Portable radiation instrumentation traceability of standards and measurements

International Nuclear Information System (INIS)

Wiserman, A.; Walke, M.

1995-01-01

Portable radiation measuring instruments are used to estimate and control doses for workers. Calibration of these instruments must be sufficiently accurate to ensure that administrative and legal dose limits are not likely to be exceeded due to measurement uncertainties. An instrument calibration and management program is established which permits measurements made with an instrument to be traced to a national standard. This paper describes the establishment and maintenance of calibration standards for gamma survey instruments and an instrument management program which achieves traceability of measurement for uniquely identified field instruments. (author)

Endoscopic management of colorectal adenomas.

Science.gov (United States)

Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur

2017-01-01

Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy.

Endoscopic and keyhole endoscope-assisted neurosurgical approaches: a qualitative survey on technical challenges and technological solutions.

Science.gov (United States)

Marcus, Hani J; Cundy, Thomas P; Hughes-Hallett, Archie; Yang, Guang-Zhong; Darzi, Ara; Nandi, Dipankar

2014-10-01

The literature reflects a resurgence of interest in endoscopic and keyhole endoscope-assisted neurosurgical approaches as alternatives to conventional microsurgical approaches in carefully selected cases. The aim of this study was to assess the technical challenges of neuroendoscopy, and the scope for technological innovations to overcome these barriers. All full members of the Society of British Neurosurgeons (SBNS) were electronically invited to participate in an online survey. The open-ended structured survey asked three questions; firstly, whether the surgeon presently utilises or has experience with endoscopic or endoscope-assisted approaches; secondly, what they consider to be the major technical barriers to adopting such approaches; and thirdly, what technological advances they foresee improving safety and efficacy in the field. Responses were subjected to a qualitative research method of multi-rater emergent theme analysis. Three clear themes emerged: 1) surgical approach and better integration with image-guidance systems (20%), 2) intra-operative visualisation and improvements in neuroendoscopy (49%), and 3) surgical manipulation and improvements in instruments (74%). The analysis of responses to our open-ended survey revealed that although opinion was varied three major themes could be identified. Emerging technological advances such as augmented reality, high-definition stereo-endoscopy, and robotic joint-wristed instruments may help overcome the technical difficulties associated with neuroendoscopic approaches. Results of this qualitative survey provide consensus amongst the technology end-user community such that unambiguous goals and priorities may be defined. Systems integrating these advances could improve the safety and efficacy of endoscopic and endoscope-assisted neurosurgical approaches.

Cytology evaluation for brushing in biliary and pancreatic stenosis during endoscopic cholangiopancreatography

International Nuclear Information System (INIS)

Ruiz, Mario H; Castano, Rodrigo; Alvarez, Oscar A; Velez, Alejandro; Munera, Veronica

2002-01-01

No surgical pathologic confirmation of malignant bile duct strictures is desirable for defining subsequent treatment and prognosis. Endoscopic retrograde cholangiopancreatography is frequently performed in patients suspected of having pancreaticobiliary obstruction, but there exists no standardized method or instruments for defining benign or malignant nature of obstructing lesions by ERCP. We prospectively evaluated the yields of endoscopic retrograde brush cytology for the diagnosis of malignant bile and pancreatic duct strictures. Fluoroscopically guided endobiliary brush cytology was performed during endoscopic retrograde cholangiopancreatography in 29 consecutive patients, 20 with malignant strictures and 9 with benign stricture. A single pathologist classified the results of these studies as positive, or negative for malignancy. The sensitivities of the procedure were 69%. Specificity proved excellent, 100%. Two major complications that occurred in the same patient were acute pancreatitis in a patient with chronic pancreatitis and bleeding from pancreatic duct. Both were managed medically and improved. This study indicates that endoscopic retrograde brush cytology alone may be sufficient in daily practice, to differentiate against benign and malignant biliary or pancreatic stenosis

[The endoscopic therapy of benign stenoses of the esophagus and cardioesophageal junction using Eder-Puestow instrumentation].

Science.gov (United States)

Donev, Sht; Bosekert, N; Belchev, B

1995-01-01

The results of palliative endoscopic treatment by bougienage using Eder-Puestow instrumentation, performed in a limited contingent of patients presenting benign esophageal strictures, are analyzed. It is underscored that the method is readily carried out and effective, and seldom leads to noteworthy complications, such as esophageal perforations--one patient alone presenting cicatricial stricture out of the total of 42 cases given treatment with bougienage over a 10-year period. The commonest cause of benign strictures of the esophagus in the series being examined is reflux (peptic) esophagitis against the background of hiatus hernia.

Endoscopic Devices for Obesity.

Science.gov (United States)

Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I

2016-06-01

The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

OpenAIRE

Gubler, Christoph; Bauerfeind, Peter

2014-01-01

OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy o...

Recognition of risk situations based on endoscopic instrument tracking and knowledge based situation modeling

Science.gov (United States)

Speidel, Stefanie; Sudra, Gunther; Senemaud, Julien; Drentschew, Maximilian; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

2008-03-01

Minimally invasive surgery has gained significantly in importance over the last decade due to the numerous advantages on patient-side. The surgeon has to adapt special operation-techniques and deal with difficulties like the complex hand-eye coordination, limited field of view and restricted mobility. To alleviate these constraints we propose to enhance the surgeon's capabilities by providing a context-aware assistance using augmented reality (AR) techniques. In order to generate a context-aware assistance it is necessary to recognize the current state of the intervention using intraoperatively gained sensor data and a model of the surgical intervention. In this paper we present the recognition of risk situations, the system warns the surgeon if an instrument gets too close to a risk structure. The context-aware assistance system starts with an image-based analysis to retrieve information from the endoscopic images. This information is classified and a semantic description is generated. The description is used to recognize the current state and launch an appropriate AR visualization. In detail we present an automatic vision-based instrument tracking to obtain the positions of the instruments. Situation recognition is performed using a knowledge representation based on a description logic system. Two augmented reality visualization programs are realized to warn the surgeon if a risk situation occurs.

Endoscopic and Photodynamic Therapy of Cholangiocarcinoma.

Science.gov (United States)

Meier, Benjamin; Caca, Karel

2016-12-01

Most patients with cholangiocarcinoma (CCA) have unresectable disease. Endoscopic bile duct drainage is one of the major objectives of palliation of obstructive jaundice. Stent implantation using endoscopic retrograde cholangiography is considered to be the standard technique. Unilateral versus bilateral stenting is associated with different advantages and disadvantages; however, a standard approach is still not defined. As there are various kinds of stents, there is an ongoing discussion on which stent to use in which situation. Palliation of obstructive jaundice can be augmented through the use of photodynamic therapy (PDT). Studies have shown a prolonged survival for the combinations of PDT and different stent applications as well as combinations of PDT and additional systemic chemotherapy. More well-designed studies are needed to better evaluate and standardize endoscopic treatment of unresectable CCA.

Electrical, instrumentation, and control codes and standards

International Nuclear Information System (INIS)

Kranning, A.N.

1978-01-01

During recent years numerous documents in the form of codes and standards have been developed and published to provide design, fabrication and construction rules and criteria applicable to instrumentation, control and power distribution facilities for nuclear power plants. The contents of this LTR were prepared by NUS Corporation under Subcontract K5108 and provide a consolidated index and listing of the documents selected for their application to procurement of materials and design of modifications and new construction at the LOFT facility. These codes and standards should be applied together with the National Electrical Code, the ID Engineering Standards and LOFT Specifications to all LOFT instrument and electrical design activities

Responsiveness of Endoscopic Indices of Disease Activity for Crohn's Disease

NARCIS (Netherlands)

Khanna, Reena; Zou, Guangyong; Stitt, Larry; Feagan, Brian G.; Sandborn, William J.; Rutgeerts, Paul; McDonald, John W. D.; Dubcenco, Elena; Fogel, Ronald; Panaccione, Remo; Jairath, Vipul; Nelson, Sigrid; Shackelton, Lisa M.; Huang, Bidan; Zhou, Qian; Robinson, Anne M.; Levesque, Barrett G.; D'Haens, Geert

2017-01-01

The Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn's Disease (SES-CD) are commonly used to assess Crohn's disease (CD) activity; however neither instrument is fully validated. We evaluated the responsiveness to change of the SES-CD and CDEIS using data

Development and content validation of performance assessments for endoscopic third ventriculostomy

NARCIS (Netherlands)

Breimer, Gerben E.; Haji, Faizal A.; Hoving, Eelco W; Drake, James M.

This study aims to develop and establish the content validity of multiple expert rating instruments to assess performance in endoscopic third ventriculostomy (ETV), collectively called the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). The important aspects of ETV were identified through

Ultrasound-assisted endoscopic partial plantar fascia release.

Science.gov (United States)

Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

2013-01-01

Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure.

Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy

Directory of Open Access Journals (Sweden)

Mohammad Etezad Razavi

2011-01-01

Full Text Available To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR. Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

Endoscopic cubital tunnel release using the Hoffmann technique.

Science.gov (United States)

Hoffmann, Reimer; Lubahn, John

2013-06-01

Endoscopic cubital tunnel release was originally described in 1989 by Tsai, and his technique has been modified by other surgeons including Mirza and Cobb. In 2006, Hoffmann and Siemionow described an endoscopic technique quite different from Tsai's original description. Instead of working from the "inside out," Hoffmann's technique is performed through an incision similar to that which would be used for an in situ release of the ulnar nerve. The main difference being that the nerve can be explored and decompressed 10 cm proximal and distal to the arcuate ligament as the surgeon looks down on the nerve and the surrounding tissues while viewing the anatomy through a camera attached to a soft tissue endoscope that is inserted in the wound. The arcuate (Osborne's) ligament is released under direct vision much like a standard in situ decompression. Using a blunt dissection instrument, a workspace is created proximally and distally to the cubital tunnel. Next an illuminated speculum is introduced, the nerve is directly visualized between 4 and 5 cm proximal and distal to the cubital tunnel, and potential compressive forearm fasciae or fibrous bands are released. Finally, a 15-cm, 30° soft tissue endoscope is introduced into the incision, and viewing the internal anatomy on a video monitor, the decompression continues using longer scissors. Any potential bleeding is controlled with a long bayonet bipolar cautery. The authors discuss indications, contraindications, and the surgical technique. Postoperative management and associated complications are also discussed. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Preclinical cadaveric study of transanal endoscopic da Vinci® surgery.

Science.gov (United States)

Hompes, R; Rauh, S M; Hagen, M E; Mortensen, N J

2012-08-01

Single-port platforms are increasingly being used for transanal surgery and may be associated with a shorter learning curve than transanal endoscopic microsurgery. However, these procedures remain technically challenging, and robotic technology could overcome some of the limitations and increase intraluminal manoeuvrability. An initial experimental experience with transanal endoscopic da Vinci(®) surgery (TEdS) using a glove port on human cadavers is reported. After initial dry laboratory experiments, the feasibility of TEdS and ideal set-up were further evaluated in human cadavers. For transanal access a glove port was constructed on-table by using a circular anal dilator, a standard wound retractor and a surgical glove. A da Vinci(®) Si HD system was used in combination with the glove port for transanal endoscopic resections. It was possible to perform all necessary tasks to complete a full-thickness excision and closure of the rectal wall, with cadavers in both prone and supine positions. The stable magnified view, combined with the EndoWrist(®) technology of the robotic instruments, made every task straightforward. Intraluminal manoeuvrability could be improved further by intersecting the robotic instruments. The glove port proved to be very reliable and the inherent flexibility of the glove facilitated docking of the robotic arms in a narrow confined space. Using a reliable and universally available glove port, TEdS was feasible and a preferred set-up was determined. Further clinical trials will be necessary to assess the safety and efficacy of this technique. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

A standardized imaging protocol for the endoscopic prediction of dysplasia within sessile serrated polyps (with video).

Science.gov (United States)

Tate, David J; Jayanna, Mahesh; Awadie, Halim; Desomer, Lobke; Lee, Ralph; Heitman, Steven J; Sidhu, Mayenaaz; Goodrick, Kathleen; Burgess, Nicholas G; Mahajan, Hema; McLeod, Duncan; Bourke, Michael J

2018-01-01

Dysplasia within sessile serrated polyps (SSPs) is difficult to detect and may be mistaken for an adenoma, risking incomplete resection of the background serrated tissue, and is strongly implicated in interval cancer after colonoscopy. The use of endoscopic imaging to detect dysplasia within SSPs has not been systematically studied. Consecutively detected SSPs ≥8 mm in size were evaluated by using a standardized imaging protocol at a tertiary-care endoscopy center over 3 years. Lesions suspected as SSPs were analyzed with high-definition white light then narrow-band imaging. A demarcated area with a neoplastic pit pattern (Kudo type III/IV, NICE type II) was sought among the serrated tissue. If this was detected, the lesion was labeled dysplastic (sessile serrated polyp with dysplasia); if not, it was labeled non-dysplastic (sessile serrated polyp without dysplasia). Histopathology was reviewed by 2 blinded specialist GI pathologists. A total of 141 SSPs were assessed in 83 patients. Median lesion size was 15.0 mm (interquartile range 10-20), and 54.6% were in the right side of the colon. Endoscopic evidence of dysplasia was detected in 36 of 141 (25.5%) SSPs; of these, 5 of 36 (13.9%) lacked dysplasia at histopathology. Two of 105 (1.9%) endoscopically designated non-dysplastic SSPs had dysplasia at histopathology. Endoscopic imaging, therefore, had an accuracy of 95.0% (95% confidence interval [CI], 90.1%-97.6%) and a negative predictive value of 98.1% (95% CI, 92.6%-99.7%) for detection of dysplasia within SSPs. Dysplasia within SSPs can be detected accurately by using a simple, broadly applicable endoscopic imaging protocol that allows complete resection. Independent validation of this protocol and its dissemination to the wider endoscopic community may have a significant impact on rates of interval cancer. (Clinical trial registration number: NCT03100552.). Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All

Training to acquire psychomotor skills for endoscopic endonasal surgery using a personal webcam trainer.

Science.gov (United States)

Hirayama, Ryuichi; Fujimoto, Yasunori; Umegaki, Masao; Kagawa, Naoki; Kinoshita, Manabu; Hashimoto, Naoya; Yoshimine, Toshiki

2013-05-01

Existing training methods for neuroendoscopic surgery have mainly emphasized the acquisition of anatomical knowledge and procedures for operating an endoscope and instruments. For laparoscopic surgery, various training systems have been developed to teach handling of an endoscope as well as the manipulation of instruments for speedy and precise endoscopic performance using both hands. In endoscopic endonasal surgery (EES), especially using a binostril approach to the skull base and intradural lesions, the learning of more meticulous manipulation of instruments is mandatory, and it may be necessary to develop another type of training method for acquiring psychomotor skills for EES. Authors of the present study developed an inexpensive, portable personal trainer using a webcam and objectively evaluated its utility. Twenty-five neurosurgeons volunteered for this study and were divided into 2 groups, a novice group (19 neurosurgeons) and an experienced group (6 neurosurgeons). Before and after the exercises of set tasks with a webcam box trainer, the basic endoscopic skills of each participant were objectively assessed using the virtual reality simulator (LapSim) while executing 2 virtual tasks: grasping and instrument navigation. Scores for the following 11 performance variables were recorded: instrument time, instrument misses, instrument path length, and instrument angular path (all of which were measured in both hands), as well as tissue damage, max damage, and finally overall score. Instrument time was indicated as movement speed; instrument path length and instrument angular path as movement efficiency; and instrument misses, tissue damage, and max damage as movement precision. In the novice group, movement speed and efficiency were significantly improved after the training. In the experienced group, significant improvement was not shown in the majority of virtual tasks. Before the training, significantly greater movement speed and efficiency were demonstrated in

ECIRS (Endoscopic Combined Intrarenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery?

Science.gov (United States)

Cracco, Cecilia Maria; Scoffone, Cesare Marco

2011-12-01

Percutaneous nephrolithotomy (PNL) is still the gold-standard treatment for large and/or complex renal stones. Evolution in the endoscopic instrumentation and innovation in the surgical skills improved its success rate and reduced perioperative morbidity. ECIRS (Endoscopic Combined IntraRenal Surgery) is a new way of affording PNL in a modified supine position, approaching antero-retrogradely to the renal cavities, and exploiting the full array of endourologic equipment. ECIRS summarizes the main issues recently debated about PNL. The recent literature regarding supine PNL and ECIRS has been reviewed, namely about patient positioning, synergy between operators, procedures, instrumentation, accessories and diagnostic tools, step-by-step standardization along with versatility of the surgical sequence, minimization of radiation exposure, broadening to particular and/or complex patients, limitation of post-operative renal damage. Supine PNL and ECIRS are not superior to prone PNL in terms of urological results, but guarantee undeniable anesthesiological and management advantages for both patient and operators. In particular, ECIRS requires from the surgeon a permanent mental attitude to synergy, standardized surgical steps, versatility and adherence to the ongoing clinical requirements. ECIRS can be performed also in particular cases, irrespective to age or body habitus. The use of flexible endoscopes during ECIRS contributes to minimizing radiation exposure, hemorrhagic risk and post-PNL renal damage. ECIRS may be considered an evolution of the PNL procedure. Its proposal has the merit of having triggered the critical analysis of the various PNL steps and of patient positioning, and of having transformed the old static PNL into an updated approach.

A new technique of single portal endoscopic carpal tunnel release.

Science.gov (United States)

Ip, Wing-Yuk Josephine; Sweed, Tamer Ahmed; Fung, Kwok Keung Boris; Tipoe, George L; Pun, Tze Shing

2012-03-01

Since the first description of endoscopic carpal tunnel release (ECTR) in 1987 by Okutsu many endoscopic techniques have been developed, but the majority of the literature on ECTR has dealt with the Chow and Agee techniques. ECTR is indicated for carpal tunnel syndrome that is not responding to conservative treatment for 6 months. This new technique of ECTR is a single-portal technique using instruments originally designed for endoscopic cubital tunnel release, with no disposable instruments used. It also has the advantage of performing the release with the median nerve protected under direct vision. Ten cases were operated with this technique after performing the procedure on 8 hands of 4 fresh frozen cadavers. There were no neurovascular or tendon injuries with this technique and patients were satisfied with the results.

Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist.

Science.gov (United States)

Christian, Eisha; Harris, Brianna; Wrobel, Bozena; Zada, Gabriel

2014-01-01

Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.

Long-term results using LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum

DEFF Research Database (Denmark)

Andersen, Michelle Fog; Trolle, Waldemar; Anthonsen, Kristian

2017-01-01

The purpose of the present study was to evaluate the long-term results and patient's satisfaction of a new approach using the LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum (ZD) and to compare with other long-term results using traditional treatment modalities. Between December ...... to traditional endoscopic techniques and is now the standard treatment method for ZD in our departments.......The purpose of the present study was to evaluate the long-term results and patient's satisfaction of a new approach using the LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum (ZD) and to compare with other long-term results using traditional treatment modalities. Between December......%) reported no symptoms at all. Our results suggest that endoscopic management of ZD with the LigaSure™ 5 mm instrument is a minimally invasive, fast and safe method with solid long-term outcome with relief of symptoms and patient satisfaction. This new operative instrument was not found inferior...

Standard practice for instrumented indentation testing

CERN Document Server

American Society for Testing and Materials. Philadelphia

2007-01-01

1.1 This practice defines the basic steps of Instrumented Indentation Testing (IIT) and establishes the requirements, accuracies, and capabilities needed by an instrument to successfully perform the test and produce the data that can be used for the determination of indentation hardness and other material characteristics. IIT is a mechanical test that measures the response of a material to the imposed stress and strain of a shaped indenter by forcing the indenter into a material and monitoring the force on, and displacement of, the indenter as a function of time during the full loading-unloading test cycle. 1.2 The operational features of an IIT instrument, as well as requirements for Instrument Verification Annex A1), Standardized Reference Blocks (Annex A2) and Indenter Requirements (Annex A3) are defined. This practice is not intended to be a complete purchase specification for an IIT instrument. 1.3 With the exception of the non-mandatory Appendix X4, this practice does not define the analysis necessary...

Standardization of Nuclear Instrumentation Applied in the NPP and in other nuclear installations

International Nuclear Information System (INIS)

Kusnowo, Arlinah; Darmawati, Suzie

2002-01-01

Nuclear power plant (NPP) and other nuclear installations have been recognized as applications needing very sophisticated technologies. One of technologies used in this all nuclear facilities is nuclear instrumentation. In order that NPP and other nuclear installations be operated safely, nuclear instrumentation requires standardization from design to its operation. Internationally, standardizations of nuclear instrumentation have been issued by IEC (International Electrotechnical Commission). Formulation of standard in nuclear instrumentation in IEC is carried out by Technical Committee (TC) 45. This paper describes briefly the standardization of nuclear instrumentation applied in Indonesia as Indonesian National Standard (SNI, Standard National Indonesia), standardization of nuclear instrumentation developed by TC 45, SC 45A, and SC 45B, as well as the possibility to adopt and apply those IEC standard in Indonesia

Per-oral endoscopic myotomy: Major advance in achalasia treatment and in endoscopic surgery

Science.gov (United States)

Friedel, David; Modayil, Rani; Stavropoulos, Stavros N

2014-01-01

Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis. PMID:25548473

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept.

Science.gov (United States)

Friedrich, D T; Sommer, F; Scheithauer, M O; Greve, J; Hoffmann, T K; Schuler, P J

2017-12-01

Objective  Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods  The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results  Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion  The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

[Endoscopic ultrasound guided rendezvous for biliary drainage].

Science.gov (United States)

Knudsen, Marie Høxbro; Vilmann, Peter; Hassan, Hazem; Karstensen, John Gésdal

2015-04-27

Endoscopic retrograde cholangiography (ERCP) is currently standard treatment for biliary drainage. Endoscopic ultrasound guided rendezvous (EUS-RV) is a novel method to overcome an unsuccessful biliary drainage procedure. Under endoscopic ultrasound guidance a guidewire is passed via a needle from the stomach or duodenum to the common bile duct and from there on to the duodenum enabling ERCP. With a relatively high rate of success EUS-RV should be considered as an alternative to biliary drainage and surgical intervention.

A hands-free region-of-interest selection interface for solo surgery with a wide-angle endoscope: preclinical proof of concept.

Science.gov (United States)

Jung, Kyunghwa; Choi, Hyunseok; Hong, Hanpyo; Adikrishna, Arnold; Jeon, In-Ho; Hong, Jaesung

2017-02-01

A hands-free region-of-interest (ROI) selection interface is proposed for solo surgery using a wide-angle endoscope. A wide-angle endoscope provides images with a larger field of view than a conventional endoscope. With an appropriate selection interface for a ROI, surgeons can also obtain a detailed local view as if they moved a conventional endoscope in a specific position and direction. To manipulate the endoscope without releasing the surgical instrument in hand, a mini-camera is attached to the instrument, and the images taken by the attached camera are analyzed. When a surgeon moves the instrument, the instrument orientation is calculated by an image processing. Surgeons can select the ROI with this instrument movement after switching from 'task mode' to 'selection mode.' The accelerated KAZE algorithm is used to track the features of the camera images once the instrument is moved. Both the wide-angle and detailed local views are displayed simultaneously, and a surgeon can move the local view area by moving the mini-camera attached to the surgical instrument. Local view selection for a solo surgery was performed without releasing the instrument. The accuracy of camera pose estimation was not significantly different between camera resolutions, but it was significantly different between background camera images with different numbers of features (P solo surgeries without a camera assistant.

Endoscopic Radiofrequency Ablation-Assisted Resection of Juvenile Nasopharyngeal Angiofibroma: Comparison with Traditional Endoscopic Technique.

Science.gov (United States)

McLaughlin, Eamon J; Cunningham, Michael J; Kazahaya, Ken; Hsing, Julianna; Kawai, Kosuke; Adil, Eelam A

2016-06-01

To evaluate the feasibility of radiofrequency surgical instrumentation for endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) and to test the hypothesis that endoscopic radiofrequency ablation-assisted (RFA) resection will have superior intraoperative and/or postoperative outcomes as compared with traditional endoscopic (TE) resection techniques. Case series with chart review. Two tertiary care pediatric hospitals. Twenty-nine pediatric patients who underwent endoscopic transnasal resection of JNA from January 2000 to December 2014. Twenty-nine patients underwent RFA (n = 13) or TE (n = 16) JNA resection over the 15-year study period. Mean patient age was not statistically different between the 2 groups (P = .41); neither was their University of Pittsburgh Medical Center classification stage (P = .79). All patients underwent preoperative embolization. Mean operative times were not statistically different (P = .29). Mean intraoperative blood loss and the need for a transfusion were also not statistically different (P = .27 and .47, respectively). Length of hospital stay was not statistically different (P = .46). Recurrence rates did not differ between groups (P = .99) over a mean follow-up period of 2.3 years. There were no significant differences between RFA and TE resection in intraoperative or postoperative outcome parameters. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Update on endoscopic pancreatic function testing

Institute of Scientific and Technical Information of China (English)

Tyler Stevens; Mansour A Parsi

2011-01-01

Hormone-stimulated pancreatic function tests (PFTs) are considered the gold standard for measuring pancreatic exocrine function. PFTs involve the administration of intravenous secretin or cholecystokinin, followed by collection and analysis of pancreatic secretions. Because exocrine function may decline in the earliest phase of pancreatic fibrosis, PFTs are considered accurate for diagnosing chronic pancreatitis. Unfortunately, these potentially valuable tests are infrequently performed except at specialized centers, because they are time consuming and complicated. To overcome these limitations, endoscopic PFT methods have been developed which include aspiration of pancreatic secretions through the suction channel of the endoscope. The secretin endoscopic pancreatic function test (ePFT) involves collection of duodenal aspirates at 15, 30, 45 and 60 min after secretin stimulation. A bicarbonate concentration greater than 80 mmol/L in any of the samples is considered a normal result. The secretin ePFT has demonstrated good sensitivity and specificity compared with various reference standards, including the "Dreiling tube" secretin PFT, endoscopic ultrasound, and surgical histology. Furthermore, a standard autoanalyzer can be used for bicarbonate analysis, which allows the secretin ePFT to be performed at any hospital. The secretin ePFT may complement imaging tests like endoscopic ultrasound (EUS) in the diagnosis of early chronic pancreatitis.This paper will review the literature validating the use of ePFT in the diagnosis of exocrine insufficiency and chronic pancreatitis. Newer developments will also be discussed, including the feasibility of combined EUS/ePFT, the use of cholecystokinin alone or in combination with secretin, and the discovery of new protein and lipid pancreatic juice biomarkers which may complement traditionalfluid analysis.

International standardization of instruments for neutron irradiation tests

International Nuclear Information System (INIS)

Tanimoto, Masataka; Shibata, Akira; Nakamura, Jinichi; Tsuchiya, Kunihiko; Cho, M.; Lee, C.; Park, S.; Choo, K.

2012-01-01

The JMTR in JAEA and HANARO in KAERI are the foremost testing/research reactors in the world and these are expected to contribute to many nuclear fields. As a part of instrument development in irradiation field, information exchange of instruments started from 2010 under the cooperation agreements between KAERI and JAEA. The instruments developed in JMTR and HANARO are introduced and cooperation experiments as future plan are discussed for international standardization. (author)

Radioactive standards and calibration methods for contamination monitoring instruments

Energy Technology Data Exchange (ETDEWEB)

Yoshida, Makoto [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

1997-06-01

Contamination monitoring in the facilities for handling unsealed radioactive materials is one of the most important procedures for radiation protection as well as radiation dose monitoring. For implementation of the proper contamination monitoring, radiation measuring instruments should not only be suitable to the purpose of monitoring, but also be well calibrated for the objective qualities of measurement. In the calibration of contamination monitoring instruments, quality reference activities need to be used. They are supplied in different such as extended sources, radioactive solutions or radioactive gases. These reference activities must be traceable to the national standards or equivalent standards. On the other hand, the appropriate calibration methods must be applied for each type of contamination monitoring instruments. In this paper, the concepts of calibration for contamination monitoring instruments, reference sources, determination methods of reference quantities and practical calibration methods of contamination monitoring instruments, including the procedures carried out in Japan Atomic Energy Research Institute and some relevant experimental data. (G.K.)

Method for radiometric calibration of an endoscope's camera and light source

Science.gov (United States)

Rai, Lav; Higgins, William E.

2008-03-01

An endoscope is a commonly used instrument for performing minimally invasive visual examination of the tissues inside the body. A physician uses the endoscopic video images to identify tissue abnormalities. The images, however, are highly dependent on the optical properties of the endoscope and its orientation and location with respect to the tissue structure. The analysis of endoscopic video images is, therefore, purely subjective. Studies suggest that the fusion of endoscopic video images (providing color and texture information) with virtual endoscopic views (providing structural information) can be useful for assessing various pathologies for several applications: (1) surgical simulation, training, and pedagogy; (2) the creation of a database for pathologies; and (3) the building of patient-specific models. Such fusion requires both geometric and radiometric alignment of endoscopic video images in the texture space. Inconsistent estimates of texture/color of the tissue surface result in seams when multiple endoscopic video images are combined together. This paper (1) identifies the endoscope-dependent variables to be calibrated for objective and consistent estimation of surface texture/color and (2) presents an integrated set of methods to measure them. Results show that the calibration method can be successfully used to estimate objective color/texture values for simple planar scenes, whereas uncalibrated endoscopes performed very poorly for the same tests.

77 FR 37409 - Request for Domains, Instruments, and Measures for Development of a Standardized Instrument for...

Science.gov (United States)

2012-06-21

... experience as well. On both issues, CMS is interested in instruments and items which can measure quality of... Measures for Development of a Standardized Instrument for Use in Public Reporting of Enrollee Satisfaction..., communication, coordination of care, customer service), instruments, and measures for measuring the level of...

Approaching time is important for assessment of endoscopic surgical skills.

Science.gov (United States)

Tokunaga, Masakazu; Egi, Hiroyuki; Hattori, Minoru; Yoshimitsu, Masanori; Sumitani, Daisuke; Kawahara, Tomohiro; Okajima, Masazumi; Ohdan, Hideki

2012-05-01

This study aimed to verify whether the approaching time (the time taken to reach the target point from another point, a short distance apart, during point-to-point movement in endoscopic surgery), assessed using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), could distinguish the skill level of surgeons. Expert surgeons (who had performed more than 50 endoscopic surgeries) and novice surgeons (who had no experience in performing endoscopic surgery) were tested using the HUESAD. The approaching time, total time, and intermediate time (total time--approaching time) were measured and analyzed using the trajectory of the tip of the instrument. The approaching time and total time were significantly shorter in the expert group than in the novice group (p time did not significantly differ between the groups (p > 0.05). The approaching time, which is a component of the total time, is very mportant in the measurement of the total time to assess endoscopic surgical skills. Further, the approaching time was useful for skill assessment by the HUESAD for evaluating the skill of surgeons performing endoscopic surgery.

Submucosal tunnel endoscopy: Peroral endoscopic myotomy and peroral endoscopic tumor resection

Science.gov (United States)

Eleftheriadis, Nikolas; Inoue, Haruhiro; Ikeda, Haruo; Onimaru, Manabu; Maselli, Roberta; Santi, Grace

2016-01-01

Peroral endoscopic myotomy (POEM) is an innovative, minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy (LHM), not only for all types of esophageal achalasia [classical (I), vigorous (II), spastic (III), Chicago Classification], but also for advanced sigmoid type achalasia (S1 and S2), failed LHM, or other esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). POEM starts with a mucosal incision, followed by submucosal tunnel creation crossing the esophagogastric junction (EGJ) and myotomy. Finally the mucosal entry is closed with endoscopic clip placement. POEM permitted relatively free choice of myotomy length and localization. Although it is technically demanding procedure, POEM can be performed safely and achieves very good control of dysphagia and chest pain. Gastroesophageal reflux is the most common troublesome side effect, and is well controllable with proton pump inhibitors. Furthermore, POEM opened the era of submucosal tunnel endoscopy, with many other applications. Based on the same principles with POEM, in combination with new technological developments, such as endoscopic suturing, peroral endoscopic tumor resection (POET), is safely and effectively applied for challenging submucosal esophageal, EGJ and gastric cardia tumors (submucosal tumors), emerged from muscularis propria. POET showed up to know promising results, however, it is restricted to specialized centers. The present article reviews the recent data of POEM and POET and discussed controversial issues that need further study and future perspectives. PMID

Requirements for a quality measurement instrument for semantic standards

NARCIS (Netherlands)

Folmer, E.J.A.; Krukkert, D.; Oude Luttighuis, P.; Hillegersberg van, J. van

2010-01-01

This study describes requirements for an instrument to measure the quality of semantic standards. A situational requirements engineering method was used, resulting in a goal-tree in which requirements are structured. This structure shows requirements related to the input of the instrument; stating

Elimination of high titre HIV from fibreoptic endoscopes.

Science.gov (United States)

Hanson, P J; Gor, D; Jeffries, D J; Collins, J V

1990-06-01

Concern about contamination of fibreoptic endoscopes with human immunodeficiency virus (HIV) has generated a variety of disruptive and possibly unnecessary infection control practices in endoscopy units. Current recommendations on the cleaning and disinfection of endoscopes have been formulated without applied experimental evidence of the effective removal of HIV from endoscopes. To study the kinetics of elimination of HIV from endoscope surfaces, we artificially contaminated the suction-biopsy channels of five Olympus GIF XQ20 endoscopes with high titre HIV in serum. The air and water channels of two instruments were similarly contaminated. Contamination was measured by irrigating channels with viral culture medium and collecting 3 ml at the distal end for antigen immunoassay. Endoscopes were then cleaned manually in neutral detergent according to the manufacturer's recommendations and disinfected in 2% alkaline glutaraldehyde (Cidex, Surgikos) for two, four, and ten minutes. Contamination with HIV antigens was measured before and after cleaning and after each period of disinfection. Initial contamination comprised 4.8 x 10(4) to 3.5 x 10(6) pg HIV antigen/ml. Cleaning in detergent achieved a reduction to 165 pg/ml (99.93%) on one endoscope and to undetectable levels (100%) on four. After two minutes in alkaline glutaraldehyde all samples were negative and remained negative after the longer disinfection times. Air and water channels, where contaminated, were tested after 10 minutes' disinfection and were negative. These findings underline the importance of cleaning in removing HIV from endoscope and indicate that the use of dedicated equipment and long disinfection times are unnecessary.

Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note.

Science.gov (United States)

Komatsu, Fuminari; Imai, Masaaki; Shigematsu, Hideaki; Aoki, Rie; Oda, Shinri; Shimoda, Masami; Matsumae, Mitsunori

2017-08-25

The authors' initial experience with the endoscopic extradural supraorbital approach to the temporal pole and adjacent area is reported. Fully endoscopic surgery using the extradural space via a supraorbital keyhole was performed for tumors in or around the temporal pole, including temporal pole cavernous angioma, sphenoid ridge meningioma, and cavernous sinus pituitary adenoma, mainly using 4-mm, 0° and 30° endoscopes and single-shaft instruments. After making a supraorbital keyhole, a 4-mm, 30° endoscope was advanced into the extradural space of the anterior cranial fossa during lifting of the dura mater. Following identification of the sphenoid ridge, orbital roof, and anterior clinoid process, the bone lateral to the orbital roof was drilled off until the dura mater of the anterior aspect of the temporal lobe was exposed. The dura mater of the temporal lobe was incised and opened, exposing the temporal pole under a 4-mm, 0° endoscope. Tumors in or around the temporal pole were safely removed under a superb view through the extradural corridor. The endoscopic extradural supraorbital approach was technically feasible and safe. The anterior trajectory to the temporal pole using the extradural space under endoscopy provided excellent visibility, allowing minimally invasive surgery. Further surgical experience and development of specialized instruments would promote this approach as an alternative surgical option.

Design and validation of a standards-based science teacher efficacy instrument

Science.gov (United States)

Kerr, Patricia Reda

National standards for K--12 science education address all aspects of science education, with their main emphasis on curriculum---both science subject matter and the process involved in doing science. Standards for science teacher education programs have been developing along a parallel plane, as is self-efficacy research involving classroom teachers. Generally, studies about efficacy have been dichotomous---basing the theoretical underpinnings on the work of either Rotter's Locus of Control theory or on Bandura's explanations of efficacy beliefs and outcome expectancy. This study brings all three threads together---K--12 science standards, teacher education standards, and efficacy beliefs---in an instrument designed to measure science teacher efficacy with items based on identified critical attributes of standards-based science teaching and learning. Based on Bandura's explanation of efficacy being task-specific and having outcome expectancy, a developmental, systematic progression from standards-based strategies and activities to tasks to critical attributes was used to craft items for a standards-based science teacher efficacy instrument. Demographic questions related to school characteristics, teacher characteristics, preservice background, science teaching experience, and post-certification professional development were included in the instrument. The instrument was completed by 102 middle level science teachers, with complete data for 87 teachers. A principal components analysis of the science teachers' responses to the instrument resulted in two components: Standards-Based Science Teacher Efficacy: Beliefs About Teaching (BAT, reliability = .92) and Standards-Based Science Teacher Efficacy: Beliefs About Student Achievement (BASA, reliability = .82). Variables that were characteristic of professional development activities, science content preparation, and school environment were identified as members of the sets of variables predicting the BAT and BASA

Present problems of standardization in nuclear instrumentation in Romania

International Nuclear Information System (INIS)

Purghel, Lidia

2001-01-01

The continuos development of nuclear techniques, based on international cooperation, led to the need for producing national and international standards referring to terminology, classification, technical characteristic, testing and calibration methods for nuclear instrumentation. The international standardization activity is organised in the frame of the well-known organization like IEC, ISO, ICRU, ICRP, IOLM, CENELEC, EFOMP, WHO. High advances were obtained in the standardization of the ionising radiation dosimetry in the frame of the International Commission for Radiation Units (ICRU) which started its works 1925. Romania is member of the International Electrotechnical Commission (IEC) from 1920 when its president was the formal member of Romanian Academy, professor Remus Radulet. Romania is effectively involved in standardization activities in the field nuclear instrumentation both as user and manufacturer of nuclear instrumentation. At national level the Technical Committee 45, as a branch of the Romanian Electrotechnical Committee is hosted by Horia Hulubei National Institute for Physics and Nuclear Engineering. The technical committee has the tasks of analysing the market, the regulations and the industry requirements and proposing new standards or revision for existing one. A table is given showing the number of IEC standards considered by TC 45, adopted RS - IEC standards (prepared/published) and planned for 2000/2001. Romania hosted IEC international plenary meetings in 1962 and 1974 and an IEC workshop 1997 with participation of specialists from USA, Sweden, Germany, France, Japan and Romania. As industry is striving to use more and more standard products, that means best quality and safety for less money, more than ever one have to convince the industry about the usefulness and specificity of the nuclear standards

Micromotor endoscope catheter for in vivo, ultrahigh-resolution optical coherence tomography

Science.gov (United States)

Herz, P. R.; Chen, Y.; Aguirre, A. D.; Schneider, K.; Hsiung, P.; Fujimoto, J. G.; Madden, K.; Schmitt, J.; Goodnow, J.; Petersen, C.

2004-10-01

A distally actuated, rotational-scanning micromotor endoscope catheter probe is demonstrated for ultrahigh-resolution in vivo endoscopic optical coherence tomography (OCT) imaging. The probe permits focus adjustment for visualization of tissue morphology at varying depths with improved transverse resolution compared with standard OCT imaging probes. The distal actuation avoids nonuniform scanning motion artifacts that are present with other probe designs and can permit a wider range of imaging speeds. Ultrahigh-resolution endoscopic imaging is demonstrated in a rabbit with micromotor endoscope catheter probe promises to improve OCT imaging performance in future endoscopic imaging applications.

[Acute asthma attacks introduced by anesthesia before nasal endoscopic surgery].

Science.gov (United States)

Lü, Xiaofei; Han, Demin; Zhou, Bing; Ding, Bin

2004-05-01

In order to pay our attention to the perioperative treatment before nasal endoscopic surgery. Three patients with asthma accompanied chronic sinusitis were analyzed systemically, who had undergone acute attacks of asthma introduced by anesthesia. Anesthetic drugs and instruments can lead to acute attacks of asthma, because sinusitis with asthma means allergic airway inflammation, broncho-hyperreactivity and lower compensatory pulmonary function. Then all of the 3 cases had missed the preoperative treatment. Anesthetic drugs and instruments can lead to acute attacks of asthma. The perioperative treatment before nasal endoscopic surgery is very important for the prevention of the occurrences of this severe complication. Except emergency, the operation should be can celled for avoiding the acute attack of asthma introduced by anesthesia.

Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

Science.gov (United States)

Campo, Rudi; Wattiez, Arnaud; Tanos, Vasilis; Di Spiezio Sardo, Attilio; Grimbizis, Grigoris; Wallwiener, Diethelm; Brucker, Sara; Puga, Marco; Molinas, Roger; O'Donovan, Peter; Deprest, Jan; Van Belle, Yves; Lissens, Ann; Herrmann, Anja; Tahir, Mahmood; Benedetto, Chiara; Siebert, Igno; Rabischong, Benoit; De Wilde, Rudy Leon

2016-04-01

In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Endoscope-assisted approach to excision of branchial cleft cysts.

Science.gov (United States)

Teng, Stephanie E; Paul, Benjamin C; Brumm, John D; Fritz, Mark; Fang, Yixin; Myssiorek, David

2016-06-01

The purpose of this study is to describe an endoscope-assisted surgical technique for the excision of branchial cleft cysts and compare it to the standard approach. Retrospective case series review. Twenty-seven cases described as branchial cleft excisions performed by a single surgeon at one academic medical center were identified between 2007 and 2014. Twenty-five cases (8 endoscopic, 17 standard approach) were included in the study. Cases were excluded if final pathology was malignant. Patient charts were reviewed, and two techniques were compared through analysis of incision size, operative time, and surgical outcomes. This study showed that the length of incision required for the endoscopic approach (mean = 2.13 ± 0.23) was significantly less than that of the standard approach (mean = 4.10 ± 1.46, P = 0.008) despite the fact that there was no significant difference in cyst size between the two groups (P = 0.09). The other variables examined, including operative time and surgical outcomes, were not significantly different between the two groups. This transcervical endoscope-assisted approach to branchial cleft cyst excision is a viable option for uncomplicated cases. It provides better cosmetic results than the standard approach and does not negatively affect outcomes, increase operative time, or result in recurrence. 4. Laryngoscope, 126:1339-1342, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

The Open Geospatial Consortium PUCK Standard: Building Sensor Networks with Self-Describing Instruments

Science.gov (United States)

O'Reilly, T. C.; Broering, A.; del Rio, J.; Headley, K. L.; Toma, D.; Bermudez, L. E.; Edgington, D.; Fredericks, J.; Manuel, A.

2012-12-01

Sensor technology is rapidly advancing, enabling smaller and cheaper instruments to monitor Earth's environment. It is expected that many more kinds and quantities of networked environmental sensors will be deployed in coming years. Knowledge of each instrument's command protocol is required to operate and acquire data from the network. Making sense of these data streams to create an integrated picture of environmental conditions requires that each instrument's data and metadata be accurately processed and that "suspect" data be flagged. Use of standards to operate an instrument and retrieve and describe its data generally simplifies instrument software development, integration, operation and data processing. The Open Geospatial Consortium (OGC) PUCK protocol enables instruments that describe themselves in a standard way. OGC PUCK defines a small "data sheet" that describes key instrument characteristics, and a standard protocol to retrieve the data sheet from the device itself. Data sheet fields include a universal serial number that is unique across all PUCK-compliant instruments. Other fields identify the instrument manufacturer and model. In addition to the data sheet, the instrument may also provide a "PUCK payload" which can contain additional descriptive information (e.g. a SensorML document or IEEE 1451 TEDS), as well as actual instrument "driver" code. Computers on the sensor network can use PUCK protocol to retrieve this information from installed instruments and utilize it appropriately, e.g. to automatically identify, configure and operate the instruments, and acquire and process their data. The protocol is defined for instruments with an RS232 or Ethernet interface. OGC members recently voted to adopt PUCK as a component of the OGC's Sensor Web Enablement (SWE) standards. The protocol is also supported by a consortium of hydrographic instrument manufacturers and has been implemented by several of them (https://sites.google.com/site/soscsite/). Thus far

Fundus imaging with a nasal endoscope

Directory of Open Access Journals (Sweden)

P Mahesh Shanmugam

2015-01-01

Full Text Available Wide field fundus imaging is needed to diagnose, treat, and follow-up patients with retinal pathology. This is more applicable for pediatric patients as repeated evaluation is a challenge. The presently available imaging machines though provide high definition images, but carry the obvious disadvantages of either being costly or bulky or sometimes both, which limits its usage only to large centers. We hereby report a technique of fundus imaging using a nasal endoscope coupled with viscoelastic. A regular nasal endoscope with viscoelastic coupling was placed on the cornea to image the fundus of infants under general anesthesia. Wide angle fundus images of various fundus pathologies in infants could be obtained easily with readily available instruments and without the much financial investment for the institutes.

Endoscopic treatment of large vesical calculi

International Nuclear Information System (INIS)

Rauf, A.; Ahmed, I.; Rauf, M.H.; Rauf, M.

2015-01-01

Objective: To determine the efficiency and safety of endoscopic treatment of large vesical calculi with the available modern endoscopic instruments. Methology: In case series, patients were collected randomly from 2007 to 2014. Patients were diagnosed with ultrasound and Nephroscope with Swiss pneumatic lithoclast, lithotrite and stone punch were used for treatment. Results: Majority of the patient could be managed with the method adopted. Stone size, hardness or softness, gender were the factors affecting treatment. Associated prostate pathology was seen in four patients. Postoperative complications included hemorrhage, perforation, residual stone and transurethral resection of prostate syndrome. Conclusion: Overall, it is a safe procedure except in patients with large enlarged prostate and large vesical calculi. Very hard vesical calculus may need vesicolithotomy. (author)

Recommendations for fluorescence instrument qualification: the new ASTM Standard Guide.

Science.gov (United States)

DeRose, Paul C; Resch-Genger, Ute

2010-03-01

Aimed at improving quality assurance and quantitation for modern fluorescence techniques, ASTM International (ASTM) is about to release a Standard Guide for Fluorescence, reviewed here. The guide's main focus is on steady state fluorometry, for which available standards and instrument characterization procedures are discussed along with their purpose, suitability, and general instructions for use. These include the most relevant instrument properties needing qualification, such as linearity and spectral responsivity of the detection system, spectral irradiance reaching the sample, wavelength accuracy, sensitivity or limit of detection for an analyte, and day-to-day performance verification. With proper consideration of method-inherent requirements and limitations, many of these procedures and standards can be adapted to other fluorescence techniques. In addition, procedures for the determination of other relevant fluorometric quantities including fluorescence quantum yields and fluorescence lifetimes are briefly introduced. The guide is a clear and concise reference geared for users of fluorescence instrumentation at all levels of experience and is intended to aid in the ongoing standardization of fluorescence measurements.

Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection.

Science.gov (United States)

Lingenfelder, Tobias; Fischer, Klaus; Sold, Moritz G; Post, Stefan; Enderle, Markus D; Kaehler, Georg F B A

2009-07-01

The safety and efficacy of endoscopic submucosal dissection (ESD) is very dependent on an effective injection beneath the submucosal lamina and on a controlled cutting technique. After our study group demonstrated the efficacy of the HydroJet in needleless submucosal injections under various physical conditions to create a submucosal fluid cushion (Selective tissue elevation by pressure = STEP technique), the next step was to develop a new instrument to combine the capabilities of an IT-Knife with a high-pressure water-jet in a single instrument. In this experimental study, we compared this new instrument with a standard ESD technique. Twelve gastric ESD were performed in six pigs under endotracheal anesthesia. Square areas measuring 4-cm x 4-cm were marked out on the anterior and posterior wall in the corpus-antrum transition region. The HybridKnife was used as an standard needle knife with insulated tip (i.e., the submucosal injection was performed with an injection needle and only the radiofrequency (RF) part of the HybridKnife was used for cutting (conventional technique)) or the HybridKnife was used in all the individual stages of the ESD, making use of the HybridKnife's combined functions (HybridKnife technique). The size of the resected specimens, the operating time, the frequency with which instruments were changed, the number of bleeding episodes, and the number of injuries to the gastric wall together with the subjective overall assessment of the intervention by the operating physician were recorded. The resected specimens were the same size, with average sizes of 16.96 cm(2) and 15.85 cm(2) resp (p = 0.8125). Bleeding episodes have been less frequent in the HybridKnife group (2.83 vs. 3.5; p = 0.5625). The standard knife caused more injuries to the lamina muscularis propria (0.17 vs. 1.33; p = 0.0313). The operating times had a tendency to be shorter with the HybridKnife technique (47.18 vs. 58.32 minute; p = 0.0313). The combination of a needle

Labour Standards and Trade: In Search of Impact and Alternative Instruments

Directory of Open Access Journals (Sweden)

Jan Orbie

2017-12-01

Full Text Available Labour standards have become an almost routine feature of trade agreements. However, we have little knowledge about whether this linkage is effective; both in absolute terms but also in comparison to other instruments that promote labour standards on a global level. Such alternative instruments include public-private agreements, value chain management and procurement policies. The articles in this thematic issue will provide insights that further the debate on the effectiveness of the connection between labour rights and international trade, looking at both ‘traditional’ trade agreements and ‘alternative’ instruments.

Limits of the endoscopic transnasal transtubercular approach.

Science.gov (United States)

Gellner, Verena; Tomazic, Peter V

2018-06-01

The endoscopic transnasal trans-sphenoidal transtubercular approach has become a standard alternative approach to neurosurgical transcranial routes for lesions of the anterior skull base in particular pathologies of the anterior tubercle, sphenoid plane, and midline lesions up to the interpeduncular cistern. For both the endoscopic and the transcranial approach indications must strictly be evaluated and tailored to the patients' morphology and condition. The purpose of this review was to evaluate the evidence in literature of the limitations of the endoscopic transtubercular approach. A PubMed/Medline search was conducted in January 2018 entering following keywords. Upon initial screening 7 papers were included in this review. There are several other papers describing the endoscopic transtubercular approach (ETTA). We tried to list the limitation factors according to the actual existing literature as cited. The main limiting factors are laterally extending lesions in relation to the optic canal and vascular encasement and/or unfavorable tumor tissue consistency. The ETTA is considered as a high level transnasal endoscopic extended skull base approach and requires excellent training, skills and experience.

Instrumentation Standard Architectures for Future High Availability Control Systems

International Nuclear Information System (INIS)

Larsen, R.S.

2005-01-01

Architectures for next-generation modular instrumentation standards should aim to meet a requirement of High Availability, or robustness against system failure. This is particularly important for experiments both large and small mounted on production accelerators and light sources. New standards should be based on architectures that (1) are modular in both hardware and software for ease in repair and upgrade; (2) include inherent redundancy at internal module, module assembly and system levels; (3) include modern high speed serial inter-module communications with robust noise-immune protocols; and (4) include highly intelligent diagnostics and board-management subsystems that can predict impending failure and invoke evasive strategies. The simple design principles lead to fail-soft systems that can be applied to any type of electronics system, from modular instruments to large power supplies to pulsed power modulators to entire accelerator systems. The existing standards in use are briefly reviewed and compared against a new commercial standard which suggests a powerful model for future laboratory standard developments. The past successes of undertaking such projects through inter-laboratory engineering-physics collaborations will be briefly summarized

Endoscopic-assisted resection of peripheral osteoma using piezosurgery.

Science.gov (United States)

Ochiai, Shigeki; Kuroyanagi, Norio; Sakuma, Hidenori; Sakuma, Hidenobu; Miyachi, Hitoshi; Shimozato, Kazuo

2013-01-01

Endoscopic-assisted surgery has gained widespread popularity as a minimally invasive procedure, particularly in the field of maxillofacial surgery. Because the surgical field around the mandibular angle is extremely narrow, the surrounding tissues may get caught in sharp rotary cutting instruments. In piezosurgery, bone tissues are selectively cut. This technique has various applications because minimal damage is caused by the rotary cutting instruments when they briefly come in contact with soft tissues. We report the case of a 33-year-old man who underwent resection of an osteoma in the region of the mandibular angle region via an intraoral approach. During surgery, the complete surgical field was within the view of the endoscope, thereby enabling the surgeon to easily resection the osteoma with the piezosurgery device. Considering that piezosurgery limits the extent of surgical invasion, this is an excellent low-risk technique that can be used in the field of maxillofacial surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

High-quality endoscope reprocessing decreases endoscope contamination.

Science.gov (United States)

Decristoforo, P; Kaltseis, J; Fritz, A; Edlinger, M; Posch, W; Wilflingseder, D; Lass-Flörl, C; Orth-Höller, D

2018-02-24

Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes, have been described. The rate of microbial endoscope contamination varies dramatically in literature. The aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture-based and molecular-based analyses. The contamination rate of GI endoscopes was 1.3%-4.6% according to the national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene-relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples failing in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly Pseudomonas oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n = 9, 17.6%) mainly due to technical faults, phase II revealed lapses (n = 6, 11.5%) only on account of microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared with results from other European countries, possibly due to the high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Endoscopic retrograde cholangiopancreatography and endoscopic ...

African Journals Online (AJOL)

An approach to suspected gallstone pancreatitis'based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCp became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on ...

Robotic Control of a Traditional Flexible Endoscope for Therapy

NARCIS (Netherlands)

Ruiter, Jeroen; Bonnema, Gerrit Maarten; van der Voort, Mascha C.; Broeders, Ivo Adriaan Maria Johannes

2013-01-01

In therapeutic flexible endoscopy a team of physician and assistant(s) is required to control all independent translations and rotations of the flexible endoscope and its instruments. As a consequence the physician lacks valuable force feedback information on tissue interaction, communication errors

The application of percutaneous endoscopic colostomy to the management of obstructed defecation.

Science.gov (United States)

Heriot, A G; Tilney, H S; Simson, J N L

2002-05-01

We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.

New methods of magnet-based instrumentation for NOTES.

Science.gov (United States)

Magdeburg, Richard; Hauth, Daniel; Kaehler, Georg

2013-12-01

Laparoscopic surgery has displaced open surgery as the standard of care for many clinical conditions. NOTES has been described as the next surgical frontier with the objective of incision-free abdominal surgery. The principal challenge of NOTES procedures is the loss of triangulation and instrument rigidity, which is one of the fundamental concepts of laparoscopic surgery. To overcome these problems necessitates the development of new instrumentation. material and methods: We aimed to assess the use of a very simple combination of internal and external magnets that might allow the vigorous multiaxial traction/counter-traction required in NOTES procedures. The magnet retraction system consisted of an external magnetic assembly and either small internal magnets attached by endoscopic clips to the designated tissue (magnet-clip-approach) or an endoscopic grasping forceps in a magnetic deflector roll (magnet-trocar-approach). We compared both methods regarding precision, time and efficacy by performing transgastric partial uterus resections with better results for the magnet-trocar-approach. This proof-of-principle animal study showed that the combination of external and internal magnets generates sufficient coupling forces at clinically relevant abdominal wall thicknesses, making them suitable for use and evaluation in NOTES procedures, and provides the vigorous multiaxial traction/counter-traction required by the lack of additional abdominal trocars.

[Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)].

Science.gov (United States)

Klemm, Eckart

2006-09-01

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

New endoscope shaft for endoscopic transsphenoidal pituitary surgery.

NARCIS (Netherlands)

Lindert, E.J. van; Grotenhuis, J.A.

2005-01-01

OBJECTIVE: To describe a new endoscope shaft developed for suction-aspiration during endoscopic transsphenoidal pituitary surgery. METHODS: A custom-made shaft for a Wolf endoscope (Richard Wolf GmbH, Knittlingen, Germany) was developed with a height of 10 mm and a width of 5 mm, allowing an

[Risk management for endoscopic surgery].

Science.gov (United States)

Kimura, Taizo

2010-05-01

The number of medical accidents in endoscopic surgery has recently increased. Surgical complications caused by inadequate preparation or immature technique or those resulting in serious adverse outcomes may be referred to as medical accidents. The Nationwide Survey of Endoscopic Surgery showed that bile duct injury and uncontrollable bleeding were seen in 0.68% and in 0.58%, respectively, of cholecystectomy patients; interoperative and postoperative complications in 0.84% and in 3.8%, respectively, of gastric cancer surgery patients; and operative complications in 6.74% of bowel surgery patients. Some required open repair, and 49 patients died. The characteristic causes of complications in endoscopic surgery are a misunderstanding of anatomy, handling of organs outside the visual field, burn by electrocautery, and injuries caused by forceps. Bleeding that requires a laparotomy for hemostasis is also a complication. Furthermore, since the surgery is usually videorecorded, immature techniques resulting in complications are easily discovered. To decrease the frequency of accidents, education through textbooks and seminars, training using training boxes, simulators, or animals, proper selection of the surgeon depending on the difficulty of the procedure, a low threshold for conversion to laparotomy, and use of the best optical equipment and surgical instruments are important. To avoid malpractice lawsuits, informed consent obtained before surgery and proper communication after accidents are necessary.

Systems workplace for endoscopic surgery.

Science.gov (United States)

Irion, K M; Novak, P

2000-01-01

With the advent of minimally invasive surgery (MIS) a decade ago, the requirements for operating rooms (OR) and their equipment have been increased. Compared with conventional open surgery, the new endoscopic techniques require additional tools. Television systems, for video-assisted image acquisition and visualisation, including cameras, monitors and light systems, as well as insufflators, pumps, high-frequency units, lasers and motorised therapy units, are nowadays usually made available on carts during endoscopic surgery. In conjunction with a set of endoscopic instruments, these high-tech units allow new operating techniques to be performed. The benefit for patients has become clear in recent years; however, the technical complexity of OR has also increased considerably. To minimise this problem for the OR personnel, the MIS concept 'OR1' (Operating Room 1) was developed and implemented. OR1 is a fully functional and integrated multi-speciality surgical suite for MIS. The centrepieces of the OR1 are the Storz Communication Bus (SCB) and the advanced image and data archiving system (Aida) from Karl Storz, Tuttlingen, Germany. Both components allow monitoring, access and networking of the MIS equipment and other OR facilities, as well as the acquisition, storage and display of image, patient and equipment data during the endoscopic procedure. A central user interface allows efficient, simplified operation and online clinical images. Due to the system integration, the handling of complex equipment is considerably simplified, logistical procedures in the OR are improved, procedure times are shorter and, particularly noteworthy, operative risk can be reduced through simplified device operation.

Decontamination of minimally invasive surgical endoscopes and accessories.

Science.gov (United States)

Ayliffe, G

2000-08-01

(1) Infections following invasive endoscopy are rare and are usually of endogenous origin. Nevertheless, infections do occur due to inadequate cleaning and disinfection and the use of contaminated rinse water and processing equipment. (2) Rigid and flexible operative endoscopes and accessories should be thoroughly cleaned and preferably sterilized using properly validated processes. (3) Heat tolerant operative endoscopes and accessories should be sterilized using a vacuum assisted steam sterilizer. Use autoclavable instrument trays or containers to protect equipment during transit and processing. Small bench top sterilizers without vacuum assisted air removal are unsuitable for packaged and lumened devices. (4) Heat sensitive rigid and flexible endoscopes and accessories should preferably be sterilized using ethylene oxide, low temperature steam and formaldehyde (rigid only) or gas plasma (if appropriate). (5) If there are insufficient instruments or time to sterilize invasive endoscopes, or if no suitable method is available locally, they may be disinfected by immersion in 2% glutaraldehyde or a suitable alternative. An immersion time of at least 10 min should be adopted for glutaraldehyde. This is sufficient to inactivate most vegetative bacteria and viruses including HIV and hepatitis B virus (HBV). Longer contact times of 20 min or more may be necessary if a mycobacterial infection is known or suspected. At least 3 h immersion in glutaraldehyde is required to kill spores. (6) Glutaraldehyde is irritant and sensitizing to the skin, eyes and respiratory tract. Measures must be taken to ensure glutaraldehyde is used in a safe manner, i.e., total containment and/or extraction of harmful vapour and the provision of suitable personal protective equipment, i.e., gloves, apron and eye protection if splashing could occur. Health surveillance of staff is recommended and should include a pre-employment enquiry regarding asthma, skin and mucosal sensitivity problems and

Standardization of portable assay instrumentation: the neutron-coincidence tree

International Nuclear Information System (INIS)

Menlove, H.O.

1983-01-01

Standardization of portable neutron assay instrumentation has been achieved by using the neutron coincidence technique as a common basis for a wide range of instruments and applications. The electronics originally developed for the High-Level Neutron Coincidence Counter has been adapted to both passive- and active-assay instrumentation for field verification of bulk plutonium, inventory samples, pellets, powders, nitrates, high-enriched uranium, and materials-testing-reactor, light-water-reactor, and mixed-oxide fuel assemblies. The family of detectors developed at Los Alamos National Laboratory and their performance under in-field conditions are described. 16 figures, 3 tables

Preparation of high purity plutonium oxide for radiochemistry instrument calibration standards and working standards

International Nuclear Information System (INIS)

Wong, A.S.; Stalnaker, N.D.

1997-04-01

Due to the lack of suitable high level National Institute of Standards and Technology (NIST) traceable plutonium solution standards from the NIST or commercial vendors, the CST-8 Radiochemistry team at Los Alamos National Laboratory (LANL) has prepared instrument calibration standards and working standards from a well-characterized plutonium oxide. All the aliquoting steps were performed gravimetrically. When a 241 Am standardized solution obtained from a commercial vendor was compared to these calibration solutions, the results agreed to within 0.04% for the total alpha activity. The aliquots of the plutonium standard solutions and dilutions were sealed in glass ampules for long term storage

Development of an international standard on instruments setpoints based on ISA S67.04 - 1994

International Nuclear Information System (INIS)

Quinn, E.L.

1996-01-01

This is a summary of the application for and development of an international standard on instrument setpoints, based on the Instrument Society of America (ISA) Standard S67.04 - 1994. The forum this new standard was proposed in is the International Electrotechnique Commission (IEC), based in Geneva, Switzerland, which is the international commission which oversees electrical and instrumentation standards for all applications around the world. The Instrument Society of America (ISA) is a United States based Society for the advancement of instrumentation and controls related science and technology and has 30,000 members. A division within the ISA is the Standard and Practices board which has over 5000 members actively involved in standards development and approval. In 1994, the ISA SP67, Nuclear Power Plant Standards Committee authorized that the IEC be approached to develop and issue an IEC standard on Instrument Setpoints. This application was formally submitted in January, 1995 to the IEC and approved for ballot to member countries in June, 1995. Approval for standard development by IEC was received in October, 1995 and the first draft vas issued in February, 1996, and is currently under review by the IEC working group. It is very important to focus on the approach that the U.S. and other countries are taking toward development of IEC standards that can apply to all nuclear instrumentation applications around the world. By referencing IEC standards in design specification, vendors can be solicited from many different countries, thereby ensuring that the highest quality products can be used. This also offsets the need to specify individual standards in the specification, based on the country that each vendor solicited, represents. In summary, this standard development process, with support from the American National Standards Institute (ANSI) will assist U.S. suppliers in competing in the global market for products and services into the next century. (author)

Development of automated endoscopes for dimensional micro-measurements

Science.gov (United States)

Hrebabetzky, Frank

2013-04-01

Increasing demands for product quality and outsourcing of production in the automobile industry lead to in­ creasingly tight tolerances for the components. In the area of metal-mechanics these are largely dimensional and require frequently uncertainties in the micron region. For optical instruments this means microscopical resolu­ tion. Dimensional measurement with uncertainties of some microns is nothing new, state of the art equipment in fact goes far below. The task becomes difficult if the measurements have to be carried out in an industrial production environment - and deep inside a bore hole. This paper describes the development of an automatic measurement system for internal dimensions of brake master cylinders, specifically the development of endoscopes, illuminations for edge detection, and integration with other sensors, actuators and controllers. The most demanding part was the endoscope development, because, surprisingly, no commercial product for microscopic view and precision measurements was found on the market. As the market for such measurement machines is very small, and as the requirements were different for each endoscope, the budget allowed only the development of prototypes, using readily available optical components. Borders between faces with different orientation of metallic structures can be difficult do detect. A satisfactory metrological performance can be achieved only with carefully shaped illumination, even if the source is a simple LED (light emitting diode). The automation was responsible for the largest part of the overall cost, coming from the desire for a high throughput of the measurement machine, even when operated by not highly qualified personnel. With the safety requirements satisfied, such a device ends up as a pretty complex equipment. Nevertheless, these aspects will be mentioned only for completeness, because standard components and methods were applied.

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

Directory of Open Access Journals (Sweden)

Wei-Chen Lin

Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

The Standard, Power, and Color Model of Instrument Combination in Romantic-Era Symphonic Works

Directory of Open Access Journals (Sweden)

Randolph Johnson

2011-08-01

Full Text Available The Standard, Power, and Color (SPC model describes the nexus between musical instrument combination patterns and expressive goals in music. Instruments within each SPC group tend to attract each other and work as a functional unit to create orchestral gestures. Standard instruments establish a timbral groundwork; Power instruments create contrast through loud dynamic climaxes; and Color instruments catch listeners’ attention by means of their sparing use. Examples within these three groups include violin (Standard, piccolo (Power, and harp (Color. The SPC theory emerges from analyses of nineteenth-century symphonic works. Multidimensional scaling analysis of instrument combination frequencies maps instrument relationships; hierarchical clustering analysis indicates three SPC groups within the map. The SPC characterization is found to be moderately robust through the results of hypothesis testing: (1 Color instruments are included less often in symphonic works; (2 when Color instruments are included, they perform less often than the average instrument; and (3 Color and non-Color instruments have equal numbers of solo occurrences. Additionally, (4 Power instruments are positively associated with louder dynamic levels; and (5 when Power instruments are present in the musical texture, the pitch range spanned by the entire orchestra does not become more extreme.

Transanal endoscopic microsurgery.

Science.gov (United States)

Smart, Christopher J; Cunningham, Chris; Bach, Simon P

2014-02-01

Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research. Copyright © 2014. Published by Elsevier Ltd.

Antrochoanal Polyps: Clinical Presentation and the Role of Powered Endoscopic Polypectomy

Directory of Open Access Journals (Sweden)

Balwant Singh Gendeh

2004-01-01

Full Text Available Antrochoanal polyps are a rare clinical entity. In this review of patients treated between January 1996 and September 2002, there were 18 cases of antrochoanal polyps. The mean age of patients was 20 years. Nasal obstruction was the most common symptom (17 cases, 94%, followed by rhinorrhoea (44%, epistaxis (33%, postnasal drip (28%, and snoring (22%. Chronic sinusitis was the most common associated rhinological finding (50%. Various surgical approaches were used: endoscopic polypectomy and middle meatal antrostomy in seven patients (38.9%, powered endoscopic polypectomy and middle meatal antrostomy in seven patients (38.9%, endoscopic polypectomy and inferior meatal antrostomy in three patients (16.7% and Caldwell-Luc surgery in one patient (5.6%. No complications were noted in patients treated with powered instrumentation, including the three patients in whom combined transcanine approaches were used. We concluded that powered endoscopic polypectomy was safe and effective. It allowed a more complete dissection and may diminish the chance of recurrence.

Flow mapping of multiphase flows using a novel single stem endoscopic particle image velocimetry instrument

International Nuclear Information System (INIS)

Lad, N; Adebayo, D; Aroussi, A

2011-01-01

Particle image velocimetry (PIV) is a successful flow mapping technique which can optically quantify large portions of a flow regime. This enables the method to be completely non-intrusive. The ability to be non-intrusive to any flow has allowed PIV to be used in a large range of industrial sectors for many applications. However, a fundamental disadvantage of the conventional PIV technique is that it cannot easily be used with flows which have no or limited optical access. Flows which have limited optical access for PIV measurement have been addressed using endoscopic PIV techniques. This system uses two separate probes which relay a light sheet and imaging optics to a planar position within the desired flow regime. This system is effective in medical and engineering applications. The present study has been involved in the development of a new endoscopic PIV system which integrates the illumination and imaging optics into one rigid probe. This paper focuses on the validation of the images taken from the novel single stem endoscopic PIV system. The probe is used within atomized spray flow and is compared with conventional PIV measurement and also pitot-static data. The endoscopic PIV system provides images which create localized velocity maps that are comparable with the global measurement of the conventional PIV system. The velocity information for both systems clearly show similar results for the spray characterization and are also validated using the pitot-static data

Flexible endoscope-assisted evacuation of chronic subdural hematomas.

Science.gov (United States)

Májovský, Martin; Masopust, Václav; Netuka, David; Beneš, Vladimír

2016-10-01

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed. All patients underwent a burr-hole evacuation of CSDH. A flexible endoscope was inserted and subdural space inspected during surgery. The surgeon was looking specifically for the presence of septations, draining catheter position and acute bleeding. Thirty-four patients underwent 37 endoscope-assisted surgeries. Presenting symptoms were hemiparesis (79%), decreased level of consciousness (18%), gait disturbances (15%), headache (12%), aphasia (6%), cognitive disturbances (6%) and epileptic seizure (3%). Average operative time was 43 min, and the average increase in operative time due to the use of the endoscope was 6 min. Recurrence rate was 8.8%, and clinical outcome was favorable (defined as mRS ≤ 2) in 97% of the cases. To our knowledge, the present cohort of 34 patients is the largest group of patients with CSDH treated using an endoscope. This technique allows decent visualization of the hematoma cavity while retaining the advantages of a minimally invasive approach under a local anesthesia. The main advantages are correct positioning of the catheter under visual control, identification of septations and early detection of cortex or vessel injury during surgery.

Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video).

Science.gov (United States)

Barakat, Monique T; Girotra, Mohit; Huang, Robert J; Banerjee, Subhas

2018-02-06

Outbreaks of transmission of infection related to endoscopy despite reported adherence to reprocessing guidelines warrant scrutiny of all potential contributing factors. Recent reports from ambulatory surgery centers indicated widespread significant occult damage within endoscope working channels, raising concerns regarding the potential detrimental impact of this damage on the adequacy of endoscope reprocessing. We inspected working channels of all 68 endoscopes at our academic institution using a novel flexible inspection endoscope. Inspections were recorded and videos reviewed by 3 investigators to evaluate and rate channel damage and/or debris. Working channel rinsates were obtained from all endoscopes, and adenosine triphosphate (ATP) bioluminescence was measured. Overall endoscope working channel damage was rated as minimal and/or mild and was consistent with expected wear and tear (median 1.59 on our 5-point scale). Our predominant findings included superficial scratches (98.5%) and scratches with adherent peel (76.5%). No channel perforations, stains, or burns were detected. The extent of damage was not predicted by endoscope age. Minor punctate debris was common, and a few small drops of fluid were noted in 42.6% of endoscopes after reprocessing and drying. The presence of residual fluid predicted higher ATP bioluminescence values. The presence of visualized working channel damage or debris was not associated with elevated ATP bioluminescence values. The flexible inspection endoscope enables high-resolution imaging of endoscope working channels and offers endoscopy units an additional modality for endoscope surveillance, potentially complementing bacterial cultures and ATP values. Our study, conducted in a busy academic endoscopy unit, indicated predominately mild damage to endoscope working channels, which did not correlate with elevated ATP values. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights

Standard audit procedure for continuous emission monitors and ambient air monitoring instruments

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-06-15

The instruments were published in an operational policy manual in 2009. This policy aims to introduce standard audit criteria that can be used to determine if continuous emission monitors and ambient air monitoring devices are operating within acceptable parameters. Before delivering upscale points of the instrument to be audited, each one of the audit equipment used in the field is required to be at normal operating conditions. Before the beginning of the audit, each one of the meteorological and flow measurement equipment is required to be conditioned to current conditions. If the audit fails, the instrument will have to be audited quarterly. The establishment of specific procedures based on instrument manufacturer or certifying body operational standards is required in the case of non-continuous monitoring instruments presenting operational principles outside of the audit procedures listed in the document.

The influence of different training schedules on the learning of psychomotor skills for endoscopic surgery.

Science.gov (United States)

Verdaasdonk, E G G; Stassen, L P S; van Wijk, R P J; Dankelman, J

2007-02-01

Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. Students with no endoscopic experience were randomly assigned either to distributed training on 3 consecutive days (group A, n = 10) or distributed training within 1 day (group B, n = 10). For this study the SIMENDO virtual reality simulator for endoscopic skills was used. The training involved 12 repetitions of three different exercises (drop balls, needle manipulation, 30 degree endoscope) in differently distributed training schedules. All the participants performed a posttraining test (posttest) for the trained tasks 7 days after the training. The parameters measured were time, nontarget environment collisions, and instrument path length. There were no significant differences between the groups in the first training session for all the parameters. In the posttest, group A (training over several days) performed 18.7% faster than group B (training on 1 day) (p = 0.013). The collision and path length scores for group A did not differ significantly from the scores for group B. The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.

Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).

Science.gov (United States)

Raczynski, Susanne; Teich, Niels; Borte, Gudrun; Wittenburg, Henning; Mössner, Joachim; Caca, Karel

2006-09-01

Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%. Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis. Case report. University hospital. Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy. Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients. Small number of patients. The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.

Advances in endoscopic surgery for small animal reproduction.

Science.gov (United States)

Katic, N; Dupré, G

2016-09-01

Although endoscopic surgery entered its "golden era" in the mid-1980s, it is still advancing at a tremendous pace. Novel surgical techniques and devices are continuously developed and applied, and new indications (and/or contraindications) for the use of endoscopic surgery are routinely reported in the literature and subjected to systematic assessments. Although endoscopic surgery (laparoscopy in particular) has already become established as the gold standard in human medicine, it has yet to be proven as a viable alternative to open surgery in the field of veterinary medicine. The advantages of minimally invasive surgery include better intra-operative visualization, reduced postoperative pain, reduced scar formation and increased postoperative mobility. Therefore, it is reasonable to expect that the application of this will continue to expand. Small animal reproduction, a field within the broad discipline of veterinary medicine, has already recognized and begun to reap the benefits of endoscopic surgery. Herein, we retrospectively review the most recent successful novel applications of endoscopic surgery in the small animal reproduction system to provide small animal reproductive surgeons with important knowledge to help improve their own veterinarian medical practice. © 2016 Blackwell Verlag GmbH.

Fluorescence-Raman Dual Modal Endoscopic System for Multiplexed Molecular Diagnostics

Science.gov (United States)

Jeong, Sinyoung; Kim, Yong-Il; Kang, Homan; Kim, Gunsung; Cha, Myeong Geun; Chang, Hyejin; Jung, Kyung Oh; Kim, Young-Hwa; Jun, Bong-Hyun; Hwang, Do Won; Lee, Yun-Sang; Youn, Hyewon; Lee, Yoon-Sik; Kang, Keon Wook; Lee, Dong Soo; Jeong, Dae Hong

2015-03-01

Optical endoscopic imaging, which was recently equipped with bioluminescence, fluorescence, and Raman scattering, allows minimally invasive real-time detection of pathologies on the surface of hollow organs. To characterize pathologic lesions in a multiplexed way, we developed a dual modal fluorescence-Raman endomicroscopic system (FRES), which used fluorescence and surface-enhanced Raman scattering nanoprobes (F-SERS dots). Real-time, in vivo, and multiple target detection of a specific cancer was successful, based on the fast imaging capability of fluorescence signals and the multiplex capability of simultaneously detected SERS signals using an optical fiber bundle for intraoperative endoscopic system. Human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) on the breast cancer xenografts in a mouse orthotopic model were successfully detected in a multiplexed way, illustrating the potential of FRES as a molecular diagnostic instrument that enables real-time tumor characterization of receptors during routine endoscopic procedures.

Analysis of cryptocurrencies as standard financial instruments

OpenAIRE

Bartoš, Jakub

2014-01-01

This paper analyzes cryptocurrencies as financial instruments. Firstly, we introduced the main features of cryptocurrencies and summarized the brief history. We found out that price of the most famous cryptocurrency Bitcoin follows the hypothesis of efficient markets and it immediately react on publicly announce information. Furthermore, Bitcoin can be seen as standard economic good that is priced by interaction of supply and demand on the market. These factors can be driven by macro financia...

Endoscopic root canal treatment.

Science.gov (United States)

Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded

2009-10-01

To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.

Endoscopic anatomy of the orbital floor and maxillary sinus.

Science.gov (United States)

Moore, Corey C; Bromwich, Matthew; Roth, Kathy; Matic, Damir B

2008-01-01

Endoscopic repair of orbital blow-out fractures could become a predictable and efficient treatment alternative to traditional methods. However, maxillary sinus endoscopy provides a complex and disorienting view of the orbital floor. To be a useful and consistent technique for providing access to the orbital floor, specific knowledge of maxillary endoscopic anatomy is required. The purpose of the study was to provide an anatomic description of the orbital floor via the endoscopic approach. Objectives include defining consistent landmarks for use in endoscopic repair of orbital floor fractures. Using 0- and 30-degree rigid endoscopes, 6 fresh cadavers (12 maxillary sinuses) were examined via a standard Caldwell-Luc approach. Computed tomographic scans, plastic molds, and digital images were used to compare observable averages within bony anatomy. Potential bony landmarks were correlated with soft-tissue anatomy in fresh specimens. The maxillary ostium, orbital floor, and lateral ethmoid air cells were visualized, and their structures were described. Observations were made in relation to the anatomy of the orbital floor and maxillary sinus, including fracture pattern and force transmission pathways. An "orbitomaxillary" sinus bony thickening was identified and described for the first time. This study provides the basis for further refinement of surgical technique and opens the door for future clinical trials using endoscopic repair.

Endoscopic Therapeutic Approach for Dysplasia in Inflammatory Bowel Disease

Directory of Open Access Journals (Sweden)

Sung Noh Hong

2017-09-01

Full Text Available Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (≥20 mm, endoscopic submucosal dissection (ESD or ESD with snaring (simplified or hybrid ESD is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

STAMINA - Model description. Standard Model Instrumentation for Noise Assessments

NARCIS (Netherlands)

Schreurs EM; Jabben J; Verheijen ENG; CMM; mev

2010-01-01

Deze rapportage beschrijft het STAMINA-model, dat staat voor Standard Model Instrumentation for Noise Assessments en door het RIVM is ontwikkeld. Het instituut gebruikt dit standaardmodel om omgevingsgeluid in Nederland in kaart te brengen. Het model is gebaseerd op de Standaard Karteringsmethode

Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience.

Science.gov (United States)

Bravi, Ivana; Ravizza, Davide; Fiori, Giancarla; Tamayo, Darina; Trovato, Cristina; De Roberto, Giuseppe; Genco, Chiara; Crosta, Cristiano

2016-01-01

Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures. Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up. The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation. Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

Is endoscopic resection an alternative to surgery for early low-risk submucosal gastric cancers: analysis of a large surgical database

NARCIS (Netherlands)

Tae, Chung Hyun; Pouw, Roos E.; Duits, Lucas C.; Sung, Young Kyung; Min, Byung-Hoon; Lee, Jun Haeng; Rhee, Poong-Lyul; Kim, Kyoung-Mee; Bergman, Jacques J. G. H. M.; Kim, Jae J.

2015-01-01

Although endoscopic resection (ER) for early gastric cancers (EGCs) has become popular with the development of endoscopic instruments and skillful endoscopists, the risk of lymph node metastasis (LNM) is still an obstacle in performing ER. In this study, we aimed to identify the risk factors of LNM

Endoscopically assisted enucleation of a large mandibular periapical cyst.

Science.gov (United States)

Nestal Zibo, Heleia; Miller, Ene

2011-01-01

Enucleation of large cysts in the jaws is an invasive method that might be associated with complications. Marsupialization is a less invasive alternative method but it involves a prolonged and uncomfortable healing period. This study addresses a contemporaneous and less invasive surgical technique for treating larger mandibular cysts. MATERIALS AND METHODS. A 48-year-old woman presented with a large mandibular apical cyst involving the left parasymphysis, body, ramus and condylar neck, with involvement of the alveolar inferior nerve. The cystic lesion was enucleated using a 30° 4.0 mm endoscopic scope and endoscopic instruments through two small accesses: the ostectomy site of previously performed marsupialization and the alveolus of the involved third molar extracted of the time of the enucleation of the cyst. RESULTS. The endoscopic scope provided good visualization of the whole cystic cavity allowing the removal of any residual pathologic tissue and preservation of the integrity of the involved inferior alveolar nerve. The morbidity of the surgical procedure was extremely reduced. At a 6-month follow-up the patient did not present any symptom of inflammation and a panoramic X-ray showed good bone repair and remodelation. CONCLUSIONS. Endoscopically assisted enucleation proved to be effective method of treating a large mandibular cyst, providing total enucleation with a minimal invasive technique.

Transgastric pure-NOTES peritoneoscopy and endoscopic ultrasonography for staging of gastrointestinal cancers

DEFF Research Database (Denmark)

Donatsky, Anders Meller; Vilmann, Peter; Meisner, Søren

2012-01-01

BACKGROUND: Human natural orifice transluminal endoscopic surgery (NOTES) has mainly been based on simultaneous laparoscopic assistance (hybrid NOTES), forgoing the theoretical benefits of the NOTES technique. This is due to a lack of NOTES-specific instruments and endoscopes, making pure-NOTES...... procedures difficult and time consuming. An area where pure NOTES could be adopted at its present stage of development is minimally invasive staging of gastrointestinal (GI) cancer. The aim of this study is to evaluate the feasibility of combining transgastric (TG) pure-NOTES peritoneoscopy...... and intraperitoneal endoscopic ultrasonography (ip-EUS) with intraluminal EUS (il-EUS) for peritoneal evaluation. METHODS: This was a feasibility and survival study where il-EUS followed by ip-EUS and peritoneoscopy was performed in 10 pigs subjected to TG pure NOTES. A score was given with regard to achieved...

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection.

Science.gov (United States)

Gubler, Christoph; Bauerfeind, Peter

2014-09-01

Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.

Evaluation of a draft standard on performance specifications for health physics instrumentation - program overview

International Nuclear Information System (INIS)

Kathren, R.L.; Selby, J.M.; Kenoyer, J.L.; Swinth, K.L.

1983-01-01

The draft ANSI Standard N42.17 on performance specifications for health physics instrumentation was written in 1981 by a task group that included both manufacturers and users of these instruments as well as representation from the regulatory bodies; the second draft of this standard is currently being evaluated by Pacific Northwest Laboratory. Objectives of this project include the evaluation of the applicability and practicality of the proposed standard and the determination of the degree of conformance of a cross-section of currently available commercial instruments to the proposed standard. This standard is being tested against such instruments as ionization chambers. G.M. detectors, alpha survey meters, and neutron dose equivalent survey meters. Radiological, electrical, mechanical, safety, and environmental performance criteria are specified and tests to evaluate conformance are detailed. Specific criteria which are discussed in this draft standard include inspection tests (e.g., readout units, scaling and zero set, decontamination, moisture protection, alarm threshold, battery status indication), AC and battery power requirements, alarm reset, stability, geotropism, response time, accuracy, precision, IER, beta, and neutron energy dependence, radiation overloads, angular dependence, extracameral response, nonionizing electromagnetic radiations, magnetic fields, interfering ionizing radiations, and effect of temperature, humidity, ambient pressure, shock, and vibration. The testing procedures were developed with emphasis on the requirements found in ANSI N42.17 with additional criteria from other draft and current ANSI and IEC standards

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves' disease: a comparison of surgical results with open thyroidectomy.

Science.gov (United States)

Jitpratoom, Pornpeera; Ketwong, Khwannara; Sasanakietkul, Thanyawat; Anuwong, Angkoon

2016-12-01

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (PGraves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.

[Flexible endoscope in thoracic surgery: CITES or cVATS?].

Science.gov (United States)

Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

2013-10-01

Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

Directory of Open Access Journals (Sweden)

Rezaul Amin

2013-01-01

Full Text Available Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22% in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay.

Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

Science.gov (United States)

Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

2015-01-01

The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures.

Endoscopic diode laser welding of mucosal grafts on the larynx: a new technique.

Science.gov (United States)

Wang, Z; Pankratov, M M; Rebeiz, E E; Perrault, D F; Shapshay, S M

1995-01-01

Epithelial coverage of a laryngotracheal wound is an important factor in preventing stenosis, and endoscopic transplantation of a free mucosal graft without stents or sutures would be a significant therapeutic advance. In vitro and in vivo canine studies were performed to explore the feasibility of transplantation with a low-power diode laser (400 mW) enhanced by indocyanine green dye-doped albumin. The tensile strength of graft adherence in 10 cadaver larynges was strong (35.25 +/- 10.39 g). Survival studies in live canine models with a specially designed endoscopic instrument set showed excellent healing at 6, 14, and 28 days. Healing was documented with photography and by histologic examination. Successful endoscopic transplantation of a free mucosal graft should improve results of treatment for laryngotracheal stenosis and laryngeal reconstructive surgery.

Evaluation of a draft standard on performance specifications for health physics instrumentation: results for environmental tests

International Nuclear Information System (INIS)

Kenoyer, J.L.; Swinth, K.L.; Mashburn, K.R.; Selby, J.M.

1984-06-01

Draft ANSI Standard N42.17 on performance specifications for health physics instrumentation is currently being evaluated by the Pacific Northwest Laboratory. Evaluation is performed by testing a cross-section of currently available instruments with testing procedures based on specifications of the standard and then determining the degree of conformance to the various elements of the proposed standard. Data will be presented on the performance of a cross-section of beta-gamma survey instruments under various environmental tests. Test results that will be presented include temperature effects, humidity effects, radio frequency (r.f.) susceptibility, ambient pressure effects, vibration effects, and shock effects. Tests performed to date show that most instruments will meet the temperature, humidity, and ambient pressure tests. A large variability is noted among instruments from the same or different vendors. Preliminary r.f. susceptibility tests have shown large artificial responses at some frequencies for specific instruments. The presentation will also include a discussion of procedures used in the testing and weaknesses identified in the proposed standard

[Endoscopic sclerotherapy in the combined treatment of portal hypertension in children].

Science.gov (United States)

Ul'rikh, E V; Korolev, M P; Kupatadze, F D; Sevriugov, B L; Nabokov, V V

1992-01-01

The authors have performed 28 sessions of endoscopic sclerotherapy of dilated esophagus veins in children. The 70% ethyl alcohol was used. Six sessions were carried out in patients with gastroesophageal hemorrhage. In 22 patients the sclerotherapy was carried on according to plan. The fiber gastroscope with a standard injector was used. A conclusion is made of expediency of using endoscopic sclerotherapy in complex treatment of portal hypertension in children.

Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER).

Science.gov (United States)

Phee, S J; Ho, K Y; Lomanto, D; Low, S C; Huynh, V A; Kencana, A P; Yang, K; Sun, Z L; Chung, S C Sydney

2010-09-01

The lack of triangulation of standard endoscopic devices limits the degree of freedom for surgical maneuvers during natural orifice transluminal endoscopic surgery (NOTES). This study explored the feasibility of adapting an intuitively controlled master and slave transluminal endoscopic robot (MASTER) the authors developed to facilitate wedge hepatic resection in NOTES. The MASTER consists of a master controller, a telesurgical workstation, and a slave manipulator that holds two end-effectors: a grasper, and a monopolar electrocautery hook. The master controller is attached to the wrist and fingers of the operator and connected to the manipulator by electrical and wire cables. Movements of the operator are detected and converted into control signals driving the slave manipulator via a tendon-sheath power transmission mechanism allowing nine degrees of freedom. Using this system, wedge hepatic resection was performed through the transgastric route on two female pigs under general anesthesia. Entry into the peritoneal cavity was via a 10-mm incision made on the anterior wall of the stomach by the electrocautery hook. Wedge hepatic resection was performed using the robotic grasper and hook. Hemostasis was achieved with the electrocautery hook. After the procedure, the resected liver tissue was retrieved through the mouth using the grasper. Using the MASTER, transgastric wedge hepatic resection was successfully performed on two pigs with no laparoscopic assistance. The entire procedure took 9.4 min (range, 8.5-10.2 min), with 7.1 min (range, 6-8.2 min) spent on excision of the liver tissue. The robotics-controlled device was able to grasp, retract, and excise the liver specimen successfully in the desired plane. This study demonstrated for the first time that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures. With it, the triangulation of surgical tools and the manipulation of tissue became easy, and wedge hepatic

"TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma.

Science.gov (United States)

Pagella, Fabio; Pusateri, Alessandro; Matti, Elina; Avato, Irene; Zaccari, Dario; Emanuelli, Enzo; Volo, Tiziana; Cazzador, Diego; Citraro, Leonardo; Ricci, Giampiero; Tomacelli, Giovanni Leo

2017-07-01

The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.

CAMAC-an international standard for data machine instrumentation

CERN Document Server

Johnsen, P J

1973-01-01

CAMAC is a standard for on-line computer instrumentation and control. Owing to the world-wide acceptance of CAMAC, standardized and mutually compatible equipment is now offered by a great number of manufacturers. CAMAC systems are modular, and with the range of modules commercially available, it is possible to build up flexible and complex data processing systems. Use of CAMAC requires a CAMAC- compatible entrance (interface) to the computer. Once established, users are later on completely independent of the type of computer used. General aspects, CAMAC systems for NORD-1 and NORD-10 are presented. The former is developed at Physics Institute, Oslo, and the latter is developed as a result of the CERN-contract gained by NORSK DATAELEKTRONIKK.

Endoscopic excision of a lateral ventricular epidermoid—A case report of a novel technique

Directory of Open Access Journals (Sweden)

Arjun Shetty

2014-01-01

CONCLUSION: A multi portal endoscope that allows use of routine pituitary instruments would enable the surgeon to achieve haemostasis effectively and, in our opinion, should be a viable alternative to microscope for excision of intra ventricular tumours.

[Design and implementation of medical instrument standard information retrieval system based on APS.NET].

Science.gov (United States)

Yu, Kaijun

2010-07-01

This paper Analys the design goals of Medical Instrumentation standard information retrieval system. Based on the B /S structure,we established a medical instrumentation standard retrieval system with ASP.NET C # programming language, IIS f Web server, SQL Server 2000 database, in the. NET environment. The paper also Introduces the system structure, retrieval system modules, system development environment and detailed design of the system.

Modelling of a laser-pumped light source for endoscopic surgery

Science.gov (United States)

Nadeau, Valerie J.; Elson, Daniel S.; Hanna, George B.; Neil, Mark A. A.

2008-09-01

A white light source, based on illumination of a yellow phosphor with a fibre-coupled blue-violet diode laser, has been designed and built for use in endoscopic surgery. This narrow light probe can be integrated into a standard laparoscope or inserted into the patient separately via a needle. We present a Monte Carlo model of light scattering and phosphorescence within the phosphor/silicone matrix at the probe tip, and measurements of the colour, intensity, and uniformity of the illumination. Images obtained under illumination with this light source are also presented, demonstrating the improvement in illumination quality over existing endoscopic light sources. This new approach to endoscopic lighting has the advantages of compact design, improved ergonomics, and more uniform illumination in comparison with current technologies.

Percutaneous endoscopic gastrostomy in porcines performed with standard medical instruments used in a general hospital routine Gastrostomia percutânea endoscópica em suínos realizada com instrumentos de uso rotineiro em hospital geral

Directory of Open Access Journals (Sweden)

Luiz Roberto do Nascimento

2004-10-01

Full Text Available PURPOSE: To perform a endoscopic gastrostomy by the introducer method with routine instruments used in a general hospital, without special instruments or special kits. METHODS: This procedure was performed in pigs (Sus scrofa domesticus under observation for seven days and then submitted to euthanasia.The technique was evaluated for macroscopic and histologic parameters. RESULTS: All animals had a good evolution without major complications. Some minor complications occurred like a rupture of Foley catheter balloon and subcutaneous space abscess. CONCLUSION: The percutaneous gastrostomy with routine general hospital instruments is successful performed, is safe,cheap and must be performed by skilled endoscopists.OBJETIVO: Realizar uma gastrostomia endoscópica pelo método de punção, porém feita com instrumentos de uso rotineiro em um hospital geral, abolindo o uso de instrumentos especiais e de kits industrializados. MÉTODOS: O procedimento foi realizado em suinos da raça Landrace (Sus scrofa domesticus , que permaneceram em observação por sete dias, quando foram submetidos a eutanasia e avaliados por parâmetros macroscópicos e histológicos. RESULTADOS: Todos os animais tiveram boa evolução, não apresentando complicações importantes. Pequenas complicações, como ruptura do balão da sonda de Foley e abscesso subcutâneo ocorreram. CONCLUSÃO: A gastrostomia percutânea endoscópica é um procedimento seguro, barato e perfeitamente realizável com materiais de uso rotineiro em um hospital geral, porém deve ser realizada por endoscopistas devidamente treinados.

Draft American National Standard N42.17A: performance specifications for health physics instrumentation

International Nuclear Information System (INIS)

Selby, J.M.

1984-07-01

The report describes the history of the development of the N42.17 standard on instrument performance, describes the standard itself and its relationship to other standards, and discusses ways the standards might be used on either a voluntary or semi-voluntary basis

Evolution of the VLT instrument control system toward industry standards

Science.gov (United States)

Kiekebusch, Mario J.; Chiozzi, Gianluca; Knudstrup, Jens; Popovic, Dan; Zins, Gerard

2010-07-01

The VLT control system is a large distributed system consisting of Linux Workstations providing the high level coordination and interfaces to the users, and VME-based Local Control Units (LCU's) running the VxWorks real-time operating system with commercial and proprietary boards acting as the interface to the instrument functions. After more than 10 years of VLT operations, some of the applied technologies used by the astronomical instruments are being discontinued making it difficult to find adequate hardware for future projects. In order to deal with this obsolescence, the VLT Instrumentation Framework is being extended to adopt well established Commercial Off The Shelf (COTS) components connected through industry standard fieldbuses. This ensures a flexible state of the art hardware configuration for the next generation VLT instruments allowing the access to instrument devices via more compact and simpler control units like PC-based Programmable Logical Controllers (PLC's). It also makes it possible to control devices directly from the Instrument Workstation through a normal Ethernet connection. This paper outlines the requirements that motivated this work, as well as the architecture and the design of the framework extension. In addition, it describes the preliminary results on a use case which is a VLTI visitor instrument used as a pilot project to validate the concepts and the suitability of some COTS products like a PC-based PLCs, EtherCAT8 and OPC UA6 as solutions for instrument control.

Evolution of Technique in Endoscopic Transsphenoidal Surgery for Pituitary Adenoma: A Single Institution Experience from 220 Procedures.

Science.gov (United States)

Hansasuta, Ake; Pokanan, Siriwut; Punyawai, Pritsana; Mahattanakul, Wattana

2018-01-01

Introduction Endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma (PA) has been a recent shift from the traditional microscopic technique. Although some literature demonstrated superiority of ETSS over the microscopic method and some evaluated mono- vs. binostril access within the ETSS, none had explored the potential influence of dedicated instrument, as this procedure had evolved, on patients' outcomes when compared to traditional microscopic tools. Objective To investigate our own clinical and radiographic outcomes of ETSS for PA with its technical evolution over time as well as a significance of, having vs. lacking, the special endoscopic tools. Methods Included patients underwent ETSS for PA performed by the first author (AH). Prospectively recorded patients' data concerning pre-, intra- and postoperative clinical and radiographic assessments were subject to analysis. The three groups of differently evolving ETSS techniques, beginning with mononostril (MN) to binostril ETSS with standard microsurgical instruments (BN1) and, lastly, binostril ETSS with specially-designed endoscopic tools (BN2), were examined for their impact on the intra- and, short- and long-term, postoperative results. Also, the survival after ETSS for PA, as defined by the need for reintervention in each technical group, was appraised. Results From January 2006 to 2012, there were 47, 101 and 72 ETSS, from 183 patients, in the MN, BN1 and BN2 cohorts, respectively. Significant preoperative findings were greater proportion of patients with prior surgery (p=0.01) and tumors with parasellar extension (p=0.02) in the binostril (BN1&2) than the MN group. Substantially shorter operative time and less amount of blood loss were evident as our technique had evolved (psurgery, Knosp grade, and firm tumor while BN1, BN2 and percentages of anteroposterior dimension PA removal had positive effect on longer survival. Conclusion The evolution of technique for ETSS for PA from MN to BN2 has shown

Evaluation of a draft standard on performance specifications for health physics instrumentation. Initial results for radiological tests

International Nuclear Information System (INIS)

Swinth, K.L.; Kenoyer, J.L.; Mileham, A.P.; Kathren, R.L.; Selby, J.M.

1983-06-01

The draft ANSI standard N42.17D2 on performance specifications for health physics instrumentation is currently being evaluated by the Pacific Northwest Laboratory. The primary objective of the project is the evaluation of the applicability and practicality of the proposed standard through testing of a cross-section of currently available commercial instruments to determine how well they conform to the standard. The standard is being tested against instruments such as ionization chambers, G.M. detectors, alpha survey meters, and neutron dose equivalent survey meters. This paper presents results of the preliminary radiological performance tests on ionization chambers and G.M. detectors. This includes both the data generated during the tests and a discussion of procedures developed to perform the testing. Results are reported for response time, accuracy, precision, radiation overloads, and angular dependence. In addition, results are reported for parameters that affect instrument performance including battery lifetime, geotropism and stability. Initial test indicates that some of the instruments will not meet the criteria specified in ANSI N42.17D2. Results cover approximately 40 instruments that have been obtained by direct purchase, by loan from instrument vendors or by loan from others including DOE licensees

A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues.

Science.gov (United States)

Sommer, Doron D; Arbab-Tafti, Sadaf; Farrokhyar, Forough; Tewfik, Marc; Vescan, Allan; Witterick, Ian J; Rotenberg, Brian; Chandra, Rakesh; Weitzel, Erik K; Wright, Erin; Ramakrishna, Jayant

2018-02-27

The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery. This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method. Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%). The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating

Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair.

Science.gov (United States)

Sherwinter, Danny A; Eckstein, Jeremy G

2009-07-01

A potentially less-invasive technique, transluminal surgery, may reduce or eliminate pain and decrease time to full return of activities after abdominal operations. Inguinal hernia repair is perfectly suited to the transgastric endoscopic approach and has not been previously reported. Our purpose was to evaluate the feasibility of transgastric bilateral inguinal herniorrhaphy (BIH). Feasibility study with a nonsurvival canine model. Under general anesthesia, male mongrel dogs weighing 20 to 30 kg had a dual-channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed, and bilateral deep and superficial inguinal rings were identified. The endoscope was removed, premounted with a 4 x 6 cm acellular human dermal implant and then readvanced intraperitoneally through the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bioglue was then applied endoscopically, and the implant was attached to the peritoneum. After completion of bilateral repairs, the animals were killed and necropsy performed. Five dogs underwent pure natural orifice transluminal endoscopic surgery (NOTES) intraperitoneal onlay mesh (IPOM) BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. At necropsy no injuries to the major structures were noted but Bioglue misapplication with contamination of unintended sites did occur. Our study involved only a small number of subjects in nonsurvival experiments, and no gastric closure was used. Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is in line with the transgastric endoscope vector, bilateral defects are adjacent, and the IPOM technique does not require significant manipulation or novel instrumentation.

Terahertz endoscopic imaging for colorectal cancer detection: Current status and future perspectives.

Science.gov (United States)

Doradla, Pallavi; Joseph, Cecil; Giles, Robert H

2017-08-16

Terahertz (THz) imaging is progressing as a robust platform for myriad applications in the field of security, health, and material science. The THz regime, which comprises wavelengths spanning from microns to millimeters, is non-ionizing and has very low photon energy: Making it inherently safe for biological imaging. Colorectal cancer is one of the most common causes of death in the world, while the conventional screening and standard of care yet relies exclusively on the physician's experience. Researchers have been working on the development of a flexible THz endoscope, as a potential tool to aid in colorectal cancer screening. This involves building a single-channel THz endoscope, and profiling the THz response from colorectal tissue, and demonstrating endogenous contrast levels between normal and diseased tissue when imaging in reflection modality. The current level of contrast provided by the prototype THz endoscopic system represents a significant step towards clinical endoscopic application of THz technology for in-vivo colorectal cancer screening. The aim of this paper is to provide a short review of the recent advances in THz endoscopic technology and cancer imaging. In particular, the potential of single-channel THz endoscopic imaging for colonic cancer screening will be highlighted.

Full spectrum endoscopy (FUSE) versus standard forward-viewing endoscope (SFV) in a high-risk population

DEFF Research Database (Denmark)

Roepstorff, Søren; Hadi, Sabah Anwar; Rasmussen, Morten

2017-01-01

OBJECTIVES: To investigate the diagnostic performance of Full Spectrum Endoscopy (FUSE) compared to a conventional standard forward-viewing endoscope (SFV). The primary outcome was adenoma detection rate (ADR) and mean adenoma detection. Secondary outcome was feasibility of FUSE opposed to SFV...... intubation time, fentanyl and midazolam sedation, CRC detection, ADR, diverticulosis, bowel preparation, patient discomfort and endoscopist difficulty rating. Participants underwent FUSE colonoscopy on days when the FUSE system was available, while the remaining participants had SFV. All colonoscopies were.......1 ± 6.2 min in the FUSE and SFV groups (p = .040). ADR was 67.0% and 59.6% (p = .097), while the mean adenoma detection was 1.79 and 1.38 (p = .022) in the FUSE and SFV groups. Endoscopists reported increased difficulty rating with FUSE compared to SFV (p > .001). CONCLUSION: FUSE colonoscopy provides...

Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models.

Science.gov (United States)

Breimer, Gerben E; Haji, Faizal A; Bodani, Vivek; Cunningham, Melissa S; Lopez-Rios, Adriana-Lucia; Okrainec, Allan; Drake, James M

2017-02-01

The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model. Copyright © 2016 by the Congress of Neurological Surgeons

Development of measurement standards for verifying functional performance of surface texture measuring instruments

Energy Technology Data Exchange (ETDEWEB)

Fujii, A [Life and Industrial Product Development Department Olympus Corporation, 2951 Ishikawa-machi, Hachiouji-shi, Tokyo (Japan); Suzuki, H [Industrial Marketing and Planning Department Olympus Corporation, Shinjyuku Monolith, 3-1 Nishi-Shinjyuku 2-chome, Tokyo (Japan); Yanagi, K, E-mail: a_fujii@ot.olympus.co.jp [Department of Mechanical Engineering, Nagaoka University of Technology, 1603-1 Kamitomioka-machi, Nagaoka-shi, Niigata (Japan)

2011-08-19

A new measurement standard is proposed for verifying overall functional performance of surface texture measuring instruments. Its surface is composed of sinusoidal surface waveforms of chirp signals along horizontal cross sections of the material measure. One of the notable features is that the amplitude of each cycle in the chirp signal form is geometrically modulated so that the maximum slope is kept constant. The maximum slope of the chirp-like signal is gradually decreased according to movement in the lateral direction. We fabricated the measurement standard by FIB processing, and it was calibrated by AFM. We tried to evaluate the functional performance of Laser Scanning Microscope by this standard in terms of amplitude response with varying slope angles. As a result, it was concluded that the proposed standard can easily evaluate the performance of surface texture measuring instruments.

Current Innovations in Endoscopic Therapy for the Management of Colorectal Cancer: From Endoscopic Submucosal Dissection to Endoscopic Full-Thickness Resection

Directory of Open Access Journals (Sweden)

Shintaro Fujihara

2014-01-01

Full Text Available Endoscopic submucosal dissection (ESD is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES. Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices.

The preparation of synthetic standards for use in instrumental neutron-activation analysis

International Nuclear Information System (INIS)

Eddy, B.T.; Watterson, J.I.W.; Erasmus, C.S.

1979-01-01

An account is given of the formulation and preparation of synthetic standards suitable for the routine analysis of minerals, ores, and ore concentrates by instrumental neutron activation. Fifteen standards were prepared, each containing from one to seven elements. The standards contain forty-four elements that produce isotopes with half-lives longer than 12 hours. An evaluation of the accuracy and precision of the method of preparation is given

Development of a Virtual Reality Simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cholecystectomy Procedure.

Science.gov (United States)

Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Lee, Jason; Li, Baichun; Pan, Junjun; Sankaranarayanan, Ganesh; Roberts, Kurt; De, Suvranu

2014-01-01

The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013.

Duodenal endoscopic findings and histopathologic confirmation of intestinal lymphangiectasia in dogs.

Science.gov (United States)

Larson, R N; Ginn, J A; Bell, C M; Davis, M J; Foy, D S

2012-01-01

The diagnosis of intestinal lymphangiectasia (IL) has been associated with characteristic duodenal mucosal changes. However, the sensitivity and specificity of the endoscopic duodenal mucosal appearance for the diagnosis of IL are not reported. To evaluate the utility of endoscopic images of the duodenum for diagnosis of IL. Endoscopic appearance of the duodenal mucosal might predict histopathologic diagnosis of IL with a high degree of sensitivity and specificity. 51 dogs that underwent upper gastrointestinal (GI) endoscopy and endoscopic biopsies. Retrospective review of images acquired during endoscopy. Dogs were included if adequate biopsies were obtained during upper GI endoscopy and digital images were saved during the procedure. Images were assessed for the presence and severity of IL. Using histopathology as the gold standard, the sensitivity and specificity of endoscopy for diagnosing IL were calculated. Intestinal lymphangiectasia (IL) was diagnosed in 25/51 dogs. Gross endoscopic appearance of the duodenal mucosa had a sensitivity and specificity (95% confidence interval) of 68% (46%, 84%) and 42% (24%, 63%), respectively for diagnosis of IL. Endoscopic images in cases with lymphopenia, hypocholesterolemia, and hypoalbuminemia had a sensitivity of 80%. Endoscopic duodenal mucosa appearance alone lacks specificity and has only a moderate sensitivity for diagnosis of IL. Evaluation of biomarkers associated with PLE improved the sensitivity; however, poor specificity for diagnosis of IL supports the need for histopathologic confirmation. Copyright © 2012 by the American College of Veterinary Internal Medicine.

Neutron cross section standards and instrumentation: Annual report

International Nuclear Information System (INIS)

1987-01-01

This annual report from the National Bureau of Standards contains a summary of the results of the Neutron Cross Section Standards and Instrumentation Program. The technical measurements for the past year are given along with the proposed program and budget needs for the next three years. The neutron standards measurements have concentrated on the most important 235 U(n,f) cross section in the thermal to 20 MeV energy range along with the development of neutron detectors required for these measurements. The NBS measurements have made a significant contribution to the improvement in the understanding of this reaction. Measurements were performed with numerous neutron detectors at overlapping energies and at different neutron sources in order to reduce the systematic errors to achieve the required accuracy in this important neutron standard. Significant progress was also made in the development of a detector to utilize the 3 He(n,p) reaction as a standard in the eV to MeV energy region. Improvements in data acquisition systems as well as additional studies of advanced neutron sources were accomplished. Contacts with private industry were maintained and coordination of the neutron standards evaluation was continued. The report also includes biographical listings of the research staff along with copies of a few of our recent publications. 13 figs., 1 tab

Endoscopic submucosal dissection

DEFF Research Database (Denmark)

Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry

2015-01-01

evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may...... RECOMMENDATIONS: 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when...

Endoscopic management of benign biliary strictures: Possibility or exercise in futility?

Directory of Open Access Journals (Sweden)

Pierre H Deprez

2012-01-01

Full Text Available Benign biliary strictures for which endoscopic treatment is proposed are mostly related to liver transplantation or chronic pancreatitis (one third of cases each and, less frequently, to other causes (e. g., cholecystectomy, sphincterotomy. The question of futility of exercise may therefore be of importance before embarking in these techniques. Endoscopic treatment of iatrogenic (post-operative benign strictures may be considered as the gold standard since 90% of success is achieved with multiple stent placement. In strictures due to chronic pancreatitis, success rates are lower and surgery may be an appropriate alternative, although it may not be futile to propose an endoscopic try, especially when strictures are related to acute pancreatitis, pseudocyst obstruction or any reversible pancreatic cause of obstruction. In sclerosing cholangitis, endoscopic management is also focused on detection of malignancy. It should therefore not be considered as a futile exercise, but indications and aims of endotherapy should be discussed in a multidisciplinary team involving gastroenterologists, radiologists, and surgical specialists.

FY1995 development of a endoscopic surgical system utilizing multi-modal functional images; 1995 nendo tashu kino gazo wo mochiiru teishinshu naishikyo shujutsu system no kaihatsu

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-05-01

The purpose of this study is to develop an endoscope system for neurosurgery that can provide not only conventional endoscopic images but also ultraviolet-visible spectra, fluorescence spectra, near infrared spectra, and ultra-soundimages of tissue aiming for real-time identification of pathological tissue. The system also incorporates surgical manipulator and devices such as micro forceps and laser surgical instruments for endoscopic image guided surgery. Surgical Manipulator should be a high performance and easy to operate surgical instrument as well as conventional surgical tools such as scissors and knife. Since living tissue deforms during surgical operation, pre-operative three dimensional information for registration of pathological tissue should be modified based on information obtained during surgery. Thus surgical manipulator should be operated under guidance of surgeon's observation. Consequently, surgical manipulator should have various types of imaging and measurement devices such as an endoscope and an ultrasound imaging probe at its end effectors. Based on this concept, a prototype of a new multi channel surgical manipulator system CM cube (CM3, Computer aided Micro Multichannel Manipulator) that has various types of imaging and measurement devices such as ultra-violet-visible camera for spectroscopic measurement, ultra-sound imaging probe, three dimensional endoscope, together with micro surgical instruments and laser surgical systems has been developed. Its performance was evaluated through in vitro/in vivo experiments and clinical application. (NEDO)

Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country.

Science.gov (United States)

De-la-Peña, Joaquín; Calderón, Ángel; Esteban, José Miguel; López-Rosés, Leopoldo; Martínez-Ares, David; Nogales, Óscar; Orive-Calzada, Aitor; Rodríguez, Sarbelio; Sánchez-Hernández, Eloy; Vila, Juan; Fernández-Esparrach, Gloria

2014-02-01

Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.

New technique using LigaSure for endoscopic mucomyotomy of Zenker's diverticulum

DEFF Research Database (Denmark)

Nielsen, Hans Ulrik Kjaerem; Trolle, Waldemar; Rubek, Niclas

2014-01-01

OBJECTIVES/HYPOTHESIS: The purpose of this study is to present a new approach for treatment of Zenker's diverticulum using the LigaSure (Covidien, Mansfield, MA) technique. STUDY DESIGN: A consecutive study with follow-up of 15 patients with Zenker's diverticulum endoscopically treated using...... patients were followed up 5 to 14 months after discharge. RESULTS: The median age of patients was 76 years. The diverticula measured between 2 and 7 cm. The median time of surgery was 33 minutes. All patients but one resumed oral intake within 24 hours. One patient experienced prolonged coughing...... condition. As a new operative instrument, the LigaSure technique constitutes in our opinion a valid and easy alternative for treatment of Zenker's diverticulum compared to other endoscopic techniques....

Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip

Directory of Open Access Journals (Sweden)

Joshua Jaramillo

2016-05-01

Full Text Available Once enteral access via gastrostomy tube (G-tube is no longer indicated, the tube is typically removed in clinic with a high probability of spontaneous closure. When spontaneous closure is not achieved, the formation of a gastrocutaneous fistula (GCF is possible. The incidence of GCF is directly related with the length of time the tube has been placed. When conservative management fails, surgical intervention is the standard treatment. Endoscopic techniques have been described for primary closure of GCF in adults including banding and cauterizing of the fistula tract with placement of a standard endoscopic clip. Over-the-scope clips (OTSC have recently been reported in primary GCF closure in children (Wright et al., 2015. In patients with skin irritation surrounding a GCF making surgical repair difficult, endoscopic OTSC closure provides particular benefit. It is our belief that this is the first case report of endoscopically salvaging a leak from a failed open GCF repair.

42 CFR 493.1252 - Standard: Test systems, equipment, instruments, reagents, materials, and supplies.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Standard: Test systems, equipment, instruments... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY... storage of reagents and specimens, accurate and reliable test system operation, and test result reporting...

endoscope-i: an innovation in mobile endoscopic technology transforming the delivery of patient care in otolaryngology.

Science.gov (United States)

Mistry, N; Coulson, C; George, A

2017-11-01

Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world's first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting. Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented. Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.

Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments

Directory of Open Access Journals (Sweden)

Patrick DL

2006-01-01

Full Text Available Abstract Background Choosing an adequate measurement instrument depends on the proposed use of the instrument, the concept to be measured, the measurement properties (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability, the requirements, the burden for subjects, and costs of the available instruments. As far as measurement properties are concerned, there are no sufficiently specific standards for the evaluation of measurement properties of instruments to measure health status, and also no explicit criteria for what constitutes good measurement properties. In this paper we describe the protocol for the COSMIN study, the objective of which is to develop a checklist that contains COnsensus-based Standards for the selection of health Measurement INstruments, including explicit criteria for satisfying these standards. We will focus on evaluative health related patient-reported outcomes (HR-PROs, i.e. patient-reported health measurement instruments used in a longitudinal design as an outcome measure, excluding health care related PROs, such as satisfaction with care or adherence. The COSMIN standards will be made available in the form of an easily applicable checklist. Method An international Delphi study will be performed to reach consensus on which and how measurement properties should be assessed, and on criteria for good measurement properties. Two sources of input will be used for the Delphi study: (1 a systematic review of properties, standards and criteria of measurement properties found in systematic reviews of measurement instruments, and (2 an additional literature search of methodological articles presenting a comprehensive checklist of standards and criteria. The Delphi study will consist of four (written Delphi rounds, with approximately 30 expert panel members with different backgrounds in clinical medicine, biostatistics, psychology, and epidemiology. The final checklist will

Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct.

Science.gov (United States)

Vettoretto, Nereo; Arezzo, Alberto; Famiglietti, Federico; Cirocchi, Roberto; Moja, Lorenzo; Morino, Mario

2018-04-11

The management of gallbladder stones (lithiasis) concomitant with bile duct stones is controversial. The more frequent approach is a two-stage procedure, with endoscopic sphincterotomy and stone removal from the bile duct followed by laparoscopic cholecystectomy. The laparoscopic-endoscopic rendezvous combines the two techniques in a single-stage operation. To compare the benefits and harms of endoscopic sphincterotomy and stone removal followed by laparoscopic cholecystectomy (the single-stage rendezvous technique) versus preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy (two stages) in people with gallbladder and common bile duct stones. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded Web of Science, and two trials registers (February 2017). We included randomised clinical trials that enrolled people with concomitant gallbladder and common bile duct stones, regardless of clinical status or diagnostic work-up, and compared laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy procedures in people undergoing laparoscopic cholecystectomy. We excluded other endoscopic or surgical methods of intraoperative clearance of the bile duct, e.g. non-aided intraoperative endoscopic retrograde cholangiopancreatography or laparoscopic choledocholithotomy (surgical incision of the common bile duct for removal of bile duct stones). We used standard methodological procedures recommended by Cochrane. We included five randomised clinical trials with 517 participants (257 underwent a laparoscopic-endoscopic rendezvous technique versus 260 underwent a sequential approach), which fulfilled our inclusion criteria and provided data for analysis. Trial participants were scheduled for laparoscopic cholecystectomy because of suspected cholecysto-choledocholithiasis. Male/female ratio was 0.7; age of men and women ranged from 21 years to 87

Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study.

Science.gov (United States)

Chan, Jason Y K; Leung, Iris; Navarro-Alarcon, David; Lin, Weiyang; Li, Peng; Lee, Dennis L Y; Liu, Yun-hui; Tong, Michael C F

2016-03-01

To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Endoscopic resection of cavernoma of foramen of Monro in a patient with familial multiple cavernomatosis.

Science.gov (United States)

Prat, Ricardo; Galeano, Inmaculada

2008-09-01

Intraventricular cavernomas are extremely infrequent and only 11 cases of cavernous hemangioma to occur at the foramen of Monro have been reported in the literature. This 56 years old patient was admitted with progressive and intractable headache of 10 days of evolution. He was known to suffer familial multiple cavernomatosis. Magnetic resonance imaging (MRI), revealed obstructive hydrocephalus due to a cavernoma located in the area of the left foramen of Monro. Under neuronavigation guidance, complete endoscopic resection of the cavernoma was performed and normal ventricular size achieved. The patient experienced transient recent memory loss that resolved within a month after surgery. In the literature attempted endoscopic resection is reported to be abandoned due to bleeding and ineffectiveness of piecemeal endoscopic resection. In this case, the multiplicity of the lesions made it advisable to resect the lesion endoscopically, to avoid an open procedure in a patient with multiple potentially surgical lesions. Endoscopic resection was uneventful with easy control of bleeding with irrigation, suction, and bipolar coagulation despite dense vascular appearance of the lesion. During the procedure, precise visualization of the vascular structures around the foramen of Monro allowed complete resection with satisfactory control of the instruments. To the best of the authors' knowledge, this is the first published cavernoma of foramen of Monro successfully resected using an endoscopic approach.

Learning endoscopic resection in the esophagus

NARCIS (Netherlands)

van Vilsteren, Frederike G. I.; Pouw, Roos E.; Herrero, Lorenza Alvarez; Bisschops, Raf; Houben, Martin; Peters, Frans T. M.; Schenk, B. E.; Weusten, Bas L. A. M.; Schoon, Erik J.; Bergman, Jacques J. G. H. M.

Background: Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a

A comparative analysis of online education resources for patients undergoing endoscopic transsphenoidal surgery.

Science.gov (United States)

Fahey, Natalie; Patel, Vimal; Rosseau, Gail

2014-12-01

Endoscopic transsphenoidal surgery has become the most commonly performed surgical procedure for pituitary tumor removal. As such, there are many patient-oriented educational materials on the technique available online for members of the public who desire to learn more about the surgery. It has been recommended that educational resources be written to the national average reading level, which in the United States is between sixth and seventh grade. This study assesses the reading level of the educational materials currently available online for endoscopic transsphenoidal surgery and determines whether these resources are written at a suitable comprehension level for most readers. Sixteen patient educational resources describing endoscopic transsphenoidal surgery were identified online and assessed using 4 standard readability assessments. Patient educational resources written for endoscopic transsphenoidal surgery are written far above the recommended reading level of sixth grade. The online educational resources written for patients about endoscopic transsphenoidal surgery are above the recommended reading level for patient education materials. Further revisions to simplify these resources on endoscopic transsphenoidal surgery are needed to ensure that most patients can comprehend this important material and make informed decisions about their health care. Copyright © 2014. Published by Elsevier Inc.

Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery.

Science.gov (United States)

Al Kadah, Basel; Piccoli, Micaela; Mullineris, Barbara; Colli, Giovanni; Janssen, Martin; Siemer, Stephan; Schick, Bernhard

2015-03-01

Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be

From an urologist view: are we safe with endoscopic surgery? Overview of ergonomic problems encountered by the urologist during video endoscopic surgery.

Science.gov (United States)

Sataa, Sallami; Benzarti, Aida; Ben Jemaa, Abdelmajid

2012-12-01

The importance of minimally invasive surgery in urology has constantly increased in the last 20 years. Endoscopic resection of prostate and bladder tumors is actually a gold standard with many advantages for patients. To analyze the problems related to the ergonomic conditions faced by urologist during video endoscopic surgery by review of the recent literature. All evidence-based experimental ergonomic studies conducted in the fields of urology endoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches. Data from ergonomic studies were evaluated in terms of efficiency as well as comfort and safety aspects. Constraint postures for urologists are described and ergonomic requirements for optimal positions are discussed. The ergonomics of urological endoscopic surgery place urologists at risk for potential injury. The amount of neck flexion or extension, the amount of shoulder girdle adduction or abduction used, and stability of the upper extremities during surgery; which are maintained in a prolonged static posture; are the main risk factors. All these constraints may lead to muscle and joint fatigue, pain, and eventual musculoskeletal injury. Moreover, these issues may impact surgical accuracy. Urologist posture, operating period, training are important ergonomic factor during video surgery to prevent musculoskeletal disorders.

Fair value and accounting standard for financial instrument

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Holban (Oncioiu Ionica

2009-06-01

Full Text Available The measurement of assets and liabilities at fair value, with its subsequent gains or lossesrecognized in profit or loss, should be limited to financial investments that are readily convertible into cash orcash equivalents in active markets, and are not constrained by any business purpose. On the other hand, eventhough assets and liabilities are exposed to changes in the market price, those that are expected to obtainfuture funds and are constrained by some business purpose (non-financial investments should not bemeasured at fair value through profit and loss. Under the Accounting Standard for Financial Instruments, fairvalue measurement is required in certain circumstances similar to IFRS or US GAAP. This paper describeshow the fair value is used under the Standard and purposes to decide whether fair value measurement isrequired or not based on the type of investment.

Results Of Endoscopic Transnasal Resection Of Sinonasal Inverted Papiloma

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Baradaranfar M. H

2003-08-01

Full Text Available Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach."nMaterials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes."nResults: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen."nConclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable.

Cecal intubation rates in different eras of endoscopic technological development.

Science.gov (United States)

Matyja, Maciej; Pasternak, Artur; Szura, Mirosław; Pędziwiatr, Michał; Major, Piotr; Rembiasz, Kazimierz

2018-03-01

Colonoscopy plays a critical role in colorectal cancer (CRC) screening and has been widely regarded as the gold standard. Cecal intubation rate (CIR) is one of the well-defined quality indicators used to assess colonoscopy. To assess the impact of new technologies on the quality of colonoscopy by assessing completion rates. This was a dual-center study at the 2 nd Department of Surgery at Jagiellonian University Medical College and at the Specialist Center "Medicina" in Krakow, Poland. The CIR and cecal intubation time (CIT) in three different eras of technological advancement were determined. The study enrolled 27 463 patients who underwent colonoscopy as part of a national CRC screening program. The patients were divided into three groups: group I - 3408 patients examined between 2000 and 2003 (optical endoscopes); group II - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); and group III - 13 650 patients examined between 2009 and 2014 (modern endoscopes). There were statistically significant differences in the CIR between successive eras. The CIR in group I (2000-2003) was 69.75%, in group II (2004-2008) was 92.32%, and in group III (2009-2014) was 95.17%. The mean CIT was significantly reduced in group III. Our study shows that the technological innovation of novel endoscopy devices has a great influence on the effectiveness of the CRC screening program. The new era of endoscopic technological development has the potential to reduce examination-related patient discomfort, obviate the need for sedation and increase diagnostic yields.

Endoscopic submucosal dissection for locally recurrent colorectal lesions after previous endoscopic mucosal resection.

Science.gov (United States)

Zhou, Pinghong; Yao, Liqing; Qin, Xinyu; Xu, Meidong; Zhong, Yunshi; Chen, Weifeng

2009-02-01

The objective of this study was to determine the efficacy and safety of endoscopic submucosal dissection for locally recurrent colorectal cancer after previous endoscopic mucosal resection. A total of 16 patients with locally recurrent colorectal lesions were enrolled. A needle knife, an insulated-tip knife and a hook knife were used to resect the lesion along the submucosa. The rate of the curative resection, procedure time, and incidence of complications were evaluated. Of 16 lesions, 15 were completely resected with endoscopic submucosal dissection, yielding an en bloc resection rate of 93.8 percent. Histologic examination confirmed that lateral and basal margins were cancer-free in 14 patients (87.5 percent). The average procedure time was 87.2 +/- 60.7 minutes. None of the patients had immediate or delayed bleeding during or after endoscopic submucosal dissection. Perforation in one patient (6.3 percent) was the only complication and was managed conservatively. The mean follow-up period was 15.5 +/- 6.8 months; none of the patients experienced lesion residue or recurrence. Endoscopic submucosal dissection appears to be effective for locally recurrent colorectal cancer after previous endoscopic mucosal resection, making it possible to resect whole lesions and provide precise histologic information.

Neutron cross section standards and instrumentation. Annual report

Energy Technology Data Exchange (ETDEWEB)

Wasson, O.A.

1993-07-01

The objective of this interagency program is to provide accurate neutron interaction measurements for the US Department of Energy nuclear programs which include waste disposal, fusion, safeguards, defense, fission, and personnel protection. These measurements are also useful to other energy programs which indirectly use the unique properties of the neutron for diagnostic and analytical purposes. The work includes the measurement of reference cross sections and related neutron data employing unique facilities and capabilities at NIST and other laboratories as required; leadership and participation in international intercomparisons and collaborations; the preservation of standard reference deposits and the development of improved neutron detectors and measurement methods. A related and essential element of the program is critical evaluation of neutron interaction data including international coordinations. Data testing of critical data for important applications is included. The program is jointly supported by the Department of Energy and the National Institute of Standards and Technology. This report from the National Institute of Standards and Technology contains a summary of the accomplishments of the Neutron Cross Section Standards and Instrumentation Project during the third year of this three-year interagency agreement. The proposed program and required budget for the following three years are also presented. The program continues the shifts in priority instituted in order to broaden the program base.

Neutron cross section standards and instrumentation. Annual report

International Nuclear Information System (INIS)

Wasson, O.A.

1993-01-01

The objective of this interagency program is to provide accurate neutron interaction measurements for the US Department of Energy nuclear programs which include waste disposal, fusion, safeguards, defense, fission, and personnel protection. These measurements are also useful to other energy programs which indirectly use the unique properties of the neutron for diagnostic and analytical purposes. The work includes the measurement of reference cross sections and related neutron data employing unique facilities and capabilities at NIST and other laboratories as required; leadership and participation in international intercomparisons and collaborations; the preservation of standard reference deposits and the development of improved neutron detectors and measurement methods. A related and essential element of the program is critical evaluation of neutron interaction data including international coordinations. Data testing of critical data for important applications is included. The program is jointly supported by the Department of Energy and the National Institute of Standards and Technology. This report from the National Institute of Standards and Technology contains a summary of the accomplishments of the Neutron Cross Section Standards and Instrumentation Project during the third year of this three-year interagency agreement. The proposed program and required budget for the following three years are also presented. The program continues the shifts in priority instituted in order to broaden the program base

Comparison between endoscopic and microscopic approaches for surgery of pituitary tumours.

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Khan, Inamullah; Shamim, Muhammad Shahzad

2017-11-01

Surgical techniques for resection of pituitary tumours have come a long way since it was first introduced in late 18th century. Nowadays, most pituitary surgeries are performed through trans-nasal trans-sphenoidal approach either using a microscope, or an endoscope. Herein the authors review the literature and compare these two instruments with regards to their outcomes when used for resection of pituitary tumours. .

Endoscopic therapy of neoplasia related to Barrett's esophagus and endoscopic palliation of esophageal cancer.

Science.gov (United States)

Vignesh, Shivakumar; Hoffe, Sarah E; Meredith, Kenneth L; Shridhar, Ravi; Almhanna, Khaldoun; Gupta, Akshay K

2013-04-01

Barrett's esophagus (BE) is the most important identifiable risk factor for the progression to esophageal adenocarcinoma. This article reviews the current endoscopic therapies for BE with high-grade dysplasia and intramucosal cancer and briefly discusses the endoscopic palliation of advanced esophageal cancer. The diagnosis of low-grade or high-grade dysplasia (HGD) is based on several cytologic criteria that suggest neoplastic transformation of the columnar epithelium. HGD and carcinoma in situ are regarded as equivalent. The presence of dysplasia, particularly HGD, is also a risk factor for synchronous and metachronous adenocarcinoma. Dysplasia is a marker of adenocarcinoma and also has been shown to be the preinvasive lesion. Esophagectomy has been the conventional treatment for T1 esophageal cancer and, although debated, is an appropriate option in some patients with HGD due to the presence of occult cancer in over one-third of patients. Endoscopic ablative modalities (eg, photodynamic therapy and cryoablation) and endoscopic resection techniques (eg, endoscopic mucosal resection) have demonstrated promising results. The significant morbidity and mortality of esophagectomy makes endoscopic treatment an attractive potential option.

Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT)

NARCIS (Netherlands)

Breimer, Gerben E.; Haji, Faizal A.; Cinalli, Giuseppe; Hoving, Eelco W.; Drake, James M.

BACKGROUND: Growing demand for transparent and standardized methods for evaluating surgical competence prompted the construction of the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). OBJECTIVE: To provide validity evidence of the NEVAT by reporting on the tool's internal structure and its

History, Current Situation, and Future Development of Endoscopic Neurosurgery in China.

Science.gov (United States)

Li, Chuzhong; Zhu, Haibo; Zong, Xuyi; Wang, Xinsheng; Gui, Songbai; Zhao, Peng; Zhang, Yazhuo

2018-02-01

During the past few decades, Chinese endoscopic neurosurgery has rapidly developed in synchrony with the rest of the world. The aim of this article is to review the development of Chinese endoscopic neurosurgery, including its birth, growth, current situation, and prospects. The history of Chinese endoscopic neurosurgery development can be divided into 3 stages: cognition and initial stage (1964-1995), exploration and maturity stage (1995-2006), and rapid development and promotion stage (2006-present). In the first stage, we mainly began to become aware of endoscopic neurosurgery from the translation and review of literature. In the mid to late 1990s, Chinese neurosurgery pioneers began using neuroendoscopic techniques. In the following decade, many leading neurosurgeons made persistent efforts to push the development of Chinese endoscopic neurosurgery forward, focusing on advocating for and promoting and popularizing neuroendoscopic technology. In the rapid development and promotion stage, many representative national and regional neurosurgical centers became skilled and efficient in the application of neuroendoscopic technology and became new advocates of the technology. The number of cases, level of technology, and treatment effectiveness are gradually nearing international standards. However, future development requires promotion of balanced development to decrease regional disparities, further strengthen international exchanges, follow the latest developments, and constantly innovate for continuous improvement. Following the dramatic efforts of several pioneers, development of Chinese endoscopic neurosurgery has been considerable, and it has become an important component of neurosurgery worldwide. Copyright © 2017 Elsevier Inc. All rights reserved.

The Impact of Clinical Information on the Assessment of Endoscopic Activity: Characteristics of the Ulcerative Colitis Endoscopic Index Of Severity [UCEIS].

Science.gov (United States)

Travis, Simon P L; Schnell, Dan; Feagan, Brian G; Abreu, Maria T; Altman, Douglas G; Hanauer, Stephen B; Krzeski, Piotr; Lichtenstein, Gary R; Marteau, Philippe R; Mary, Jean-Yves; Reinisch, Walter; Sands, Bruce E; Schnell, Patrick; Yacyshyn, Bruce R; Colombel, Jean-Frédéric; Bernhardt, Christian A; Sandborn, William J

2015-08-01

To determine whether clinical information influences endoscopic scoring by central readers using the Ulcerative Colitis Endoscopic Index of Severity [UCEIS; comprising 'vascular pattern', 'bleeding', 'erosions and ulcers']. Forty central readers performed 28 evaluations, including 2 repeats, from a library of 44 video sigmoidoscopies stratified by Mayo Clinic Score. Following training, readers were randomised to scoring with ['unblinded', n = 20, including 4 control videos with misleading information] or without ['blinded', n 20] clinical information. A total of 21 virtual Central Reader Groups [CRGs], of three blinded readers, were created. Agreement criteria were pre-specified. Kappa [κ] statistics quantified intra- and inter-reader variability. Mean UCEIS scores did not differ between blinded and unblinded readers for any of the 40 main videos. UCEIS standard deviations [SD] were similar [median blinded 0.94, unblinded 0.93; p = 0.97]. Correlation between UCEIS and visual analogue scale [VAS] assessment of overall severity was high [r blinded = 0.90, unblinded = 0.93; p = 0.02]. Scores for control videos were similar [UCEIS: p ≥ 0.55; VAS: p ≥ 0.07]. Intra- [κ 0.47-0.74] and inter-reader [κ 0.40-0.53] variability for items and full UCEIS was 'moderate'-to-'substantial', with no significant differences except for intra-reader variability for erosions and ulcers [κ blinded: 0.47 vs unblinded: 0.74; p 0.047]. The SD of CRGs was lower than for individual central readers [0.54 vs 0.95; p < 0.001]. Correlation between blinded UCEIS and patient-reported symptoms was high [stool frequency: 0.76; rectal bleeding: 0.82; both: 0.81]. The UCEIS is minimally affected by knowledge of clinical details, strongly correlates with patient-reported symptoms, and is a suitable instrument for trials. CRGs performed better than individuals. © European Crohn’s and Colitis Organisation 2015.

Development of international standards for instrumentation used for detection of illicit trafficking of radioactive material

International Nuclear Information System (INIS)

Voytchev, M.; Chiaro, P.; Radev, R.

2006-01-01

Subcommittee 45 B 'Radiation Protection Instrumentation' of the International Electrotechnical Commission (I.E.C.) is charged with the development of international standards for instrumentation used for monitoring of illicit trafficking of radioactive material through international boarders and territories, as well as inside countries. Currently three I.E.C. standards are in advanced stages of development. They are expected to be approved and published in 2006-2007. The international participation and the main characteristics of the following three standards are discussed and presented: I.E.C. 62327 'Hand-held Instruments for the Detection and Identification of Radionuclides and Additionally for the Indication of Ambient Dose Equivalent Rate from Photon Radiation', I.E.C. 62401 'Alarming Personal Radiation Devices for Detection of Illicit Trafficking of Radioactive Material' and I.E.C. 62244 'Installed Radiation Monitors for the Detection of Radioactive and Special Nuclear Materials at National Borders'

Design of a modified endoscope illuminator for spectral imaging of colorectal tissues

Science.gov (United States)

Browning, Craig M.; Mayes, Samuel; Rich, Thomas C.; Leavesley, Silas J.

2017-02-01

The gold standard for locating colonic polyps is a white light endoscope in a colonoscopy, however, polyps smaller than 5 mm can be easily missed. Modified procedures such as narrow band imaging have shown only marginal increases in detection rates. Spectral imaging is a potential solution to improve the sensitivity and specificity of colonoscopies by providing the ability to distinguish molecular fluorescence differences in tissues. The goal of this work is to implement a spectral endoscopic light source to acquire spectral image data of colorectal tissues. A beta-version endoscope light source was developed, by retrofitting a white light endoscope light source (Olympus, CLK-4) with 16 narrow band LEDs. This redesigned, beta-prototype uses high-power LEDs with a minimum output of 500 mW to provide sufficient spectral output (0.5 mW) through the endoscope. A mounting apparatus was designed to provide sufficient heat dissipation. Here, we report recent results of our tests to characterize the intensity output through the light source and endoscope to determine the flat spectral output for imaging and intensity losses through the endoscope. We also report preliminary spectral imaging data from transverse pig colon that demonstrates the ability to result in working practical spectral data. Preliminary results of this revised prototype spectral endoscope system demonstrate that there is sufficient power to allow the imaging process to continue and potentially determine spectral differences in cancerous and normal tissue from imaging ex vivo pairs. Future work will focus on building a spectral library for the colorectal region and refining the user interface the system for in vivo use.

Visual tracking of da Vinci instruments for laparoscopic surgery

Science.gov (United States)

Speidel, S.; Kuhn, E.; Bodenstedt, S.; Röhl, S.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.

2014-03-01

Intraoperative tracking of laparoscopic instruments is a prerequisite to realize further assistance functions. Since endoscopic images are always available, this sensor input can be used to localize the instruments without special devices or robot kinematics. In this paper, we present an image-based markerless 3D tracking of different da Vinci instruments in near real-time without an explicit model. The method is based on different visual cues to segment the instrument tip, calculates a tip point and uses a multiple object particle filter for tracking. The accuracy and robustness is evaluated with in vivo data.

Endoscopic Therapy of Refractory Post-Papillotomy Bleeding With Electrocautery Forceps Coagulation Method Combined With Prophylactic Pancreatic Stenting

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Zsolt Dubravcsik

2014-01-01

Conclusion: We presented a new, effective and safe second line endoscopic hemostatic method in patients with therapy resistant post-papillotomy bleeding. Combination of prophylactic pancreatic stenting and thermal coagulation with coagulation forceps might be suggested as a rescue treatment in patients with severe post-papillotomy bleeding, resistant to standard endoscopic therapy.

Endoscopic Endonasal Approach in the Management of Rathke's Cleft Cysts.

Directory of Open Access Journals (Sweden)

Domenico Solari

Full Text Available Rathke's cleft cysts (RCCs are quite uncommon sellar lesions that can extend or even arise in the suprasellar area. The purpose of this study is to evaluate the effectiveness of both standard and extended endoscopic endonasal approaches in the management of different located RCCs.We retrospectively analyzed a series of 29 patients (9 males, 20 females complaining of a RCC, who underwent a standard or an extended endoscopic transsphenoidal approach at the Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, of the Università degli Studi di Napoli "Federico II". Data regarding patients' demographics, clinical evaluation, cyst characteristics, surgical treatments, complications and outcomes were extracted from our electronic database (Filemaker Pro 11, File Maker Inc., Santa Clara, California, USA.A standard transsphenoidal approach was used in 19 cases, while the extended variation of the approach in 10 cases (5 purely suprasellar and 5 intra-suprasellar RCC. Cysts contents was fully drained in all the 29 cases, whilst a gross total removal, that accounts on the complete cyst wall removal, was achieved in an overall 55,1% of patients (16/29, specifically 36,8% (7/19 that received standard approach and 90% (9/10 of those that underwent to extended approach. We reported a 56.2% of recovery from headache, 38.5% of complete recovery and 53.8% of improvement from visual field defect and an overall 46.7% of improvement of the endocrine functions. Postoperative permanent DI rate was 10.3%, overall post-operative CSF leak rate 6.9%; recurrence/regrowth occurred in 4 patients (4/29, 13.8%, but only one required a second surgery.The endoscopic transsphenoidal approach for the removal of a symptomatic RCC offers several advantages in terms of visualization of the surgical field during both the exposure and removal of the lesion. The "extended" variation of the endoscopic approach provides a direct access

Ergonomic design and evaluation of the handle for an endoscopic dissector.

Science.gov (United States)

Shimomura, Yoshihiro; Minowa, Keita; Kawahira, Hiroshi; Katsuura, Tetsuo

2016-05-01

The purpose of this study was to design an endoscopic dissector handle and objectively assess its usability. The handles were designed with increased contact area between the fingers and thumb and the eye rings, and the eye rings were modified to have a more perpendicular insertion angle to the finger midline. Four different handle models were compared, including a conventional product. Subjects performed dissection, exclusion, grasping, precision manipulation and precision handling tasks. Electromyography and subjective evaluations were measured. Compared to conventional handles, the designated handle reduced the muscle load in the extensor and flexor muscles of the forearm and increased subjective stability. The activity of the first dorsal interosseous muscle was sometimes influenced by the shape of the other parts. The ergonomically designed endoscopic dissector handle used in this study achieved high usability. Medical instrument designs based on ergonomic concepts should be assessed with objective indices. Practitioner Summary: The endoscopic dissector handles were designed with increased contact area and more suitable insertion angle between the fingers and thumb and the eye rings. Compared to conventional handles, the designated handle reduced the muscle load in the extensor and flexor muscles of the forearm and increased subjective stability.

Repetitive endoscopic sinus surgery failure: a role for radical surgery?

NARCIS (Netherlands)

Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

2006-01-01

OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

Improving superficial target delineation in radiation therapy with endoscopic tracking and registration

Energy Technology Data Exchange (ETDEWEB)

Weersink, R. A.; Qiu, J.; Hope, A. J.; Daly, M. J.; Cho, B. C. J.; DaCosta, R. S.; Sharpe, M. B.; Breen, S. L.; Chan, H.; Jaffray, D. A. [Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada)

2011-12-15

Purpose: Target delineation within volumetric imaging is a critical step in the planning process of intensity modulated radiation therapy. In endoluminal cancers, endoscopy often reveals superficial areas of visible disease beyond what is seen on volumetric imaging. Quantitatively relating these findings to the volumetric imaging is prone to human error during the recall and contouring of the target. We have developed a method to improve target delineation in the radiation therapy planning process by quantitatively registering endoscopic findings contours traced on endoscopic images to volumetric imaging. Methods: Using electromagnetic sensors embedded in an endoscope, 2D endoscopic images were registered to computed tomography (CT) volumetric images by tracking the position and orientation of the endoscope relative to a CT image set. Regions-of-interest (ROI) in the 2D endoscopic view were delineated. A mesh created within the boundary of the ROI was projected onto the 3D image data, registering the ROI with the volumetric image. This 3D ROI was exported to clinical radiation treatment planning software. The precision and accuracy of the procedure was tested on two solid phantoms with superficial markings visible on both endoscopy and CT images. The first phantom was T-shaped tube with X-marks etched on the interior. The second phantom was an anatomically correct skull phantom with a phantom superficial lesion placed on the pharyngeal surface. Markings were contoured on the endoscope images and compared with contours delineated in the treatment planning system based on the CT images. Clinical feasibility was tested on three patients with early stage glottic cancer. Image-based rendering using manually identified landmarks was used to improve the registration. Results: Using the T-shaped phantom with X-markings, the 2D to 3D registration accuracy was 1.5-3.5 mm, depending on the endoscope position relative to the markings. Intraobserver standard variation was 0

Experimental study of hybrid-knife endoscopic submucosal dissection (ESD versus standard ESD in a Western country

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Joaquín de-la Peña

2014-02-01

Full Text Available Background: Endoscopic submucosal dissection (ESD is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high-pressure water jet and to compare with standard ESD. Material and methods: We performed a prospective non-survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0, size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard. Results: Forty-six (92% ESD were en-bloc and 25 (50% R0 (hybrid-knife: n = 13, 44%; standard: n = 16, 80%; p = 0.04. Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm²/min vs. 14.3 ± 9.3 mm²/min (p = 0.079. Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm²/min; p = 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm²/min; p = 0.607. The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30% to 100%. Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid-knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.

Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology.

Science.gov (United States)

Cicchetti, Domenic V.

1994-01-01

In the context of developing assessment instruments in psychology, issues of standardization, norming procedures, and test reliability and validity are discussed. Criteria, guidelines, and rules of thumb are provided to help the clinician with instrument selection for a given psychological assessment. (SLD)

Endoscopic resection of subepithelial tumors.

Science.gov (United States)

Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

2014-12-16

Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.

Development of international standards for instrumentation used for detection of illicit trafficking of radioactive material

Energy Technology Data Exchange (ETDEWEB)

Voytchev, M. [Institut de Radioprotection et de Surete Nucleaire (IRSN/DSU/SERAC/CTHIR), 91 - Gif sur Yvette (France); Chiaro, P. [Oak Ridge National Lab., TN (United States); Radev, R. [LLNL, Livermore, CA (United States)

2006-07-01

Subcommittee 45 B 'Radiation Protection Instrumentation' of the International Electrotechnical Commission (I.E.C.) is charged with the development of international standards for instrumentation used for monitoring of illicit trafficking of radioactive material through international boarders and territories, as well as inside countries. Currently three I.E.C. standards are in advanced stages of development. They are expected to be approved and published in 2006-2007. The international participation and the main characteristics of the following three standards are discussed and presented: I.E.C. 62327 'Hand-held Instruments for the Detection and Identification of Radionuclides and Additionally for the Indication of Ambient Dose Equivalent Rate from Photon Radiation', I.E.C. 62401 'Alarming Personal Radiation Devices for Detection of Illicit Trafficking of Radioactive Material' and I.E.C. 62244 'Installed Radiation Monitors for the Detection of Radioactive and Special Nuclear Materials at National Borders'.

A new robotic-assisted flexible endoscope with single-hand control: endoscopic submucosal dissection in the ex vivo porcine stomach.

Science.gov (United States)

Iwasa, Tsutomu; Nakadate, Ryu; Onogi, Shinya; Okamoto, Yasuharu; Arata, Jumpei; Oguri, Susumu; Ogino, Haruei; Ihara, Eikichi; Ohuchida, Kenoki; Akahoshi, Tomohiko; Ikeda, Tetsuo; Ogawa, Yoshihiro; Hashizume, Makoto

2018-04-17

Difficulties in endoscopic operations and therapeutic procedures seem to occur due to the complexity of operating the endoscope dial as well as difficulty in performing synchronized movements with both hands. We developed a prototype robotic-assisted flexible endoscope that can be controlled with a single hand in order to simplify the operation of the endoscope. The aim of this study was to confirm the operability of the robotic-assisted flexible endoscope (RAFE) by performing endoscopic submucosal dissection (ESD). Study 1: ESD was performed manually or with RAFE by an expert endoscopist in ex vivo porcine stomachs; six operations manually and six were performed with RAFE. The procedure time per unit circumferential length/area was calculated, and the results were statistically analyzed. Study 2: We evaluated how smoothly a non-endoscopist can move a RAFE compared to a manual endoscope by assessing the designated movement of the endoscope. Study 1: En bloc resection was achieved by ESD using the RAFE. The procedure time was gradually shortened with increasing experience, and the procedure time of ESD performed with the RAFE was not significantly different from that of ESD performed with a manual endoscope. Study 2: The time for the designated movement of the endoscope was significantly shorter with a RAFE than that with a manual endoscope as for a non-endoscopist. The RAFE that we developed enabled an expert endoscopist to perform the ESD procedure without any problems and allowed a non-endoscopist to control the endoscope more easily and quickly than a manual endoscope. The RAFE is expected to undergo further development.

Integrated endoscopic OCT system and in-vivo images of human internal organs

Science.gov (United States)

Sergeev, Alexander M.; Gelikonov, Valentin M.; Gelikonov, Grigory V.; Feldchtein, Felix I.; Kuranov, Roman V.; Gladkova, Natalia D.; Shakhova, Natalia M.; Snopova, Ludmila; Shakhov, Andrei; Kuznetzova, Irina N.; Denisenko, Arkady; Pochinko, Vitaly; Chumakov, Yuri; Almasov, Valentin

1998-04-01

First results of endoscopic applications of optical coherence tomography (OCT) for in vivo studies of human mucosa in respiratory, gastrointestinal, urinary and genital tracts are presented. A novel endoscopic OCT (EOCT) system has been created that is based on the integration of a sampling arm of an all-optical-fiber interferometer into standard endoscopic devices using their biopsy channel to transmit low-coherence radiation to investigated tissue. We have studied mucous membranes of esophagus, larynx, stomach, urinary bladder, uterine cervix and endometrium as typical localization for carcinomatous processes. Images of tumor tissues versus healthy tissues have been recorded and analyzed. Violations of well-defined stratified healthy mucosa structure in cancered tissue is distinctly seen by EOCT, thus making this technique promising for early diagnosis of tumors and precise guiding of excisional biopsy.

Comparison of impact of four surgical methods on surgical outcomes in endoscopic dacryocystorhinostomy.

Science.gov (United States)

Roh, Hyun Cheol; Baek, Sehyun; Lee, Hwa; Chang, Minwook

2016-06-01

To evaluate differences in the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) according to four different surgical methods. This retrospective study included 222 patients who underwent endoscopic DCR from 2011 to 2013. All patients were assigned to one of four groups according to instruments for incision of nasal mucosa and the formation of mucosal flap: group 1, a sickle knife with mucosal flap; group 2, a sickle knife without mucosal flap; group 3, electrocautery with mucosal flap; and group 4, electrocautery without mucosal flap. The follow up period was at least 6 months. There were 33 eyes in group 1, 44 eyes in group 2, 49 eyes in group 3, and 97 eyes in group 4. There were no significant differences in success rate between groups (P = 0.878). Wound healing time was significantly different between groups (P knife may be more helpful and effective for shortening wound healing time rather than making mucosal flaps in endoscopic DCR. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Endoscopic approaches to treatment of achalasia

Science.gov (United States)

Friedel, David; Modayil, Rani; Iqbal, Shahzad; Grendell, James H.

2013-01-01

Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy. PMID:23503707

Comprehensive review on endonasal endoscopic sinus surgery

Science.gov (United States)

Weber, Rainer K.; Hosemann, Werner

2015-01-01

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

Economical and organizational aspects of radiopulmonology instrumentation

International Nuclear Information System (INIS)

Chikirdin, Eh.G.; Astrakhantsev, F.A.

1986-01-01

It is shown that the introduction of X-ray endoscopic rooms (radiology treatment rooms) equipped with appropriate installations into pulmonologic departments provides more valid diagnosis of carcinoma of the lungs, the cost of examinations being increased only by 15.7%. The latter can be compensated for with improved instrumentation of both preventive and general X-ray rooms

[Endoscopic extraction of gallbladder calculi].

Science.gov (United States)

Kühner, W; Frimberger, E; Ottenjann, R

1984-06-29

Endoscopic extraction of gallbladder stones were performed, as far as we know for the first time, in three patients with combined choledochocystolithiasis. Following endoscopic papillotomy (EPT) and subsequent mechanical lithotripsy of multiple choledochal concrements measuring up to 3 cm the gallbladder stones were successfully extracted with a Dormia basket through the cystic duct. The patients have remained free of complications after the endoscopic intervention.

Endoscopic vs. microscopic transsphenoidal surgery for Cushing's disease: a systematic review and meta-analysis.

Science.gov (United States)

Broersen, Leonie H A; Biermasz, Nienke R; van Furth, Wouter R; de Vries, Friso; Verstegen, Marco J T; Dekkers, Olaf M; Pereira, Alberto M

2018-05-16

Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible. Pooled proportions were reported including 95% confidence intervals. We included 97 articles with 6695 patients in total (5711 microscopically and 984 endoscopically operated). Overall, remission was achieved in 5177 patients (80%), with no clear difference between both techniques. Recurrence was around 10% and short term mortality surgery (12.9 vs. 4.0%), whereas transient diabetes insipidus occurred less often (11.3 vs. 21.7%). For microadenomas, results were comparable between both techniques. For macroadenomas, the percentage of patients in remission was higher after endoscopic surgery (76.3 vs. 59.9%), and the percentage recurrence lower after endoscopic surgery (1.5 vs. 17.0%). Endoscopic surgery for patients with Cushing's disease reaches comparable results for microadenomas, and probably better results for macroadenomas than microscopic surgery. This is present despite the presumed learning curve of the newer endoscopic technique, although confounding cannot be excluded. Based on this study, endoscopic surgery may thus be considered the current standard of care. Microscopic surgery can be used based on neurosurgeon's preference. Endocrinologists and neurosurgeons in pituitary centers performing the microscopic technique should at least consider referring Cushing's disease patients with a macroadenoma.

Endoscopic findings following retroperitoneal pancreas transplantation.

Science.gov (United States)

Pinchuk, Alexey V; Dmitriev, Ilya V; Shmarina, Nonna V; Teterin, Yury S; Balkarov, Aslan G; Storozhev, Roman V; Anisimov, Yuri A; Gasanov, Ali M

2017-07-01

An evaluation of the efficacy of endoscopic methods for the diagnosis and correction of surgical and immunological complications after retroperitoneal pancreas transplantation. From October 2011 to March 2015, 27 patients underwent simultaneous retroperitoneal pancreas-kidney transplantation (SPKT). Diagnostic oesophagogastroduodenoscopy (EGD) with protocol biopsy of the donor and recipient duodenal mucosa and endoscopic retrograde pancreatography (ERP) were performed to detect possible complications. Endoscopic stenting of the main pancreatic duct with plastic stents and three-stage endoscopic hemostasis were conducted to correct the identified complications. Endoscopic methods showed high efficiency in the timely diagnosis and adequate correction of complications after retroperitoneal pancreas transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

AN EXPERIMENTAL STUDY OF THE EFFICACY AND SAFETY OF VARIOUS ENDOSCOPIC HEMOSTASIS TECHNIQUES

Directory of Open Access Journals (Sweden)

A. I. Cherepanin

2014-01-01

Full Text Available ABSTRACT. The treatment of bleeding peptic ulcers remains one of the pressing challenges in urgent surgery. Currently available endoscopic hemostasis modalities only partially meet the requirements of safety, efficiency and reliability, and therefore total and postoperative mortality rates are still high, both in our country, and around the world. The aim of the study was to identify the benefits and shortcomings of endoscopic radiofrequency energy exposure compared to standard hemostatic techniques used in the world practice to treat bleeding peptic ulcers. 

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)

NARCIS (Netherlands)

F.J.C. van den Broek (Frank); E.J.R. de Graaf (Eelco); M.G.W. Dijkgraaf (Marcel); J.B. Reitsma (Johannes); J. Haringsma (Jelle); R. Timmer (Robin); B.L. Weusten (Bas); M.F. Gerhards (Michael); E.C. Consten (Esther); M.P. Schwartz (Matthijs); M.J. Boom (Maarten); E.J. Derksen (Erik); A.B. Bijnen (Bart); P.H.P. Davids (Paul); C. Hoff (Christiaan); H.M. van Dullemen (Hendrik); G.D.N. Heine (Dimitri); K. van der Linde (Klaas); J.M. Jansen (Jeroen); R.C.H. Mallant-Hent (Rosalie); R. Breumelhof (Ronald); H. Geldof (Han); J.C. Hardwick (James); P. Doornebosch (Pascal); A.C.T.M. Depla (Annekatrien); M.F. Ernst (Miranda); I.P. van Munster (Ivo); I.H.J.T. de Hingh (Ignace); E.J. Schoon (Erik); W.A. Bemelman (Willem); P. Fockens (Paul); E. Dekker (Evelien)

2009-01-01

textabstractBackground: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does

Synthetic multielement standards used for instrumental neutron activation analysis as rock imitations

International Nuclear Information System (INIS)

Leypunskaya, D.I.; Drynkin, V.I.; Belenky, B.V.; Kolomijtsev, M.A.; Dundera, V.Yu.; Pachulia, N.V.

1975-01-01

Complex (multielemental) standards representing microelement composition of standard rocks such as trap ST-1 (USSR), gabbrodiorite SGD-1 (USSR), albitized granite SG-1 (USSR), basalt BCR-1 (USA) and granodiorite GSP-1 (USA) have been synthesized. It has been shown that the concentration of each microelement in the synthetic standards can be given with a high precision. Comparative investigation has been carried out of the synthetic imitations and the above natural standard rocks. It has been found that the result of the instrumental neutron activation analysis using the synthetic standards is as good as in the case when natural standard rocks are used. The results obtained have been also used for substantiation of the versatility of the method used for standard preparation, i.e. a generalization has been made of a possibility of using this method for the preparation of synthetic standards representing the microelement composition of any natural rocks with various compositions and concentrations of microelements. (T.G.)

X-ray endoscopic techniques for external and internal drainage of bile ducts in mechanical jaundice

International Nuclear Information System (INIS)

Kharchenko, V.P.; Sinev, Yu.V.; Solomatin, A.D.

2000-01-01

Generalized information is considered on the application of external-internal X-ray endoscopic drainage of stomach, gallbladder, bile ducts in case of mechanical jaundice caused by both neoplasms and other diseases of pancreatobiliary zone. Indications for drainage are presented as well as contraindications, necessary equipment and instruments, recommendations on procedure realization [ru

Methodological proposal for validation of the disinfecting efficacy of an automated flexible endoscope reprocessor

Directory of Open Access Journals (Sweden)

Kazuko Uchikawa Graziano

Full Text Available ABSTRACT Objective: to elaborate and apply a method to assess the efficacy of automated flexible endoscope reprocessors at a time when there is not an official method or trained laboratories to comply with the requirements described in specific standards for this type of health product in Brazil. Method: the present methodological study was developed based on the following theoretical references: International Organization for Standardization (ISO standard ISO 15883-4/2008 and Brazilian Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA Collegiate Board Resolution (Resolução de Diretoria Colegiada - RDC no. 35/2010 and 15/2012. The proposed method was applied to a commercially available device using a high-level 0.2% peracetic acid-based disinfectant. Results: the proposed method of assessment was found to be robust when the recommendations made in the relevant legislation were incorporated with some adjustments to ensure their feasibility. Application of the proposed method provided evidence of the efficacy of the tested equipment for the high-level disinfection of endoscopes. Conclusion: the proposed method may serve as a reference for the assessment of flexible endoscope reprocessors, thereby providing solid ground for the purchase of this category of health products.

[Surveillance cultures after high-level disinfection of flexible endoscopes in a general hospital].

Science.gov (United States)

Robles, Christian; Turín, Christie; Villar, Alicia; Huerta-Mercado, Jorge; Samalvides, Frine

2014-04-01

Flexible endoscopes are instruments with a complex structure which are used in invasive gastroenterological procedures, therefore high-level disinfection (HLD) is recommended as an appropriate reprocessing method. However, most hospitals do not perform a quality control to assess the compliance and results of the disinfection process. To evaluate the effectiveness of the flexible endoscopes’ decontamination after high-level disinfection by surveillance cultures and to assess the compliance with the reprocessing guidelines. Descriptive study conducted in January 2013 in the Gastroenterological Unit of a tertiary hospital. 30 endoscopic procedures were randomly selected. Compliance with guidelines was evaluated and surveillance cultures for common bacteria were performed after the disinfection process. On the observational assessment, compliance with the guidelines was as follows: pre-cleaning 9 (30%), cleaning 5 (16.7%), rinse 3 (10%), first drying 30 (100%), disinfection 30 (100%), final rinse 0 (0%) and final drying 30 (100%), demonstrating that only 3 of 7 stages of the disinfection process were optimally performed. In the microbiological evaluation, 2 (6.7%) of the 30 procedures had a positive culture obtained from the surface of the endoscope. Furthermore, 1 (4.2%) of the 24 biopsy forcepsgave a positive culture. The organisms isolated were different Pseudomonas species. High-level disinfection procedures were not optimally performed, finding in 6.7% positive cultures of Pseudomonas species.

Therapeutic aspects of endoscopic ultrasound

Science.gov (United States)

Woodward, Timothy A.

1999-06-01

Endoscopic ultrasound (EUS) is a technology that had been used primarily as a passive imaging modality. Recent advances have enabled us to move beyond the use of EUS solely as a staging tool to an interventional device. Current studies suggest that interventional applications of EUS will allow for minimally invasive assessment and therapies in a cost-effective manner. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has been demonstrated to be a technically feasible, relatively safe method of obtaining cytologic specimens. The clinical utility of EUS- FNA appears to be greatest in the diagnosis and staging of pancreatic cancer and in the nodal staging of gastrointestinal and pulmonary malignancies. In addition, EUS-FNA has demonstrated utility in the sampling pleural and ascitic fluid not generally appreciated or assessable to standard interventions. Interventional applications of EUS include EUS-guided pseudocyst drainage, EUS-guided injection of botulinum toxin in the treatment of achalasia, and EUS- guided celiac plexus neurolysis in the treatment of pancreatic cancer pain. Finally, EUS-guided fine-needle installation is being evaluated, in conjunction with recent bimolecular treatment modalities, as a delivery system in the treatment of certain gastrointestinal tumors.

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)

NARCIS (Netherlands)

van den Broek, Frank J. C.; de Graaf, Eelco J. R.; Dijkgraaf, Marcel G. W.; Haringsma, Jelle; Timmer, Robin; Weusten, Bas L. A. M.; Gerhards, Michael F.; Consten, Esther C. J.; Schwartz, Matthijs P.; Boom, Maarten J.; Derksen, Erik J.; Bijnen, A. Bart; Davids, Paul H. P.; Hoff, Christiaan; van Dullemen, Hendrik M.; Heine, G. Dimitri N.; van der Linde, Klaas; Jansen, Jeroen M.; Mallant-Hent, Rosalie C. H.; Breumelhof, Ronald; Geldof, Han; Hardwick, James C. H.; Doornebosch, Pascal G.; Depla, Annekatrien C. T. M.; Ernst, Miranda F.; van Munster, Ivo P.; de Hingh, Ignace H. J. T.; Schoon, Erik J.; Bemelman, Willem A.; Fockens, Paul; Dekker, Evelien; Reitsma, J.

2009-01-01

Background: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require

[Endoscopic full-thickness resection].

Science.gov (United States)

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

The transition from microscopic to endoscopic transsphenoidal surgery: the experience at Brigham and Women's Hospital.

Science.gov (United States)

Laws, Edward R; Barkhoudarian, Garni

2014-12-01

As interest and enthusiasm for the use of the endoscope in transsphenoidal anterior skull base and pituitary surgery increases, neurosurgeons are increasingly adopting endoscopic technology and associated novel concepts. Often this involves a transition from the standard operating microscope as the main means of visualization to the operating endoscope (2D or 3D) during surgery. The authors' experience with this transition is described, including the rationale, advantages and disadvantages of the two surgical techniques. The successful use of endoscopic surgery for a large variety of pathological problems involving the anterior skull base and the pituitary region is presented. Perceived advantages for the patient and the surgeon are described, as is the occasional need for transition back to the microscopic approach. The endoscopic approach and its allied technology are here to stay. They are useful and occasionally preferable methods for treating a variety of suitable lesions involving the anterior skull base. The importance of incorporating the basic principles of skull base surgery is emphasized. Copyright © 2014 Elsevier Inc. All rights reserved.

In vivo endoscopic OCT imaging of precancer and cancer states of human mucosa

Science.gov (United States)

Sergeev, Alexander M.; Gelikonov, V. M.; Gelikonov, G. V.; Feldchtein, Felix I.; Kuranov, R. V.; Gladkova, N. D.; Shakhova, N. M.; Snopova, L. B.; Shakhov, A. V.; Kuznetzova, I. A.; Denisenko, A. N.; Pochinko, V. V.; Chumakov, Yu P.; Streltzova, O. S.

1997-12-01

First results of endoscopic applications of optical coherence tomography for in vivo studies of human mucosa in respiratory, gastrointestinal, urinary and genital tracts are presented. A novel endoscopic OCT (EOCT) system has been created that is based on the integration of a sampling arm of an all-optical-fiber interferometer into standard endoscopic devices using their biopsy channel to transmit low-coherence radiation to investigated tissue. We have studied mucous membranes of esophagus, larynx, stomach, urinary bladder, uterine cervix and body as typical localization for carcinomatous processes. Images of tumor tissues versus healthy tissues have been recorded and analyzed. Violations of well-defined stratified healthy mucosa structure in cancered tissue are distinctly seen by EOCT, thus making this technique promising for early diagnosis of tumors and precise guiding of excisional biopsy.

Computer-based endoscopic image-processing technology for endourology and laparoscopic surgery

International Nuclear Information System (INIS)

Igarashi, Tatsuo; Suzuki, Hiroyoshi; Naya, Yukio

2009-01-01

Endourology and laparoscopic surgery are evolving in accordance with developments in instrumentation and progress in surgical technique. Recent advances in computer and image-processing technology have enabled novel images to be created from conventional endoscopic and laparoscopic video images. Such technology harbors the potential to advance endourology and laparoscopic surgery by adding new value and function to the endoscope. The panoramic and three-dimensional images created by computer processing are two outstanding features that can address the shortcomings of conventional endoscopy and laparoscopy, such as narrow field of view, lack of depth cue, and discontinuous information. The wide panoramic images show an anatomical map' of the abdominal cavity and hollow organs with high brightness and resolution, as the images are collected from video images taken in a close-up manner. To assist in laparoscopic surgery, especially in suturing, a three-dimensional movie can be obtained by enhancing movement parallax using a conventional monocular laparoscope. In tubular organs such as the prostatic urethra, reconstruction of three-dimensional structure can be achieved, implying the possibility of a liquid dynamic model for assessing local urethral resistance in urination. Computer-based processing of endoscopic images will establish new tools for endourology and laparoscopic surgery in the near future. (author)

Meckel's cave access: anatomic study comparing the endoscopic transantral and endonasal approaches.

Science.gov (United States)

Van Rompaey, Jason; Suruliraj, Anand; Carrau, Ricardo; Panizza, Benedict; Solares, C Arturo

2014-04-01

Recent advances in endonasal endoscopy have facilitated the surgical access to the lateral skull base including areas such as Meckel's cave. This approach has been well documented, however, few studies have outlined transantral specific access to Meckel's. A transantral approach provides a direct pathway to this region obviating the need for extensive endonasal and transsphenoidal resection. Our aim in this study is to compare the anatomical perspectives obtained in endonasal and transantral approaches. We prepared 14 cadaveric specimens with intravascular injections of colored latex. Eight cadavers underwent endoscopic endonasal transpterygoid approaches to Meckel's cave. Six additional specimens underwent an endoscopic transantral approach to the same region. Photographic evidence was obtained for review. 30 CT scans were analyzed to measure comparative distances to Meckel's cave for both approaches. The endoscopic approaches provided a direct access to the anterior and inferior portions of Meckel's cave. However, the transantral approach required shorter instrumentation, and did not require clearing of the endonasal corridor. This approach gave an anterior view of Meckel's cave making posterior dissection more difficult. A transantral approach to Meckel's cave provides access similar to the endonasal approach with minimal invasiveness. Some of the morbidity associated with extensive endonasal resection could possibly be avoided. Better understanding of the complex skull base anatomy, from different perspectives, helps to improve current endoscopic skull base surgery and to develop new alternatives, consequently, leading to improvements in safety and efficacy.

Endoscopic full-thickness resection: Current status.

Science.gov (United States)

Schmidt, Arthur; Meier, Benjamin; Caca, Karel

2015-08-21

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

Novel methods for endoscopic training.

Science.gov (United States)

Gessner, C E; Jowell, P S; Baillie, J

1995-04-01

The development of past, present, and future endoscopic training methods is described. A historical perspective of endoscopy training guidelines and devices is used to demonstrate support for the use of novel endoscopic training techniques. Computer simulation of endoscopy, interactive learning, and virtual reality applications in endoscopy and surgery are reviewed. The goals of endoscopic simulation and challenges facing investigators in this field are discussed, with an emphasis on current and future research.

Endoscopic OCT for in-vivo imaging of precancer and cancer states of human mucosa

Science.gov (United States)

Sergeev, Alexander M.; Gelikonov, Valentin M.; Gelikonov, Grigory V.; Feldchtein, Felix I.; Kuranov, Roman V.; Gladkova, Natalia D.; Shakhova, Natalia M.; Kuznetzova, Irina N.; Snopova, Ludmila; Denisenko, Arkady; Almasov, Valentin

1998-01-01

First results of endoscopic applications of optical coherence tomography for in vivo studies of human mucosa in gastrointestinal and genital tracts are presented. A novel endoscopic OCT system has ben created that is based on the integration of a sampling arm of an all-optical-fiber interferometer into standard endoscopic devices using their biopsy channel to transmit low-coherence radiation to investigated tissue. We have studied mucous membranes of esophagus, stomach and uterine cervix as typical localization for carcinomatous processes. Images of tumor tissues versus healthy tissues have been recorded and analyzed. Violations of well-defined stratified healthy mucosa structure in cancerous tissue is distinctly seen by EOCT, thus making this technique promising for early diagnosis of tumors and precise guiding of excisional biopsy.

Development of the Test Of Astronomy STandards (TOAST) Assessment Instrument

Science.gov (United States)

Slater, Timothy F.; Slater, S. J.

2008-05-01

Considerable effort in the astronomy education research (AER) community over the past several years has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important in advancing the AER discipline so that researchers could establish the initial knowledge state of students as well as to attempt measure some of the impacts of innovative instructional interventions. Unfortunately, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives. This was not done in oversight, but rather as a result of the relative youth of AER as a discipline. Now that several important science education reform documents exist and are generally accepted by the AER community, we are in a position to develop, validate, and disseminate a new assessment instrument which is tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. In response, researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science & Math Teaching Center (UWYO SMTC) have designed a criterion-referenced assessment tool, called the Test Of Astronomy STandards (TOAST). Through iterative development, this instrument has a high degree of reliability and validity for instructors and researchers needing information on students’ initial knowledge state at the beginning of a course and can be used, in aggregate, to help measure the impact of course-length duration instructional strategies for courses with learning goals tightly aligned to the consensus goals of our community.

Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives

Directory of Open Access Journals (Sweden)

Elia Pulvirenti

2010-01-01

Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC should be distinguished between “pure”, in which the entire operation is performed through the transvaginal route, and “hybrid”, in which the colpotomy represents only a support to introduce instruments and the operation is performed mainly by the classic transabdominal-introduced instruments. Although this new technique seems very appealing for patients, on the other hand it is very challenging for the surgeon because of the difficulties related to the mode of access, the limited technology currently available and the risk of complications related to the organ utilized for access. In this brief review all the most recent advancements in the field of TVC's techniques and instrumentations are listed and discussed.

Endoscopic medial maxillectomy breaking new frontiers.

Science.gov (United States)

Mohanty, Sanjeev; Gopinath, M

2013-07-01

Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

Endoscopic management of bleeding peptic ulcers

International Nuclear Information System (INIS)

Farooqi, J.I.; Farooqi, R.J.

2001-01-01

Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

Endoscopic tissue diagnosis of cholangiocarcinoma.

LENUS (Irish Health Repository)

Harewood, Gavin C

2008-09-01

The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics.

First Results from the Test Of Astronomy STandards (TOAST) Assessment Instrument

Science.gov (United States)

Slater, Stephanie

2009-01-01

Considerable effort in the astronomy education research over the past several years has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important in advancing astronomy as a sub-discipline of physics education research, allowing researchers to establish the initial knowledge state of students as well as to attempt to measure some of the impacts of innovative instructional interventions. Before now, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives. Moving beyond the 10-year old Astronomy Diagnostics Test, we have developed and validated a new assessment instrument that is tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. Researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science and Math Teaching Center (UWYO SMTC) designed a criterion-referenced assessment tool, called the Test Of Astronomy STandards (TOAST). Through iterative development, this multiple-choice instrument has a high degree of reliability and validity for instructors and researchers needing information on students’ initial knowledge state at the beginning of a course and can be used, in aggregate, to help measure the impact of course-length duration instructional strategies for undergraduate science survey courses with learning goals tightly aligned to the consensus goals of the astronomy education community.

Current Status of Peroral Endoscopic Myotomy

Science.gov (United States)

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders. PMID:29397656

Current Status of Peroral Endoscopic Myotomy.

Science.gov (United States)

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Current Status of Peroral Endoscopic Myotomy

Directory of Open Access Journals (Sweden)

Young Kwan Cho

2018-01-01

Full Text Available Peroral endoscopic myotomy (POEM has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

WE-AB-BRA-12: Virtual Endoscope Tracking for Endoscopy-CT Image Registration

International Nuclear Information System (INIS)

Ingram, W; Rao, A; Wendt, R; Court, L; Yang, J; Beadle, B

2015-01-01

Purpose: The use of endoscopy in radiotherapy will remain limited until we can register endoscopic video to CT using standard clinical equipment. In this phantom study we tested a registration method using virtual endoscopy to measure CT-space positions from endoscopic video. Methods: Our phantom is a contorted clay cylinder with 2-mm-diameter markers in the luminal surface. These markers are visible on both CT and endoscopic video. Virtual endoscope images were rendered from a polygonal mesh created by segmenting the phantom’s luminal surface on CT. We tested registration accuracy by tracking the endoscope’s 6-degree-of-freedom coordinates frame-to-frame in a video recorded as it moved through the phantom, and using these coordinates to measure CT-space positions of markers visible in the final frame. To track the endoscope we used the Nelder-Mead method to search for coordinates that render the virtual frame most similar to the next recorded frame. We measured the endoscope’s initial-frame coordinates using a set of visible markers, and for image similarity we used a combination of mutual information and gradient alignment. CT-space marker positions were measured by projecting their final-frame pixel addresses through the virtual endoscope to intersect with the mesh. Registration error was quantified as the distance between this intersection and the marker’s manually-selected CT-space position. Results: Tracking succeeded for 6 of 8 videos, for which the mean registration error was 4.8±3.5mm (24 measurements total). The mean error in the axial direction (3.1±3.3mm) was larger than in the sagittal or coronal directions (2.0±2.3mm, 1.7±1.6mm). In the other 2 videos, the virtual endoscope got stuck in a false minimum. Conclusion: Our method can successfully track the position and orientation of an endoscope, and it provides accurate spatial mapping from endoscopic video to CT. This method will serve as a foundation for an endoscopy-CT registration

WE-AB-BRA-12: Virtual Endoscope Tracking for Endoscopy-CT Image Registration

Energy Technology Data Exchange (ETDEWEB)

Ingram, W; Rao, A; Wendt, R; Court, L [The University of Texas MD Anderson Cancer Center, Houston, TX (United States); The University of Texas Graduate School of Biomedical Sciences, Houston, TX (United States); Yang, J; Beadle, B [The University of Texas MD Anderson Cancer Center, Houston, TX (United States)

2015-06-15

Purpose: The use of endoscopy in radiotherapy will remain limited until we can register endoscopic video to CT using standard clinical equipment. In this phantom study we tested a registration method using virtual endoscopy to measure CT-space positions from endoscopic video. Methods: Our phantom is a contorted clay cylinder with 2-mm-diameter markers in the luminal surface. These markers are visible on both CT and endoscopic video. Virtual endoscope images were rendered from a polygonal mesh created by segmenting the phantom’s luminal surface on CT. We tested registration accuracy by tracking the endoscope’s 6-degree-of-freedom coordinates frame-to-frame in a video recorded as it moved through the phantom, and using these coordinates to measure CT-space positions of markers visible in the final frame. To track the endoscope we used the Nelder-Mead method to search for coordinates that render the virtual frame most similar to the next recorded frame. We measured the endoscope’s initial-frame coordinates using a set of visible markers, and for image similarity we used a combination of mutual information and gradient alignment. CT-space marker positions were measured by projecting their final-frame pixel addresses through the virtual endoscope to intersect with the mesh. Registration error was quantified as the distance between this intersection and the marker’s manually-selected CT-space position. Results: Tracking succeeded for 6 of 8 videos, for which the mean registration error was 4.8±3.5mm (24 measurements total). The mean error in the axial direction (3.1±3.3mm) was larger than in the sagittal or coronal directions (2.0±2.3mm, 1.7±1.6mm). In the other 2 videos, the virtual endoscope got stuck in a false minimum. Conclusion: Our method can successfully track the position and orientation of an endoscope, and it provides accurate spatial mapping from endoscopic video to CT. This method will serve as a foundation for an endoscopy-CT registration

[Pay attention to the standardized application of new techniques in surgical treatment of thyroid disease].

Science.gov (United States)

Tian, W; Xi, H Q; Wang, B

2017-08-01

The continuous development and application of new technology in thyroid surgery has promoted the rapid improvement of thyroid surgery. New technology in the field of thyroid surgery has developed rapidly. The application of neural monitoring technology has enabled the thyroid surgery to enter an accurate era. Imtraoperative neuromonitoring and continuous intraoperative neuromonitoring have made the recurrent laryngeal nerve protection more secure. Nano-carbon parathyroid gland negative imaging technology could identify parathyroid gland more precise. However, when the nano-carbon was used, the injection time, position and dosage should be grasped so as to achieve the best effect of negative imaging. Endoscopic and robotic thyroid surgery could meet the demand of cosmetic. "Treatment first, beauty second" is still the principle to be strictly followed. Do not blindly expand indications and pursue endoscopic surgery. Energy surgical instruments' update made the operation more efficient, while the instruments have some disadvantages. Thyroid surgeon must correctly understand the working principle of new energy devices and use them rationally. Through grasping the working principle and application skills of new technology in clinical work, definiting its advantages and disadvantages, adhereing to the "reasonable choice, standard application" principle, learning the pioneers' experience, the application of new thyroid diagnosis and treatment technology could be more reasonable and safe.

[Pull percutaneous endoscopic gastrostomy: personal experience].

Science.gov (United States)

Geraci, G; Sciumè, C; Pisello, F; Li Volsi, F; Facella, T; Tinaglia, D; Modica, G

2007-04-01

To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). Retrospective review of patients referred for PEG placement from 2003 to 2005. Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

Development of stereo endoscope system with its innovative master interface for continuous surgical operation.

Science.gov (United States)

Kim, Myungjoon; Lee, Chiwon; Hong, Nhayoung; Kim, Yoon Jae; Kim, Sungwan

2017-06-24

Although robotic laparoscopic surgery has various benefits when compared with conventional open surgery and minimally invasive surgery, it also has issues to overcome and one of the issues is the discontinuous surgical flow that occurs whenever control is swapped between the endoscope system and the operating robot arm system. This can lead to problems such as collision between surgical instruments, injury to patients, and increased operation time. To achieve continuous surgical operation, a wireless controllable stereo endoscope system is proposed which enables the simultaneous control of the operating robot arm system and the endoscope system. The proposed system consists of two improved novel master interfaces (iNMIs), a four-degrees of freedom (4-DOFs) endoscope control system (ECS), and a simple three-dimensional (3D) endoscope. In order to simultaneously control the proposed system and patient side manipulators of da Vinci research kit (dVRK), the iNMIs are installed to the master tool manipulators of dVRK system. The 4-DOFs ECS consists of four servo motors and employs a two-parallel link structure to provide translational and fulcrum point motion to the simple 3D endoscope. The images acquired by the endoscope undergo stereo calibration and rectification to provide a clear 3D vision to the surgeon as available in clinically used da Vinci surgical robot systems. Tests designed to verify the accuracy, data transfer time, and power consumption of the iNMIs were performed. The workspace was calculated to estimate clinical applicability and a modified peg transfer task was conducted with three novice volunteers. The iNMIs operated for 317 min and moved in accordance with the surgeon's desire with a mean latency of 5 ms. The workspace was calculated to be 20378.3 cm 3 , which exceeds the reference workspace of 549.5 cm 3 . The novice volunteers were able to successfully execute the modified peg transfer task designed to evaluate the proposed system's overall

Standardization and improvement of safety for radioisotope equipped instruments

International Nuclear Information System (INIS)

Sumi, Tetsuo

1980-01-01

The safety for radioisotope-equipped instruments is considered. The one is the safety for the source assembly. The radioisotopes employed for radioisotope-equipped instruments are sealed sources which are used in the state of being contained in the enclosures. Many of the enclosures are provided with shutter mechanism for the purpose of emitting radiation only during the period required. If the possible troubles that might lead to the accidents are sampled out of the results of field operation of radiation instruments, and the safety measures for source enclosures are considered in connection with these troubles, it is no exaggeration to say that the safety for source enclosures has been maintained by preventing the critical accidents by the management of users and the cooperation of manufactures though there were the chance for investigating the safety in the common field and the establishment of JIS Z 4614 standard. Another consideration is concerned with the measures to improve the safety. No accident in the past never guarantees no accident in the future. Accumulation of experience is most effective for those measures, and the more experiences the better. It may be most effective that the manufacturers disclose their experiences each other from the wide outlook overcoming the barrier of trade secret. Fortunately, such consciousness has risen since a few years ago, and the investigation group is doing the works in the Japan Radioisotope Association. On the other hand, the reasonable revision of the radiation injury prevention law is desired. (Wakatsuki, Y.)

Ling classification describes endoscopic progressive process of achalasia and successful peroral endoscopy myotomy prevents endoscopic progression of achalasia.

Science.gov (United States)

Zhang, Wen-Gang; Linghu, En-Qiang; Chai, Ning-Li; Li, Hui-Kai

2017-05-14

To verify the hypothesis that the Ling classification describes the endoscopic progressive process of achalasia and determine the ability of successful peroral endoscopic myotomy (POEM) to prevent endoscopic progression of achalasia. We retrospectively reviewed the endoscopic findings, symptom duration, and manometric data in patients with achalasia. A total of 359 patients (197 women, 162 men) with a mean age of 42.1 years (range, 12-75 years) were evaluated. Symptom duration ranged from 2 to 360 mo, with a median of 36 mo. Patients were classified with Ling type I ( n = 119), IIa ( n = 106), IIb ( n = 60), IIc ( n = 60), or III ( n = 14), according to the Ling classification. Of the 359 patients, 349 underwent POEM, among whom 21 had an endoscopic follow-up for more than 2 years. Pre-treatment and post-treatment Ling classifications of these 21 patients were compared. Symptom duration increased significantly with increasing Ling classification (from I to III) ( P achalasia and may be able to serve as an endoscopic assessment criterion for achalasia. Successful POEM (Eckardt score ≤ 3) seems to have the ability to prevent endoscopic evolvement of achalasia. However, studies with larger populations are warranted to confirm our findings.

21 CFR 884.4100 - Endoscopic electrocautery and accessories.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endoscopic electrocautery and accessories. 884... Surgical Devices § 884.4100 Endoscopic electrocautery and accessories. (a) Identification. An endoscopic electrocautery is a device used to perform female sterilization under endoscopic observation. It is designed to...

Clinical assessment of diode laser-assisted endoscopic intrasphenoidal vidian neurectomy in the treatment of refractory rhinitis.

Science.gov (United States)

Lai, Wen-Sen; Cheng, Sheng-Yao; Lin, Yuan-Yung; Yang, Pei-Lin; Lin, Hung-Che; Cheng, Li-Hsiang; Yang, Jinn-Moon; Lee, Jih-Chin

2017-12-01

For chronic rhinitis that is refractory to medical therapy, surgical intervention such as endoscopic vidian neurectomy (VN) can be used to control the intractable symptoms. Lasers can contribute to minimizing the invasiveness of ENT surgery. The aim of this retrospective study is to compare in patients who underwent diode laser-assisted versus traditional VN in terms of operative time, surgical field, quality of life, and postoperative complications. All patients had refractory rhinitis with a poor treatment response to a 6-month trial of corticosteroid nasal sprays and underwent endoscopic VN between November 2006 and September 2015. They were non-randomly allocated into either a cold instrument group or a diode laser-assisted group. Vidian nerve was excised with a 940-nm continuous wave diode laser through a 600-μm silica optical fiber, utilizing a contact mode with the power set at 5 W. A visual analog scale (VAS) was used to grade the severity of the rhinitis symptoms for quality of life assessment before the surgery and 6 months after. Of the 118 patients enrolled in the study, 75 patients underwent cold instrument VN and 43 patients underwent diode laser-assisted VN. Patients in the laser-assisted group had a significantly lower surgical field score and a lower postoperative bleeding rate than those in the cold instrument group. Changes in the VAS were significant in preoperative and postoperative nasal symptoms in each group. The application of diode lasers for vidian nerve transection showed a better surgical field and a lower incidence of postoperative hemorrhage. Recent advancements in laser application and endoscopic technique has made VN safer and more effective. We recommend this surgical approach as a reliable and effective treatment for patients with refractory rhinitis.

Endoscopic management of hilar biliary strictures

Science.gov (United States)

Singh, Rajiv Ranjan; Singh, Virendra

2015-01-01

Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345

Endoscopes with latest technology and concept.

Science.gov (United States)

Gotoh

2003-09-01

Endoscopic imaging systems that perform as the "eye" of the operator during endoscopic surgical procedures have developed rapidly due to various technological developments. In addition, since the most recent turn of the century robotic surgery has increased its scope through the utilization of systems such as Intuitive Surgical's da Vinci System. To optimize the imaging required for precise robotic surgery, a unique endoscope has been developed, consisting of both a two dimensional (2D) image optical system for wider observation of the entire surgical field, and a three dimensional (3D) image optical system for observation of the more precise details at the operative site. Additionally, a "near infrared radiation" endoscopic system is under development to detect the sentinel lymph node more readily. Such progress in the area of endoscopic imaging is expected to enhance the surgical procedure from both the patient's and the surgeon's point of view.

Training With Curved Laparoscopic Instruments in Single-Port Setting Improves Performance Using Straight Instruments: A Prospective Randomized Simulation Study.

Science.gov (United States)

Lukovich, Peter; Sionov, Valery Ben; Kakucs, Timea

2016-01-01

Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum. A prospective study on a box trainer in single-port setting was conducted using 2 groups. Each group performed 2 tasks on the box trainer in single-port setting. Group-S used conventional straight laparoscopic instruments, and Group-C used curved laparoscopic instruments. Learning curves were obtained by daily measurements recorded in 7-day sessions. On the last day, the 2 groups changed instruments between each other. 1st Department of Surgery, Semmelweis University of Medicine from Budapest, Hungary, a university teaching hospital. In all, 20 fifth-year medical students were randomized into 2 groups. None of them had any laparoscopic or endoscopic experience. Participation was voluntary. Although Group-S performed all tasks significantly faster than Group-C on the first day, the difference proved to be nonsignificant on the last day. All participants achieved significantly shorter task completion time on the last day than on the first day, regardless of the instrument they used. Group-S showed improvement of 63.5%, and Group-C 69.0% improvement by the end of the session. After swapping the instruments, Group-S reached significantly higher task completion time with curved instruments, whereas Group-C showed further progression of 8.9% with straight instruments. Training with curved instruments in a single-port setting allows for a better acquisition of skills in a shorter period. For this

Endoscopic vision-based tracking of multiple surgical instruments during robot-assisted surgery.

Science.gov (United States)

Ryu, Jiwon; Choi, Jaesoon; Kim, Hee Chan

2013-01-01

Robot-assisted minimally invasive surgery is effective for operations in limited space. Enhancing safety based on automatic tracking of surgical instrument position to prevent inadvertent harmful events such as tissue perforation or instrument collisions could be a meaningful augmentation to current robotic surgical systems. A vision-based instrument tracking scheme as a core algorithm to implement such functions was developed in this study. An automatic tracking scheme is proposed as a chain of computer vision techniques, including classification of metallic properties using k-means clustering and instrument movement tracking using similarity measures, Euclidean distance calculations, and a Kalman filter algorithm. The implemented system showed satisfactory performance in tests using actual robot-assisted surgery videos. Trajectory comparisons of automatically detected data and ground truth data obtained by manually locating the center of mass of each instrument were used to quantitatively validate the system. Instruments and collisions could be well tracked through the proposed methods. The developed collision warning system could provide valuable information to clinicians for safer procedures. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Endoscopic and Histological Findings Are Predicted by Fecal Calprotectin in Acute Intestinal Graft-Versus-Host-Disease.

Science.gov (United States)

Adam, Birgit; Koldehoff, Michael; Ditschkowski, Markus; Gromke, Tanja; Hlinka, Michal; Trenschel, Rudolf; Kordeals, Lambros; Steckel, Nina K; Beelen, Dietrich W; Liebregts, Tobias

2016-07-01

Gastrointestinal graft-versus-host-disease (GI-GVHD) is a major cause of nonrelapse mortality after hematopoietic stem cell transplantation (HSCT) necessitating endoscopic examinations and biopsies for diagnosis. Fecal calprotectin (CPT) has been widely used in gastrointestinal inflammation, but comprehensive data in GI-GVHD are lacking. We aimed to identify an association of CPT with endoscopic findings, mucosal damage and symptoms for diagnosing and monitoring acute GI-GVHD. Symptoms were prospectively evaluated in 110 consecutive HSCT recipients by standardized questionnaires and Bristol Stool Scale (BSS). CPT was assayed by ELISA. Symptom assessment and CPT were performed weekly and with onset of first symptoms. GVHD was diagnosed according to the Glucksberg criteria and by endoscopic biopsies. Patients with GI-GVHD received standard high-dose corticosteroid therapy and follow-up CPT, and symptom evaluation was performed after 28 days. Patients not responding to steroid treatment were re-evaluated by colonoscopy. GI-GVHD was diagnosed in 40 patients. Twelve patients with GI symptoms and CMV colitis and 24 patients with isolated skin GVHD were included as control subjects. CPT was significantly higher in GI-GVHD compared to skin GVHD and CMV colitis. Endoscopic findings, histological grading, abdominal cramps, diarrhea, urgency and BSS correlated with CPT. At follow-up, CPT correlated with abdominal cramps, diarrhea, urgency and BSS. In steroid refractory patients, CPT level was still significantly associated with severity of mucosal damage. CPT predicts endoscopic and histological findings in GI-GVHD and correlates with lower GI symptoms. It enables to discriminate GVHD from CMV colitis and to monitor therapeutic success.

Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent.

Science.gov (United States)

Klein, Amir; Qi, Zhengyan; Bahin, Farzan F; Awadie, Halim; Nayyar, Dhruv; Ma, Michael; Voermans, Rogier P; Williams, Stephen J; Lee, Eric; Bourke, Michael J

2018-05-16

 Endoscopic resection of ampullary adenomas is a safe and effective alternative to surgical resection. A subgroup of patients have large laterally spreading lesions of the papilla Vateri (LSL-P), which are frequently managed surgically. Data on endoscopic resection of LSL-P are limited and long-term outcomes are unknown. The aim of this study was to compare the outcomes of endoscopic resection of LSL-P with those of standard ampullary adenomas.  A retrospective analysis of a prospectively collected and maintained database was conducted. LSL-P was defined as extension of the lesion ≥ 10 mm from the edge of the ampullary mound. Piecemeal endoscopic mucosal resection of the laterally spreading component was followed by resection of the ampulla. Patient, lesion, and procedural data, as well as results of endoscopic follow-up, were collected.  125 lesions were resected. Complete endoscopic resection was achieved in 97.6 % at the index procedure (median lesion size 20 mm, interquartile range [IQR] 13 - 30 mm). Compared with ampullary adenomas, LSL-Ps were significantly larger (median 35 mm vs. 15 mm), contained a higher rate of advanced pathology (38.6 % vs. 18.5 %), and had higher rates of intraprocedural bleeding (50 % vs. 24.7 %) and delayed bleeding (25.0 % vs. 12.3 %). Both groups had similar rates of histologically proven recurrence at first surveillance (16.4 % vs. 17.9 %). Median follow-up for the entire cohort was 18.5 months. For patients with at least two surveillance endoscopies (n = 68; median follow-up 29 months, IQR 18 - 48 months), 95.6 % were clear of disease and considered cured.  LSL-P can be resected endoscopically with comparable outcomes to standard ampullectomy, albeit with a higher risk of bleeding. Endoscopic treatment should be considered as an alternative to surgical resection, even for large LSL-P. © Georg Thieme Verlag KG Stuttgart · New York.

Successful endoscopic treatment of gastric phytobezoar: A case report.

Science.gov (United States)

Ugenti, Ippazio; Travaglio, Elisabetta; Lagouvardou, Elpiniki; Caputi Iambrenghi, Onofrio; Martines, Gennaro

2017-01-01

Gastric bezoars are a rare condition associated with situations of gastric dysmotility and prior gastric surgery, though sometimes they can present without any risk factor. We describe the first successful treatment in medical literature of a large gastric bezoar in the outpatient setting through endoscopic fragmentation. A 76-year-old man was referred to our outpatient endoscopy clinic because of dyspepsia and epigastric pain. Upper GI endoscopy with a standard endoscope revealed a 10-cm-diameter gastric phytobezoar with necrotic pressure ulcer of the angulus. We fragmentized the bezoar into smaller pieces, with complete dissolution and without any complication. The patient was then promptly discharged home with a medical therapy. Follow-up endoscopy at 6 months showed the total disappearance of any residual fibers. Different types of bezoars are described in literature, of which phyto- and trychobezoars are the most frequent. They can be absolutely asymptomatic or can arise with epigastric pain, pressure ulcer bleeding, gastrointestinal perforation or small bowel obstruction. The treatment is debated though endoscopic removal or fragmentation with the help of Coca-Cola lavages has showed the best success rate. The main experiences in literature concern hospitalized patients or describe treatment techniques which require overnight stays. An effective and rapid treatment in the outpatient setting is described in our experience, without short- or long-term complications. The endoscopic fragmentation of large gastric bezoars in the outpatient setting is safe with a good clinical course. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Endoscopic transmission of Helicobacter pylori

NARCIS (Netherlands)

Tytgat, G. N.

1995-01-01

The contamination of endoscopes and biopsy forceps with Helicobacter pylori occurs readily after endoscopic examination of H. pylori-positive patients. Unequivocal proof of iatrogenic transmission of the organism has been provided. Estimates for transmission frequency approximate to 4 per 1000

Assessment of test methods for evaluating effectiveness of cleaning flexible endoscopes.

Science.gov (United States)

Washburn, Rebecca E; Pietsch, Jennifer J

2018-06-01

Strict adherence to each step of reprocessing is imperative to removing potentially infectious agents. Multiple methods for verifying proper reprocessing exist; however, each presents challenges and limitations, and best practice within the industry has not been established. Our goal was to evaluate endoscope cleaning verification tests with particular interest in the evaluation of the manual cleaning step. The results of the cleaning verification tests were compared with microbial culturing to see if a positive cleaning verification test would be predictive of microbial growth. This study was conducted at 2 high-volume endoscopy units within a multisite health care system. Each of the 90 endoscopes were tested for adenosine triphosphate, protein, microbial growth via agar plate, and rapid gram-negative culture via assay. The endoscopes were tested in 3 locations: the instrument channel, control knob, and elevator mechanism. This analysis showed substantial level of agreement between protein detection postmanual cleaning and protein detection post-high-level disinfection at the control head for scopes sampled sequentially. This study suggests that if protein is detected postmanual cleaning, there is a significant likelihood that protein will also be detected post-high-level disinfection. It also infers that a cleaning verification test is not predictive of microbial growth. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Rare earths analysis of rock samples by instrumental neutron activation analysis, internal standard method

International Nuclear Information System (INIS)

Silachyov, I.

2016-01-01

The application of instrumental neutron activation analysis for the determination of long-lived rare earth elements (REE) in rock samples is considered in this work. Two different methods are statistically compared: the well established external standard method carried out using standard reference materials, and the internal standard method (ISM), using Fe, determined through X-ray fluorescence analysis, as an element-comparator. The ISM proved to be the more precise method for a wide range of REE contents and can be recommended for routine practice. (author)

Transoral endoscopic esophageal myotomy based on esophageal function testing in a survival porcine model.

Science.gov (United States)

Perretta, Silvana; Dallemagne, Bernard; Donatelli, Gianfranco; Diemunsch, Pierre; Marescaux, Jacques

2011-01-01

The most effective treatment of achalasia is Heller myotomy. To explore a submucosal endoscopic myotomy technique tailored on esophageal physiology testing and to compare it with the open technique. Prospective acute and survival comparative study in pigs (n = 12; 35 kg). University animal research center. Eight acute-4 open and 4 endoscopic-myotomies followed by 4 survival endoscopic procedures. Preoperative and postoperative manometry; esophagogastric junction (EGJ) distensibility before and after selective division of muscular fibers at the EGJ and after the myotomy was prolonged to a standard length by using the EndoFLIP Functional Lumen Imaging Probe (Crospon, Galway, Ireland). All procedures were successful, with no intraoperative and postoperative complications. In the survival group, the animals recovered promptly from surgery. Postoperative manometry demonstrated a 50% drop in mean lower esophageal sphincter pressure (LESp) in the endoscopic group (mean preoperative LESp, 22.2 ± 3.3 mm Hg; mean postoperative LESp, 11.34 ± 2.7 mm Hg; P open procedure group (mean preoperative LESp, 24.2 ± 3.2 mm Hg; mean postoperative LESp, 7.4 ± 4 mm Hg; P myotomy is feasible and safe. The lack of a significant difference in EGJ distensibility between the open and endoscopic procedure is very appealing. Were it to be perfected in a human population, this endoscopic approach could suggest a new strategy in the treatment of selected achalasia patients. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Endoscopic Medial Maxillectomy Breaking New Frontiers

OpenAIRE

Mohanty, Sanjeev; Gopinath, M.

2011-01-01

Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management ...

Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

Science.gov (United States)

Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

2011-01-01

Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

Instrument performance evaluation

International Nuclear Information System (INIS)

Swinth, K.L.

1993-03-01

Deficiencies exist in both the performance and the quality of health physics instruments. Recognizing the implications of such deficiencies for the protection of workers and the public, in the early 1980s the DOE and the NRC encouraged the development of a performance standard and established a program to test a series of instruments against criteria in the standard. The purpose of the testing was to establish the practicality of the criteria in the standard, to determine the performance of a cross section of available instruments, and to establish a testing capability. Over 100 instruments were tested, resulting in a practical standard and an understanding of the deficiencies in available instruments. In parallel with the instrument testing, a value-impact study clearly established the benefits of implementing a formal testing program. An ad hoc committee also met several times to establish recommendations for the voluntary implementation of a testing program based on the studies and the performance standard. For several reasons, a formal program did not materialize. Ongoing tests and studies have supported the development of specific instruments and have helped specific clients understand the performance of their instruments. The purpose of this presentation is to trace the history of instrument testing to date and suggest the benefits of a centralized formal program

Endoscopic approach for a laryngeal neoplasm in a dog

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Pedro Paulo Maia Teixeira

2015-01-01

Full Text Available Laryngeal and tracheal tumors are rare in pets; some piece of information on their disease behavior, therapy and evolution are limited. Neoplasms in this area are a diagnostic challenge. In many cases, they can be biopsied and excised using endoscopic instruments, but there is no report of this in canines. The goal of this study is to report a successful case of a laryngeal neoplasm removal through endoscopy. A head and neck radiogram revealed a mass in the laryngeal lumen protruding into the trachea. The patient then underwent an endoscopy to confirm the radiographic diagnosis and to surgically remove the tumor. The histopathological diagnosis was poorly differentiated carcinoma. The most appropriate treatment for laryngeal tumors is the resection of the submucosa or a partial laryngectomy however, partial and total laryngectomies are associated with many postoperative complications. In contrast, the endoscopic approach allows for highly magnified visualization of the lesion in situ, which facilitates the surgical removal of the mass through videosurgery. With little manipulation of the affected area, the chances of postoperative complications are reduced, leading to a more rapid recovery.

Endoscopic versus transcranial procurement of allograft tympano-ossicular systems: a prospective double-blind randomized controlled audit.

Science.gov (United States)

Caremans, Jeroen; Hamans, Evert; Muylle, Ludo; Van de Heyning, Paul; Van Rompaey, Vincent

2016-06-01

Allograft tympano-ossicular systems (ATOS) have proven their use over many decades in tympanoplasty and reconstruction after resection of cholesteatoma. The transcranial bone plug technique has been used in the past 50 years to procure en bloc ATOS (tympanic membrane with malleus, incus and stapes attached). Recently, our group reported the feasibility of the endoscopic procurement technique. The aim of this study was to assess whether clinical outcome is equivalent in ATOS acquired by using the endoscopic procurement technique compared to ATOS acquired by using the transcranial technique. A double-blind randomized controlled audit was performed in a tertiary referral center in patients that underwent allograft tympanoplasty because of chronic otitis media with and without cholesteatoma. Allograft epithelialisation was evaluated at the short-term postoperative visit by microscopic examination. Failures were reported if reperforation was observed. Fifty patients underwent allograft tympanoplasty: 34 received endoscopically procured ATOS and 16 received transcranially procured ATOS. One failed case was observed, in the endoscopic procurement group. We did not observe a statistically significant difference between the two groups in failure rate. This study demonstrates equivalence of the clinical outcome of allograft tympanoplasty using either endoscopic or transcranial procured ATOS and therefore indicates that the endoscopic technique can be considered the new standard procurement technique. Especially because the endoscopic procurement technique has several advantages compared to the former transcranial procurement technique: it avoids risk of prion transmission and it is faster while lacking any noticeable incision.

Improved retrieval of cloud base heights from ceilometer using a non-standard instrument method

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Wang, Yang; Zhao, Chuanfeng; Dong, Zipeng; Li, Zhanqing; Hu, Shuzhen; Chen, Tianmeng; Tao, Fa; Wang, Yuzhao

2018-04-01

Cloud-base height (CBH) is a basic cloud parameter but has not been measured accurately, especially under polluted conditions due to the interference of aerosol. Taking advantage of a comprehensive field experiment in northern China in which a variety of advanced cloud probing instruments were operated, different methods of detecting CBH are assessed. The Micro-Pulse Lidar (MPL) and the Vaisala ceilometer (CL51) provided two types of backscattered profiles. The latter has been employed widely as a standard means of measuring CBH using the manufacturer's operational algorithm to generate standard CBH products (CL51 MAN) whose quality is rigorously assessed here, in comparison with a research algorithm that we developed named value distribution equalization (VDE) algorithm. It was applied to both the profiles of lidar backscattering data from the two instruments. The VDE algorithm is found to produce more accurate estimates of CBH for both instruments and can cope with heavy aerosol loading conditions well. By contrast, CL51 MAN overestimates CBH by 400 m and misses many low level clouds under such conditions. These findings are important given that CL51 has been adopted operationally by many meteorological stations in China.

Towards automated visual flexible endoscope navigation.

Science.gov (United States)

van der Stap, Nanda; van der Heijden, Ferdinand; Broeders, Ivo A M J

2013-10-01

The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research. A systematic literature search was performed using three general search terms in two medical-technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included. Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date. Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process.

A Vehicular Mobile Standard Instrument for Field Verification of Traffic Speed Meters Based on Dual-Antenna Doppler Radar Sensor.

Science.gov (United States)

Du, Lei; Sun, Qiao; Cai, Changqing; Bai, Jie; Fan, Zhe; Zhang, Yue

2018-04-05

Traffic speed meters are important legal measuring instruments specially used for traffic speed enforcement and must be tested and verified in the field every year using a vehicular mobile standard speed-measuring instrument to ensure speed-measuring performances. The non-contact optical speed sensor and the GPS speed sensor are the two most common types of standard speed-measuring instruments. The non-contact optical speed sensor requires extremely high installation accuracy, and its speed-measuring error is nonlinear and uncorrectable. The speed-measuring accuracy of the GPS speed sensor is rapidly reduced if the amount of received satellites is insufficient enough, which often occurs in urban high-rise regions, tunnels, and mountainous regions. In this paper, a new standard speed-measuring instrument using a dual-antenna Doppler radar sensor is proposed based on a tradeoff between the installation accuracy requirement and the usage region limitation, which has no specified requirements for its mounting distance and no limitation on usage regions and can automatically compensate for the effect of an inclined installation angle on its speed-measuring accuracy. Theoretical model analysis, simulated speed measurement results, and field experimental results compared with a GPS speed sensor with high accuracy showed that the dual-antenna Doppler radar sensor is effective and reliable as a new standard speed-measuring instrument.

Foreign bodies in upper gastrointestinal tract and urgent endoscopic interventions – review of a ten-year period

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Pavel Skok

2005-07-01

Full Text Available Background: Foreign bodies in the upper digestive tube are rarely the cause of an urgent condition in gastroenterology. They usually enter the digestive tube during nutrition or by mistake. However, certain groups of the population such as convicts or psychiatric patients tend to swallow them intentionally. The authors aim was to assess the percentage of patients in which urgent endoscopic investigation revealed true foreign bodies in the upper digestive tube, to evaluate the success of endoscopic procedures and the resolution of eventual complications.Patients and methods: The study includes patients in which urgent endoscopic investigations of the upper digestive tract were performed in a 10-year period (1 January 1994 to 31 December 2003.Results: Altogether 6416 patients were investigated, mean age 59.3 years, SD ± 17.2 years, range 1–106 years, 2452 females and 3964 males. In 51 patients, 0.8% of all subjects, foreign bodies were detected in the esophagus or stomach. In these patients a total of 65 endoscopic investigations were performed, in 94% the foreign bodies were removed endoscopically (48/51 patients, in three cases the endoscopic procedures were not successful. Among the foreign bodies removed were various metal or plastic objects: coins, keys, screws, hooks, batteries, razor blades, needles, parts of kitchen, toilet or writing utensils, lighters, buttons, toys, a toothbrush as well as impacted pieces of bone. In the patients with successful endoscopic removal of the objects, no significant complications were noted. In 3 patients (3/48, 6.3% only mild hemorrhages from the region of the esophagogastric junction were observed.Conclusions: The technological development of endoscopic instruments made it possible to carry out different therapeutic procedures. The method has proved successful in removing foreign bodies from the upper digestive tube. Various factors affect the success of the procedure, the more important being adequate

Evrim Bougie: A new instrument in the management of urethral strictures

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Soylu Ahmet

2001-08-01

Full Text Available Abstract Background In this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments. Methods Three patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation. Conclusion Internal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery.

Effect of endoscopic transpapillary biliary drainage with/without endoscopic sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with biliary stricture (E-BEST): a protocol for a multicentre randomised controlled trial.

Science.gov (United States)

Kato, Shin; Kuwatani, Masaki; Sugiura, Ryo; Sano, Itsuki; Kawakubo, Kazumichi; Ono, Kota; Sakamoto, Naoya

2017-08-11

The effect of endoscopic sphincterotomy prior to endoscopic biliary stenting to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis remains to be fully elucidated. The aim of this study is to prospectively evaluate the non-inferiority of non-endoscopic sphincterotomy prior to stenting for naïve major duodenal papilla compared with endoscopic sphincterotomy prior to stenting in patients with biliary stricture. We designed a multicentre randomised controlled trial, for which we will recruit 370 patients with biliary stricture requiring endoscopic biliary stenting from 26 high-volume institutions in Japan. Patients will be randomly allocated to the endoscopic sphincterotomy group or the non-endoscopic sphincterotomy group. The main outcome measure is the incidence of pancreatitis within 2 days of initial transpapillary biliary drainage. Data will be analysed on completion of the study. We will calculate the 95% confidence intervals (CIs) of the incidence of pancreatitis in each group and analyse weather the difference in both groups with 95% CIs is within the non-inferiority margin (6%) using the Wald method. This study has been approved by the institutional review board of Hokkaido University Hospital (IRB: 016-0181). Results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal. The University Hospital Medical Information Network ID: UMIN000025727 Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

New techniques in gastrointestinal endoscopic surgery

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Rafael Antonio Luengas Tello

2012-09-01

Full Text Available Gastrointestinal endoscopic surgery has been making great progress since the seventies in the management paradigms of conditions such as gastrointestinal bleeding, polyp resection and diagnostic and therapeutic management of the biliary tract. The current challenge is the development of techniques that allow endoscopic treatment of emerging diseases such as cancer, morbid obesity, gastro-esophageal reflux and achalasia. This article reports on new techniques and expectations for the future in the endoscopic management of these diseases.

[Gastro-entero anastomosis with flexible endoscope with the help of rare-earth magnets on biosynthetic model made of the gastrointestinal tract of slaughtered pigs].

Science.gov (United States)

Lukovich, Péter; Jónás, Attila; Bata, Pál; Tari, Krisztina; Váradi, Gábor; Kádár, Balázs; Mehdi, Sadat Akhavi; Kupcsulik, Péter

2007-04-01

Gastro-entero anastomosis with flexible endoscope with the help of rare-earth magnets on biosynthetic model made of the gastrointestinal tract of slaughtered pigs Numerous malignant diseases may cause gastric outlet obstruction. The surgical gastrointestinal bypass, besides the fact that it requires narcosis, is also associated with high risks for patients with poor general condition. Endoscopic insertion of self-expandable metal stent is less invasive, but often causes complications. In the last years some studies examined a new minimal invasive technique, in which magnets are used to create gastroenteric anastomosis. A biosynthetic model was developed from combined synthetic materials with biogenic specimens taken from slaughtered domestic pigs. The procedure was performed with endoscopic and fluoroscopic guidance. To increase X-ray contrast differences the model was put into physiological saline solution. Two rare-earth magnets (Br: 2500 Gauss, D: 10 mm) with central hole were inserted with the help of a guiding wire and duodenal probe. The first magnet was placed in the first jejunal loop; the second one was placed in the stomach. The gastric magnet was maneuvered using the endoscope. When the magnets reached the right position, the guiding wires were removed to let the magnets stick together. The pressure between the magnets will result in a sterile inflammation on the living tissue which develops adhesion between the bowels, and 7-10 days later anastomosis will develop as a result of the necrosis. The biosynthetic model could be used for training endoscopy without sacrificing animals. In the end of the procedure the magnets stuck together across gastric and jejunal walls in all ten cases successfully. By practice the period necessary for the procedure could be decreased from 40 to 20 minutes. The technique could be made with standard upper endoscope and instruments, and after practice on living animals it could potentially be a useful solution for complaints

Integrated biophotonics in endoscopic oncology

Science.gov (United States)

Muguruma, Naoki; DaCosta, Ralph S.; Wilson, Brian C.; Marcon, Norman E.

2009-02-01

Gastrointestinal endoscopy has made great progress during last decade. Diagnostic accuracy can be enhanced by better training, improved dye-contrast techniques method, and the development of new image processing technologies. However, diagnosis using conventional endoscopy with white-light optical imaging is essentially limited by being based on morphological changes and/or visual attribution: hue, saturation and intensity, interpretation of which depends on the endoscopist's eye and brain. In microlesions in the gastrointestinal tract, we still rely ultimately on the histopathological diagnosis from biopsy specimens. Autofluorescence imaging system has been applied for lesions which have been difficult to morphologically recognize or are indistinct with conventional endoscope, and this approach has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract, supplementing the information from white light endoscopy. This system has an advantage that it needs no administration of a photosensitive agent, making it suitable as a screening method for the early detection of neoplastic tissues. Narrow band imaging (NBI) is a novel endoscopic technique which can distinguish neoplastic and non-neoplastic lesions without chromoendoscopy. Magnifying endoscopy in combination with NBI has an obvious advantage, namely analysis of the epithelial pit pattern and the vascular network. This new technique allows a detailed visualization in early neoplastic lesions of esophagus, stomach and colon. However, problems remain; how to combine these technologies in an optimum diagnostic strategy, how to apply them into the algorithm for therapeutic decision-making, and how to standardize several classifications surrounding them. 'Molecular imaging' is a concept representing the most novel imaging methods in medicine, although the definition of the word is still controversial. In the field of gastrointestinal endoscopy, the future of

[Natural Orifice Transluminal Endoscopic Surgery (NOTES)].

Science.gov (United States)

Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai

2008-03-01

Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.

Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

LENUS (Irish Health Repository)

Nugent, Emmeline

2011-03-01

The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

A prospective qualitative study on patients' perceptions of endoscopic endonasal transsphenoidal surgery.

Science.gov (United States)

Edem, Idara J; Banton, Beverly; Bernstein, Mark; Lwu, Shelly; Vescan, Allan; Gentilli, Fred; Zadeh, Gelareh

2013-02-01

Endoscopic transsphenoidal surgery has been shown to be a safe and effective treatment option for patients with pituitary tumours, but no study has explored patients' perceptions before and after this surgery. The authors in this study aim to explore patients' perceptions on endoscopic transsphenoidal surgery. Using qualitative research methodology, two semi-structured interviews were conducted with 30 participants who were adults aged > 18 undergoing endoscopic transsphenoidal surgery for the resection of a pituitary tumour between December 2008 and June 2011. The interviews were audiotaped and transcribed. The resulting data was analyzed using a modified thematic analysis. Seven overarching themes were identified: (1) Patients had a positive surgical experience; (2) patients were satisfied with the results of the procedure; (3) patients were initially surprised that neurosurgery could be performed endonasally; (4) patients expected a cure and to feel better after the surgery; (5) many patients feared that something might go wrong during the surgery; (6) patients were psychologically prepared for the surgery; (7) most patients reported receiving adequate pre-op and post-op information. This is the first qualitative study reporting on patients' perceptions before and after an endoscopic endonasal transsphenoidal pituitary surgery, which is increasingly used as a standard surgical approach for patients with pituitary tumours. Patients report a positive perception and general satisfaction with the endoscopic transsphenoidal surgical experience. However, there is still room for improvement in post-surgical care. Overall, patients' perceptions can help improve the delivery of comprehensive care to future patients undergoing pituitary tumour surgery.

Methodological proposal for validation of the disinfecting efficacy of an automated flexible endoscope reprocessor

OpenAIRE

Graziano, Kazuko Uchikawa; Pereira, Marta Elisa Auler; Koda, Elaine

2016-01-01

ABSTRACT Objective: to elaborate and apply a method to assess the efficacy of automated flexible endoscope reprocessors at a time when there is not an official method or trained laboratories to comply with the requirements described in specific standards for this type of health product in Brazil. Method: the present methodological study was developed based on the following theoretical references: International Organization for Standardization (ISO) standard ISO 15883-4/2008 and Brazilian ...

Endoscopic removal of malfunctioning biliary self-expandable metallic stents.

Science.gov (United States)

Familiari, Pietro; Bulajic, Milutin; Mutignani, Massimiliano; Lee, Linda S; Spera, Gianluca; Spada, Cristiano; Tringali, Andrea; Costamagna, Guido

2005-12-01

Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. All patients who underwent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMS removal were the following: distal migration of the stent or impaction to the duodenum, impaction into the bile-duct wall, tissue ingrowth, and inappropriate length of the stent causing occlusion of intrahepatic ducts. SEMS were removed by using foreign-body forceps or polypectomy snares. Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard deviation) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and in 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than uncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were not predictive of success at stent removal. Endoscopic removal of biliary SEMS is feasible and safe in more than 70% of cases. Because only 38% of uncovered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe ingrowth was the main feature limiting SEMS removal.

Gastroesophageal reflux disease. Scintigraphic, endoscopic and histologic considerations

Energy Technology Data Exchange (ETDEWEB)

Kault, B.; Halvorsen, T.; Petersen, H.; Grette, K.; Myrvold, H.E.

1986-01-01

Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% of the patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes, and in 43.7% of the patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis. 15 of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation. 31 refs.

A Framework for Establishing Standard Reference Scale of Texture by Multivariate Statistical Analysis Based on Instrumental Measurement and Sensory Evaluation.

Science.gov (United States)

Zhi, Ruicong; Zhao, Lei; Xie, Nan; Wang, Houyin; Shi, Bolin; Shi, Jingye

2016-01-13

A framework of establishing standard reference scale (texture) is proposed by multivariate statistical analysis according to instrumental measurement and sensory evaluation. Multivariate statistical analysis is conducted to rapidly select typical reference samples with characteristics of universality, representativeness, stability, substitutability, and traceability. The reasonableness of the framework method is verified by establishing standard reference scale of texture attribute (hardness) with Chinese well-known food. More than 100 food products in 16 categories were tested using instrumental measurement (TPA test), and the result was analyzed with clustering analysis, principal component analysis, relative standard deviation, and analysis of variance. As a result, nine kinds of foods were determined to construct the hardness standard reference scale. The results indicate that the regression coefficient between the estimated sensory value and the instrumentally measured value is significant (R(2) = 0.9765), which fits well with Stevens's theory. The research provides reliable a theoretical basis and practical guide for quantitative standard reference scale establishment on food texture characteristics.

Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection.

Science.gov (United States)

Machida, H; Tominaga, K; Minamino, H; Sugimori, S; Okazaki, H; Yamagami, H; Tanigawa, T; Watanabe, K; Watanabe, T; Fujiwara, Y; Arakawa, T

2012-06-01

This prospective study aimed to evaluate the feasibility and safety of locoregional mitomycin C (MMC) injection to treat refractory esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Patients with dysphagia and strictures that were refractory to repeated endoscopic balloon dilation (EBD) were eligible. After EBD, MMC was injected into the dilated site. Between June 2009 and August 2010, five patients were recruited. The treatment was performed once in two patients and twice in three patients with recurrent dysphagia or restenosis. In all patients, passing a standard endoscope through the site was easy and the dysphagia grade improved (grade 3→1 in 3 patients, grade 4→2 in 2 patients). No serious complications were noted. During the observation period of 4.8 months, neither recurrent dysphagia nor re-stricture appeared in any of the patients. The combination of locoregional MMC injections and EBD is feasible and safe for the treatment of esophageal strictures after ESD.Recently, endoscopic submucosal dissection (ESD) has been developed and accepted as a new endoscopic treatment for gastrointestinal tumors. ESD is a promising treatment for superficial esophageal carcinoma (SEC), and it has a reliable en bloc resection rate. However, the application of ESD for widespread lesions is challenging because of the high risk of the development of severe strictures, which lead to a low quality of life after ESD. Although endoscopic balloon dilation (EBD) is effective for benign strictures, it needs to be performed frequently until the dysphagia disappears 1. Mitomycin C (MMC), which is a chemotherapeutic agent derived from some Streptomyces species 2, reduces scar formation when topically applied to a surgical lesion. MMC has been applied to treat strictures in a variety of anatomical locations, including a variety of organs 3. The aim of this study was to prospectively evaluate both the feasibility and the safety of

Conventional Versus Rosemont Endoscopic Ultrasound Criteria for Chronic Pancreatitis: Comparing Interobserver Reliability and Intertest Agreement

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Bruce Kalmin

2011-01-01

Full Text Available BACKGROUND: The Rosemont criteria (RC were recently proposed by expert consensus to standardize endoscopic ultrasound (EUS features and thresholds for diagnosing chronic pancreatitis (CP; however, they are cumbersome and are not validated.

[PACS-based endoscope image acquisition workstation].

Science.gov (United States)

Liu, J B; Zhuang, T G

2001-01-01

A practical PACS-based Endoscope Image Acquisition Workstation is here introduced. By a Multimedia Video Card, the endoscope video is digitized and captured dynamically or statically into computer. This workstation realizes a variety of functions such as the endoscope video's acquisition and display, as well as the editing, processing, managing, storage, printing, communication of related information. Together with other medical image workstation, it can make up the image sources of PACS for hospitals. In addition, it can also act as an independent endoscopy diagnostic system.

Endoscopic treatment of vesicoureteral reflux in pediatric patients

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Jong Wook Kim

2013-04-01

Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea

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Yu Kyung Cho

2016-11-01

Full Text Available Background/Aims In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions. Methods We surveyed the staff of institutional endoscopic units via e-mail. Results Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93% or improved endoscopic practice (40%. The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%, used more disinfectants (34%, washed endoscopes longer (28%, reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%, and created their own quality education programs (59%. Many responders said they felt that QA was associated with some degree of burden (48%, especially financial burden caused by purchasing new equipment. Reasonable quality standards (45% and incentives (38% were considered important to the success of the QA program. Conclusions Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis.

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Jiang, Li; Ning, Deng; Cheng, Qi; Chen, Xiao-Ping

2018-04-21

Endoscopic therapy and surgery are both conventional treatments to remove pancreatic duct stones that developed during the natural course of chronic pancreatitis. However, few studies comparing the effect and safety between surgery drainage and endoscopic drainage (plus Extracorporeal Shock Wave Lithotripsy, ESWL).The aim of this study was to compare the benefits between endoscopic and surgical drainage of the pancreatic duct for patients with calcified chronic pancreatitis. A total of 86 patients were classified into endoscopic/ESWL (n = 40) or surgical (n = 46) treatment groups. The medical records of these patients were retrospectively analyzed. Pain recurrence and hospital stays were similar between the endoscopic/ESWL treatment and surgery group. However, endoscopic/ESWL treatment yielded significantly lower medical expense and less complications compared with the surgical treatment. In selective patients, endoscopic/ESWL treatment could achieve comparable efficacy to the surgical treatment. With lower medical expense and less complications, endoscopic/ESWL treatment would be much preferred to be the initial treatment of choice for patients with calcified chronic pancreatitis. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Asymptomatic Esophageal Varices Should Be Endoscopically Treated

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Nib Soehendra

1998-01-01

Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

Endoscopic Management of an Intramural Sinus Leak After Per- Oral Endoscopic Myotomy

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Al Taii, Haider; Confer, Bradley; Gabbard, Scott; Kroh, Matthew; Jang, Sunguk; Rodriguez, John; Parsi, Mansour A.; Vargo, John J.; Ponsky, Jeffrey

2016-01-01

Per-oral endoscopic myotomy (POEM) was developed less than a decade ago for the treatment of achalasia. Its minimally invasive approach and the favorable short-term outcome have led to rapid adoption of the technique throughout the world. As with any new technique, there will be adverse events, and it is important that effective treatments for these adverse events be discussed. We present a case of successful endoscopic management of an intramural sinus leak after a POEM procedure using tandem fully covered esophageal stents. PMID:27921057

Investigating the application of diving endoscopic technique in determining the extent of pituitary adenoma resection via the trans-nasal-sphenoidal approach.

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Gao, Hai-Bin; Wang, Li-Qing; Zhou, Jian-Yun; Sun, Wei

2018-04-01

The aim of the present study was to investigate the advantages and disadvantages of the diving endoscopic technique in pituitary adenoma surgery, and the application value in determining the extent of tumor resection. A total of 37 patients with pituitary adenoma initially underwent tumor resection under an endoscope-assisted microscope via standard trans-nasal-sphenoidal approach, and tumor cavity structure was observed by applying the diving endoscopic technique. Surgery was subsequently performed again under a microscope or endoscope. The diving endoscopic technique allowed surgeons to directly observe the structure inside a tumor cavity in high-definition. In the present study, 24 patients had pituitary macroadenomas or microadenomas that did not invade the cavernous sinus, and were considered to have undergone successful total resection. Among these patients, no tumor residues were observed through the diving endoscopic technique. Some white lichenoid or fibrous cord-like tissues in the tumor cavity were considered to be remnants of tumors. However, pathology confirmed that these were not tumor tissues. For tumors that invaded the cavernous sinus in 13 patients, observation could only be conducted under the angulation endoscope of the diving endoscope; i.e., the operation could not be conducted under an endoscope. The present study suggests that the diving endoscopic technique may be used to directly observe the resection extent of tumors within the tumor cavity, especially the structure of the tumor cavity inside the sella turcica. The present study also directly validates the reliability of pituitary adenoma resection under endoscope-assisted microscope. In addition, the diving endoscopic technique also allows the surgeon to observe the underwater environment within the sella turcica.

Endoscopic versus open bursectomy of lateral malleolar bursitis.

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Choi, Jae Hyuck; Lee, Kyung Tai; Lee, Young Koo; Kim, Dong Hyun; Kim, Jeong Ryoul; Chung, Woo Chull; Cha, Seung Do

2012-06-01

Compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis. Prospective evaluation of 21 patients (22 ankles) undergoing either open or endoscopic excision of lateral malleolar bursitis. The median age was 64 (38-79) years old. The median postoperative follow-up was 15 (12-18) months. Those patients undergoing endoscopic excision showed a higher satisfaction rate (excellent 9, good 2) than open excision (excellent 4, good 3, fair 1). The wounds also healed earlier in the endoscopic group although the operation time was slightly longer. One patient in the endoscopic group had recurrence of symptoms but complications in the open group included one patient with skin necrosis, one patient with wound dehiscence, and two patients of with superficial peroneal nerve injury. Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favorable results compared to the open resection. Therapeutic studies-Investigating the result of treatment, Level II.

Technical consideration of transforaminal endoscopic spine surgery for central herniation

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Girish P Datar

2017-01-01

Full Text Available Introduction: Lumbar disc prolapse is most common between 30 and 50 years of age and is associated with severe disability and pain. It commonly occurs at L4/5 and L5/S1. Transforaminal endoscopic discectomy is an emerging technique for treatment of degenerative disc disease. Literature has shown clinical outcomes, comparable to classical open and micro lumbar discectomy. Central disc herniations in lumbar spine pose technical challenge for transforaminal endoscopic decompression due to its location. Existing techniques to access central herniations and ventral epidural space have trajectory related challenges due to the proximity of the retroperitoneal space and abdominal organs and technically difficult for the less experienced surgeon. Materials and Methods: Thirty patients – 19 males and 11 females – with central, multifocal, central-paracentral disc herniations in the lumbar spine operated in 2015 and 2016 were considered in this study. All patients underwent selective endoscopic discectomy under monitored care anesthesia and local anesthesia with modification of the classical technique, medialization of annulotomy, undercutting the nonarticular part of superior articular process (foraminotomy and use of articulating and long jaw instruments either alone or in combination. Results: In all the thirty patients, we were able to achieve adequate decompression with neurological recovery. All patients improved in their neurological status. Postoperatively, visual analog scale dropped from 7.8 to 1.8 and ODI dropped from 73.46% to 32. 90% of the patients reported excellent and good results. One patient had recurrent herniation and was treated with transforaminal surgery. One patient had persistent back pain and reported poor outcome. Three patients underwent medial branch block for facet joint pain followed by medial branch rhizotomy and reported excellent and good results. Conclusion: Transforaminal endoscopic spine surgery with modifications

Conjugation of fiber-coupled wide-band light sources and acousto-optical spectral elements

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Machikhin, Alexander; Batshev, Vladislav; Polschikova, Olga; Khokhlov, Demid; Pozhar, Vitold; Gorevoy, Alexey

2017-12-01

Endoscopic instrumentation is widely used for diagnostics and surgery. The imaging systems, which provide the hyperspectral information of the tissues accessible by endoscopes, are particularly interesting and promising for in vivo photoluminescence diagnostics and therapy of tumour and inflammatory diseases. To add the spectral imaging feature to standard video endoscopes, we propose to implement acousto-optical (AO) filtration of wide-band illumination of incandescent-lamp-based light sources. To collect maximum light and direct it to the fiber-optic light guide inside the endoscopic probe, we have developed and tested the optical system for coupling the light source, the acousto-optical tunable filter (AOTF) and the light guide. The system is compact and compatible with the standard endoscopic components.

SU-C-18A-02: Image-Based Camera Tracking: Towards Registration of Endoscopic Video to CT

International Nuclear Information System (INIS)

Ingram, S; Rao, A; Wendt, R; Castillo, R; Court, L; Yang, J; Beadle, B

2014-01-01

Purpose: Endoscopic examinations are routinely performed on head and neck and esophageal cancer patients. However, these images are underutilized for radiation therapy because there is currently no way to register them to a CT of the patient. The purpose of this work is to develop a method to track the motion of an endoscope within a structure using images from standard clinical equipment. This method will be incorporated into a broader endoscopy/CT registration framework. Methods: We developed a software algorithm to track the motion of an endoscope within an arbitrary structure. We computed frame-to-frame rotation and translation of the camera by tracking surface points across the video sequence and utilizing two-camera epipolar geometry. The resulting 3D camera path was used to recover the surrounding structure via triangulation methods. We tested this algorithm on a rigid cylindrical phantom with a pattern spray-painted on the inside. We did not constrain the motion of the endoscope while recording, and we did not constrain our measurements using the known structure of the phantom. Results: Our software algorithm can successfully track the general motion of the endoscope as it moves through the phantom. However, our preliminary data do not show a high degree of accuracy in the triangulation of 3D point locations. More rigorous data will be presented at the annual meeting. Conclusion: Image-based camera tracking is a promising method for endoscopy/CT image registration, and it requires only standard clinical equipment. It is one of two major components needed to achieve endoscopy/CT registration, the second of which is tying the camera path to absolute patient geometry. In addition to this second component, future work will focus on validating our camera tracking algorithm in the presence of clinical imaging features such as patient motion, erratic camera motion, and dynamic scene illumination

Determination of gold and silver in geological standard samples MGI by instrument neutron activation analysis

International Nuclear Information System (INIS)

Lu Huijiuan; Zhou; Yunlu

1987-01-01

Gold and silver in geological standard samples MGI were determined by instrument neutron activation analysis. The various interferences of nuclides were considered. Corrected factors of the geometry in different positions have been determined. Using the geological standard sample MGM and radiochemical separation neutron activation method as reference, the reliability of this method is proved. Gold content in samples is 0.4-0.009 g/t, silver content is 9-0.3 g/t. Standard deviation is less than 3.5%, the precision of the measurement is 4.8-11.6%

Emphysema. Imaging for endoscopic lung volume reduction

International Nuclear Information System (INIS)

Storbeck, B.; Oldigs, M.; Rabe, K.F.; Weber, C.; University Medical Center Hamburg-Eppendorf

2015-01-01

Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type (''bronchitis'') on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thin-section reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

Contrast-enhanced endoscopic ultrasonography

DEFF Research Database (Denmark)

Reddy, Nischita K; Ioncica, Ana Maria; Saftoiu, Adrian

2011-01-01

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast...... agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder...

Is endoscopic nodular gastritis associated with premalignant lesions?

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Niknam, R; Manafi, A; Maghbool, M; Kouhpayeh, A; Mahmoudi, L

2015-06-01

Nodularity on the gastric mucosa is occasionally seen in general practice. There is no consensus about the association of nodular gastritis and histological premalignant lesions. This study is designed to investigate the prevalence of histological premalignant lesions in dyspeptic patients with endoscopic nodular gastritis. Consecutive patients with endoscopic nodular gastritis were compared with an age- and sex-matched control group. Endoscopic nodular gastritis was defined as a miliary nodular appearance of the gastric mucosa on endoscopy. Biopsy samples of stomach tissue were examined for the presence of atrophic gastritis, intestinal metaplasia, and dysplasia. The presence of Helicobacter pylori infection was determined by histology. From 5366 evaluated patients, a total of 273 patients with endoscopic nodular gastritis and 1103 participants as control group were enrolled. H. pylori infection was detected in 87.5% of the patients with endoscopic nodular gastritis, whereas 73.8% of the control group were positive for H. pylori (p gastritis were significantly higher than in the control group. Prevalence of atrophic gastritis and complete intestinal metaplasia were also more frequent in patients with endoscopic nodular gastritis than in the control group. Dysplasia, incomplete intestinal metaplasia and H. pylori infection are significantly more frequent in patients with endoscopic nodular gastritis. Although further studies are needed before a clear conclusion can be reached, we suggest that endoscopic nodular gastritis might serve as a premalignant lesion and could be biopsied in all patients for the possibility of histological premalignancy, in addition to H. pylori infection.

Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open.

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Yao, Christopher M; Kahane, Alyssa; Monteiro, Eric; Gentili, Fred; Zadeh, Gelareh; de Almeida, John R

2017-08-01

Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results  There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p  < 0.001) and watchful waiting (0.88 vs.0.74; p  = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p  = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting ( p  = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores ( p  = 0.017). Conclusion  The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients With Severe Nonvariceal Upper Gastrointestinal Hemorrhage.

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Jensen, Dennis M; Kovacs, Thomas O G; Ohning, Gordon V; Ghassemi, Kevin; Machicado, Gustavo A; Dulai, Gareth S; Sedarat, Alireza; Jutabha, Rome; Gornbein, Jeffrey

2017-05-01

For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F). Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Endoscopic skull base training using 3D printed models with pre-existing pathology.

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Narayanan, Vairavan; Narayanan, Prepageran; Rajagopalan, Raman; Karuppiah, Ravindran; Rahman, Zainal Ariff Abdul; Wormald, Peter-John; Van Hasselt, Charles Andrew; Waran, Vicknes

2015-03-01

Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

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Ricardo Landini Lutaif Dolci

Full Text Available Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity and the subarachnoid space (sterile area, reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy, internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension, three had meningiomas (two tuberculum sellae and one olfactory groove, two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%, meningitis (three patients; 7.3%, nasal fossa synechia (eight patients; 19.5%, internal nasal valve failure (six patients; 14.6%, and complaints of worsening of the sense of smell (16 patients; 39%. The olfactory test showed anosmia or hyposmia in ten patients (24.3%. No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted

[Study on the situation regarding endoscope cleaning and disinfection in the department of otolaryngology in Hunan hospitals].

Science.gov (United States)

Wang, Fang; Li, Wei; Li, Rong; Tan, Guolin; Luo, Dan

2016-05-01

To investigate the situation regarding the cleaning and sterilization of endonasal endoscopes in department of otolaryngology in Hunan Province, and to provide strategy for improving the level of sterilization and management of endonasal endoscopes.
 A total of 100 medical institutions were investigated by spot assessment, check and sampling. Data was analyzed by multivariate analysis.
 The qualified rate of rules and regulations for endoscopy was 28.8% in the second-class hospitals and 45% in the top-class hospitals. The qualified rate of environment for endoscopy cleaning and sterilization was 36.3% in the second-class hospitals and 85% in the top-class hospitals. The main problems include lack of independent disinfection room, the space not large enough, and/or lack of ventilation system. The qualified rate of bacterial detection for post-sterilized endoscopes and biopsy forceps was 93.8% in the second-class hospitals and 95.0% in the top-class hospitals, and the main pathogenic bacteria was gram-positive cocci and gram-negative bacilli. The multivariate analysis showed that the influencial factors for endoscope cleaning and disinfection are as follows: staffs responsible for the cleaning and sterilization of otolaryngology endoscopes, the standard for cleaning and disinfection process, and the frequency of endoscope use.
 The present situation of cleaning and sterilization for otolaryngology endoscopes is better in the top-class hospitals than that in the second-class hospitals. The sterilization and management of otolaryngology endoscopy are needed to be improved, and the staff training is needed, especially in the primary hospitals.

Usefulness of combined percutaneous-endoscopic rendezvous techniques after failed therapeutic endoscopic retrograde cholangiography in the era of endoscopic ultrasound guided rendezvous.

Science.gov (United States)

Yang, Min Jae; Kim, Jin Hong; Hwang, Jae Chul; Yoo, Byung Moo; Kim, Soon Sun; Lim, Sun Gyo; Won, Je Hwan

2017-12-01

The rendezvous approach is a salvage technique after failure of endoscopic retrograde cholangiography (ERC). In certain circumstances, percutaneous-endoscopic rendezvous (PE-RV) is preferred, and endoscopic ultrasound-guided rendezvous (EUS-RV) is difficult to perform. We aimed to evaluate PE-RV outcomes, describe the PE-RV techniques, and identify potential indications for PE-RV over EUS-RV.Retrospective analysis was conducted of a prospectively designed ERC database between January 2005 and December 2016 at a tertiary referral center including cases where PE-RV was used as a salvage procedure after ERC failure.During the study period, PE-RV was performed in 42 cases after failed therapeutic ERC; 15 had a surgically altered enteric anatomy. The technical success rate of PE-RV was 92.9% (39/42), with a therapeutic success rate of 88.1% (37/42). Potential indications for PE-RV over EUS-RV were identified in 23 cases, and either PE-RV or EUS-RV could have effectively been used in 19 cases. Endoscopic bile duct access was successfully achieved with PE-RV in 39 cases with accessible biliary orifice using one of PE-RV cannulation techniques (classic, n = 11; parallel, n = 19; and adjunctive maneuvers, n = 9).PE-RV uses a unique technology and has clinical indications that distinguish it from EUS-RV. Therefore, PE-RV can still be considered a useful salvage technique for the treatment of biliary obstruction after ERC failure.

Standardization of 8-color flow cytometry across different flow cytometer instruments: A feasibility study in clinical laboratories in Switzerland.

Science.gov (United States)

Glier, Hana; Heijnen, Ingmar; Hauwel, Mathieu; Dirks, Jan; Quarroz, Stéphane; Lehmann, Thomas; Rovo, Alicia; Arn, Kornelius; Matthes, Thomas; Hogan, Cassandra; Keller, Peter; Dudkiewicz, Ewa; Stüssi, Georg; Fernandez, Paula

2017-07-29

The EuroFlow Consortium developed a fully standardized flow cytometric approach from instrument settings, through antibody panel, reagents and sample preparation protocols, to data acquisition and analysis. The Swiss Cytometry Society (SCS) promoted a study to evaluate the feasibility of using such standardized measurements of 8-color data across two different flow cytometry platforms - Becton Dickinson (BD) FACSCanto II and Beckman Coulter (BC) Navios, aiming at increasing reproducibility and inter-laboratory comparability of immunophenotypic data in clinical laboratories in Switzerland. The study was performed in two phases, i.e. a learning phase (round 1) and an analytical phase (rounds 2 and 3) consisting of a total of three rounds. Overall, 10 laboratories using BD FACSCanto II (n=6) or BC Navios (n=4) flow cytometers participated. Each laboratory measured peripheral blood samples from healthy donors stained with a uniform antibody panel of reagents - EuroFlow Lymphoid Screening Tube (LST) - applying the EuroFlow standardized protocols for instrument setup and sample preparation (www.EuroFlow.org). All data files were analyzed centrally and median fluorescence intensity (MedFI) values for individual markers on defined lymphocyte subsets were recorded; variability from reference MedFI values was assessed using performance scores. Data troubleshooting and discussion of the results with the participants followed after each round at SCS meetings. The results of the learning phase demonstrated that standardized instrument setup and data acquisition are feasible in routine clinical laboratories without previous experience with EuroFlow. During the analytical phase, highly comparable data were obtained at the different laboratories using either BD FACSCanto II or BC Navios. The coefficient of variation of MedFI for 7 of 11 markers performed repeatedly below 30%. In the last study round, 89% of participants scored over 90% MedFI values within the acceptance criteria

Balancing the shortcomings of microscope and endoscope: endoscope-assisted technique in microsurgical removal of recurrent epidermoid cysts in the posterior fossa.

Science.gov (United States)

Ebner, F H; Roser, F; Thaher, F; Schittenhelm, J; Tatagiba, M

2010-10-01

We report about endoscope-assisted surgery of epidermoid cysts in the posterior fossa focusing on the application of neuro-endoscopy and the clinical outcome in cases of recurrent epidermoid cysts. 25 consecutively operated patients with an epidermoid cyst in the posterior fossa were retrospectively analysed. Surgeries were performed both with an operating microscope (OPMI Pentero or NC 4, Zeiss Company, Oberkochen, Germany) and endoscopic equipment (4 mm rigid endoscopes with 30° and 70° optics; Karl Storz Company, Tuttlingen, Germany) under continuous intraoperative monitoring. Surgical reports and DVD-recordings were evaluated for identification of adhesion areas and surgical details. 7 (28%) of the 25 patients were recurrences of previously operated epidermoid cysts. Mean time to recurrence was 17 years (8-22 years). In 5 cases the endoscope was used as an adjunctive tool for inspection/endoscope-assisted removal of remnants. The effective time of use of the endoscope was limited to the end stage of the procedure, but was very effective. In a modern operative setting and with the necessary surgical experience recurrent epidermoid cysts may be removed with excellent clinical results. The combined use of microscope and endoscope offers relevant advantages in demanding anatomic situations. © Georg Thieme Verlag KG Stuttgart · New York.

Taking NOTES: translumenal flexible endoscopy and endoscopic surgery.

Science.gov (United States)

Willingham, Field F; Brugge, William R

2007-09-01

To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research. Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials. While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.

Pragmatics of policy: the compliance of dutch environmental policy instruments to European union standards.

Science.gov (United States)

Kruitwagen, Sonja; Reudink, Melchert; Faber, Albert

2009-04-01

Despite a general decrease in Dutch environmental emission trends, it remains difficult to comply with European Union (EU) environmental policy targets. Furthermore, environmental issues have become increasingly complex and entangled with society. Therefore, Dutch environmental policy follows a pragmatic line by adopting a flexible approach for compliance, rather than aiming at further reduction at the source of emission. This may be politically useful in order to adequately reach EU targets, but restoration of environmental conditions may be delayed. However, due to the complexity of today's environmental issues, the restoration of environmental conditions might not be the only standard for a proper policy approach. Consequently this raises the question how the Dutch pragmatic approach to compliance qualifies in a broader policy assessment. In order to answer this question, we adapt a policy assessment framework, developed by Hemerijck and Hazeu (Bestuurskunde 13(2), 2004), based on the dimensions of legitimacy and policy logic. We apply this framework for three environmental policy assessments: flexible instruments in climate policy, fine-tuning of national and local measures to meet air quality standards, and derogation for the Nitrate Directive. We conclude with general assessment notes on the appliance of flexible instruments in environmental policy, showing that a broad and comprehensive perspective can help to understand the arguments to put such policy instruments into place and to identify trade-offs between assessment criteria.

Endoscopic approach to the infratemporal fossa

Directory of Open Access Journals (Sweden)

Ahmed Youssef

2014-06-01

Conclusions: Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa.

Assessing validity of a depression screening instrument in the absence of a gold standard.

Science.gov (United States)

Gelaye, Bizu; Tadesse, Mahlet G; Williams, Michelle A; Fann, Jesse R; Vander Stoep, Ann; Andrew Zhou, Xiao-Hua

2014-07-01

We evaluated the extent to which use of a hypothesized imperfect gold standard, the Composite International Diagnostic Interview (CIDI), biases the estimates of diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9). We also evaluate how statistical correction can be used to address this bias. The study was conducted among 926 adults where structured interviews were conducted to collect information about participants' current major depressive disorder using PHQ-9 and CIDI instruments. First, we evaluated the relative psychometric properties of PHQ-9 using CIDI as a gold standard. Next, we used a Bayesian latent class model to correct for the bias. In comparison with CIDI, the relative sensitivity and specificity of the PHQ-9 for detecting major depressive disorder at a cut point of 10 or more were 53.1% (95% confidence interval: 45.4%-60.8%) and 77.5% (95% confidence interval, 74.5%-80.5%), respectively. Using a Bayesian latent class model to correct for the bias arising from the use of an imperfect gold standard increased the sensitivity and specificity of PHQ-9 to 79.8% (95% Bayesian credible interval, 64.9%-90.8%) and 79.1% (95% Bayesian credible interval, 74.7%-83.7%), respectively. Our results provided evidence that assessing diagnostic validity of mental health screening instrument, where application of a gold standard might not be available, can be accomplished by using appropriate statistical methods. Copyright © 2014 Elsevier Inc. All rights reserved.

Significance of endoscopic screening and endoscopic resection for esophageal cancer in patients with hypopharyngeal cancer

International Nuclear Information System (INIS)

Morimoto, Masahiro; Nishiyama, Kinji; Nakamura, Satoaki

2010-01-01

The efficacy of endoscopic screening for esophageal cancer in patients with hypopharyngeal cancer remains controversial and its impact on prognosis has not been adequately discussed. We studied the use of endoscopic screening to detect esophageal cancer in hypopharyngeal cancer patients by analyzing the incidence, stage and prognosis. We included 64 patients with hypopharyngeal cancer who received radical radiotherapy at our institute. Chromoendoscopic esophageal examinations with Lugol dye solution were routinely performed at and after treatment for hypopharyngeal cancer. Twenty-eight esophageal cancers were detected in 28 (41%) patients (18 synchronous and 10 metachronous cancers). Of the 28 cancers, 23 were stage 0 or I cancer and 15 of these were treated with endoscopic resection. Local control was achieved in all of these 23 stage 0 or I cancers. The 5-year overall survival rates with esophageal cancer were 83% in stage 0, 47% in stage I and 0% in stage IIA-IVB. This study showed a strikingly high incidence of esophageal cancer in hypopharyngeal cancer patients. We suppose that the combination of early detection by chromoendoscopic examination and endoscopic resection for associated esophageal cancer in hypopharyngeal cancer patients improve prognosis and maintain quality of life. (author)

Jones' instrument technology

CERN Document Server

Jones, Ernest Beachcroft; Kingham, Edward G; Radnai, Rudolf

1985-01-01

Jones' Instrument Technology, Volume 5: Automatic Instruments and Measuring Systems deals with general trends in automatic instruments and measuring systems. Specific examples are provided to illustrate the principles of such devices. A brief review of a considerable number of standards is undertaken, with emphasis on the IEC625 Interface System. Other relevant standards are reviewed, including the interface and backplane bus standards. This volume is comprised of seven chapters and begins with a short introduction to the principles of automatic measurements, classification of measuring system

Endoscopic Management of Epistaxis in Lumbini Medical College

Directory of Open Access Journals (Sweden)

Anup Acharya

2015-12-01

Full Text Available Introduction: Epistaxis is one of the commonest Ear Nose Throat (ENT emergency. Proper guidelines for its management are lacking; on the other hand, the management is mostly done by the junior health service providers which has invited non-standardized practice of epistaxis management. Thereby this study was much inclined towards assessment of the effectiveness of endoscopic management of epistaxis.   Methods: This prospective study included patients above 16 years who were diagnosed with idiopathic epistaxis visiting Out Patient of ENT Department or in the Emergency Department of Lumbini Medical College from 1st of July 2014 to 30th of June 2015. ENT examination was done to find the cause and site of bleeding. Thereafter different epistaxis management interventions were done depending on the bleeding condition. The data were collected, entered and then analyzed using SPSS version 21. The descriptive statistics were applied.   Results: Of the total 116 patients, 53 (45.69% were male and 63 (54.31% were female showing no gender preponderance with epistaxis in our study. Majority (49% of the patients were managed with cauterization with silver nitrate or electrocautery in out-patient clinic. Second most common (18% procedure was endoscopic sphenopalatine artery cauterization. Nasal packing was done only in three cases with zero posterior pack.   Conclusion: Endoscopic intervention of epistaxis seems to be safe, simple, fast, and effective for the management of epistaxis with low rates of morbidity and complications. Thereby it can be preferred over the conservative nasal packing and considered as immediate second-line management.

Endoscopic inspection of steam turbines

International Nuclear Information System (INIS)

Maliniemi, H.; Muukka, E.

1990-01-01

For over ten years, Imatran Voima Oy (IVO) has developed, complementary inspection methods for steam turbine condition monitoring, which can be applied both during operation and shutdown. One important method used periodically during outages is endoscopic inspection. The inspection is based on the method where the internal parts of the turbine is inspected through access borings with endoscope and where the magnified figures of the internal parts is seen on video screen. To improve inspection assurance, an image-processing based pattern recognition method for cracks has been developed for the endoscopic inspection of turbine blades. It is based on the deduction conditions derived from the crack shape. The computer gives an alarm of a crack detection and prints a simulated image of the crack, which is then checked manually

Endoscopic Palliation for Pancreatic Cancer

Directory of Open Access Journals (Sweden)

Mihir Bakhru

2011-04-01

Full Text Available Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.

Cost-effectiveness of endoscopic ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients suspected of pancreaticobiliary disease

DEFF Research Database (Denmark)

Ainsworth, A P; Rafaelsen, S R; Wamberg, P A

2004-01-01

BACKGROUND: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163...

Instrumentation for Nuclear Applications

International Nuclear Information System (INIS)

1998-01-01

The objective of this project was to develop and coordinate nuclear instrumentation standards with resulting economies for the nuclear and radiation fields. There was particular emphasis on coordination and management of the Nuclear Instrument Module (NIM) System, U.S. activity involving the CAMAC international standard dataway system, the FASTBUS modular high-speed data acquisition and control system and processing and management of national nuclear instrumentation and detector standards, as well as a modest amount of assistance and consultation services to the Pollutant Characterization and Safety Research Division of the Office of Health and Environmental Research. The principal accomplishments were the development and maintenance of the NIM instrumentation system that is the predominant instrumentation system in the nuclear and radiation fields worldwide, the CAMAC digital interface system in coordination with the ESONE Committee of European Laboratories, the FASTBUS high-speed system and numerous national and international nuclear instrumentation standards

Endoscopic Submucosal Dissection. A more effective procedure compared to mucosectomy for the treatment of Early Gastric Cancer

International Nuclear Information System (INIS)

Emura, Fabian; Oda, Ichiro; Hiroyuki, Ono

2007-01-01

The new development in endoscopic techniques like endoscopic submucosal dissection (ESD) has revolutionized the minimally invasive treatment of gastric cancer. Different to conventional surgery, now it is possible treat large and ulcerative lesion with ESD and with low morbimortality. ESD constitutes a new development that allows direct visualization and cutting of the submucosal layer using el IT-Knife. Although mucosectomy is minimally invasive and safe, it is limited for the treatment of lesions ≥ 15 mm. Evidence suggests that if larger lesions are treated by this technique the resection will probably be a piecemeal resection due to limitations of standard mucosectomy. The largest series has reported 1033 ESD using the IT-knife in 945 patients. The en-block resection rate was 98% (1008/1033) and the rate en-block resection and negative margins was 93% (957/1033). In spite of these promising results, the complications rate is higher than that of standard mucosectomy since ESD needs high levels of endoscopic skills and experience. In addition evaluation of long term results is still ongoing. A detailed histological analysis along with adhesion to strict inclusion criteria are determinant for the reproducibility of success of DES in the west

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

Science.gov (United States)

Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Zotani, Hitomi; Kasuga, So

2018-03-27

The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach. Copyright © 2018 Elsevier Inc. All rights reserved.

Imaging of common bile duct by linear endoscopic ultrasound

Institute of Scientific and Technical Information of China (English)

Malay; Sharma; Amit; Pathak; Abid; Shoukat; Chittapuram; Srinivasan; Rameshbabu; Akash; Ajmera; Zeeshn; Ahamad; Wani; Praveer; Rai

2015-01-01

Imaging of common bile duct(CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound(EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations:(1) the fundus of stomach;(2) body of stomach;(3) duodenal bulb;(4) descending duodenum; and(5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.

The standard calibration instrument automation system for the atomic absorption spectrophotometer. Part 3: Program documentation

Science.gov (United States)

Ryan, D. P.; Roth, G. S.

1982-04-01

Complete documentation of the 15 programs and 11 data files of the EPA Atomic Absorption Instrument Automation System is presented. The system incorporates the following major features: (1) multipoint calibration using first, second, or third degree regression or linear interpolation, (2) timely quality control assessments for spiked samples, duplicates, laboratory control standards, reagent blanks, and instrument check standards, (3) reagent blank subtraction, and (4) plotting of calibration curves and raw data peaks. The programs of this system are written in Data General Extended BASIC, Revision 4.3, as enhanced for multi-user, real-time data acquisition. They run in a Data General Nova 840 minicomputer under the operating system RDOS, Revision 6.2. There is a functional description, a symbol definitions table, a functional flowchart, a program listing, and a symbol cross reference table for each program. The structure of every data file is also detailed.

Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial.

Science.gov (United States)

van Brunschot, Sandra; van Grinsven, Janneke; van Santvoort, Hjalmar C; Bakker, Olaf J; Besselink, Marc G; Boermeester, Marja A; Bollen, Thomas L; Bosscha, Koop; Bouwense, Stefan A; Bruno, Marco J; Cappendijk, Vincent C; Consten, Esther C; Dejong, Cornelis H; van Eijck, Casper H; Erkelens, Willemien G; van Goor, Harry; van Grevenstein, Wilhelmina M U; Haveman, Jan-Willem; Hofker, Sijbrand H; Jansen, Jeroen M; Laméris, Johan S; van Lienden, Krijn P; Meijssen, Maarten A; Mulder, Chris J; Nieuwenhuijs, Vincent B; Poley, Jan-Werner; Quispel, Rutger; de Ridder, Rogier J; Römkens, Tessa E; Scheepers, Joris J; Schepers, Nicolien J; Schwartz, Matthijs P; Seerden, Tom; Spanier, B W Marcel; Straathof, Jan Willem A; Strijker, Marin; Timmer, Robin; Venneman, Niels G; Vleggaar, Frank P; Voermans, Rogier P; Witteman, Ben J; Gooszen, Hein G; Dijkgraaf, Marcel G; Fockens, Paul

2018-01-06

Infected necrotising pancreatitis is a potentially lethal disease and an indication for invasive intervention. The surgical step-up approach is the standard treatment. A promising alternative is the endoscopic step-up approach. We compared both approaches to see whether the endoscopic step-up approach was superior to the surgical step-up approach in terms of clinical and economic outcomes. In this multicentre, randomised, superiority trial, we recruited adult patients with infected necrotising pancreatitis and an indication for invasive intervention from 19 hospitals in the Netherlands. Patients were randomly assigned to either the endoscopic or the surgical step-up approach. The endoscopic approach consisted of endoscopic ultrasound-guided transluminal drainage followed, if necessary, by endoscopic necrosectomy. The surgical approach consisted of percutaneous catheter drainage followed, if necessary, by video-assisted retroperitoneal debridement. The primary endpoint was a composite of major complications or death during 6-month follow-up. Analyses were by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN09186711. Between Sept 20, 2011, and Jan 29, 2015, we screened 418 patients with pancreatic or extrapancreatic necrosis, of which 98 patients were enrolled and randomly assigned to the endoscopic step-up approach (n=51) or the surgical step-up approach (n=47). The primary endpoint occurred in 22 (43%) of 51 patients in the endoscopy group and in 21 (45%) of 47 patients in the surgery group (risk ratio [RR] 0·97, 95% CI 0·62-1·51; p=0·88). Mortality did not differ between groups (nine [18%] patients in the endoscopy group vs six [13%] patients in the surgery group; RR 1·38, 95% CI 0·53-3·59, p=0·50), nor did any of the major complications included in the primary endpoint. In patients with infected necrotising pancreatitis, the endoscopic step-up approach was not superior to the surgical step-up approach in reducing major

Endoscopic management of bile leaks after laparoscopic ...

African Journals Online (AJOL)

Endoscopic management of bile leaks after laparoscopic cholecystectomy. ... endoscopic management at a median of 12 days (range 2 - 104 days) after surgery. Presenting features included intra-abdominal collections with pain in 58 cases ...

Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions

Directory of Open Access Journals (Sweden)

Eun Jeong Gong

2016-09-01

Full Text Available Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

Science.gov (United States)

Kim, Young-Il

2015-01-01

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

Development and evaluation of a light-emitting diode endoscopic light source

Science.gov (United States)

Clancy, Neil T.; Li, Rui; Rogers, Kevin; Driscoll, Paul; Excel, Peter; Yandle, Ron; Hanna, George; Copner, Nigel; Elson, Daniel S.

2012-03-01

Light-emitting diode (LED) based endoscopic illumination devices have been shown to have several benefits over arclamp systems. LEDs are energy-efficient, small, durable, and inexpensive, however their use in endoscopy has been limited by the difficulty in efficiently coupling enough light into the endoscopic light cable. We have demonstrated a highly homogenised lightpipe LED light source that combines the light from four Luminus LEDs emitting in the red, green, blue and violet using innovative dichroics that maximise light throughput. The light source spectrally combines light from highly divergent incoherent sources that have a Lambertian intensity profile to provide illumination matched to the acceptance numerical aperture of a liquid light guide or fibre bundle. The LED light source was coupled to a standard laparoscope and performance parameters (power, luminance, colour temperature) compared to a xenon lamp. Although the total illuminance from the endoscope was lower, adjustment of the LEDs' relative intensities enabled contrast enhancement in biological tissue imaging. The LED light engine was also evaluated in a minimally invasive surgery (MIS) box trainer and in vivo during a porcine MIS procedure where it was used to generate 'narrowband' images. Future work using the violet LED could enable photodynamic diagnosis of bladder cancer.

Comparison of the Standards applied to Instrumentation and Control Systems for Nuclear Power Stations in Korea and Russia

International Nuclear Information System (INIS)

Park, Joo Hyun; Hwang, In Koo; Lee, Dong Young

2005-04-01

This report describes a comparison result of technical standards applied to instrumentation and control systems for nuclear power plants between in Korea and in Russia. Russia also has a state-run organization authorized to conduct approval, cancellation, and audit in use of nuclear facility or equipment. The Russian standards for nuclear instrumentation and control equipment are analogous with the Korean ones in the aspect of basic concepts and principles. However, there are some differences in document structure, design requirements, qualification test items, depth of contents between two standard systems. The biggest deviation exists in the standard documents for seismic qualification and electromagnetic interference qualification. Korean seismic qualification standard utilizing US approach, defines testing and qualification methods specifically and clearly. Russian standards however provide only conceptual definitions and requirements in the seismic related aspects. Therefore, it is conceived that any equipment or system qualified seismically in accordance with Korean standards should additionally provide technical evidence that it is satisfactory with Russian standards as well. In electromagnetic interference qualification, because Russian standard requires more testing items than the current Korean standard, the additional qualification tests are necessary to meet the Russian requirements. However, these additional test items are based on IEC(International Electrotechnical Commission), therefore it is not a problem to perform those tests in a Korean testing facility

Comparison of the Standards applied to Instrumentation and Control Systems for Nuclear Power Stations in Korea and Russia

Energy Technology Data Exchange (ETDEWEB)

Park, Joo Hyun; Hwang, In Koo; Lee, Dong Young

2005-04-15

This report describes a comparison result of technical standards applied to instrumentation and control systems for nuclear power plants between in Korea and in Russia. Russia also has a state-run organization authorized to conduct approval, cancellation, and audit in use of nuclear facility or equipment. The Russian standards for nuclear instrumentation and control equipment are analogous with the Korean ones in the aspect of basic concepts and principles. However, there are some differences in document structure, design requirements, qualification test items, depth of contents between two standard systems. The biggest deviation exists in the standard documents for seismic qualification and electromagnetic interference qualification. Korean seismic qualification standard utilizing US approach, defines testing and qualification methods specifically and clearly. Russian standards however provide only conceptual definitions and requirements in the seismic related aspects. Therefore, it is conceived that any equipment or system qualified seismically in accordance with Korean standards should additionally provide technical evidence that it is satisfactory with Russian standards as well. In electromagnetic interference qualification, because Russian standard requires more testing items than the current Korean standard, the additional qualification tests are necessary to meet the Russian requirements. However, these additional test items are based on IEC(International Electrotechnical Commission), therefore it is not a problem to perform those tests in a Korean testing facility.

Antibiotic prophylaxis for patients undergoing elective endoscopic ...

African Journals Online (AJOL)

Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. M Brand, D Bisoz. Abstract. Background. Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among ...

Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study.

Science.gov (United States)

Berlucchi, Marco; Castelnuovo, Paolo; Vincenzi, Andrea; Morra, Bruno; Pasquini, Ernesto

2009-06-01

Nasal packings can aid in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS), but traditional non-resorbable stents have several inherent drawbacks. We performed a randomized, controlled, multicenter clinical trial to assess efficacy of resorbable nasal packing in patients undergoing FESS for chronic rhinosinusitis. A total of 66 patients for 88 nasal cavities were randomized to receive either hyaluronan resorbable packing (MeroGel) or standard non-resorbable nasal dressing after FESS. All underwent preoperative rhinoscopy, CT of sinuses, and, after surgery, were reassessed by rhinoscopy at 2, 4, and 12 weeks in blinded fashion. A total of 44 nasal cavities (MeroGel-group) received resorbable packing, whereas the remaining 44 were packed with non-resorbable nasal dressing. At follow-up endoscopic visit, the presence of nasal synechia was evaluated as primary outcome. Moreover, the tolerability and surgical handling properties of MeroGel and its comfort were assessed by surgeons and patients. Preoperative severity of rhinosinusitis was similar in both groups. No significant adverse events were observed in all patients. Follow-up endoscopy showed a lower proportion of nasal adhesions in MeroGel-group at both 4 (P = 0.041) and 12 weeks (P appearance of nasal mucosa of nasal cavities after FESS was observed in the MeroGel-group. Tolerability and surgical handling properties of MeroGel were positively rated by clinicians and the overall patient judged comfort of MeroGel was favorable. In conclusion, MeroGel can be considered a valid alternative to standard non-resorbable nasal dressings. It is safe, well-accepted, well-tolerated, and has significant advantage of being resorbable. Moreover, it may favor improved healing in patients undergoing FESS and reduce formation of adhesions.

77 FR 2982 - Request for Measures and Domains To Use in Development of a Standardized Instrument for Use in...

Science.gov (United States)

2012-01-20

... Measures and Domains To Use in Development of a Standardized Instrument for Use in Public Reporting of... Department of Health and Human Services with improving pediatric health care quality measures. The Agency for Healthcare Research and Quality (AHRQ) is soliciting the submission of instruments or domains (for example...

Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach.

LENUS (Irish Health Repository)

Dunne, Ruth

2013-12-01

Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations.

Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

Science.gov (United States)

Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

1977-05-09

Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy

Directory of Open Access Journals (Sweden)

Harith M. Alkhateeb

2015-01-01

Conclusions: (1 Following endoscopic retrograde cholangiopancreatography, a patient’s complaints should not be ignored. (2 A massive biloma can occur due to such procedures. (3 Conservative treatment with minimal invasive technique can prove to be effective.

Peroral endoscopic myotomy (POEM) for treating esophageal motility disorders

Science.gov (United States)

Wong, Ian

2017-01-01

Pneumatic dilatation and Heller myotomy have been thoroughly studied as the most viable treatment options for achalasia. The pendulum, however, is shifting to the minimally invasive approach. Since Inoue et al. published the experience of the first 17 cases of peroral endoscopic myotomy (POEM) in 2010, there have been at least 5,000 cases performed worldwide and the number is increasing exponentially. Experts across the globe have been extending the indications to various esophageal motility disorders, to patients of extremes of age, sigmoidal esophagus and re-operated patients. There are a few variations in technique across different centers in defining the gastroesophageal junction (GEJ) and adequacy of myotomy, the optimal length, site of myotomy and whether the full thickness of the muscle wall should be cut. Large case series demonstrated its promising efficacy & reasonable complication profile. Randomized controlled trial in comparison with the gold standard, Heller myotomy, is ongoing. The future application of submucosal tunnelling technique is thrilling with its extension in tumour resection, antropyloromyotomy and other natural orifice transluminal endoscopic surgery (NOTES). PMID:28616407

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

Science.gov (United States)

Upadhyay, Smita; Dolci, Ricardo L L; Buohliqah, Lamia; Fiore, Mariano E; Ditzel Filho, Leo F S; Prevedello, Daniel M; Otto, Bradley A; Carrau, Ricardo L

2016-02-01

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

Duodenal diverticular bleeding: an endoscopic challenge

Directory of Open Access Journals (Sweden)

Eduardo Valdivielso-Cortázar

Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

The Astronomy and Space Science Concept Inventory: Assessment Instruments Aligned with the K-12 National Science Standards

Science.gov (United States)

Sadler, Philip M.

2011-01-01

We report on the development of an item test bank and associated instruments based on those K-12 national standards which involve astronomy and space science. Utilizing hundreds of studies in the science education research literature on student misconceptions, we have constructed 211 unique items that measure the degree to which students abandon such ideas for accepted scientific views. Piloted nationally with 7599 students and their 88 teachers spanning grades 5-12, the items reveal a range of interesting results, particularly student difficulties in mastering the NRC Standards and AAAS Benchmarks. Teachers generally perform well on items covering the standards of the grade level at which they teach, exhibiting few misconceptions of their own. Teachers dramatically overestimate their students’ performance, perhaps because they are unaware of their students’ misconceptions. Examples are given showing how the developed instruments can be used to assess the effectiveness of instruction and to evaluate the impact of professional development activities for teachers.

Instrumentation

International Nuclear Information System (INIS)

Prieur, G.; Nadi, M.; Hedjiedj, A.; Weber, S.

1995-01-01

This second chapter on instrumentation gives little general consideration on history and classification of instrumentation, and two specific states of the art. The first one concerns NMR (block diagram of instrumentation chain with details on the magnets, gradients, probes, reception unit). The first one concerns precision instrumentation (optical fiber gyro-meter and scanning electron microscope), and its data processing tools (programmability, VXI standard and its history). The chapter ends with future trends on smart sensors and Field Emission Displays. (D.L.). Refs., figs

Optical characterization and polarization calibration for rigid endoscopes

Science.gov (United States)

Garcia, Missael; Gruev, Viktor

2017-02-01

Polarization measurements give orthogonal information to spectral images making them a great tool in the characterization of environmental parameters in nature. Thus, polarization imagery has proven to be remarkably useful in a vast range of biomedical applications. One such application is the early diagnosis of flat cancerous lesions in murine colorectal tumor models, where polarization data complements NIR fluorescence analysis. Advances in nanotechnology have led to compact and precise bio-inspired imaging sensors capable of accurately co-registering multidimensional spectral and polarization information. As more applications emerge for these imagers, the optics used in these instruments get very complex and can potentially compromise the original polarization state of the incident light. Here we present a complete optical and polarization characterization of three rigid endoscopes of size 1.9mm x 10cm (Karl Storz, Germany), 5mm x 30cm, and 10mm x 33cm (Olympus, Germany), used in colonoscopy for the prevention of colitis-associated cancer. Characterization results show that the telescope optics act as retarders and effectively depolarize the linear component. These incorrect readings can cause false-positives or false-negatives leading to an improper diagnosis. In this paper, we offer a polarization calibration scheme for these endoscopes based on Mueller calculus. By modeling the optical properties from training data as real-valued Mueller matrices, we are able to successfully reconstruct the initial polarization state acquired by the imaging system.

[Current Status of Endoscopic Resection of Early Gastric Cancer in Korea].

Science.gov (United States)

Jung, Hwoon Yong

2017-09-25

Endoscopic resection (Endoscopic mucosal resection [EMR] and endoscopic submucosal dissection [ESD]) is already established as a first-line treatment modality for selected early gastric cancer (EGC). In Korea, the number of endoscopic resection of EGC was explosively increased because of a National Cancer Screening Program and development of devices and techniques. There were many reports on the short-term and long-term outcomes after endoscopic resection in patients with EGC. Long-term outcome in terms of recurrence and death is excellent in both absolute and selected expanded criteria. Furthermore, endoscopic resection might be positioned as primary treatment modality replacing surgical gastrectomy. To obtain these results, selection of patients, perfect en bloc procedure, thorough pathological examination of resected specimen, accurate interpretation of whole process of endoscopic resection, and rational strategy for follow-up is necessary.

Endoscopic Management of Peri-Pancreatic Fluid Collections.

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Yip, Hon Chi; Teoh, Anthony Yuen Bun

2017-09-15

In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.

The Impact of Scholastic Instrumental Music and Scholastic Chess Study on the Standardized Test Scores of Students in Grades Three, Four, and Five

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Martinez, Edwin E.

2012-01-01

This study examines the impact of instrumental music study and group chess lessons on the standardized test scores of suburban elementary public school students (grades three through five) in Levittown, New York. The study divides the students into the following groups and compares the standardized test scores of each: a) instrumental music…

Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery.

Science.gov (United States)

Donatelli, Gianfranco; Fuks, David; Cereatti, Fabrizio; Pourcher, Guillaume; Perniceni, Thierry; Dumont, Jean-Loup; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno; Gayet, Brice

2018-05-01

Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n  = 5), and other type of surgery (n  = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

Endoscopic submucosal dissection for esophageal squamous cell neoplasms.

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Fujishiro, Mitsuhiro; Kodashima, Shinya; Goto, Osamu; Ono, Satoshi; Niimi, Keiko; Yamamichi, Nobutake; Oka, Masashi; Ichinose, Masao; Omata, Masao

2009-04-01

Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for early esophageal cancer, as well as for early gastric cancer in Japan, but standardization of the knowledge is still incomplete. The final goal to perform ESD is not to resect the lesion in an en bloc fashion, but to save the patient from esophageal cancer-related death. Thus, the indications should be considered based on the entire patient, not just the target lesion itself, and pre-, peri- and postoperative management of the patient is also very important, as well as technical aspects of ESD. In terms of the techniques of ESD, owing to refinement of the procedural strategy, invention of the devices, and the learning curve, acceptable safety and favorable middle-term efficacy have been obtained. We believe that ESD will become a standard treatment for early esophageal cancer not only in Japan but also worldwide in the near future.

Endoscopic management of peripancreatic fluid collections.

Science.gov (United States)

Goyal, Jatinder; Ramesh, Jayapal

2015-07-01

Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most of the fluid-filled pseudocysts tend to resolve spontaneously with conservative management, intervention is necessary in symptomatic patients. Open surgery has been the traditional treatment modality of choice though endoscopic, laparoscopic and transcutaneous techniques offer alternative drainage approaches. During the last decade, improvement in endoscopic ultrasound technology has enabled real-time access and drainage of fluid collections that were previously not amenable to blind transmural drainage. This has initiated a trend towards use of this modality for treatment of pseudocysts. In this review, we have summarised the existing evidence for endoscopic drainage of peripancreatic fluid collections from published studies.

The Gaia spectrophotometric standard stars survey: II. Instrumental effects of six ground-based observing campaigns

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Altavilla, G.; Marinoni, S.; Pancino, E.; Galleti, S.; Ragaini, S.; Bellazzini, M.; Cocozza, G.; Bragaglia, A.; Carrasco, J. M.; Castro, A.; Di Fabrizio, L.; Federici, L.; Figueras, F.; Gebran, M.; Jordi, C.; Masana, E.; Schuster, W.; Valentini, G.; Voss, H.

2015-08-01

The Gaia SpectroPhotometric Standard Stars (SPSS) survey started in 2006, was awarded almost 450 observing nights and accumulated almost 100 000 raw data frames with both photometric and spectroscopic observations. Such large observational effort requires careful, homogeneous, and automatic data reduction and quality control procedures. In this paper, we quantitatively evaluate instrumental effects that might have a significant (i.e., ≥ 1 %) impact on the Gaia SPSS flux calibration. The measurements involve six different instruments, monitored over the eight years of observations dedicated to the Gaia flux standards campaigns: DOLORES@TNG in La Palma, EFOSC2@NTT and ROSS@REM in La Silla, CAFOS@2.2 m in Calar Alto, BFOSC@Cassini in Loiano, and LaRuca@1.5 m in San Pedro Mártir. We examine and quantitatively evaluate the following effects: CCD linearity and shutter times, calibration frames stability, lamp flexures, second order contamination, light polarization, and fringing. We present methods to correct for the relevant effects which can be applied to a wide range of observational projects at similar instruments. Based on data obtained with BFOSC@Cassini in Loiano, Italy; EFOSC2@NTT in La Silla, Chile; DOLORES@TNG in La Palma, Spain; CAFOS@2.2 m in Calar Alto, Spain; LaRuca@1.5 m in San Pedro Mártir, Mexico (see acknowledgements for more details).

Nasal encephalocele: endoscopic excision with anesthetic consideration.

Science.gov (United States)

Abdel-Aziz, Mosaad; El-Bosraty, Hussam; Qotb, Mohamed; El-Hamamsy, Mostafa; El-Sonbaty, Mohamed; Abdel-Badie, Hazem; Zynabdeen, Mustapha

2010-08-01

Nasal encephalocele may presents as a nasal mass, its treatment is surgical and it should be done early in life. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach. However, the treatment of a basal intranasal encephalocele using transnasal endoscopic approach could obviates the possible morbidity associated with other approaches. The aim of this study was to evaluate the efficacy of endoscopic removal of intranasal encephalocele, also to document the role of anesthetist in the operative and postoperative periods. Nine cases with nasal encephalocele were included in this study; CT and/or MRI were used in their examination. The lesions were removed via transnasal endoscopic approach. Preoperative evaluation, intervention and postoperative follow-up were presented with discussion of anesthesia used for those children. The lesions of all patients were removed successfully with no recurrence through the follow-up period of at least 21 months. No cases showed morbidity or mortality intra- or post-operatively. Endoscopic excision of intranasal encephalocele is an effective method with high success rate. Anesthetist plays an important role in the operative and postoperative period, even during the endoscopic follow up; sedation of the children is usually needed. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Transanal endoscopic microsurgery: a New Zealand experience.

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Bloomfield, Ian; Van Dalen, Roelof; Lolohea, Simione; Wu, Linus

2017-12-03

Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques. A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow-up data were sourced from patient records and from local centres around New Zealand. A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien-Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%. Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow-up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision. © 2017 Royal Australasian College of Surgeons.

Endoscopic ultrasonography-guided rendezvous technique.

Science.gov (United States)

Tsuchiya, Takayoshi; Itoi, Takao; Sofuni, Atsushi; Tonozuka, Ryosuke; Mukai, Shuntaro

2016-04-01

Endoscopic retrograde cholangiopancreatography (ERCP) requires deep biliary cannulation. When deep biliary cannulation is failed, the endoscopic ultrasonography rendezvous technique (EUS-RV) is a useful salvage method. From the previous 15 articles that included 382 EUS-RV cases, the overall success rate of EUS-RV is 81 % with a complication rate of 10 %. In EUS-RV, the bile duct is punctured under EUS guidance and a guidewire is advanced into the duodenum via the papilla. The EUS scope is then switched to a duodenoscope and inserted into the bile duct over the guidewire exiting the papilla, or the guidewire is grasped with forceps and passed through the working channel; the catheter can then be inserted through the papilla over the wire. There are three puncture routes for EUS-RV: transgastric puncture of the intrahepatic bile duct (IHBD), transduodenal puncture of the extrahepatic bile duct (EHBD) via the proximal duodenum (D1), and transduodenal puncture of the EHBD via the second portion of the duodenum (D2). The puncture route for each patient should be selected based on the patient condition. GW selection for EUS-RV is critical, a hydrophilic GW is useful for this procedure. Although EUS-RV is now performed relatively routinely in a few high-volume centers, procedure standardization and the development of exclusive devices for EUS-RV are still underway. The development of exclusive devices for EUS-RV and prospective comparative studies with other salvage methods are needed to truly evaluate the procedure's usefulness and safety.

Per-oral endoscopic myotomy (POEM) for esophageal achalasia.

Science.gov (United States)

Pescarus, Radu; Shlomovitz, Eran; Swanstrom, Lee L

2014-01-01

Per-oral endoscopic myotomy (POEM) is a new minimally invasive endoscopic treatment for achalasia. Since the first modern human cases were published in 2008, around 2,000 cases have been performed worldwide. This technique requires advanced endoscopic skills and a learning curve of at least 20 cases. POEM is highly successful with over 90 % improvement in dysphagia while offering patients the advantage of a low impact endoscopic access. The main long-term complication is gastroesophageal reflux (GER) with an estimated incidence of 35 %, similar to the incidence of GER post-laparoscopic Heller with fundoplication. Although POEM represents a paradigm shift in the treatment of achalasia, more long-term data are clearly needed to further define its role in the treatment algorithm of this rare disease.

High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

DEFF Research Database (Denmark)

Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars

2016-01-01

was requested eight times (0.4 %). One patient was intubated due to suspected aspiration. CONCLUSIONS: Intermittent deep NAPS for advanced endoscopies in selected patients provided an almost 100 % success rate. However, the rate of hypoxia, hypotension and respiratory support was high compared with previously......BACKGROUND AND STUDY AIMS: Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ERCP......) and Endoscopic Ultrasound (EUS) are available and potential benefits or hazards remain unclear. The aims of this study were to investigate the efficacy of intermittent deep sedation with propofol for a large cohort of advanced endoscopies and to provide data on the safety. PATIENTS AND METHODS: All available...

New developments in endoscopic treatment of chronic pancreatitis.

Science.gov (United States)

Didden, P; Bruno, M; Poley, J W

2012-12-01

The aim of endoscopic therapy of chronic pancreatitis (CP) is to treat pain by draining the pancreatic duct or managing loco-regional complications. Recent decennia were characterized by continuous improvement of endoscopic techniques and devices, resulting in a better clinical outcome. Novel developments now also provide the opportunity to endoscopically treat refractory CP-related complications. Especially suboptimal surgical candidates could potentially benefit from these new developments, consequently avoiding invasive surgery. The use of fully covered self-expandable metal stents (SEMS) has been explored in pancreatic and CP-related biliary duct strictures, resistant to conventional treatment with plastic endoprotheses. Furthermore, endosonography-guided transmural drainage of the main pancreatic duct via duct-gastrostomy is an alternative treatment option in selected cases. Pancreatic pseudocysts represent an excellent indication for endoscopic therapy with some recent case series demonstrating effective drainage with the use of a fully covered SEMS. Although results of these new endoscopic developments are promising, high quality randomized trials are required to determine their definite role in the management of chronic pancreatitis.

Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis.

Science.gov (United States)

Eastwood, Kyle W; Bodani, Vivek P; Haji, Faizal A; Looi, Thomas; Naguib, Hani E; Drake, James M

2018-06-01

than 90% of participants indicated that handling the endoscope and the instruments was realistic, and also that the steps required to perform the procedure were representative of the steps required in real life. CONCLUSIONS Both the metopic and sagittal craniosynostosis simulators were developed using low-cost methods and were successfully designed to be reusable. The simulators were found to realistically represent the surgical procedure and can be used to develop the technical skills required for performing an endoscope-assisted craniosynostosis repair.

Surgical management of failed endoscopic treatment of pancreatic disease.

Science.gov (United States)

Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E

2008-11-01

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

Calibration procedures of the Tore-Supra infrared endoscopes

Science.gov (United States)

Desgranges, C.; Jouve, M.; Balorin, C.; Reichle, R.; Firdaouss, M.; Lipa, M.; Chantant, M.; Gardarein, J. L.; Saille, A.; Loarer, T.

2018-01-01

Five endoscopes equipped with infrared cameras working in the medium infrared range (3-5 μm) are installed on the controlled thermonuclear fusion research device Tore-Supra. These endoscopes aim at monitoring the plasma facing components surface temperature to prevent their overheating. Signals delivered by infrared cameras through endoscopes are analysed and used on the one hand through a real time feedback control loop acting on the heating systems of the plasma to decrease plasma facing components surface temperatures when necessary, on the other hand for physics studies such as determination of the incoming heat flux . To ensure these two roles a very accurate knowledge of the absolute surface temperatures is mandatory. Consequently the infrared endoscopes must be calibrated through a very careful procedure. This means determining their transmission coefficients which is a delicate operation. Methods to calibrate infrared endoscopes during the shutdown period of the Tore-Supra machine will be presented. As they do not allow determining the possible transmittances evolution during operation an in-situ method is presented. It permits the validation of the calibration performed in laboratory as well as the monitoring of their evolution during machine operation. This is possible by the use of the endoscope shutter and a dedicated plasma scenario developed to heat it. Possible improvements of this method are briefly evoked.

Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Directory of Open Access Journals (Sweden)

YU Yong

2012-08-01

Full Text Available Objective To introduce the surgical techniques of image-guided endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations and describe several advantages compared to the traditional transoral procedure. Methods From September 2009 to February 2010, two cases with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. Case 2 also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability. The clinical symptoms of the two cases were evaluated by using the Japanese Orthopaedic Association (JOA score for the evaluation of cervical myelopathy. Results Both patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow?up time was more than 24 months. Remarkable neurological recovery was observed at postoperation in both patients. The JOA scores elevated from preoperative 12 and 8 to postoperative 17 and 15. Conclusion The endoscopic transnasal odontoidectomy is a more minimally invasive approach for anterior decompression of cervicomedullary with basilar invagination. The advantages over the standard transoral odontoidectomy include visualization improvement, elimination of risk of tongue swelling and teeth damaging, alleviation of prolonged intubation, reduction of need for enteral tube feeding, and less risk of affecting phonation.

Endoscopic Rectus Abdominis and Prepubic Aponeurosis Repairs for Treatment of Athletic Pubalgia.

Science.gov (United States)

Matsuda, Dean K; Matsuda, Nicole A; Head, Rachel; Tivorsak, Tanya

2017-02-01

Review of the English orthopaedic literature reveals no prior report of endoscopic repair of rectus abdominis tears and/or prepubic aponeurosis detachment. This technical report describes endoscopic reattachment of an avulsed prepubic aponeurosis and endoscopic repair of a vertical rectus abdominis tear immediately after endoscopic pubic symphysectomy for coexistent recalcitrant osteitis pubis as a single-stage outpatient surgery. Endoscopic rectus abdominis repair and prepubic aponeurosis repair are feasible surgeries that complement endoscopic pubic symphysectomy for patients with concurrent osteitis pubis and expand the less invasive options for patients with athletic pubalgia.

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Directory of Open Access Journals (Sweden)

Keunmo Kim

2017-03-01

Full Text Available Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP. We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

Endoscopic brow lifts uber alles.

Science.gov (United States)

Patel, Bhupendra C K

2006-12-01

Innumerable approaches to the ptotic brow and forehead have been described in the past. Over the last twenty-five years, we have used all these techniques in cosmetic and reconstructive patients. We have used the endoscopic brow lift technique since 1995. While no one technique is applicable to all patients, the endoscopic brow lift, with appropriate modifications for individual patients, can be used effectively for most patients with brow ptosis. We present the nuances of this technique and show several different fixation methods we have found useful.

Evaluation of the tip-bending response in clinically used endoscopes

NARCIS (Netherlands)

Rozeboom, Esther; Reilink, Rob; Schwartz, Matthijs P.; Fockens, Paul; Broeders, Ivo Adriaan Maria Johannes

Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current

Evaluation of the tip-bending response in clinically used endoscopes

NARCIS (Netherlands)

Rozeboom, Esther D.; Reilink, Rob; Schwartz, Matthijs P.; Fockens, Paul; Broeders, Ivo A. M. J.

2016-01-01

Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience

Directory of Open Access Journals (Sweden)

Dadang Makmun

2017-09-01

Full Text Available Background/Aims Biliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP, endoscopic ultrasonography (EUS and magnetic resonance cholangiopancreatography (MRCP are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis. Methods This retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients underwent EUS and the second group (31 patients underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard. Results The male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively. Conclusions EUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series.

Science.gov (United States)

Ecker, J; Perera, N; Ebert, J

2015-02-01

Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques. © The Author(s) 2014.

Endoscopic laser-urethroplasty

Science.gov (United States)

Gilbert, Peter

2006-02-01

The objective was to prove the advantage of endoscopic laser-urethroplasty over internal urethrotomy in acquired urethral strictures. Patients and Method: From January, 1996 to June, 2005, 35 patients with a mean age of 66 years were submitted to endoscopic laser-urethroplasty for strictures of either the bulbar (30) or membranous (5) urethra. The operations were carried out under general anesthesia. First of all, the strictures were incised at the 4, 8 and 12 o'clock position by means of a Sachse-urethrotom. Then the scar flap between the 4 and 8 o'clock position was vaporized using a Nd:YAG laser, wavelength 1060 nm and a 600 pm bare fiber, the latter always being in contact with the tissue. The laser worked at 40W power in continuous mode. The total energy averaged 2574 J. An indwelling catheter was kept in place overnight and the patients were discharged the following day. Urinalysis, uroflowmetry and clinical examination were performed at two months after surgery and from then on every six months. Results: No serious complications were encountered. Considering a mean follow-up of 18 months, the average peak flow improved from 7.3 ml/s preoperatively to 18.7 mVs postoperatively. The treatment faded in 5 patients ( 14.3% ) who finally underwent open urethroplasty. Conclusions: Endoscopic laser-urethroplasty yields better short-term results than internal visual urethrotomy. Long-term follow-up has yet to confirm its superiority in the treatment of acquired urethral strictures.

Endoscopic surgery of the nose and paranasal sinus.

Science.gov (United States)

Palmer, Orville; Moche, Jason A; Matthews, Stanley

2012-05-01

Mucosal preservation is of paramount importance in the diagnosis and surgical management of the sinonasal tract. The endoscope revolutionized the practice of endoscopic nasal surgery. As a result, external sinus surgery is performed less frequently today, and more emphasis is placed on functional endoscopy and preservation of normal anatomy. Endoscopic surgery of the nose and paranasal sinus has provided improved surgical outcomes and has shortened the length of stay in hospital. It has also become a valuable teaching tool. Copyright © 2012 Elsevier Inc. All rights reserved.

Current Status of Peroral Endoscopic Myotomy

OpenAIRE

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic ...

Dextranomer Based Implant (Deflux) for Endoscopic Treatment of Post-Prostatectomy Incontinence

International Nuclear Information System (INIS)

Abu-El-Azayem, Khaled M.; Abdel-Meguid, Taha A.; Soliman, S.

2006-01-01

Endoscopic treatment for post-prostatectomy urinary incontinence has gained popularity using several inject-able bulking materials. The current study reports our experience with endoscopic submucosal injection of dextranomer/hyaluronic acid copolymer for treatment of post-prostatectomy incontinence due to sphincteric deficiency. A total of 14 patients with post-prostatectomy urinary incontinence; 13 post-trans urethral resection of prostate (TURP) and 1 post-open prostatectomy, were enrolled. The patients aged between 59-85 years. Preoperative evaluation included multi-channel video urodynamics. Patients who had verified intrinsic sphincteric deficiency, adequate bladder capacity, absent unhibited detrusor contractions and minimal or no post void residual (PVR) urine were selected for injection therapy. The standard 4 quadrant sub-mucosal injection technique was utilized. Follow-up was scheduled at 1 month after each injection and at 6-months interval thereafter. A total of 25 procedures were done. Seven patients (50%) received single injection, 3 patients (21.4%) required 2 injections and 4 patients (28.6%) needed 3 injections. The mean volume of injected material was 3.7 mL per procedure (range 2-8). The mean operative time was 30 minutes (range 15-60). The procedure was performed without intraoperative adverse events or significant postoperative complications. The overall cure rate, significant improvement rate and failure rate were 28.6%, 35.7% and 35.7%.respectively, with a total of 64.3% considered as success (cured or significantly improved). At 1 year of follow-up, 71.4% of the patients (cured or improved) demonstrated persistence of the favourable outcome. Endoscopic treatment of post prostatectomy incontinence due sphinteric deficiency is a minimally invasive, safe and successful procedure. Endoscopic submucosal injection of dextranomer has shown a durable favorable outcome at 1 year of follow-up. (author)

Measurement of Henry's Law Constants Using Internal Standards: A Quantitative GC Experiment for the Instrumental Analysis or Environmental Chemistry Laboratory

Science.gov (United States)

Ji, Chang; Boisvert, Susanne M.; Arida, Ann-Marie C.; Day, Shannon E.

2008-01-01

An internal standard method applicable to undergraduate instrumental analysis or environmental chemistry laboratory has been designed and tested to determine the Henry's law constants for a series of alkyl nitriles. In this method, a mixture of the analytes and an internal standard is prepared and used to make a standard solution (organic solvent)…

APSIC guidelines for disinfection and sterilization of instruments in health care facilities

Directory of Open Access Journals (Sweden)

Moi Lin Ling

2018-02-01

Full Text Available Abstract Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

Endoscopic Management of a Primary Duodenal Carcinoid Tumor

Directory of Open Access Journals (Sweden)

Albin Abraham

2012-03-01

Full Text Available Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

Endoscopic sleeve gastroplasty: the learning curve.

Science.gov (United States)

Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

2017-09-01

 Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

Endoscopic removal of a dislocated tomour prothesis from the stomach

International Nuclear Information System (INIS)

Rueckauer, K.; Dinkel, E.

1985-01-01

Endoscopic pertubation of oesophagogustric neoplasms is an established method of palliative treatment. The dislocated plastic prosthesis may be removed with difficulties from the stomach endoscopically. A simple technique for endoscopic removal of the prosthesis is described. The tube can be precisely centred within the oesophageal lumen by use of an intestinal decompression tube and additional guidance by the endoscopic retraction forceps. Thus gross damge of the exophytic tumor tissue with bleeding or perforation sequelae can be avoided. Injury to the patient does not exceed that caused by an ordinary gastroscopy. (orig.) [de

Endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and laparoscopic cholecystectomy in a patient with choledocolitiasis and cholelitiasis

International Nuclear Information System (INIS)

Riveron Quevedo, Kelly; Irsula Ballaga, Vladimir; Gonzalez Ulloa, Lianne; Deborah LLorca, Armando

2012-01-01

The case report of a 30 year-old presumably healthy patient, who attended the Gastroenterology Department from 'Dr Juan Bruno Zayas Alfonso' Teaching General Hospital in Santiago de Cuba, and suffering from biliary cholic, ictero, choluria, nausea, vomit and loss of appetite is presented. The complementary examinations confirmed the choledocolitiasis and cholelitiasis diagnosis, reason why it was necessary to carry out a endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and ambulatory laparoscopic cholecystectomy, in a single anesthetic injection. The postoperative clinical course was favorable and she was discharged without complications 24 hours before the intervention

Endoscope disinfection and its pitfalls--requirement for retrograde surveillance cultures.

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Buss, A J; Been, M H; Borgers, R P; Stokroos, I; Melchers, W J; Peters, F T; Limburg, A J; Degener, J E

2008-04-01

Several endoscopy-related outbreaks of infection have been reported in recent years. For early recognition of inadequate disinfection of endoscopes we designed a microbiological surveillance system to evaluate the efficacy of the cleaning and disinfection procedure, and to trace disinfection problems to individual endoscopes or washer-disinfectors. Our surveillance protocol included anterograde and retrograde sampling, a decision algorithm, genetic fingerprinting, and scanning electron microscopy. Over a period of 29 months we found an increasing number of patient-ready endoscopes testing positive for Candida species other than albicans, especially C. parapsilosis. These yeasts were also isolated from the washer-disinfectors. The number of positive tests for Candida species varied from 1 out of 21 to 14 out of 27 samples from nine frequently used endoscopes. The number of colony-forming units per milliliter ranged from 1 - 10 to 3000 for endoscopes and 0.002 to 0.06 for the washer disinfectors. DNA fingerprinting was not able to discriminate different strains within C. parapsilosis. Our protocol was able to detect a structural problem in the endoscope disinfection process. Retrograde sampling was crucial for this purpose, because it has much higher sensitivity than anterograde sampling. Endoscopes with damaged working channels are probably the source of the contamination problem with Candida species.

A Haptic Guided Robotic System for Endoscope Positioning and Holding.

Science.gov (United States)

Cabuk, Burak; Ceylan, Savas; Anik, Ihsan; Tugasaygi, Mehtap; Kizir, Selcuk

2015-01-01

To determine the feasibility, advantages, and disadvantages of using a robot for holding and maneuvering the endoscope in transnasal transsphenoidal surgery. The system used in this study was a Stewart Platform based robotic system that was developed by Kocaeli University Department of Mechatronics Engineering for positioning and holding of endoscope. After the first use on an artificial head model, the system was used on six fresh postmortem bodies that were provided by the Morgue Specialization Department of the Forensic Medicine Institute (Istanbul, Turkey). The setup required for robotic system was easy, the time for registration procedure and setup of the robot takes 15 minutes. The resistance was felt on haptic arm in case of contact or friction with adjacent tissues. The adaptation process was shorter with the mouse to manipulate the endoscope. The endoscopic transsphenoidal approach was achieved with the robotic system. The endoscope was guided to the sphenoid ostium with the help of the robotic arm. This robotic system can be used in endoscopic transsphenoidal surgery as an endoscope positioner and holder. The robot is able to change the position easily with the help of an assistant and prevents tremor, and provides a better field of vision for work.

Per-oral Endoscopic Myotomy (POEM): A safe and effective treatment for achalasia in geriatric

Science.gov (United States)

Hernández-Mondragón, Oscar Víctor; Solórzano-Pineda, Omar Michel; Blancas-Valencia, Juan Manuel; González-Martínez, Marina Alejandra

2017-01-01

Esophageal achalasia is a primary motor disorder of the esophagus characterized by impair relaxation of the lower esophageal sphincter and absent of esophageal peristalsis. Per-oral endoscopic myotomy is an alternative treatment to surgical Heller myotomy in patients over 65 years old. The aim of this paper was to describe the results of peroral endoscopic myotomy (POEM) or the treatment of achalasia in geriatric patients. We included patients over 65 years old with POEM, from retrospective cohort review, in which POEM was performed with a standardized technique in our department. 12 patients were included, the procedure was successful in 98% of patients, minor adverse events occurred without mortality. POEM is a safe and effective technique for the treatment of achalasia, the results of the study are similar to those reported in The literature.

Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation.

Science.gov (United States)

Ismail, Mostafa; Fares, Abd Alla; Abdelhak, Balegh; D'Haens, Jean; Michel, Olaf

2016-01-01

Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A - with no intrasellar packing, Group B - with haemostatic materials packing, and Group C - with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no

In-Use Evaluation of Peracetic Acid for High-Level Disinfection of Endoscopes.

Science.gov (United States)

Chenjiao, Wu; Hongyan, Zhang; Qing, Gu; Xiaoqi, Zhong; Liying, Gu; Ying, Fang

2016-01-01

Many high-level disinfectants have been used for disinfection of endoscopes such as 2% glutaraldehyde (GA), 0.55% ortho-phthalaldehyde (OPA), and peracetic acid (PAA). Both GA and OPA are widely used in disinfection of endoscopes and have been previously discussed, but there is little research on the practical use of PAA as an endoscope disinfectant. An experimental model of a flexible gastrointestinal endoscope being contaminated with 9 strains of microorganism was designed. After the cleaning and disinfecting procedure was completed, we evaluated the biocidal activity (850 ppm PAA, 2% GA, and 0.55% OPA) on our flexible gastrointestinal endoscope model. We also evaluated sterilization effectiveness of PAA on other bacteria, including some antibiotic-resistant bacteria (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile). The residual bacterial colony count number of the PAA-disinfected endoscope was significantly lower than that of the GA- and OPA-disinfected endoscopes. The biocidal effect and efficiency of the endoscope disinfection by PAA appeared to be better than either the GA- or OPA-disinfected endoscope. PAA has demonstrated a good sterilization effect on other bacterial species; of particular note are common antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile. The results of this study demonstrate that PAA is a fast and effective high-level disinfectant for use in the reprocessing of flexible endoscopes.

Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.

Science.gov (United States)

Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José

2011-01-01

Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions

Science.gov (United States)

Alatawi, Abdullah; Beuvon, Frédéric; Grabar, Sophie; Leblanc, Sarah; Chaussade, Stanislas; Terris, Benoit; Barret, Maximilien

2015-01-01

Objectives Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using standard needles has a high diagnostic value in the evaluation of solid pancreatic masses. Fenestrated needles have been developed to improve the quality of EUS-guided tissue sampling by providing core biopsies (FNB). Methods Patients with solid pancreatic masses of >2 cm were prospectively included in our study and randomized to receive EUS sampling, using either a standard 22G FNA or a 22G Procore® FNB needle. The main study endpoint was the number of needle passes required to obtain a diagnosis in more than 90% of cases. Results We included 100 patients (male = 63, female = 37; mean age = 68.4 years) in our study. We found that 88% of the lesions were malignant, with a mean size of 32 mm. A sample adequate for diagnosis was obtained in more than 90% of cases after the second needle pass in the FNB group, versus the third needle pass in the FNA group. Slide cellularity and presence of tissue microfragments were significantly higher in the FNB group. Sensitivity for the diagnosis of malignancy was 88.4% versus 97.8% for the EUS-FNA and EUS-FNB group, respectively, while specificity for both techniques was 100%. No complications were recorded. Conclusions Although the accuracy of both needle types for proving malignancy was similar, a lower number of passes was required with the FNB needles to achieve the same contributive sample rate as with the FNA needles. FNB also improved the histopathological quality of specimens, suggesting an overall superiority of FNB sampling. PMID:26279842

Endoscopic and laparoscopic treatment of gastroesophageal reflux.

Science.gov (United States)

Watson, David I; Immanuel, Arul

2010-04-01

Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

[Virtual bronchoscopy: the correlation between endoscopic simulation and bronchoscopic findings].

Science.gov (United States)

Salvolini, L; Gasparini, S; Baldelli, S; Bichi Secchi, E; Amici, F

1997-11-01

We carried out a preliminary clinical validation of 3D spiral CT virtual endoscopic reconstructions of the tracheobronchial tree, by comparing virtual bronchoscopic images with actual endoscopic findings. Twenty-two patients with tracheobronchial disease suspected at preliminary clinical, cytopathological and plain chest film findings were submitted to spiral CT of the chest and bronchoscopy. CT was repeated after endobronchial therapy in 2 cases. Virtual endoscopic shaded-surface-display views of the tracheobronchial tree were reconstructed from reformatted CT data with an Advantage Navigator software. Virtual bronchoscopic images were preliminarily evaluated with a semi-quantitative quality score (excellent/good/fair/poor). The depiction of consecutive airway branches was then considered. Virtual bronchoscopies were finally submitted to double-blind comparison with actual endoscopies. Virtual image quality was considered excellent in 8 cases, good in 14 and fair in 2. Virtual exploration was stopped at the lobar bronchi in one case only; the origin of segmental bronchi was depicted in 23 cases and that of some subsegmental branches in 2 cases. Agreement between actual and virtual bronchoscopic findings was good in all cases but 3 where it was nevertheless considered satisfactory. The yield of clinically useful information differed in 8/24 cases: virtual reconstructions provided more information than bronchoscopy in 5 cases and vice versa in 3. Virtual reconstructions are limited in that the procedure is long and difficult and needing a strictly standardized threshold value not to alter virtual findings. Moreover, the reconstructed surface lacks transparency, there is the partial volume effect and the branches < or = 4 pixels phi and/or meandering ones are difficult to explore. Our preliminary data are encouraging. Segmental bronchi were depicted in nearly all cases, except for the branches involved by disease. Obstructing lesions could be bypassed in some cases

Standard practice of calibration of force-measuring instruments for verifying the force indication of testing machines

CERN Document Server

American Society for Testing and Materials. Philadelphia

2006-01-01

1.1 The purpose of this practice is to specify procedures for the calibration of force-measuring instruments. Procedures are included for the following types of instruments: 1.1.1 Elastic force-measuring instruments, and 1.1.2 Force-multiplying systems, such as balances and small platform scales. Note 1Verification by deadweight loading is also an acceptable method of verifying the force indication of a testing machine. Tolerances for weights for this purpose are given in Practices E 4; methods for calibration of the weights are given in NIST Technical Note 577, Methods of Calibrating Weights for Piston Gages. 1.2 The values stated in SI units are to be regarded as the standard. Other metric and inch-pound values are regarded as equivalent when required. 1.3 This practice is intended for the calibration of static force measuring instruments. It is not applicable for dynamic or high speed force calibrations, nor can the results of calibrations performed in accordance with this practice be assumed valid for...

Combined endoscopic approaches to the cardiac sphincter achalasia treatment

Directory of Open Access Journals (Sweden)

V. N. Klimenko

2015-12-01

Full Text Available Aim. To assess combined endoscopic approaches to the cardiac sphincter achalasia treatment. Results. There are preliminary results of treatment and methods of carrying out of combined endoscopic pneumocardiodilatation and injections of botulotoxin type A ‘Disport’ at achalasia cardia are described in the article. Aethio-pathogenetic aspects in the development of achalasia cardia, action of botulotoxin type A and balloon pneumocardiodilatation of the esophagus, were described. And modern roentgen-endoscopic classification of achalasia cardia was given. Prognostic estimation scale of possibility to implement further combined endoscopic or surgical treatment is defined and is being in subsequent working out. Conclusion. Described clinical cases most brightly demonstrate variety of clinical achalasia cardia manifestations and also determine of the earlier display of surgical treatment.

Contrast-enhanced endoscopic ultrasonography

DEFF Research Database (Denmark)

Reddy, Nischita K; Ioncică, Ana Maria; Săftoiu, Adrian

2011-01-01

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast...... agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder...... cancers and visualization of the portal venous system and esophageal varices. In addition, contrast agents can be used to differentiate pancreatic lesions. The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies. The sensitivity of power Doppler...

Evaluation of flexible endoscope steering using haptic guidance

NARCIS (Netherlands)

Reilink, Rob; Stramigioli, Stefano; Kappers, Astrid M L; Misra, Sarthak

Background: Steering the tip of a flexible endoscope relies on the physician's dexterity and experience. For complex flexible endoscopes, conventional controls may be inadequate. Methods: A steering method based on a multi-degree-of-freedom haptic device is presented. Haptic cues are generated based

Evaluation of flexible endoscope steering using haptic guidance

NARCIS (Netherlands)

Reilink, Rob; Stramigioli, Stefano; Kappers, Astrid M.L.; Misra, Sarthak

2011-01-01

Background - Steering the tip of a flexible endoscope relies on the physician’s dexterity and experience. For complex flexible endoscopes, conventional controls may be inadequate. Methods - A steering method based on a multi-degree-of-freedom haptic device is presented. Haptic cues are generated

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

Science.gov (United States)

Vladimirov, B; Petkov, R; Viiachki, I; Damianov, D; Iarŭmov, N

1996-01-01

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Accidental ingestion of a barbed wire broach and its endoscopic retrieval: Prevention better than cure

Directory of Open Access Journals (Sweden)

Rajashekar Mohan

2011-01-01

Full Text Available Ingestion of instruments is a potential complication that can occur during dental procedures. We report a case of accidental ingestion of an endodontic barbed wire broach during root canal treatment and its subsequent retrieval by endoscopic methods. Although prevention is the best approach, proper management of such an event is also crucial. The objective of this report is to draw attention to the potentially serious complications that can occur if preventive techniques are not practised, and to discuss the accepted guidelines for management of such an event.

Design of signal reception and processing system of embedded ultrasonic endoscope

Science.gov (United States)

Li, Ming; Yu, Feng; Zhang, Ruiqiang; Li, Yan; Chen, Xiaodong; Yu, Daoyin

2009-11-01

Embedded Ultrasonic Endoscope, based on embedded microprocessor and embedded real-time operating system, sends a micro ultrasonic probe into coelom through the biopsy channel of the Electronic Endoscope to get the fault histology features of digestive organs by rotary scanning, and acquires the pictures of the alimentary canal mucosal surface. At the same time, ultrasonic signals are processed by signal reception and processing system, forming images of the full histology of the digestive organs. Signal Reception and Processing System is an important component of Embedded Ultrasonic Endoscope. However, the traditional design, using multi-level amplifiers and special digital processing circuits to implement signal reception and processing, is no longer satisfying the standards of high-performance, miniaturization and low power requirements that embedded system requires, and as a result of the high noise that multi-level amplifier brought, the extraction of small signal becomes hard. Therefore, this paper presents a method of signal reception and processing based on double variable gain amplifier and FPGA, increasing the flexibility and dynamic range of the Signal Reception and Processing System, improving system noise level, and reducing power consumption. Finally, we set up the embedded experiment system, using a transducer with the center frequency of 8MHz to scan membrane samples, and display the image of ultrasonic echo reflected by each layer of membrane, with a frame rate of 5Hz, verifying the correctness of the system.

Endoscopic Management of Bile Leakage after Liver Transplantation

Science.gov (United States)

Oh, Dongwook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

2015-01-01

Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Methods Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. Results In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. Conclusions ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients. PMID:25717048

Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms.

Science.gov (United States)

Yamamoto, Hironori

2007-09-01

Gastrointestinal neoplasms can be cured by local resection as long as the lesions are in the early stage and have not metastasized. Endoscopic resection is a minimally invasive treatment for early-stage gastrointestinal neoplasms, and endoscopic submucosal dissection (ESD) is one type of endoscopic resection that has been developed in the past 10 years. For ESD to be a reliable, curative treatment for gastrointestinal neoplasms, it is necessary for the endoscopist to detect the lesion early, make a precise pretreatment diagnosis, ensure that the patient has the correct indication for endoscopic resection, and have the skill to perform ESD. For early lesion detection, endoscopists should pay attention to subtle changes in the surface structure, the color of the mucosa and the visibility of underlying submucosal vessels. Chromoendoscopy and magnifying endoscopy are useful for determining the margin of the lesions for pretreatment diagnosis, and endoscopic ultrasonography and magnifying endoscopy are useful for determining the depth of invasion. For ESD to be successful, local injection of sodium hyaluronate helps maintain mucosal elevation during dissection. Selecting the appropriate knife, using transparent hoods wisely, employing a good strategy that uses gravity, and having good control of bleeding are all needed to make ESD reliable.

Advances in the endoscopic management of pancreatic collections.

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Ruiz-Clavijo, David; de la Higuera, Belen González; Vila, Juan J

2015-04-16

Treatment of pancreatic collections has experienced great progress in recent years with the emergence of alternative minimally invasive techniques comparing to the classic surgical treatment. Such techniques have been shown to improve outcomes of morbidity vs surgical treatment. The recent emergence of endoscopic drainage is noteworthy. The advent of endoscopic ultrasonography has been crucial for treatment of these specific lesions. They can be characterized, their relationships with neighboring structures can be evaluated and the drainage guided by this technique has been clearly improved compared with the conventional endoscopic drainage. Computed tomography is the technique of choice to characterize the recently published new classification of pancreatic collections. For this reason, the radiologist's role establishing and classifying in a rigorously manner the collections according to the new nomenclature is essential to making therapeutic decisions. Ideal scenario for comprehensive treatment of these collections would be those centers with endoscopic ultrasound and interventional radiology expertise together with hepatobiliopancreatic surgery. This review describes the different types of pancreatic collections: acute peripancreatic fluid collection, pancreatic pseudocysts, acute necrotic collection and walled-off necrosis; the indications and the contraindications for endoscopic drainage, the drainage technique and their outcomes. The integrated management of pancreatic collections according to their type and evolution time is discussed.

[Endoscopic realignment for post-traumatic rupture of posterior urethra].

Science.gov (United States)

Tazi, Hicham; Ouali, Mohammed; Lrhorfi, My Hfid; Moudouni, Saïd; Tazi, Karim; Lakrissa, Ahmed

2003-12-01

To analyse the long-term results of treatment of posterior urethral disruptions with endoscopic realignment, and to assess the efficacy, simplicity and benefit of this technique. Between 1989 and 2001, thirty six patients were treated by endoscopic realignment for traumatic rupture of the posterior urethra. The analysis of the results took in consideration the quality of urinary stream, the continence and the erectile function. With a mean follow-up of thirty four months (12 to 72 months), the 36 patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output. This result was obtained after internal urethrotomy in 13 patients (36.1%), and after transperineal urethroplasty in two patients. Only 7 patients (19.4%) developed an impotence. The endoscopic realignment can be considered like initial treatment of all post-traumatic rupture of the posterior urethra. This simple and little aggressive technique doesn't compromise the recourse to another type of ulterior treatment and resulted in negligible morbidity. The secondary urethral strictures are short and accessible to an endoscopic urethrotomy.

Endoscopic or surgical intervention for painful obstructive chronic pancreatitis.

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Ahmed Ali, Usama; Pahlplatz, Johanna M; Nealon, Wiliam H; van Goor, Harry; Gooszen, Hein G; Boermeester, Marja A

2015-03-19

Endoscopy and surgery are the treatment modalities of choice for patients with chronic pancreatitis and dilated pancreatic duct (obstructive chronic pancreatitis). Physicians face, without clear consensus, the choice between endoscopy or surgery for this group of patients. To assess and compare the effects and complications of surgical and endoscopic interventions in the management of pain for obstructive chronic pancreatitis. We searched the following databases in The Cochrane Library: CENTRAL (2014, Issue 2), the Cochrane Database of Systematic Reviews (2014, Issue 2), and DARE (2014, Issue 2). We also searched the following databases up to 25 March 2014: MEDLINE (from 1950), Embase (from 1980), and the Conference Proceedings Citation Index - Science (CPCI-S) (from 1990). We performed a cross-reference search. Two review authors independently performed the selection of trials. All randomised controlled trials (RCTs) of endoscopic or surgical interventions in obstructive chronic pancreatitis. We included trials comparing endoscopic versus surgical interventions as well as trials comparing either endoscopic or surgical interventions to conservative treatment (i.e. non-invasive treatment modalities). We included relevant trials irrespective of blinding, the number of participants randomised, and the language of the article. We used standard methodological procedures expected by The Cochrane Collaboration. Two authors independently extracted data from the articles. We evaluated the methodological quality of the included trials and requested additional information from study authors in the case of missing data. We identified three eligible trials. Two trials compared endoscopic intervention with surgical intervention and included a total of 111 participants: 55 in the endoscopic group and 56 in the surgical group. Compared with the endoscopic group, the surgical group had a higher proportion of participants with pain relief, both at middle/long-term follow-up (two to

Endoscopical appearances of nonsteroidal anti inflammatory drug (NSAID- enteropathy

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Marcellus Simadibrata

2005-12-01

Full Text Available Non Steroidal Anti Inflammatory Drugs (NSAID have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb. (Med J Indones 2005; 14: 225-9Keywords: NSAID-enteropathy, endoscopical appearances.

Landmark-based augmented reality system for paranasal and transnasal endoscopic surgeries.

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Thoranaghatte, Ramesh; Garcia, Jaime; Caversaccio, Marco; Widmer, Daniel; Gonzalez Ballester, Miguel A; Nolte, Lutz-P; Zheng, Guoyan

2009-12-01

In this paper we present a landmark-based augmented reality (AR) endoscope system for endoscopic paranasal and transnasal surgeries along with fast and automatic calibration and registration procedures for the endoscope. Preoperatively the surgeon selects natural landmarks or can define new landmarks in CT volume. These landmarks are overlaid, after proper registration of preoperative CT to the patient, on the endoscopic video stream. The specified name of the landmark, along with selected colour and its distance from the endoscope tip, is also augmented. The endoscope optics are calibrated and registered by fast and automatic methods. Accuracy of the system is evaluated in a metallic grid and cadaver set-up. Root mean square (RMS) error of the system is 0.8 mm in a controlled laboratory set-up (metallic grid) and was 2.25 mm during cadaver studies. A novel landmark-based AR endoscope system is implemented and its accuracy is evaluated. Augmented landmarks will help the surgeon to orientate and navigate the surgical field. Studies prove the capability of the system for the proposed application. Further clinical studies are planned in near future. Copyright (c) 2009 John Wiley & Sons, Ltd.

Modified endoscopic medial maxillectomy for zygomatic implant salvage.

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Schwartz, Joseph S; Tajudeen, Bobby A; Adappa, Nithin D; Palmer, James N

2016-01-01

Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant.

[Endonasal endoscopic surgery in the treatment of spontaneous or post-traumatic cerebrospinal fluid (csf) leaks].

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Nallet, E; Decq, P; Bezzo, A; Le Lievre, G; Peynegre, R; Coste, A

1998-10-01

The incidence and the risk of meningitidis justify treatment in all cases of cerebrospinal fluid rhinorrhea with spontaneous etiology or after traumatic injury. Endonasal surgery with endoscopic instruments provides many advantages compared with transcranial or transfacial approach used by neurosurgeons. We report our experience and our surgical technique in the treatment of CSF leaks in 5 patients. Intrathecal injection of fluoresceine was very useful in all cases for detecting the CSF leak. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enables detection and repair of CSF leaks from the sphenoid cavity. A free graft of inferior turbinal mucosal was used to repair the breache. This rapid low morbidity surgery offered secure closure of rhinorrhea in 4 cases after one procedure and in 1 case after two procedures with an average follow up of 22 months. Cerebrospinal fluid rhinorrhea can be managed in first line therapy with endoscopic intranasal surgical techniques when they are localized in the anterior ethmoid or in the sphenoid cavity.

Endoscopic Radial Artery Harvest for Coronary Artery Bypass Surgery

Directory of Open Access Journals (Sweden)

Kuan-Ming Chiu

2006-01-01

Conclusion: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

High-Level Disinfection of Otorhinolaryngology Clinical Instruments: An Evaluation of the Efficacy and Cost-effectiveness of Instrument Storage.

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Yalamanchi, Pratyusha; Yu, Jason; Chandler, Laura; Mirza, Natasha

2018-01-01

Objectives Despite increasing interest in individual instrument storage, risk of bacterial cross-contamination of otorhinolaryngology clinic instruments has not been assessed. This study is the first to determine the clinical efficacy and cost-effectiveness of standard high-level disinfection and clinic instrument storage. Methods To assess for cross-contamination, surveillance cultures of otorhinolaryngology clinic instruments subject to standard high-level disinfection and storage were obtained at the start and end of the outpatient clinical workday. Rate of microorganism recovery was compared with cultures of instruments stored in individual peel packs and control cultures of contaminated instruments. Based on historical clinic data, the direct allocation method of cost accounting was used to determine aggregate raw material cost and additional labor hours required to process and restock peel-packed instruments. Results Among 150 cultures of standard high-level disinfected and co-located clinic instruments, 3 positive bacterial cultures occurred; 100% of control cultures were positive for bacterial species ( P cost of individual semicritical instrument storage at $97,852.50 per year. Discussion With in vitro inoculation of >200 otorhinolaryngology clinic instruments, this study demonstrates that standard high-level disinfection and storage are equally efficacious to more time-consuming and expensive individual instrument storage protocols, such as peel packing, with regard to bacterial contamination. Implications for Practice Standard high-level disinfection and storage are equally effective to labor-intensive and costly individual instrument storage protocols.

Nasal and skull base anatomy of endoscopic endonasal transsphenoidal surgery with multi-detector computed tomography

International Nuclear Information System (INIS)

Hasegawa, Yuzo; Saeki, Naokatsu; Murai, Hisayuki; Horiguchi, Kentaro; Hanazawa, Toyoyuki; Okamoto, Miyoshi; Yanagawa, Noriyuki

2008-01-01

The endoscope is a new and highly useful instrument for transphenoidal surgery (TSS), and is generally used because of its minimally invasiveness. In addition, endoscopic transsphenoidal surgey (eTSS) has a potential for more radical tumor removal at the pituitary and the parasellar regions by wider visualization and more powerful illumination. To operate these regions safely, we need to know nasal and skull base anatomy under the endoscope which looks different from images under a microscope. In this paper, we demonstrated nasal and skull base anatomy with multi-detector computed tomography, which was performed in 23 recent patients with pituitary and parasellar legions. In the nasal legion, deviation of nasal septum and deviation of sphenoid ostium are important for endonasal approach of eTSS, and often determine the difficulty of surgery in the nasal cavity. Our study showed that deviation of nasal septum was seen in 26% of patients. Deviation of sphenoid ostium was 5.5±1.5 mm from the midline. The anatomy of sphenoid sinus plays a key role in our determination of the safety of a bony opening of the sella. In addition to sellar, presellar, and concha types, carotid prominence and optic prominence are important to determine the midline orientation. Development of carotid prominence was significantly related to the extent of lateral pneumatization of sphenoid sinus (P=0.0016). Reconstructed 3D-image of sphenoid sinus was very useful in visual understanding skull base anatomy. (author)

Is It Working? Distractor Analysis Results from the Test Of Astronomy STandards (TOAST) Assessment Instrument

Science.gov (United States)

Slater, Stephanie

2009-05-01

The Test Of Astronomy STandards (TOAST) assessment instrument is a multiple-choice survey tightly aligned to the consensus learning goals stated by the American Astronomical Society - Chair's Conference on ASTRO 101, the American Association of the Advancement of Science's Project 2061 Benchmarks, and the National Research Council's National Science Education Standards. Researchers from the Cognition in Astronomy, Physics and Earth sciences Research (CAPER) Team at the University of Wyoming's Science and Math Teaching Center (UWYO SMTC) have been conducting a question-by-question distractor analysis procedure to determine the sensitivity and effectiveness of each item. In brief, the frequency each possible answer choice, known as a foil or distractor on a multiple-choice test, is determined and compared to the existing literature on the teaching and learning of astronomy. In addition to having statistical difficulty and discrimination values, a well functioning assessment item will show students selecting distractors in the relative proportions to how we expect them to respond based on known misconceptions and reasoning difficulties. In all cases, our distractor analysis suggests that all items are functioning as expected. These results add weight to the validity of the Test Of Astronomy STandards (TOAST) assessment instrument, which is designed to help instructors and researchers measure the impact of course-length duration instructional strategies for undergraduate science survey courses with learning goals tightly aligned to the consensus goals of the astronomy education community.

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

Science.gov (United States)

Kamel, Reda H; Abdel Fattah, Ahmed F; Awad, Ayman G

2014-12-01

Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

Direct cost comparison of totally endoscopic versus open ear surgery.

Science.gov (United States)

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Does endoscopic ultrasound improve detection of locally recurrent anal squamous-cell cancer?

Science.gov (United States)

Peterson, Carrie Y; Weiser, Martin R; Paty, Philip B; Guillem, Jose G; Nash, Garrett M; Garcia-Aguilar, Julio; Patil, Sujata; Temple, Larissa K

2015-02-01

Evaluating patients for recurrent anal cancer after primary treatment can be difficult owing to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown. The aim of this study is to compare the effectiveness of digital rectal examination and endoscopic ultrasound in detecting locally recurrent disease during routine follow-up of patients with anal cancer. This study is a retrospective, single-institution review. This study was conducted at an oncologic tertiary referral center. Included were 175 patients with nonmetastatic anal squamous-cell cancer, without persistent disease after primary chemoradiotherapy, who had at least 1 posttreatment ultrasound and examination by a colorectal surgeon. The primary outcomes measured were the first modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value. Eight hundred fifty-five endoscopic ultrasounds and 873 digital rectal examinations were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital examination detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital examination. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital examination in detecting recurrent disease was fair at 0.37 (SE, 0.08; 95% CI, 0.21-0.54), and there was no difference in crude cancer detection rate, sensitivity, specificity, and negative or positive predictive values. The heterogeneity of follow-up timing and examinations is not standardized in this study but is reflective of general practice. Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for

New flexible endoscope for otologic application

Science.gov (United States)

Marchan, Mark L.

1993-07-01

Endoscopy has become an important procedure in many medical specialties. For the Otologist, however, space limitations within the ear have restricted development of endoscopic procedures. The desire for minimally invasive techniques in Otology has demonstrated itself through the work of numerous physicians who have performed procedures ranging from diagnostic inspection of the middle ear to viewing the interior of the cochlea. To assist in performing such endoscopic procedures, Xomed-Treace has developed a line of flexible fiberoptic endoscopes for use by the Otologist. These scopes combine illumination and imaging fiber bundles within a small diameter unit ranging in size from 0.8 mm to 1.2 mm. The 1.2 mm scope is produced with an angled, rigid stainless steel sheath. The 0.8 mm scope is flexible with the ability to articulate 120 degree(s) in one direction. The fiberscopes have been designed for the Otologist to produce a good resolution image while allowing ease of operation through ergonomics and consideration of the surgical anatomy.

21 CFR 876.4300 - Endoscopic electrosurgical unit and accessories.

Science.gov (United States)

2010-04-01

... Endoscopic electrosurgical unit and accessories. (a) Identification. An endoscopic electrosurgical unit and... device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self...

Endoscopic removal of over-the-scope clips: Clinical experience with a bipolar cutting device

Science.gov (United States)

Meier, Benjamin; Caca, Karel; Schmidt, Arthur

2016-01-01

Background Over-the-scope clips (OTSCs) are increasingly used for the closure of perforations/fistulae, hemostasis and endoscopic full-thickness resection (FTRD system). When OTSC-associated complications occur or re-therapy at the OTSC site is needed, OTSC removal may be indicated. An experimental study in an animal model and a case series have shown good results for OTSC removal with a bipolar cutting device. We present a larger clinical study using this device. Methods Data of all consecutive patients with indication for OTSC removal were collected and analyzed retrospectively. OTSCs were cut at two opposing sites using a bipolar grasping device to apply short direct current impulses. OTSC fragments were extracted with a standard forceps and a cap at the tip of the endoscope to avoid tissue damage. Results Between December 2012 and February 2016 a total of 42 OTSC removals in the upper (n = 25) and lower (n = 17) gastrointestinal tract have been performed at our department. Overall technical success, defined as cutting the OTSC at two opposing sites and extraction of both fragments, was achieved in 92.9% (39/42) of all cases. Successful fragmentation of the OTSC was achieved in 97.6% (41/42). Minor bleedings were rare and could be managed endoscopically in all cases. There were no perforations and no major or delayed bleedings. Conclusion Endoscopic OTSC removal with a bipolar cutting device is feasible, effective and safe. This technique can be applied in the upper and lower gastrointestinal tract. PMID:28588877

Novel biomarkers and endoscopic techniques for diagnosing pancreaticobiliary malignancy [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Margaret G Keane

2017-09-01

Full Text Available The UK incidence of pancreatic ductal adenocarcinoma is 9 per 100,000 population, and biliary tract cancer occurs at a rate of 1–2 per 100,000. The incidence of both cancers is increasing annually and these tumours continue to be diagnosed late and at an advanced stage, limiting options for curative treatment. Population-based screening programmes do not exist for these cancers, and diagnosis currently is dependent on symptom recognition, but often symptoms are not present until the disease is advanced. Recently, a number of promising blood and urine biomarkers have been described for pancreaticobiliary malignancy and are summarised in this review. Novel endoscopic techniques such as single-operator cholangioscopy and confocal endomicroscopy have been used in some centres to enhance standard endoscopic diagnostic techniques and are also evaluated in this review.

The application of wedge type compensation filter for uniform density on the endoscopic retrograde pancreatography

International Nuclear Information System (INIS)

Son, Soon Yong; Lee, Hee Jeong; Lee, Won Hong; Cho, Cheong Chan; Ryu, Meung Sun; Jung, Hong Ryang

2001-01-01

Over-density of pancreatic duct tail part on the endoscopic retrograde pancreatogram results from patient's position and inserted air during the study. The aim of this paper is to decide the filter angle to obtain an uniform density. Endoscopic retrograde pancratography was performed to 234 patients, and angled wedge filter was used differently. They are 10 deg (47), 20 deg (45), 30 deg (50). We also did not use wedge filter to 42 patients. We decided reliance degree in 95%. The statistical difference was p<0.05. The patients' sex rate was 1.8:1 between 18 and 87 years old(average age 58 years). Their body girth was 18.71 cm on the average. Of total 234 patients, difference of right and left average density was 0.01 by 30 deg wedge filter, -0.08 40 deg wedge filter and 0.27 non-wedge filter. These average values of difference density were very significant statistically, and standard deviation also was close to regular distribution. In conclusion, there is a usefulness of angled wedge filter for increasing diagnostic value of pancreatic duct tail part on the endoscopic retrograde pancreatogram

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

Science.gov (United States)

Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

2017-01-01

Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

Implementation of remote video auditing with feedback and compliance for manual-cleaning protocols of endoscopic retrograde cholangiopancreatography endoscopes.

Science.gov (United States)

Armellino, Donna; Cifu, Kelly; Wallace, Maureen; Johnson, Sherly; DiCapua, John; Dowling, Oonagh; Jacobs, Mitchel; Browning, Susan

2018-05-01

A pilot initiative to assess the use of remote video auditing in monitoring compliance with manual-cleaning protocols for endoscopic retrograde cholangiopancreatography (ERCP) endoscopes was performed. Compliance with manual-cleaning steps following the initiation of feedback was measured. A video feed of the ERCP reprocessing room was provided to remote auditors who scored items of an ERCP endoscope manual-cleaning checklist. Compliance feedback was provided in the form of reports and reeducation. Outcomes were reported as checklist compliance. The use of remote video auditing to document manual processing is a feasible approach and feedback and reeducation increased manual-cleaning compliance from 53.1% (95% confidence interval, 34.7-71.6) to 98.9% (95.0% confidence interval, 98.1-99.6). Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Endoscopic treatment of esophageal achalasia.

Science.gov (United States)

Esposito, Dario; Maione, Francesco; D'Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D

2016-01-25

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.

Endoscopic treatment of esophageal achalasia

Science.gov (United States)

Esposito, Dario; Maione, Francesco; D’Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D

2016-01-01

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies. PMID:26839644

Microfluidic cartridges for DNA purification and genotyping processed in standard laboratory instruments

Science.gov (United States)

Focke, Maximilian; Mark, Daniel; Stumpf, Fabian; Müller, Martina; Roth, Günter; Zengerle, Roland; von Stetten, Felix

2011-06-01

Two microfluidic cartridges intended for upgrading standard laboratory instruments with automated liquid handling capability by use of centrifugal forces are presented. The first microfluidic cartridge enables purification of DNA from human whole blood and is operated in a standard laboratory centrifuge. The second microfluidic catridge enables genotyping of pathogens by geometrically multiplexed real-time PCR. It is operated in a slightly modified off-the-shelf thermal cycler. Both solutions aim at smart and cost-efficient ways to automate work flows in laboratories. The DNA purification cartridge automates all liquid handling steps starting from a lysed blood sample to PCR ready DNA. The cartridge contains two manually crushable glass ampoules with liquid reagents. The DNA yield extracted from a 32 μl blood sample is 192 +/- 30 ng which corresponds to 53 +/- 8% of a reference extraction. The genotyping cartridge is applied to analyse isolates of the multi-resistant Staphyloccus aureus (MRSA) by real-time PCR. The wells contain pre-stored dry reagents such as primers and probes. Evaluation of the system with 44 genotyping assays showed a 100% specificity and agreement with the reference assays in standard tubes. The lower limit of detection was well below 10 copies of DNA per reaction.

Computer-aided recording of automatic endoscope washing and disinfection processes as an integral part of medical documentation for quality assurance purposes

Directory of Open Access Journals (Sweden)

Klein Stefanie

2010-07-01

Full Text Available Abstract Background The reprocessing of medical endoscopes is carried out using automatic cleaning and disinfection machines. The documentation and archiving of records of properly conducted reprocessing procedures is the last and increasingly important part of the reprocessing cycle for flexible endoscopes. Methods This report describes a new computer program designed to monitor and document the automatic reprocessing of flexible endoscopes and accessories in fully automatic washer-disinfectors; it does not contain nor compensate the manual cleaning step. The program implements national standards for the monitoring of hygiene in flexible endoscopes and the guidelines for the reprocessing of medical products. No FDA approval has been obtained up to now. The advantages of this newly developed computer program are firstly that it simplifies the documentation procedures of medical endoscopes and that it could be used universally with any washer-disinfector and that it is independent of the various interfaces and software products provided by the individual suppliers of washer-disinfectors. Results The computer program presented here has been tested on a total of four washer-disinfectors in more than 6000 medical examinations within 9 months. Conclusions We present for the first time an electronic documentation system for automated washer-disinfectors for medical devices e.g. flexible endoscopes which can be used on any washer-disinfectors that documents the procedures involved in the automatic cleaning process and can be easily connected to most hospital documentation systems.

Feasibility of adapting the fundamentals of laparoscopic surgery trainer box to endoscopic skills training tool.

Science.gov (United States)

Crespin, Oscar M; Okrainec, Allan; Kwong, Andrea V; Habaz, Ilay; Jimenez, Maria Carolina; Szasz, Peter; Weiss, Ethan; Gonzalez, Cecilia G; Mosko, Jeffrey D; Liu, Louis W C; Swanstrom, Lee L; Perretta, Silvana; Shlomovitz, Eran

2018-06-01

The fundamentals of laparoscopic surgery (FLS) training box is a validated tool, already accessible to surgical trainees to hone their laparoscopic skills. We aim to investigate the feasibility of adapting the FLS box for the practice and assessment of endoscopic skills. This would allow for a highly available, reusable, low-cost, mechanical trainer. The design and development process was based on a user-centered design, which is a combination of the design thinking method and cognitive task analysis. The process comprises four phases: empathy, cognitive, prototyping/adaptation, and end user testing. The underlying idea was to utilize as many of the existing components of FLS training to maintain simplicity and cost effectiveness while allowing for the practice of clinically relevant endoscopic skills. A sample size of 18 participants was calculated to be sufficient to detect performance differences between experts and trainees using a two tailed t test with alpha set at 0.05, standard deviation of 5.5, and a power of 80%. Adaptation to the FLS box included two fundamental attachments: a front panel with an insertion point for an endoscope and a shaft which provides additional support and limits movement of the scope. The panel also allows for mounting of retroflexion tasks. Six endoscopic tasks inspired by FLS were designed (two of which utilize existing FLS components). Pilot testing with 38 participants showed high user's satisfaction and demonstrated that the trainer was robust and reliable. Task performance times was able to discriminate between trainees and experts for all six tasks. A mechanical, reusable, low-cost adaptation of the FLS training box for endoscopic skills is feasible and has high user satisfaction. Preliminary testing shows that the simulator is able to discriminate between trainees and experts. Following further validation, this adaptation may act as a supplement to the FES program.

Surgical stress response: does endoscopic surgery confer an advantage?

DEFF Research Database (Denmark)

Kehlet, H

1999-01-01

of postoperative pulmonary function and less hypoxemia with endoscopic operation. The slight modification of surgical stress responses by endoscopic surgery is in contrast to the common, though not universal, demonstration of less pain, shorter hospital stay, and less morbidity after endoscopic surgery...... operations where differences are more likely to be found. The clinical consequences of these findings in relation to all over surgical outcome remain to be defined, but effective pain treatment, stress reduction by other techniques, and provision of an active rehabilitation program with early mobilization...

Effect of endoscopic brow lift on contractures and synkinesis of the facial muscles in patients with a regenerated postparalytic facial nerve syndrome.

Science.gov (United States)

Bran, Gregor M; Börjesson, Pontus K E; Boahene, Kofi D; Gosepath, Jan; Lohuis, Peter J F M

2014-01-01

Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the postparalytic facial nerve syndrome. The authors present an alternative surgical approach for improvement of periocular movement disorders in patients with postparalytic facial nerve syndrome. The authors proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input. Eleven patients (seven women and four men) with a mean age of 54 years (range, 33 to 85 years) and with postparalytic facial nerve syndrome underwent endoscopic brow lift under general anesthesia. Patients' preoperative condition was compared with their postoperative condition using a retrospective questionnaire. Subjects were also asked to compare the therapeutic effectiveness of endoscopic brow lift and botulinum toxin type A. Mean follow-up was 52 months (range, 22 to 83 months). No intraoperative or postoperative complications occurred. During follow-up, patients and physicians observed an improvement of periorbital contractures and oculofacial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when botulinum toxin type A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect. These findings suggest endoscopic brow lift as a promising additional treatment modality for the treatment of periocular postparalytic facial nerve syndrome-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical botulinum toxin type A administration could become a new therapeutic standard.

Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation

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Ismail, Mostafa

2016-06-01

Full Text Available Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing.Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome.Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages

“Lock-in” effect of emission standard and its impact on the choice of market based instruments

International Nuclear Information System (INIS)

Haoqi, Qian; Libo, Wu; Weiqi, Tang

2017-01-01

A country's existing emission standard policy will lead to a “lock in” effect. When the country plans to adopt new market-based instruments to control greenhouse gas emissions, it must consider this effect as it chooses among instruments to avoid larger efficiency loss. In this paper, we find that the “lock in” effect will cause a kink point to occur on the marginal abatement cost (MAC) curve. This change of shape for the MAC curve reminds us to be cautious in choosing market-based instruments when applying Weitzman's rule. We also introduce this concept into a dynamic multi-regional computable general equilibrium (CGE) model for China and simulate MAC curves for all regions. After applying Weitzman's rule, we propose a timeline for introducing price instruments under different marginal benefit (MB) curve scenarios. - Highlights: • China's existing carbon intensity policy has a “lock-in” effect and leads to a “kink point” on MAC. • A dynamic inter-regional CGE model is developed to simulate the regional kinked MAC curves in China. • A timeline of introducing new market based instrument is proposed by combining different MB scenarios.

Temporary endoscopic metallic stent for idiopathic esophageal achalasia.

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Coppola, Franco; Gaia, Silvia; Rolle, Emanuela; Recchia, Serafino

2014-02-01

Idiopathic achalasia is a motor disorder of the esophagus of unknown etiology caused by loss of motor neurons determining an altered motility. It may determine severe symptoms such as progressive dysphagia, regurgitations, and pulmonary aspirations. Many therapeutic options may be offered to patients with achalasia, from surgery to endoscopic treatments such as pneumatic dilation, botulinum injection, peroral endoscopic myotomy, or endoscopic stenting. Recently, temporary placement of a stent was proposed by Cheng as therapy for achalasia disorders, whereas no Western authors have dealt with it up to date. The present study reports our preliminary experience in 7 patients with achalasia treated with a temporary stent. Partially covered self-expanding metallic stents (Micro-Tech, Nanjin, China) 80 mm long and 30 mm wide were placed under fluoroscopic control and removed after 6 days. Clinical follow-up was scheduled to check endoscopic success, symptoms release, and complications. The placement and the removal of the stents were obtained in all patients without complications. Mean clinical follow-up was 19 months. Five out of 7 patients referred total symptoms release and 2 experienced significant improvement of dysphagia. The procedure was not time consuming and was safe; no mild or severe complications were registered. In conclusion, our results may suggest a possible safe and effective endoscopic alternative treatment in patients with achalasia; however, further larger studies are necessary to confirm these promising, but very preliminary, data.

Anatomic structural study of cerebellopontine angle via endoscope

Institute of Scientific and Technical Information of China (English)

XIA Yin; LI Xi-ping; HAN De-min; ZHENG Jun; LONG Hai-shan; SHI Jin-feng

2007-01-01

Background Minimally invasive surgery in skull base relying on searching for possible anatomic basis for endoscopic technology is controversial. The objective of this study was to observe the spatial relationships between main blood vessels and nerves in the cerebellopontine angle area and provide anatomic basis for lateral and posterior skull base minimally invasive surgery via endoscopic retrosigmoid keyhole approach.Methods This study was conducted on thirty dried adult skulls to measure the spatial relationships among the surface bony marks of posterior cranial fossa, and to locate the most appropriate drilling area for retrosigmoid keyhole approach.In addition, we used 10 formaldehyde-fixed adult cadaver specimens for simulating endoscopic retrosigmoid approach to determine the visible scope.Results The midpoint between the mastoid tip and the asterion was the best drilling point for retrosigmoid approach. A hole centered on this point with the 2.0 cm in diameter was suitable for exposing the related structures in the cerebellopontine angle. Retrosigmoid keyhole approach can decrease the pressure on the cerebellum and expose the related structures effectively which include facial nerve, vestibulocochlear nerve, trigeminal nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, hypoglossal nerve, anterior inferior cerebellar artery, posterior inferior cerebellar artery and labyrinthine artery, etc.Conclusions Exact location on endoscope retrosigmoid approach can avoid dragging cerebellum during the minimally invasive surgery. The application of retrosigmoid keyhole approach will extend the application of endoscopic technology.

Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

Science.gov (United States)

Lee, J H; Kim, B K; Seol, D C; Byun, S J; Park, K H; Sung, I K; Park, H S; Shim, C S

2013-06-01

Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible. © Georg Thieme Verlag KG Stuttgart · New York.

Crack detection with an eddy-current probe integrated into an endoscope

International Nuclear Information System (INIS)

Elfinger, F.X.

1982-01-01

Objective and quantitive crack detection in inaccessible machine internals is possible without dismantling the equipment through the combination of endoscopic and eddy-current techniques, whereby the endoscope is used both as an optical and a mechanical manipulator. Thus the availability of machinery can be increased and the overhaul costs lowered. The integrated endoscope/eddy-current probe should be utilised whenever normal endoscopic inspection indicates a possible crack location which cannot be assessed definitively through visual observation alone. Its use is also advantageous in monitoring crack propagation within a component. (orig.) [de

Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions

Directory of Open Access Journals (Sweden)

Konda VJA

2011-11-01

Full Text Available Vani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett's esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett's esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett's segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett's esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett's epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett's esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett's esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.Keywords: Barrett's esophagus, high

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Institute of Scientific and Technical Information of China (English)

Kazuto Kishimoto; Akira Hokama; Tetsuo Hirata; Yasushi Ihama; Manabu Nakamoto; Nagisa Kinjo; Fukunori Kinjo; Jiro Fujita

2008-01-01

AIM: To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (5. stercoralis) hyperinfection.METHODS: Over a period of 23 years (1984-2006), we investigated 25 patients with 5. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively.RESULTS: Twenty-four (96%) of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P ＜ 0.05).CONCLUSION: Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that 5. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

Instrumental charged-particle activation analysis of several selected elements in biological materials using the internal standard method

International Nuclear Information System (INIS)

Yagi, M.; Masumoto, K.

1987-01-01

In order to study instrumental charged-particle activation analysis using the internal standard method, simultaneous determinations of several selected elements such as Ca, Ti, V, Fe, Zn, As, Sr, Zr and Mo, in oyster tissue, brewer's yeast and mussel were carried out by using the respective (p, n) reactions and a personal computer-based gamma-ray spectrometer equipped with a micro-robot for sample changing. In the determination constant amounts of Y and La were added to the sample and comparative standard as exotic internal standards. As a result, it was demonstrated that concentrations of the above elements could be determined accurately and precisely. (author)

Endoscopic treatment of early colorectal cancer – just a competition with surgery?

Directory of Open Access Journals (Sweden)

Ebigbo Alanna

2017-11-01

Full Text Available The endoscopic treatment of cancerous and precancerous lesions in the gastrointestinal (GI tract has experienced major breakthroughs in the past years. Endoscopic mucosal resection (EMR is a simple and efficient method for the treatment of most benign lesions in the GI tract. However, with the introduction of endoscopic submucosal dissection (ESD and endoscopic full-thickness resection (EFTR, the scope of lesions eligible for endoscopic treatment has been widened significantly even in the colon. These methods are now being used routinely not just for the treatment of benign lesions but also in the curative en bloc resection of early colorectal cancers. The quick, efficient, and noninvasive character of these endoscopic procedures make them not just an alternative to surgery but, in many cases, the methods of choice for the treatment of most early colon cancers and some rectal cancers.

Transsphenoidal surgery for pituitary tumors from microsurgery to the endoscopic surgery. Single surgeon's experience

International Nuclear Information System (INIS)

Iwai, Yoshiyasu; Yoshimura, Masaki; Terada, Aiko; Yamanaka, Kazuhiro; Koshimo, Naomi

2011-01-01

We reviewed results of the surgical outcome of pituitary tumors treated via the transsphenoidal approach between January, 1994 and January, 2010 at our institution. This data included 100 patients (124 procedures) treated through the sublabial transsphenoidal approach and 45 patients (54 procedures) treated through the endoscopic endonasal (bilateral nostrils) transsphenoidal approach performed by a single surgeon. The extent of tumor removal was significantly improved with endoscopic surgery; adjuvant gamma knife radiosurgery was needed for 65% of patients undergoing microsurgery vs. 30% for patients who had endoscopic surgery (p<0.0001). Patients who underwent endoscopic surgery had less intraoperative blood loss (mean volume: 100 mL for microsurgery patients vs. 30 mL for endoscopic surgery patients, p<0.0001), less pain, and less need for postoperative hormone replacement therapy (19% for microsurgery patients vs. 6% for endoscopic surgery patients; p<0.05). Cerebrospinal fluid (CSF) leakage and meningitis were experienced in one microsurgery patient (1%) and one endoscopic surgery patient (2.2%). Endoscopic surgery is a reasonable alternative to microsurgery and our experience supports the concept that an otolaryngologist/neurosurgeon team skilled in endoscopic techniques and pituitary surgery can safely make the transition from microsurgery to endoscopic surgery. (author)

The Efficacy of Endoscopic Palliation of Obstructive Jaundice in Hepatocellular Carcinoma

Science.gov (United States)

Park, Semi; Park, Jeong Youp; Chung, Moon Jae; Chung, Jae Bock; Park, Seung Woo; Han, Kwang-Hyub; Song, Si Young

2014-01-01

Purpose Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention. Materials and Methods From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks. Results Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1±5.3 mg/dL vs. 23.1±10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p≤0.001). Conclusion Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC. PMID:25048484

Endoscopic and minimally-invasive ear surgery: A path to better outcomes

Directory of Open Access Journals (Sweden)

Natasha Pollak

2017-09-01

Full Text Available The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.

Endoscopic Surgery for Traumatic Acute Subdural Hematoma

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Hiroyuki Kon

2014-01-01

Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly.

Science.gov (United States)

Kim, Jung Hee; Hur, Kyu Yeon; Lee, Jung Hyun; Lee, Ji Hyun; Se, Young-Bem; Kim, Hey In; Lee, Seung Hoon; Nam, Do-Hyun; Kim, Seong Yeon; Kim, Kwang-Won; Kong, Doo-Sik; Kim, Yong Hwy

2017-08-01

Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea. We enrolled 134 patients with acromegaly (microadenomas, n = 15; macroadenomas, n = 119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n = 74) and Samsung Medical Center (n = 60) between January 2009 and March 2016. Remission was defined as having a normal insulin-like growth factor-1 and a suppressed growth hormone (GH) surgery, normal pituitary function was maintained in 34 patients (25.4%). Sixty-four patients (47.7%) presented complete (n = 59, 44.0%) or incomplete (n = 5, 3.7%) recovery of pituitary function. Hypopituitarism persisted in 20 patients (14.9%) and worsened in 16 patients (11.9%). Postoperatively, transient diabetes insipidus was reported in 52 patients (38.8%) but only persisted in 2 patients (1.5%). Other postoperative complications were epistaxis (n = 2), cerebral fluid leakage (n = 4), infection (n = 1), and intracerebral hemorrhage (n = 1). Endoscopic transsphenoidal surgery for acromegaly presented high remission rates and a low incidence of endocrine deficits and complications. Regardless of surgical techniques, invasive pituitary tumors were associated with poor outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

[Diagnostic utility of endoscopic ultrasonography elastography and contrast-enhanced harmonic endoscopic ultrasonography in a patient with type 2 autoimmune pancreatitis].

Science.gov (United States)

Yokode, Masataka; Shiomi, Hideyuki; Itai, Ryosuke; Mikami, Sakae; Yamashita, Yukimasa; Nakano, Ryota; Ezaki, Takeshi; Masuda, Atsuhiro; Zen, Yoh

2018-01-01

A referring hospital diagnosed a 57-year-old man with a pancreatic head mass. The initial endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) was inconclusive because of the small sample size. Endoscopic ultrasonography elastography (EUS-EG) and contrast-enhanced harmonic endoscopic ultrasonography (CE-EUS), conducted at our institute, raised the possibility of mass-forming pancreatitis or autoimmune pancreatitis (AIP). A repeat EUS-FNA revealed inflammatory changes, including a neutrophilic duct injury suggestive of type 2 AIP. The pancreatic lesion responded well to the steroid therapy. The present case suggests that EUS-EG and CE-EUS may be useful for diagnostic exclusion of pancreatic cancers, and the combined use of EUS-EG and CE-EUS, with EUS-FNA, may help characterize inflammatory pancreatic lesions.

FUNCTIONAL RESULTS OF ENDOSCOPIC EXTRAPERITONEAL RADICAL INTRAFASCIAL PROSTATECTOMY

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D. V. Perlin

2014-01-01

Full Text Available Introduction. Endoscopic radical prostatectomy is a highly effective treatment for localized prostate cancer. Intrafascial prostate dissection ensures early recovery of urine continence function and erectile function. This article sums up our own experience of performing intrafascial endoscopic prostatectomy.Materials and methods. 25 patients have undergone this procedure. 12 months after surgery 88.2 % of the patients were fully continent, 11.7 % had symptoms of minimal stress urinary incontinence. We encountered no cases of positive surgical margins and one case of bio-chemical recurrence of the disease.Conclusion. Oncologically, intrafascial endoscopic radical prostatectomy is as effective as other modifications of radical prostatectomy and has the benefits of early recovery of urine continence function and erectile function. 

[Endoscopic assistance in surgery of cerebellopontine angle tumors].

Science.gov (United States)

Poshataev, V K; Shimansky, V N; Tanyashin, S V; Karnaukhov, V V

2014-01-01

During the period of 2010-2012, 33 patients with cerebellopontine angle tumors were operated on at the Burdenko Neurosurgical Institute (Moscow, Russia) using different types of endoscopic assistance. All patients were operated on via the retrosigmoid suboccipital approach in semi-sitting and prone positions. 30° and 70° endoscopes were used during the surgery. Endoscopic assistance allowed us to increase the completeness of tumor removal and to reduce the risk of postoperative complications by retaining the anatomic integrity of cranial nerves and vascular structures in the base of the posterior cranial fossa. These benefits made it possible to maintain and improve quality of life in patients with CPA tumors in the postoperative period.

Non-Exposure, Device-Assisted Endoscopic Full-thickness Resection.

Science.gov (United States)

Bauder, Markus; Schmidt, Arthur; Caca, Karel

2016-04-01

Recent developments have expanded the frontier of interventional endoscopy toward more extended resections following surgical principles. This article presents two new device-assisted techniques for endoscopic full-thickness resection in the upper and lower gastrointestinal tract. Both methods are nonexposure techniques avoiding exposure of gastrointestinal contents to the peritoneal cavity by a "close first-cut later" principle. The full-thickness resection device is a novel over-the-scope device designed for clip-assisted full-thickness resection of colorectal lesions. Endoscopic full-thickness resection of gastric subepithelial tumors can be performed after placing transmural sutures underneath the tumor with a suturing device originally designed for endoscopic antireflux therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Performance specifications for health physics instrumentation: portable instrumentation for use in normal work environments. Part 2. Test results

International Nuclear Information System (INIS)

Kenoyer, J.L.; Swinth, K.L.; Stoetzel, G.A.; Selby, J.M.

1986-09-01

The Pacific Northwest Laboratory evaluated a draft American National Standards Institute Standard N42.17 (ANSI N42.17) on performance specifications for health physics instrumentation through a project jointly funded by the US Department of Energy and the US Nuclear Regulatory Commission. The evaluation involved testing a representative cross section of instruments against criteria in the standard. This report presents results of the testing program. A brief history of the project is included in the introduction. The instrumentation tested is described in general terms (i.e., types, ranges); however, no direct relationship between the results and a specific instrument model is made in this report. Testing requirements in ANSI N42.17D4, Revision 1 (May 1985) are summarized and the methods by which the tests are performed are discussed. Brief descriptions of the testing equipment are included in the methods section of the report. More detailed information about the draft standard, testing requirements and procedures, and the test equipment is included in ''Performance Specifications for Health Physics Instrumentation - Portable Instrumentation for Use in Normal Work Environments, Part 1: Manual of Testing Procedures.'' Results of testing are given in two formats: test-by-test and instrument-by-instrument. Discussion is included on significant and interesting findings, on comparisons of results from the same type of instruments from same and different manufacturers, and on data grouped by manufacturer. Conclusions are made on the applicability and practicality of the proposed standard and on instrument performance. Changes that have been made to the proposed standard based on findings of the testing program are listed and discussed. 22 refs., 11 figs., 77 tabs

Endoscopic facial skeletal surgery using a neuronavigator.

Science.gov (United States)

Sakai, Y; Kobayashi, S; Watanabe, E; Sekiya, S; Ohmori, K

1996-09-01

In the reconstruction of asymmetrical deformities of the facial skeleton, both an endoscope and a neuronavigator have been used. The endoscope allows the surgeon a wide view of the object on a television monitor, reduces the scarring, minimizes the undermined field, and reduces the need to work blind. The neuronavigator is a frameless computed tomographic stereotactic device that has been mainly used in neurosurgery. The device is easy to use and can offer the surgeon three-dimensional coordinates of the status during the operation. We have used this new technique in three clinical cases, two involving augmentation of the zygomatic bone on one side and one involving reduction of the frontal bone on one side. The surgical techniques we used and the versatility of both the endoscope and the neuronavigator are discussed herein based on our own experience.

ENDOSCOPIC ENUCLEATION OF THE PROSTATE – A NEW STANDARD IN SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Directory of Open Access Journals (Sweden)

D. V. Enikeev

2017-01-01

Full Text Available The latest guideline of the European Association of Urology (2016 for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH.Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium of the prostate according to the literature data and own observations.Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP, 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP. All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS, patients’ quality of life (QoL, peak flow rate (Qmax, and residual urine volume prior to surgery and 1 month after it.Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections.

Science.gov (United States)

Seewald, Stefan; Ang, Tiing Leong; Richter, Hugo; Teng, Karl Yu Kim; Zhong, Yan; Groth, Stefan; Omar, Salem; Soehendra, Nib

2012-01-01

To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%). Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections. © 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.

Endoscopic lesions in Crohn's disease early after ileocecal resection

NARCIS (Netherlands)

Tytgat, G. N.; Mulder, C. J.; Brummelkamp, W. H.

1988-01-01

Fifty patients with Crohn's disease were studied endoscopically 6 weeks to 6 months (median 9 weeks) after ileocecal or ileocolonic resection for evidence of non-resected abnormality. Only 8 of the 50 patients were endoscopically free of abnormalities. Microscopic examination of the surgical

Transaxillary Endoscopic Breast Augmentation

Directory of Open Access Journals (Sweden)

Hyung-Bo Sim

2014-09-01

Full Text Available The axillary technique is the most popular approach to breast augmentation among Korean women. Transaxillary breast augmentation is now conducted with sharp electrocautery dissection under direct endoscopic vision throughout the entire process. The aims of this method are clear: both a bloodless pocket and a sharp non-traumatic dissection. Round textured or anatomical cohesive gel implants have been used to make predictable well-defined inframammary creases because textured surface implants demonstrated a better stability attributable to tissue adherence compared with smooth surface implants. The axillary endoscopic technique has greatly evolved, and now the surgical results are comparable to those with the inframammary approach. The author feels that this technique is an excellent choice for young patients with an indistinct or absent inframammary fold, who do not want a scar in the aesthetic unit of their chest.

[GERD: endoscopic antireflux therapies].

Science.gov (United States)

Caca, K

2006-08-02

A couple of minimally-invasive, endoscopic antireflux procedures have been developed during the last years. Beside endoscopic suturing these included injection/implantation technique of biopolymers and application of radiofrequency. Radiofrequency (Stretta) has proved only a very modest effect, while implantation techniques have been abandoned due to lack of long-term efficacy (Gatekeeper) or serious side effects (Enteryx). While first generation endoluminal suturing techniques (EndoCinch, ESD) demonstrated a proof of principle their lack of durability, due to suture loss, led to the development of a potentially durable transmural plication technique (Plicator). In a prospective-randomized, sham-controlled trial the Plicator procedure proved superiority concerning reflux symptoms, medication use and esophageal acid exposure (24-h-pH-metry). While long-term data have to be awaited to draw final conclusions, technical improvements will drive innovation in this field.

An unusual experience with endoscopic retrograde cholangiopancreatography

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Mallikarjun Patil

2013-01-01

Full Text Available The endoscopic retrograde cholangiopancreatography (ERCP is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

Importance of radiographic monitoring of endoscopic sphincterotomy

International Nuclear Information System (INIS)

Greenberg, H.M.; Goldberg, H.I.; Shapiro, H.A.

1981-01-01

The radiographic features of endoscopic sphincterotomies performed in 44 patients were evaluated. Radiographic landmarks aided in proper sphincterotome placement and also disclosed conditions and anatomic variations that made catheter placement difficult. Fluoroscopic and radiographic monitoring not only assisted the performance of endoscopic sphincterotomy, but also confirmed successful results and revealed reasons for failure. Radiographic changes in the biliary tract after sphincterotomy, as well as potential complications of sphincterotomy, are discussed and illustrated

Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice

DEFF Research Database (Denmark)

Andersen, J R; Sørensen, S M; Kruse, A

1989-01-01

In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangi......In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic...... in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass....

Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy.

Science.gov (United States)

Lee, Doh Young; Baek, Seung-Kuk; Jung, Kwang-Yoon

2017-01-01

This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.

Endoscopic management of posterior epistaxis.

Science.gov (United States)

Paul, J; Kanotra, Sohit Paul; Kanotra, Sonika

2011-04-01

The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.

The clinical and endoscopic spectrum of the watermelon stomach

NARCIS (Netherlands)

Gostout, C. J.; Viggiano, T. R.; Ahlquist, D. A.; Wang, K. K.; Larson, M. V.; Balm, R.

1992-01-01

The watermelon stomach is an uncommon but treatable cause of chronic gastrointestinal bleeding. We report our experience with the clinical and endoscopic features of 45 consecutive patients treated by endoscopic Nd:YAG laser coagulation. The prototypic patient was a woman (71%) with an average age

[Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess].

Science.gov (United States)

Yu, Huanxin; Liu, Gang

2014-01-01

To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess. Eighteen pathologically diagnosed pituitary abscess were resected through transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011.Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache (13 cases), pituitary dysfunction (10 cases), Diabetes Insipidus (4 cases) visual interference (8 cases) and fever (4 cases). All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up results were recorded. All patients were followed up from 6 months to 6 years. Postoperatively, headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach. Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.

Endoscopic Submucosal Dissection: Indications and Application in Western Endoscopy Practice.

Science.gov (United States)

Bourke, Michael J; Neuhaus, Horst; Bergman, Jacques J

2018-05-01

Endoscopic submucosal dissection was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. Previously, the majority of these patients were treated surgically at substantial cost and with significant risk of short- and long-term morbidity. En-bloc excision of these early cancers, most with a limited risk of nodal metastasis, allowed complete staging of the tumor, stratification of the subsequent therapeutic approach, and potential cure. This transformative innovation changed the nature of endoscopic treatment for superficial mucosal neoplasia and, ultimately, for the first time allowed endoscopists to assert that the early cancer had been definitively cured. Subsequently, Western endoscopists have increasingly embraced the therapeutic possibilities offered by endoscopic submucosal dissection, but with some justifiable scientific caution. Here we provide an evidence-based critical appraisal of the role of endoscopic submucosal dissection in advanced endoscopic tissue resection. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

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Turan Calhan

2015-01-01

Full Text Available Duodenal intramural hematoma (DIH usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

Endoscopic burr hole evacuation of an acute subdural hematoma.

Science.gov (United States)

Codd, Patrick J; Venteicher, Andrew S; Agarwalla, Pankaj K; Kahle, Kristopher T; Jho, David H

2013-12-01

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed. Copyright © 2013. Published by Elsevier Ltd.

Endoscopic Findings of Upper Gastrointestinal Involvement in Primary Vasculitis.

Science.gov (United States)

Gong, Eun Jeong; Kim, Do Hoon; Chun, Joo Hyun; Ahn, Ji Yong; Choi, Kwi-Sook; Jung, Kee Wook; Lee, Jeong Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Jung, Hwoon-Yong; Kim, Jin Ho; Song, In Hye; Kim, Yong-Gil

2016-07-15

Gastrointestinal involvement in vasculitis may result in life-threatening complications. However, its variable clinical presentations and endoscopic features, and the rarity of the disease, often result in delayed diagnosis. Clinical characteristics, endoscopic features, and histopathological findings were reviewed from medical records. Of 6,477 patients with vasculitis, 148 were diagnosed as primary vasculitis with upper gastrointestinal involvement. Of these, 21 cases (14.2%) were classified as large-vessel vasculitis, 17 cases (11.5%) as medium-vessel vasculitis, and 110 cases (74.3%) as small-vessel vasculitis. According to the specific diagnosis, IgA vasculitis (Henoch-Schönlein purpura) was the most common diagnosis (56.8%), followed by Takayasu arteritis (14.1%), microscopic polyangiitis (10.1%), and polyarteritis nodosa (6.8%). Gastrointestinal symptoms were present in 113 subjects (76.4%), with abdominal pain (78.8%) the most common symptom. Erosion and ulcers were striking endoscopic features, and the second portion of the duodenum was the most frequently involved site. Biopsy specimens were obtained from 124 patients, and only eight (5.4%) presented histopathological signs of vasculitis. Diagnosis of vasculitis involving the upper gastrointestinal tract is difficult. Because of the widespread use of endoscopy, combining clinical features with endoscopic findings may facilitate making appropriate diagnoses; however, the diagnostic yield of endoscopic biopsy is low.

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

Science.gov (United States)

Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

2016-01-01

Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

Directory of Open Access Journals (Sweden)

Liang Li

Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

Engineering aspects of a fully mirrored endoscope

International Nuclear Information System (INIS)

Terra, A.; Huber, A.; Schweer, B.; Mertens, Ph.; Arnoux, G.; Balshaw, N.; Brezinsek, S.; Egner, S.; Hartl, M.; Kampf, D.; Klammer, J.; Lambertz, H.T.; Morlock, C.; Murari, A.; Reindl, M.; Sanders, S.; Sergienko, G.; Spencer, G.

2013-01-01

Highlights: ► Replacement of JET diagnostics to match the new ITER-like Wall. ► The endoscope test ITER-like design with only mirror based optics. ► Withstanding and diagnostic capability during Plasma operation and disruptions. ► Engineering process from design to installation and procurement. -- Abstract: The development of optical diagnostics, like endoscopes, compatible with the ITER environment (metallic plasma facing components, neutron proof optics, etc.) is a challenge, but current tokamaks such as JET provide opportunities to test fully working concepts. This paper describes the engineering aspects of a fully mirrored endoscope that has recently been designed, procured and installed on JET. The system must operate in a very strict environment with high temperature, high magnetic fields up to B = 4 T and rapid field variations (∂B/∂t ∼ 100 T/s) that induce high stresses due to eddy currents in the front mirror assembly. It must be designed to withstand high mechanical loads especially during disruptions, which lead to acceleration of about 7 g at 14 Hz. For the JET endoscope, when the plasma thermal loading, direct and indirect, was added to the assumed disruption loads, the reserve factor, defined as a ratio of yield strength over summed up von Mises stresses, was close to 1 for the mirror components. To ensure reliable operation, several analyses were performed to evaluate the thermo-mechanical performance of the endoscope and a final validation was obtained from mechanical and thermal tests, before the system's final installation in May 2011. During the tests, stability of the field of view angle variation was kept below 1° despite the high thermal gradient on endoscope head (∂T/∂x ∼ 500 K/m). In parallel, to ensure long time operation and to prevent undesirable performance degradation, a shutter system was also implemented in order to reduce impurity deposition on in-vessel mirrors but also to allow in situ transmission calibration

Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma.

Science.gov (United States)

Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kudo, Taiki; Taya, Yoko A; Kawahata, Shuhei; Kubota, Yoshimasa; Kubo, Kimitoshi; Eto, Kazunori; Ehira, Nobuyuki; Yamato, Hiroaki; Onodera, Manabu; Sakamoto, Naoya

2016-05-10

To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma. In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage. In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.

Development and initial porcine and cadaver experience with three-dimensional printing of endoscopic and laparoscopic equipment.

Science.gov (United States)

del Junco, Michael; Okhunov, Zhamshid; Yoon, Renai; Khanipour, Ramtin; Juncal, Samuel; Abedi, Garen; Lusch, Achim; Landman, Jaime

2015-01-01

Recent advances in three-dimensional (3D) printing technology have made it possible to print surgical devices. We report our initial experience with the printing and deployment of endoscopic and laparoscopic equipment. We created computer-aided designs for ureteral stents and laparoscopic trocars using SolidWorks. We developed three generations of stents, which were printed with an Objet500 Connex printer, and a fourth generation was printed with an EOSINT P395 printer. The trocars were printed with an Objet30 Pro printer. We deployed the printed stents and trocars in a female cadaver and in vivo porcine model. We compared the printed trocars to two standard trocars for defect area and length using a digital caliper. Paired T-tests and ANOVA were used to test for statistical difference. The first two generations of stents (7F and 9F) were functional failures as their diminutive inner lumen failed to allow the passage of a 0.035 guidewire. The third generation 12F stent allowed passage of a 0.035 guidewire. The 12F diameter limited its deployment, but it was introduced in a cadaver through a ureteral access sheath. The fourth-generation 9F stents were printed and deployed in a porcine model using the standard Seldinger technique. The printed trocars were functional for the maintenance of the pneumoperitoneum and instrument passage. The printed trocars had larger superficial defect areas (pcadaver models. Three-dimensional printing is rapidly advancing and may be clinically viable in the future.

Diagnosis and treatment with endoscopic retrograde cholangiopancreatography

International Nuclear Information System (INIS)

Soendenaa, K.; Horn, A.; Viste, A.

1994-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation. 31 refs., 2 tabs

Endoscopic Camera Control by Head Movements for Thoracic Surgery

NARCIS (Netherlands)

Reilink, Rob; de Bruin, Gart; Franken, M.C.J.; Mariani, Massimo A.; Misra, Sarthak; Stramigioli, Stefano

2010-01-01

In current video-assisted thoracic surgery, the endoscopic camera is operated by an assistant of the surgeon, which has several disadvantages. This paper describes a system which enables the surgeon to control the endoscopic camera without the help of an assistant. The system is controlled using

Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

Directory of Open Access Journals (Sweden)

Yohei Honkura

2015-02-01

Full Text Available Nasopalatine duct cysts are the most common non-odontogenic cysts in the maxilla, and are conventionally treated through a sublabial or palatine approach. Recently, the endoscopic approach has been used, but experience is extremely limited. We treated a 29-year-old male with nasopalatine duct cyst by endoscopic marsupialization, but paresthesia of the incisor region occurred after surgery. This paresthesia gradually remitted within 6 months. The nasopalatine nerve, which innervates the upper incisor region, enters two lateral canals separately at the nasal floor and exits the central main canal at the palate. Damage to the bilateral nasopalatine nerves might lead to paresthesia, so we recommend careful examination for nerve fibers during endoscopic surgery, especially if fenestration is performed on both sides.

Radiological findings after endoscopic incision of ureterocele

International Nuclear Information System (INIS)

Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang; Cheon, Jung Eun; Seok, Eul Hye; Cha, Joo Hee; Choi, Guk Myung

2001-01-01

Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required

Endoscopic management of biliary injuries and leaks

Directory of Open Access Journals (Sweden)

T S Chandrasekar

2012-01-01

Full Text Available Bile duct injuries and subsequent leaks can occur following laparoscopic and open cholecystectomies and also during other hepatobiliary surgeries. Various patient related and technical factors are implicated in the causation of biliary injuries. Over a period of twenty five years managing such patients of biliary injuries our team has found a practical approach to assess the cause of biliary injuries based on the symptoms, clinical examination and imaging. Bismuth classification is helpful in most of the cases. Immediate referral to a centre experienced in the management of bile duct injury and timely intervention is associated with improved outcomes. Resuscitation, correcting dyselectrolytemia, aspiration of undrained biloma and antibiotics take the priority in the management. The goal is to restore the bile conduit, and to prevent short and longterm complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis and secondary biliary cirrhosis. Endoscopic therapy by reducing the transpapillary pressure gradient helps in reducing the leak. Endoscopic therapy with biliary sphincterotomy alone or with additional placement of a biliary stent/ nasobiliary drainage is advocated. In our tertiary care referral unit, we found endoscopic interventions are useful in situations where there is leak with associated CBD calculus or a foreign body, peripheral bile duct injury, cystic duct stump leak and partial bile duct injury with leak/ narrowing of the lumen. Endotherapy is not useful in case of complete transection (total cut off and complete stricture involving common hepatic or common bile ducts. In conclusion, endoscopic treatment can be considered a highly effective therapy and should be the first-line therapy in such patients. Though less successful, an endoscopic attempt is warranted in patients suffering from central bile duct leakages failing which surgical management is recommended.

A comparative study on radiological and endoscopic examinations of the stomach cancer

Energy Technology Data Exchange (ETDEWEB)

Lee, Jung Sook; Lee, Yong Chul; Kim, Han Suk [National Medical Center, Seoul (Korea, Republic of)

1985-12-15

An analysis was done for the diagnostic accuracy of radiological and endoscopic examinations in 132 cases of the histologically proved stomach cancer at the national Medical Center from Jan. 1975 to Jan. 1979. The problem in radiological misdiagnosis was especially discussed aimed to improve the further diagnostic accuracy. The following results were obtained: 1. The incidence of the stomach cancer was higher in male than that of female, and was most prevalent in 5th and 6th decades. 2. The misdiagnosis rate of radiological examination of the stomach cancer was 13.5% (18 cases), that of endoscopic examination was 8.3% (11 cases) and that of both examination was 4.6% (6 cases). 3. In most cases of misdiagnosis, the majority were diagnosed as benign gastric ulcer. 4. The causative factors of misdiagnosis in radiological examination were interpretation error in 8 cases and technically poor, unsatisfactory study in 10 cases. 5. In order to decrease the misdiagnosis rate, standardization of radiological examination and careful interpretation are necessary. 6. Complementary examinations of radiology and endoscopy can decrease the misdiagnosis rate.

Comparative cost-efficiency of the EVOTECH endoscope cleaner and reprocessor versus manual cleaning plus automated endoscope reprocessing in a real-world Canadian hospital endoscopy setting

Directory of Open Access Journals (Sweden)

Shum Cynthia

2011-10-01

Full Text Available Abstract Background Reprocessing of endoscopes generally requires labour-intensive manual cleaning followed by high-level disinfection in an automated endoscope reprocessor (AER. EVOTECH Endoscope Cleaner and Reprocessor (ECR is approved for fully automated cleaning and disinfection whereas AERs require manual cleaning prior to the high-level disinfection procedure. The purpose of this economic evaluation was to determine the cost-efficiency of the ECR versus AER methods of endoscopy reprocessing in an actual practice setting. Methods A time and motion study was conducted at a Canadian hospital to collect data on the personnel resources and consumable supplies costs associated with the use of EVOTECH ECR versus manual cleaning followed by AER with Medivators DSD-201. Reprocessing of all endoscopes was observed and timed for both reprocessor types over three days. Laboratory staff members were interviewed regarding the consumption and cost of all disposable supplies and equipment. Exact Wilcoxon rank sum test was used for assessing differences in total cycle reprocessing time. Results Endoscope reprocessing was significantly shorter with the ECR than with manual cleaning followed by AER. The differences in median time were 12.46 minutes per colonoscope (p Conclusions The EVOTECH ECR was more efficient and less costly to use for the reprocessing of endoscopes than manual cleaning followed by AER disinfection. Although the cost of consumable supplies required to reprocess endoscopes with EVOTECH ECR was slightly higher, the value of the labour time saved with EVOTECH ECR more than offset the additional consumables cost. The increased efficiency with EVOTECH ECR could lead to even further cost-savings by shifting endoscopy laboratory personnel responsibilities but further study is required.

Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas.

Science.gov (United States)

Pledger, Carrie L; Elzoghby, Mohamed A; Oldfield, Edward H; Payne, Spencer C; Jane, John A

2016-08-01

OBJECT Both endoscopic and microscopic transsphenoidal approaches are accepted techniques for the resection of pituitary adenomas. Although studies have explored patient outcomes for each technique individually, none have prospectively compared sinonasal and quality of life outcomes in a concurrent series of patients at the same institution, as has been done in the present study. METHODS Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were assessed for sinonasal function, quality of life, and pain using the Sino-Nasal Outcome Test-20 (SNOT-20), the short form of the Nasal Obstruction Symptom Evaluation (NOSE) instrument, the SF-36, and a headache scale. Eighty-two patients undergoing either endoscopic (47 patients) or microscopic (35 patients) surgery were surveyed preoperatively and at 24-48 hours, 2 weeks, 4 weeks, 8 weeks, and 1 year after surgery. RESULTS Patients who underwent endoscopic and microscopic transsphenoidal surgery experienced a similar recovery pattern, showing an initial increase in symptoms during the first 2 weeks, followed by a return to baseline by 4 weeks and improvement beyond baseline functioning by 8 weeks. Patients who underwent endoscopic surgery experienced better sinonasal outcomes at 24-48 hours (SNOT total p = 0.015, SNOT rhinologic subscale [ssRhino] p surgery, no significant differences in sinonasal outcomes were observed between the 2 groups. Headache scales at 1 year improved in all dimensions except duration for both groups (total result 73%, p = 0.004; severity 46%, p surgery, both groups experienced significant improvements in mental health (13%, p = 0.005) and vitality (15%, p = 0.037). By 1 year after surgery, patients improved significantly in mental health (14%, p = 0.03), role physical (14%, p = 0.036), social functioning (16%, p = 0.009), vitality (22%, p = 0.002), and SF-36 total (10%, p = 0.024) as compared with preoperative measures. There were no significant differences at any time point

Slit-scanning technique using standard cell sorter instruments for analyzing and sorting nonacrocentric human chromosomes, including small ones

NARCIS (Netherlands)

Rens, W.; van Oven, C. H.; Stap, J.; Jakobs, M. E.; Aten, J. A.

1994-01-01

We have investigated the performance of two types of standard flow cell sorter instruments, a System 50 Cytofluorograph and a FACSTar PLUS cell sorter, for the on-line centromeric index (CI) analysis of human chromosomes. To optimize the results, we improved the detection efficiency for centromeres

Molecular Endoscopic Ultrasound for Diagnosis of Pancreatic Cancer

Energy Technology Data Exchange (ETDEWEB)

Bournet, Barbara [Department of Gastroenterology, University Hospital Center Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9 (France); INSERM U1037, University Hospital Center Rangueil, Toulouse (France); Pointreau, Adeline; Delpu, Yannick; Selves, Janick; Torrisani, Jerome [INSERM U1037, University Hospital Center Rangueil, Toulouse (France); Buscail, Louis, E-mail: buscail.l@chu-toulouse.fr [Department of Gastroenterology, University Hospital Center Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9 (France); INSERM U1037, University Hospital Center Rangueil, Toulouse (France); Cordelier, Pierre [INSERM U1037, University Hospital Center Rangueil, Toulouse (France)

2011-02-24

Endoscopic ultrasound-guided fine needle aspiration-biopsy is a safe and effective technique in diagnosing and staging of pancreatic ductal adenocarcinoma. However its predictive negative value does not exceed 50% to 60%. Unfortunately, the majority of pancreatic cancer patients have a metastatic and/or a locally advanced disease (i.e., not eligible for curative resection) which explains the limited access to pancreatic tissue specimens. Endoscopic ultrasound-guided fine needle aspiration-biopsy is the most widely used approach for cytological and histological material sampling in these situations used in up to two thirds of patients with pancreatic cancer. Based on this unique material, we and others developed strategies to improve the differential diagnosis between carcinoma and inflammatory pancreatic lesions by analysis of KRAS oncogene mutation, microRNA expression and methylation, as well as mRNA expression using both qRT-PCR and Low Density Array Taqman analysis. Indeed, differentiating pancreatic cancer from pseudotumoral chronic pancreatitis remains very difficult in current clinical practice, and endoscopic ultrasound-guided fine needle aspiration-biopsy analysis proved to be very helpful. In this review, we will compile the clinical and molecular advantages of using endoscopic ultrasound-guided fine needle aspiration-biopsy in managing pancreatic cancer.

Molecular Endoscopic Ultrasound for Diagnosis of Pancreatic Cancer

International Nuclear Information System (INIS)

Bournet, Barbara; Pointreau, Adeline; Delpu, Yannick; Selves, Janick; Torrisani, Jerome; Buscail, Louis; Cordelier, Pierre

2011-01-01

Endoscopic ultrasound-guided fine needle aspiration-biopsy is a safe and effective technique in diagnosing and staging of pancreatic ductal adenocarcinoma. However its predictive negative value does not exceed 50% to 60%. Unfortunately, the majority of pancreatic cancer patients have a metastatic and/or a locally advanced disease (i.e., not eligible for curative resection) which explains the limited access to pancreatic tissue specimens. Endoscopic ultrasound-guided fine needle aspiration-biopsy is the most widely used approach for cytological and histological material sampling in these situations used in up to two thirds of patients with pancreatic cancer. Based on this unique material, we and others developed strategies to improve the differential diagnosis between carcinoma and inflammatory pancreatic lesions by analysis of KRAS oncogene mutation, microRNA expression and methylation, as well as mRNA expression using both qRT-PCR and Low Density Array Taqman analysis. Indeed, differentiating pancreatic cancer from pseudotumoral chronic pancreatitis remains very difficult in current clinical practice, and endoscopic ultrasound-guided fine needle aspiration-biopsy analysis proved to be very helpful. In this review, we will compile the clinical and molecular advantages of using endoscopic ultrasound-guided fine needle aspiration-biopsy in managing pancreatic cancer

A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy

NARCIS (Netherlands)