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  • 1
    Electronic Resource
    Electronic Resource
    Evaluation of mechanism of increased intracranial pressure with insufflation (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 266-269 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Intracranial pressure — Physiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Previous studies have documented an increase in intracranial pressure with abdominal insufflation, but the mechanism has not been explained. Methods: Nine 30–35-kg domestic pigs underwent carbon dioxide insufflation at 1.5 l/min. Intracranial pressure (ICP), lumbar spinal pressure (LP), central venous pressure (CVP), inferior vena cava pressure (IVCP), heart rate, systemic arterial blood pressure, pulmonary arterial pressure, cardiac output, heart rate, respiratory rate, temperature, and end-tidal CO2 were continuously measured. Mechanical ventilation was used to maintain a constant pCO2. Measurements were recorded at 0, 5, 10, and 15 mmHg of abdominal pressure with animals in supine, Trendelenburg (T), and reverse Trendelenburg (RT) positions. Prior to recording measurements, the animals were allowed to stabilize for 40 min after each increase in abdominal pressure and for 20 min after each position change. Results: The animals showed a significant increase in ICP (mmHg) with each 5-mmHg increase in abdominal pressure (0 mmHg: 14 ± 1.7; 5 mmHg: 19.8 ± 2.3, p 〈 0.001; 10 mmHg: 24.8 ± 2.5, p 〈 0.001; 15 mmHg: 29.8 ± 4.7, p 〈 0.01). The ICP at 15 mmHg abdominal pressure increased further in the T position (39 ± 4, p 〈 0.01). Insufflating in the RT position did not significantly reduce the increase in ICP. The IVCP (mmHg) increased with increased abdominal pressure (0 mmHg: 11.5 ± 6.2, 15 mmHg: 22.1 ± 3.5, p 〈 0.01). This increase correlated with the increase in ICP and LP (r of mean pressures ≥0.95). There was no significant change in CVP. Conclusions: This study suggests that care may be needed with laparoscopy in patients at risk for increased ICP due to head injury or a space occupying lesion. The mechanism of increased ICP associated with insufflation is most likely impaired venous drainage of the lumbar venous plexus at increased intraabdominal pressure. Further studies of cerebral spinal fluid movement during insufflation are currently underway to confirm this hypothesis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900648
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  • 2
    Electronic Resource
    Electronic Resource
    Endoscopic axillary exploration and sentinel lymphadenectomy (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 43-47 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Breast cancer — Sentinel nodes — Endoscopy — Axilla
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients. Methods: A total of 23 patients with biopsy-proven breast carcinoma were enrolled. Patients were positioned in the supine position with the ipsilateral arm abducted at 90°. A 1-cm skin incision was made at the superior aspect of the axilla. Dissection was carried bluntly to the lateral border of the pectoralis major. A balloon distention device was inserted into the tract and distended under endoscopic vision to create a working space. Insufflation was initiated up to a pressure of 8 mmHg. A 30° laparoscope was introduced for visualization of axillary contents. One or two additional 5-mm cannulas were placed as needed under direct visualization. Manipulation of axillary contents was performed, and in 19 patients a sentinel node identification technique was applied. Results: In all patients, using insufflation and minimal instrument dissection, the axillary vein, long thoracic, and thoracodorsal nerves were found in their usual anatomical locations. Utilizing blunt and sharp dissection, the axilla was thoroughly inspected, and individual lymph nodes were easily identified and extracted. In 11 of 19 patients, a sentinel node or blue dye was identified using isosulfan blue. There was a procedure concordance of 84%, and there were no complications. Conclusions: We describe a novel endoscopic technique for the evaluation of the axilla in breast cancer patients. This technique allows (a) creation of a minimally invasive working space within the axilla, (b) recognition of key axillary anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes, and apply the sentinel node technique. This is the first report of a minimally invasive approach to axillary exploration to employ sentinel lymph node mapping.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900895
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  • 3
    Electronic Resource
    Electronic Resource
    Intraabdominal adhesion formation after preperitoneal dissection in the murine model (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 14-16 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Adhesions — Herniorraphy — Inguinal hernia repair — Laparoscopy — Peritoneum — Totally extraperitoneal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The laparoscopic approach to hernia repair has been advocated by many as a potentially superior method of herniorraphy. Several techniques have been described, each with its own proposed advantages. These techniques involve different anatomic approaches, the most recent of which is the totally extraperitoneal approach (TEPA). One presumed advantage of the extraperitoneal approach is the avoidance of adhesion formation because the peritoneum is not entered and mesh is not placed in direct contact with intra-abdominal structures. We hypothesize, however, that when the peritoneum is dissected from the abdominal wall, it is partially devascularized, leading to scar formation and potential adhesion formation. This would suggest that the TEPA method of herniorraphy may not completely avoid the risks of intra-abdominal adhesion formation. Methods: After appropriate approval was obtained, 88 male Sprague-Dawley rats were divided into two equal groups. One group underwent laparotomy followed by careful blunt dissection of the peritoneum from the left abdominal wall. The control group underwent laparotomy without manipulation of the peritoneum. All animals were re-explored 14 days later, and the abdominal cavity was examined for adhesions. The type and location of any adhesion was recorded. Results: Adhesion formation occurred in 10 of 44 (23%) subjects in the peritoneal dissection group, compared with 3 of 44 (7%) in the nondissection group (p 〈 0.05). Conclusions: Dissection of the peritoneum from the overlying abdominal wall in the murine model leads to intra-abdominal adhesion formation. This suggests that peritoneal dissection in the TEPA method of herniorraphy may lead to intra-abdominal adhesion formation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900888
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  • 4
    Electronic Resource
    Electronic Resource
    Determination of the learning curve of the AESOP robot (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 54 -55 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — AESOP robot — Learning curve
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: As the variety of procedures performed with laparoscopic technology increases, the skill levels and equipment demands also increase. Laparoscopic appendectomy, hernia repair, colon resection, and Nissen fundoplication all require someone whose only responsibility is to control the laparoscope and therefore the operative field. This is usually the most inexperienced person on the operating team. The Automated Endoscope System for Optimal Positioning (AESOP) robot provides a means to eliminate the need for the camera person, returns control of the camera and operative field to the operating surgeon, and enhances human performance. The purpose of this study was to evaluate the acquisition of skills to control the laparoscope in a satisfactory fashion. Methods: We selected medical students as our study group because they have no prior experience in laparoscopic procedures. They performed a readily reproducible task in a pelvic trainer with hand control and with the AESOP robot. Their initial times are compared, as is the improvement in their times after 10 min of practice with the AESOP robot. Results: These data show that in this study group use of the AESOP robot was not as fast as hand control but the skill to use it was learned as quickly. Additional features of the robut such as a steady view and the ability to acquire images and return to them reliably are other advantages. Conclusion: The AESOP robotic arm provides a stable support for the laparoscope during laparoscopic procedures which can be manipulated by the surgeon. We found that the time required to learn control of the laparoscope manually and with the AESOP robot is equal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900294
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  • 5
    Electronic Resource
    Electronic Resource
    Common bile duct T-tubes (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 60-62 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Bile leak — T-tube — Biliary tree
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Operations on the common bile duct can result in severe long-term consequences. To prevent some of these complications, it is common practice to drain the biliary tree with a T-tube. The T-tube is usually removed 2 weeks after it was placed. There have been numerous reports of bile leak following T-tube removal in the literature. These leaks can result in bile ascites, biloma, or bile peritonitis. Control of bile leaks can be accomplished in a number of ways, including endoscopically or radiologically placed stents or drains and radiologic techniques to drain the fluid collections. We describe a novel technique that can be utilized at the time of T-tube removal that will allow immediate control of the bile leak and prevent the complications of bile accumulation within the peritoneal cavity. We have performed fluoroscopic removal of T-tubes on two patients and found no complications with the technique. We have successfully visualized the T-tube tract in both patients. The T-tube tract can be visualized at the time of T-tube removal in an effort to prevent the complications of tract disruption and subsequent bile leak.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900595
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  • 6
    Electronic Resource
    Electronic Resource
    Leber’s hereditary optic neuropathy mitochondrial DNA mutations in familial multiple sclerosis (1999)
    Springer
    Graefe's archive for clinical and experimental ophthalmology 237 (1999), S. 348-350 
    Details
    ISSN: 1435-702X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Leber’s hereditary optic neuropathy (LHON) can be difficult to distinguish from optic neuritis due to multiple sclerosis (MS). For several decades an association of LHON and MS has been suspected, and within the past 7 years the LHON nucleotide (nt)-3460 and nt-11778 mtDNA mutations have been identified in several patients with MS-like phenotypes. To further study this association, we tested 42 index patients with clinically definite, familial MS for the LHON mtDNA mutations at nt-3460, nt-11778, and nt-14484. No patients had a pathogenic LHON mtDNA mutation; however, two MS patients with unilateral optic neuritis harbored the nt-15257 mtDNA polymorphism that was reported originally as a pathogenic LHON mutation. Several investigators have shown evidence that the nt-15257 mtDNA mutation is not primarily pathogenic. Therefore, we conclude that pathogenic LHON mtDNA mutations are absent or rare in unselected patients with familial, clinically definite MS (95% confidence intervals for each of the negative mutations 0–7.0%).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004170050243
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  • 7
    Electronic Resource
    Electronic Resource
    The chemical control of biofouling in industrial water systems (1998)
    Springer
    Biodegradation 9 (1998), S. 23-37 
    Details
    ISSN: 1572-9729
    Keywords: bacterial resistance ; biocides ; biocorrosion ; biofouling monitoring dispersants
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Energy, Environment Protection, Nuclear Power Engineering , Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition
    Notes: Abstract Oxidising and non-oxidising biocides are commonly used in an attempt to control biofouling in industrial water systems. Many of these programmes, however, fail due to the incorrect selection and application of these chemical compounds. Knowledge of the organisms to be eliminated and system hydraulics are important operational parameters in ensuring the successful application of chemical control programmes. A further complicating factor is the build up of bacterial resistance to many of these compounds. One way of limiting resistance is the alteration of oxidising and non-oxidising biocides at the correct miminum inhibitory concentration and using these in combination with surface active compounds to dislodge any biofilm. A variety of surface monitoring techniques are in use in order to monitor the success of biofouling control programmes. Unfortunately none of these techniques are ideal and results have to be considered very carefully.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008216209206
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  • 8
    Electronic Resource
    Electronic Resource
    Mercury cycling in the water column of a seasonally anoxic urban lake (Onondaga Lake, NY) (1995)
    Springer
    Water, air & soil pollution 80 (1995), S. 553-562 
    Details
    ISSN: 1573-2932
    Source: Springer Online Journal Archives 1860-2000
    Topics: Energy, Environment Protection, Nuclear Power Engineering
    Notes: Abstract Onondaga Lake, New York, is a hypereutrophic, urban lake that was subjected to industrial discharges of mercury (Hg) between 1947 and 1988. Water samples were collected from April through November 1992 and analyzed for filtered and unfiltered total Hg, methylmercury (CH3Hg), dimethylmercury, ionic Hg, and elemental Hg to characterize the biogeochemical cycling of Hg during water column stratification and hypolimnetic anoxia. In the spring and late fall when the water column was isothermal, total Hg and CH3Hg concentrations were relatively constant throughout the water column, at approximately 3–7 ng/L and 0.3–1 ng/L, respectively. Through the summer and early fall, CH3Hg concentrations systematically increased in the deeper waters, reaching peak concentration in August and September. In September 1992, CH3Hg concentrations increased from 0.3 ng/L in the epilimnion to 10.6 ng/L in the hypolimnion, an increase of nearly 2 orders of magnitude. At the same time, total Hg increased from 6.6 ng/L in surface water to 21.7 ng/L at depth, a 3-fold increase. The spatial and temporal patterns observed for CH3Hg agree well with manganese, suggesting that CH3Hg and manganese are controlled by processes of the same or parallel cycles.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01189705
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  • 9
    Electronic Resource
    Electronic Resource
    Distribution of mercury in the sediments of Onondaga Lake, N.Y. (1995)
    Springer
    Water, air & soil pollution 80 (1995), S. 1035-1038 
    Details
    ISSN: 1573-2932
    Source: Springer Online Journal Archives 1860-2000
    Topics: Energy, Environment Protection, Nuclear Power Engineering
    Notes: Abstract Sediment cores and surface grab samples were collected throughout Onondaga Lake, New York, to determine the concentrations and distribution of mercury (Hg) in the sediments. Horizontal distribution patterns show the effect of sediment focusing and localized sources, with generally low Hg concentrations in the littoral zone sediments, higher concentrations in the profundal sediments, and highest concentrations near known sources of Hg. Several cores were dated and reflect historical loading patterns, with low-level increases in Hg concentration starting in the early 1800s and a large increase in 1947 and decrease in 1970 related to the local chloralkali industry. These cores indicate that Hg has low mobility in profundal sediments and that the contaminated sediments are effectively being buried.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01189761
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