into 3 groups, which differed in the way they were exposed to laparoscopic simulation training but were comparable in regard to ambidexterity, sex, age, and laparoscopic psychomotoric skills. The control group received only clinical training during surgical residentship, whereas the interval group received clinical training in combination with simulation training. The registrars were allowed to do deliberate practice. The Centre for Surgical Technologies Preclinical Training Programme (CST PTP) group received a preclinical simulation course during the final year as medical students, but was not exposed to any extra simulation training during surgical residentship. At the beginning of surgical residentship and 6 months later, all subjects performed a standardized suturing task and a laparoscopic cholecystectomy in a POP Trainer. All procedures were recorded together with time and motion tracking parameters. All videos were scored by a blinded observer using global rating scales. At baseline the 3 groups were comparable. At 6 months, for suturing, the CST PTP group was better than both the other groups with respect to time, checklist, and amount of movements. The interval group was better than the control group on only the time and checklist score. For the cholecystectomy evaluation, there was a statistical difference between the CST PTP study group and both other groups on all evaluation scales in favor of the CST PTP

3D vision improves outcomes in early cervical cancer treated with laparoscopic type B radical hysterectomy and pelvic lymphadenectomy.

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Raspagliesi, Francesco; Bogani, Giorgio; Martinelli, Fabio; Signorelli, Mauro; Scaffa, Cono; Sabatucci, Ilaria; Lorusso, Domenica; Ditto, Antonino

2017-01-21

To evaluate the alterations on surgical outcomes after of the implementation of 3D laparoscopic technology for the surgical treatment of early-stage cervical carcinoma. Data of patients undergoing type B radical hysterectomy (with or without bilateral salpingo-oophorectomy) and pelvic lymphadenectomy via 3D laparoscopy were compared with a historical cohort of patients undergoing type B radical hysterectomy via conventional laparoscopy. Complications (within 60 days) were graded per the Accordion severity system. Data of 75 patients were studied: 15 (20%) and 60 (80%) patients undergoing surgery via 3D laparoscopy and conventional laparoscopy, respectively. Baseline patient characteristics as well as pathologic findings were similar between groups (p>0.1). Patients undergoing 3D laparoscopy experienced a trend toward shorter operative time than patients undergoing conventional laparoscopy (176.7 ± 74.6 vs 215.9 ± 61.6 minutes; p = 0.09). Similarly, patients undergoing 3D laparoscopic radical hysterectomy experienced shorter length of hospital stay (2 days, range 2-6, vs 4 days, range 3-11; p<0.001) in comparison to patients in the control group, while no difference in estimated blood loss was observed (p = 0.88). No between-group difference in complication rate was observed. 3D technology is a safe and effective way to perform type B radical hysterectomy and pelvic node dissection in early-stage cervical cancer. Further large prospective studies are warranted in order to assess the cost-effectiveness of the introduction of 3D technology in comparison to robotic assisted surgery.

Growth and development in Syrian Awassi ewes during patterns of ovarian follicular different reproductive stages monitored by laparoscopy

International Nuclear Information System (INIS)

Zarkawi, M.; Soukouti, A.

2009-06-01

An in situ study was conducted on Syrian Awassi ewes, inside and outside the breeding season, untreated or treated with vaginal sponges together with or without equine chorionic gonadotropin aiming at monitoring the ovaries' diameters, number of different follicular categories, number, diameters and lifespan of corpora lutea in each ovary using a laparoscope and finding out the relationship among these parameters and progesterone concentration. For the first time, it has been possible to characterise the Syrian Awassi sheep at the ovarian follicles level during different reproductive stages using a laparoscope. (author)

Laparoscopy hepatic biopsy through cauterization Biópsia hepática laparoscopica por cauterização

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Alexandra Pinheiro Fantinatti

2003-08-01

Full Text Available Hepatic biopsy was realized through laparoscopy with simultaneous cauterization in the present study, whose principal aim was to evaluate the efficacy of the applied method and to study its effects in the liver of healthy dogs. Furthermore, we tried to verify the main hematological and chemistry profile alterations related to the hepatic function, and to investigate the viability of the fragments collected by histopathology. To attain this objective, 21 clinically healthy dogs, weighing between 10 and 15kg were submitted to hepatic biopsy with forceps connected to the cautery. Cautery was performed by applying radiofrequency energy at 45 watts. Forty-two hepatic biopsies through laparoscopy were conducted in the animals. At group I one hepatic fragment per animal was collected, at group II two hepatic fragments per animal were collected, and at group III three fragments were collected. Hematocrit and alanine-aminotransferase measurements were employed to evaluate the animals at the pre-operative period, at four and six hour post-operative, and at day 30 post-operative. The results revealed that the procedure was safe and effective for hepatic biopsy in dogs. There were no clinical alterations related to the technique. The fragments collected were viable for histopathology. Hepatic biopsy through laparoscopy with simultaneous cauterization is an effective and usefull method in dogs.Este estudo visou avaliar a eficácia do método de biópsia hepática laparoscópica por cauterização e estudar os seus efeitos no fígado de cães sadios. Além disso, procurou-se verificar as principais alterações hematológicas e bioquímicas-séricas relacionadas às funções hepáticas e averiguar a viabilidade dos fragmentos colhidos por exame de histopatologia. Para tanto, 21 cães clinicamente sadios pesando entre 10 e 15kg, foram separados em três grupos de sete animais cada grupo. As amostras foram retiradas da borda no lobo lateral esquerdo

Minimal access surgery of pediatric inguinal hernias: a review.

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Saranga Bharathi, Ramanathan; Arora, Manu; Baskaran, Vasudevan

2008-08-01

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.

Take-Home Training in Laparoscopy

DEFF Research Database (Denmark)

Thinggaard, Ebbe

2017-01-01

this aim, we recruited participants from the intervention arm in our randomised controlled trial. All participants had access to the simulation centre and were given a port-able trainer to train on at home. Participants were asked to use a logbook during training. At the end of the course, they were...

Increased levels of proteins of the acute inflammatory phase in the peritoneal fluid of women with advanced stages of endometriosis.

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Polak, Grzegorz; Barczyński, Bartłomiej; Bednarek, Wiesława; Kwaśniewski, Wojciech; Wertell, Iwona; Derewianka-Polak, Magdalena; Makara-Studzińska, Marta; Kotarski, Jan

2015-06-01

Most investigators agree that endometriosis is associated with a state of subclinical, non-infectious peritoneal inflammation. The objective of the study was to assess concentrations of two markers of the acute inflammatory phase proteins, haptoglobin and ceruloplasmin, in peritoneal fluid of endometriotic women. 229 women who underwent diagnostic or therapeutic laparoscopy were included in the study Minimal, mild, moderate and severe endometriosis according to ASRM was confirmed in 119 women (study groups), whereas 110 patients suffered from simple serous or dermoid ovarian cysts (reference groups). Haptoglobin and ceruloplasmin concentrations in the peritoneal fluid samples aspirated during laparoscopy were measured using commercially available radial immunodiffusion kits. The concentration of haptoglobin in the peritoneal fluid of women with endometriosis was significantly higher as compared to patients with serous and dermoid ovarian cysts. Significantly higher haptoglobin level was observed in patients with severe and moderate endometriosis as compared to women from both reference groups. No significant difference in the peritoneal fluid ceruloplasmin levels was found between patients with endometriosis and women from reference groups. However, it was noted that ceruloplasmin levels are higher in the subgroup of patients with severe endometriosis as compared to both reference groups and women with mild disease. Our results support the hypothesis that endometriosis is associated with subclinical inflammation within the peritoneal cavity It may be speculated that pro-inflammatory stimuli strong enough to cause an increase in acute inflammatory phase proteins peritoneal fluid concentrations are observed only in the advanced stages of the disease.

Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy

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Erdem Fadıloğlu

2017-09-01

Full Text Available Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

Housing accessibility problems for people with Parkinson's disease.

Science.gov (United States)

Slaug, B; Iwarsson, S; Ayala, J A; Nilsson, M H

2017-11-01

Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems. The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied. HE-scores differed significantly (Phousing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

"Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

Directory of Open Access Journals (Sweden)

Antonio Marte

2011-01-01

Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

76 FR 76907 - Small Business Investment Companies-Early Stage SBICs

Science.gov (United States)

2011-12-09

... dollars went to early stage or start-up businesses. Of the financings that went to early stage and start... went to early stage and start-up businesses not in those three states. SBA will seek to expand access...% decline from 2007. Less than a third of these financing dollars went to early stage or start-up businesses...

Stereoscopic (3D) versus monoscopic (2D) laparoscopy: comparative study of performance using advanced HD optical systems in a surgical simulator model.

Science.gov (United States)

Schoenthaler, Martin; Schnell, Daniel; Wilhelm, Konrad; Schlager, Daniel; Adams, Fabian; Hein, Simon; Wetterauer, Ulrich; Miernik, Arkadiusz

2016-04-01

To compare task performances of novices and experts using advanced high-definition 3D versus 2D optical systems in a surgical simulator model. Fifty medical students (novices in laparoscopy) were randomly assigned to perform five standardized tasks adopted from the Fundamentals of Laparoscopic Surgery (FLS) curriculum in either a 2D or 3D laparoscopy simulator system. In addition, eight experts performed the same tasks. Task performances were evaluated using a validated scoring system of the SAGES/FLS program. Participants were asked to rate 16 items in a questionnaire. Overall task performance of novices was significantly better using stereoscopic visualization. Superiority of performances in 3D reached a level of significance for tasks peg transfer and precision cutting. No significant differences were noted in performances of experts when using either 2D or 3D. Overall performances of experts compared to novices were better in both 2D and 3D. Scorings in the questionnaires showed a tendency toward lower scores in the group of novices using 3D. Stereoscopic imaging significantly improves performance of laparoscopic phantom tasks of novices. The current study confirms earlier data based on a large number of participants and a standardized task and scoring system. Participants felt more confident and comfortable when using a 3D laparoscopic system. However, the question remains open whether these findings translate into faster and safer operations in a clinical setting.

Single-incision total laparoscopic hysterectomy

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Sinha Rakesh

2011-01-01

Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

Acceptance, Prevalence and Indications for Robot-Assisted Laparoscopy - Results of a Survey Among Urologists in Germany, Austria and Switzerland.

Science.gov (United States)

Imkamp, Florian; Herrmann, Thomas R W; Tolkach, Yuri; Dziuba, Sebastian; Stolzenburg, Jens U; Rassweiler, Jens; Sulser, Tullio; Zimmermann, Uwe; Merseburger, Axel S; Kuczyk, Markus A; Burchardt, Martin

2015-01-01

Robotic-assisted laparoscopy (RAL) is being widely accepted in the field of urology as a replacement for conventional laparoscopy (CL). Nevertheless, the process of its integration in clinical routines has been rather spontaneous. To determine the prevalence of robotic systems (RS) in urological clinics in Germany, Austria and Switzerland, the acceptance of RAL among urologists as a replacement for CL and its current use for 25 different urological indications. To elucidate the practice patterns of RAL, a survey at hospitals in Germany, Austria and Switzerland was conducted. All surgically active urology departments in Germany (303), Austria (37) and Switzerland (84) received a questionnaire with questions related to the one-year period prior to the survey. The response rate was 63%. Among the participants, 43% were universities, 45% were tertiary care centres, and 8% were secondary care hospitals. A total of 60 RS (Germany 35, Austria 8, Switzerland 17) were available, and the majority (68%) were operated under public ownership. The perception of RAL and the anticipated superiority of RAL significantly differed between robotic and non-robotic surgeons. For only two urologic indications were more than 50% of the procedures performed using RAL: pyeloplasty (58%) and transperitoneal radical prostatectomy (75%). On average, 35% of robotic surgeons and only 14% of non-robotic surgeons anticipated RAL superiority in some of the 25 indications. This survey provides a detailed insight into RAL implementation in Germany, Austria and Switzerland. RAL is currently limited to a few urological indications with a small number of high-volume robotic centres. These results might suggest that a saturation of clinics using RS has been achieved but that the existing robotic capacities are being utilized ineffectively. The possible reasons for this finding are discussed, and certain strategies to solve these problems are offered. © 2015 S. Karger AG, Basel.

Evaluation of the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice.

Science.gov (United States)

Jones, Kelly; Case, J Brad; Evans, Brian; Monnet, Eric

2017-04-01

OBJECTIVE To evaluate the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice. DESIGN Prospective study. SAMPLE A single 2-veterinarian small animal practice in southern California. PROCEDURES In early 2012, endoscopic equipment was purchased, and both veterinarians in the practice undertook training in rigid endoscopic and laparoscopic procedures. Subsequently, information for client-owned animals that underwent endoscopic and laparoscopic procedures during a 12-month period (2012 to 2013) was collected. Cost of equipment and training, revenue generated, specific procedures performed, surgery time, complications, and client satisfaction were evaluated. RESULTS 78 endoscopic procedures were performed in 73 patients, including 71 dogs, 1 cat, and 1 rabbit. Cost of endoscopic and laparoscopic equipment and training in the first year was $14,809.71; most equipment was financed through a 5-year lease at a total cost of $57,507.70 ($ 10,675.20/y). Total revenue generated in the first year was $50,423.63. The most common procedures performed were ovariectomy (OVE; n = 49), prophylactic gastropexy (6), and video otoscopy (12). Mean ± SD surgery times for OVE (n = 44) and for OVE with gastropexy (5) were 63.7 ± 19.7 minutes and 73.0 ± 33.5 minutes; respectively. Twelve of 54 patients undergoing laparoscopic procedures experienced minor intraoperative complications. Conversion to laparotomy was not required in any patient. There were no major complications. All 49 clients available for follow-up were satisfied. CONCLUSIONS AND CLINICAL RELEVANCE With appropriate training and equipment, incorporation of basic rigid endoscopy and laparoscopy may be feasible in small animal general practice. However, results of the present study are not applicable to all veterinarians and practice settings, and patient safety considerations should always be paramount.

On the economics of staging for reusable launch vehicles

Science.gov (United States)

Griffin, Michael D.; Claybaugh, William R.

1996-03-01

There has been much recent discussion concerning possible replacement systems for the current U.S. fleet of launch vehicles, including both the shuttle and expendable vehicles. Attention has been focused upon the feasibility and potential benefits of reusable single-stage-to-orbit (SSTO) launch systems for future access to low Earth orbit (LEO). In this paper we assume the technical feasibility of such vehicles, as well as the benefits to be derived from system reusability. We then consider the benefits of launch vehicle staging from the perspective of economic advantage rather than performance necessity. Conditions are derived under which two-stage-to-orbit (TSTO) launch systems, utilizing SSTO-class vehicle technology, offer a relative economic advantage for access to LEO.

What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?

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Gehrig, Paola A; Cantrell, Leigh A; Shafer, Aaron; Abaid, Lisa N; Mendivil, Alberto; Boggess, John F

2008-10-01

Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for staging the obese and morbidly obese woman with endometrial cancer. Consecutive robotic endometrial cancer staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (ptool for the comprehensive surgical staging of the obese and morbidly obese woman with endometrial cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.

Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs.

Science.gov (United States)

Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir

2014-01-01

Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE.

Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

DEFF Research Database (Denmark)

Thorup, J M; Cortes, D; Visfeldt, J

1999-01-01

PURPOSE: Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides...... studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS: Median number of spermatogonia per tubular cross section...... of the biopsies taken at stage 2 was slightly lower (0.03) compared to the median number at stage 1 (0.06) of the operation but this difference was not significant (p = 0.2031). CONCLUSIONS: Our study shows that the spermatogonia may survive clipping and division of the spermatic vessels, although the number...

Evaluation of Basic Skills Improvement for Laparoscopy by Training with a Video Game

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María Fernanda Gómez-Ramírez

2014-06-01

Full Text Available Introduction: Due to the growing economical and ethical limitations in surgeons training for minimally invasive surgery (mis, e.g. laparoscopy, this study aims at evaluating the effect of a continuous practice of a particular videogame on the development of the fundamental and specific skills needed to perform this type of procedure successfully. Materials and methods: To evaluate the effectiveness of video game practicing, three essential and common activities were chosen (cutting, suturing, and eye-hand coordination to be performed in laparoscopic simulators. Eight different indexes or variables of performance were measured in the three activities. Fourteen voluntaries without previous experience in surgery were divided in two groups (intervention and control and their performance was evaluated before and after a one-month standardized training program with the video game Marble Mania®. Results: A general improvement of all the performance variables was observed after one month training in the intervention group. This improvement was significant with respect to the control group in three of the eight variables: suturing errors (p = 0.003, and the execution and number of errors in the eye-hand coordination (p = 0.025 and 0.001, respectively.

Sectoral Plan 'Deep Geological Disposal', Stage 2. Proposed site areas for the surface facilities of the deep geological repositories as well as for their access infrastructure. General report

International Nuclear Information System (INIS)

2011-12-01

In line with the provisions of the nuclear energy legislation, the sites for deep geological disposal of Swiss radioactive waste are selected in a three-stage Sectoral Plan process (Sectoral Plan for Deep Geological Disposal). The disposal sites are specified in Stage 3 of the selection process with the granting of a general licence in accordance with the Nuclear Energy Act. The first stage of the process was completed on 30 th November 2011, with the decision of the Federal Council to incorporate the six geological siting regions proposed by the National Cooperative for the Disposal of Radioactive Waste (NAGRA) into the Sectoral Plan for Deep Geological Disposal, for further evaluation in Stage 2. The decision also specifies the planning perimeters within which the surface facilities and shaft locations for the repositories will be constructed. In the second stage of the process, at least two geological siting regions each will be specified for the repository for low- and intermediate-level waste (L/ILW) and for the high-level waste (HLW) repository and these will undergo detailed geological investigation in Stage 3. For each of these potential siting regions, at least one location for the surface facility and a corridor for the access infrastructure will also be specified. NAGRA is responsible, at the beginning of Stage 2, for submitting proposals for potential locations for the surface facilities and their access infrastructure to the Federal Office of Energy (SFOE); these are then considered by the regional participation bodies in the siting regions. The present report and its annexes volume document these proposals. In Stage 2, under the lead of the SFOE, socio-economic-ecological studies will also be carried out to investigate the impact of a repository project on the environment, economy and society. The present reports also contain the input data to be provided by NAGRA for the generic (site-independent) part of these impact studies. A meaningful discussion

Easing access for lifelong learners

DEFF Research Database (Denmark)

Müller, Romina; Remdisch, Sabine; Köhler, Katharina

2015-01-01

developmental stages. This article maps the development in Denmark, Finland, Germany and England using a case study approach deploying data triangulation from a national and institutional perspective. It explores the extent/commonality of structural factors for easing access for students engaging in lifelong...

Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

Science.gov (United States)

Imamura, Taisuke; Komatsu, Shuhei; Ichikawa, Daisuke; Kobayashi, Hiroki; Miyamae, Mahito; Hirajima, Shoji; Kawaguchi, Tsutomu; Kubota, Takeshi; Kosuga, Toshiyuki; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Ogiso, Kiyoshi; Yagi, Nobuaki; Yanagisawa, Akio; Ando, Takashi; Otsuji, Eigo

2015-01-01

Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland (HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery (LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor (SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm into the submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG. PMID:26306144

PATIENT POSITION AS A POSSIBLE RISK FACTOR FOR POSTOPERATIVE NAUSEA AND VOMITING (PONV IN GYNECOLOGIC LAPAROSCOPY

Directory of Open Access Journals (Sweden)

Aleksandar Ćirić

2012-01-01

Full Text Available Postoperative nausea and vomiting (PONV are still a significant problem in modern anesthetic practice. Discomfort caused by PONV intensifies other unpleasant elements of recovery, such as pain, frustration or fear. PONV also generates aversion to future anesthesia and have a negative impact on staff and patient's family. PONV can increase the cost of completing a surgical procedure, because it extends the time a patient spends in the postanesthesia care unit (PACU or delay discharge of ambulatory patients. It is generally accepted that the incidence of PONV after general anesthesia for various types of surgery in the last decade is still between 20-30%, and 70% in laparoscopic abdominal surgery. The incidence is three times higher in females compared to males. Many factors are involved in triggering PONV, such as patientrelated factors, the type of surgery, anesthesia management, etc. The results of this study suggest that the patient positioning (modified supine lithotomy position with ''Trendelenburg" increases the risk of PONV in gynecologic laparoscopy.

Sectoral Plan 'Deep Geological Disposal', Stage 2. Proposed site areas for the surface facilities of the deep geological repositories as well as for their access infrastructure. Annexes

International Nuclear Information System (INIS)

2011-12-01

In line with the provisions of the nuclear energy legislation, the sites for deep geological disposal of Swiss radioactive waste are selected in a three-stage Sectoral Plan process (Sectoral Plan for Deep Geological Disposal). The disposal sites are specified in Stage 3 of the selection process with the granting of a general licence in accordance with the Nuclear Energy Act. The first stage of the process was completed on 30 th November 2011, with the decision of the Federal Council to incorporate the six geological siting regions proposed by the National Cooperative for the Disposal of Radioactive Waste (NAGRA) into the Sectoral Plan for Deep Geological Disposal, for further evaluation in Stage 2. The decision also specifies the planning perimeters within which the surface facilities and shaft locations for the repositories will be constructed. In the second stage of the process, at least two geological siting regions each will be specified for the repository for low- and intermediate-level waste (L/ILW) and for the high-level waste (HLW) repository and these will undergo detailed geological investigation in Stage 3. For each of these potential siting regions, at least one location for the surface facility and a corridor for the access infrastructure will also be specified. NAGRA is responsible, at the beginning of Stage 2, for submitting proposals for potential locations for the surface facilities and their access infrastructure to the Federal Office of Energy (SFOE); these are then considered by the regional participation bodies in the siting regions. The general report and the present annexes volume document these proposals. In Stage 2, under the lead of the SFOE, socio-economic-ecological studies will also be carried out to investigate the impact of a repository project on the environment, economy and society. The present reports also contain the input data to be provided by NAGRA for the generic (site-independent) part of these impact studies. A meaningful

Virtual reality laparoscopy: which potential trainee starts with a higher proficiency level?

Science.gov (United States)

Paschold, M; Schröder, M; Kauff, D W; Gorbauch, T; Herzer, M; Lang, H; Kneist, W

2011-09-01

Minimally invasive surgery requires technical skills distinct from those used in conventional surgery. The aim of this prospective study was to identify personal characteristics that may predict the attainable proficiency level of first-time virtual reality laparoscopy (VRL) trainees. Two hundred and seventy-nine consecutive undergraduate medical students without experience attended a standardized VRL training. Performance data of an abstract and a procedural task were correlated with possible predictive factors providing potential competence in VRL. Median global score requirement status was 86.7% (interquartile range (IQR) 75-93) for the abstract task and 74.4% (IQR 67-88) for the procedural task. Unadjusted analysis showed significant increase in the global score in both tasks for trainees who had a gaming console at home and frequently used it as well as for trainees who felt self-confident to assist in a laparoscopic operation. Multiple logistic regression analysis identified frequency of video gaming (often/frequently vs. rarely/not at all, odds ratio: abstract model 2.1 (95% confidence interval 1.2; 3.6), P = 0.009; virtual reality operation procedure 2.4 (95% confidence interval 1.3; 4.2), P = 0.003) as a predictive factor for VRL performance. Frequency of video gaming is associated with quality of first-time VRL performance. Video game experience may be used as trainee selection criteria for tailored concepts of VRL training programs.

Rectosigmoid endometriosis: Comparison between CT water enema and video laparoscopy

International Nuclear Information System (INIS)

Stabile Ianora, A.A.; Moschetta, M.; Lorusso, F.; Lattarulo, S.; Telegrafo, M.; Rella, L.; Scardapane, A.

2013-01-01

Aim: To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Materials and methods: Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. Results: In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Conclusion: Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated

Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT).

Science.gov (United States)

Trillsch, Fabian; Ruetzel, Jan David; Herwig, Uwe; Doerste, Ulrike; Woelber, Linn; Grimm, Donata; Choschzick, Matthias; Jaenicke, Fritz; Mahner, Sven

2013-07-09

Surgery is the cornerstone for clinical management of patients with borderline ovarian tumors (BOT). As these patients have an excellent overall prognosis, perioperative morbidity is the critical point for decision making when the treatment strategy is developed and the primary surgical approach is defined. Clinical and surgical parameters of patients undergoing surgery for primary BOT at our institutions between 1993 and 2008 were analyzed with regard to perioperative morbidity depending on the surgical approach (laparotomy vs. laparoscopy). A total of 105 patients were analyzed (44 with primary laparoscopy [42%], 61 with primary laparotomy [58%]). Complete surgical staging was achieved in 33 patients at primary surgical approach (31.4%) frequently leading to formal indication of re-staging procedures. Tumor rupture was significantly more frequent during laparoscopy compared to laparotomy (29.5% vs. 13.1%, p = 0.038) but no other intraoperative complications were seen in laparoscopic surgery in contrast to 7 of 61 laparotomies (0% vs. 11.5%, p = 0.020). Postoperative complication rates were similar in both groups (19.7% vs. 18.2%, p = 0.848). Irrespective of the surgical approach, surgical management of BOT has acceptable rates of perioperative complications and morbidity. Choice of initial surgical approach can therefore be made independent of complication-concerns. As the recently published large retrospective AGO ROBOT study observed similar oncologic outcome for both approaches, laparoscopy can be considered for staging of patients with BOT if this appears feasible. An algorithm for the surgical management of BOT patients has been developed.

Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

Institute of Scientific and Technical Information of China (English)

Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim

2005-01-01

AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (＜200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

Evaluación y selección de accesiones en una colección de Teramnus spp: Etapa de establecimiento. Evaluation and selection of accessions in a Teramnus spp. collection.: Establishment stage

Directory of Open Access Journals (Sweden)

Yuseika Olivera

2009-06-01

Full Text Available Se evaluó una colección de 50 accesiones de Teramnus spp, con el objetivo de seleccionar las de mejor comportamiento durante la etapa de establecimiento. El estudio se realizó en la EEPF «Indio Hatuey», en un suelo Ferralítico Rojo compactado. Para ello se dividió esta etapa en dos fases, la primera correspondió al monitoreo durante el tiempo que estuvieron las plantas en bolsas y la segunda desde que se pasaron a campo hasta que se completó dicha etapa; en esta segunda fase se estimó cada 15 días la cobertura y se utilizó la siguiente escala: 1= 10-20% de área cubierta (muy poco cubierta, 2= 21-40% de área cubierta (poco cubierta, 3= 41-60% de área cubierta (parcialmente cubierta, 4= 61-80% de área cubierta (cubierta y 5= > 80% de área cubierta (bien cubierta. Al realizar el monitoreo en la primera fase del establecimiento se constató que se sembraron en bolsas el 98% (49 accesiones, ya que de una no se obtuvo semilla; de estas accesiones solo fue posible pasar a campo el 67,3% (33 accesiones, ya que el resto (16 accesiones murieron antes que alcanzaran el tamaño establecido para ello. De las pasadas a campo cinco murieron durante los primeros 15 días de evaluación, por lo que se mantuvieron 28. De estas, el 67,8% (19 accesiones mostraron los mejores valores de cobertura durante el establecimiento, por lo que se recomienda realizar su evaluación durante la fase de explotación.A collection of 50 Teramnus spp. accessions was evaluated, with the objective of selecting those with better performance during the establishment stage. The study was conducted at the EEPF «Indio Hatuey», on a compacted Ferralitic Red soil. For that this stage was divided in two phases, the first one corresponded to monitoring during the time the plants were kept in bags and the second phase since they were transferred to the field until such stage was completed; in this second phase cover was estimated every 15 days and the following scale was

Meta-analysis of Gaussian individual patient data: Two-stage or not two-stage?

Science.gov (United States)

Morris, Tim P; Fisher, David J; Kenward, Michael G; Carpenter, James R

2018-04-30

Quantitative evidence synthesis through meta-analysis is central to evidence-based medicine. For well-documented reasons, the meta-analysis of individual patient data is held in higher regard than aggregate data. With access to individual patient data, the analysis is not restricted to a "two-stage" approach (combining estimates and standard errors) but can estimate parameters of interest by fitting a single model to all of the data, a so-called "one-stage" analysis. There has been debate about the merits of one- and two-stage analysis. Arguments for one-stage analysis have typically noted that a wider range of models can be fitted and overall estimates may be more precise. The two-stage side has emphasised that the models that can be fitted in two stages are sufficient to answer the relevant questions, with less scope for mistakes because there are fewer modelling choices to be made in the two-stage approach. For Gaussian data, we consider the statistical arguments for flexibility and precision in small-sample settings. Regarding flexibility, several of the models that can be fitted only in one stage may not be of serious interest to most meta-analysis practitioners. Regarding precision, we consider fixed- and random-effects meta-analysis and see that, for a model making certain assumptions, the number of stages used to fit this model is irrelevant; the precision will be approximately equal. Meta-analysts should choose modelling assumptions carefully. Sometimes relevant models can only be fitted in one stage. Otherwise, meta-analysts are free to use whichever procedure is most convenient to fit the identified model. © 2018 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

[Fortuitous discovery of gallbladder cancer].

Science.gov (United States)

Chiche, L; Metairie, S

2001-12-01

The prognosis of gallbladder cancer is basically dependent on the histological stage at diagnosis. In practice, the discovery of a small cancer of the bladder, generally during cholecystectomy give the patient a better care for curative treatment. The advent of laparoscopy has increased the number of cholecstectomies and could increase the frequency of this situation but also raises the difficult problem of metastatic dissemination. In the literature the figures on parietal metastasis after laparoscopy have ranged from 125% to 19%. The median delay to diagnosis of recurrence is 6 months. The cause of this phenomenon (role of the pneumoperitoneum) remains poorly elucidated. Risk factors for the development of a metastasis on the trocar orifice are: rupture of the gallbladder perioperatively and extraction of the gallbladder without protection. It is important to keep in mind this exceptional but serious risk and apply rigorous operative technique. In case of suspected gallbladder we do not advocate laparoscopy. Surgery (hepatectomy, lymphodenectomy, possibly resection of the biliary tract) would be indicted for all stages except pTis and T1a, taking into consideration the localization of the tumor and the patient's general status. It is also classical to recommend resection of the trocar orifices after laparoscopic cholecystectomy. There is a dual challenge today for small-sized gallbladder cancer: improving treatment and avoiding poorer prognosis due to the specific problems raised by laparoscopy.

The Two-Word Stage: Motivated by Linguistic or Cognitive Constraints?

Science.gov (United States)

Berk, Stephanie; Lillo-Martin, Diane

2012-01-01

Child development researchers often discuss a "two-word" stage during language acquisition. However, there is still debate over whether the existence of this stage reflects primarily cognitive or linguistic constraints. Analyses of longitudinal data from two Deaf children, Mei and Cal, not exposed to an accessible first language (American Sign…

Rectosigmoid endometriosis: comparison between CT water enema and video laparoscopy.

Science.gov (United States)

Stabile Ianora, A A; Moschetta, M; Lorusso, F; Lattarulo, S; Telegrafo, M; Rella, L; Scardapane, A

2013-09-01

To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

ROLE OF DIAGNOSTIC LAPAROSCOPY IN OBSCURE ASCITES ...

African Journals Online (AJOL)

Scientific Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 4 (2000) >. Log in or Register to get access to full text downloads.

Efficient Unsteady Flow Visualization with High-Order Access Dependencies

Energy Technology Data Exchange (ETDEWEB)

Zhang, Jiang; Guo, Hanqi; Yuan, Xiaoru

2016-04-19

We present a novel high-order access dependencies based model for efficient pathline computation in unsteady flow visualization. By taking longer access sequences into account to model more sophisticated data access patterns in particle tracing, our method greatly improves the accuracy and reliability in data access prediction. In our work, high-order access dependencies are calculated by tracing uniformly-seeded pathlines in both forward and backward directions in a preprocessing stage. The effectiveness of our proposed approach is demonstrated through a parallel particle tracing framework with high-order data prefetching. Results show that our method achieves higher data locality and hence improves the efficiency of pathline computation.

The laparoscopic approach in emergency surgery: A review of the literature

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Ionut Negoi

2018-01-01

Full Text Available The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

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Prasanta K Nayak

2013-01-01

Full Text Available Objective: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. Materials and Methods: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. Results: Out of 300 cases, 206 (69% patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14% and adnexal adhesion (12% in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

Results of an Advanced Fan Stage Operating Over a Wide Range of Speed and Bypass Ratio. Part 1; Fan Stage Design and Experimental Results

Science.gov (United States)

Suder, Kenneth L.; Prahst, Patricia S.; Thorp, Scott A.

2011-01-01

NASA s Fundamental Aeronautics Program is investigating turbine-based combined cycle (TBCC) propulsion systems for access to space because it provides the potential for aircraft-like, space-launch operations that may significantly reduce launch costs and improve safety. To this end, National Aeronautics and Space Administration (NASA) and General Electric (GE) teamed to design a Mach 4 variable cycle turbofan/ramjet engine for access to space. To enable the wide operating range of a Mach 4+ variable cycle turbofan ramjet required the development of a unique fan stage design capable of multi-point operation to accommodate variations in bypass ratio (10 ), fan speed (7 ), inlet mass flow (3.5 ), inlet pressure (8 ), and inlet temperature (3 ). In this paper, NASA has set out to characterize a TBCC engine fan stage aerodynamic performance and stability limits over a wide operating range including power-on and hypersonic-unique "windmill" operation. Herein, we will present the fan stage design, and the experimental test results of the fan stage operating from 15 to 100 percent corrected design speed. Whereas, in the companion paper, we will provide an assessment of NASA s APNASA code s ability to predict the fan stage performance and operability over a wide range of speed and bypass ratio.

Nuclear information access system

International Nuclear Information System (INIS)

Ham, C. H.; Yang, M. H.; Yoon, S. W.

1998-01-01

The energy supply in the countries, which have abundant energy resources, may not be affected by accepting the assertion of anti-nuclear and environment groups. Anti-nuclear movements in the countries which have little energy resources may cause serious problem in securing energy supply. Especially, it is distinct in Korea because she heavily depends on nuclear energy in electricity supply(nuclear share in total electricity supply is about 40%).The cause of social trouble surrounding nuclear energy is being involved with various circumstances. However, it is very important that we are not aware of the importance of information access and prepared for such a situation from the early stage of nuclear energy's development. In those matter, this paper analyzes the contents of nuclear information access system in France and Japan which have dynamic nuclear development program and presents the direction of the nuclear access regime through comparing Korean status and referring to progresses of the regime

Modeling Remote I/O versus Staging Tradeoff in Multi-Data Center Computing

International Nuclear Information System (INIS)

Suslu, Ibrahim H

2014-01-01

In multi-data center computing, data to be processed is not always local to the computation. This is a major challenge especially for data-intensive Cloud computing applications, since large amount of data would need to be either moved the local sites (staging) or accessed remotely over the network (remote I/O). Cloud application developers generally chose between staging and remote I/O intuitively without making any scientific comparison specific to their application data access patterns since there is no generic model available that they can use. In this paper, we propose a generic model for the Cloud application developers which would help them to choose the most appropriate data access mechanism for their specific application workloads. We define the parameters that potentially affect the end-to-end performance of the multi-data center Cloud applications which need to access large datasets over the network. To test and validate our models, we implemented a series of synthetic benchmark applications to simulate the most common data access patterns encountered in Cloud applications. We show that our model provides promising results in different settings with different parameters, such as network bandwidth, server and client capabilities, and data access ratio

Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

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Kazuhito Yajima

2012-01-01

Full Text Available We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

The AAS Working Group on Accessibility and Disability (WGAD) Year 1 Highlights and Database Access

Science.gov (United States)

Knierman, Karen A.; Diaz Merced, Wanda; Aarnio, Alicia; Garcia, Beatriz; Monkiewicz, Jacqueline A.; Murphy, Nicholas Arnold

2017-06-01

The AAS Working Group on Accessibility and Disability (WGAD) was formed in January of 2016 with the express purpose of seeking equity of opportunity and building inclusive practices for disabled astronomers at all educational and career stages. In this presentation, we will provide a summary of current activities, focusing on developing best practices for accessibility with respect to astronomical databases, publications, and meetings. Due to the reliance of space sciences on databases, it is important to have user centered design systems for data retrieval. The cognitive overload that may be experienced by users of current databases may be mitigated by use of multi-modal interfaces such as xSonify. Such interfaces would be in parallel or outside the original database and would not require additional software efforts from the original database. WGAD is partnering with the IAU Commission C1 WG Astronomy for Equity and Inclusion to develop such accessibility tools for databases and methods for user testing. To collect data on astronomical conference and meeting accessibility considerations, WGAD solicited feedback from January AAS attendees via a web form. These data, together with upcoming input from the community and analysis of accessibility documents of similar conferences, will be used to create a meeting accessibility document. Additionally, we will update the progress of journal access guidelines and our social media presence via Twitter. We recommend that astronomical journals form committees to evaluate the accessibility of their publications by performing user-centered usability studies.

Totally laparoscopic feeding jejunostomy – a technique modification

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Maciej Bobowicz

2011-12-01

Full Text Available In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy orjejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modifiedtechnique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient withgastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on usingthe described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made usinga Cystofix® TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches.Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention ofjejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications.The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were nomortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some stepsadded from the open operation making the procedure easier to perform as part of a staging operation with a relativelyshort additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional‘anti-torsion sutures’ prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of thecatheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies onlarger groups of patients are required to assess long-term outcomes of the proposed modified technique.

Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung's disease.

LENUS (Irish Health Repository)

Ruttenstock, Elke

2012-02-01

PURPOSE: The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung\\'s disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung\\'s disease (HAEC) still remains to be a potentially life-threatening complication after pull-through operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure. METHODS: A meta-analysis of cases of TERPT reported between 1998 and 2009 was performed. Detailed information was recorded regarding intraoperative details and postoperative complications with particular emphasis on incidence of HAEC. Diagnosis of HAEC in a HD patient was based on the clinical presentation of diarrhoea, abdominal distension, and fever. RESULTS: Of the 54 published articles worldwide, 27 articles, including 899 patients were identified as reporting entirely TERPT procedure. Postoperative HAEC occurred in 92 patients (10.2%). Recurrent episodes of HAEC were reported in 18 patients (2%). Conservative treatment of HAEC was successful in 75 patients (81.5%), whereas in 17 patients (18.5%) surgical treatment was needed. CONCLUSIONS: This systematic review reveals that TERPT is a safe and less-invasive procedure with a low incidence of postoperative HAEC.

Factors affecting vegetable preference in adolescents: stages of change and social cognitive theory.

Science.gov (United States)

Woo, Taejung; Lee, Kyung-Hea

2017-08-01

Despite the importance of consuming sufficient amounts of vegetables, daily vegetable intake among adolescents in Korea is lower than the current dietary recommendation. The objective of this study was to examine determinants affecting vegetable preference in order to suggest a stage-tailored education strategy that can promote vegetable consumption in adolescents. Adolescents (n = 400, aged 16-17 years) from two high schools participated in a cross-sectional study. Survey variables were vegetable preference, the social cognitive theory (SCT) and stages of change (SOC) constructs. Based on vegetable preference, subjects were classified into two groups: a low-preference group (LPG) and a high-preference group (HPG). SOC was subdivided into pre-action and action/maintenance stages. To compare SCT components and SOC related to vegetable preference, chi-squared and t-tests, along with stepwise multiple-regression analysis, were applied. In the LPG, a similar number of subjects were classified into each stage. Significant differences in self-efficacy, affective attitudes, and vegetable accessibility at home and school were detected among the stages. Subjects in the HPG were mainly at the maintenance stage (81%), and there were significant differences among the stages regarding self-efficacy, affective attitudes, and parenting practice. In the predictions of vegetable preference, self-efficacy and parenting practice had a significant effect in the "pre-action" stage. In the action/maintenance stage, outcome expectation, affective attitudes, and vegetable accessibility at school had significant predictive value. In predicting the vegetable preference for all subjects, 42.8% of the predictive variance was accounted for by affective attitudes, self-efficacy, and vegetable accessibility at school. The study revealed that different determinants affect adolescent vegetable preference in each stage. Self-efficacy and affective attitudes are important determinants affecting

Open access for REF2020

Directory of Open Access Journals (Sweden)

Simon Kerridge

2014-03-01

Full Text Available Open access (OA may have been the ‘big thing’ in 2013 but the OA juggernaut is still rolling and plans are now afoot for the requirements for the ‘next REF’ (which from now on we will refer to as REF2020. In 2013, on behalf of the four UK Funding Councils, the Higher Education Funding Council for England (HEFCE undertook a two-stage consultation exercise on open access requirements for articles submitted to REF2020. There are a number of nuances and caveats to the current proposals. This article will reflect on what the probable rules might be, and their implications for research managers, administrators and institutional repository managers alike.

Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Transverse Contrast-Enhanced Computed Tomography in Preoperative Tumor Staging of Advanced Gastric Carcinoma.

Science.gov (United States)

He, Xuemei; Sun, Jing; Huang, Xiaoling; Zeng, Chun; Ge, Yinggang; Zhang, Jun; Wu, Jingxian

2017-12-01

This study assessed the diagnostic performance of transabdominal oral contrast-enhanced ultrasound (US) imaging for preoperative tumor staging of advanced gastric carcinoma by comparing it with transverse contrast-enhanced computed tomography (CT). This retrospective study included 42 patients with advanced gastric cancer who underwent laparoscopy, radical surgery, or palliative surgery because of serious complications and had a body mass index of less than 25 kg/m 2 . A cereal-based oral contrast agent was used for transabdominal oral contrast-enhanced US. Retrospective analyses were conducted using preoperative tumor staging data acquired by either transabdominal oral contrast-enhanced US or transverse contrast-enhanced CT. Both contrast-enhanced US and contrast-enhanced CT examinations were reviewed by 2 experienced radiologists independently for preoperative tumor staging according to the seventh edition of the TNM classification. The accuracy, sensitivity, and specificity were calculated by comparing the results of contrast-enhanced US and contrast-enhanced CT with pathologic findings. The overall accuracies of the imaging modalities were compared by the McNemar test. No significant difference was noted in the overall accuracy of transabdominal oral contrast-enhanced US (86% [36 of 42]) and transverse contrast-enhanced CT (83% [35 of 42] P > .999). For stage T2 to T4 gastric cancer, the accuracies of transabdominal oral contrast-enhanced US were 88%, 86%, and 98%, respectively, and those of transverse contrast-enhanced CT were 93%, 83%, and 90%. The overall accuracy of transabdominal oral contrast-enhanced US was comparable with that of transverse contrast-enhanced CT for preoperative tumor staging of advanced gastric cancer. © 2017 by the American Institute of Ultrasound in Medicine.

Correlation between aromatase expression in the eutopic endometrium of symptomatic patients and the presence of endometriosis

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Maia Jr H

2012-02-01

Full Text Available Hugo Maia Jr1,2, Clarice Haddad1,2, Julio Casoy11CEPARH, 2Itaigara Memorial Day Hospital, Salvador, Bahia, BrazilObjective: To investigate whether aromatase expression in the eutopic endometrium correlates with the presence and severity of endometriosis in patients with infertility and/or dysmenorrhea undergoing laparoscopy and hysteroscopy.Patients: The study involved 106 patients of reproductive age with symptoms of dysmenorrhea and infertility. Sixteen endometriosis-free asymptomatic patients were used as a control group.Methods: Concomitant laparoscopy and hysteroscopy was carried out in all cases. An endometrial biopsy was taken to determine aromatase p450 expression by immunohistochemistry. Endometriosis was staged according to the American Society of Reproductive Medicine classification.Results: Endometriosis was diagnosed by laparoscopy in 92/106 symptomatic patients. In this group, aromatase expression was detected in the eutopic endometrium of 66/92 patients with endometriosis (72% and in 13/14 (95% patients in the symptomatic, endometriosis-free group (P = 0.09. Aromatase expression was not detected in any patients from the control group. In the endometriosis group, aromatase expression was detected in the eutopic endometrium of 28/45 patients (62% with American Society of Reproductive Medicine classification stage 1 of the disease, in 11/14 patients (78% with stage II, 14/20 patients (70% with stage III, and in 12/13 patients (92% with stage IV; however, the difference was only statistically significant between stages I and IV (P = 0.04.Conclusion: Aromatase expression in the endometrium was associated with the presence of dysmenorrhea and infertility irrespective of the presence of endometriosis. When endometriosis was present, however, there was a tendency for aromatase expression to be positively correlated with dysmenorrhea severity.Keywords: aromatase, endometrium, endometriosis, Cox-2, dysmenorrhea

Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors.

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Lin, Yan; Wimberly, Michael C

2017-04-01

The purpose of this study was to examine the geographic variations of late-stage diagnosis in colorectal cancer (CRC) and breast cancer as well as to investigate the effects of 3 neighborhood-level factors-socioeconomic deprivation, urban/rural residence, and spatial accessibility to health care-on the late-stage risks. This study used population-based South Dakota cancer registry data from 2001 to 2012. A total of 4,878 CRC cases and 6,418 breast cancer cases were included in the analyses. Two-level logistic regression models were used to analyze the risk of late-stage CRC and breast cancer. For CRC, there was a small geographic variation across census tracts in late-stage diagnosis, and residing in isolated small rural areas was significantly associated with late-stage risk. However, this association became nonsignificant after adjusting for census-tract level socioeconomic deprivation. Socioeconomic deprivation was an independent predictor of CRC late-stage risk, and it explained the elevated risk among American Indians. No relationship was found between spatial accessibility and CRC late-stage risk. For breast cancer, no geographic variation in the late-stage diagnosis was observed across census tracts, and none of the 3 neighborhood-level factors was significantly associated with late-stage risk. Results suggested that socioeconomic deprivation, rather than spatial accessibility, contributed to CRC late-stage risks in South Dakota as a rural state. CRC intervention programs could be developed to target isolated small rural areas, socioeconomically disadvantaged areas, as well as American Indians residing in these areas. © 2016 National Rural Health Association.

Isolated port-site metastasis after laparoscopic surgery for endometrial cancer: A case report

OpenAIRE

Palomba, Stefano; Falbo, Angela; Oppedisano, Rosamaria; Russo, Tiziana; Zullo, Fulvio

2012-01-01

► Isolated port-site metastasis is a rare event after laparoscopy in the surgical staging of endometrial cancer. ► More aggressive strategies in case of potentially increased risk for port-site metastasis are needed.

Exploring the umbilical and vaginal port during minimally invasive surgery.

Science.gov (United States)

Tinelli, Andrea; Tsin, Daniel A; Forgione, Antonello; Zorron, Ricardo; Dapri, Giovanni; Malvasi, Antonio; Benhidjeb, Tahar; Sparic, Radmila; Nezhat, Farr

2017-09-01

This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.

[Effects of the combined therapy of heat sensitive moxibustion and acupoint injection on endometrial receptivity of hypdrosalphinx infertility in the patients after hysteroscopy and laparoscopy].

Science.gov (United States)

Liu, Yanling; Pan, Lizhen; Wang, Ying

2018-01-12

To explore the effects of the combined therapy of heat sensitive moxibustion and acupoint injection on endometrial receptivity of hypdrosalphinx infertility in the patients after hysteroscopy and laparoscopy on the base of routine post-operative anti-inflammation. A total of 210 patients of hypdrosalphinx infertility after hysteroscopy and laparoscopy were divided into a combined therapy group, a heat sensitive moxibustion group and a control group, 70 cases in each one according to the random number table. In the control group, the intravenous drip of cefoxitin sodium was adopted, and the anti-inflammation treatment was given for 1 week after operation. In the heat sensitive moxibustion group, on the basis of the treatment as the control group, the heat sensitive moxibustion was applied after vaginal bleeding stopped. The acupoints were Yaoyangguan (GV 3), Guanyuan (CV 4), Qihai (CV 6), Shenshu (BL 23), Sanyinjiao (SP 6), Yinlingquan (SP 9) and Zigong (EX-CA1). The acupoints were modified according to the different syndromes. In the combined therapy group, on the basis of the regimen as the heat sensitive moxibustion group, after vaginal bleeding stopped, the acupoint injection was given alternatively at bilateral Tiangong (extra, 1.0 cm inferior and bilateral to the cervix) with lidocaine 1 mL, amikacin 2 mL and salvia injection 2 mL. The treatment was given once every day, the treatment for 10 times as one course and a total of 3 courses were required. The endometrial type, thickness, uterine arterial plusatility index (PI) and resistance index (RI) were observed in the patients of each group. After treatment, the numbers of A-type endometrial type in the combined therapy group and the heat sensitive moxibustion group were remarkably higher than those of the control group [57.1% (40/7) vs 31.4% (22/70), 50.0% (35/70) vs 31.4% (22/70), both P <0.05]. The endometrial thickness after treatment was all increased as compared with that before treatment in each group

Antiretroviral therapy (ART) rationing and access mechanisms and their impact on youth ART utilization in Malawi.

Science.gov (United States)

Dixon, Jimmy-Gama; Gibson, Sarah; McPake, Barbara; Maleta, Ken

2011-06-01

The World Health Organization (WHO) staging is a commonly used rationing mechanism for highly active antiretroviral therapy (HAART) among various HIV infected populations including youths in most developing countries. Rationing is defined as any policy or practice that restricts consumption of or access to certain goods due to its limited supply. However, as HIV prevalence is rapidly increasing among youth, understanding the capacity of the staging approach to achieve HAART uptake in youth is of considerable importance. This study aimed to explore how HAART rationing and access mechanisms impact on youth's utilization of HAART in Malawi. The study used mixed methods with quantitative analysis of existing Ministry of Health Clinical HIV Unit data used to determine existing levels of youth HAART use. Qualitative methods employed in-depth interviews that interviewed nine ART providers, nine HIV positive youth on HAART and nine HIV positive youth not on HAART; and field observations to nine ART clinics were used to understand HAART rationing and access mechanisms and how such mechanisms impact youth uptake of HAART. The findings revealed that ART providers use both explicit rationing mechanisms like WHO clinical staging and implicit rationing mechanisms like use of waiting lists, queues and referral in ART provision. However, the WHO staging approach had some challenges in its implementation. It was also observed that factors like non-comprehensive approach to HAART provision, costs incurred to access HAART, negative beliefs and misconceptions about HAART and HIV were among the key factors that limit youth access to HAART. The study recommends that while WHO staging is successful as a rationing mechanism in Malawi, measures should be put in place to improve access to CD4 assessment for clients who may need it. ART providers also need to be made aware of the implicit rationing mechanisms that may affect HAART access. There is also need to improve monitoring of those HIV

Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

LENUS (Irish Health Repository)

McCartan, D P

2012-02-01

Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

Directory of Open Access Journals (Sweden)

I. L. Chernikovskiy

2016-01-01

Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of

Single site laparoscopic right hemicolectomy: an oncological feasible option

Directory of Open Access Journals (Sweden)

Lim Yon Kuei

2010-09-01

Full Text Available Abstract Introduction We present the first 7 cases of single site right hemicolectomy in Asia using the new Single Site Laparoscopy (SSL access system from Ethicon Endo-surgery. Methods Right hemicolectomy was performed using the new Single Site Laparoscopy (SSL access system. Patient demographics, operative time, histology and post operative recovery and complications were collected and analysed. Results The median operative time was 90 mins (range 60 - 150 mins and a median wound size of 2.5 cm (range 2 to 4.5 cm. The median number of lymph nodes harvested was 24 (range 20 to 34 lymph nodes. The median length of proximal margin was 70 mm (range 30 to 145 mm and that of distal margin was 50 mm (35 to 120 mm. All patients had a median hospital stay of 7 days (range 5 to 11 and there were no significant perioperative complications except for 1 patient who had a minor myocardial event. Conclusion Right hemicolectomy using SSL access system is feasible and safe for oncologic surgery.

A two-stage flow-based intrusion detection model for next-generation networks.

Science.gov (United States)

Umer, Muhammad Fahad; Sher, Muhammad; Bi, Yaxin

2018-01-01

The next-generation network provides state-of-the-art access-independent services over converged mobile and fixed networks. Security in the converged network environment is a major challenge. Traditional packet and protocol-based intrusion detection techniques cannot be used in next-generation networks due to slow throughput, low accuracy and their inability to inspect encrypted payload. An alternative solution for protection of next-generation networks is to use network flow records for detection of malicious activity in the network traffic. The network flow records are independent of access networks and user applications. In this paper, we propose a two-stage flow-based intrusion detection system for next-generation networks. The first stage uses an enhanced unsupervised one-class support vector machine which separates malicious flows from normal network traffic. The second stage uses a self-organizing map which automatically groups malicious flows into different alert clusters. We validated the proposed approach on two flow-based datasets and obtained promising results.

Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated.

Science.gov (United States)

Matorras, Roberto; Rabanal, Aintzane; Prieto, Begoña; Diez, Santiago; Brouard, Iñaki; Mendoza, Rosario; Exposito, Antonia

2013-07-01

To evaluate, in patients with hydrosalpinges, the effect on in vitro fertilization (IVF) outcome of the insertion by hysteroscopy of an intratubal blocking device, in cases where laparoscopic salpingectomy or laparoscopy was contraindicated. A prospective interventional case series study was conducted in fifteen women with unilateral (N=6) or bilateral hydrosalpinges (N=9) submitted for IVF. In all of them, laparoscopic salpingectomy was contraindicated. Hysteroscopic insertion of the Essure intratubal device in a consultation room setting was performed. IVF results were compared with those of women where hydrosalpinx was treated by laparoscopic salpingectomy (48 women, 76 cycles). There were no complications during or immediately after the procedure in any of the patients. There were four pregnancies from 16 embryo-transfers with own oocytes, one spontaneous pregnancy after unilateral Essure insertion, and one pregnancy after oocyte donation. In one case the hydrosalpinx grew and pelvic inflammatory disease developed 6 months after the insertion, requiring bilateral adnexectomy. Although not of statistical significance, IVF pregnancy rates were somewhat lower than in the laparoscopic salpingectomy group, which was attributed to the lower ovarian reserve before Essure insertion. The hysteroscopic insertion of the Essure intratubal device prior to IVF is a reasonable option in cases where laparoscopic salpingectomy is contraindicated. Larger series are required to assess pregnancy outcome. Copyright © 2013. Published by Elsevier Ireland Ltd.

Effects of laparoscopy on the cardiorespiratory system of brown brocket deer (Mazama gouazoubira anesthetized with ketamine/ xylazine/ midazolam combination and isoflurane Efeitos da laparoscopia sobre o sistema cardiorrespiratório de veados-catingueiro (Mazama gouazoubira anestesiados com a associação cetamina/xilazina/midazolam e isofluorano

Directory of Open Access Journals (Sweden)

Marina Salles Munerato

2008-11-01

Full Text Available Laparoscopy is not widely used as a tool to perform assisted reproduction techniques in South American cervids; thus, scarce information in literature is available regarding its effects and appropriate anesthetic protocols to perform it. This study evaluated the effect of laparoscopy on heart rate (HR, respiration rate (RR, saturation of oxyhemoglobin (SpO2 and rectal temperature (RT of six female brown brocket deer (Mazama gouazoubira anesthetized with ketamine (5mg/kg, xylazine (0.3mg/kg, midazolam (0.5mg/kg combination i.v. and isoflurane. Twelve laparoscopies were performed and each animal was used twice with a 40-day interval. After anesthetized, the animals were placed in dorsal recumbency to perform laparoscopy procedure using abdominal CO2 insufflations (14.2 ± 2.39mmHg; M ± SE. The main events of the laparoscopy procedure were divided into three periods: animal without (P1 and with abdominal insufflation (P2 and abdominal insufflation with the hips raised at 45º (P3. As a control, the animals were anesthetized again 40 days after the last laparoscopy, and were maintained in a dorsal recumbency for the same average duration of the previous anesthesia and no laparoscopy procedure was conducted. The period of anesthesia for the controls was also divided into P1, P2, and P3 considering the average duration of these periods in previous laparoscopies performed. Data were analyzed through the (ANOVA variance analysis followed by Tukey test and values at PA laparoscopia ainda é pouco utilizada como ferramenta para técnicas de reprodução assistida em cervídeos sul-americanos, não havendo informações sobre seus efeitos e protocolos anestésicos seguros para sua realização. Objetivaramse avaliar as possíveis alterações na freqüência cardíaca (FC, respiratória (FR, saturação de oxihemoglobina (SpO2 e temperatura retal (TR durante a laparoscopia para visualização dos órgãos reprodutivos de seis fêmeas de veado

Comparisons of Hysterosalpingography and Laparoscopy Results in the Diagnosis of Tubal Occlusion

Directory of Open Access Journals (Sweden)

Rafet Duraker

2011-03-01

Full Text Available Objective: The compliance rate between the hysterosalpingography (HSG and laparoscopy (L/S results in patients who diagnosed tubal occlusion on the HSG was investigated. Also, the incidence of endometriosis was evaluated in the study population. Material and Methods: Medical records of 139 women who were underwent L/S for the investigation of the tubal occlusion were reviewed retrospectively. The concordance rate between the HSG and L/S was investigated. The incidence of endometriosis in patients with no tubal pathology was compared with patients with unilaterally and bilaterally tubal occlusion. Results: Mean age of the women was 31.8±5.7years, mean BMI was measured as 24.6±4.6 kg/m2, and gravida 0 (0-5, mean infertility period was 30.7±3.7 months. Tubal occlusion was confirmed after the L/S in 38.8% of the patients (n=38 who has unilaterally tubal occlusion on the HSG. However, 58.8% (n=20 of the patients who were diagnosed as bilaterally tubal occlusion on the HSG was confirmed with the L/S. The misdiagnosis rate of the HSG was significantly high in women with unilaterally tubal occlusions compared with bilaterally tubal occlusions [(respectively, 61.2%, 51.2% (p: 0.001]. Endometriosis was observed in 28.4% of the patients who had patent tubes and in 13.9% of the patients in the unilaterally tubal occlusion group and and in 22.7% of the patients in the bilaterally tubal occlusion group. But the difference was not statistically significant when groups were compared according to the rate of endometriosis (p=0.24. Conclusion: HSG is the first step diagnostic test for the assessment of the fallopian tubes. Although L/S is more invasive technique than HSG, L/S with chromopertubation is the gold standard test for identifying periadnexal adhesive disease and endometriosis.

Técnica de biópsia hepática em eqüino por laparoscopia Hepatic biopsy in horses by laparoscopy

Directory of Open Access Journals (Sweden)

Luis Cláudio Lopes Correia da Silva

2002-06-01

Full Text Available Este trabalho experimental objetivou a avaliação do uso da laparoscopia para biópsia hepática em eqüino e o estudo das possíveis alterações clínicas e laboratoriais decorrentes de tal procedimento. Foram utilizados 10 animais, os quais foram submetidos a procedimento cirúrgico em posição quadrupedal, por abordagem pelo flanco direito, no 17º espaço intercostal, após jejum alimentar e hídrico de 36 e 18 horas respectivamente. A avaliação pós-operatória constou de exame físico diário e colheita de amostras de sangue seriadas. O procedimento possibilitou inspeção dos órgãos e estruturas anatômicas localizados dorsalmente à direita da cavidade abdominal, favorecendo a escolha do local de biópsia hepática. Não foram observadas alterações no exame físico dos animais. Os exames hematológicos e de função hepática não apresentaram alterações significativas. Concluiu-se que o emprego da laparoscopia para realização de biópsia hepática em eqüino é simples, eficaz e seguro.The purpose of this research was to evaluate the use of laparoscopy in obtaining hepatic biopsy in horses and to determine a possible clinical and laboratorial changes related to the procedure. Ten animals were submitted to 36 hours of fastening and 18 hours of water deprivation and then operated in the standing position, through a right flank approach at the level of the 17th intercostal space. Post-operative evaluation consisted of daily physical examination and seriated blood sampling. The procedure allowed for wide visualization of the viscera and anatomical structures located on the right side of the abdominal cavity, favouring the choice of the spot for hepatic biopsy collection. No changes were noted in the physical state of the animals and alterations in hemogram and hepatic function tests were not statistically significant. It was concluded that laparoscopy is a simple, effective and safe technique for obtaining hepatic biopsy

Spoken word production: A theory of lexical access

NARCIS (Netherlands)

Levelt, W.J.M.

2001-01-01

A core operation in speech production is the preparation of words from a semantic base. The theory of lexical access reviewed in this article covers a sequence of processing stages beginning with the speaker's focusing on a target concept and ending with the initiation of articulation. The initial

Do elderly people at more severe activity of daily living limitation stages fall more?

Science.gov (United States)

Henry-Sánchez, John T; Kurichi, Jibby E; Xie, Dawei; Pan, Qiang; Stineman, Margaret G

2012-07-01

The aim of this study was to explore how activity of daily living (ADL) stages and the perception of unmet needs for home accessibility features associate with a history of falling. Participants were from a nationally representative sample from the Second Longitudinal Survey of Aging conducted in 1994. The sample included 9250 community-dwelling persons 70 yrs or older. The associations of ADL stage and perception of unmet needs for home accessibility features with a history of falling within the past year (none, once, or multiple times) were explored after accounting for sociodemographic characteristics and comorbidities using a multinomial logistic regression model. The adjusted relative risk of falling more than once peaked at 4.30 (95% confidence interval, 3.29-5.61) for persons with severe limitation (ADL-III) compared those with no limitation (ADL-0) then declined for those at complete limitation (ADL-IV). The adjusted relative risks of falling once and multiple times were 1.42 (95% confidence interval, 1.07-1.87) and 1.85 (95% confidence interval, 1.44-2.36), respectively, for those lacking home accessibility features. Risk of falling appeared greatest for those whose homes lacked accessibility features and peaked at intermediate ADL limitation stages, presumably at a point when people have significant disabilities but sufficient function to remain partially active.

77 FR 74908 - Small Business Investment Companies-Early Stage SBICs

Science.gov (United States)

2012-12-18

... Early Stage SBICs, SBA seeks to expand entrepreneurs' access to capital and encourage innovation as part... addressing barriers to success for entrepreneurs and small businesses. II. Management Assessment... return expectations of a fund and excessive concentration in a single year could substantially increase...

JUNE NJCP 2009 FINAL sp.cdr

African Journals Online (AJOL)

User

Laparoscopy is direct visualization of the peritoneal cavity, ovaries, outside of the tubes and uterus using a laparoscope. A laparoscope is an instrument similar ... uterine fibroids, ectopic pregnancies, endometriosis and gynaecological malignancies. This has led to the concept of minimal-access surgery and broadened.

Modern techniques and technologies for unbundled access in the local loop

Science.gov (United States)

Bacis Vasile, Irina Bristena; Schiopu, Paul; Marghescu, Cristina

2015-02-01

The efficient and unbundled use of the existing telecommunications infrastructure represents a major goal for the development of the services offered by telecommunications providers. A major telecommunications operator can provide services to a subscriber using a copper wire pair or part of the frequency spectrum of a copper wire pair, together with other operators, through a process of unbundling access in the local loop. Since access to the vocal band is an already solved problem, concerns turn to the broadband access with xDSL service delivery on ungrouped subscriber loops; besides the legal and economic aspects involved this has become an engineering problem also. The local loop unbundling methods have a substantial technical impact. This impact should be taken into account right from the design stage and then in the standardization stage of broadband systems intended to operate on copper wire pairs in the local loop. These systems are known under the generic term of xDSL and began to be analyzed in the late 90s. xDSL became the dominant solution for providing Internet at a reasonable price for both residential and business subscribers. In this massive development scenario, certain problems will arise from the early stages of deployment, and another type of problems will occur later on when a large number of systems will be installed in a single beam.

Questioning the efficacy of 'gold' open access to published articles.

Science.gov (United States)

Fredericks, Suzanne

2015-07-01

To question the efficacy of 'gold' open access to published articles. Open access is unrestricted access to academic, theoretical and research literature that is scholarly and peer-reviewed. Two models of open access exist: 'gold' and 'green'. Gold open access provides everyone with access to articles during all stages of publication, with processing charges paid by the author(s). Green open access involves placing an already published article into a repository to provide unrestricted access, with processing charges incurred by the publisher. This is a discussion paper. An exploration of the relative benefits and drawbacks of the 'gold' and 'green' open access systems. Green open access is a more economic and efficient means of granting open access to scholarly literature but a large number of researchers select gold open access journals as their first choices for manuscript submissions. This paper questions the efficacy of gold open access models and presents an examination of green open access models to encourage nurse researchers to consider this approach. In the current academic environment, with increased pressures to publish and low funding success rates, it is difficult to understand why gold open access still exists. Green open access enhances the visibility of an academic's work, as increased downloads of articles tend to lead to increased citations. Green open access is the cheaper option, as well as the most beneficial choice, for universities that want to provide unrestricted access to all literature at minimal risk.

Administering an epoch initiated for remote memory access

Science.gov (United States)

Blocksome, Michael A; Miller, Douglas R

2012-10-23

Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

The immunomodulatory effects of laparoscopic surgery.

LENUS (Irish Health Repository)

Corrigan, Mark

2012-02-03

Laparoscopic alternatives to conventional surgical procedures confer many advantages to patients including reduced postoperative pain, shortened convalescence and, perhaps, improved disease-related outcomes. The diminished degree of immune dysfunction apparent with these techniques may underpin these beneficial aspects. However, minimal access is accompanied by various ancillary anesthetic and mechanical associations (including the induction of a carbon dioxide pneumoperitoneum), which must be considered in addition to reduced tissue trauma when attempting to correlate cause with effect. Furthermore, the opportunity to establish causation between the immunomodulatory aspects of laparoscopy and subsequent clinical outcome by prospective, randomized study is difficult because of the rapid incorporation of minimal access techniques into clinical practice. Therefore, experimental in vitro and in vivo studies must be used to complement the limitations of clinical studies in this area. Although the initial investigations into the immunological effects of laparoscopy are encouraging, many of the intricacies associated with this approach still await elaboration.

Knowledge deficit of patients with stage 1-4 CKD: a focus group study.

Science.gov (United States)

Lopez-Vargas, Pamela A; Tong, Allison; Phoon, Richard K S; Chadban, Steven J; Shen, Yvonne; Craig, Jonathan C

2014-04-01

Patients with early-stage chronic kidney disease (CKD) must make lifestyle modifications and adhere to treatment regimens to prevent their progression to end-stage kidney disease. The aim of this study was to elicit the perspectives of patients with stage 1-4 CKD about their disease, with a specific focus on their information needs in managing and living with CKD and its sequelae. Patients with CKD stages 1-4 were purposively sampled from three major hospitals in Sydney, Australia to participate in focus groups. Transcripts were thematically analysed. From nine focus groups including 38 participants, six major themes were identified: medical attentiveness (shared decision-making, rapport, indifference and insensitivity); learning self-management (diet and nutrition, barriers to physical activity, medication safety); contextualizing comorbidities (prominence of CKD, contradictory treatment); prognostic uncertainty (hopelessness, fear of disease progression, disbelief regarding diagnosis); motivation and coping mechanisms (engage in research, pro-active management, optimism, feeling normal); and knowledge gaps (practical advice, access to information, comprehension of pathology results and CKD diagnosis, education for general practitioners). Patients capacity to slow the progression of CKD may be limited by their lack of knowledge about the disease, its comorbidities, psychosocial influences and their ability to interact and communicate effectively with their health-care provider. Support from a multidisciplinary care team, combined with provision of comprehensive, accessible and practical educational resources may enhance patients' ability and motivation to access and adhere to therapeutic and lifestyle interventions to retard progression of CKD. © 2014 Asian Pacific Society of Nephrology.

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Science.gov (United States)

Bogner, Hillary R.; de Vries McClintock, Heather F.; Hennessy, Sean; Kurichi, Jibby E.; Streim, Joel E.; Xie, Dawei; Pezzin, Liliana E.; Kwong, Pui L.; Stineman, Margaret G.

2016-01-01

OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care was related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (n= 42,584) of persons 65 years of age and older living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS Compared to older beneficiaries with no limitations at ADL Stage 0, the adjusted odds ratios (OR) (95% confidence intervals (CI)) for Stage I (mild) to Stage III (severe) for satisfaction with care coordination and quality ranged from OR = 0.85 (95% CI: 0.80-0.92) to OR = 0.79 (95% CI: 0.70-0.89). Compared to ADL Stage 0, satisfaction with access barriers ranged from OR = 0.81 (95% CI: 0.76-0.87) at Stage I (mild) to a minimum of OR = 0.67 (95% CI: 0.59-0.76) at Stage III (severe). Similarly, compared to older beneficiaries at ADL Stage 0, perceived quality of the technical skills of their primary care physician ranged from OR = 0.87 (95% CI: 0.82-0.94) at Stage I (mild) to a minimum of OR = 0.81 (95% CI: 0.72-0.91) at Stage III (severe). CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation although not necessarily the highest stage of activity limitation reported less satisfaction with medical care. PMID:26119464

Virtual laparoscopy: Initial experience with three-dimensional ultrasonography to characterize hepatic surface features

International Nuclear Information System (INIS)

Sekimoto, Tadashi; Maruyama, Hitoshi; Kondo, Takayuki; Shimada, Taro; Takahashi, Masanori; Yokosuka, Osamu; Otsuka, Masayuki; Miyazaki, Masaru; Mine, Yoshitaka

2013-01-01

Objective: To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics. Materials and methods: A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined. Results: The phantom study revealed that 0.4 mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10 mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p = 0.02; accuracy, p = 0.02) or 3D-imaging alone (sensitivity, p = 0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ = 1.0). Conclusion: 3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis

Remote data access in computational jobs on the ATLAS data grid

CERN Document Server

Begy, Volodimir; The ATLAS collaboration; Lassnig, Mario

2018-01-01

This work describes the technique of remote data access from computational jobs on the ATLAS data grid. In comparison to traditional data movement and stage-in approaches it is well suited for data transfers which are asynchronous with respect to the job execution. Hence, it can be used for optimization of data access patterns based on various policies. In this study, remote data access is realized with the HTTP and WebDAV protocols, and is investigated in the context of intra- and inter-computing site data transfers. In both cases, the typical scenarios for application of remote data access are identified. The paper also presents an analysis of parameters influencing the data goodput between heterogeneous storage element - worker node pairs on the grid.

Construct and concurrent validity of a Nintendo Wii video game made for training basic laparoscopic skills.

Science.gov (United States)

Jalink, M B; Goris, J; Heineman, E; Pierie, J P E N; ten Cate Hoedemaker, H O

2014-02-01

Virtual reality (VR) laparoscopic simulators have been around for more than 10 years and have proven to be cost- and time-effective in laparoscopic skills training. However, most simulators are, in our experience, considered less interesting by residents and are often poorly accessible. Consequently, these devices are rarely used in actual training. In an effort to make a low-cost and more attractive simulator, a custom-made Nintendo Wii game was developed. This game could ultimately be used to train the same basic skills as VR laparoscopic simulators ought to. Before such a video game can be implemented into a surgical training program, it has to be validated according to international standards. The main goal of this study was to test construct and concurrent validity of the controls of a prototype of the game. In this study, the basic laparoscopic skills of experts (surgeons, urologists, and gynecologists, n = 15) were compared to those of complete novices (internists, n = 15) using the Wii Laparoscopy (construct validity). Scores were also compared to the Fundamentals of Laparoscopy (FLS) Peg Transfer test, an already established assessment method for measuring basic laparoscopic skills (concurrent validity). Results showed that experts were 111 % faster (P = 0.001) on the Wii Laparoscopy task than novices. Also, scores of the FLS Peg Transfer test and the Wii Laparoscopy showed a significant, high correlation (r = 0.812, P < 0.001). The prototype setup of the Wii Laparoscopy possesses solid construct and concurrent validity.

Survey of home hemodialysis patients and nursing staff regarding vascular access use and care

OpenAIRE

Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D

2014-01-01

Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then ...

Laparoscopic management of 128 undescended testes: Our ...

African Journals Online (AJOL)

African Journal of Paediatric Surgery ... Open Access DOWNLOAD FULL TEXT ... Materials and Methods: The medical records of all the patients, managed ... In 38 (42.2%) patients, UDT were bilateral, whereas in 33 (36.7%), these were right ... laparoscopy followed by inguinal exploration and orchidopexy in 19 testes (3 ...

Laparoscopic Conservative Management Of A Spontaneously ...

African Journals Online (AJOL)

A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability ...

Implementing an Open Access Policy – Modeling KAUST in the Region

KAUST Repository

Baessa, Mohamed A.; Vijayakumar, J.K.

2014-01-01

The presentation will discuss different open access approaches, and what can well-fit academic and governmental institutions. As a case study of KAUST, presenters will discuss how it can be initiated in a university set-up, how to get academic stakeholder engaged with support, and how the final stage is reached. Details about the KAUST Open Access Policy for research articles, theses and dissertations and the required tools and workflow to implement the policies will be highlighted.

Implementing an Open Access Policy – Modeling KAUST in the Region

KAUST Repository

Baessa, Mohamed A.

2014-11-12

The presentation will discuss different open access approaches, and what can well-fit academic and governmental institutions. As a case study of KAUST, presenters will discuss how it can be initiated in a university set-up, how to get academic stakeholder engaged with support, and how the final stage is reached. Details about the KAUST Open Access Policy for research articles, theses and dissertations and the required tools and workflow to implement the policies will be highlighted.

[Accessible health information: a question of age?].

Science.gov (United States)

Loos, E F

2012-04-01

Aging and digitalisation are important trends which have their impact on information accessibility. Accessible information about products and services is of crucial importance to ensure that all citizens can participate fully as active members of society. Senior citizens who have difficulties using new media run the risk of exclusion in today's information society. Not all senior citizens, however, encounter problems with new media. Not by a long shot. There is much to be said for 'aged heterogeneity', the concept that individual differences increase as people age. In two explorative qualitative case studies related to accessible health information--an important issue for senior citizens--that were conducted in the Netherlands, variables such as gender, education level and frequency of internet use were therefore included in the research design. In this paper, the most important results of these case studies will be discussed. Attention will be also paid to complementary theories (socialisation, life stages) which could explain differences in information search behaviour when using old or new media.

Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting.

Science.gov (United States)

Brown, Carolyn A; Suneja, Gita; Tapela, Neo; Mapes, Abigail; Pusoentsi, Malebogo; Mmalane, Mompati; Hodgeman, Ryan; Boyer, Matthew; Musimar, Zola; Ramogola-Masire, Doreen; Grover, Surbhi; Nsingo-Bvochora, Memory; Kayembe, Mukendi; Efstathiou, Jason; Lockman, Shahin; Dryden-Peterson, Scott

2016-06-01

Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access. Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV). Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0-185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59-653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79-1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09-1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30-1.70). Factors significantly associated with advanced cancer included income oncology care was 13 months. For HIV-infected patients (51% of total), regular longitudinal contact with the health system, through quarterly doctor visits for HIV management, was not successful in providing faster linkages into oncology care. However, patients who used traditional medicine/healers engaged in cancer care faster, indicating potential for leveraging traditional healers as partners in early cancer detection. New strategies are urgently needed to facilitate diagnosis and timely treatment of cancer in low- and middle-income countries. ©AlphaMed Press.

Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?

Science.gov (United States)

Abdel-Rahman, Omar

2018-02-01

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance, epidemiology and end results (SEER) database. SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan-Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and according to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox proportional hazard model. A total of 18  948 patients with pancreatic adenocarcinoma were identified in the period from 2010-2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between stage IA and stage IB (P = 0.307) and the comparison between stage IB and stage IIA (P = 0.116). Moreover, P value for stage IA vs IIA was 0.014; while pancreatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between IA and IB (P = 0.072), the comparison between stage IIA and stage IIB (P = 0.065), the comparison between stage IIA and stage III (P = 0.059) and the comparison between IIB and III (P = 0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was

Intraabdominal laparoscopy-assisted "open" vessel ligation of testicular vessels: a potential treatment for varicocele.

Science.gov (United States)

Miyano, Go; Miyahara, Katsumi; Halibieke, Abudebieke; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki

2011-10-01

We tested our laparoscopy-assisted "open" ligation (LOL) technique on testicular vessels. We ligated the left testicular artery and vein (TAV) in 8-week-old male Wister rats using LOL (LOL group; n=10) or laparotomy (open group; n=10). In LOL, a 0-degree laparoscope was introduced through a 5-mm epigastric trocar. A 3-mm grasper was used to expose the left TAV. A lapa-her-closure (LHC) needle loaded with 3-0 SurgiPro was directly inserted into the left lower quadrant where the left TAV should be and advanced under the vessels, and the suture material was released leaving one end outside. The LHC was then withdrawn a little and advanced again over the vessels to grasp the end of the suture material just released to bring it outside. This was proximally repeated. The two ends of both sutures were conventionally tied outside, and the knot was passed through the insertion site and tightened around the vessels. In the open group, the left TAV were ligated using two 3-0 SurgiPro ties. In both groups, the right side was left intact. All rats were sacrificed 2 weeks postoperatively, and both testes were examined with hematoxylin and eosin. Treatment time was 5-7 minutes for LOL and 7-8 minutes for the open group. Postoperative recovery was uneventful. No adhesions were present between the ligated vessels and bowel in any rat. Histopathology of all left testes showed coagulative necrosis of germinal cells and seminiferous tubules; all right testes were normal. LOL appears to be as effective as open ligation and may find application for treating varicocele.

Remote I/O : fast access to distant storage.

Energy Technology Data Exchange (ETDEWEB)

Foster, I.; Kohr, D., Jr.; Krishnaiyer, R.; Mogill, J.

1997-12-17

As high-speed networks make it easier to use distributed resources, it becomes increasingly common that applications and their data are not colocated. Users have traditionally addressed this problem by manually staging data to and from remote computers. We argue instead for a new remote I/O paradigm in which programs use familiar parallel I/O interfaces to access remote file systems. In addition to simplifying remote execution, remote I/O can improve performance relative to staging by overlapping computation and data transfer or by reducing communication requirements. However, remote I/O also introduces new technical challenges in the areas of portability, performance, and integration with distributed computing systems. We propose techniques designed to address these challenges and describe a remote I/O library called RIO that we have developed to evaluate the effectiveness of these techniques. RIO addresses issues of portability by adopting the quasi-standard MPI-IO interface and by defining a RIO device and RIO server within the ADIO abstract I/O device architecture. It addresses performance issues by providing traditional I/O optimizations such as asynchronous operations and through implementation techniques such as buffering and message forwarding to off load communication overheads. RIO uses the Nexus communication library to obtain access to configuration and security mechanisms provided by the Globus wide area computing tool kit. Microbenchmarks and application experiments demonstrate that our techniques achieve acceptable performance in most situations and can improve turnaround time relative to staging.

The role of MR in the evaluation of endometriosis

International Nuclear Information System (INIS)

Worthington, B.S.; Powell, M.; Symonds, E.M.

1986-01-01

Thirty patients with endometriosis were studied by US and MR imaging performed using a 0.15-T resistive system. Imaging findings were compared with findings on laparoscopy. Spin-echo sequences with a long echo time and a short tau inversion-recovery sequence were the most useful in highlighting pelvic implants. The signal patterns associated with the altered blood products within endometriotic cysts allowed the age of the cysts to be estimated. The authors conclude that MR imaging is superior to US in the diagnosis of endometriosis and is useful for monitoring treatment by surgery and estrogen therapy, but laparoscopy is required staging to detect any implants beyond the range of imaging techniques

Do stage of disease, comorbidity or access to treatment explain socioeconomic differences in survival after ovarian cancer?

DEFF Research Database (Denmark)

Ibfelt, Else Helene; Dalton, Susanne Oksbjerg; Høgdall, Claus

2015-01-01

educated women. After adjustment for comorbid conditions, cancer stage, tumour histology, operation status and lifestyle factors, socioeconomic differences in survival persisted. CONCLUSIONS: Socioeconomic disparities in survival after ovarian cancer were to some extent, but not fully explained...... we retrieved information on prognostic factors, treatment information and lifestyle factors. Age, vital status, comorbidity, education, income and cohabitation status were ascertained from nationwide administrative registers. Associations were analyzed with logistic regression and Cox regression...... models. RESULTS: Educational level was weakly associated with cancer stage. Short education, lower income and living without a partner were related to poorer survival after ovarian cancer. Among women with early cancer stage, HR (95% CI) for death was 1.75 (1.20-2.54) in shorter compared to longer...

Incidental pT2-T3 gallbladder cancer after a cholecystectomy: outcome of staging at 3 months prior to a radical resection

Science.gov (United States)

Ausania, Fabio; Tsirlis, Theodoris; White, Steven A; French, Jeremy J; Jaques, Bryon C; Charnley, Richard M; Manas, Derek M

2013-01-01

Introduction Patients with incidental pT2-T3 gallbladder cancer (IGC) after a cholecystectomy may benefit from a radical re-resection although their optimal treatment strategy is not well defined. In this Unit, such patients undergo delayed staging at 3 months after a cholecystectomy to assess the evidence of a residual tumour, extra hepatic spread and the biological behaviour of the tumour. The aim of this study was to evaluate the outcome of patients who had delayed staging at 3 months after a cholecystectomy. Methods From July 2003 to July 2011, 56 patients with T2-T3 gallbladder cancer were referred to this Unit of which 49 were diagnosed incidentally on histology after a cholecystectomy. All 49 patients underwent delayed pre-operative staging using multi-detector computed tomography (MDCT) followed selectively by laparoscopy at 3 months after a cholecystectomy. Data were collected from a prospectively held database. The peri-operative and long-term outcomes of patients were analysed. SPSS software was used for statistical analysis. Results There were 38 pT2 and 11 pT3 tumours. After delayed staging, 24/49 (49%) patients underwent a radical resection, 24/49 (49%) were found to be inoperable on pre-operative assessment and 1/49 (2%) patient underwent an exploratory laparotomy and were found to be unresectable. The overall median survival from referral was 20.7 months (54.8 months for the group who had a radical re-resection versus 9.7 months for the group who had unresectable disease, P < 0.001). These results compare favourably with the reported outcome of fast-track management for incidental pT2-T3 gallbladder cancer from other major series in the literature. Conclusion Delayed staging in patients with incidental T2-T3 gallbladder cancer after a cholecystectomy is a useful strategy to select patients who will benefit from a resection and avoid unnecessary major surgery. PMID:23458168

Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases

OpenAIRE

Özmen, Batuhan; Şükür, Yavuz Emre; Atabekoglu, Cem Somer; Heper, Aylin Okçu; Sönmezer, Murat; Güngör, Mete

2011-01-01

Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we ...

Flooding tolerance in cotton (gossypium hirsutum l.) at early vegetative and reproductive growth stages

International Nuclear Information System (INIS)

Hussain, A.

2014-01-01

Periodic flooding at any growth stage greatly affects growth and yield of crops. In order to develop flooding tolerant cotton cultivar and to identify the most sensitive growth stage to periodic flooding, a field experiment was conducted in which 60-cultivars/accessions/lines were subjected to two week flooding at seedling/early vegetative, flower and boll formation growth stages. Pre- and post-flooding soil analysis was also carried out. Nitrate-N was greatly reduced due to flooding applied at all growth stages, whereas NH4-N increased significantly. Similarly, Fe and Mn were also increased to many folds in flooded soils. Under hypoxic conditions, depletion of nitrates and toxic effects of accumulated NH4, Fe and Mn caused severe damages to cotton plants and even death of plants. Of the three growth stages, early vegetative growth stage is most sensitive to two week flooding. Flooding imposed at the flowering and boll formation growth stages caused a substantial amount of yield penalty. On the basis of survival percentage, the 60-cultivars/accessions/lines were categorized into tolerant (61%), moderately tolerant (31=60%) and sensitive (31%) to short term flooding. At the seedling or early vegetative growth stage, genotypes DPL-SR-2 followed by 124-F and MNH-427 were most tolerant to flooding, while AET-5, N-KRISHMA, LRA-5166, CEDIX and H-142 were ranked as sensitive to flooding stress. At the flowering stage, the genotype NIAB-92 followed by S-14 and MNH-427 were highly tolerant to flooding. At the boll formation stage, genotypes DPL-70010-N followed by GH-11-9-75 and B-2918-2 were highly tolerant waterlogging. More than 50% of the genotypes maintained the degree of flooding tolerance at three growth stages. However, on the basis of survival percentage at three growth stages, genotypes MNH-564, FH-114, MNH-786 and CIM-573 were included in the tolerant group and the genotypes N-KRISHMA, LRA-5166, CEDIX and H-142 were included in the sensitive group. These

Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy

Directory of Open Access Journals (Sweden)

Alberto Santoro

2014-01-01

Full Text Available Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy.

Virtual reality: emerging role of simulation training in vascular access.

Science.gov (United States)

Davidson, Ingemar J A; Lok, Charmaine; Dolmatch, Bart; Gallieni, Maurizio; Nolen, Billy; Pittiruti, Mauro; Ross, John; Slakey, Douglas

2012-11-01

Evolving new technologies in vascular access mandate increased attention to patient safety; an often overlooked yet valuable training tool is simulation. For the end-stage renal disease patient, simulation tools are effective for all aspects of creating access for peritoneal dialysis and hemodialysis. Based on aviation principles, known as crew resource management, we place equal emphasis on team training as individual training to improve interactions between team members and systems, cumulating in improved safety. Simulation allows for environmental control and standardized procedures, letting the trainee practice and correct mistakes without harm to patients, compared with traditional patient-based training. Vascular access simulators range from suture devices, to pressurized tunneled conduits for needle cannulation, to computer-based interventional simulators. Simulation training includes simulated case learning, root cause analysis of adverse outcomes, and continual update and refinement of concepts. Implementation of effective human to complex systems interaction in end-stage renal disease patients involves a change in institutional culture. Three concepts discussed in this article are as follows: (1) the need for user-friendly systems and technology to enhance performance, (2) the necessity for members to both train and work together as a team, and (3) the team assigned to use the system must test and practice it to a proficient level before safely using the system on patients. Copyright © 2012 Elsevier Inc. All rights reserved.

The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy.

Science.gov (United States)

Van Sickle, K R; Gallagher, A G; Smith, C D

2007-02-01

In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple

Referential Choices in a Collaborative Storytelling Task: Discourse Stages and Referential Complexity Matter.

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Fossard, Marion; Achim, Amélie M; Rousier-Vercruyssen, Lucie; Gonzalez, Sylvia; Bureau, Alexandre; Champagne-Lavau, Maud

2018-01-01

During a narrative discourse, accessibility of the referents is rarely fixed once and for all. Rather, each referent varies in accessibility as the discourse unfolds, depending on the presence and prominence of the other referents. This leads the speaker to use various referential expressions to refer to the main protagonists of the story at different moments in the narrative. This study relies on a new, collaborative storytelling in sequence task designed to assess how speakers adjust their referential choices when they refer to different characters at specific discourse stages corresponding to the introduction, maintaining, or shift of the character in focus, in increasingly complex referential contexts. Referential complexity of the stories was manipulated through variations in the number of characters (1 vs. 2) and, for stories in which there were two characters, in their ambiguity in gender (different vs. same gender). Data were coded for the type of reference markers as well as the type of reference content (i.e., the extent of the information provided in the referential expression). Results showed that, beyond the expected effects of discourse stages on reference markers (more indefinite markers at the introduction stage, more pronouns at the maintaining stage, and more definite markers at the shift stage), the number of characters and their ambiguity in gender also modulated speakers' referential choices at specific discourse stages, For the maintaining stage, an effect of the number of characters was observed for the use of pronouns and of definite markers, with more pronouns when there was a single character, sometimes replaced by definite expressions when two characters were present in the story. For the shift stage, an effect of gender ambiguity was specifically noted for the reference content with more specific information provided in the referential expression when there was referential ambiguity. Reference content is an aspect of referential marking

Referential Choices in a Collaborative Storytelling Task: Discourse Stages and Referential Complexity Matter

Directory of Open Access Journals (Sweden)

Marion Fossard

2018-02-01

Full Text Available During a narrative discourse, accessibility of the referents is rarely fixed once and for all. Rather, each referent varies in accessibility as the discourse unfolds, depending on the presence and prominence of the other referents. This leads the speaker to use various referential expressions to refer to the main protagonists of the story at different moments in the narrative. This study relies on a new, collaborative storytelling in sequence task designed to assess how speakers adjust their referential choices when they refer to different characters at specific discourse stages corresponding to the introduction, maintaining, or shift of the character in focus, in increasingly complex referential contexts. Referential complexity of the stories was manipulated through variations in the number of characters (1 vs. 2 and, for stories in which there were two characters, in their ambiguity in gender (different vs. same gender. Data were coded for the type of reference markers as well as the type of reference content (i.e., the extent of the information provided in the referential expression. Results showed that, beyond the expected effects of discourse stages on reference markers (more indefinite markers at the introduction stage, more pronouns at the maintaining stage, and more definite markers at the shift stage, the number of characters and their ambiguity in gender also modulated speakers' referential choices at specific discourse stages, For the maintaining stage, an effect of the number of characters was observed for the use of pronouns and of definite markers, with more pronouns when there was a single character, sometimes replaced by definite expressions when two characters were present in the story. For the shift stage, an effect of gender ambiguity was specifically noted for the reference content with more specific information provided in the referential expression when there was referential ambiguity. Reference content is an aspect of

Preliminary work for stage 2 decommissioning of B16 pile chimney

International Nuclear Information System (INIS)

Wright, E.M.; Mathews, R.F.

1991-01-01

Planning of the second stage of decommissioning of the two pile chimneys at Sellafield started while work was underway on the first stage, which involved removal of the sections above the filters. The second stage requires the removal of all radio-active parts and the dismantling of the filter and diffuser sections, and has to be completed by 1997. The planning involved studying the many possible options and their effects on both radiological and industrial safety. This decommissioning project employs a high proportion of civil engineering and construction techniques, which are then developed to eliminate the hazards from radioactive dusts, and to minimise the effect of radiation on operatives working on the project. Much of this equipment is modified forms of standard construction equipment and includes cutting equipment and remotely operated vehicles. The initial phases of the work involve: provision of a waste packaging and access building; provision of temporary ventilation systems to control the dust generated by the work, cutting of 3 m square access doorway through the 1.5 m thick reinforced concrete wall of the chimney; provision of Remotely Operated Vehicle (ROV) to act as a tool carrier for lining stripping work; removal of the thermal lining from the floor and lower walls of the chimney, and installation of precast concrete walls which separate the pile reactor core from the chimney flue. (author)

Treatment of lower extremity arterial occlusive through retrograde access

International Nuclear Information System (INIS)

Liu Xueqiang; Guo Pingfan; Zhang Jinchi; Cai Fanggang

2012-01-01

Objective: To explore the clinical significance of retrograde access for the interventional treatment of lower extremity arterial occlusive diseases when the occluded segment of lower extremity artery could not be reached through antegrade access. Methods: Twenty-seven cases (male 17, female 10; age range 32-89 years) were retrospectively investigated, including 18 with lower limb arteriosclerosis obliterans, 7 with diabetic foot and 2 with thromboangiitis obliterans. According to the Fontaine staging, 6 cases were classified as Fontaine Ⅱ, 11 were classified as Fontaine Ⅲ and 10 were classified as Fontaine Ⅳ. All cases underwent endovascular operation through antegrade access first with an attempt to cross the occlusive segment, but in vain. So retrograde access was tried via puncture of pedis dorsalis or posterior tibial artery or exposure of lateral branches of posterior tibial artery, peroneal artery or dorsal artery by open surgery,which followed by Percutaneous transluminal angiography and (or) stenting. Results: The operation through retrograde access was successful in all cases with obvious improvement of ischemic symptoms. Hematoma at the puncture site occurred in 3 patients, and paresthesia of toes occurred in 1 after dorsalis pedis arteriotomy. No severe perioperative complication occurred. The average ankle brachial index increased from 0.37 ± 0.11 preoperatively to 0.85 ± 0.12 postoperatively. Conclusions: Retrograde access could be used as an alternative strategy in lower extremity arterial occlusive diseases when the occluded segment could not reach through antegrade access. (authors)

Access safety systems - New concepts from the LHC experience

International Nuclear Information System (INIS)

Ladzinski, T.; Delamare, C.; Luca, S. di; Hakulinen, T.; Hammouti, L.; Havart, F.; Juget, J.F.; Ninin, P.; Nunes, R.; Riesco, T.; Sanchez-Corral Mena, E.; Valentini, F.

2012-01-01

The LHC Access Safety System has introduced a number of new concepts into the domain of personnel protection at CERN. These can be grouped into several categories: organisational, architectural and concerning the end-user experience. By anchoring the project on the solid foundations of the IEC 61508/61511 methodology, the CERN team and its contractors managed to design, develop, test and commission on time a SIL3 safety system. The system uses a successful combination of the latest Siemens redundant safety programmable logic controllers with a traditional relay logic hard wired loop. The external envelope barriers used in the LHC include personnel and material access devices, which are interlocked door-booths introducing increased automation of individual access control, thus removing the strain from the operators. These devices ensure the inviolability of the controlled zones by users not holding the required credentials. To this end they are equipped with personnel presence detectors and the access control includes a state of the art bio-metry check. Building on the LHC experience, new projects targeting the refurbishment of the existing access safety infrastructure in the injector chain have started. This paper summarises the new concepts introduced in the LHC access control and safety systems, discusses the return of experience and outlines the main guiding principles for the renewal stage of the personnel protection systems in the LHC injector chain in a homogeneous manner. (authors)

Stages in the research process.

Science.gov (United States)

Gelling, Leslie

2015-03-04

Research should be conducted in a systematic manner, allowing the researcher to progress from a general idea or clinical problem to scientifically rigorous research findings that enable new developments to improve clinical practice. Using a research process helps guide this process. This article is the first in a 26-part series on nursing research. It examines the process that is common to all research, and provides insights into ten different stages of this process: developing the research question, searching and evaluating the literature, selecting the research approach, selecting research methods, gaining access to the research site and data, pilot study, sampling and recruitment, data collection, data analysis, and dissemination of results and implementation of findings.

Domestic Violence Survivors' Access of Career Counseling Services: A Qualitative Investigation

Science.gov (United States)

Chronister, Krista M.; Linville, Deanna; Kaag, Kristi Palmer

2008-01-01

The present study was a qualitative investigation of the impact of domestic violence on women's career development and the contextual barriers and supports that affect women's ability to access career counseling services. Our sample included 11 women who completed various stages of a community-based career counseling intervention program. The…

Adding a PECS II block for proximal arm arteriovenous access - a randomised study.

Science.gov (United States)

Quek, K H; Low, E Y; Tan, Y R; Ong, A S C; Tang, T Y; Kam, J W; Kiew, A S C

2018-05-01

Brachial plexus block is often utilised for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anaesthetised, requiring repeated, intraoperative local anaesthetic supplementation, or conversion into general anaesthesia. We hypothesised that the addition of a PECS II block would improve anaesthesia and analgesia for proximal arm arteriovenous access surgery. In this prospective, double-blinded, randomised proof-of-concept study, 36 consenting adults with end-stage renal disease aged between 21 and 90 years received either a combined supraclavicular and PECS II block (Group PECS, n = 18), or combined supraclavicular and sham block (Group SCB, n = 18) for proximal arm arteriovenous access surgery. Primary outcome was whether patients required intraoperative local anaesthetic supplementation by the surgeon. In Group PECS, 33.3% (6/18) needed local anaesthetic supplementation vs. 100% (18/18) in Group SCB. Group SCB had three times (RR 3.0, 95% CI 1.6-5.8; P PECS required lower volume of supplemental local anaesthetic compared to Group SCB (0.0 ml, IQR 0.0-6.3 ml vs. 15.0 ml, IQR 7.4-17.8 ml; P PECS II block to a supraclavicular block improves regional anaesthesia for patients with end-stage renal disease undergoing proximal arm arteriovenous access surgery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Health system delay and its effect on clinical stage of breast cancer: Multicenter study.

Science.gov (United States)

Unger-Saldaña, Karla; Miranda, Alfonso; Zarco-Espinosa, Gelasio; Mainero-Ratchelous, Fernando; Bargalló-Rocha, Enrique; Miguel Lázaro-León, Jesús

2015-07-01

The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. This was a cross-sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Breast cancer stage at diagnosis: is travel time important?

Science.gov (United States)

Henry, Kevin A; Boscoe, Francis P; Johnson, Christopher J; Goldberg, Daniel W; Sherman, Recinda; Cockburn, Myles

2011-12-01

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

[Transgastric laparo-endoscopic approach for difficult access lesions. Experimental mode].

Science.gov (United States)

Tapia-Vega, Marcel Adalid; Morales-Chávez, Carlos Ernesto; Aguirre-Olmedo, Itzé; Cuendis-Velázquez, Adolfo; Rojano-Rodríguez, Martín Edgardo; Cárdenas-Lailson, Luis Eduardo

2014-01-01

Gastric neoplasms can be treated by laparoscopy in a safe and efficient way. Some lesions are not accessible to laparoscopic surgery due to their location. A transgastric approach is proposed as an alternative. Show the results with the application of an endoscopic laparotomy in an animal model that maintains functional anatomy, to resect the posterior gastric neoplasms of the stomach wall, close to the cardia and pre-pyloric region. The laparo-endoscopic technique for resection of gastric neoplasms located in the posterior wall was developed in twelve pigs at the Hospital General Gea González from May to December 2011. An endoscopy was performed to establish the site of insertion of intragastric trocars. Three gastrotomies were made in the anterior wall; under endoscopic and laparoscopic vision the trocars were inserted. The stomach was insufflated with CO2. The lesion was resected maintaining a 20 mm circumferencial margin. The gastrotomies were sutured. The statistic analysis was made with t Student and exact Fisher tests. One-hundred percent of resections were achieved in an average time of 102.33 minutes (± 4.50). Two complications and no transoperatory deceases occurred. The technique we describe allows an appropriate approach to gastric lesions located in the posterior wall, those near to the esophagogastric juntion and the prepiloric region, due to the excellent exposure managed by working inside the stomach with a laparoscopic vision and the two intragastric movile ports. The laparoscopic transgastric approach is feasible and safe for the resection of gastric neoplasms located in the posterior wall, those close to the esophago-gastric junction, and the pre-pyloric region.

Design Strategies for Efficient Access to Mobile Device Users via Amazon Mechanical Turk

OpenAIRE

Jacques, Jason; Kristensson, Per Ola

2017-01-01

It is often challenging to access a pool of mobile device users and instruct them to perform an interactive task. Yet such data is often vital to provide design insight at various stages of the design process of a mobile application, service or system. We propose accessing a pool of mobile device users via the microtask market Amazon Mechanical Turk (MTurk). While mobile device users are still a minority on MTurk, they provide unique opportunities for requesters. Not only does catering to mob...

Reliability of visual diagnosis of endometriosis.

Science.gov (United States)

Fernando, Shavi; Soh, Pei Qian; Cooper, Michael; Evans, Susan; Reid, Geoffrey; Tsaltas, Jim; Rombauts, Luk

2013-01-01

To determine whether accuracy of visual diagnosis of endometriosis at laparoscopy is determined by stage of disease. Prospective longitudinal cohort study (Canadian Task Force classification II-2). Tertiary referral centers in three Australian states. Of 1439 biopsy specimens, endometriosis was proved in at least one specimen in 431 patients. Laparoscopy with visual diagnosis and staging of endometriosis followed by histopathologic analysis and confirmation. Operations were performed by five experienced laparoscopic gynecologists. Histopathologic confirmation of visual diagnosis of endometriosis adjusted for significant covariates. Endometriosis was accurately diagnosed in 49.7% of American Society for Reproductive Medicine (ASRM) stage I, which was significantly less accurate than for other stages of endometriosis. Deep endometriosis was more likely to be diagnosed accurately than superficial endometriosis (adjusted odds ratio, 2.51; 95% confidence interval, 1.50-4.18; p < .01). Lesion volume was also predictive, with larger lesions diagnosed more accurately than smaller lesions. In general, lesion site did not greatly influence accuracy except for superficial ovarian lesions, which were more likely to be incorrectly diagnosed visually as endometriosis (adjusted odds ratio, 0.16; 95% confidence interval, 0.06-0.41; p < .01). There was no statistically significant difference in accuracy between the gynecologic surgeons. The accuracy of visual diagnosis of endometriosis was substantially influenced by American Society of Reproductive Medicine stage, the depth and volume of the lesion, and to a lesser extent the location of the lesion. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Laparoscopic training model using fresh human cadavers without the establishment of penumoperitoneum

Directory of Open Access Journals (Sweden)

Ernesto Sasaki Imakuma

2016-01-01

Full Text Available Background: Laparoscopy is a well-established alternative to open surgery for treating many diseases. Although laparoscopy has many advantages, it is also associated with disadvantages, such as slow learning curves and prolonged operation time. Fresh frozen cadavers may be an interesting resource for laparoscopic training, and many institutions have access to cadavers. One of the main obstacles for the use of cadavers as a training model is the difficulty in introducing a sufficient pneumoperitoneum to distend the abdominal wall and provide a proper working space. The purpose of this study was to describe a fresh human cadaver model for laparoscopic training without requiring a pneumoperitoneum. Materials and Methods and Results: A fake abdominal wall device was developed to allow for laparoscopic training without requiring a pneumoperitoneum in cadavers. The device consists of a table-mounted retractor, two rail clamps, two independent frame arms, two adjustable handle and rotating features, and two frames of the abdominal wall. A handycam is fixed over a frame arm, positioned and connected through a USB connection to a television and dissector; scissors and other laparoscopic materials are positioned inside trocars. The laparoscopic procedure is thus simulated. Conclusion: Cadavers offer a very promising and useful model for laparoscopic training. We developed a fake abdominal wall device that solves the limitation of space when performing surgery on cadavers and removes the need to acquire more costly laparoscopic equipment. This model is easily accessible at institutions in developing countries, making it one of the most promising tools for teaching laparoscopy.

How Applicable Are "Ages and Stages Questionnaires" for Use with Turkish Children?

Science.gov (United States)

Kapci, Emine Gul; Kucuker, Sevgi; Uslu, Runa I.

2010-01-01

The majority of eligible children cannot access early intervention services in Turkey, often because they are not assessed. The authors adapted the "Ages and Stages Questionnaires" (ASQ) for Turkish children ages 3 to 72 months. Study participants consisted of 375 children who were classified as at risk for developmental delays, 564…

Pediatric laparoscopic surgery in North-Central Nigeria: Achievements and challenges

Directory of Open Access Journals (Sweden)

Lukman Olajide Abdur-Rahman

2016-01-01

Full Text Available Background and Objective: Advances in laparoscopy are making the service accessible even in resource-poor countries where adaptations are made to meet local challenges. We report our experience in the provision of laparoscopy service to children at a tertiary health center in North-central Nigeria. Methods: A team of pediatric surgeons, anesthetists, and nurses collaborated to provide service and train other personnel. A prospective collection of data on biodata, diagnoses, procedure, and outcome over an effective period of 36 months of laparoscopy intervention of the 54 months between September 2009 and February 2014 was done. Consent, which also included the possibility of conversion to open was obtained from the parents of the patients. Results: A total of 73 patients aged 2 weeks to 16 years with a male: female ratio of 3 to 1 had laparoscopy done during the period. Fifty-two (71.2% procedures were therapeutic, and 21 (28.8% cases were done as emergency. Laparoscopic appendectomy was the most commonly performed procedure 25 (34.3%, followed by laparoscopic orchidopexy 17 (23. 3%, and diagnostic laparoscopy for disorders of sexual differentiation in 13 (17.8%. The length of stay in hospital postoperative was 1-3 days with a mean of 1.34 ΁ 0.45 days. The complications recorded included hemorrhage, in a case of infantile hypertrophic pyloric stenosis due to failed electrocautery, one port site burns injury from diathermy dissection, and two periport pain postoperation. There was no mortality recorded. Conclusion: Pediatric laparoscopic service is gaining recognition in our practice in spite of poor resources, incessant industrial actions, and apathy from support staff. The outcomes are encouraging as the patients had minimal morbidities. Skills are improved through practice and retraining and manpower, and instruments are being expanded through our collaboration and training.

Ontogenetic changes and developmental adjustments in lactate dehydrogenase isozymes of an obligate air-breathing fish Channa punctatus during deprivation of air access.

Science.gov (United States)

Ahmad, Riaz; Hasnain, Absar-Ul

2005-02-01

In air-breathing snakehead Channa punctatus, Ldh-B is expressed at all ontogenetic and developmental stages, while Ldh-A is expressed temporally in pre-hatchlings 12-13 days ahead of bimodal respiration marked by air-breathing. Remarkable differences are observed in the LDH isozyme expression among various ontogenetic and developmental stages upon denying air access. When denied air access, water-breathing larvae show two distinct characteristics: (i) they survive longer than transitory air-breathers due to independence from air-breathing and (ii) there is more transient induction of Ldh-B than Ldh-A. Transition to bimodal breathing, which occurred post-hatching in 15-day old larvae, is coincidental with inducibility of Ldh-A and concomitant down-regulation of Ldh-B. Heart tissue from air-breathing adults denied air access shows a preferential expression of LDH-A subunit and slight down-regulation of LDH-B. Heterotetramers of A and B subunits participate in adjusting LDH levels among those stages which either precede air-breathing switchover, or are subsequent to this transition. The contribution of heterotetramers depends on the stage-specific levels of LDH homotetramers A(4) or B(4). Scaling of muscle mass during growth, tolerance to extended deprivation of air access and induction of Ldh-A are correlated. Response to restoring air contact indicated that advanced air-breathing stages of C. punctatus possess an inherent capacity to sense surface air. In kinetic properties, LDH isozymes of C. punctatus are teleost-like but species specificity is displayed in oxidative potential by cardiac muscle and in L-lactate reduction by skeletal muscle.

Essential oils of Varronia curassavica accessions have different activity against white spot disease in freshwater fish.

Science.gov (United States)

de Castro Nizio, Daniela Aparecida; Fujimoto, Rodrigo Yudi; Maria, Alexandre Nizio; Carneiro, Paulo César Falanghe; França, Carina Caroline Silva; da Costa Sousa, Natalino; de Andrade Brito, Fabiany; Sampaio, Taís Santos; de Fátima Arrigoni-Blank, Maria; Blank, Arie Fitzgerald

2018-01-01

The aim of this study was to evaluate the antiprotozoal activity of essential oils from Varronia curassavica accessions against different stages of Ichthyophthirius multifiliis. Essential oils from each accession were tested in vitro at the concentrations 0, 10, 25, 50, 75, 100, and 200 mg/L. The VCUR-001, VCUR-202, VCUR-509, and VCUR-601 accessions presented the major compounds α-pinene, germacrene D-4-ol, (E)-caryophyllene and epiglobulol, and sabinene, respectively. These isolated compounds were tested in vitro at a concentration proportional to that found in the essential oil which caused 100% mortality of the parasite. The concentrations of 10 and 50 mg/L of the essential oil of accession VCUR-202 provided 100% mortality of trophonts and tomonts, respectively. For the accession VCUR-509, 100% mortality of trophonts and tomonts was observed at concentrations 75 and 200 mg/L of essential oil, respectively. The same mortality was observed at concentration 200 mg/L in both stages of the parasite for the other accessions. The major compounds α-pinene, sabinene, and the (E)-caryophyllene + epiglobulol mixture caused 100% mortality of trophonts and tomonts. The in vivo assay for white spot disease control was performed in a therapeutic bath of 1 h with the essential oil of accession VCUR-202 at concentrations of 0.5 and 2.0 mg/L. A significant reduction of about 30% of trophonts on infected fish was observed, independent of the oil concentration. The V. curassavica essential oil, especially the VCUR-202 accession, is a potential source of raw material for the formulation and commercialization of bioproducts to control freshwater white spot disease in fish.

The Challenge of Access: Using Road Construction as a Tool in Counterinsurgency

Science.gov (United States)

2011-06-10

furnished the advertised advantages to the tribes, and the frequency of military movement on them betrayed their fundamental use as methods of access into...staging area. Nestled in a small valley amongst towering Shahmardan Mountains, the area was referred to as the ―belly button.‖ The Chenartu valley

Czechoslovakia's participation in IAEA's INIS/AGRIS direct access experiment

International Nuclear Information System (INIS)

Stanik, Z.

1980-01-01

The task of establishing direct access to the INIS data base is being implemented in Czechoslovakia by the Nuclear Information Centre in Prague-Zbraslav. The aim and meaning of the experiment is to build a Czechoslovak network of terminals linked to the IAEA with the possibility of future connections to other data bases. The first stage is characterized by the use of a dial-up line. (M.S.)

Antioxidant Capacity and Total Phenolic Content in Fruit Tissues from Accessions of Capsicum chinense Jacq. (Habanero Pepper at Different Stages of Ripening

Directory of Open Access Journals (Sweden)

Lizbeth A. Castro-Concha

2014-01-01

Full Text Available In the past few years, there has been a renewed interest in studying a wide variety of food products that show beneficial effects on human health. Capsicum is an important agricultural crop, not only because its economic importance, but also for the nutritional values of its pods, mainly due to the fact that they are an excellent source of antioxidant compounds, and also of specific constituents such as the pungent capsaicinoids localized in the placental tissue. This current study was designed to evaluate the antioxidant capacity and total phenolic contents from fruits tissues of two Capsicum chinense accessions, namely, Chak k’an-iik (orange and MR8H (red, at contrasting maturation stages. Results showed that red immature placental tissue, with a Trolox equivalent antioxidant capacity (TEAC value of 55.59 μmols TE g−1 FW, exhibited the strongest total antioxidant capacity using both the 2,2-diphenyl-1-picrylhydrazyl (DPPH and the CUPRAC methods. Placental tissue also had the highest total phenolic content (27 g GAE 100 g−1 FW. The antioxidant capacity of Capsicum was directly related to the total amount of phenolic compounds detected. In particular, placentas had high levels of capsaicinoids, which might be the principal responsible for their strong antioxidant activities.

Antioxidant Capacity and Total Phenolic Content in Fruit Tissues from Accessions of Capsicum chinense Jacq. (Habanero Pepper) at Different Stages of Ripening

Science.gov (United States)

Tuyub-Che, Jemina; Moo-Mukul, Angel; Vazquez-Flota, Felipe A.; Miranda-Ham, Maria L.

2014-01-01

In the past few years, there has been a renewed interest in studying a wide variety of food products that show beneficial effects on human health. Capsicum is an important agricultural crop, not only because its economic importance, but also for the nutritional values of its pods, mainly due to the fact that they are an excellent source of antioxidant compounds, and also of specific constituents such as the pungent capsaicinoids localized in the placental tissue. This current study was designed to evaluate the antioxidant capacity and total phenolic contents from fruits tissues of two Capsicum chinense accessions, namely, Chak k'an-iik (orange) and MR8H (red), at contrasting maturation stages. Results showed that red immature placental tissue, with a Trolox equivalent antioxidant capacity (TEAC) value of 55.59 μmols TE g−1 FW, exhibited the strongest total antioxidant capacity using both the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and the CUPRAC methods. Placental tissue also had the highest total phenolic content (27 g GAE 100 g−1 FW). The antioxidant capacity of Capsicum was directly related to the total amount of phenolic compounds detected. In particular, placentas had high levels of capsaicinoids, which might be the principal responsible for their strong antioxidant activities. PMID:24683361

Improving patient access to an interventional US clinic.

Science.gov (United States)

Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

2014-01-01

A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014.

Scintigraphy in the diagnosis of liver cancers. Study of 54 observations with anatomical confrontation

International Nuclear Information System (INIS)

Labro, R.D.A.

1976-01-01

This study attempts to judge the reliability of scintigraphy in the diagnosis of liver cancers. It concerns 54 observations with anatomical confrontation (laparoscopy, biopsy, laparotomy and/or autopsy). Technetium 99m scintigraphy gives a correct diagnosis in 81.5% of the cases, whether cirrhosis is present or not. Scintigraphy is only one stage in the investigation of neoplasic liver disease. This study shows that all too often it is practised alone since of 201 observations only 54 include another examination, and of these only 21 a laparoscopy. The simultaneous use of scintigraphy and laparoscopy eliminates false positives and reduces the percentage of false negatives from 7.5% to 4%. The two methods combined are therefore reliable to 96% (i.e. 96% of successful diagnosis in liver cancer tests. This work was performed with the techniques available in 1973. The quality of the scintigraphic image should be improved by technical progress in the form of new isotopic products, cameras with better definition and computerized data processing. With these new techniques it will certainly be possible to detect very small lacunae and to observe in more detail their diffusion in the liver parenchyma [fr

[Combination Chemotherapy Including Intraperitoneal(IP)Administration of Paclitaxel(PTX)followed by PTX, CDDP and S-1Triplet Chemotherapy for CY1P0 Gastric Cancer].

Science.gov (United States)

Shinkai, Masayuki; Imano, Motohiro; Hiraki, Yoko; Kato, Hiroaki; Iwama, Mitsuru; Shiraishi, Osamu; Yasuda, Atsushi; Kimura, Yutaka; Imamoto, Haruhiko; Furukawa, Hiroshi; Yasuda, Takushi

2017-11-01

We evaluate the feasibility and efficacy of combination chemotherapy including single intraperitoneal( IP)administration of paclitaxel(PTX), followed by triplet chemotherapy(PTX, cisplatin[CDDP]and S-1: PCS)for CY1P0 gastric cancer. First of all, we performed staging laparoscopy and confirmed CY1P0, and secondary, administrated PTX intraperitoneally. Thirdly, patients received PCS chemotherapy for 2 courses. After antitumor effect had been confirmed, we performed second look laparoscopy. In the case of CY0P0, we performed gastrectomy with D2 lymph nodes dissection. Total 4 patients were enrolled. Grade 3 leukopenia and neutropenia were observed in one patient while intraperitoneal and systemic-chemotherapy. One patients showed PR and 3 patients showed SD. All patients underwent second look laparoscopy. CY0P0 was observed in all patients and gastrectomy with D2 dissection was performed for all patients. Postoperative complications were observed in 2 patients. Two patients were still alive without recurrence, while the remaining 2 had died of liver metastasis and #16 LN metastasis. Combination chemotherapy including single IP PTX followed by PCS systemic-chemotherapy for CY1P0 gastric cancer is feasible and efficient.

The Effect of Haemodialysis Access Types on Cardiac Performance and Morbidities in Patients with Symptomatic Heart Disease.

Science.gov (United States)

Chuang, Min-Kai; Chang, Chin-Hao; Chan, Chih-Yang

2016-01-01

Little is known about whether the arteriovenous type haemodialysis access affects cardiac function and whether it is still advantageous to the uremic patient with symptomatic heart disease. We conducted a retrospective comparative study. Patients with heart disease and end-stage renal disease that had a new chronic access created between January 2007 and December 2008 and met the inclusion criteria were assessed. The endpoint was major adverse event (MAE)-free survivals of arteriovenous access (AVA) and tunneled cuffed double-lumen central venous catheter (CVC) groups. Whether accesses worsened heart failure was also evaluated. There were 43 CVC patients and 60 AVA patients. The median follow-up time from access creation was 27.6 months (IQR 34.7, 10.9~45.6). Although CVC patients were older than AVA patients (median age 78.0, IQR 14.0 vs. 67.5, IQR 16.0, respectively, p = .009), they manifested non-inferior MAE-free survival (mean 17.1, 95% CI 10.3~24.0 vs. 12.9, 95% CI 8.5~17.4 months in CVC and AVA patients, respectively, p = .290). During follow-up, more patients in the AVA group than in the CVC group deteriorated in heart failure status (35 of 57 vs. 10 of 42, respectively, odds ratio 5.1, p heart disease and end stage renal disease (ESRD), CVC patients showed non-inferior MAE-free survival in comparison to those in the AVA group. AV type access could deteriorate heart failure. Accordingly, uremic patients with symptomatic heart disease are not ideal candidates for AV type access creation.

Low-sampling-rate M-ary multiple access UWB communications in multipath channels

KAUST Repository

Alkhodary, Mohammad T.

2015-08-31

The desirable characteristics of ultra-wideband (UWB) technology are challenged by formidable sampling frequency, performance degradation in the presence of multi-user interference, and complexity of the receiver due to the channel estimation process. In this paper, a low-rate-sampling technique is used to implement M-ary multiple access UWB communications, in both the detection and channel estimation stages. A novel approach is used for multiple-access-interference (MAI) cancelation for the purpose of channel estimation. Results show reasonable performance of the proposed receiver for different number of users operating many times below Nyquist rate.

Low-sampling-rate M-ary multiple access UWB communications in multipath channels

KAUST Repository

Alkhodary, Mohammad T.; Ballal, Tarig; Al-Naffouri, Tareq Y.; Muqaibel, Ali H.

2015-01-01

The desirable characteristics of ultra-wideband (UWB) technology are challenged by formidable sampling frequency, performance degradation in the presence of multi-user interference, and complexity of the receiver due to the channel estimation process. In this paper, a low-rate-sampling technique is used to implement M-ary multiple access UWB communications, in both the detection and channel estimation stages. A novel approach is used for multiple-access-interference (MAI) cancelation for the purpose of channel estimation. Results show reasonable performance of the proposed receiver for different number of users operating many times below Nyquist rate.

In vitro propagation and acclimatization of genipapo accessions

Directory of Open Access Journals (Sweden)

Francielen Paola de Sa

2016-04-01

Full Text Available ABSTRACT Genipapo is a species with an intermediate seed storage behavior, and its germination is slow and asynchronous; therefore the tissue culture is an alternative strategy for the propagation in large-scale. This study aimed to evaluate three genipapo accessions at different micropropagation stages (adventitious shoot induction, in vitro rooting and acclimatization. Genipapo nodal segments from the Sabinópolis (AS, Cruz das Almas (CZA and Núcleo Bandeirante (NB accessions were used and inoculated in culture media with 0 and 1.0 mg L-1 6-benzylaminopurine (BAP. Different indole-3-butyric acid (IBA concentrations were tested for in vitro rooting. Subsequently, the effect of two substrates on the seedling development of three genipapo accessions was assessed. The molecular characterization of accessions was performed using 15 inter-simple sequence repeat (ISSR primers, and genotype clustering was performed based on genetic dissimilarity using the Unweighted Pair-Group Method with Arithmetic Mean (UPGMA. Culture media supplementation with 1.0 mg L-1 BAP favors the development of adventitious shoots and promotes a higher callogenesis percentage, leaf number and feasibility at 90 days of in vitro culture. The immersion of the basal portion of shoots for 20 seconds in all IBA solutions induces the rhizogenesis in the genipapo accessions at 90 days of in vitro culture. The substrates consisting of washed sand + dried coconut shell powder, at a 1:1 ratio by volume, and Topstrato HT(r may be recommended for genipapo acclimatization. The NB accession is genetically different from the CZA and AS populations and shows superiority for most of the variables analyzed.

Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery

DEFF Research Database (Denmark)

Schulze, S; Lyng, K M; Bugge, K

1999-01-01

Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery.......Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery....

Accessing external innovation in drug discovery and development.

Science.gov (United States)

Tufféry, Pierre

2015-06-01

A decline in the productivity of the pharmaceutical industry research and development (R&D) pipeline has highlighted the need to reconsider the classical strategies of drug discovery and development, which are based on internal resources, and to identify new means to improve the drug discovery process. Accepting that the combination of internal and external ideas can improve innovation, ways to access external innovation, that is, opening projects to external contributions, have recently been sought. In this review, the authors look at a number of external innovation opportunities. These include increased interactions with academia via academic centers of excellence/innovation centers, better communication on projects using crowdsourcing or social media and new models centered on external providers such as built-to-buy startups or virtual pharmaceutical companies. The buzz for accessing external innovation relies on the pharmaceutical industry's major challenge to improve R&D productivity, a conjuncture favorable to increase interactions with academia and new business models supporting access to external innovation. So far, access to external innovation has mostly been considered during early stages of drug development, and there is room for enhancement. First outcomes suggest that external innovation should become part of drug development in the long term. However, the balance between internal and external developments in drug discovery can vary largely depending on the company strategies.

OneGeology - Access to geoscience for all

Science.gov (United States)

Komac, Marko; Lee, Kathryn; Robida, Francois

2014-05-01

OneGeology is an initiative of Geological Survey Organisations (GSO) around the globe that dates back to Brighton, UK in 2007. Since then OneGeology has been a leader in developing geological online map data using a new international standard - a geological exchange language known as 'GeoSciML'. Increased use of this new language allows geological data to be shared and integrated across the planet with other organisations. One of very important goals of OneGeology was a transfer of valuable know-how to the developing world, hence shortening the digital learning curve. In autumn 2013 OneGeology was transformed into a Consortium with a clearly defined governance structure, making its structure more official, its operability more flexible and its membership more open where in addition to GSO also to other type of organisations that manage geoscientific data can join and contribute. The next stage of the OneGeology initiative will hence be focused into increasing the openness and richness of that data from individual countries to create a multi-thematic global geological data resource on the rocks beneath our feet. Authoritative information on hazards and minerals will help to prevent natural disasters, explore for resources (water, minerals and energy) and identify risks to human health on a planetary scale. With this new stage also renewed OneGeology objectives were defined and these are 1) to be the provider of geoscience data globally, 2) to ensure exchange of know-how and skills so all can participate, and 3) to use the global profile of 1G to increase awareness of the geosciences and their relevance among professional and general public. We live in a digital world that enables prompt access to vast amounts of open access data. Understanding our world, the geology beneath our feet and environmental challenges related to geology calls for accessibility of geoscientific data and OneGeology Portal (portal.onegeology.org) is the place to find them.

Minimal Access Surgery Educational Needs of Trainees from Africa: Perspectives from an Asian Training Institution.

Science.gov (United States)

Ahmad, J I; Mishra, R K

2015-01-01

The establishment of minimal access surgery (MAS) in the last three decades brought new dimensions to surgical training. The sole role of traditional apprenticeship training model was challenged and adjunctive surgical simulation models were introduced. Knowledge of the trainees' educational needs is important in designing MAS training curriculum. To study the MAS educational needs of trainees from Africa, review MAS training models and offer recommendations for MAS training. Data was obtained from questionnaires filled by trainees from Africa who attended the monthly MAS training at the World Laparoscopy Hospital, India from October 2013 to May 2014 about their MAS educational needs. There were 38 trainees from different parts of Africa (Central, East, North, South and West Africa) with average age of 41.92 ± 8.67 years (minimum-28 years and maximum 63 years) and majority were males (92%). General surgeons constituted 57% while Gynaecologists were 41%. Only a quarter have MAS training integrated in their training curriculum. Box trainers, Animal models, live human surgeries and virtual reality simulation were the commonest models used in previous trainings and favoured in the educational needs for MAS training. Using cadaveric models and self sponsorship were deemphasised. Widespread application of MAS, globalisation and trainees educational needs call for establishing training programmes. Box trainers, animal models, live human surgeries and virtual reality simulators should be adopted and a synergy between Postgraduate surgical programmes, biomedical industry, universities and trainees will facilitate the setting of MAS skills laboratories and programmes.

Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol.

Science.gov (United States)

Mheta, Doreen; Mashamba-Thompson, Tivani P

2017-05-16

The Sustainable Development Goals (SDGs) emphasises the increasing equitable coverage of quality health care and provision of integrated services as means of reducing maternal mortality. Despite so much effort being placed on improved access to maternity health care, studies show that women with disabilities are being systemically excluded from the mainstream maternal health services. The proposed scoping review aims to map literature on the barriers and facilitators of access to maternal services for women with disabilities. The search strategy for this scoping review study will involve electronic databases including Pubmed, MEDLINE via EBSCOhost, CINAHL Plus with full text via EBSCOhost, Africa-Wide Info via EBSCOhost, JSTOR and Proquest Health and Medical Complete. Articles will also be searched through the "Cited by" search as well as citations included in the reference lists of included articles. A two-stage mapping strategy would be conducted. Stage 1 would be to screen studies through examining their titles. Furthermore, we will screen abstracts of the identified studies descriptively and by focus and method as stipulated by the inclusion and exclusion criteria. In stage 2, we will extract data from the included studies. A parallel screening and data extraction will be undertaken by two reviewers. We will access the quality of the included studies using the mixed methods appraisal tool (MMAT). We will use NVIVO version 10 to extract the relevant outcomes and thematic analysis of the studies. We anticipate to find relevant studies reporting evidence on the barriers and facilitators of access to maternal health services in Sub-Saharan Africa. The evidence obtained from the included studies when summarised will help guide future research. The study findings will be disseminated electronically and in print. In addition, it will be presented at conferences related to sexual reproductive health, maternal health care and reproductive health.

The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.

Science.gov (United States)

Johnson, Jeremy J; Garwe, Tabitha; Raines, Alexander R; Thurman, Joseph B; Carter, Sandra; Bender, Jeffrey S; Albrecht, Roxie M

2013-03-01

Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

Outcomes of patients presenting to a dedicated rapid access lung cancer clinic.

LENUS (Irish Health Repository)

Dunican, E

2012-02-01

We examined the outcomes of the first 500 patients referred to a dedicated Rapid Access Lung Cancer Clinic. A total of 206 patients (41.2%) were diagnosed with a thoracic malignancy; 179 had primary lung cancer and 27 had secondary or other thoracic cancers. Pulmonary nodules requiring ongoing surveillance were found in a further 79 patients (15.8%). Of those patients found to have primary lung cancer, 24 (13.4%) had Small Cell and 145 (81%) had Non Small Cell Lung Cancer. In patients with Non small cell tumours, 26 (21.1%) were stage 1, 14 (11.4%) stage II, 37 (30.1%) stage III and 46 (37.4%) stage IV at diagnosis. For the 129 patients (72%) in whom the thoracic MDT recommended active treatment, primary therapy was surgical resection in 44 (24.6%), combined chemoradiation in 31 patients (17.3%), chemotherapy alone in 39 (21.8%) and radiation in 15 (8.4%).

Accessible Knowledge - Knowledge on Accessibility

DEFF Research Database (Denmark)

Kirkeby, Inge Mette

2015-01-01

Although serious efforts are made internationally and nationally, it is a slow process to make our physical environment accessible. In the actual design process, architects play a major role. But what kinds of knowledge, including research-based knowledge, do practicing architects make use of when...... designing accessible environments? The answer to the question is crucially important since it affects how knowledge is distributed and how accessibility can be ensured. In order to get first-hand knowledge about the design process and the sources from which they gain knowledge, 11 qualitative interviews...... were conducted with architects with experience of designing for accessibility. The analysis draws on two theoretical distinctions. The first is research-based knowledge versus knowledge used by architects. The second is context-independent knowledge versus context-dependent knowledge. The practitioners...

Are stage IV vestibular schwannomas preoperatively different from other stages?

Science.gov (United States)

Tringali, Stéphane; Dubreuil, Christian; Zaouche, Sandra; Ferber-Viart, Chantal

2008-01-01

The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs). In this prospective study, we included 734 patients who have VS and candidates for operation. Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison. Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In

New capabilities in the HENP grand challenge storage access system and its application at RHIC

International Nuclear Information System (INIS)

Bernardo, L.; Gibbard, B.; Malon, D.; Nordberg, H.; Olson, D.; Porter, R.; Shoshani, A.; Sim, A.; Vaniachine, A.; Wenaus, T.; Wu, K.; Zimmerman, D.

2000-01-01

The High Energy and Nuclear Physics Data Access Grand Challenge project has developed an optimizing storage access software system that was prototyped at RHIC. It is currently undergoing integration with the STAR experiment in preparation for data taking that starts in mid-2000. The behavior and lessons learned in the RHIC Mock Data Challenge exercises are described as well as the observed performance under conditions designed to characterize scalability. Up to 250 simultaneous queries were tested and up to 10 million events across 7 event components were involved in these queries. The system coordinates the staging of ''bundles'' of files from the HPSS tape system, so that all the needed components of each event are in disk cache when accessed by the application software. The caching policy algorithm for the coordinated bundle staging is described in the paper. The initial prototype implementation interfaced to the Objectivity/DB. In this latest version, it evolved to work with arbitrary files and use CORBA interfaces to the tag database and file catalog services. The interface to the tag database and the MySQL-based file catalog services used by STAR are described along with the planned usage scenarios

Towards Communication and Information Access for Deaf People

Directory of Open Access Journals (Sweden)

Edwin Blake

2014-10-01

Full Text Available In tightly circumscribed communication situations an interactive system resident on a mobile device can assist Deaf people with their communication and information needs. The Deaf users considered here use South African Sign Language and information is conveyed by a collection of pre-recorded video clips and images. The system was developed according to our method of community-based co-design. We present several stages of the development as a series of case studies and highlight our experience. The first stage involved ethnographically inspired methods such as cultural probes. In the next stage we co-designed a medical consultation system that was ultimately dropped for technical reasons. A smaller system was developed for pharmaceutical dispensing and successfully implemented and tested. It now awaits deployment in an actual pharmacy. We also developed a preliminary authoring tool to tackle the problem of content generation for interactive computer literacy training. We are also working on another medical health information tool. We intend that a generic authoring tool be able to generate mobile applications for all of these scenarios. These mobile applications bridge communication gaps for Deaf people via accessible and affordable assistive technology.

Access to dental care among 15–64 year old people

Science.gov (United States)

Eslamipour, Faezeh; Heydari, Kamal; Ghaiour, Marzieh; Salehi, Hoda

2018-01-01

INTRODUCTION: The current study aims to study people's access to oral and dental health-care services and their satisfaction with the services provided to them. MATERIALS AND METHODS: A descriptive study with multi-stage sampling was conducted on 1360 people aged 16–64 years residing in Isfahan city, Iran. The required data were collected by a questionnaire which comprised of three main parts: demographic characteristics, patients’ access to oral and dental health-care services and its barriers and participants’ satisfaction with access to services. Data were analyzed by SPSS statistical software. RESULTS: The results showed 40% of participants reported an average level for oral health, and 82% of them did not have any problems regarding access to dental care facilities. The main causes of their dissatisfaction were high cost of services (60%) and insufficient health insurance coverage (40%). About 73% reported that they had to spend 30 min or less to access to a dental health-care facility. In addition, 50% of participants were satisfied with the provided services. The main reported reasons for referring to dentists were oral and dental problems (69%) and regular check-ups (15%). There was no significant relationship between participants’ gender, education level, insurance coverage, and access to dental health-care centers (P > 0.05). CONCLUSION: Most participants were satisfied with access to dental healthcare, but they were dissatisfied with the costs and inadequate insurance coverage. About half of the participants were satisfied with the services provided to them, and the highest level of satisfaction was reported for easy access to health-care centers. PMID:29693027

A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712

Directory of Open Access Journals (Sweden)

Piller Marsha D

2003-08-01

Full Text Available Abstract Background Gynecological laparoscopic surgery procedures are often complicated by postoperative pain resulting in an unpleasant experience for the patient, delayed discharge, and increased cost. Glucocorticosteroids have been suggested to reduce the severity and incidence of postoperative pain. Methods This study examines the efficacy of a sustained release betamethasone preparation to reduce postoperative pain and the requirement for pain relief drugs after either diagnostic laparoscopy or tubal ligation. Patients were recruited, as presenting, after obtaining informed consent. Prior to surgery, patients were randomly selected by a computer generated table to receive either pharmacy-coded betamethasone (12 mg IM Celestone™ or an optically identical placebo injection of Intralipid™ and isotonic saline mixture. The effect of non-controlled prophylactic intraoperative treatment with either fentanyl or ketorolac per surgeon's orders was also noted in this study. Blood samples taken at recovery and at discharge times were extracted and analyzed for circulating betamethasone. Visual analog scale data on pain was gathered at six post-recovery time points in a triple blind fashion and statistically compared. The postoperative requirement for pain relief drugs was also examined. Results Although the injection achieved a sustained therapeutic concentration, no beneficial effect of IM betamethasone on postoperative pain or reduction in pain relief drugs was observed during the postoperative period. Indeed, the mean combined pain scores during the 2 hour postoperative period, adjusted for postoperative opioids as the major confounding factor, were higher approaching statistical significance (P = 0.056 in the treatment group. Higher pain scores were also observed for the tubal ligation patients relative to diagnostic laparoscopy. Intraoperative fentanyl treatment did not significantly lower the average pain score during the 2 hour postoperative

Prolactin and cortisol levels in women with endometriosis

Directory of Open Access Journals (Sweden)

A.P. Lima

2006-08-01

Full Text Available Endometriosis is a progressive estrogen-dependent disease affecting women during their reproductive years. The objective of the present study was to investigate whether endometriosis is associated with stress parameters. We determined cortisol and prolactin levels in serum, peritoneal and follicular fluid from infertile women with endometriosis and fertile women without the disease. The extent of the disease was staged according to the revised American Fertility Society classification (1997. Serum and peritoneal fluid were collected from 49 women aged 19 to 39 years undergoing laparoscopy. Eighteen women had stage I-II endometriosis and 10 had stage III-IV. Controls were 21 women undergoing laparoscopy for tubal sterilization. Follicular fluid was obtained from 39 women aged 25-39 years undergoing in vitro fertilization (21 infertile women with endometriosis and 18 infertile women without endometriosis. Serum prolactin levels were significantly higher in infertile women with stage III-IV endometriosis (28.9 ± 2.1 ng/mL than in healthy controls (13.2 ± 2.1 ng/mL. Serum cortisol levels were significantly higher in infertile women with stage III-IV endometriosis (20.1 ± 1.3 ng/mL than in controls (10.5 ± 1.4 ng/mL. Cortisol and prolactin levels in follicular fluid and peritoneal fluid did not differ significantly between groups. The high levels of cortisol and prolactin in the serum from women with endometriosis might contribute to the subfertility frequently associated with the disease. Moreover, since higher levels of cortisol and prolactin are often associated with stress, it is probable that stress might contribute to the development of endometriosis and its progression to advanced stages of the disease.

Plant and Floret Growth at Distinct Developmental Stages During the Stem Elongation Phase in Wheat

Directory of Open Access Journals (Sweden)

Zifeng Guo

2018-03-01

Full Text Available Floret development is critical for grain setting in wheat (Triticum aestivum, but more than 50% of grain yield potential (based on the maximum number of floret primordia is lost during the stem elongation phase (SEP, from the terminal spikelet stage to anthesis. Dynamic plant (e.g., leaf area, plant height and floret (e.g., anther and ovary size growth and its connection with grain yield traits (e.g., grain number and width are not clearly understood. In this study, for the first time, we dissected the SEP into seven stages to investigate plant (first experiment and floret (second experiment growth in greenhouse- and field-grown wheat. In the first experiment, the values of various plant growth trait indices at different stages were generally consistent between field and greenhouse and were independent of the environment. However, at specific stages, some traits significantly differed between the two environments. In the second experiment, phenotypic and genotypic similarity analysis revealed that grain number and size corresponded closely to ovary size at anthesis, suggesting that ovary size is strongly associated with grain number and size. Moreover, principal component analysis (PCA showed that the top six principal components PCs explained 99.13, 98.61, 98.41, 98.35, and 97.93% of the total phenotypic variation at the green anther, yellow anther, tipping, heading, and anthesis stages, respectively. The cumulative variance explained by the first PC decreased with floret growth, with the highest value detected at the green anther stage (88.8% and the lowest at the anthesis (50.09%. Finally, ovary size at anthesis was greater in wheat accessions with early release years than in accessions with late release years, and anther/ovary size shared closer connections with grain number/size traits at the late vs. early stages of floral development. Our findings shed light on the dynamic changes in plant and floret growth-related traits in wheat and the

Permanent vascular access survival in children on long-term chronic hemodialysis.

Science.gov (United States)

Briones, Liliana; Diaz Moreno, Alexia; Sierre, Sergio; Lopez, Laura; Lipsich, José; Adragna, Marta

2010-09-01

The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p Access stenosis, thrombosis and infection episodes occurred more frequently in AVG (p = 0.02). VAs had a high rate of interventions. Our study demonstrated better results of AVFs formation over AVGs, for long-term HD access in pediatrics. Surveillance and radiologic procedures are necessary for early detection and treatment of access complications in order to extend access survival.

Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer

Science.gov (United States)

2017-05-03

Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

Insurance status effects on stage of diagnosis and surgical options used in the treatment of breast cancer.

Science.gov (United States)

Lukavsky, Robert; Sariego, Jack

2015-05-01

Insurance status has the potential to play a significant role in an individual's health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered. The American College of Surgeons' National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated. There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively. The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.

Fixing Accessibility Issues in Open-Source Teaching Repositories

Directory of Open Access Journals (Sweden)

Francisco Javier Díaz

2017-12-01

Full Text Available In the LINTI, New Information Technologies Research Laboratory at the Computer Science School, in the National University of La Plata, it is being developed a project that involves the integration of the repository, implemented using DSpace, with different tools and platforms used in academic tasks. Accessibility is a process that cuts across all software development stages, so when using a free software product it is important to evaluate it in order to correct faults if it´s necessary. This article describes a DSpace repository accessibility validation, using screen readers for manual test, automatic validation with software tools and experimental test with users with and without disabilities. The evaluation involves the proper basic functions and the implemented extensions. The original DSpace software was extended through the integration with different tools and platforms, such as Moodle LMS, the library management system called Meran, file management services like DropBox and GoogleDrive and the social network Facebook.  The tools used during accessibility evaluation were Examinator, Google ChromeVox and one entirely implemented in the LINTI, called SiMor. The experimental tests were made with blind and deaf persons, most of them college students. All the validation results are detailed using tables and graphs, where it can observe the measured values. It is also described the changes that was necessary to carry out in the repository to improve the user experience and ensure Web service accessibility.

Survival Advantage Associated with Decrease in Stage at Detection from Stage IIIC to Stage IIIA Epithelial Ovarian Cancer

Science.gov (United States)

Lefringhouse, Jason; Pavlik, Edward; Miller, Rachel; DeSimone, Christopher; Ueland, Frederick; Kryscio, Richard; van Nagell, J. R.

2014-01-01

Objective. The aim of this study was to document the survival advantage of lowering stage at detection from Stage IIIC to Stage IIIA epithelial ovarian cancer. Methods. Treatment outcomes and survival were evaluated in patients with Stage IIIA and Stage IIIC epithelial ovarian cancer treated from 2000 to 2009 at the University of Kentucky Markey Cancer Center (UKMCC) and SEER institutions. Results. Cytoreduction to no visible disease (P < 0.0001) and complete response to platinum-based chemotherapy (P < 0.025) occurred more frequently in Stage IIIA than in Stage IIIC cases. Time to progression was shorter in patients with Stage IIIC ovarian cancer (17 ± 1 months) than in those with Stage II1A disease (36 ± 8 months). Five-year overall survival (OS) improved from 41% in Stage IIIC patients to 60% in Stage IIIA patients treated at UKMCC and from 37% to 56% in patients treated at SEER institutions for a survival advantage of 19% in both data sets. 53% of Stage IIIA and 14% of Stage IIIC patients had NED at last followup. Conclusions. Decreasing stage at detection from Stage IIIC to stage IIIA epithelial ovarian cancer is associated with a 5-year survival advantage of nearly 20% in patients treated by surgical tumor cytoreduction and platinum-based chemotherapy. PMID:25254047

Open DOAR the Directory of Open Access Repositories

CERN Multimedia

CERN. Geneva

2005-01-01

The last year has seen wide-spread growth in the idea of using open access repositories as a part of a research institution's accepted infrastructure. Policy development from institutions and funding bodies has also supported the growth of the repository network. The next stage of expansion will be in the provision of services and cross-repository facilities and resources. Of course, it is hoped that these will then establish a feed-back loop to encourage repository population and further repository establishment, as the potential of open access to research materials is realised. The growth of repositories has been organic, with a variety of different repositories based in departments, institutions, funding agencies or subject communities, with a range of content, both in type and subject. Existing repositories are expanding their holdings, from eprints to associated research data-sets, or with learning objects and multimedia material. This presentation will look at the development of the Directory of Open Ac...

Access Request Trustworthiness in Weighted Access Control Framework

Institute of Scientific and Technical Information of China (English)

WANG Lun-wei; LIAO Xiang-ke; WANG Huai-min

2005-01-01

Weighted factor is given to access control policies to express the importance of policy and its effect on access control decision. According to this weighted access control framework, a trustworthiness model for access request is also given. In this model, we give the measure of trustworthiness factor to access request, by using some idea of uncertainty reasoning of expert system, present and prove the parallel propagation formula of request trustworthiness factor among multiple policies, and get the final trustworthiness factor to decide whether authorizing. In this model, authorization decision is given according to the calculation of request trustworthiness factor, which is more understandable, more suitable for real requirement and more powerful for security enhancement than traditional methods. Meanwhile the finer access control granularity is another advantage.

Musculoskeletal pain among surgeons performing minimally invasive surgery

DEFF Research Database (Denmark)

Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup

2017-01-01

BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this ......BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons......, and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality...... fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18. DISCUSSION: Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological...

Case-matched study of short-term effects of 3D vs 2D laparoscopic radical resection of rectal cancer.

Science.gov (United States)

Zeng, QingMin; Lei, Fuming; Gao, ZhaoYa; Wang, YanZhao; Gao, Qing Kun

2017-09-22

The purpose of this study is to compare and evaluate the security and efficacy of 3D vs 2D laparoscopy in rectal cancer treatment. Forty-six patients who suffered from rectal cancer and went on laparoscopic radical resection of rectal carcinoma in Peking University Shougang Hospital from Feb. 2015 to Mar. 2016 were included in the study. They were randomly divided into two groups. The 23 patients operated with the 3D system were compared with 23 patients operated with the 2D system by perioperative data. There were no significant differences in age, sex, pathological type, tumor differentiation, TNM staging, and surgical procedures (P > 0.05). The average operating time of 3D laparoscopic surgery group (172.2 ± 27.5 min) was shorter than that of 2D group (192.6 ± 22.3) (P  0.05) were not significantly different. There were no differences in other complications between the two groups. No significantly different recrudescence and death rates were found between the two groups (P > 0.05). The 3D laparoscopy shortens the operation time of rectum cancer. 3D laparoscopic surgery is more efficient in treatment of rectal cancer than 2D laparoscopy and is worth of being generalized.

One-stage and two-stage penile buccal mucosa urethroplasty

Directory of Open Access Journals (Sweden)

G. Barbagli

2016-03-01

Full Text Available The paper provides the reader with the detailed description of current techniques of one-stage and two-stage penile buccal mucosa urethroplasty. The paper provides the reader with the preoperative patient evaluation paying attention to the use of diagnostic tools. The one-stage penile urethroplasty using buccal mucosa graft with the application of glue is preliminary showed and discussed. Two-stage penile urethroplasty is then reported. A detailed description of first-stage urethroplasty according Johanson technique is reported. A second-stage urethroplasty using buccal mucosa graft and glue is presented. Finally postoperative course and follow-up are addressed.

Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves.

Science.gov (United States)

Melich, George; Hong, Young Ki; Kim, Jieun; Hur, Hyuk; Baik, Seung Hyuk; Kim, Nam Kyu; Sender Liberman, A; Min, Byung Soh

2015-03-01

Laparoscopy offers some evidence of benefit compared to open rectal surgery. Robotic rectal surgery is evolving into an accepted approach. The objective was to analyze and compare laparoscopic and robotic rectal surgery learning curves with respect to operative times and perioperative outcomes for a novice minimally invasive colorectal surgeon. One hundred and six laparoscopic and 92 robotic LAR rectal surgery cases were analyzed. All surgeries were performed by a surgeon who was primarily trained in open rectal surgery. Patient characteristics and perioperative outcomes were analyzed. Operative time and CUSUM plots were used for evaluating the learning curve for laparoscopic versus robotic LAR. Laparoscopic versus robotic LAR outcomes feature initial group operative times of 308 (291-325) min versus 397 (373-420) min and last group times of 220 (212-229) min versus 204 (196-211) min-reversed in favor of robotics; major complications of 4.7 versus 6.5 % (NS), resection margin involvement of 2.8 versus 4.4 % (NS), conversion rate of 3.8 versus 1.1 (NS), lymph node harvest of 16.3 versus 17.2 (NS), and estimated blood loss of 231 versus 201 cc (NS). Due to faster learning curves for extracorporeal phase and total mesorectal excision phase, the robotic surgery was observed to be faster than laparoscopic surgery after the initial 41 cases. CUSUM plots demonstrate acceptable perioperative surgical outcomes from the beginning of the study. Initial robotic operative times improved with practice rapidly and eventually became faster than those for laparoscopy. Developing both laparoscopic and robotic skills simultaneously can provide acceptable perioperative outcomes in rectal surgery. It might be suggested that in the current milieu of clashing interests between evolving technology and economic constrains, there might be advantages in embracing both approaches.

CCDC22 gene polymorphism is associated with advanced stages of endometriosis in a sample of Brazilian women.

Science.gov (United States)

de Oliveira Francisco, Daniela; de Paula Andres, Marina; Gueuvoghlanian-Silva, Bárbara Yasmim; Podgaec, Sergio; Fridman, Cintia

2017-07-01

Based on the assumption that genetic factors are involved in the etiology of endometriosis, this study aimed to investigate the possibility of rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), and rs2294021 (CCDC22 gene) polymorphisms being associated with the occurrence of this disease in a sample of Brazilian women. We conducted a case-control study with 100 women with histological confirmation of endometriosis (endometriosis group) and 100 women submitted to laparoscopy for benign disorders, in which the absence of endometriosis was confirmed (control group). All samples were genotyped by real-time PCR technique for rs498679, rs1799964, rs3024496, and rs2294021 polymorphisms. No significant difference was observed in genotypic or allelic frequencies between control and endometriosis groups for rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), neither when comparing endometriosis subgroups (I-II versus III-IV). On the other hand, significant difference between stages I-II and III-IV of the disease was found in genotypic and allelic frequencies for the rs2294021 (CCDC22 gene) SNP (p = 0.048 and p = 0.017, respectively). Our results suggest that the rs2294021 (CCDC22 gene) polymorphism could be associated with increased susceptibility to endometriosis in Brazilian women when the allele C is present. In order to clarify this result, further studies should be conducted on a larger population.

Radiation diagnosis of stomach cancer. A critical analysis of deeply rooted misconceptions

International Nuclear Information System (INIS)

Vlasov, P.V.

2000-01-01

Present notions on the problem of early diagnosis of stomach carcinoma are presented. Achievements in the field of realizing preventive examinations for early identification of stomach carcinoma are shown. Technique for biomedical radiography study is described, local and organ semiotics of stomach carcinoma are presented. Potentialities of present techniques (computerized tomography, ultrasonography, video-laparoscopy) in the assessment of spreading and staging of stomach carcinoma are analysed [ru

Novel clinical staging for patients with end-stage gastrointestinal carcinoma.

Science.gov (United States)

Yasuda, Naokuni; Nakashima, Osamu; Ohnaka, Toru; Kamisaka, Koji; Tsunoda, Akira; Kusano, Mitsuo

2006-01-01

We created a new clinical staging system for end-stage gastrointestinal (GI) carcinoma to clarify the therapeutic goals for these patients. Data were obtained from a retrospective review of medical charts. Based on daily clinical observation of 144 patients with end-stage GI carcinoma, we classified the terminal stages as A, B, C, and D. The mean durations of terminal stages A, B, C, and D were 19, 16.6, 6.6, and 1.8 days, respectively, in patients with end-stage gastric cancer and 28.5, 9.1, 5.4, and 1.9 days, respectively, in patients with colorectal cancer. Moreover, 88.0% of patients with gastric carcinoma and 82.6% of patients with colorectal carcinoma passed through terminal stages A, B, C, and D sequentially. The patients in terminal stage B experienced temporary relief of symptoms, but those in terminal stage C did not (P terminal stages can easily be judged by clinical observation and may be an effective new tool with which to manage patients with end-stage GI carcinoma and their families.

Colorectal cancer stage at diagnosis in migrants versus non-migrants (KoMigra): study protocol of a cross-sectional study in Germany

International Nuclear Information System (INIS)

Dahlhaus, Anne; Gerlach, Ferdinand M; Blettner, Maria; Siebenhofer, Andrea; Guethlin, Corina; Schall, Arthur; Taubenroth, Maja; Ewijk, Reyn van; Zeeb, Hajo; Albay, Zeycan; Schulz-Rothe, Sylvia; Beyer, Martin

2014-01-01

In Germany, about 20% of the total population have a migration background. Differences exist between migrants and non-migrants in terms of health care access and utilisation. Colorectal cancer is the second most common malignant tumour in Germany, and incidence, staging and survival chances depend, amongst other things, on ethnicity and lifestyle. The current study investigates whether stage at diagnosis differs between migrants and non-migrants with colorectal cancer in an area of high migration and attempts to identify factors that can explain any differences. Data on tumour and migration status will be collected for 1,200 consecutive patients that have received a new, histologically verified diagnosis of colorectal cancer in a high migration area in Germany in the previous three months. The recruitment process is expected to take 16 months and will include gastroenterological private practices and certified centres for intestinal diseases. Descriptive and analytical analysis will be performed: the distribution of variables for migrants versus non-migrants and participants versus non-participants will be analysed using appropriate χ2-, t-, F- or Wilcoxon tests. Multivariable, logistic regression models will be performed, with the dependent variable being the dichotomized stage of the tumour (UICC stage I versus more advanced than UICC stage I). Odds ratios and associated 95%-confidence intervals will be calculated. Furthermore, ordered logistic regression models will be estimated, with the exact stage of the tumour at diagnosis as the dependent variable. Predictors used in the ordered logistic regression will be patient characteristics that are specific to migrants as well as patient characteristics that are not. Interaction models will be estimated in order to investigate whether the effects of patient characteristics on stage of tumour at the time of the initial diagnosis is different in migrants, compared to non-migrants. An association of migration status or

Limiting the access to direct-acting antivirals against HCV: an ethical dilemma.

Science.gov (United States)

Gentile, Ivan; Maraolo, Alberto E; Niola, Massimo; Graziano, Vincenzo; Borgia, Guglielmo; Paternoster, Mariano

2016-11-01

Hepatitis C virus (HCV) infection affects about 200 million people worldwide and represents a leading cause of liver-related mortality. Eradication of HCV infection, achieved mainly through direct-acting antivirals (DAA), results in a decrease of mortality and an improvement of quality of life. These drugs have a maximal efficacy and an optimal tolerability. However, their high cost precludes a universal access even in wealthy countries. Areas covered: This article deals with the policies adopted for the use of the new anti-HCV drugs, especially in Europe and most of all in Italy, supposedly the developed country with the highest HCV prevalence. The literature search was performed using Pubmed and Web of Science. Moreover, national regulatory institutional websites were consulted. Expert commentary: The current policy of limitation to the access of the DAA presents a series of ethical issues that makes it non-applicable. A 'treat-all' strategy should resolve all ethical dilemmas, by virtue of the wide benefits of anti-HCV treatment not only for the advanced stage of infection, but also for the initial stages. A reduction in price of the drugs is the actual condition to achieve such a change.

A stage is a stage is a stage: a direct comparison of two scoring systems.

Science.gov (United States)

Dawson, Theo L

2003-09-01

L. Kohlberg (1969) argued that his moral stages captured a developmental sequence specific to the moral domain. To explore that contention, the author compared stage assignments obtained with the Standard Issue Scoring System (A. Colby & L. Kohlberg, 1987a, 1987b) and those obtained with a generalized content-independent stage-scoring system called the Hierarchical Complexity Scoring System (T. L. Dawson, 2002a), on 637 moral judgment interviews (participants' ages ranged from 5 to 86 years). The correlation between stage scores produced with the 2 systems was .88. Although standard issue scoring and hierarchical complexity scoring often awarded different scores up to Kohlberg's Moral Stage 2/3, from his Moral Stage 3 onward, scores awarded with the two systems predominantly agreed. The author explores the implications for developmental research.

Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study.

Science.gov (United States)

Reardon, Tessa; Harvey, Kate; Young, Bridget; O'Brien, Doireann; Creswell, Cathy

2018-01-25

Anxiety disorders are among the most common mental health disorders experienced by children, but only a minority of these children access professional help. Understanding the difficulties parents face seeking support for child anxiety disorders could inform targeted interventions to improve treatment access. The aims of the study were to identify barriers and facilitators to seeking and accessing professional support for child anxiety disorders, and ways to minimise these barriers. A qualitative interview study was conducted with parents of 16 children (aged 7-11 years) with anxiety disorders identified through screening in schools. Barriers and facilitators were identified in relation to four distinct stages in the help-seeking process: parents recognising the anxiety difficulty, parents recognising the need for professional support, parents contacting professionals, and families receiving professional support. Barriers and facilitators at each stage related to the child's difficulties, the role of the parent, and parent perceptions of professionals and services. Findings illustrate the need (1) for readily available tools to help parents and professionals identify clinically significant anxiety in children, (2) to ensure that families and professionals can easily access guidance on the help-seeking process and available support, and (3) to ensure existing services offer sufficient provision for less severe difficulties that incorporates direct support for parents.

Alpha oscillations and early stages of visual encoding

Directory of Open Access Journals (Sweden)

Wolfgang eKlimesch

2011-05-01

Full Text Available For a long time alpha oscillations have been functionally linked to the processing of visual information. Here we propose an new theory about the functional meaning of alpha. The central idea is that synchronized alpha reflects a basic processing mode that controls access to information stored in a complex long-term memory system, which we term knowledge system (KS in order to emphasize that it comprises not only declarative memories but any kind of knowledge comprising also procedural information. Based on this theoretical background, we assume that during early stages of perception, alpha ‘directs the flow of information’ to those neural structures which represent information that is relevant for encoding. The physiological function of alpha is interpreted in terms of inhibition. We assume that alpha enables access to stored information by inhibiting task irrelevant neuronal structures and by timing cortical activity in task relevant neuronal structures. We discuss a variety findings showing that evoked alpha and phase locking reflect successful encoding of global stimulus features in an early poststimulus interval of about 0 - 150 ms.

SiGe/Si layers-early stages of plastic relaxation

International Nuclear Information System (INIS)

Koehler, R; Raidt, H; Neumann, W; Pfeiffer, J-U; Schaefer, H; Richter, U

2005-01-01

The plastic relaxation of SiGe/Si is closely related to the nucleation of misfit dislocations at early stages. We have investigated the very early stages at annealing temperatures ranging from 520 deg. C to 670 deg. C by means of x-ray topography (XRT), atomic force microscopy (AFM) and transmission electron microscopy. At misfit dislocation densities within the range accessible by XRT, i.e. up to about 1000 cm -1 , dislocations bundles predominate. This is verified by AFM and is explained by heterogeneous nucleation. The fewer the dislocations that are contained within dislocation bundles the rarer the blocking and cross slip that are observed. It is demonstrated that laser heating increases the number of nucleation centres drastically and is well suited to induce nucleation at selected sites. Furthermore, these nucleation centres provide dislocation bundles containing only a few dislocations. In contrast to this, implantation can produce defects that stop dislocation propagation quite effectively at the comparatively low temperatures used in our experiments

Easing Access for Lifelong Learners: A Comparison of European Models for University Lifelong Learning

Science.gov (United States)

Müller, Romina; Remdisch, Sabine; Köhler, Katharina; Marr, Liz; Repo, Saara; Yndigegn, Carsten

2015-01-01

Easing access to higher education (HE) for those engaging in lifelong learning has been a common policy objective across the European Union since the late 1990s. To reach this goal, the transition between vocational and academic routes must be simplified, but European countries are at different developmental stages. This article maps the…

Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis.

Science.gov (United States)

Marschall, Paul; Flessa, Steffen

2011-07-20

Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care.

Developing Plasmodium vivax Resources for Liver Stage Study in the Peruvian Amazon Region.

Science.gov (United States)

Orjuela-Sanchez, Pamela; Villa, Zaira Hellen; Moreno, Marta; Tong-Rios, Carlos; Meister, Stephan; LaMonte, Gregory M; Campo, Brice; Vinetz, Joseph M; Winzeler, Elizabeth A

2018-04-13

To develop new drugs and vaccines for malaria elimination, it will be necessary to discover biological interventions, including small molecules that act against Plasmodium vivax exoerythrocytic forms. However, a robust in vitro culture system for P. vivax is still lacking. Thus, to study exoerythrocytic forms, researchers must have simultaneous access to fresh, temperature-controlled patient blood samples, as well as an anopheline mosquito colony. In addition, researchers must rely on native mosquito species to avoid introducing a potentially dangerous invasive species into a malaria-endemic region. Here, we report an in vitro culture system carried out on site in a malaria-endemic region for liver stage parasites of P. vivax sporozoites obtained from An. darlingi, the main malaria vector in the Americas. P. vivax sporozoites were obtained by dissection of salivary glands from infected An. darlingi mosquitoes and purified by Accudenz density gradient centrifugation. HC04 liver cells were exposed to P. vivax sporozoites and cultured up to 9 days. To overcome low P. vivax patient parasitemias, potentially lower mosquito vectorial capacity, and humid, nonsterile environmental conditions, a new antibiotic cocktail was included in tissue culture to prevent contamination. Culturing conditions supported exoerythrocytic (EEF) P. vivax liver stage growth up to 9 days and allowed for maturation into intrahepatocyte merosomes. Some of the identified small forms were resistant to atovaquone (1 μM) but sensitive to the phosphatidylinositol 4-kinase inhibitor, KDU691 (1 μM). This study reports a field-accessible EEF production process for drug discovery in a malaria-endemic site in which viable P. vivax sporozoites are used for drug studies using hepatocyte infection. Our data demonstrate that the development of meaningful, field-based resources for P. vivax liver stage drug screening and liver stage human malaria experimentation in the Amazon region is feasible.

Multi-stage open peer review: scientific evaluation integrating the strengths of traditional peer review with the virtues of transparency and self-regulation

Directory of Open Access Journals (Sweden)

Ulrich ePöschl

2012-07-01

Full Text Available The traditional forms of scientific publishing and peer review do not live up to the demands of efficient communication and quality assurance in today’s highly diverse and rapidly evolving world of science. They need to be advanced and complemented by interactive and transparent forms of review, publication, and discussion that are open to the scientific community and to the public.The advantages of open access, public peer review and interactive discussion can be efficiently and flexibly combined with the strengths of traditional scientific peer review. Since 2001 the benefits and viability of this approach are clearly demonstrated by the highly successful interactive open access journal Atmo¬sphe¬ric Chemistry and Physics (ACP and a growing number of sister journals launched and operated by the European Geosciences Union (EGU and the open access publisher Copernicus.The interactive open access journals are practicing an integrative multi-stage process of publication and peer review combined with interactive public discussion, which effectively resolves the dilemma between rapid scientific exchange and thorough quality assurance. The high efficiency and predictive validity of multi-stage open peer review have been confirmed in a series of dedicated studies by evaluation experts from the social sciences, and the same or similar concepts have recently also been adopted in other disciplines, including the life sciences and economics. Multi-stage open peer review can be flexibly adjusted to the needs and peculiarities of different scientific communities. Due to the flexibility and compatibility with traditional structures of scientific publishing and peer review, the multi-stage open peer review concept enables efficient evolution in scientific communication and quality assurance. It has the potential for swift replacement of hidden peer review as the standard of scientific quality assurance, and it provides a basis for open evaluation in

OPPORTUNITIES OF LAPAROSCOPY IN THE TREATMENT OF ESOPHAGEAL ACHALASIA

Directory of Open Access Journals (Sweden)

A. S. Allakhverdyan

2015-01-01

Full Text Available The article describes opportunities and results of laparoscopic oesophagocardiomiotomy and laparoscopic transhiatal oesophagus removal without hand assistance in esophageal achalasia (cardiospasm. In total, such operations were performed in 196 and 31 of cases (of 423 patients, respectively. There were minimal numbers of relapses (below 2.3% after laparoscopic oesophagocardiomiotomy done by the proposed technique. All cases of reflux esophagitis were diagnosed after esophagocardiomiotomy with Dor fundoplication.After cardiodilatation, disease relapses were registered in 57% of patients. The advantages of a laparoscopic access for oesophagectomy are shown and technical particular of this intervention are analyzed based on a case history. The principles of Fast track surgery in this patient category are discussed that allow for reduction of the length of hospital stay by 40%.

Disruptive technological advances in vascular access for dialysis: an overview.

Science.gov (United States)

Yeo, Wee-Song; Ng, Qin Xiang

2017-11-29

End-stage kidney disease (ESKD), one of the most prevalent diseases in the world and with increasing incidence, is associated with significant morbidity and mortality. Current available modes of renal replacement therapy (RRT) include dialysis and renal transplantation. Though renal transplantation is the preferred and ideal mode of RRT, this modality may not be available to all patients with ESKD. Moreover, renal transplant recipients are constantly at risk of complications associated with immunosuppression and immunosuppressant use, and posttransplant lymphoproliferative disorder. Dialysis may be the only available modality in certain patients. However, dialysis has its limitations, which include issues associated with lack of vascular access, risks of infections and vascular thrombosis, decreased quality of life, and absence of biosynthetic functions of the kidney. In particular, the creation and maintenance of hemodialysis vascular access in children poses a unique set of challenges to the pediatric nephrologist owing to the smaller vessel diameters and vascular hyperreactivity compared with adult patients. Vascular access issues continue to be one of the major limiting factors prohibiting the delivery of adequate dialysis in ESKD patients and is the Achilles' heel of hemodialysis. This review aims to provide a critical overview of disruptive technological advances and innovations for vascular access. Novel strategies in preventing neointimal hyperplasia, novel bioengineered products, grafts and devices for vascular access will be discussed. The potential impact of these solutions on improving the morbidity encountered by dialysis patients will also be examined.

Web accessibility standards and disability: developing critical perspectives on accessibility.

Science.gov (United States)

Lewthwaite, Sarah

2014-01-01

Currently, dominant web accessibility standards do not respect disability as a complex and culturally contingent interaction; recognizing that disability is a variable, contrary and political power relation, rather than a biological limit. Against this background there is clear scope to broaden the ways in which accessibility standards are understood, developed and applied. Commentary. The values that shape and are shaped by legislation promote universal, statistical and automated approaches to web accessibility. This results in web accessibility standards conveying powerful norms fixing the relationship between technology and disability, irrespective of geographical, social, technological or cultural diversity. Web accessibility standards are designed to enact universal principles; however, they express partial and biopolitical understandings of the relation between disability and technology. These values can be limiting, and potentially counter-productive, for example, for the majority of disabled people in the "Global South" where different contexts constitute different disabilities and different experiences of web access. To create more robust, accessible outcomes for disabled people, research and standards practice should diversify to embrace more interactional accounts of disability in different settings. Implications for Rehabilitation Creating accessible experiences is an essential aspect of rehabilitation. Web standards promote universal accessibility as a property of an online resource or service. This undervalues the importance of the user's intentions, expertize, their context, and the complex social and cultural nature of disability. Standardized, universal approaches to web accessibility may lead to counterproductive outcomes for disabled people whose impairments and circumstances do not meet Western disability and accessibility norms. Accessible experiences for rehabilitation can be enhanced through an additional focus on holistic approaches to

Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Koshy, Linda M; Aberle, Laura H; Krucoff, Mitchell W; Hess, Connie N; Mazzaferri, Ernest; Jolly, Sanjit S; Jacobs, Alice; Gibson, C Michael; Mehran, Roxana; Gilchrist, Ian C; Rao, Sunil V

2018-01-01

This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI). Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown. We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference. Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound. This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.

Stage design

International Nuclear Information System (INIS)

Shacter, J.

1975-01-01

A method is described of cycling gases through a plurality of diffusion stages comprising the steps of admitting the diffused gases from a first diffusion stage into an axial compressor, simultaneously admitting the undiffused gases from a second diffusion stage into an intermediate pressure zone of said compressor corresponding in pressure to the pressure of said undiffused gases, and then admitting the resulting compressed mixture of diffused and undiffused gases into a third diffusion stage

Broadband Access

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. Broadband Access. Worldwide market for broadband access $30 Billion! Over 200 million broadband subscribers worldwide! Various Competing Broadband access. Digital Subscriber line; Wireless; Optical Fiber.

[Minimal and mild endometriosis: Impact of the laparoscopic surgery on pelvic pain and fertility. CNGOF-HAS Endometriosis Guidelines].

Science.gov (United States)

Ploteau, S; Merlot, B; Roman, H; Canis, M; Collinet, P; Fritel, X

2018-03-01

Minimal and mild endometriosis (stage 1 and 2 AFSR) can lead to chronic pelvic pain and infertility but can also exist in asymptomatic patients. The prevalence of asymptomatic patients with minimal and mild endometriosis is not clear but typical endometriosis lesions are found in about 5 to 10% of asymptomatic women and more than 50% of painful and/or infertile women. Laparoscopic treatment of minimal and mild endometriotic lesions is justified in case of pelvic pain because their destruction decrease significatively the pain compared with diagnostic laparoscopy alone. In this context, ablation and excision give identical results in terms of pain reduction. Moreover, literature shows no interest in uterine nerve ablation in case of dysmenorrhea due to minimal and mild endometriosis. Then, it is recommended to treat these lesions during a laparoscopy realised as part of pelvic pain. On the other hand, it is not recommended to treat asymptomatic patients. With regard to treatment of minimal and mild endometriosis in infertile patients, only two studies can be selected and both show that laparoscopy with excision or ablation and ablation of adhesions is superior to diagnostic laparoscopy alone in terms of pregnancy rate. However, it is not recommended to treat these lesions when they are asymptomatic because there is no evidence that they can progress with symptomatic disease. There is no study assessing the interest to treat these lesions when they are found fortuitously. Adhesion barrier utilisation permits to reduce post-operative adhesions, however literature failed to demonstrate the clinical profit in terms of reduction of the risk of pain or infertility. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Recurrent vascular access trombosis associated with the prothrombin mutation G20210A in a adult patient in haemodialysis].

Science.gov (United States)

Quintana, L F; Coll, E; Monteagudo, I; Collado, S; López-Pedret, J; Cases, A

2005-01-01

Vascular access-related complications are a frequent cause of morbidity in haemodialysis patients and generate high costs. We present the case of an adult patient with end-stage renal disease and recurrent vascular access thrombosis associated with the prothrombin mutation G20210A and renal graft intolerance. The clinical expression of this heterozygous gene mutation may have been favoured by inflammatory state, frequent in dialysis patients. In this patient, the inflammatory response associated with the renal graft intolerance would have favored the development of recurrent vascular access thrombosis in a adult heterozygous for prothrombin mutation G20210A. In the case of early dysfunction of haemodialysis vascular access and after ruling out technical problems, it is convenient to carry out a screening for thrombophilia.

Achados de laparoscopias ginecológicas realizadas em mulheres com dificuldade reprodutiva atendidas em um hospital-escola: série de casos Findings of gynecological laparoscopies in women with reproductive problems in a teaching hospital: a case series

Directory of Open Access Journals (Sweden)

Maria da Conceição Farias Souto Maior

2007-06-01

Full Text Available OBJETIVO: descrever as características das videolaparoscopias ginecológicas realizadas em pacientes com dificuldade reprodutiva atendidas em um hospital-escola no Recife, Pernambuco. MÉTODOS: foi realizado um estudo descritivo, de base hospitalar, do tipo série de casos. As informações foram obtidas a partir dos relatórios cirúrgicos das videolaparoscopias realizadas no Instituto Materno Infantil Professor Fernando Figueira, em Recife, entre janeiro de 2000 e dezembro de 2004. O critério de inclusão foi infertilidade ou estudo pré-recanalização como indicação cirúrgica. Para análise, utilizou-se o programa estatístico Epi-Info 3.3.2. Criaram-se tabelas de medidas de tendência central e de dispersão para as variáveis quantitativas e distribuição de freqüência para as variáveis categóricas. RESULTADOS: foram analisados 462 laudos de laparoscopias, dos quais 295 (63,8% tiveram como indicação a infertilidade ou o estudo para recanalização tubária. A média de idade de ambos os grupos foi de 30 a 34 anos. Nos casos de infertilidade, os achados mais freqüentes foram aderências (60,6%, obstrução tubária (40,9% e endometriose (36,1%. Nos casos de estudo da condição tubária pré-recanalização, das 87 pacientes analisadas, 55,2% apresentavam uma ou ambas as trompas inadequadas. Dentre estas, em 52,1% foi diagnosticada amputação tubária. Os procedimentos mais realizados foram adesiólise (34,2%, biópsias (21%, tratamento da endometriose (10,8% e salpingostomia (8,1%. CONCLUSÃO: a videolaparoscopia apresenta-se como importante instrumento na pesquisa e tratamento dos casos de dificuldade reprodutiva principalmente em serviços que não dispõem de técnicas avançadas de reprodução humana.PURPOSE: to identify the main characteristics of the diagnostic and surgical gynecological laparoscopies carried out in patients with reproductive difficulties at a teaching hospital in Recife, from 2000 and 2004. METHODS: a

Staging Mobilities

DEFF Research Database (Denmark)

Jensen, Ole B.

and lived as people are “staging themselves” (from below). Staging mobilities is a dynamic process between “being staged” (for example, being stopped at traffic lights) and the “mobile staging” of interacting individuals (negotiating a passage on the pavement). Staging Mobilities is about the fact...

Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

Directory of Open Access Journals (Sweden)

Danyelle Romana Alves Rios

2017-01-01

Full Text Available Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I and 46 patients had previously presented this complication (group II. Plasma levels of cytokines including interleukin (IL- 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γ were measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II had higher levels of the IL-2, IL-4, IL-5, and IFN-γ when compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.

Trading stages

DEFF Research Database (Denmark)

Steiner, Uli; Tuljapurkar, Shripad; Coulson, Tim

2012-01-01

Interest in stage-and age structured models has recently increased because they can describe quantitative traits such as size that are left out of age-only demography. Available methods for the analysis of effects of vital rates on lifespan in stage-structured models have not been widely applied ...... examples. Much of our approach relies on trading of time and mortality risk in one stage for time and risk in others. Our approach contributes to the new framework of the study of age- and stage-structured biodemography....

Value of pelvic MRI in the preoperative diagnosis of endometriosis; Wertigkeit der Magnetresonanztomographie (MRT) des Beckens in der praeoperativen Diagnostik der Endometriose

Energy Technology Data Exchange (ETDEWEB)

Hauth, E.A.M.; Antoch, G.; Ruehm, S.G.; Forsting, M. [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Boeing, C.; Kimmig, R. [Universitaetsklinikum Essen (Germany). Klinik fuer Frauenheilkunde und Geburtshilfe

2004-09-01

Purpose: To determine the value of magnetic resonance imaging (MRI) of the pelvis in the preoperative diagnosis of endometriosis. Materials and Methods: Over a period of 8 months, preoperative MRI of the pelvis were obtained in 13 patients with suspected endometriosis (mean patient age 34.6 years; range 25-47 years). Results: In 9 of 13 patients (69%), the diagnosis of endometriosis was made by MRI and confirmed by laparoscopy in 8 cases. In 2 of 13 patients, endometriotic lesions were detectable by laparoscopy only. In the remaining 2 patients, no endometriosis was visible on MRI or by laparoscopy. MRI was able to visualize a total of 19 endometriotic lesions, with 14 (74%) confirmed by histopathologic examination following laparoscopy. Five of these 19 lesions (26%) visible on MRI were not seen by laparoscopy. Using laparoscopy and subsequent histopathologic examination, 27 endometriotic lesions were diagnosed, with 13 (48%) not seen on the preoperative MRI. Conclusion: MRI and laparoscopy are complementary diagnostic tools that will best document the full extent of endometriosis when combined. MRI can visualize additional lesions inaccessible to laparoscopy. Thus, MRI of the pelvis should used preoperatively for surgical treatment planning. (orig.)

Does visual short-term memory have a high-capacity stage?

Science.gov (United States)

Matsukura, Michi; Hollingworth, Andrew

2011-12-01

Visual short-term memory (VSTM) has long been considered a durable, limited-capacity system for the brief retention of visual information. However, a recent work by Sligte et al. (Plos One 3:e1699, 2008) reported that, relatively early after the removal of a memory array, a cue allowed participants to access a fragile, high-capacity stage of VSTM that is distinct from iconic memory. In the present study, we examined whether this stage division is warranted by attempting to corroborate the existence of an early, high-capacity form of VSTM. The results of four experiments did not support Sligte et al.'s claim, since we did not obtain evidence for VSTM retention that exceeded traditional estimates of capacity. However, performance approaching that observed in Sligte et al. can be achieved through extensive practice, providing a clear explanation for their findings. Our evidence favors the standard view of VSTM as a limited-capacity system that maintains a few object representations in a relatively durable form.

End-stage renal failure and national resources: the Brazilian experience.

Science.gov (United States)

Zatz, Roberto; Romão, João Egídio

2006-01-01

Brazil is the fifth largest and the fifth most populous nation in the world. Its economy rivals Mexico as the strongest in Latin America and ranks among the 15 largest economies in the world. Despite these achievements, a substantial fraction of the Brazilian population still lives in poverty, and many still have limited access to medical assistance. There are currently about 380 patients on hemodialysis per million populations (pmp), approximately one third of the U.S. prevalence, suggesting that a large fraction of end-stage renal disease (ESRD) patients are not diagnosed and treated properly. In Brazil, access to renal replacement therapy (RRT), including renal transplantation, is universal, and the corresponding costs, including those of medications (immunosuppressors and treatment of ESRD complications), are covered by the Brazilian government. However, given the continuous growth of the ESRD population and of the costs incurred by RRT, the efficacy and reach of this system may be severely limited in years to come. In the current struggle against the ESRD epidemics, the Brazilian medical community and health authorities face a triple challenge: to limit the incidence of renal disease, slow or detain the progression of established chronic nephropathies, and ensure that access to quality RRT remains granted to all those who, despite all efforts, reach ESRD.

The influence of preburial insect access on the decomposition rate.

Science.gov (United States)

Bachmann, Jutta; Simmons, Tal

2010-07-01

This study compared total body score (TBS) in buried remains (35 cm depth) with and without insect access prior to burial. Sixty rabbit carcasses were exhumed at 50 accumulated degree day (ADD) intervals. Weight loss, TBS, intra-abdominal decomposition, carcass/soil interface temperature, and below-carcass soil pH were recorded and analyzed. Results showed significant differences (p decomposition rates between carcasses with and without insect access prior to burial. An approximately 30% enhanced decomposition rate with insects was observed. TBS was the most valid tool in postmortem interval (PMI) estimation. All other variables showed only weak relationships to decomposition stages, adding little value to PMI estimation. Although progress in estimating the PMI for surface remains has been made, no previous studies have accomplished this for buried remains. This study builds a framework to which further comparable studies can contribute, to produce predictive models for PMI estimation in buried human remains.

Acute Liver Failure in a Patient Travelling From Asia: The Other Face of the Coin of Infectious Disease.

Science.gov (United States)

Abdulrahman, Balen; Ahmed, Mohamed H; Ramage, John

2017-08-01

We present a case of a 63-year-old male who had travelled from South India to United Kingdom (UK) visiting relatives. He had developed episodes of diarrhea, vomiting and fevers while travelling and on assessment in hospital, mild abdominal distension was noted with rapid deterioration to hypovolemic shock. Initial blood test showed a low platelet count with deranged liver function tests (LFTs). It was noted that during admission to intensive care unit (ICU), blood continued to ooze from a previous surgical laparoscopy wound, central and arterial line access sites. Blood results revealed ongoing derangement of clotting and LFT. Computed tomography (CT) scan showed possible acute cholecystitis and a laparoscopy showed an ischemic-looking liver and gut but no significant gallbladder abnormality. The virology screen was positive for dengue virus antibodies IgM and IgG. The patient developed multi-organ failure and deteriorated despite intensive support. Post mortem showed fulminant hepatic failure and acute tubular necrosis of kidneys.

Emotion, Etmnooi, or Emitoon?--Faster lexical access to emotional than to neutral words during reading.

Science.gov (United States)

Kissler, Johanna; Herbert, Cornelia

2013-03-01

Cortical processing of emotional words differs from that of neutral words. Using EEG event-related potentials (ERPs), the present study examines the functional stage(s) of this differentiation. Positive, negative, and neutral nouns were randomly mixed with pseudowords and letter strings derived from words within each valence and presented for reading while participants' EEG was recorded. Results indicated emotion effects in the N1 (110-140 ms), early posterior negativity (EPN, 216-320) and late positive potential (LPP, 432-500 ms) time windows. Across valence, orthographic word-form effects occurred from about 180 ms after stimulus presentation. Crucially, in emotional words, lexicality effects (real words versus pseudowords) were identified from 216 ms, words being more negative over posterior cortex, coinciding with EPN effects, whereas neutral words differed from pseudowords only after 320 ms. Emotional content affects word processing at pre-lexical, lexical and post-lexical levels, but remarkably lexical access to emotional words is faster than access to neutral words. Copyright © 2012 Elsevier B.V. All rights reserved.

Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

Directory of Open Access Journals (Sweden)

Solati

2015-06-01

Full Text Available Background Today, with improvements in laparoscopy technique, surgery of rectal cancer is performed by laparoscopy. Objectives This study was performed to evaluate oncologic results of open versus laparoscopic surgery of rectal cancer in terms of resection margins, removal of lymph nodes and recurrence rate. Patients and Methods This descriptive-analytic study was performed on 88 patients with middle and lower rectal cancer in the two equivalent groups of laparoscopic and open surgery in Mashhad Ghaem and Omid hospitals during 2011 - 2013. Information including age, sex, number of removed and involved lymph nodes, proximal, distal, and radial margins, tumor stage and location, recurrence and disease-free survival collected in the questionnaire and analyzed using descriptive statistics and frequency distribution tables and t-test. Results Both groups of open and laparoscopic surgery had similar characteristics of age, sex, recurrence and disease-free survival, tumor margins and one-year mortality. The number of removed and involved lymph nodes was higher in the laparoscopic group (5.16 vs. 3.55, respectively, with P < 0.050, and 1.74 vs. 0.59 with P = 0.023, but the ratio of involved lymph nodes to the total number of removed lymph nodes was not different between the two groups (LNR (P = 0.071. Tumor stage was higher in the laparoscopic group and most were in stages II and III (P < 0.001. Conclusions Laparoscopic surgery is an effective technique for safe margin and removing lymph nodes in rectal cancer.

Open access

NARCIS (Netherlands)

Valkenburg, P.M.

2015-01-01

Open access week Van 19 tot en met 25 oktober 2015 vond wereldwijd de Open Access Week plaats. Tijdens deze week werden er over de hele wereld evenementen georganiseerd waar open access een rol speelt. Ook in Nederland zijn er diverse symposia, workshops en debatten georganiseerd zoals het debat in

TRPV1 expression on peritoneal endometriosis foci is associated with chronic pelvic pain.

Science.gov (United States)

Rocha, Marcelo Gondim; e Silva, Júlio César Rosa; Ribeiro da Silva, Alfredo; Candido Dos Reis, Francisco José; Nogueira, Antonio Alberto; Poli-Neto, Omero Benedicto

2011-06-01

To investigate the expression of capsaicin receptor (transient receptor potential vanilloid type 1 [TRPV1]) in the peritoneal endometriosis foci of women with and without chronic pelvic pain (CPP). A case-control study was conducted on 49 women with endometriosis who underwent laparoscopy, 28 of whom had CPP and 21 without CPP. Samples from peritoneum of the rectouterine excavation (2 cm2) were obtained by laparoscopy, fixed in 4% formaldehyde, and underwent immunohistochemistry analysis using rabbit anti-TRPV1 (1:400) polyclonal antibody. Image analysis revealed that the immunoreactivity for TRPV1 was more frequent in specimens (endometriosis foci) from women with CPP (n = 15 of 28, 53.6%), compared to samples from the endometriosis foci of women without CPP (n = 6 of 21, 28.6%; P = .04). There was no correlation with duration, intensity of pain, or stage of the disease (endometriosis). The present study shows that TRPV1 expression in peritoneal endometriosis foci is related to CPP in women. However, this association is not related to the endometriosis stage. In view of the immunoreactivity for TRPV1 observed here, we believe that some endometriotic lesions may provide a scenario for TRPV1 to be tonically active and this activity may contribute to the underlying pathology of CPP.

Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes.

Science.gov (United States)

Sheng, Weizheng; Zhang, Bo; Chen, Weifeng; Gu, Dayong; Gao, Weidong

2015-01-01

This study evaluated the short- and long-term outcomes of laparoscopic colectomy compared with open colectomy for patients with transverse colon cancer by matched-pair analysis. This study enrolled 59 patients who underwent laparoscopic colectomy and compared them with 59 matched patients who underwent open colectomy for transverse colon cancer. The following parameters were matched: clinical stage and type of resection. Both short- and long-term outcomes of laparoscopic colectomy were compared with those of open colectomy. No difference was observed between the two groups in terms of age, gender, ASA score, comorbidity, clinical stage and operative procedures. Regarding short-term outcomes, blood loss, time to first flatus, time to liquid diet and postoperative stay were significantly shorter in the laparoscopy group than in the open group, while operation time was significantly longer in the laparoscopy group than in the open group. Postoperative complication was similar between the two groups. With respect to long-term outcomes, the two groups did not differ significantly in terms of 5-year overall and disease-free survival. In summary, laparoscopic colectomy is a safe and feasible option for selected patients with transverse colon cancer. The short- and long-term outcomes of laparoscopic colectomy are considered to be acceptable.

Open Access @ DTU

DEFF Research Database (Denmark)

Ekstrøm, Jeannette

Open Access is high on the agenda in Denmark and internationally. Denmark has announced a national strategy for Open Access that aims to achieve Open Access to 80% in 2017 and 100% in 2022 to peer review research articles. All public Danish funders as well as H2020 requires that all peer review...... articles that is an outcome of their funding will be Open Access. Uploading your full texts (your final author manuscript after review ) to DTU Orbit is a fundamental part of providing Open Access to your research. We are here to answer all your questions with regards to Open Access and related topics...... such as copyright, DTU Orbit, Open Access journals, APCs, Vouchers etc....

Comparisons of single-stage and two-stage approaches to genomic selection.

Science.gov (United States)

Schulz-Streeck, Torben; Ogutu, Joseph O; Piepho, Hans-Peter

2013-01-01

Genomic selection (GS) is a method for predicting breeding values of plants or animals using many molecular markers that is commonly implemented in two stages. In plant breeding the first stage usually involves computation of adjusted means for genotypes which are then used to predict genomic breeding values in the second stage. We compared two classical stage-wise approaches, which either ignore or approximate correlations among the means by a diagonal matrix, and a new method, to a single-stage analysis for GS using ridge regression best linear unbiased prediction (RR-BLUP). The new stage-wise method rotates (orthogonalizes) the adjusted means from the first stage before submitting them to the second stage. This makes the errors approximately independently and identically normally distributed, which is a prerequisite for many procedures that are potentially useful for GS such as machine learning methods (e.g. boosting) and regularized regression methods (e.g. lasso). This is illustrated in this paper using componentwise boosting. The componentwise boosting method minimizes squared error loss using least squares and iteratively and automatically selects markers that are most predictive of genomic breeding values. Results are compared with those of RR-BLUP using fivefold cross-validation. The new stage-wise approach with rotated means was slightly more similar to the single-stage analysis than the classical two-stage approaches based on non-rotated means for two unbalanced datasets. This suggests that rotation is a worthwhile pre-processing step in GS for the two-stage approaches for unbalanced datasets. Moreover, the predictive accuracy of stage-wise RR-BLUP was higher (5.0-6.1%) than that of componentwise boosting.

MR staging accuracy for endometrial cancer based on the new FIGO stage

International Nuclear Information System (INIS)

Shin, Kyung Eun; Park, Byung Kwan; Kim, Chan Kyo; Bae, Duk Soo; Song, Sang Yong; Kim, Bohyun

2011-01-01

Background: Magnetic resonance imaging (MRI) has been frequently used to determine a preoperative treatment plan for gynecologic cancers. However, the MR accuracy for staging an endometrial cancer is not satisfactory based on the old FIGO staging system. Purpose: To evaluate MR accuracy for staging endometrial cancer using the new FIGO staging system. Material and Methods: Between January 2005 and May 2009, 199 women underwent surgery due to endometrial cancer. In each patient, an endometrial cancer was staged using MR findings based on the old FIGO staging system and then repeated according to the new FIGO staging system for comparison. Histopathologic findings were used as a standard of reference. Results: The accuracy of MRI in the staging of endometrial carcinoma stage I, II, III, and IV using the old FIGO staging system were 80% (159/199), 89% (178/199), 90% (179/199), and 99% (198/199), respectively, compared to 87% (174/199), 97% (193/199), 90% (179/199), and 99% (198/199), respectively, when using the new FIGO staging criteria. The overall MR accuracy of the old and new staging systems were 51% (101/199) and 81% (161/199), respectively. Conclusion: MRI has become a more useful tool in the preoperative staging of endometrial cancers using the new FIGO staging system compared to the old one with increased accuracy

Temporal neural mechanisms underlying conscious access to different levels of facial stimulus contents.

Science.gov (United States)

Hsu, Shen-Mou; Yang, Yu-Fang

2018-04-01

An important issue facing the empirical study of consciousness concerns how the contents of incoming stimuli gain access to conscious processing. According to classic theories, facial stimuli are processed in a hierarchical manner. However, it remains unclear how the brain determines which level of stimulus content is consciously accessible when facing an incoming facial stimulus. Accordingly, with a magnetoencephalography technique, this study aims to investigate the temporal dynamics of the neural mechanism mediating which level of stimulus content is consciously accessible. Participants were instructed to view masked target faces at threshold so that, according to behavioral responses, their perceptual awareness alternated from consciously accessing facial identity in some trials to being able to consciously access facial configuration features but not facial identity in other trials. Conscious access at these two levels of facial contents were associated with a series of differential neural events. Before target presentation, different patterns of phase angle adjustment were observed between the two types of conscious access. This effect was followed by stronger phase clustering for awareness of facial identity immediately during stimulus presentation. After target onset, conscious access to facial identity, as opposed to facial configural features, was able to elicit more robust late positivity. In conclusion, we suggest that the stages of neural events, ranging from prestimulus to stimulus-related activities, may operate in combination to determine which level of stimulus contents is consciously accessed. Conscious access may thus be better construed as comprising various forms that depend on the level of stimulus contents accessed. NEW & NOTEWORTHY The present study investigates how the brain determines which level of stimulus contents is consciously accessible when facing an incoming facial stimulus. Using magnetoencephalography, we show that prestimulus

Endovascular Treatment of Dialysis Access-Induced Hand Ischemia Using a Flared Stent-Graft.

Science.gov (United States)

Png, Chien Yi M; Beckerman, William E; Faries, Peter L; Finlay, David J

2017-10-01

To report an investigation of a purely endovascular procedure to address access-induced hand ischemia in dialysis patients. Two dialysis patients presented with stage III steal syndrome consisting of severe pain and numbness in their fingers. Preoperative fistulograms distal to the anastomosis showed alternating antegrade and retrograde flow. Under ultrasound guidance, the fistula was accessed and a 4-F micropuncture sheath placed. An angled guidewire was then advanced proximally into the brachial artery. A 6-F short sheath with marker was placed followed by a 4-F straight guide catheter inserted into the proximal brachial artery. A 9-F Flair endovascular stent-graft was advanced over a 0.035-inch stiff angled Glidewire into the fistula just distal to the arterial anastomosis and deployed. Postoperatively, pain and numbness resolved in both patients immediately. Postoperative fistulograms documented antegrade flow. Access flow velocity readings decreased significantly and pulse oximetry readings increased significantly in both patients, who were followed for >6 months with no reported complications. These 2 cases suggest that this endovascular approach to access-induced hand ischemia may be a viable alternative to open/hybrid surgery.

[Gestrinone in pelvic endometriosis. A one-year evaluation].

Science.gov (United States)

Cervantes Villarreal, E; García Zamarripa, H R; Herrera Prado, E; Barrón Vallejo, J

1995-08-01

The therapeutical effectiveness of gestrinone in endometriosis treatment, as well as its long term side effects, were evaluated. Prospective, clinical trial. At "Dr. Alejandro Castanedo Kimball" Hospital (PEMEX). Salamanca, Guanajuato. México. Thirty women with laparoscopically confirmed endometriosis, were studied. Subjects received 2.5 mg. of gestrinone two times per week for 6 months. Laparoscopy was performed before treatment, and clinical response was determined by second laparoscopy after 6 months. The pregnancy rate, frequency of side effects and recurrence of symptoms were determined. Median total endometriosis scores and symptoms decreased significantly after treatment. Four pregnancies were observed after treatment. The principal side effects were: ponderal increase, changes in the voice and hirsutism. However, the side effects disappeared after one year of clinical survey. The results indicate that gestrinone is effective in the treatment of pelvic endometriosis. In despite of a clear benefic effect on stage of the disease and symptoms; the use of gestrinone should weigh the risk-benefit (cost versus metabolic side effects) of treatment.

Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience

International Nuclear Information System (INIS)

Mammen, Suraj; Keshava, Shyamkumar N; Moses, Vinu; Babu, Surendra; Varughese, Santhosh

2012-01-01

Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution

Access Denied! Contrasting Data Access in the United States and Ireland

Directory of Open Access Journals (Sweden)

Grogan Samuel

2016-07-01

Full Text Available The ability of an Internet user to access data collected about himself as a result of his online activity is a key privacy safeguard. Online, data access has been overshadowed by other protections such as notice and choice. This paper describes attitudes about data access. 873 US and Irish Internet users participated in a survey designed to examine views on data access to information held by online companies and data brokers. We observed low levels of awareness of access mechanisms along with a high desire for access in both participant groups. We tested three proposed access systems in keeping with industry programs and regulatory proposals. User response was positive. We conclude that access remains an important privacy protection that is inadequately manifested in practice. Our study provides insight for lawmakers and policymakers, as well as computer scientists who implement these systems.

Uniportal thoracoscopy combined with laparoscopy as minimally invasive treatment of esophageal cancer.

Science.gov (United States)

Caronia, Francesco Paolo; Arrigo, Ettore; Failla, Andrea Valentino; Sgalambro, Francesco; Giannone, Giorgio; Lo Monte, Attilio Ignazio; Cajozzo, Massimo; Santini, Mario; Fiorelli, Alfonso

2018-04-01

A 67-year-old man was referred to our attention for management of esophageal adenocarcinoma, localized at the level of the esophagogastric junction and obstructed the 1/3 of the esophageal lumen. Due to the extension of the disease (T3N1M0-Stage IIIA), the patient underwent neo-adjuvant chemo-radiation therapy and he was then scheduled for a minimally invasive surgical procedure including laparoscopic gastroplasty, uniportal thoracoscopic esophageal dissection and intrathoracic end-to-end esophago-gastric anastomosis. No intraoperative and post-operative complications were seen. The patient was discharged in post-operative day 9. Pathological study confirmed the diagnosis of adenocarcinoma (T2N1M0-Stage IIB) and he underwent adjuvant chemotherapy. At the time of present paper, patient is alive and well without signs of recurrence or metastasis. Our minimally approach compared to standard open procedure would help reduce post-operative pain and favours early return to normal activity. However, future experiences with a control group are required before our strategy can be widely used.

Efectividad del adhesivo tisular Tisuacryl® para el cierre de heridas cutáneas en cirugía laparoscópica Effectiveness of the Tisuacryl® as tissue adhesive for closure of cutaneous wounds in laparoscopy surgery

Directory of Open Access Journals (Sweden)

Rosalba Roque González

2011-06-01

including infection and tissue reaction to a foreign body. The aim of present research was to assess the effectiveness and safety of Tisuacryl® for synthesis of approaches in patients operated on by minimally invasive methods without the need of to apply sutures. METHODS. A tissue adhesive was applied in 100 patients came to National Center of Minimal Access Surgery to undergo different surgical procedures. Among the variables to assess the effectiveness and safety of treatment were the wound dehiscence, appearance of infection, wound synthesis time and scar esthetics. Patients were assessed during the immediate postoperative period and in external consultation at 7 and 21 days after surgery. RESULTS. Excellent results were achieved as regards the coping and the wounds' esthetics. Also, patients were satisfied with the use of this material and there were not infections. CONCLUSIONS. Results of present research demonstrated that the Tisuacryl® may be used with a high level of effectiveness for closure of 5 mm and 10 mm wounds in laparoscopy surgery to replace sutures.

Tredimensional laparoskopi har potentiale til at erstatte todimensional laparoskopi ved abdominalkirurgi

DEFF Research Database (Denmark)

Fergo, Charlotte; Pommergaard, Hans-Christian; Burcharth, Jakob

2016-01-01

Studies comparing three-dimensional (3D) laparoscopy with 2D laparoscopy have shown shorter operation time, a short learning curve as well as better depth perception. Robotic surgery includes the EndoWrist function in addition to the 3D view; however robotic surgery lacks haptic feedback....... No evidence from clinical trials for the potential benefits of robotic surgery exists. Thus, 3D laparoscopy is an eligible alternative to both 2D laparoscopy and robotic surgery....

ESTIMATION OF SURVIVAL IN PATIENTS WITH ADVANCED OVARIAN CANCER – ABSTRACT OF THE RESEARCH PROJECT

Directory of Open Access Journals (Sweden)

Špela Smrkolj

2018-02-01

Full Text Available Background: Morbidity and mortality caused by cancer persist to be an important health problem world- wide and in the European Union member states as well. In Slovenia, most ovarian cancer cases are detected in advanced stages, hence a rather high mortality rate. Aims: The purpose of this research project is to analyze the primary cytoreduction in the patients with advanced ovarian cancer. The main objective of the project is to assess the use of lap- aroscopy in the prediction of optimal cytoreduction in these patients. Applicative research project ‘Estimation of survial in patients with advanced ovarian can- cer based on primary laparoscopical assessment of optimal cytoreduction’ (L3-2371 was approved and has been financed by the Slovene Research Agency and co-financed by the Ministry of Health of RS; Duration: May 1, 2009–April 30, 2012. Methods: The research project will consist of retrospective and prospective study. In all the patients with advanced ovarian cancer managed at the Department of Obstetrics and Gynecol- ogy, University Medical Centre Ljubljana in the years 2003–2008, and in whom optimal primary cytoreduction was made using either laparoscopy or laparotomy, certain clinical and pathomorphological factors will be compared, and the effects of all analyzed factors on the outcome of treatment assessed. In the prospective study, we will aim at assessing the use of laparoscopy in the prediction of optimal cytoreduction in all newly detected cases using a laparoscopy-based score (Fagotti’s scoring system. Conclusions: The standard management of advanced ovarian cancer patients consists of primary surgical optimal and/or suboptimal cytoreduction followed by aggressive cytotoxic chemotherapy. In line with our experience and with that published most recently, laparoscopy seems to be a promising method with which we will attempt to most accurately assess the optimal cytoreduction in surgical treatment of ovarian cancer patients.

Comparison of single-port and conventional laparoscopic abdominoperineal resection

DEFF Research Database (Denmark)

Nerup, Nikolaj; Rosenstock, Steffen; Bulut, Orhan

2018-01-01

with conventional laparoscopy and 12 with SP surgery. RESULTS: Patients' characteristics were in general comparable, but patients in the conventional laparoscopy-group had a significantly higher American Society of Anesthesiologists-score. The operative time was slightly shorter in the conventional laparoscopy...

Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer.

Science.gov (United States)

Lin, Chun Chieh; Bruinooge, Suanna S; Kirkwood, M Kelsey; Hershman, Dawn L; Jemal, Ahmedin; Guadagnolo, B Ashleigh; Yu, James B; Hopkins, Shane; Goldstein, Michael; Bajorin, Dean; Giordano, Sharon H; Kosty, Michael; Arnone, Anna; Hanley, Amy; Stevens, Stephanie; Olsen, Christine

2016-03-15

Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT. A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics. Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, Ptravel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care. Copyright © 2016 Elsevier Inc. All rights reserved.

Sleep Stage Transition Dynamics Reveal Specific Stage 2 Vulnerability in Insomnia.

Science.gov (United States)

Wei, Yishul; Colombo, Michele A; Ramautar, Jennifer R; Blanken, Tessa F; van der Werf, Ysbrand D; Spiegelhalder, Kai; Feige, Bernd; Riemann, Dieter; Van Someren, Eus J W

2017-09-01

Objective sleep impairments in insomnia disorder (ID) are insufficiently understood. The present study evaluated whether whole-night sleep stage dynamics derived from polysomnography (PSG) differ between people with ID and matched controls and whether sleep stage dynamic features discriminate them better than conventional sleep parameters. Eighty-eight participants aged 21-70 years, including 46 with ID and 42 age- and sex-matched controls without sleep complaints, were recruited through www.sleepregistry.nl and completed two nights of laboratory PSG. Data of 100 people with ID and 100 age- and sex-matched controls from a previously reported study were used to validate the generalizability of findings. The second night was used to obtain, in addition to conventional sleep parameters, probabilities of transitions between stages and bout duration distributions of each stage. Group differences were evaluated with nonparametric tests. People with ID showed higher empirical probabilities to transition from stage N2 to the lighter sleep stage N1 or wakefulness and a faster decaying stage N2 bout survival function. The increased transition probability from stage N2 to stage N1 discriminated people with ID better than any of their deviations in conventional sleep parameters, including less total sleep time, less sleep efficiency, more stage N1, and more wake after sleep onset. Moreover, adding this transition probability significantly improved the discriminating power of a multiple logistic regression model based on conventional sleep parameters. Quantification of sleep stage dynamics revealed a particular vulnerability of stage N2 in insomnia. The feature characterizes insomnia better than-and independently of-any conventional sleep parameter. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome : a coomputer model perspective

NARCIS (Netherlands)

Merkx, M.A.G.; Huberts, W.; Bosboom, E.M.H.; Bode, A.S.; Bescos, J.O.; Tordoir, J.H.M.; Breeuwer, M.; Vosse, van de F.N.

2013-01-01

Introduction Vascular access (VA) surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD) patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative

Accessibility and sensory experiences

DEFF Research Database (Denmark)

Ryhl, Camilla

2010-01-01

and accessibility. Sensory accessibility accommodates aspects of a sensory disability and describes architectural design requirements needed to ensure access to architectural experiences. In the context of architecture accessibility has become a design concept of its own. It is generally described as ensuring...... physical access to the built environment by accommodating physical disabilities. While the existing concept of accessibility ensures the physical access of everyone to a given space, sensory accessibility ensures the choice of everyone to stay and be able to participate and experience....

Sociocultural Barriers Related to Late-Stage Presentation of Breast Cancer in Morocco.

Science.gov (United States)

Soliman, Ann A; Khouchani, Mouna; Renne, Elisha P

2018-04-23

Breast cancer is the most prevalent cancer affecting women globally and in Morocco, where more than one fourth of patients are diagnosed at advanced stages. This study aimed to investigate sociocultural barriers that contribute to delayed presentation and diagnosis of breast cancer among women in Marrakesh, Morocco. Qualitative interviews were conducted with 25 breast cancer patients who received care at the CHU Mohammed VI Hospital in Marrakesh to elicit barriers to diagnosis and treatment and ease of access to care. Interviews with breast cancer patients revealed several themes regarding structural and sociocultural barriers to initial diagnosis and treatment. Structural barriers included high treatment-associated costs for patients and their families, burden of transportation to central treatment centers, and limited access to appropriate health care resources. Sociocultural barriers included perceived attack on one's identity associated with breast cancer diagnosis and treatment, influence of the local community, and ideas of faith, spirituality, and conception of death. Findings from this study can help identify areas for improved access and education of patients in order to improve breast cancer diagnostic and treatment efforts and enhance opportunities for early detection.

Second stage gasifier in staged gasification and integrated process

Science.gov (United States)

Liu, Guohai; Vimalchand, Pannalal; Peng, Wan Wang

2015-10-06

A second stage gasification unit in a staged gasification integrated process flow scheme and operating methods are disclosed to gasify a wide range of low reactivity fuels. The inclusion of second stage gasification unit operating at high temperatures closer to ash fusion temperatures in the bed provides sufficient flexibility in unit configurations, operating conditions and methods to achieve an overall carbon conversion of over 95% for low reactivity materials such as bituminous and anthracite coals, petroleum residues and coke. The second stage gasification unit includes a stationary fluidized bed gasifier operating with a sufficiently turbulent bed of predefined inert bed material with lean char carbon content. The second stage gasifier fluidized bed is operated at relatively high temperatures up to 1400.degree. C. Steam and oxidant mixture can be injected to further increase the freeboard region operating temperature in the range of approximately from 50 to 100.degree. C. above the bed temperature.

ESI-LC-MS based-metabolomics data of mangosteen (Garcinia mangostana Linn. fruit pericarp, aril and seed at different ripening stages

Directory of Open Access Journals (Sweden)

Siti Farah Mamat

2018-04-01

Full Text Available Fruit ripening is a complex phenomenon involving a series of biochemical, physiological and organoleptic changes. Ripening process in mangosteen (Garcinia mangostana Linn. is unique of which the fruit will only ripen properly if harvested during its middle stage (emergence of purple/pink colour but not earlier (green stage. The knowledge on the molecular mechanism and regulation behind this phenomenon is still limited. Hence, electrospray ionization liquid chromatography mass spectrometry (ESI-LC-MS based metabolomics analysis was applied to determine the metabolome of mangosteen ripening. Specifically, mangosteen pericarp, aril and seed were collected at four different ripening stages (stage 0: green, stage 2: yellowish with pink patches, stage 4: brownish red and stage 6: dark purple and subjected to metabolite profiling analysis. The data provided in this article have been deposited to the EMBL-EBI MetaboLights database (DOI: 10.1093/nar/gks1004. PubMed PMID: 23109552 with the identifier MTBLS595. The complete dataset can be accessed here https://www.ebi.ac.uk/metabolights/MTBLS595. Keywords: Ripening, Garcinia mangostana Linn., Metabolomics, ESI-LC-MS

Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

Directory of Open Access Journals (Sweden)

Swart Annemiek

2006-11-01

Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

Tredimensional laparoskopi har potentiale til at erstatte todimensional laparoskopi ved abdominalkirurgi

DEFF Research Database (Denmark)

Fergo, Charlotte; Pommergaard, Hans-Christian; Burcharth, Jakob

2015-01-01

Studies comparing three-dimensional (3D) laparoscopy with 2D laparoscopy have shown shorter operation time, a short lear-ning curve as well as better depth perception. Robotic surgery includes the EndoWrist function in addition to the 3D view; however robotic surgery lacks haptic feedback....... No evidence from clinical trials for the potential benefits of robotic surgery exists. Thus, 3D laparoscopy is an eligible alternative to both 2D laparoscopy and robotic surgery....

Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review

Science.gov (United States)

Corkum, Mark; Urquhart, Robin; Burge, Fred; Porter, Geoffrey; Johnston, Grace

2013-01-01

Purpose Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of pre-diagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care. Methods A literature search was conducted in relevant databases using title/abstract terms which included “cancer,” “stage,” “diagnosis,” “determinants,” “predictors,” and “associated.” Included studies examined whether comorbidity and/or healthcare utilization had an impact on the stage at which CRC was diagnosed. A standardized data abstraction form was used to assess the eligibility of each study. Thirteen articles were included in the literature review. These studies were assessed and synthesized using qualitative methodology. Results We found much heterogeneity among study variables. The findings of this literature review point to the presence of comorbidity and non-emergent healthcare utilization as having no association with late-stage diagnosis. Conversely, emergency room presentation (ERP) was associated with late-stage diagnosis. Conclusions The results of this literature review did not find strong evidence to suggest that comorbidity and healthcare utilization are potential indicators of late-stage diagnosis. However, ERP may be useful as a flag for consideration of prompt referral to palliative care. Additional research is required to identify potential indicators of late-stage diagnosis that may be available in administrative databases, particularly in the area of healthcare utilization. PMID:22101505

Lexical semantic access and letter access are involved in different aspects of reading

DEFF Research Database (Denmark)

Poulsen, Mads

). In this subset sample, both letter access and lexical access accounted for unique variance in reading fluency. The pattern of effects for lexical access did not change by controlling for serial rapid naming (RAN). Conclusions: The results suggest that letter access and lexical access are important for different......Purpose: This study investigated the effects of lexical access speed and letter access speed on reading fluency and reading comprehension. We hypothesized that 1) letter access speed would correlate with reading fluency but not comprehension, while 2) lexical access speed would influence reading...... comprehension. For readers who are struggling with recoding, most of the reading effort is probably tied up with recoding, leaving little to be explained by lexical access. Therefore we expected that 3) lexical access speed would primarily predict reading fluency for readers who were no longer struggling...

A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory

Directory of Open Access Journals (Sweden)

Dastjerdi Mahdieh

2012-09-01

Full Text Available Abstract Background Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services. Methods The research question guiding this study was, “What are the processes by which Iranian immigrants learn to access health care services in Canada?” To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men who were adults (at least 18 years old and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview. Results Using a constructivist grounded theory approach, “tackling the stumbling blocks of access” emerged as the core category. The basic social process (BSP, becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that “tackling the stumbling blocks of access” was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin. Conclusion During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains

Prostate cancer staging

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000397.htm Prostate cancer staging To use the sharing features on this ... trials you may be able to join How Prostate Cancer Staging is Done Initial staging is based on ...

Comparative effectiveness of one-stage versus two-stage basilic vein transposition arteriovenous fistulas.

Science.gov (United States)

Ghaffarian, Amir A; Griffin, Claire L; Kraiss, Larry W; Sarfati, Mark R; Brooke, Benjamin S

2018-02-01

Basilic vein transposition (BVT) fistulas may be performed as either a one-stage or two-stage operation, although there is debate as to which technique is superior. This study was designed to evaluate the comparative clinical efficacy and cost-effectiveness of one-stage vs two-stage BVT. We identified all patients at a single large academic hospital who had undergone creation of either a one-stage or two-stage BVT between January 2007 and January 2015. Data evaluated included patient demographics, comorbidities, medication use, reasons for abandonment, and interventions performed to maintain patency. Costs were derived from the literature, and effectiveness was expressed in quality-adjusted life-years (QALYs). We analyzed primary and secondary functional patency outcomes as well as survival during follow-up between one-stage and two-stage BVT procedures using multivariate Cox proportional hazards models and Kaplan-Meier analysis with log-rank tests. The incremental cost-effectiveness ratio was used to determine cost savings. We identified 131 patients in whom 57 (44%) one-stage BVT and 74 (56%) two-stage BVT fistulas were created among 8 different vascular surgeons during the study period that each performed both procedures. There was no significant difference in the mean age, male gender, white race, diabetes, coronary disease, or medication profile among patients undergoing one- vs two-stage BVT. After fistula transposition, the median follow-up time was 8.3 months (interquartile range, 3-21 months). Primary patency rates of one-stage BVT were 56% at 12-month follow-up, whereas primary patency rates of two-stage BVT were 72% at 12-month follow-up. Patients undergoing two-stage BVT also had significantly higher rates of secondary functional patency at 12 months (57% for one-stage BVT vs 80% for two-stage BVT) and 24 months (44% for one-stage BVT vs 73% for two-stage BVT) of follow-up (P < .001 using log-rank test). However, there was no significant difference

The academic, economic and societal impacts of Open Access: an evidence-based review.

Science.gov (United States)

Tennant, Jonathan P; Waldner, François; Jacques, Damien C; Masuzzo, Paola; Collister, Lauren B; Hartgerink, Chris H J

2016-01-01

Ongoing debates surrounding Open Access to the scholarly literature are multifaceted and complicated by disparate and often polarised viewpoints from engaged stakeholders. At the current stage, Open Access has become such a global issue that it is critical for all involved in scholarly publishing, including policymakers, publishers, research funders, governments, learned societies, librarians, and academic communities, to be well-informed on the history, benefits, and pitfalls of Open Access. In spite of this, there is a general lack of consensus regarding the potential pros and cons of Open Access at multiple levels. This review aims to be a resource for current knowledge on the impacts of Open Access by synthesizing important research in three major areas: academic, economic and societal. While there is clearly much scope for additional research, several key trends are identified, including a broad citation advantage for researchers who publish openly, as well as additional benefits to the non-academic dissemination of their work. The economic impact of Open Access is less well-understood, although it is clear that access to the research literature is key for innovative enterprises, and a range of governmental and non-governmental services. Furthermore, Open Access has the potential to save both publishers and research funders considerable amounts of financial resources, and can provide some economic benefits to traditionally subscription-based journals. The societal impact of Open Access is strong, in particular for advancing citizen science initiatives, and leveling the playing field for researchers in developing countries. Open Access supersedes all potential alternative modes of access to the scholarly literature through enabling unrestricted re-use, and long-term stability independent of financial constraints of traditional publishers that impede knowledge sharing. However, Open Access has the potential to become unsustainable for research communities if

The academic, economic and societal impacts of Open Access: an evidence-based review

Science.gov (United States)

Tennant, Jonathan P.; Waldner, François; Jacques, Damien C.; Masuzzo, Paola; Collister, Lauren B.; Hartgerink, Chris. H. J.

2016-01-01

Ongoing debates surrounding Open Access to the scholarly literature are multifaceted and complicated by disparate and often polarised viewpoints from engaged stakeholders. At the current stage, Open Access has become such a global issue that it is critical for all involved in scholarly publishing, including policymakers, publishers, research funders, governments, learned societies, librarians, and academic communities, to be well-informed on the history, benefits, and pitfalls of Open Access. In spite of this, there is a general lack of consensus regarding the potential pros and cons of Open Access at multiple levels. This review aims to be a resource for current knowledge on the impacts of Open Access by synthesizing important research in three major areas: academic, economic and societal. While there is clearly much scope for additional research, several key trends are identified, including a broad citation advantage for researchers who publish openly, as well as additional benefits to the non-academic dissemination of their work. The economic impact of Open Access is less well-understood, although it is clear that access to the research literature is key for innovative enterprises, and a range of governmental and non-governmental services. Furthermore, Open Access has the potential to save both publishers and research funders considerable amounts of financial resources, and can provide some economic benefits to traditionally subscription-based journals. The societal impact of Open Access is strong, in particular for advancing citizen science initiatives, and leveling the playing field for researchers in developing countries. Open Access supersedes all potential alternative modes of access to the scholarly literature through enabling unrestricted re-use, and long-term stability independent of financial constraints of traditional publishers that impede knowledge sharing. However, Open Access has the potential to become unsustainable for research communities if

Implementation strategies to increase access and demand of long-lasting insecticidal nets: a before-and-after study and scale-up process in Mozambique.

Science.gov (United States)

Arroz, Jorge A H; Mendis, Chandana; Pinto, Liliana; Candrinho, Baltazar; Pinto, João; Martins, Maria do Rosário O

2017-10-25

The universal coverage bed nets campaign is a proven health intervention promoting increased access, ownership, and use of bed nets to reduce malaria burden. This article describes the intervention and implementation strategies that Mozambique carried out recently in order to improve access and increase demand for long-lasting insecticidal nets (LLINs). A before-and-after study with a control group was used during Stage I of the implementation process. The following strategies were tested in Stage I: (1) use of coupons during household registration; (2) use of stickers to identify the registered households; (3) new LLIN ascription formula (one LLIN for every two people). In Stage II, the following additional strategies were implemented: (4) mapping and micro-planning; (5) training; and (6) supervision. Odds ratio (OR) and 95% confidence interval (CI) were used to compare and establish differences between intervened and control districts in Stage I. Main outcomes were: percentage of LLINs distributed, percentage of target households benefited. In Stage I, 87.8% (302,648) of planned LLINs were distributed in the intervention districts compared to 77.1% (219,613) in the control districts [OR: 2.14 (95% CI 2.11-2.16)]. Stage I results also showed that 80.6% (110,453) of households received at least one LLIN in the intervention districts compared to 72.8% (87,636) in the control districts [OR: 1.56 (95% CI 1.53-1.59)]. In Stage II, 98.4% (3,536,839) of the allocated LLINs were delivered, covering 98.6% (1,353,827) of the registered households. Stage I results achieved better LLINs and household coverage in districts with the newly implemented strategies. The results of stage II were also encouraging. Additional strategies adaptation is required for a wide-country LLIN campaign.

Assessment of Laparoscopic Skills Performance: 2D Versus 3D Vision and Classic Instrument Versus New Hand-Held Robotic Device for Laparoscopy.

Science.gov (United States)

Leite, Mariana; Carvalho, Ana F; Costa, Patrício; Pereira, Ricardo; Moreira, Antonio; Rodrigues, Nuno; Laureano, Sara; Correia-Pinto, Jorge; Vilaça, João L; Leão, Pedro

2016-02-01

Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons' performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Each participant performed 3 laparoscopic tasks-Peg transfer, Wire chaser, Knot-in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks (P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands (P < .05). The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures. © The Author(s) 2015.

Predicting Effects of Water Regime Changes on Waterbirds: Insights from Staging Swans.

Science.gov (United States)

Nolet, Bart A; Gyimesi, Abel; van Krimpen, Roderick R D; de Boer, Willem F; Stillman, Richard A

2016-01-01

Predicting the environmental impact of a proposed development is notoriously difficult, especially when future conditions fall outside the current range of conditions. Individual-based approaches have been developed and applied to predict the impact of environmental changes on wintering and staging coastal bird populations. How many birds make use of staging sites is mostly determined by food availability and accessibility, which in the case of many waterbirds in turn is affected by water level. Many water systems are regulated and water levels are maintained at target levels, set by management authorities. We used an individual-based modelling framework (MORPH) to analyse how different target water levels affect the number of migratory Bewick's swans Cygnus columbianus bewickii staging at a shallow freshwater lake (Lauwersmeer, the Netherlands) in autumn. As an emerging property of the model, we found strong non-linear responses of swan usage to changes in water level, with a sudden drop in peak numbers as well as bird-days with a 0.20 m rise above the current target water level. Such strong non-linear responses are probably common and should be taken into account in environmental impact assessments.

Predicting Effects of Water Regime Changes on Waterbirds: Insights from Staging Swans.

Directory of Open Access Journals (Sweden)

Bart A Nolet

Full Text Available Predicting the environmental impact of a proposed development is notoriously difficult, especially when future conditions fall outside the current range of conditions. Individual-based approaches have been developed and applied to predict the impact of environmental changes on wintering and staging coastal bird populations. How many birds make use of staging sites is mostly determined by food availability and accessibility, which in the case of many waterbirds in turn is affected by water level. Many water systems are regulated and water levels are maintained at target levels, set by management authorities. We used an individual-based modelling framework (MORPH to analyse how different target water levels affect the number of migratory Bewick's swans Cygnus columbianus bewickii staging at a shallow freshwater lake (Lauwersmeer, the Netherlands in autumn. As an emerging property of the model, we found strong non-linear responses of swan usage to changes in water level, with a sudden drop in peak numbers as well as bird-days with a 0.20 m rise above the current target water level. Such strong non-linear responses are probably common and should be taken into account in environmental impact assessments.

Technique of ‘suture less’ appendicectomy by laparoscopy in children: Preliminary communication

OpenAIRE

Bajpai, Minu

2014-01-01

Objective: Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted ′pick and fix′ stitch in three cases. Materials and Methods: Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappend...

Association analysis of salt tolerance in cowpea (Vigna unguiculata (L.) Walp) at germination and seedling stages.

Science.gov (United States)

Ravelombola, Waltram; Shi, Ainong; Weng, Yuejin; Mou, Beiquan; Motes, Dennis; Clark, John; Chen, Pengyin; Srivastava, Vibha; Qin, Jun; Dong, Lingdi; Yang, Wei; Bhattarai, Gehendra; Sugihara, Yuichi

2018-01-01

This is the first report on association analysis of salt tolerance and identification of SNP markers associated with salt tolerance in cowpea. Cowpea (Vigna unguiculata (L.) Walp) is one of the most important cultivated legumes in Africa. The worldwide annual production in cowpea dry seed is 5.4 million metric tons. However, cowpea is unfavorably affected by salinity stress at germination and seedling stages, which is exacerbated by the effects of climate change. The lack of knowledge on the genetic underlying salt tolerance in cowpea limits the establishment of a breeding strategy for developing salt-tolerant cowpea cultivars. The objectives of this study were to conduct association mapping for salt tolerance at germination and seedling stages and to identify SNP markers associated with salt tolerance in cowpea. We analyzed the salt tolerance index of 116 and 155 cowpea accessions at germination and seedling stages, respectively. A total of 1049 SNPs postulated from genotyping-by-sequencing were used for association analysis. Population structure was inferred using Structure 2.3.4; K optimal was determined using Structure Harvester. TASSEL 5, GAPIT, and FarmCPU involving three models such as single marker regression, general linear model, and mixed linear model were used for the association study. Substantial variation in salt tolerance index for germination rate, plant height reduction, fresh and dry shoot biomass reduction, foliar leaf injury, and inhibition of the first trifoliate leaf was observed. The cowpea accessions were structured into two subpopulations. Three SNPs, Scaffold87490_622, Scaffold87490_630, and C35017374_128 were highly associated with salt tolerance at germination stage. Seven SNPs, Scaffold93827_270, Scaffold68489_600, Scaffold87490_633, Scaffold87490_640, Scaffold82042_3387, C35069468_1916, and Scaffold93942_1089 were found to be associated with salt tolerance at seedling stage. The SNP markers were consistent across the three models and

Long-term results of the Heller-Dor operation with intraoperative manometry for the treatment of esophageal achalasia.

Science.gov (United States)

Mattioli, Sandro; Ruffato, Alberto; Lugaresi, Marialuisa; Pilotti, Vladimiro; Aramini, Beatrice; D'Ovidio, Frank

2010-11-01

Quality of outcome of the Heller-Dor operation is sometimes different between studies, likely because of technical reasons. We analyze the details of myotomy and fundoplication in relation to the results achieved over a 30-year single center's experience. From 1979-2008, a long esophagogastric myotomy and a partial anterior fundoplication to protect the surface of the myotomy was routinely performed with intraoperative manometry in 202 patients (97 men; median age, 55.5 years; interquartile range, 43.7-71 years) through a laparotomy and in 60 patients (24 men; median age, 46 years; interquartile range, 36.2-63 years) through a laparoscopy. The follow-up consisted of periodical interview, endoscopy, and barium swallow, and a semiquantitative scale was used to grade results. Mortality was 1 of 202 in the laparotomy group and 0 of 60 in the laparoscopy group. Median follow-up was 96 months (interquartile range, 48-190.5 months) in the laparotomy group and 48 months (interquartile range, 27-69.5 months) in the laparoscopy group. At intraoperative manometry, complete abolition of the high-pressure zone was obtained in 100%. The Dor-related high-pressure zone length and mean pressure were 4.5 ± 0.4 cm and 13.3 ± 2.2 mm Hg in the laparotomy group and 4.5 ± 0.5 cm and 13.2 ± 2.2 mm Hg in the laparoscopy group (P = .75). In the laparotomy group poor results (19/201 [9.5%]) were secondary to esophagitis in 15 (7.5%) of 201 patients (in 2 patients after 184 and 252 months, respectively) and to recurrent dysphagia in 4 (2%) of 201 patients, all with end-stage sigmoid achalasia. In the laparoscopy group 2 (3.3%) of 60 had esophagitis. A long esophagogastric myotomy protected by means of Dor fundoplication cures or substantially reduces dysphagia in the great majority of patients affected by esophageal achalasia and effectively controls postoperative esophagitis. Intraoperative manometry is likely the key factor for achieving the reported results. Copyright © 2010 The

Optical Access Networks

Science.gov (United States)

Zheng, Jun; Ansari, Nirwan

2005-06-01

Call for Papers: Optical Access Networks With the wide deployment of fiber-optic technology over the past two decades, we have witnessed a tremendous growth of bandwidth capacity in the backbone networks of today's telecommunications infrastructure. However, access networks, which cover the "last-mile" areas and serve numerous residential and small business users, have not been scaled up commensurately. The local subscriber lines for telephone and cable television are still using twisted pairs and coaxial cables. Most residential connections to the Internet are still through dial-up modems operating at a low speed on twisted pairs. As the demand for access bandwidth increases with emerging high-bandwidth applications, such as distance learning, high-definition television (HDTV), and video on demand (VoD), the last-mile access networks have become a bandwidth bottleneck in today's telecommunications infrastructure. To ease this bottleneck, it is imperative to provide sufficient bandwidth capacity in the access networks to open the bottleneck and thus present more opportunities for the provisioning of multiservices. Optical access solutions promise huge bandwidth to service providers and low-cost high-bandwidth services to end users and are therefore widely considered the technology of choice for next-generation access networks. To realize the vision of optical access networks, however, many key issues still need to be addressed, such as network architectures, signaling protocols, and implementation standards. The major challenges lie in the fact that an optical solution must be not only robust, scalable, and flexible, but also implemented at a low cost comparable to that of existing access solutions in order to increase the economic viability of many potential high-bandwidth applications. In recent years, optical access networks have been receiving tremendous attention from both academia and industry. A large number of research activities have been carried out or

Multi-Stage Open Peer Review: Scientific Evaluation Integrating the Strengths of Traditional Peer Review with the Virtues of Transparency and Self-Regulation

Science.gov (United States)

Pöschl, Ulrich

2012-01-01

The traditional forms of scientific publishing and peer review do not live up to all demands of efficient communication and quality assurance in today’s highly diverse and rapidly evolving world of science. They need to be advanced and complemented by interactive and transparent forms of review, publication, and discussion that are open to the scientific community and to the public. The advantages of open access, public peer review, and interactive discussion can be efficiently and flexibly combined with the strengths of traditional scientific peer review. Since 2001 the benefits and viability of this approach are clearly demonstrated by the highly successful interactive open access journal Atmospheric Chemistry and Physics (ACP, www.atmos-chem-phys.net) and a growing number of sister journals launched and operated by the European Geosciences Union (EGU, www.egu.eu) and the open access publisher Copernicus (www.copernicus.org). The interactive open access journals are practicing an integrative multi-stage process of publication and peer review combined with interactive public discussion, which effectively resolves the dilemma between rapid scientific exchange and thorough quality assurance. Key features and achievements of this approach are: top quality and impact, efficient self-regulation and low rejection rates, high attractivity and rapid growth, low costs, and financial sustainability. In fact, ACP and the EGU interactive open access sister journals are by most if not all standards more successful than comparable scientific journals with traditional or alternative forms of peer review (editorial statistics, publication statistics, citation statistics, economic costs, and sustainability). The high efficiency and predictive validity of multi-stage open peer review have been confirmed in a series of dedicated studies by evaluation experts from the social sciences, and the same or similar concepts have recently also been adopted in other disciplines, including

Public Access and Open Access: Is There a Difference? | Poster

Science.gov (United States)

By Robin Meckley, Contributing Writer, and Tracie Frederick, Guest Writer Open access and public access—are they different concepts or are they the same? What do they mean for the researchers at NCI at Frederick? “Open-access (OA) literature is digital, online, free of charge, and free of most copyright and licensing restrictions. What makes it possible is the Internet and the consent of the author or copyright-holder,” according to an open access website maintained by Peter Suber, director, Harvard Open Access Project.

Moving toward a universally accessible web: Web accessibility and education.

Science.gov (United States)

Kurt, Serhat

2017-12-08

The World Wide Web is an extremely powerful source of information, inspiration, ideas, and opportunities. As such, it has become an integral part of daily life for a great majority of people. Yet, for a significant number of others, the internet offers only limited value due to the existence of barriers which make accessing the Web difficult, if not impossible. This article illustrates some of the reasons that achieving equality of access to the online world of education is so critical, explores the current status of Web accessibility, discusses evaluative tools and methods that can help identify accessibility issues in educational websites, and provides practical recommendations and guidelines for resolving some of the obstacles that currently hinder the achievability of the goal of universal Web access.

Improved design for a low temperature scanning tunneling microscope with an in situ tip treatment stage.

Science.gov (United States)

Kim, J-J; Joo, S H; Lee, K S; Yoo, J H; Park, M S; Kwak, J S; Lee, Jinho

2017-04-01

The Low Temperature Scanning Tunneling Microscope (LT-STM) is an extremely valuable tool not only in surface science but also in condensed matter physics. For years, numerous new ideas have been adopted to perfect LT-STM performances-Ultra-Low Vibration (ULV) laboratory and the rigid STM head design are among them. Here, we present three improvements for the design of the ULV laboratory and the LT-STM: tip treatment stage, sample cleaving stage, and vibration isolation system. The improved tip treatment stage enables us to perform field emission for the purpose of tip treatment in situ without exchanging samples, while our enhanced sample cleaving stage allows us to cleave samples at low temperature in a vacuum without optical access by a simple pressing motion. Our newly designed vibration isolation system provides efficient space usage while maintaining vibration isolation capability. These improvements enhance the quality of spectroscopic imaging experiments that can last for many days and provide increased data yield, which we expect can be indispensable elements in future LT-STM designs.

The first preliminary experiments on an 84 GHz gyrotron with a single-stage depressed collector

International Nuclear Information System (INIS)

Shimozuma, T.; Sato, M.; Takita, Y.

1997-10-01

We fabricated and tested an 84GHz gyrotron with a single-stage depressed collector. The gyrotron has a high-voltage insulating section made of a low loss silicon nitride composite. In this preliminary experiment in the depressed collector configuration, we obtained 591kW, 41% operation with a depression voltage of 22.5kV. Access to the higher efficiency region was inhibited by an increase in anode current. (author)

Access Customized Forms

OpenAIRE

Cosma Emil; Jeflea Victor

2010-01-01

By using Word, Excel or PowerPoint one can automate routine operations using the VBA language (Visual Basic for Applications). This language is also used in Access, allowing access to data stored in tables or queries. Thus, Access and VBA resources can be used together. Access is designed for programming forms and reports (among other things), so there won’t be found any of the VBA editor’s specific forms.

The influence of magnetic field strength in ionization stage on ion transport between two stages of a double stage Hall thruster

International Nuclear Information System (INIS)

Yu Daren; Song Maojiang; Li Hong; Liu Hui; Han Ke

2012-01-01

It is futile for a double stage Hall thruster to design a special ionization stage if the ionized ions cannot enter the acceleration stage. Based on this viewpoint, the ion transport under different magnetic field strengths in the ionization stage is investigated, and the physical mechanisms affecting the ion transport are analyzed in this paper. With a combined experimental and particle-in-cell simulation study, it is found that the ion transport between two stages is chiefly affected by the potential well, the potential barrier, and the potential drop at the bottom of potential well. With the increase of magnetic field strength in the ionization stage, there is larger plasma density caused by larger potential well. Furthermore, the potential barrier near the intermediate electrode declines first and then rises up while the potential drop at the bottom of potential well rises up first and then declines as the magnetic field strength increases in the ionization stage. Consequently, both the ion current entering the acceleration stage and the total ion current ejected from the thruster rise up first and then decline as the magnetic field strength increases in the ionization stage. Therefore, there is an optimal magnetic field strength in the ionization stage to guide the ion transport between two stages.

A national survey of public support for restrictions on youth access to tobacco.

Science.gov (United States)

Bailey, W J; Crowe, J W

1994-10-01

A national telephone survey was conducted to measure public support for seven proposals to restrict youth access to tobacco products, including increases in the cigarette excise tax. A random digit dialing survey, using computer-assisted telephone interviews and a two-stage Mitofsky-Waksberg design, was used to generate and replace telephone numbers and to select individuals from within households. More than 94% of respondents believed cigarette smoking by children and adolescents to be a "very serious" or "somewhat serious" problem. Most respondents expressed support for all the proposed measures to restrict youth access to tobacco products (fines for sellers, fines for youthful violators, licensing of all tobacco vendors, restrictions on cigarette vending machines, ban on sponsorship of youth-oriented events, and ban on all tobacco advertising), and for increases in the cigarette excise tax.

Optics of two-stage photovoltaic concentrators with dielectric second stages

Science.gov (United States)

Ning, Xiaohui; O'Gallagher, Joseph; Winston, Roland

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Optics of two-stage photovoltaic concentrators with dielectric second stages.

Science.gov (United States)

Ning, X; O'Gallagher, J; Winston, R

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Multiple stage railgun

International Nuclear Information System (INIS)

Aaland, K.; Hawke, R.S.; Scudder, J.K.

1982-01-01

A multiple stage magnetic railgun accelerator for accelerating a projectile by movement of a plasma arc along the rails. The railgun is divided into a plurality of successive rail stages which are sequentially energized by separate energy sources as the projectile moves through the bore of the railgun. Propagation of energy from an energized rail stage back towards the breech end of the railgun can be prevented by connection of the energy sources to the rails through isolation diodes. Propagation of energy from an energized rail stage back towards the breech end of the railgun can also be prevented by dividing the rails into electrically isolated rail sections. In such case means are used to extinguish the arc at the end of each energized stage and a fuse or laser device is used to initiate a new plasma arc in the next energized rail stage

Open access

CERN Document Server

Suber, Peter

2012-01-01

The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder consent, and many authors, musicians, filmmakers, and other creators who depend on royalties are understandably unwilling to give their consent. But for 350 years, scholars have written peer-reviewed journal articles for impact, not for money, and are free to consent to open access without losing revenue. In this concise introduction, Peter Suber tells us what open access is and isn't, how it benefits authors and readers of research, how we pay for it, how it avoids copyright problems, how it has moved from the periphery to the mainstream, and what its future may hold. Distilling a decade of Suber's influential writing and thinking about open access, this is the indispe...

[Laparoscopic management of ovarian borderline tumors].

Science.gov (United States)

Cortés Algara, A; Charles, L; González Ramírez, P; Río de la Loza, F; Aranda Flores, C E

2001-09-01

The objective of this communication is to present a patient case with ovarian borderline tumor. The conservative management for laparoscopy, and we performed an analysis of the mundial literature in which respect to the conservative and laparoscopy management, in spite of the laparoscopy management are of controversy.

The protection motivation theory within the stages of the transtheoretical model - stage-specific interplay of variables and prediction of exercise stage transitions.

Science.gov (United States)

Lippke, Sonia; Plotnikoff, Ronald C

2009-05-01

Two different theories of health behaviour have been chosen with the aim of theory integration: a continuous theory (protection motivation theory, PMT) and a stage model (transtheoretical model, TTM). This is the first study to test whether the stages of the TTM moderate the interrelation of PMT-variables and the mediation of motivation, as well as PMT-variables' interactions in predicting stage transitions. Hypotheses were tested regarding (1) mean patterns, stage pair-comparisons and nonlinear trends using ANOVAs; (2) prediction-patterns for the different stage groups employing multi-group structural equation modelling (MSEM) and nested model analyses; and (3) stage transitions using binary logistic regression analyses. Adults (N=1,602) were assessed over a 6 month period on their physical activity stages, PMT-variables and subsequent behaviour. (1) Particular mean differences and nonlinear trends in all test variables were found. (2) The PMT adequately fitted the five stage groups. The MSEM revealed that covariances within threat appraisal and coping appraisal were invariant and all other constrains were stage-specific, i.e. stage was a moderator. Except for self-efficacy, motivation fully mediated the relationship between the social-cognitive variables and behaviour. (3) Predicting stage transitions with the PMT-variables underscored the importance of self-efficacy. Only when threat appraisal and coping appraisal were high, stage movement was more likely in the preparation stage. Results emphasize stage-specific differences of the PMT mechanisms, and hence, support the stage construct. The findings may guide further theory building and research integrating different theoretical approaches.

Removal of pharmaceuticals in pre-denitrifying MBBR – Influence of organic substrate availability in single- and three-stage configurations

DEFF Research Database (Denmark)

Polesel, Fabio; Torresi, Elena; Loreggian, L.

2017-01-01

kinetics were observed, with highest and lowest rates/rate constants in the first (S1) and the last (S3) staged sub-reactors, respectively. These observations were confirmed by removal efficiency data obtained during continuous-flow operation, with limited removal (... and highest removal in S1 within the three-stage MBBR. Notably, biotransformation rate constants obtained for non-recalcitrant pharmaceuticals correlated with mean specific denitrification rates, maximum specific growth rates and observed growth yield values. Overall, these findings suggest that: (i) the long......-term exposure to tiered substrate accessibility in the three-stage configuration shaped the denitrification and biotransformation capacity of biofilms, with significant reduction under substrate limitation; (ii) biotransformation of pharmaceuticals may have occurred as a result of cometabolism by heterotrophic...

76 FR 40497 - Medicare Program; Changes to the End-Stage Renal Disease Prospective Payment System for CY 2012...

Science.gov (United States)

2011-07-08

... problems accessing any of the Addenda to the proposed and final rules that are posted on the CMS Web site.... Statement of Need 3. Overall Impact B. Detailed Economic Analysis 1. CY 2012 End-Stage Renal Disease... transition) period during which ESRD facilities receive a blend of payments under the prior basic case-mix...

Design considerations for single-stage and two-stage pneumatic pellet injectors

International Nuclear Information System (INIS)

Gouge, M.J.; Combs, S.K.; Fisher, P.W.; Milora, S.L.

1988-09-01

Performance of single-stage pneumatic pellet injectors is compared with several models for one-dimensional, compressible fluid flow. Agreement is quite good for models that reflect actual breech chamber geometry and incorporate nonideal effects such as gas friction. Several methods of improving the performance of single-stage pneumatic pellet injectors in the near term are outlined. The design and performance of two-stage pneumatic pellet injectors are discussed, and initial data from the two-stage pneumatic pellet injector test facility at Oak Ridge National Laboratory are presented. Finally, a concept for a repeating two-stage pneumatic pellet injector is described. 27 refs., 8 figs., 3 tabs

Barriers to access prevention of mother-to-child transmission for HIV positive women in a well-resourced setting in Vietnam

NARCIS (Netherlands)

Nguyen, T.A.; Oosterhoff, P.P.J.; Yen, P.N.; Wright, P.; Hardon, A.P.

2008-01-01

Background: According to Vietnamese policy, HIV-infected women should have access at least to HIV testing and Nevirapine prophylaxis, or where available, to adequate counselling, HIV infection staging, ARV prophylaxis, and infant formula. Many studies in high HIV prevalence settings have reported

From spatial to social accessibility: How socio-economic factors can affect accessibility?

OpenAIRE

Mercier , Aurélie

2016-01-01

The concept of accessibility cannot only focus on " spatial accessibility " measurement but has to integer a " social accessibility " level to take into account individual inequalities and socioeconomic disparities to access to urban opportunities. In this context, this contribution focuses on socioeconomic disparities integration on accessibility measurement, considering the Lyon case study. The paper is divided into three parts The first part aims to present a method for integrating the soc...

Accessibility

DEFF Research Database (Denmark)

Brooks, Anthony Lewis

2017-01-01

This contribution is timely as it addresses accessibility in regards system hardware and software aligned with introduction of the Twenty-First Century Communications and Video Accessibility Act (CVAA) and adjoined game industry waiver that comes into force January 2017. This is an act created...... by the USA Federal Communications Commission (FCC) to increase the access of persons with disabilities to modern communications, and for other purposes. The act impacts advanced communications services and products including text messaging; e-mail; instant messaging; video communications; browsers; game...... platforms; and games software. However, the CVAA has no legal status in the EU. This text succinctly introduces and questions implications, impact, and wider adoption. By presenting the full CVAA and game industry waiver the text targets to motivate discussions and further publications on the subject...

Permanent vascular access in patients with end-stage renal disease, Brazil Acceso vascular permanente en pacientes renales crónicos terminales en Brasil Acesso vascular permanente em pacientes renais crônicos terminais no Brasil

Directory of Open Access Journals (Sweden)

Gisele Macedo da Silva

2011-04-01

Full Text Available OBJECTIVE: To assess factors associated with the establishment of permanent vascular access for patients with end-stage renal disease. METHODS: Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276. Data were from the TRS Project - "Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS: About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure OBJETIVO: Analizar factores asociados a la provisión de acceso vascular arteriovenoso en Brasil. MÉTODOS: Estudio transversal, nacionalmente representativo, con pacientes con enfermedad renal crónica terminal acompañados en servicios de diálisis o en centros transplantadores en el año de 2007. La muestra incluyó pacientes que tuvieron la hemodiálisis como primera modalidad de tratamiento y que sabían con que tipo de acceso vascular habían iniciado el tratamiento (N=2.276. Los datos son oriundos del Proyecto TRS - "Evaluación económica-epidemiológica de las modalidades de Terapia renal Sustitutiva en Brasil". Fue utilizada la regresión logística múltiple. RESULTADOS: Aproximadamente 30% de los pacientes tenían acceso vascular arteriovenoso. Los factores asociados a la baja probabilidad de tener acceso vascular arteriovenoso como primer tipo de acceso fueron: tiempo de diagnóstico de enfermedad

Optical Access Networks

Science.gov (United States)

Zheng, Jun; Ansari, Nirwan

2005-01-01

Call for Papers: Optical Access Networks Guest Editors Jun Zheng, University of Ottawa Nirwan Ansari, New Jersey Institute of Technology Submission Deadline: 1 June 2005 Background With the wide deployment of fiber-optic technology over the past two decades, we have witnessed a tremendous growth of bandwidth capacity in the backbone networks of today's telecommunications infrastructure. However, access networks, which cover the "last-mile" areas and serve numerous residential and small business users, have not been scaled up commensurately. The local subscriber lines for telephone and cable television are still using twisted pairs and coaxial cables. Most residential connections to the Internet are still through dial-up modems operating at a low speed on twisted pairs. As the demand for access bandwidth increases with emerging high-bandwidth applications, such as distance learning, high-definition television (HDTV), and video on demand (VoD), the last-mile access networks have become a bandwidth bottleneck in today's telecommunications infrastructure. To ease this bottleneck, it is imperative to provide sufficient bandwidth capacity in the access networks to open the bottleneck and thus present more opportunities for the provisioning of multiservices. Optical access solutions promise huge bandwidth to service providers and low-cost high-bandwidth services to end users and are therefore widely considered the technology of choice for next-generation access networks. To realize the vision of optical access networks, however, many key issues still need to be addressed, such as network architectures, signaling protocols, and implementation standards. The major challenges lie in the fact that an optical solution must be not only robust, scalable, and flexible, but also implemented at a low cost comparable to that of existing access solutions in order to increase the economic viability of many potential high-bandwidth applications. In recent years, optical access networks

Repercussões respiratórias e hemodinâmicas do pneumoperitônio na lesão do diafragma: estudo experimental Hemodynamic and respiratory changes caused by CO2 laparoscopy in an experimental model of diaphragmatic injury

Directory of Open Access Journals (Sweden)

Sílvia Cristine Soldá

2007-08-01

Full Text Available OBJETIVO: Analisar as alterações hemodinâmicas e respiratórias secundárias à laparoscopia em modelo experimental de lesão diafragmática. MÉTODOS: Foram utilizados 15 suínos, distribuídos em três grupos com cinco animais cada, assim constituídos: Grupo 1 - Portadores de lesão diafragmática e avaliados sem pneumoperitônio (CLSP; Grupo 2 - Sem lesão diafragmática e avaliados com pneumoperitônio (SLCP; Grupo 3 - Portadores de lesão diafragmática e avaliados com pneumoperitônio (CLCP. Foram avaliadas variáveis gasométricas, hemodinâmicas e respiratórias. RESULTADOS: Houve alterações significantes da pressão média de artéria pulmonar (PAP, pressão de capilar pulmonar (PCP, PAO2, SAO2 e SVO2. CONCLUSÃO: A videolaparoscopia na presença de lesão do diafragma não acarreta alterações do débito cardíaco e pode ser realizada com segurança, desde que a pressão de pneumoperitônio não ultrapasse valores de 15 mmHg.OBJECTIVE: The objective of this study was to analyze the hemodynamic and respiratory changes caused by CO2 laparoscopy in an experimental model of diaphragmatic injury. METHODS: Fifteen animals chosen at random were submitted to diaphragmatic injury by means of CO2 laparoscopy. Evaluation consisted of drawing blood samples to analyze blood gases, as well as the hemodynamic and respiratory variables. RESULTS: Alterations occurred in APA, CPP, PAO2, ASO2, VSO2. CONCLUSION: We concluded that videolaparoscopy with pneumoperitoneum pressure under 15mmHg is a safe procedure in patients with diaphragmatic injuries because this pressure level does not cause hemodynamic changes, such as decrease of the cardiac output. [Rev Assoc Med Bras 2007; 53(4: 294-9

Demystifying Open Access

International Nuclear Information System (INIS)

Mele, Salvatore

2007-01-01

The tenets of Open Access are to grant anyone, anywhere and anytime free access to the results of scientific research. HEP spearheaded the Open Access dissemination of scientific results with the mass mailing of preprints in the pre-WWW era and with the launch of the arXiv preprint system at the dawn of the '90s. The HEP community is now ready for a further push to Open Access while retaining all the advantages of the peer-review system and, at the same time, bring the spiralling cost of journal subscriptions under control. I will present a possible plan for the conversion to Open Access of HEP peer-reviewed journals, through a consortium of HEP funding agencies, laboratories and libraries: SCOAP3 (Sponsoring Consortium for Open Access Publishing in Particle Physics). SCOAP3 will engage with scientific publishers towards building a sustainable model for Open Access publishing, which is as transparent as possible for HEP authors. The current system in which journals income comes from subscription fees is replaced with a scheme where SCOAP3 compensates publishers for the costs incurred to organise the peer-review service and give Open Access to the final version of articles. SCOAP3 will be funded by all countries active in HEP under a 'fair share' scenario, according to their production of HEP articles. In this talk I will present a short overview of the history of Open Access in HEP, the details of the SCOAP3 model and the outlook for its implementation.

Diagnostic Laparoscopy

Science.gov (United States)

... a laparoscope. Most patients feel a short-lived “bee sting” that lasts a second or two. Small ... procedure was performed. You should have nothing to eat or drink for a set time period before ...

Pelvic laparoscopy

Science.gov (United States)

... does not go away Nausea and vomiting Severe abdominal pain ... Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. ... pain in women of childbearing age. Cochrane Database Syst ...

Overview: Routes to Open Access

OpenAIRE

Tullney, Marco; van Wezenbeek, Wilma

2017-01-01

Slides of an overview presentation given at a CESAER workshop on Open Access, February 2nd, 2017, in Brussels Cover major routes to more open access as discussed in the Task Force Open Science of CESAER: (national) open access strategies open access mandates open access incentives open access awareness open access publishing open access infrastructure

Turbine stage model

International Nuclear Information System (INIS)

Kazantsev, A.A.

2009-01-01

A model of turbine stage for calculations of NPP turbine department dynamics in real time was developed. The simulation results were compared with manufacturer calculations for NPP low-speed and fast turbines. The comparison results have shown that the model is valid for real time simulation of all modes of turbines operation. The model allows calculating turbine stage parameters with 1% accuracy. It was shown that the developed turbine stage model meets the accuracy requirements if the data of turbine blades setting angles for all turbine stages are available [ru

Accessing Electronic Journals.

Science.gov (United States)

McKay, Sharon Cline

1999-01-01