Minimally invasive techniques have been described recently for liver resections. We have developed a surgical approach to liver resection that combines the benefits of minimally invasive surgery with ...the safety of open liver resection. We have applied this hybrid approach to selected cases, and we feel that it can be adopted by most hepatobiliary surgeons, even those with minimal or no laparoscopic experience. Briefly, this technique consists of laparoscopic mobilization of the target liver lobe, followed by standard open liver resection through the extraction site. The required incisions parallel those needed for hand-assisted laparoscopic liver resections. We have compared these hybrid procedures with contemporaneous laparoscopic, hand-assisted, and open liver resections at our institution and have found that they compare favorably with minimally invasive procedures. A wider utilization of this approach by both general and hepatobiliary surgeons will result in a more generalized acceptance of minimally invasive liver resection that ultimately will advance the field and benefit patients in need of liver surgery.
The effects of process variables on regenerable antimicrobial finishing of cotton fabric with nitrogen plasma treatment were investigated. Cotton fabric was treated with a mixture of nitrogen and ...helium plasma, and it was chlorinated with sodium hypochlorite to impart antimicrobial properties. An orthogonal array testing strategy (OATS) was used in the finishing process to determine the optimum treatment conditions. After finishing, the properties of cotton fabric, including concentration of chlorine, tearing strength, and presence of functional groups, were evaluated by ultraviolet spectroscopy (UV), tear testing, and Fourier transform infrared spectroscopy (FTIR). Cotton fabric treated with nitrogen plasma and chlorination effectively blocked microorganism growth. The resistance to Staphylococcus aureus bacteria was regenerable, and nitrogen plasma treatment showed no noticeable influence on the tearing strength of the cotton fabric.
Hayek et al present the case of a 58-year-old Caucasian man with high output heart failure in renal cell carcinoma. He had presented to the emergency department complaining of progressive shortness ...of breath and leg swelling over the past 9 months. Radical right nephrectomy was performed, and histopathology showed renal cell carcinoma of the clear cell variant. The presence of abnormally thickened arteriolar walls confirmed high-grade flow and pressure consistent with arteriovenous shunting. Postoperatively, the patient's renal function normalized, and a repeat transthoracic echocardiogram 7 days after surgery showed a significantly improved ejection fraction of 40% and a normal cardiac index of 2.6 L/min/m^sup 2^. Ultimately, the patient did well, with recovery of his baseline functional status and no signs of disease recurrence at the 6-month follow-up visit.
We present the largest, most comprehensive, single center experience to date of minimally invasive liver resection (MILR).
Despite anecdotal reports of MILR, few large single center reports have ...examined these procedures by comparing them to their open counterparts.
Three hundred MILR were performed between July 2001 and November 2006 at our center for both benign and malignant conditions. These included 241 pure laparoscopic, 32 hand-assisted laparoscopic, and 27 laparoscopy-assisted open (hybrid) resections.These MILR were compared with 100 contemporaneous, cohort-matched open resections. MILR included segmentectomies (110), bisegmentectomies (63), left hepatectomies (47), right hepatectomies (64), extended right hepatectomies (8), and caudate lobe (8) resections. Benign etiologies encompassed cysts (70), hemangiomata (37), focal nodular hyperplasia (FNH) (23), adenomata (47), and 20 live donor right lobectomies. Malignant etiologies included primary (43) and metastatic (60) tumors. Hepatic fibrosis/cirrhosis was present in 25 of 103 patients with malignant diseases (24%).
There was high data consistency within the 3 types of MILR. MILR compared favorably with standard open techniques: operative times (99 vs. 182 minutes), blood loss (102 vs. 325 ml), transfusion requirement (2 of 300 vs. 8 of 100), length of stay (1.9 vs. 5.4 days), overall operative complications (9.3% vs. 22%), and local malignancy recurrence (2% vs. 3%). No port-site recurrences occurred. Conversion from laparoscopic to hand-assisted laparoscopic resection occurred in 20 patients (6%), with no conversions to open. No hand-assisted procedures were converted to open, but 2 laparoscopy-assisted (7%) were converted to open.
Our data show that MILR outcomes compare favorably with those of the open standard technique. Our experience suggests that MILR of varying magnitudes is safe and effective for both benign and malignant conditions.
Parkinson, F.; Douglas, K.; Li, Z.; Meijer, A.; Stacey, C.D.; Kung, R., and Podhorodeski, A., 2024. A generalized semiautomated method for seabed geology classification using multibeam data and ...maximum likelihood classification. Journal of Coastal Research, 40(1), 1–16. Charlotte (North Carolina), ISSN 0749-0208. This paper presents a GIS-based model to perform semiautomated seabed classification that can act as a first-pass, pseudoclassified surficial geological map. The user can then edit the output into a finalized map in less time than by manual classification. The model uses maximum likelihood classification with unsupervised classification through iterative self-organizing clusters. This model is fully contained within the ArcGIS software suite as a ModelBuilder workflow composed of geoprocessing tools and Python script tools. Model inputs tested include different combinations of multibeam echosounder–derived data: slope, backscatter, and terrain ruggedness. Furthermore, to test the assumption of Gaussian distribution of input data required for maximum likelihood classification, Box–Cox power transformations were applied to slope and backscatter data and were used as model inputs. To illustrate the performance of the model, two locations are highlighted as case studies: Milbanke Sound and Spiller Channel, located on the central coast of British Columbia, Canada. Association between model outputs and ground-truth classes was generally weak to moderate when measured using Cramér's V association scores. Overall, the slope and backscatter parameter model had the highest scores of association. Results from an overlay analysis comparing model outputs with user-confirmed polygons show that the slope and backscatter model performs best in regions with distinct changes in the hardness of sediments but that in fjord regions dominated geologically by steeper bathymetric change, the slope parameter model may perform better. However, all model outputs had difficulty delineating bedrock units. The model has the flexibility to identify certain seabed habitat features as well, including glass sponge reefs—biologically active bioherms that have led to marine protected area designations in other areas of British Columbia.
Three hundred cases of minimally invasive liver resections at a single institution are reviewed and compared with a matched cohort of 100 open resections. These include resections for various types ...of liver lesions, both benign and malignant, and varying magnitudes of resection. The data show that minimally invasive liver resections are safe, efficacious, and cost-effective.
Heart Booster: a pericardial support device Kung, Robert T.V; Rosenberg, Meir
The Annals of thoracic surgery,
08/1999, Letnik:
68, Številka:
2
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Background. Congestive heart failure is a pervasive disease afflicting millions of people. For many, their quality of life can be significantly improved by a pericardial device that can enhance ...cardiac output without the added risk of thromboembolism associated with direct blood contact.
Methods. A cardiac assist device with tubular elements is wrapped around the heart. Fluid is pumped into and out of the wrap causing contraction and dilation of its circumference. This contracting and relaxing action generates cardiac assistance without the need to contact blood. In vitro characterization and in vivo studies in calves were conducted to demonstrate the characteristics of the device.
Results. In vitro characterization with the device wrapped around one-half of a ventricle to simulate left ventricular support demonstrated outputs of 6.5 L/min at physiological afterloads. In vivo studies in calves demonstrated both cardiac output and afterload enhancements when the device is activated.
Conclusions. This study provides a first demonstration of a device that provides cardiac support by a contraction and relaxation scheme with the device wrapped around the epicardium of the heart. The main feature of this actuation method is the potential for building a small device for implantation without blood contact.
We describe a revised understanding of the extent and dynamics of the Cordilleran Ice Sheet on the continental shelf of northern British Columbia, Canada. During the Local Last Glacial Maximum ice ...streams occupied two of the three shelf‐crossing troughs in Queen Charlotte Sound (Goose Island Trough and Mitchell's Trough). A 25‐km‐wide outlet glacier – the Hecate Glacier – flowed south in Hecate Strait, parallel to the modern coast. It reached a grounding line at the head of Moresby Trough, beyond which an ice shelf may have extended to the edge of the continental shelf. The southern part of the independent Haida Gwaii Ice Cap formed piedmont lobes dissected by tunnel valleys. An emergent area east of the ice cap corresponds with the ‘Hecate Refugium’. Subsequently grounded ice retreated from the shelf troughs. The Hecate Glacier retreated incrementally towards the north. Mainland ice then stabilized along a north–south margin near modern coasts, marked by submarine moraines in the Chatham Sound region and elsewhere. This margin was probably contemporaneous with the margin at Mt. Buxton in the south of the study area, dated at c. 17.6 to 16.6 ka (Darvill et al. 2018). Off southern Haida Gwaii, following a retreat, a glacier margin was established east of Juan Perez Sound, proximal to a sandur plain graded to a water level of −150 m. Proglacial lakes to the north of here were the likely source for an outburst flood that created gravel bedforms and an area of sea‐floor scour. In a final phase, diminished mainland ice was confined to fjords, and retreat inland is marked by a succession of submarine moraines, beginning with a moraine at the Douglas Channel sill. The study has implications for the migration pathways for human migration into the Americas following deglaciation.
Postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and disorders in patients who have previously undergone cholecystectomy. While it is relatively uncommon, it is defined ...by chronic recurring pain, often with no clear source. Recent studies suggest its pathogenesis depends on different factors, but it remains poorly understood and complex to treat. Here, we present a brief overview of this syndrome, review recent literature regarding its etiology, and present a systematic approach to diagnosis and management.
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