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Sample records for endoscopic local injection

  1. Endoscopic local injection of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer: a controlled trial.

    PubMed Central

    Moretó, M; Zaballa, M; Suárez, M J; Ibáñez, S; Ojembarrena, E; Castillo, J M

    1992-01-01

    The injection of a mixture of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer was evaluated in 38 patients entered in a randomised prospective controlled trial. After a one week observation period, 1/19 (5.3%) treated patients and 11/19 (57.9%) control patients had suffered further bleeding (p less than 0.005; CI = 22%-74%). Emergency surgery was required in 1/19 in the treated group compared with 8/19 in the untreated group (CI = 13%-61%; p less than 0.05). The mean (SD) transfusion requirement in the treated group was 1.9 (0.5) U blood compared with 5.3 (0.7) U in the control group. No significant differences related to mortality were detected. In conclusion, local injection therapy is an effective means of haemostasis in patients with bleeding duodenal ulcer who are at risk of further bleeding. PMID:1582586

  2. [Successful Removal of Hard Sigmoid Fecaloma Using Endoscopic Cola Injection].

    PubMed

    Lee, Jong Jin; Kim, Jeong Wook

    2015-07-01

    Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery. PMID:26194129

  3. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  4. Endoscopic ultrasound-fine needle injection for oncological therapy

    PubMed Central

    Kaplan, Jeremy; Khalid, Amaara; Cosgrove, Natalie; Soomro, Ayesha; Mazhar, Syed Mohsin; Siddiqui, Ali A

    2015-01-01

    The minimal invasiveness and precision of endoscopic ultrasound (EUS) has lead to both its widespread use as a diagnostic and staging modality for gastrointestinal and pancreaticobiliary malignancies, and to its expanding role as a therapeutic modality. EUS-guided celiac plexus neurolysis is now a well-accepted modality for palliation of pain in patients with pancreatic cancer. EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described as methods of performing minimally invasive oncological therapy. EUS-fine needle injection may be performed as adjunctive, alternative, or palliative treatment. This review summarizes the studies to date that have described these methods. A literature search using the PubMed/MEDLINE databases was performed. While most published studies to date are limited with disappointing outcomes, the concept of a role of EUS in oncological therapy seems promising. PMID:26691224

  5. Local excision by transanal endoscopic surgery

    PubMed Central

    García-Flórez, Luis J; Otero-Díez, Jorge L

    2015-01-01

    Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision. PMID:26309355

  6. Visceral artery embolization after endoscopic injection of Enteryx for gastroesophageal reflux disease.

    PubMed

    Helo, Naseem; Wu, Alex; Moon, Eunice; Wang, Weiping

    2014-09-01

    Gastroesophageal reflux disease (GERD) can be difficult to manage medically and may require endoscopic or surgical interventions. The Enteryx procedure was designed to enhance the gastroesophageal barrier function by endoscopic injection of a copolymer into the lower esophageal sphincter. We present a rare case of a patient who was found to have migration of the copolymer into the celiac trunk and bilateral renal arteries during a work-up for persistent intermittent hematuria, which began shortly after Enteryx therapy for GERD. PMID:25426247

  7. Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer.

    PubMed Central

    Brullet, E; Campo, R; Calvet, X; Coroleu, D; Rivero, E; Simó Deu, J

    1996-01-01

    BACKGROUND: Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding. AIM: To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer. SUBJECTS: One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included. METHODS: Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure. RESULTS: Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89). CONCLUSION: These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy. PMID:8977333

  8. Treatment of a Splenic Artery Pseudoaneurysm by Endoscopic Ultrasound-Guided Thrombin Injection

    SciTech Connect

    Robinson, Mark Richards, Dafydd; Carr, Nicholas

    2007-06-15

    We present a case of a splenic artery pseudoaneurysm secondary to pancreatitis that was successfully treated by transgastric injection of thrombin under endoscopic ultrasound guidance. There has been no recurrence on follow-up CT angiography, and thus complex surgery or endovascular intervention has been avoided.

  9. Direct Endoscopic Intratumoral Injection of Onyx for the Preoperative Embolization of a Recurrent Juvenile Nasal Angiofibroma

    PubMed Central

    Hira, A.; Chao, K.

    2011-01-01

    Summary Percutaneous injection of embolization material within head and neck tumors is being described as an alternative or adjunct to transarterial embolization. Access in these reports is by computed tomography (CT) guidance, which is cumbersome given the need to transport the patient from the CT scanner to angiography suite. We describe a case of direct percutaneous onyx embolization of juvenile nasal angiofibroma following endoscopic access in the angiography suite including self-sustained onyx combustion during surgical electrocautery. PMID:22192553

  10. High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience

    PubMed Central

    Pioche, Mathieu; Lépilliez, Vincent; Déprez, Pierre; Giovannini, Marc; Caillol, Fabrice; Piessevaux, Hubert; Rivory, Jérôme; Guillaud, Olivier; Ciocîrlan, Mihai; Salmon, Damien; Lienhart, Isabelle; Lafon, Cyril; Saurin, Jean-Christophe; Ponchon, Thierry

    2015-01-01

    Background: Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract. Methods: We retrospectively report all of the consecutive ESD procedures performed with jet injection of viscous solutions in four centers. Information was collected about the lesion, the procedure, the histological result, and the outcomes for the patient. Results: In total, 45 resections were completed by six operators: five experts and one beginner with only one previous experience in human ESD. Lesions were located in the esophagus (10), the stomach (11), the duodenum (1), the colon (1) and the rectum (22). Average maximal lesion diameter was 4.8 cm (SD 2.4, range 2 – 11 cm), average lesion surface area was 19.8 cm2 (SD 17.7, range 2.2 – 72 cm2), and average duration of procedure was 79.9 min (SD 50.3 min, range 19 – 225 min). ESD could be conducted while the endoscope was retroflexed at its maximum in 26 cases. Four adverse events were observed: two diminutive perforations and two delayed bleeding occurrences treated conservatively. The R0 resection rate was 91.1 %. The catheter was obstructed in six occurrences of bleeding. Conclusion: Endoscopic submucosal dissection using high pressure injection of viscous macromolecular solutions is safe and effective in different parts of the digestive tract. It does not impede working with the endoscope in the maximal retroflexed position. PMID:26356488

  11. Direct endoscopic intratumoral injection of Onyx for the preoperative embolization of a recurrent juvenile nasal angiofibroma.

    PubMed

    Hira, A; Chao, K

    2011-12-01

    Percutaneous injection of embolization material within head and neck tumors is being described as an alternative or adjunct to transarterial embolization. Access in these reports is by computed tomography (CT) guidance, which is cumbersome given the need to transport the patient from the CT scanner to angiography suite. We describe a case of direct percutaneous onyx embolization of juvenile nasal angiofibroma following endoscopic access in the angiography suite including self-sustained onyx combustion during surgical electrocautery. PMID:22192553

  12. Benign Post-Radiation Rectal Stricture Treated with Endoscopic Balloon Dilation and Intralesional Triamcinolone Injection

    PubMed Central

    Karanikas, Michael; Touzopoulos, Panagiotis; Mitrakas, Alexandros; Zezos, Petros; Zarogoulidis, Paul; Machairiotis, Nikolaos; Efremidou, Eleni; Liratzopoulos, Nikolaos; Polychronidis, Alexandros; Kouklakis, George

    2012-01-01

    Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment. PMID:23271987

  13. Endoscopic botox injections in therapy of refractory gastroparesis

    PubMed Central

    Ukleja, Andrew; Tandon, Kanwarpreet; Shah, Kinchit; Alvarez, Alicia

    2015-01-01

    Gastroparesis (GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A (BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades. PMID:26191343

  14. Endoscopic cyanoacrylate injection for the treatment of gastric varices in children

    PubMed Central

    Oh, Seak Hee; Kim, Seung Jin; Rhee, Kang Won; Kim, Kyung Mo

    2015-01-01

    AIM: To evaluate the efficacy and safety of N-butyl-2-cyanoacrylate in treating acute bleeding of gastric varices in children. METHODS: The retrospective study included 21 children with 47 episodes of active gastric variceal bleeding who were treated by endoscopic injection of N-butyl-2-cyanoacrylate at Asan Medical Center Children’s Hospital between August 2004 and December 2011. To reduce the risk of embolism, each injection consisted of 0.1-0.5 mL of 0.5 mL N-butyl-2-cyanoacrylate diluted with 0.5 or 0.8 mL Lipiodol. The primary outcome was incidence of hemostasis after variceal obliteration and the secondary outcome was complication of the procedure. RESULTS: The 21 patients experienced 47 episodes of active gastric variceal bleeding, including rebleeding, for which they received a total of 52 cyanoacrylate injections. Following 42 bleeding episodes, hemostasis was achieved after one injection and following five bleeding episodes it was achieved after two injections. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1-0.5 mL). Injection achieved hemostasis in 45 of 47 (95.7%) episodes of acute gastric variceal bleeding. Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications such as distal embolism were noted with the exception of abdominal pain in one patient (4.8%). Among four mortalities, one patient died of variceal rebleeding. CONCLUSION: Endoscopic variceal obliteration using a small volume of aliquots with repeated cyanoacrylate injection was an effective and safe option for the treatment of gastric varices in children. PMID:25759541

  15. [Endoscopic Ultrasound-guided Local Therapy of Pancreatic Tumors].

    PubMed

    Yoon, Won Jae; Seo, Dong Wan

    2015-09-01

    The development of curvilinear EUS has enabled EUS-guided fine-needle aspiration of intra-abdominal mass lesions. With the introduction of interventional EUS, this technology has undergone several modifications in order to be applied to clinical medicine. One of the potential uses of interventional EUS is the EUS-guided local therapy of pancreatic tumors. Various treatment modalities such as fine-needle injection, radiofrequency ablation, photodynamic therapy, laser ablation, and brachytherapy have been tried under EUS guidance. Some of these modalities are being applied clinically. These methods for EUS-guided local therapy of pancreatic tumors will be reviewed in this article. PMID:26387698

  16. Endoscopically assisted laparoscopic local resection of gastric tumor

    PubMed Central

    2013-01-01

    Background Minimally invasive procedures have been applied in treatment of gastric submucosal tumors. Currently, combined laparoscopic - endoscopic rendezvous resection (CLERR) emerges as a new technique which further reduces operative invasiveness. Case presentation A-57-year-old female patient presented with epigastric pain. She was submitted to gastroscopy, which revealed a tumor located at the angle of His. Biopsy specimens demonstrated a leiomyoma. The patient underwent endoscopically assisted laparoscopic resection of the tumor. The operative time was 45 minutes. Diagnosis of leiomyoma was confirmed by the final histopathological examination. The patient had an uneventful postoperative recovery and was discharged on the 2nd postoperative day. Conclusion Combined laparoscopic and endoscopic rendezvous resection appears as a promising alternative minimally invasive technique. It offers easy recognition of the tumor, regardless of location, safe dissection, and full thickness resection with adequate margins as well as less operative time. PMID:24119820

  17. Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults

    PubMed Central

    Stark, Timothy W; Lacy, John M; Preston, David M

    2016-01-01

    A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. PMID:27162514

  18. Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults.

    PubMed

    Stark, Timothy W; Lacy, John M; Preston, David M

    2016-01-01

    A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. PMID:27162514

  19. Relationship between indeterminate or positive lateral margin and local recurrence after endoscopic resection of colorectal polyps

    PubMed Central

    Makazu, Makomo; Sakamoto, Taku; So, Eriko; Otake, Yosuke; Nakajima, Takeshi; Matsuda, Takahisa; Kushima, Ryoji; Saito, Yutaka

    2015-01-01

    Background and study aims: Although endoscopic resection is widely used for the treatment of superficial colorectal neoplasms, the rate of local recurrence of lesions with a positive or indeterminate lateral margin on histologic evaluation is unclear. We aimed to demonstrate the relationship between lateral margin status and local recurrence after the endoscopic resection of intramucosal colorectal neoplasms. Patients and methods: We retrospectively collected the clinical and pathologic data for 844 endoscopically resected colorectal intramucosal neoplasms with a size of 10 mm or larger. We investigated the relationship between the local recurrence rate and the lateral margin status (categorized as LM0 [negative], LM1 [positive], or LMX [indeterminate]). Results: In total, 389 lesions were evaluated as LM0 and showed no local recurrence. Of the 455 lesions evaluated as LMX or LM1, 30 showed local recurrence within a median period of 6.3 months (range, 1.7 – 48.1) from the initial endoscopic resection. The local recurrence rate of the en bloc-LMX group (2.2 %) was significantly lower than that of the piecemeal-LMX group (15.2 %). Of the 30 cases of recurrence, 28 were successfully treated with a second endoscopic resection. Of the two lesions that showed further recurrence, one was treated with a third endoscopic resection, whereas the other – which was a piecemeal-LMX lesion – was eventually diagnosed as invasive cancer and treated with surgery. Conclusions: The local recurrence rate was lower in the en bloc-LMX group than in the piecemeal-LMX group. Thus, we believe that en bloc-LMX lesions that are completely and confidently resected endoscopically can be treated as en bloc-LM0 lesions. PMID:26171439

  20. Local Erythropoietin Injection in Tibiofibular Fracture Healing

    PubMed Central

    Bakhshi, Hooman; Kazemian, Gholamhossein; Emami, Mohammad; Nemati, Ali; Karimi Yarandi, Hossein; Safdari, Farshad

    2013-01-01

    Background Erythropoietin (EPO), in addition to its function as an erythropoiesis regulator has a regenerative activity on some nonhematopoietic tissues. Animal studies have suggested a role for erythropoietin in bone healing. Objectives The present study aimed to evaluate the effects of local EPO injection in healing of tibiofibular fractures. Materials and Methods In a prospective double blind study, 60 patients with tibiofibular fracture were divided to equal EPO or placebo groups, randomly. Patients received local injection of either EPO or a placebo to the site of fracture two weeks after surgical fixation. Patients were followed by clinical and radiographic examination to determine the union rate. The period of fracture union and incidence of nonunion were compared between the two groups. Results The demographic data and types of fractures were similar in the both groups. The mean duration of the fracture union was 2.1 weeks shorter in those treated with EPO (P = 0.01). Nonunion was observed in 6 patients of the control group and 2 receiving EPO (P = 0.02). No patient experienced any adverse effect from local EPO injections. Conclusions EPO injection into the site of tibiofibular fractures may possibly accelerate healing. PMID:24350133

  1. Solutions for submucosal injection in endoscopic resection: a systematic review and meta-analysis

    PubMed Central

    Ferreira, Alexandre Oliveira; Moleiro, Joana; Torres, Joana; Dinis-Ribeiro, Mario

    2016-01-01

    Background and aims: Submucosal injection is standard practice in endoscopic mucosal resection of gastrointestinal lesions. Several solutions are used. Our aim was to systematically review their efficacy and safety. Patients and methods: We performed a systematic review and meta-analysis using a random effects model of randomized controlled trials (RCTs) from MEDLINE. Studies in animal models were qualitatively assessed for efficacy and safety. Results: In total, 54 studies were qualitatively assessed. Eleven RCTs were analyzed, two of which were on endoscopic submucosal dissection (ESD). The quantitative synthesis included nine RCTs on endoscopic mucosal resection (EMR), comprising 792 subjects and 793 lesions. Mean lesion size was 20.9 mm (range 8.5 – 46 mm). A total of 209 lesions were randomized to sodium hyaluronate (SH) vs normal saline (NS), 72 to 50 % dextrose (D50) vs NS, 82 to D50 vs SH, 43 to succinylated gelatin, 25 to hydroxyethyl starch and 36 to fibrinogen. In total, 385 were randomized to NS as controls. NS and SH are the best studied solutions and seem to be equally effective in achieving complete resection (OR 1.09; 95 %CI 0.82, 1.45). No solution was proven to be superior in complete resection rate, post-polypectomy bleeding or coagulation syndrome/perforation incidence. Many solutions have been tested in animal studies and most seem more effective for mucosal elevation than NS. Conclusions: There are several solutions in clinical use and many more under research, but most are poorly studied. SH seems to be clinically equivalent to NS. There are no significant differences in post-polypectomy complications. Larger RCTs are needed to determine any small differences that may exist between solutions. PMID:26793777

  2. A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels

    PubMed Central

    Hepworth, C; Kadirkamanathan, S; Gong, F; Swain, C

    1998-01-01

    Background and aims—A randomised controlled comparison of haemostatic efficacy of mechanical, injection, and thermal methods of haemostasis was undertaken using canine mesenteric vessels to test the hypothesis that mechanical methods of haemostasis are more effective in controlling haemorrhage than injection or thermal methods. The diameter of arteries in human bleeding ulcers measures up to 3.45 mm; mesenteric vessels up to 5 mm were therefore studied. 
Methods—Mesenteric vessels were randomised to treatment with injection sclerotherapy (adrenaline and ethanolamine), bipolar diathermy, or mechanical methods (band, clips, sewing machine, endoloops). The vessels were severed and haemostasis recorded. 
Results—Injection sclerotherapy and clips failed to stop bleeding from vessels of 1 mm (n=20) and 2 mm (n=20). Bipolar diathermy was effective on 8/10 vessels of 2 mm but failed on 3 mm vessels (n=5). Unstretched elastic bands succeeded on 13/15 vessels of 2 mm but on only 3/10 vessels of 3 mm. The sewing machine achieved haemostasis on 8/10 vessels of 4 mm but failed on 5 mm vessels (n=5); endoloops were effective on all 5 mm vessels (n=5). 
Conclusions—Only mechanical methods were effective on vessels greater than 2 mm in diameter. Some mechanical methods (banding and clips) were less effective than expected and need modification. Thermal and (effective) mechanical methods were significantly (p<0.01) more effective than injection sclerotherapy. The most effective mechanical methods were significantly more effective (p<0.01) than thermal or injection on vessels greater than 2mm. 

 Keywords: endoscopic haemostasis; mesenteric vessels PMID:9616305

  3. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding

    PubMed Central

    Qiao, Weiguang; Ren, Yutang; Bai, Yang; Liu, Side; Zhang, Qiang; Zhi, Fachao

    2015-01-01

    Abstract The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival. Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14–17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included. Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed. PMID

  4. Development of the local magnification method for quantitative evaluation of endoscope geometric distortion

    NASA Astrophysics Data System (ADS)

    Wang, Quanzeng; Cheng, Wei-Chung; Suresh, Nitin; Hua, Hong

    2016-05-01

    With improved diagnostic capabilities and complex optical designs, endoscopic technologies are advancing. As one of the several important optical performance characteristics, geometric distortion can negatively affect size estimation and feature identification related diagnosis. Therefore, a quantitative and simple distortion evaluation method is imperative for both the endoscopic industry and the medical device regulatory agent. However, no such method is available yet. While the image correction techniques are rather mature, they heavily depend on computational power to process multidimensional image data based on complex mathematical model, i.e., difficult to understand. Some commonly used distortion evaluation methods, such as the picture height distortion (DPH) or radial distortion (DRAD), are either too simple to accurately describe the distortion or subject to the error of deriving a reference image. We developed the basic local magnification (ML) method to evaluate endoscope distortion. Based on the method, we also developed ways to calculate DPH and DRAD. The method overcomes the aforementioned limitations, has clear physical meaning in the whole field of view, and can facilitate lesion size estimation during diagnosis. Most importantly, the method can facilitate endoscopic technology to market and potentially be adopted in an international endoscope standard.

  5. Fatal necrotising fasciitis associated with intramuscular injection of nonsteroidal anti-inflammatory drugs after uncomplicated endoscopic polypectomy.

    PubMed

    Orlando, A; Marrone, C; Nicoli, N; Tamburello, G; Rizzo, A; Pagliaro, L; Cottone, M; D'Amico, G

    2007-03-01

    Necrotising fasciitis is a life-threatening infection of the superficial muscle fascia and the adjacent deep layer of subcutaneous tissue that is often fatal. A 46-year-old woman was admitted to the intensive care unit (ICU) three days after an uncomplicated endoscopic polypectomy because of necrotising fasciitis of left tight, buttock and retroperitoneal space and septic shock. Six hours after the polypectomy she was given an intramuscular injection of ketorolac in the left tight because of moderate low abdominal pain. Twelve and 24h later she was treated with another two intramuscular injection of diclofenac in the left tight for severe pains in the left hip joint region. The shock was unresponsive to any treatment and the fasciitis extended to the whole body even after surgical specific treatment and the patient died in four days. This is the first report of a necrotising fasciitis following intramuscular administration of nonsteroidal anti-inflammatory drugs after an endoscopic procedure. PMID:17052758

  6. Successful treatment with a combination of endoscopic injection and irrigation with coca cola for gastric bezoar-induced gastric outlet obstruction.

    PubMed

    Lin, Chen-Sheng; Tung, Chun-Fang; Peng, Yen-Chun; Chow, Wei-Keung; Chang, Chi-Sen; Hu, Wei-Hsiung

    2008-01-01

    We report a case of gastric bezoar-induced gastric outlet obstruction that was successfully treated with a combination of endoscopic injection and irrigation with Coca Cola. A 73-year-old diabetic woman had a history of perforated peptic ulcer and had received pyloroplasty more than 20 years previously. She had been ingesting Pho Pu Zi (Cordia dichotoma Forst. f.) as an appetizer for 1 month. She presented with epigastric pain, nausea, and vomiting. Upper gastrointestinal endoscopy, performed at a local hospital, showed 2 gastric bezoars in the stomach, and 1 of them impacted at the pylorus. She was referred to our emergency department for removal of the gastric bezoars that were suspected to be causing gastric outlet obstruction. All attempts at endoscopic removal using a polypectomy snare, biopsy forceps and Dormia basket failed. We then injected Coca Cola directly into the bezoar mass, followed by irrigation with Coca Cola. Follow-up endoscopy was performed the next day, which revealed that the gastric bezoars had dissolved spontaneously. PMID:18218561

  7. DOES ENDOSCOPIC ULTRASOUND IMPROVE DETECTION OF LOCALLY RECURRENT ANAL SQUAMOUS CELL CANCER?

    PubMed Central

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

    2015-01-01

    Background Evaluating patients for recurrent anal cancer after primary treatment can be difficult due to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown. Objective To compare the effectiveness of digital rectal exam and endoscopic ultrasound during routine follow-up of anal cancer patients in detecting locally recurrent disease. Design Retrospective, single-institution review Settings Oncologic tertiary referral center Patients 175 patients with nonmetastatic anal squamous cell cancer without persistent disease after primary chemoradiotherapy who had at least one post-treatment ultrasound and examination by a colorectal surgeon. Main Outcome Measures First modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value. Results 855 endoscopic ultrasounds and 873 digital rectal exams were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital exam detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital exam. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital exam 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. Limitations The heterogeneity of follow-up timing and exams is not standardized in this study but is reflective of general practice. Conclusions Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for routine surveillance. PMID:25585077

  8. Endoscopic mucosal incision by diode laser for early cancer treatment in the alimentary tract: effect of submucosal indocyanine green solution injection

    NASA Astrophysics Data System (ADS)

    Hayashi, Takuya; Arai, Tsunenori; Nakamura, Naoko; Tajiri, Hisao; Miura, Soichiro; Kikuchi, Makoto

    1999-06-01

    Mucosal incision technique by diode laser ablation was studied to ensure the operation of endoscopic mucosal resection (EMR), which is gold standard method for early gastric cancer with little/no risk of lymphnode metastasis. Our method was designed to facilitate grasping a large lesion by hitching the snaring wire on the incised mucosal groove around the lesion. We employed local submucosal injection of indocyanine green (ICG) solution. ICG solution was used to prevent direct laser light penetration to the muscularis propriae owing to strong absorption of 805nm light (absorption coefficent at 805 nm is about 200cm-1). We used diode laser radiation with an output of 25W by contact (0.1, 0.5, 1.0 kg/cm2) and non-contact irradiation methods. In the preliminary experiment with resected porcine stomach, muscularis propriae was intact by the 60s non-contact irradiation or the 8s contact irradiation with contact pressure of 1kg/cm2. In the endoscopic experiment we used 3 dogs. Using conical contact probe, we successfully demonstrated 3cm diameter circular incision with sharp groove in 10 minutes. We could place the snaring wire on the incised groove. Histology of the endoscopically incised canine stomach revealed that the submucosal layer welled up to 6mm in thickness and the bottom of the incision groove reached 1.9mm at deepest below the mucosal muscle. The thickness of the coagulation layer around the incised groove was up to 1.8mm. No damage was seen a the muscularis propriae. We demonstrate easy as well as sure snaring by using our laser incision technique. We think our technique may be available to enhance the efficacy of EMR for early gastric cancer including the lesion over 2cm in diameter.

  9. Endoscopic Foraminal Decompression for Failed Back Surgery Syndrome under local Anesthesia

    PubMed Central

    Gore, Satishchandra

    2014-01-01

    Background The most common causes of failed back surgery are residual or recurrent herniation, foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. Residual back ache may also be from facetal causes or denervation and scarring of the paraspinal muscles.1–6 The original surgeon may advise his patient that nothing more can be done on the basis of his opinion that the nerve was visually decompressed by the original surgery, supported by improved post-op imaging and follow-up studies such as EMG and conduction velocity studies. Post-op imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of Failed back surgery by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain, therefore necessitating fusion. The authors, having limited their practice to endoscopic MIS surgery over the last 15-20 years, report on their experience gained during that period to relieve pain by endoscopically visualizing and treating unrecognized causative patho-anatomy in FBSS.7 Methods Thirty consecutive patients with FBSS presenting with back and leg pain that had supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections (Figure 1), were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open translaminar surgical treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla, also known as the

  10. Morphological Characteristics of the Sphenoid Sinus and Endoscopic Localization of the Cavernous Sinus.

    PubMed

    Yang, Youxiong; Zhan, Guowen; Liao, Jianchun; Dang, Ruishan; Wang, Hongli; Li, Yang; Zhang, Xiaote

    2015-09-01

    The aim of this study was to investigate the relationship between the morphological characteristics of the sphenoid sinus and endoscopic localization of the cavernous sinus (CS) using an extended endoscopic endonasal transsphenoidal approach. Thirty sides of CS in 15 adult cadaver heads were dissected to simulate the extended endoscopic endonasal transsphenoidal approach, and the morphology of the sphenoid sinus and anatomic structures of CS were observed. The opticocarotid recess (OCR), ophthalmomaxillary recess (V1V2R), and maxillomandibular recess (V2V3R) in the lateral wall of the sphenoid sinus were presented in 16 sides (53.3%), 6 sides (20%), and 4 sides (13.3%) of the 30 sides, respectively. OCR is a constant anatomic landmark in endoscopy and coincides with the anterior portion of the clinoidal triangle. The C-shaped internal carotid artery (ICA) in the lateral wall of the sphenoid sinus was presented in 11 sides (36.7%), the upper one-third of which corresponds to the middle portion of the clinoidal triangle, and the lower two-thirds of which correlates to the supratrochlear triangle, infratrochlear triangle, and ophthalmic nerve in CS, around which the medial, lateral, and anteroinferior interspaces are distributed. From a front-to-behind perspective, the C-shaped ICA consists of inferior horizontal segment, anterior vertical segment, clinoidal segment as well as partial subarachnoid segment of the ICA. OCR and C-shaped ICA in the lateral wall of the sphenoid sinus are the 2 reliable anatomic landmarks in the intraoperative location of the parasellar region of CS. PMID:26221856

  11. Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond

    PubMed Central

    Althumairi, Azah A.

    2015-01-01

    The goal of treatment for early stage rectal cancer is to optimize oncologic control while minimizing the long-term impact of treatment on quality of life. The standard of care treatment for most stage I and II rectal cancers is radical surgery alone, specifically total mesorectal excision (TME). For early rectal cancers, this procedure is usually curative but can have a substantial impact on quality of life, including the possibility of permanent colostomy and the potential for short and long-term bowel, bladder, and sexual dysfunction. Given the morbidity associated with radical surgery, alternative approaches to management of early rectal cancer have been explored, including local excision (LE) via transanal excision (TAE) or transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). Compared to the gold standard of radical surgery, local procedures for strictly selected early rectal cancers should lead to identical oncological results and even better outcomes regarding morbidity, mortality, and quality of life. PMID:26029457

  12. Endoscopic injection therapy to prevent rebleeding from peptic ulcers with a protruding vessel: a controlled comparative trial.

    PubMed Central

    Rutgeerts, P; Gevers, A M; Hiele, M; Broeckaert, L; Vantrappen, G

    1993-01-01

    Seventy five patients with severely bleeding peptic ulcer were included in a controlled comparative trial to assess the efficacy and safety of endoscopic injection therapy in preventing rebleeding from peptic ulcers that presented at endoscopy with a protruding vessel. Twenty five patients were treated with injection of epinephrine followed by polidocanol, 25 were treated with injection of absolute alcohol, and 25 with sham injection. Rebleeding occurred in 44% of patients in the sham group, 40% of those treated with epinephrine and polidocanol, and in 20% of those treated with absolute ethanol. The difference in the haemostasis rate between the control and ethanol treated subjects nearly reached significance (p = 0.07). A second therapy session resulted in haemostasis rates of 68% in the epinephrine-polidocanol group and of 88% in the absolute ethanol group. These rates after two treatments as well as the emergency surgery rates (32% in the epinephrine-polidocanol group and 8% in the absolute ethanol group; p = 0.07) were not significantly different. In eight of the 11 patients with rebleeding in the sham treatment group, definitive haemostasis was achieved by elective injection therapy. Overall transfusion requirements were mean (SD) 6.0 (0.7) units in the sham group, 6.0 (0.9) in the epinephrine-polidocanol group, and 3.9 (0.5) in the absolute ethanol group. Only the difference between ethanol and sham was significant (p = 0.02). This study shows that injection with absolute ethanol reduces rebleeding in these patients and significantly lowers transfusion requirements. Absolute ethanol was superior to epinephrine-polidocanol, which was not significantly better than sham therapy. PMID:8472981

  13. Investigation of in-body path loss in different human subjects for localization of capsule endoscope.

    PubMed

    Ara, Perzila; Cheng, Shaokoon; Heimlich, Michael; Dutkiewicz, Eryk

    2015-01-01

    Recent developments in capsule endoscopy have highlighted the need for accurate techniques to estimate the location of a capsule endoscope. A highly accurate location estimation of a capsule endoscope in the gastrointestinal (GI) tract in the range of several millimeters is a challenging task. This is mainly because the radio-frequency signals encounter high loss and a highly dynamic channel propagation environment. Therefore, an accurate path-loss model is required for the development of accurate localization algorithms. This paper presents an in-body path-loss model for the human abdomen region at 2.4 GHz frequency. To develop the path-loss model, electromagnetic simulations using the Finite-Difference Time-Domain (FDTD) method were carried out on two different anatomical human models. A mathematical expression for the path-loss model was proposed based on analysis of the measured loss at different capsule locations inside the small intestine. The proposed path-loss model is a good approximation to model in-body RF propagation, since the real measurements are quite infeasible for the capsule endoscopy subject. PMID:26737527

  14. Injectable therapies for localized fat loss: state of the art.

    PubMed

    Duncan, Diane; Rotunda, Adam M

    2011-07-01

    This review presents mechanisms of action and a review of the clinical applications of injections currently in development for localized fat reduction. After being received with initial enthusiasm earlier in the decade, mesotherapy and other injectable methods for fat loss (Lipodissolve, PC/DC, DC, injection lipolysis, adipolysis) have been subjects of critical scrutiny by the media and the US Food and Drug Administration. Several medications with novel detergent and lipolytic activity are in development and have demonstrated potential as minimally invasive fat reducing treatments. PMID:21824545

  15. A simplified technique for tumor localization using preoperative endoscopic clipping and radio-opaque markers during totally laparoscopic gastrectomy.

    PubMed

    Kim, Beom Su; Yook, Jeong Hwan; Kim, Byung Sik; Jung, Hwoon-Yong

    2014-12-01

    Tumor localization during intracorporeal anastomosis after totally laparoscopic distal gastrectomy (TLDG) is challenging. The aim of this study was to assess the simplicity and feasibility of locating tumors in the stomach using radio-opaque markers and preoperative endoscopic clipping. The intra- and postoperative findings of 29 patients who underwent TLDG with intracorporeal anastomosis between January 2012 and March 2013 were reviewed. Preoperative endoscopic clips were applied just proximal to the tumor by specialized endoscopists, and surgical gauze with an attached radio-opaque marker (3 mm × 60 mm) was prepared. The marker was fixed to either the anterior or posterior of the stomach, above the predicted site of the tumor, using suture ties. Portable abdominal radiography was used during the laparoscopic surgery, and the stomach was resected using guidance by the radiomarker. The radio-opaque marker and the endoscopic clips were clearly visible by intraoperative abdominal radiography. All patients received curative resection. No complications or deaths were encountered. The mean distance between the endoscopic clips and the radiomarker by portable intraoperative radiography was 21.3 ± 18.3 mm, whereas the actual in situ mean distance was 20.7 ± 17.6 mm. This difference was not statistically significant (P > 0.05). It is imperative that preoperative endoscopic clips are applied just proximal to the tumor by specialized endoscopists. The use of a radio-opaque marker is a simple and feasible way to locate tumors during totally laparoscopic gastrectomy. PMID:25513928

  16. Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

    PubMed Central

    Biočíc, Mihovil; Todoríc, Jakov; Budimir, Dražen; Roíc, Andrea Cvitkovíc; Pogorelíc, Zenon; Juríc, Ivo; Šušnjar, Tomislav

    2012-01-01

    Background The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection. Methods Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux. Results A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate. PMID:22854114

  17. Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer

    PubMed Central

    Lee, Ju Yup; Cho, Kwang Bum; Kim, Eun Soo; Park, Kyung Sik; Lee, Yoo Jin; Lee, Yoon Suk; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2016-01-01

    AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC). METHODS: A total of 1121 patients (1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients (415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases (8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach (OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm (log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in cases in which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important. PMID:27076871

  18. Automatic localization of endoscope in intraoperative CT image: A simple approach to augmented reality guidance in laparoscopic surgery.

    PubMed

    Bernhardt, Sylvain; Nicolau, Stéphane A; Agnus, Vincent; Soler, Luc; Doignon, Christophe; Marescaux, Jacques

    2016-05-01

    The use of augmented reality in minimally invasive surgery has been the subject of much research for more than a decade. The endoscopic view of the surgical scene is typically augmented with a 3D model extracted from a preoperative acquisition. However, the organs of interest often present major changes in shape and location because of the pneumoperitoneum and patient displacement. There have been numerous attempts to compensate for this distortion between the pre- and intraoperative states. Some have attempted to recover the visible surface of the organ through image analysis and register it to the preoperative data, but this has proven insufficiently robust and may be problematic with large organs. A second approach is to introduce an intraoperative 3D imaging system as a transition. Hybrid operating rooms are becoming more and more popular, so this seems to be a viable solution, but current techniques require yet another external and constraining piece of apparatus such as an optical tracking system to determine the relationship between the intraoperative images and the endoscopic view. In this article, we propose a new approach to automatically register the reconstruction from an intraoperative CT acquisition with the static endoscopic view, by locating the endoscope tip in the volume data. We first describe our method to localize the endoscope orientation in the intraoperative image using standard image processing algorithms. Secondly, we highlight that the axis of the endoscope needs a specific calibration process to ensure proper registration accuracy. In the last section, we present quantitative and qualitative results proving the feasibility and the clinical potential of our approach. PMID:26925804

  19. Magnetic localization and orientation of the capsule endoscope based on a random complex algorithm

    PubMed Central

    He, Xiaoqi; Zheng, Zizhao; Hu, Chao

    2015-01-01

    The development of the capsule endoscope has made possible the examination of the whole gastrointestinal tract without much pain. However, there are still some important problems to be solved, among which, one important problem is the localization of the capsule. Currently, magnetic positioning technology is a suitable method for capsule localization, and this depends on a reliable system and algorithm. In this paper, based on the magnetic dipole model as well as magnetic sensor array, we propose nonlinear optimization algorithms using a random complex algorithm, applied to the optimization calculation for the nonlinear function of the dipole, to determine the three-dimensional position parameters and two-dimensional direction parameters. The stability and the antinoise ability of the algorithm is compared with the Levenberg–Marquart algorithm. The simulation and experiment results show that in terms of the error level of the initial guess of magnet location, the random complex algorithm is more accurate, more stable, and has a higher “denoise” capacity, with a larger range for initial guess values. PMID:25914561

  20. Endoscopic Combination Therapy Of Nd:YAG Laser In Conjunction With Conventional Treatments

    NASA Astrophysics Data System (ADS)

    Suzuki, Sohtaro; Aoki, Jun; Shiina, Yasubimi; Miwa, Takeshi; Daikuzono, Norio; Joffe, Stephen N.

    1988-06-01

    In this paper, we discuss the possibilities of the clinical application of the contact method with various endoprobes, either alone or combination with other conventional treat ment such as endoscopic polypectomy, local injection therapy, intubation of prosthesis, radiation therapy and general chemotherapy. According to the type of lesions and the severity of the complicated diseases, endoscopic techniques were chosen and combined. It was generally recognized that all of the endoscopic treatments were not curative therapies but applied as local therapeutics. Therefore, during the management of high risk patients with GI cancer within the mucosa, contact endoscopic Nd:YAG laser therapy should be preferred to general surgery.

  1. Triggering Edge Localized Modes through Lithium Dust Injection

    NASA Astrophysics Data System (ADS)

    John, Brendan; Roquemore, Lane; Mansfield, Dennis; Friesen, Forrest

    2010-11-01

    Edge Localized Modes (ELMs) of low amplitude should have the beneficial effect of transporting impurities away from the core plasma, without reducing the plasma stored energy, thus improving the performance of a Tokamak fusion device. In past experiments deuterium pellets have been injected into the DIII-D Tokamak, successfully triggering ELMs, and ITER is considering using deuterium pellets injected by a gas gun to trigger ELMs. Here, a new apparatus for injecting packets of lithium powder into a Tokamak at a frequency of greater than 100Hz, with the hope of triggering ELMs, was designed, built, and tested in a small vacuum chamber. The apparatus drops a thin sheet of lithium powder of diameter 40 micrometers to 500 micrometers onto a rotating paddle wheel, which propels packets of the lithium forward at greater than 20m/s. A fast framing camera was used to measure the velocity and spatial distributions of the particles leaving the paddle wheel.

  2. Endoscopic Endonasal Repair of Spontaneous and Traumatic Cerebrospinal Fluid Rhinorrhea: A Review and Local Experience.

    PubMed

    Gonen, Lior; Monteiro, Eric; Klironomos, George; Alghonaim, Yazeed; Vescan, Allan; Zadeh, Gelareh; Gentili, Fred

    2015-07-01

    This article presents an overview of endoscopic endonasal repair of cerebrospinal fluid (CSF) rhinorrhea. In recent years, endoscopic repair has become the standard of care for managing this condition, because it gradually replaces the traditional open transcranial approach. Discussion includes the etiologic classification of CSF rhinorrhea, management paradigm for each category, diagnosis algorithm, comprehensive description of the surgical technique, and an updated review of the literature regarding the safety and efficacy of this procedure. In addition, the authors present their experience, including 2 surgical videos demonstrating endoscopic repair of CSF rhinorrhea in 2 distinct clinical scenarios. PMID:26141354

  3. A system for endoscopic mechanically scanned localized proton MR and light-induced fluorescence emission spectroscopies

    NASA Astrophysics Data System (ADS)

    Sonmez, Ahmet E.; Webb, Andrew G.; Spees, William M.; Ozcan, Alpay; Tsekos, Nikolaos V.

    2012-09-01

    Molecular and near-cellular modalities offer new opportunities in assessing living tissue in situ, and multimodality approaches, which offer complementary information, may lead to improved characterization of tissue pathophysiology benefiting diagnosis and focal therapy. However, many such modalities are limited by their low penetration through tissue, which has led to minimally invasive trans-cannula approaches to place the corresponding sensors locally at the area of interest. This work presents a system for performing localized fluorescence emission and proton magnetic resonance (MR) spectroscopies via endoscopic access. The in-house developed side-firing 1.9-mm wide dual-sensor integrates a three-fiber optical sensor for fluorescence emission optical spectroscopy and a 1-mm circular radiofrequency (RF) coil for localized MR proton spectroscopy. An MR-compatible manipulator was developed for carrying and mechanically translating the dual-sensor along a linear access channel. The hardware and software control of the system allows reconfigurable synchronization of the manipulator-assisted translation of the sensor, and MR and optical data collection. The manipulator serves as the mechanical link for the three modalities and MR images, MR spectra and optical spectra are inherently co-registered to the MR scanner coordinate system. These spectra were then used to generate spatio-spectral maps of the fluorophores and proton MR-signal sources in three-compartment phantoms with optically- and MR-visible, and distinguishable, materials. These data demonstrate a good spatial match between MR images, MR spectra and optical spectra along the scanned path. In addition to basic research, such a system may have clinical applications for assessing and characterizing cancer in situ, as well as guiding focal therapies.

  4. Fully automated glottis segmentation in endoscopic videos using local color and shape features of glottal regions.

    PubMed

    Gloger, Oliver; Lehnert, Bernhard; Schrade, Andreas; Völzke, Henry

    2015-03-01

    Exact analysis of glottal vibration patterns is indispensable for the assessment of laryngeal pathologies. Increasing demand of voice related examination and large amount of data provided by high-speed laryngoscopy and stroboscopy call for automatic assistance in research and patient care. Automatic glottis segmentation is necessary to assist glottal vibration pattern analysis, but unfortunately proves to be very challenging. Previous glottis segmentation approaches hardly consider characteristic glottis features as well as inhomogeneity of glottal regions and show serious drawbacks in their application for diagnostic purposes. We developed a fully automated glottis segmentation framework that extracts a set of glottal regions in endoscopic videos by using a flexible thresholding technique combined with a refining level set method that incorporates prior glottis shape knowledge. A novel descriptor for glottal regions is presented to remove potential nonglottal fake regions that show glottis-like shape properties. Knowledge of local color distributions is incorporated into Bayesian probability image generation. Glottal regions are then tracked frame-by-frame in probability images with a region-based level set segmentation strategy. Principal component analysis of pixel coordinates is applied to determine glottal orientation in each frame and to remove nonglottal regions if erroneous regions are included. The framework shows very promising results concerning segmentation accuracy and processing times and is applicable for both stroboscopic and high-speed videos. PMID:25350912

  5. An Injectable and Drug-loaded Supramolecular Hydrogel for Local Catheter Injection into the Pig Heart

    PubMed Central

    Tseng, Cheyenne C. S.; Bastings, Maartje M. C.; Koudstaal, Stefan; Agostoni, Pierfrancesco; Chamuleau, Steven A. J.; Dankers, Patricia Y. W.

    2015-01-01

    Regeneration of lost myocardium is an important goal for future therapies because of the increasing occurrence of chronic ischemic heart failure and the limited access to donor hearts. An example of a treatment to recover the function of the heart consists of the local delivery of drugs and bioactives from a hydrogel. In this paper a method is introduced to formulate and inject a drug-loaded hydrogel non-invasively and side-specific into the pig heart using a long, flexible catheter. The use of 3-D electromechanical mapping and injection via a catheter allows side-specific treatment of the myocardium. To provide a hydrogel compatible with this catheter, a supramolecular hydrogel is used because of the convenient switching from a gel to a solution state using environmental triggers. At basic pH this ureido-pyrimidinone modified poly(ethylene glycol) acts as a Newtonian fluid which can be easily injected, but at physiological pH the solution rapidly switches into a gel. These mild switching conditions allow for the incorporation of bioactive drugs and bioactive species, such as growth factors and exosomes as we present here in both in vitro and in vivo experiments. The in vitro experiments give an on forehand indication of the gel stability and drug release, which allows for tuning of the gel and release properties before the subsequent application in vivo. This combination allows for the optimal tuning of the gel to the used bioactive compounds and species, and the injection system. PMID:26132631

  6. Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study.

    PubMed

    Emori, Keigo; Toyonaga, Atsushi; Oho, Kazuhiko; Kumamoto, Masafumi; Haruta, Tsuyoshi; Inoue, Hiroto; Morita, Yukihiko; Mitsuyama, Keiichi; Tsuruta, Osamu; Sata, Michio

    2014-01-01

    Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (p<0.05). The EIS group had significantly more patients with IGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding. PMID:24858411

  7. Towards a Predictive Capability for Local Helicity Injection Startup

    NASA Astrophysics Data System (ADS)

    Barr, J. L.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Hinson, E. T.; Lewicki, B. T.; Perry, J. M.; Redd, A. J.; Schlossberg, D. J.

    2014-10-01

    Local helicity injection (LHI) is a non-solenoidal tokamak startup technique under development on the Pegasus ST. New designs of the injector cathode geometry and plasma-facing shield rings support high-voltage operation up to 1.5 kV. This leads to reduced requirements in injector area for a given helicity input rate. Near-term experiments in Pegasus are testing the gain in Ip obtained with a 1 . 5 × increase in the helicity input rate and the efficacy of helicity injection in the lower divertor region. A predictive model for LHI is needed to project scalable scenarios for larger devices. A lumped-parameter circuit model using power and helicity balance is being developed for LHI on Pegasus-U and NSTX-U. The model indicates that MA-class startup on NSTX-U will require operating in a regime where the drive from LHI dominates the inductive effects arising from dynamically evolving plasma geometry. The physics of this new regime can be tested in Pegasus-U at Ip ~ 0 . 3 MA. The LHI systems on the proposed Pegasus-U will be expanded to provide 3 - 4 × helicity injection rate and the toroidal field doubled to reach this regime. Predictive models to be validated on Pegasus-U include the 0-D power balance model, NIMROD, and TSC. Work supported by US DOE Grants DE-FG02-96ER54375 and DE-SC0006928.

  8. Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

    PubMed Central

    Mori, Hirohito; Kobayashi, Nobuya; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Chiyo, Taiga; Ayaki, Maki; Nagase, Takashi; Masaki, Tsutomu

    2016-01-01

    AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not. METHODS: Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port. CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human. PMID:27053847

  9. Concept and simulation study of a novel localization method for robotic endoscopic capsules using multiple positron emission markers

    SciTech Connect

    Than, Trung Duc Alici, Gursel Zhou, Hao Li, Weihua; Harvey, Steven

    2014-07-15

    Purpose: Over the last decade, wireless capsule endoscope has been the tool of choice for noninvasive inspection of the gastrointestinal tract, especially in the small intestine. However, the latest clinical products have not been equipped with a sufficiently accurate localization system which makes it difficult to determine the location of intestinal abnormalities, and to apply follow-up interventions such as biopsy or drug delivery. In this paper, the authors present a novel localization method based on tracking three positron emission markers embedded inside an endoscopic capsule. Methods: Three spherical {sup 22}Na markers with diameters of less than 1 mm are embedded in the cover of the capsule. Gamma ray detectors are arranged around a patient body to detect coincidence gamma rays emitted from the three markers. The position of each marker can then be estimated using the collected data by the authors’ tracking algorithm which consists of four consecutive steps: a method to remove corrupted data, an initialization method, a clustering method based on the Fuzzy C-means clustering algorithm, and a failure prediction method. Results: The tracking algorithm has been implemented inMATLAB utilizing simulation data generated from the Geant4 Application for Emission Tomography toolkit. The results show that this localization method can achieve real-time tracking with an average position error of less than 0.4 mm and an average orientation error of less than 2°. Conclusions: The authors conclude that this study has proven the feasibility and potential of the proposed technique in effectively determining the position and orientation of a robotic endoscopic capsule.

  10. Local delivery of tobramycin from injectable biodegradable polyurethane scaffolds.

    PubMed

    Hafeman, Andrea E; Zienkiewicz, Katarzyna J; Carney, Erin; Litzner, Brandon; Stratton, Charles; Wenke, Joseph C; Guelcher, Scott A

    2010-01-01

    Infections often compromise the healing of open fractures. While local antibiotic delivery from PMMA beads is an established clinical treatment of infected fractures, surgical removal of the beads is required before implanting a bone graft. A more ideal therapy would comprise a scaffold and antibiotic delivery system administered in one procedure. Biodegradable polyurethane (PUR) scaffolds have been shown in previous studies to promote new bone formation in vivo, but their potential to control infection through release of antibiotics has not been investigated. In this study, injectable PUR scaffolds incorporating tobramycin were prepared by reactive liquid molding. Scaffolds had compressive moduli of 15-115 kPa and porosities ranging from 85-93%. Tobramycin release was characterized by a 45-95% burst (tuned by the addition of PEG), followed by up to 2 weeks of sustained release, with total release 4-5-times greater than equivalent volumes of PMMA beads. Released tobramycin remained biologically active against Staphylococcus aureus, as verified by Kirby-Bauer assays. Similar results were observed for the antibiotics colistin and tigecycline. The versatility of the materials, as well as their potential for injection and controlled release, may present promising opportunities for new therapies for healing of infected wounds. PMID:20040156

  11. Ultrastructural localization of intravenously injected carbon nanohorns in tumor

    PubMed Central

    Matsumura, Sachiko; Yuge, Ryota; Sato, Shigeo; Tomida, Akihiro; Ichihashi, Toshinari; Irie, Hiroshi; Iijima, Sumio; Shiba, Kiyotaka; Yudasaka, Masako

    2014-01-01

    Nanocarbons have many potential medical applications. Drug delivery, diagnostic imaging, and photohyperthermia therapy, especially in the treatment of tumors, have attracted interest. For the further advancement of these application studies, the microscopic localization of nanocarbons in tumor tissues and cells is a prerequisite. In this study, carbon nanohorns (CNHs) with sizes of about 100 nm were intravenously injected into mice having subcutaneously transplanted tumors, and the CNHs in tumor tissue were observed with optical and electron microscopy. In the tumor tissue, the CNHs were found in macrophages and endothelial cells within the blood vessels. Few CNHs were found in tumor cells or in the region away from blood vessels, suggesting that, under these study conditions, the enhanced permeability of tumor blood vessels was not effective for the movement of CNHs through the vessel walls. The CNHs in normal skin tissue were similarly observed. The extravasation of CNHs was not so obvious in tumor but was easily found in normal skin, which was probably due to their vessel wall structure difference. Proper understanding of the location of CNHs in tissues is helpful in the development of the medical uses of CNHs. PMID:25092979

  12. Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer

    PubMed Central

    Jeong, Sang-Ho; Bae, Kyungsoo; Ha, Chang-Youn; Lee, Ok-Jae; Jung, Woon-Tae; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

    2013-01-01

    Purpose Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap). Methods In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis). Results PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both). Conclusion Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy. PMID:23396626

  13. Localized interstitial granuloma annulare induced by subcutaneous injections for desensitization.

    PubMed

    Spring, Philipp; Vernez, Maxime; Maniu, Christa-Maria; Hohl, Daniel

    2013-06-01

    We describe a patient with interstitial granuloma annulare associated with subcutaneous injection therapy (SIT) for desensitization to a type I allergy. Asymptomatic, erythematous, violaceous annular patches were located at the injection sites on both her arms. Medical history revealed perennial rhinoconjonctivitis treated with SIT (Phostal Stallergen® cat 100% and D. pteronyssinus/D.farinae 50%:50%). PMID:24011321

  14. Initial Injection Pressure for Dental Local Anesthesia: Effects on Pain and Anxiety

    PubMed Central

    Kudo, Masaru

    2005-01-01

    This study quantitatively assessed injection pressure, pain, and anxiety at the start of injection of a local anesthetic into the oral mucosa, and confirmed the relationship between injection pressure and pain, as well as between injection pressure and anxiety. Twenty-eight healthy men were selected as subjects and a 0.5-inch (12 mm) 30-gauge disposable needle attached to a computer-controlled local anesthetic delivery system (the Wand) was used. A 0.5 mL volume of local anesthetic solution was injected submucosally at a speed of either 30 or 160 s/mL. Three seconds after the start of local anesthetic injection, injection pressure was measured and pain and anxiety were assessed. Injection pressure was measured continuously in real time by using an invasive sphygmomanometer and analytical software, and pain was assessed on the Visual Analogue Scale and anxiety on the Faces Anxiety Scale. A significant correlation was evident between injection pressure and pain (rs = .579, P = .00124) and between intensity of injection pressure and state anxiety (rs = .479, P = .00979). It is therefore recommended that local anesthetic be injected under low pressure (less than 306 mm Hg) to minimize pain and anxiety among dental patients. PMID:16252739

  15. Endoscopic ultrasonography (EUS) as a method used in spatial localization of digestive tract tumors

    NASA Astrophysics Data System (ADS)

    Skrzywanek, Pawel; Sowier, Aleksander; Cysewska-Sobusiak, Anna R.

    2004-07-01

    The subject of the paper is devoted to a modern diagnostic method called the endoscopic ultrasonography (EUS) that is still not widely implemented in many countries. This method bases on two imaging techniques: videoendoscopy and ultrasonography, making possible effective aiding of diagnostics as well as evaluating possibilities of performing radical surgical therapy. Rotating USG probes enable acquiring images vertical to an axis for the round angle area. Small diameters and adequate frequencies of these microprobes make possible their deep penetration into such difficult sites as the biliary and pancreatic ducts. The EUS advantages are presented here on the basis of several examples of real minimally invasive interventions as well diagnostic procedures practiced by the authors. EUS has allowed precise diagnostics without disturbances occurring at conventional ultrasound imaging. The presented images concern EUS used for examination of different digestive tract diseases, including biliary and pancreatic ducts.

  16. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement.

    PubMed

    Qiao, Weiguang; Ren, Yutang; Bai, Yang; Liu, Side; Zhang, Qiang; Zhi, Fachao

    2015-10-01

    The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted.Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival.Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included.Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed. PMID:26469912

  17. Results of treatment of esophageal variceal hemorrhage with endoscopic injection of n-butyl-2-cyanoacrylate in patients with Child-Pugh class C cirrhosis

    PubMed Central

    Ribeiro, Joao Paulo; Matuguma, Sérgio Eiji; Cheng, Spencer; Herman, Paulo; Sakai, Paulo; D'Albuquerque, Luiz Augusto Carneiro; Maluf-Filho, Fauze

    2015-01-01

    Background and study aims: The results of endoscopic treatment with elastic band ligation for esophageal variceal bleeding in patients with Child-Pugh class C cirrhosis remain poor. In comparison with treatment with elastic band ligation, we have found lower rates of rebleeding and mortality with n-butyl-2-cyanoacrylate injections. Thus, the aim of the current study was to describe our unit’s 10 years of experience with injection of n-butyl-2-cyanoacrylate to control esophageal variceal ruptures in patients with Child-Pugh class C cirrhosis. Patients and methods: A single-center, retrospective study was conducted. Sixty-three patients with Child-Pugh class C cirrhosis had been admitted to the center with an acute episode of esophageal variceal bleeding. All were treated with injection of n-butyl-2-cyanoacrylate. The patients were assigned to 1 of 2 groups according to their Child-Pugh class C cirrhosis scores: group I (score range, 10 through 13 points) and group II (score, 14 or 15 points). The 3 variables studied were rates of initial failure to control bleeding, failure to prevent rebleeding (secondary prophylaxis), and mortality. Patients in the 2 groups (group I, n = 50; group II, n = 13) had similar characteristics. Results: Bleeding was successfully controlled in almost 75 % of the patients during the first 5 days after treatment, with no significant differences observed between groups I and II. There were no significant differences between the 2 groups with respect to mortality rate for the first 5 days after treatment. Thirty-four patients (54 %) were free of bleeding at 6 weeks after treatment, with a significant difference noted between the groups: group I, 64 %, versus group II, 15.4 % (P < 0.001). The overall mortality rate was 44.4 %, with a significant difference noted between the groups: group I, 34 %, versus group II, 84.6 % (P < 0.001). Conclusion: Endoscopic injection of n-butyl-2-cyanoacrylate is a valid treatment

  18. Endoscopic treatment of gastroparesis

    PubMed Central

    McCarty, Thomas R; Rustagi, Tarun

    2015-01-01

    Gastroparesis has traditionally been a largely medically managed disease with refractory symptoms typically falling under the umbrella of the surgical domain. Surgical options include, but are not limited to, gastrostomy, jejunostomy, pyloromyotomy, or pyloroplasty, and the Food and Drug Administration approved gastric electrical stimulation implantation. Endoscopic management of gastroparesis most commonly involves intrapyloric botulinum toxin injection; however, there exists a variety of endoscopic approaches on the horizon that have the potential to radically shift standard of care. Endoscopic management of gastroparesis seeks to treat delayed gastric emptying with a less invasive approach compared to the surgical approach. This review will serve to highlight such innovative and potentially transformative, endoscopic interventions available to gastroenterologists in the management of gastroparesis. PMID:26078560

  19. Endoscopic ultrasound

    MedlinePlus

    Endoscopic ultrasound is a type of imaging test. It is used to see organs in and near the digestive ... Ultrasound is a way to see the inside of the body using high-frequency sound waves. Endoscopic ...

  20. Successful emergency combined therapy with partial splenic arterial embolization and endoscopic injection therapy against a bleeding duodenal varix in a child.

    PubMed

    Sunakawa, Hironori; Tokuhara, Daisuke; Yamamoto, Akira; Sugimori, Satoshi; Morotomi, Yoshiki; Taniguchi, Shino; Nakaya, Masaharu; Cho, Yuki; Matsui, Katsutoshi; Kasuga, Saki; Sakae, Yukari; Yamato, Kazumi; Nishida, Norifumi; Tokimasa, Sadao; Shintaku, Haruo

    2015-06-01

    There is no consensus guidelines for treating duodenal variceal bleeding, which is a rare and life-threatening complication of portal hypertension. Here we report an exceedingly unusual case in a 9-year-old boy who had developed left-sided portal hypertension after surgical treatment for pancreatoblastoma followed by a duodenal variceal bleeding with massive melena, severe anemia (hemoglobin 4.5 g/dL) and hypovolemic shock. Emergency partial splenic arterial embolization (PSE) provided a reduction of variceal bleeding and improved blood pressure. Endoscopic injection sclerotherapy (EIS) was subsequently performed and stopped the duodenal variceal bleeding without the complication of portal vein thrombosis caused by injected sclerosant under hepatopetal flow. Our case demonstrates that emergency combined therapy with PSE and EIS can be considered as the therapeutic option for the management of left-sided portal hypertension-induced ectopic variceal bleedings in order to avoid the complication of portal embolization by EIS and provide effective hematostasis. PMID:25851961

  1. The inhibitory effect of locally injected dexmedetomidine on carrageenan-induced nociception in rats.

    PubMed

    Honda, Yuka; Higuchi, Hitoshi; Matsuoka, Yoshikazu; Yabuki-Kawase, Akiko; Ishii-Maruhama, Minako; Tomoyasu, Yumiko; Maeda, Shigeru; Morimatsu, Hiroshi; Miyawaki, Takuya

    2015-10-01

    Recent studies showed that the administration of dexmedetomidine relieved hyperalgesia in the presence of neuropathic pain. These findings have led to the hypothesis that the local administration of dexmedetomidine is useful for relieving acute inflammatory nociception, such as postoperative pain. Thus, we evaluated the inhibitory effect of locally injected dexmedetomidine on acute inflammatory nociception. Acute inflammatory nociception was induced by an intraplantar injection of 1% carrageenan into the hindpaws of rats, and dexmedetomidine was also injected combined with carrageenan. The paw withdrawal threshold based on von Frey filament stimulation was measured until 12 h after injection. We compared the area under the time-curve (AUC) between carrageenan and carrageenan with dexmedetomidine. To clarify that the action of dexmedetomidine was via α2-adrenoceptors, we evaluated the effect of yohimbine, a selective antagonist of α2-adrenoceptors, on the anti-nociception of dexmedetomidine. As the results, the intraplantar injection of carrageenan with over 10 μM dexmedetomidine significantly increased AUC, compared to that with only carrageenan injection. This effect of dexmedetomidine was reversed by the addition of yohimbine to carrageenan and dexmedetomidine. These results demonstrated that the locally injected dexmedetomidine was effective against carrageenan-induced inflammatory nociception via α2-adrenoceptors. The findings suggest that the local injection of dexmedetomidine is useful for relieving local acute inflammatory nociception. PMID:26160316

  2. Minimally Painful Local Anesthetic Injection for Cleft Lip/Nasal Repair in Grown Patients

    PubMed Central

    Price, Christopher; Wong, Alison L.; Chokotho, Tilinde

    2014-01-01

    Introduction: There has been a recent interest in injecting large body and face areas with local anesthetic in a minimally painful manner. The method includes adherence to minimal pain injection details as well feedback from the patient who counts the number of times he feels pain during the injection process. This article describes the successes and limitations of this technique as applied to primary cleft lip/nasal repair in grown patients. Methods: Thirty-two primary cleft lip patients were injected with local anesthesia by 3 surgeons and then underwent surgical correction of their deformity. At the beginning of the injection of the local anesthetic, patients were instructed to clearly inform the injector each and every time they felt pain during the entire injection process. Results: The average patient felt pain only 1.6 times during the injection process. This included the first sting of the first 27-gauge needle poke. The only pain that 51% of the patients felt was that first poke of the first needle; 24% of the patients only felt pain twice during the whole injection process. The worst pain score occurred in a patient who felt pain 6 times during the injection process. Ninety-one percent of the patients felt no pain at all after the injection of the local anesthetic and did not require a top-up. Conclusion: It is possible to successfully and reliably inject local anesthesia in a minimally painful manner for cleft lip and nasal repair in the fully grown cleft patient. PMID:25289364

  3. [Endoscopic Therapy for Esophageal Cancer].

    PubMed

    Sakai, Makoto; Kuwano, Hiroyuki

    2016-07-01

    Endoscopic treatment for esophageal neoplasms includes endoscopic resection, argon plasma coagulation(APC), photodynamic therapy( PDT) and stent placement. Endoscopic resection is widely used as an effective, less invasive treatment for superficial esophageal carcinoma in Japan. APC is considered to be safe and effective treatment for superficial esophageal carcinoma which cannot be resected endoscopically because of severe comorbidities, as well as for local recurrence after endoscopic resection or chemoradiotherapy. PDT is thought to be an effective option as salvage treatment for local failure after chemoradiotherapy. Stent placement mainly using self-expanding metallic stents have been used as a minimally invasive and effective modality for the palliative treatment of malignant esophageal obstruction. Endoscopic treatment is expected to have more important role in the treatment of esophageal neoplasms in the future. PMID:27440040

  4. Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

    PubMed Central

    Law, Joanna K.; Singh, Vikesh K.; Khashab, Mouen A.; Hruban, Ralph H.; Canto, Marcia Irene; Shin, Eun Ji; Saxena, Payal; Weiss, Matthew J.; Pawlik, Timothy M.; Wolfgang, Christopher L.

    2014-01-01

    Background Parenchymal-sparing pancreatic surgery is ideal for lesions such as small pancreatic neuroendocrine tumors (PanNET). However, precise localization of these small tumors at surgery can be difficult. The placement of fiducials under endoscopic ultrasound (EUS) guidance (EUS-F) has been used to direct stereotactic radiation therapy for pancreatic adenocarcinoma. This report describes two cases in which placement of fiducials was used to guide surgical resection. This study aimed to assess the feasibility, safety, and efficacy of using EUS-F for intraoperative localization of small PanNETs. Methods A retrospective study analyzed two consecutive patients with small PanNETs who underwent EUS-F followed by enucleation in a tertiary-care referral hospital. The following features were examined: technical success and complication rates of EUS-F, visibility of the fiducial at the time of surgery, and fiducial migration. Results In the study, EUS-F was performed for two female patients with a 7-mm and a 9-mm PanNET respectively in the uncinate process and neck of the pancreas. In both patients, EUS-F was feasible with two Visicoil fiducials (Core Oncology, Santa Barbara, CA, USA) placed either within or adjacent to the tumors using a 22-gauge Cook Echotip needle. At surgery, the fiducials were clearly visible on intraoperative ultrasound, and both the tumor and the fiducials were successfully enucleated in both cases. No complications were associated with EUS-F, and no evidence of pancreatitis was shown either clinically or on surgical pathology. This investigation had the limitations of a small single-center study. Conclusions For patients undergoing enucleation, EUS-F is technically feasible and safe and aids intraoperative localization of small PanNETs. PMID:23636530

  5. The Effect and Safety of Steroid Injection in Lumbar Spinal Stenosis: With or Without Local Anesthetics

    PubMed Central

    Song, Sung Hyuk; Ryu, Gi Hyeong; Park, Jin Woo; Lee, Ho Jun; Nam, Ki Yeun; Kim, Hyojun; Kim, Seung Yeon

    2016-01-01

    Objective To compare the long-term effect and safety of an epidural steroid injection in spinal stenosis patients, with or without local anesthetics. Methods Twenty-nine patients diagnosed with spinal stenosis were included and randomly divided into two groups. Translaminar epidural and selective nerve root spinal injection procedures were performed using steroids mixed with local anesthetics or normal saline. The effects of spinal injection procedures were measured with visual analogue scale (VAS) and functional rate index (FRI). These measurements were performed before injection, at 1 month after injection and at 3 months after injection. The occurrence of side effects was investigated each time. Results The VAS and FRI scores were significantly reduced in both the local anesthetics group and normal saline group at 1 and 3 months after the injection. However, there was no significant difference in VAS and FRI score reduction between the two groups each time. Side effects are not noted in both groups. Conclusion The spinal injection procedures using steroids mixed either with local anesthetics or normal saline have an effect in reducing pain and improving functional activities. However, there was no significant difference between the two groups in relation to side effects and the long-term effects of pain and function. PMID:26949664

  6. [Is the localization of the tumor in intra-peritoneal part of the rectum contraindication to transanal endoscopic microsurgery].

    PubMed

    Shelygin, Iu A; Rybakov, E G; Chernyshov, S V; Kuznetsov, N S

    2014-01-01

    Transanal endoscopic microsurgery (TEM) is the method used in cases of benign tumors at the early stages of rectal cancer. The tumor localization in peritonized part of the rectum indicates a limiting level for removal of the neoplasm. TEM was performed on 137 patients. The mean age was 63.8 ± 9.8 years and the number of women consisted of 65.7%. Neoplasms were located in the upper ampullar rectum and a potential possibility of connection with the peritoneal cavity was noted in 12 (8.7%) patients, but during TEM it was only in 5 cases. There wasn't any conversion to a peritoneal surgery. The wound closures were carried out from the side of the rectum lumen and all the operations were finished with the control laparoscopy and formation of sigmostoma. The stomas were closed in 3 patients on fifth- sixth weeks. A connection with the peritoneal cavity during TEM isn't critical event in the case of wound closure through surgical rectoscope and it doesn't lead to the conversion to radical operation. PMID:25552105

  7. Is photodynamic therapy a selective treatment? Analysis of local complications after endoscopic photodynamic therapy of early stage tumors of gastrointestinal, tracheobronchial, and urinary tracts

    NASA Astrophysics Data System (ADS)

    Spinelli, Pasquale; Dal Fante, Marco; Mancini, Andrea

    1995-03-01

    Selectivity is the most emphasized advantage of photodynamic therapy (PDT). However, at drug and light doses used for clinical applications, response from normal tissue surrounding the tumor reduces the real selectivity of the drug-light system and increases the surface of the area responding to the treatment. It is now evident that light irradiation of a sensitized patient produces damage at a various degree not only in the tumor but also in non-neoplastic tissues included in the field of irradiation. We report our experience in endoscopic PDT of early stage tumors in tracheobronchial, gastrointestinal and urinary tracts, describing early and late local complications caused by the damage of normal tissues adjacent to the tumors and included in the field of light irradiation. Among 44 patients treated, local complications, attributable to a poor selectivity of the modality, occurred in 6 patients (14%). In particular, the rate of local complications was 9% in patients treated for esophageal tumors, 14% in patients with gastric tumors, 9% in patients with tracheobronchial tumors, and 67% in bladder cancer patients. Clinical pictures as well as endoscopic findings at various intervals from treatment showed that mucositis is a common event following endoscopic PDT. It causes exudation and significant tissue inflammatory response, whose consequences are different in the various organs treated. Photoradiation must be, as much as possible, limited to the malignant area.

  8. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anesthesia

    PubMed Central

    Chen, Hsien-Te; Tsai, Chun-Hao; Chao, Shao-Ching; Kao, Ting-Hsien; Chen, Yen-Jen; Hsu, Horng-Chaung; Shen, Chiung-Chyi; Tsou, Hsi-Kai

    2011-01-01

    Background: Open discectomy remains the standard method for treatment of lumbar disc herniation, but can traumatize spinal structure and leaves symptomatic epidural scarring in more than 10% of cases. The usual transforaminal approach may be associated with difficulty reaching the epidural space due to anatomical peculiarities at the L5–S1 level. The endoscopic interlaminar approach can provide a direct pathway for decompression of disc herniation at the L5–S1 level. This study aimed to evaluate the clinical results of endoscopic interlaminar lumbar discectomy at the L5–S1 level and compare the technique feasibility, safety, and efficacy under local and general anesthesia (LA and GA, respectively). Methods: One hundred twenty-three patients with L5–S1 disc herniation underwent endoscopic interlaminar lumbar discectomy from October 2006 to June 2009 by two spine surgeons using different anesthesia preferences in two medical centers. Visual analog scale (VAS) scores for back pain and leg pain and Oswestry Disability Index (ODI) sores were recorded preoperatively, and at 3, 6, and 12 months postoperatively. Results were compared to evaluate the technique feasibility, safety, and efficacy under LA and GA. Results: VAS scores for back pain and leg pain and ODI revealed statistically significant improvement when they were compared with preoperative values. Mean hospital stay was statistically shorter in the LA group. Complications included one case of dural tear with rootlet injury and three cases of recurrence within 1 month who subsequently required open surgery or endoscopic interlaminar lumbar discectomy. There were no medical or infectious complications in either group. Conclusion: Disc herniation at the L5–S1 level can be adequately treated endoscopically with an interlaminar approach. GA and LA are both effective for this procedure. However, LA is better than GA in our opinion. PMID:21748045

  9. Localized chrysiasis, aluminum salt deposition and dystrophic calcification a decade after gold injections.

    PubMed

    Gowring, Lena E; Kobayashi, Todd T; Lewin-Smith, Michael R

    2015-08-01

    Localized chrysiasis is rare and can occur in two settings: after localized or traumatic implantation of elemental gold or gold salts or after localized laser or light therapy in someone who has been previously exposed to systemic gold therapy. We report a unique case of localized chrysiasis with associated aluminum salt deposition and sclerosing lipogranulomas because of previous injections of aurothioglucose (Solganal®). The unique histopathologic findings seen in this case have not been previously reported. PMID:25950356

  10. Endoscopic full-thickness resection of a lateral spreading rectal tumor after unplanned injection of dilute hyaluronic acid into the subserosal layer (with video).

    PubMed

    Konuma, H; Fu, K I; Konuma, I; Ueyama, H; Takahashi, T; Ogura, K; Miyazaki, A; Watanabe, S

    2012-06-01

    A 74-year-old woman underwent colonoscopy for investigation of a liver tumor. A lateral spreading tumor of the non-granular type (LST-NG), 25 mm in diameter, was detected at the rectosigmoid junction. As magnifying image-enhanced colonoscopy suggested a tubulovillous adenoma, endoscopic mucosal resection (EMR) was chosen for removal of the LST-NG. The lesion was effectively and evenly lifted after injection of 0.4% hyaluronic acid diluted with glycerol in the ratio of 1:1. A small amount of indigo-carmine dye was also added for coloration of the plane of resection. The lesion was completely removed en bloc. Although a blue-colored layer was identified in the resection defect, a small amount of a whitish layer was detected above the blue layer. The muscle layer was clearly located on the underside of the resected polyp. A total of 14 endoclips were used to close the defect completely. The patient was successfully treated conservatively without surgery. Histology of the resected specimen showed that it contained a tubulovillous adenoma with the submucosal layer and both layers of the muscularis propria. The surgical margin was free of neoplastic change horizontally and vertically. To the best of our knowledge, this is the first case report of full-thickness resection associated with EMR after unplanned injection of dilute hyaluronic acid into the subserosal layer rather than the intended submucosal layer. We describe how to promptly recognize this complication during colonoscopy, in order to achieve immediate closure of the defect, with the identification of a "mirror target sign" on the colonic wall. PMID:22350267

  11. Expanding Non-solenoidal Startup with Local Helicity Injection to Increased Toroidal Field and Helicity Injection Rate

    NASA Astrophysics Data System (ADS)

    Perry, J. M.; Barr, J. L.; Bodner, G. M.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Hinson, E. T.; Lewicki, B. T.; Reusch, J. A.; Schlossberg, D. J.; Winz, G. R.

    2015-11-01

    Local helicity injection (LHI) is a non-solenoidal startup technique under development on the Pegasus ST. Plasma currents up to 0.18 MA have been initiated by LHI in conjunction with poloidal field induction. A 0-D power balance model has been developed to predict plasma current evolution by balancing helicity input against resistive dissipation. The model is being validated against a set of experimental measurements and magnetic reconstructions with radically varied plasma geometric evolutions. Outstanding physics issues with LHI startup are the scalings of confinement and MHD activity with helicity injection rate and toroidal field strength, as well as injector behavior at high field. Preliminary results from the newly-installed Thomson scattering system suggest core temperatures of a few hundred eV during LHI startup. Measurements are being expanded to multiple spatial points for ongoing confinement studies. A set of larger-area injectors is being installed in the lower divertor region, where increased toroidal field will provide a helicity injection rate over 3 times that of outboard injectors. In this regime helicity injection will be the dominant current drive. Experiments with divertor injectors will permit experimental differentiation of several possible confinement models, and demonstrate the feasibility of LHI startup at high field. Work supported by US DOE grant DE-FG02-96ER54375.

  12. Endoscopic treatment of oesophageal varices.

    PubMed

    Krige, J E; Bornman, P C

    2000-12-01

    Major variceal bleeding is a life-threatening complication of portal hypertension. Therapy for bleeding may be difficult and requires expertise and appropriate facilities. Endoscopic therapy using either injection sclerotherapy or band ligation after adequate resuscitation and diagnostic endoscopy is the preferred first-line treatment. Bleeding not controlled by initial endoscopic therapy requires balloon tamponade followed by repeat variceal ligation or sclerotherapy. Patients who continue to bleed after endoscopic therapy are best treated with percutaneous radiological transjugular intrahepatic portosystemic shunt stent (TIPSS) insertion. After variceal eradication, patients require lifelong surveillance endoscopy and re-obliteration of varices by endoscopic therapy if they recur. Beta-blockers to prevent recurrent bleeding are reserved for selected patients. Patients with severe liver decompensation have a poor prognosis and should be evaluated for liver transplantation. Prophylactic endoscopic therapy in patients who have never bled from varices is contraindicated as it is associated with increased morbidity and mortality. PMID:11424860

  13. Therapeutic angiogenesis in ischemic muscles after local injection of fragmented fibers with loaded traditional Chinese medicine.

    PubMed

    Li, Huiyan; Wan, Huiying; Xia, Tian; Chen, Maohua; Zhang, Yun; Luo, Xiaoming; Li, Xiaohong

    2015-08-14

    Therapeutic angiogenesis remains the most effective method to re-establish a proper blood flow in ischemic tissues. There is a great clinical need to identify an injectable format to achieve a well accumulation following local administration and a sustained delivery of biological factors at the ischemic sites. In the current study, fragmented nanofibers with loaded traditional Chinese medicines, astragaloside IV (AT), the main active ingredient of astragalus, and ferulic acid (FA), the main ingredient of angelica, were proposed to promote the microvessel formation after intramuscular injection into ischemic hindlimbs. Fragmented fibers with average lengths of 5 (FF-5), 20 (FF-20) and 80 μm (FF-80) were constructed by the cryocutting of aligned electrospun fibers. Their dispersion in sodium alginate solution (0.2%) indicated good injectability. After injection into the quadriceps muscles of the hindlimbs, FF-20 and FF-80 fiber fragments showed higher tissue retentions than FF-5, and around 90% of the injected doses were determined after 7 days. On a hindlimb ischemia model established by ligating the femoral arteries, intramuscular injection of the mixtures of FA-loaded and AT-loaded FF-20 fiber fragments substantially reduced the muscle degeneration with minimal fibrosis formation, significantly enhanced the neovessel formation and hindlimb perfusion in the ischemic tissues, and efficiently promoted the limb salvage with few limb losses. Along with the easy manipulation and lower invasiveness for in vivo administration, fragmented fibers should become potential drug carriers for disease treatment, wound recovery and tissue repair after local injection. PMID:26176198

  14. Therapeutic angiogenesis in ischemic muscles after local injection of fragmented fibers with loaded traditional Chinese medicine

    NASA Astrophysics Data System (ADS)

    Li, Huiyan; Wan, Huiying; Xia, Tian; Chen, Maohua; Zhang, Yun; Luo, Xiaoming; Li, Xiaohong

    2015-07-01

    Therapeutic angiogenesis remains the most effective method to re-establish a proper blood flow in ischemic tissues. There is a great clinical need to identify an injectable format to achieve a well accumulation following local administration and a sustained delivery of biological factors at the ischemic sites. In the current study, fragmented nanofibers with loaded traditional Chinese medicines, astragaloside IV (AT), the main active ingredient of astragalus, and ferulic acid (FA), the main ingredient of angelica, were proposed to promote the microvessel formation after intramuscular injection into ischemic hindlimbs. Fragmented fibers with average lengths of 5 (FF-5), 20 (FF-20) and 80 μm (FF-80) were constructed by the cryocutting of aligned electrospun fibers. Their dispersion in sodium alginate solution (0.2%) indicated good injectability. After injection into the quadriceps muscles of the hindlimbs, FF-20 and FF-80 fiber fragments showed higher tissue retentions than FF-5, and around 90% of the injected doses were determined after 7 days. On a hindlimb ischemia model established by ligating the femoral arteries, intramuscular injection of the mixtures of FA-loaded and AT-loaded FF-20 fiber fragments substantially reduced the muscle degeneration with minimal fibrosis formation, significantly enhanced the neovessel formation and hindlimb perfusion in the ischemic tissues, and efficiently promoted the limb salvage with few limb losses. Along with the easy manipulation and lower invasiveness for in vivo administration, fragmented fibers should become potential drug carriers for disease treatment, wound recovery and tissue repair after local injection.

  15. Endoscopic submucosal dissection versus local excision for early rectal cancer: a systematic review and meta-analysis.

    PubMed

    Wang, S; Gao, S; Yang, W; Guo, S; Li, Y

    2016-01-01

    Endoscopic submucosal dissection (ESD) and local excision (LE) are minimally invasive procedures that can be used to treat early rectal cancer. There are no current guidelines or consensus on the optimal treatment strategy for these lesions. A systematic review was conducted to compare the efficacy and safety of ESD and LE. A meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. To perform the statistical analysis, the odds ratio (OR) was used for categorical variables and the weighted mean difference (WMD) for continuous variables. Four studies, involving a total of 307 patients, were identified. The length of hospital stay was longer in the group of patients undergoing LE [weighted mean difference (WMD) -1.94; 95% CI -2.85 to -1.02; p < 0.0001]. The combined results of the individual studies showed no significant differences as regards en-bloc resection rate (OR 0.82; 95% CI 0.25-2.70; p = 0.74), R0 resection rate (OR 1.53; 95% CI 0.62-3.73; p = 0.35), overall complication rate (OR 0.67; 95% CI 0.26-1.69; p = 0.40), and tumor size (WMD 0.57; 95% CI -3.64 to 4.78; p = 0.79) between ESD and LE. When adopting the fixed effect model which takes into account the study size, ESD was associated with a lower recurrence rate than LE (OR 0.15; 95% CI 0.03-0.87; p = 0.03), while with the random-effect model the difference was not significant (OR 0.18; 95% CI 0.02-2.04; p = 0.17). Over the last decade improvements in technology have improved the technical feasibility of rectal ESD. In specialized centers with highly experienced endoscopists, ESD can provide high-quality en-bloc excision of rectal neoplasms equivalent to traditional local excision. PMID:26519288

  16. Teaching medical students and residents how to inject local anesthesia almost painlessly

    PubMed Central

    Farhangkhoee, Hana; Lalonde, Jan; Lalonde, Donald H

    2012-01-01

    The objective of the present study was to determine whether it is possible to consistently and reliably teach medical students and resident learners how to administer local anesthetics in an almost painless manner. Using the published technique, 25 consecutive medical students and residents were taught how to inject local anesthetics for carpal tunnel release by watching the senior author perform the technique once. The learner then independently administered the anesthesia to the next patient who then scored the learner’s ability to inject the local anesthetic from a pain perspective. The teaching technique is demonstrated in an accompanying online video. The learners were consistently capable of administering local anesthetics with minimal pain. During the injection process, the patients only felt pain once (‘hole-in-one’) 76% of the time. This pain was attributed to the first 27-gauge needle poke. The other 24% of the time, patients felt pain twice (eagle) during the 5 min injection process. All 25 patients rated the entire pain experience to be less than 2/10. Eighty-four per cent of the patients indicated that the experience was better than local anesthetic given at the dentist’s office. Medical students and residents can quickly and reliably learn how to administer local anesthesia for carpal tunnel release with minimal pain to the patient. PMID:23997583

  17. Endoscopic management of esophageal varices

    PubMed Central

    Poza Cordon, Joaquin; Froilan Torres, Consuelo; Burgos García, Aurora; Gea Rodriguez, Francisco; Suárez de Parga, Jose Manuel

    2012-01-01

    The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis PMID:22816012

  18. Generating local amyloidosis in mice by the subcutaneous injection of human insulin amyloid fibrils.

    PubMed

    Chinisaz, Maryam; Ebrahim-Habibi, Azadeh; Yaghmaei, Parichehreh; Parivar, Kazem; Dehpour, Ahmad-Reza

    2014-08-01

    Localized deposits of amyloid structures are observed in various pathological conditions. One example of when local amyloidosis occurs is following repeated insulin injections in diabetic patients. The present study aimed to simulate the same condition in mice. To obtain the amyloid structures, regular insulin was incubated at 57°C for 24 h. The subsequently formed amyloid fibrils were analyzed using the Congo red absorbance test, as well as transmission electron microscopy images, and then injected into mice once per day for 21 consecutive days. Firm waxy masses were developed following this period, which were excised, prepared as thin sections and stained with hematoxylin and eosin, Congo red and Sudan black. Histological examination revealed that these masses contained adipose cells and connective tissue, in which amyloid deposition was visible. Thus, localized amyloidosis was obtained by the subcutaneous injection of insulin fibrils. The present results may be of further use in the development of models of amyloid tumors. PMID:25009591

  19. Generating local amyloidosis in mice by the subcutaneous injection of human insulin amyloid fibrils

    PubMed Central

    CHINISAZ, MARYAM; EBRAHIM-HABIBI, AZADEH; YAGHMAEI, PARICHEHREH; PARIVAR, KAZEM; DEHPOUR, AHMAD-REZA

    2014-01-01

    Localized deposits of amyloid structures are observed in various pathological conditions. One example of when local amyloidosis occurs is following repeated insulin injections in diabetic patients. The present study aimed to simulate the same condition in mice. To obtain the amyloid structures, regular insulin was incubated at 57°C for 24 h. The subsequently formed amyloid fibrils were analyzed using the Congo red absorbance test, as well as transmission electron microscopy images, and then injected into mice once per day for 21 consecutive days. Firm waxy masses were developed following this period, which were excised, prepared as thin sections and stained with hematoxylin and eosin, Congo red and Sudan black. Histological examination revealed that these masses contained adipose cells and connective tissue, in which amyloid deposition was visible. Thus, localized amyloidosis was obtained by the subcutaneous injection of insulin fibrils. The present results may be of further use in the development of models of amyloid tumors. PMID:25009591

  20. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps.

    PubMed

    Saunders, Brian P; Tsiamoulos, Zacharias P

    2016-08-01

    Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR. PMID:27353401

  1. Local Helicity Injection Systems for Non-solenoidal Startup in the PEGASUS Toroidal Experiment

    NASA Astrophysics Data System (ADS)

    Perry, J. M.; Barr, J. L.; Bongard, M. W.; Fonck, R. J.; Hinson, E. T.; Lewicki, B. T.; Redd, A. J.

    2013-10-01

    Local helicity injection is being developed in the PEGASUS Toroidal Experiment for non-solenoidal startup in spherical tokamaks. The effective loop voltage due to helicity injection scales with the area of the injectors, requiring the development of electron current injectors with areas much larger than the 2 cm2 plasma arc injectors used to date. Solid and gas-effused metallic electrodes were found to be unusable due to reduced injector area utilization from localized cathode spots and narrow operational regimes. An integrated array of 8 compact plasma arc sources is thus being developed for high current startup. It employs two monolithic power systems, for the plasma arc sources and the bias current extraction system. The array effectively eliminates impurity fueling from plasma-material interaction by incorporating a local scraper-limiter and conical-frustum bias electrodes to mitigate the effects of cathode spots. An energy balance model of helicity injection indicates that the resulting 20 cm2 of total injection area should provide sufficient current drive to reach 0.3 MA. At that level, helicity injection drive exceeds that from poloidal induction, which is the relevant operational regime for large-scale spherical tokamaks. Future placement of the injector array near an expanded boundary divertor region will test simultaneous optimization of helicity drive and the Taylor relaxation current limit. Work supported by US DOE Grant DE-FG02-96ER54375.

  2. Effect of needle design on pain from dental local anesthetic injections.

    PubMed

    McPherson, Joanna Saenz; Dixon, Sara A; Townsend, Richard; Vandewalle, Kraig S

    2015-01-01

    The purpose of this randomized, double-blind clinical study was to evaluate the effectiveness of a larger-bore compared with a standard-bore dental local anesthetic needle of the same gauge in reducing pain during inferior alveolar (IA) and long buccal (LB) nerve block injections. Twenty active duty military or Department of Defense beneficiaries undergoing dental treatment were anesthetized using a split-mouth design with 4 anesthetic dental injections. Both sides of the mouth received IA nerve block and LB nerve injections, one using the 27-gauge large-bore Septoject XL needle and other using a 27-gauge standard-bore Septoject needle. Patients rated the pain experienced with each method using a visual analogue scale (VAS). The IA injection mean VAS score and standard deviation were 38.9 ± 22.7 mm and 37.1 ± 22.4 mm, respectively, for the larger and standard-bore needles. The LB injection mean VAS score and standard deviation were 33.5 ± 22.8 mm and 35.1 ± 19.6 mm, respectively, for the larger and standard-bore needles. The data were analyzed with a paired t test (α = .05). No significant difference was found between the IA (P = .70) or LB injections (P = .73). The use of a larger-bore 27-gauge needle did not reduce pain on injection compared with the standard-bore 27-gauge needle. PMID:25849467

  3. Effect of Needle Design on Pain From Dental Local Anesthetic Injections

    PubMed Central

    McPherson, Joanna Saenz; Dixon, Sara A.; Townsend, Richard; Vandewalle, Kraig S.

    2015-01-01

    The purpose of this randomized, double-blind clinical study was to evaluate the effectiveness of a larger-bore compared with a standard-bore dental local anesthetic needle of the same gauge in reducing pain during inferior alveolar (IA) and long buccal (LB) nerve block injections. Twenty active duty military or Department of Defense beneficiaries undergoing dental treatment were anesthetized using a split-mouth design with 4 anesthetic dental injections. Both sides of the mouth received IA nerve block and LB nerve injections, one using the 27-gauge large-bore Septoject XL needle and other using a 27-gauge standard-bore Septoject needle. Patients rated the pain experienced with each method using a visual analogue scale (VAS). The IA injection mean VAS score and standard deviation were 38.9 ± 22.7 mm and 37.1 ± 22.4 mm, respectively, for the larger and standard-bore needles. The LB injection mean VAS score and standard deviation were 33.5 ± 22.8 mm and 35.1 ± 19.6 mm, respectively, for the larger and standard-bore needles. The data were analyzed with a paired t test (α = .05). No significant difference was found between the IA (P = .70) or LB injections (P = .73). The use of a larger-bore 27-gauge needle did not reduce pain on injection compared with the standard-bore 27-gauge needle. PMID:25849467

  4. The Diagnosis of the Os Trigonum Syndrome with a Fluoroscopically Controlled Injection of Local Anesthetic

    PubMed Central

    Jones, Darron M; Saltzman, Charles L; El-Khoury, George

    1999-01-01

    Purpose To report the results of excision of the os trigonum using a fluoroscopically controlled injection of local anesthetic to diagnose the os trigonum syndrome. Design and patients Os trigonum syndrome is a recognized cause of pain in the posterior aspect of the foot and ankle. The symptoms and physical findings, however, are often nonspecific and difficult to differentiate from other causes of posterior ankle pain. We report four patients with persistent posterolateral ankle pain despite prolonged nonoperative treatment. An os trigonal syndrome was diagnosed by a positive response to a fluoroscopically guided local anesthetic injection in the region of synchondrosis between the os trigonum and the posterior talus. Results All four patients underwent excision of the os trigonum with complete resolution of symptoms and return to full activity. Conclusions Fluoroscopically controlled injection can help confirm the suspected diagnosis of an os trigonum syndrome and may have positive predictive value regarding the outcome of excisional surgery. PMID:10847526

  5. Hyperthermia-induced drug delivery from thermosensitive liposomes encapsulated in an injectable hydrogel for local chemotherapy.

    PubMed

    López-Noriega, Adolfo; Hastings, Conn L; Ozbakir, Burcin; O'Donnell, Kathleen E; O'Brien, Fergal J; Storm, Gert; Hennink, Wim E; Duffy, Garry P; Ruiz-Hernández, Eduardo

    2014-06-01

    A novel drug delivery system, enabling an in situ, thermally triggered drug release is described, consisting of an injectable thermoresponsive chitosan hydrogel containing doxorubicin-loaded thermosensitive liposomes. The design, fabrication, characterization, and an assessment of in vitro bioactivity of this formulation is detailed. Combining on-demand drug delivery with in situ gelation results in a promising candidate for local chemotherapy. PMID:24436226

  6. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report.

    PubMed

    Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Abe, Mitsunobu; Morimoto, Masatoshi; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    Percutaneous endoscopic discectomy (PED) is a minimally invasive spinal technique and has several advantages compared with open surgery. We describe repeat PED surgery for recurrent herniated nucleus pulposus (HNP). The patient was a 33-year-old handball high level player. Previously, he underwent transforaminal PED under local anesthesia for intracanalicular HNP at L4-5 level about 2 years ago. He could return to his original competitive level. Two years later, he felt low back and right leg pain again when he was playing handball. Magnetic resonance imaging revealed the recurrence of HNP at the same level. We conducted transforaminal PED again using the exact same route as the previous surgery. Although there was a little adhesion around the L5 nerve root, we could easily identify and remove the herniated mass using endoscopic forceps. Immediately after the surgery, the low back and leg pain disappeared. Repeat PED surgery for recurrence of lumbar disc herniation is effective especially for athletes because of the benefits of PED, including surgery under local anesthesia, preservation of normal posterior structures, less postoperative pain, early discharge, and faster return to sports. PMID:27040069

  7. Acute Compartment Syndrome of the Foot due to Infection After Local Hydrocortisone Injection: A Case Report.

    PubMed

    Patil, Sampat Dumbre; Patil, Vaishali Dumbre; Abane, Sachin; Luthra, Rohit; Ranaware, Abhijit

    2015-01-01

    High-energy trauma associated with calcaneal fracture or Lisfranc fracture dislocation and midfoot crushing injuries are known causes of compartment syndrome in the foot. Suppurative infection in the deep osseofascial compartments can also cause compartment syndrome. We describe the case of a 29-year-old female who had developed a suppurative local infection that resulted in acute compartment syndrome after receiving a local hydrocortisone injection for plantar fasciitis. We diagnosed the compartment syndrome, and fasciotomy was promptly undertaken. After more than 2 years of follow-up, she had a satisfactory functional outcome without substantial morbidity. To our knowledge, no other report in the English-language studies has described compartment syndrome due to abscess formation after a local injection of hydrocortisone. The aim of our report was to highlight this rare, but serious, complication of a routine outpatient clinical procedure. PMID:24838218

  8. Effect of local insulin injection on wound vascularization in patients with diabetic foot ulcer

    PubMed Central

    ZHANG, ZHAOXIN; LV, LEI

    2016-01-01

    The aim of the present study was to investigate the effect of local insulin injection on granulation tissue formation in the wounds of patients with diabetic foot ulcer. Thirty-two patients with diabetic foot ulcer were randomly divided into an insulin (n=18) and a control (n=14) group. In the diabetic foot ulcer wound, the insulin group were administered insulin and the control group were administered an equal volume of saline. Prior to injection and at 0.5, 1.0, 2.0 and 4.0 h after injection, the fingertip blood glucose levels were determined. The growth of granulation tissue was assessed continuously for 12 days. Wound tissue was harvested at 0, 5, 7 and 12 days for the detection of CD34 expression by immunohistochemistry. The microvessel density (MVD) was calculated. No significant difference in the fasting blood glucose level was found between the two groups at any time-point (P>0.05). Growth of granulation tissue in the insulin group was more marked from 7 days after local insulin injection (24.87±0.24) and was significantly different from that in the control group (18.66±0.45) (P<0.01). New vessels were observed in the insulin group 3 days after insulin injection; however, there was no significant difference in MVD compared with the control group (P>0.05). The MVD in the insulin group increased markedly from 5 days after treatment, and the difference between the two groups was significant (P<0.01). In conclusion, local injection of insulin into the base of a diabetic foot ulcer has a significant effect on systemic blood glucose and may promote wound healing by improving the growth of granulation tissue. PMID:26893621

  9. A microwave imaging-based 3D localization algorithm for an in-body RF source as in wireless capsule endoscopes.

    PubMed

    Chandra, Rohit; Balasingham, Ilangko

    2015-08-01

    A microwave imaging-based technique for 3D localization of an in-body RF source is presented. Such a technique can be useful for localization of an RF source as in wireless capsule endoscopes for positioning of any abnormality in the gastrointestinal tract. Microwave imaging is used to determine the dielectric properties (relative permittivity and conductivity) of the tissues that are required for a precise localization. A 2D microwave imaging algorithm is used for determination of the dielectric properties. Calibration method is developed for removing any error due to the used 2D imaging algorithm on the imaging data of a 3D body. The developed method is tested on a simple 3D heterogeneous phantom through finite-difference-time-domain simulations. Additive white Gaussian noise at the signal-to-noise ratio of 30 dB is added to the simulated data to make them more realistic. The developed calibration method improves the imaging and the localization accuracy. Statistics on the localization accuracy are generated by randomly placing the RF source at various positions inside the small intestine of the phantom. The cumulative distribution function of the localization error is plotted. In 90% of the cases, the localization accuracy was found within 1.67 cm, showing the capability of the developed method for 3D localization. PMID:26737194

  10. Dental Students’ Perception and Anxiety Levels during their First Local Anesthetic Injection

    PubMed Central

    CHANDRASEKARAN, Balamanikandasrinivasan; CUGATI, Navaneetha; KUMARESAN, Ramesh

    2014-01-01

    Background: Student-to-student administration of local anesthesia (LA) has been widely used as the teaching modality to train preclinical dental students. However, studies assessing students’ outlook towards their first injection were limited. Therefore, this study aims to evaluate students’ perception and anxiety levels towards their first LA injection. Methods: Sixty three pre-clinical dental students swapped their roles as both operator and respondents in relation to their first supraperiosteal injection. After being injected, the students conferred their opinion and experiences to the questionnaire based on the five point Likert’s scale and indicated their anxiety levels based on the Interval Scale of Anxiety response (ISAR). Their perception was described using frequencies and percentages and anxiety levels were statistically analysed using one way analysis variance and paired t test. Results: Students learning LA techniques directly on human subjects depicted not only greater confidence in them but also increased anxiety levels. The anxiety levels were found to be high before and during injection in both operator and respondent. Conclusion: The students’ preferred the use of preclinical models rather than student to student administration for their first LA injection exercise. Based on the results obtained, we recommend the need of preclinical simulation model in LA training program. PMID:25897282

  11. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice

    PubMed Central

    Peters-Veluthamaningal, Cyriac; Winters, Jan C; Groenier, Klaas H; Meyboom-deJong, Betty

    2009-01-01

    Background De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed. Methods Participants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections) were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA) or 1 ml of NaCl 0.9% (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF). Results 11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015), perceived improvement (78% vs. 33%; p = 0.047) and severity of pain (4.27 vs. 1.33; p = 0.031) but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112). Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76) with a number needed to treat of 2 (95% CI: 1, 3). In the cohort of steroid responders (n = 12) the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67) and scores of Dutch AIMS-2-HFF (p = 0.36), but not for patient perceived improvement (p = 0.02). No adverse events were observed during the 12 months of follow

  12. Endoscopic ultrasound guided antitumor therapy.

    PubMed

    Bhutani, M S

    2003-08-01

    This paper will review the possibilities of EUS guided anti-tumor therapy. Ablative energy may be delivered to a tumor under EUS guidance to destruct tumor cells by ultrasound itself, radiofrequency or radiation. Pilot results of endoscopic high intensity focused ultrasound in a human trial have been reported. The feasibility of performing EUS guided radiofrequency ablation has been reported in a swine model. An EUS bases radiation target simulation method has been developed for anal cancer therapy. Targeted delivery of an anti-cancer agent into a tumor under EUS guidance is possible as reported in an early clinical trial of local immunotherapy (Cytoimplant) or modified viruses delivered by EUS guided fine needle injection in patients with advanced pancreatic carcinoma. Image guided injection of alcohol is another approach used for local tumor ablation. Application of other ablation therapies such as laser, microwave and cryo is also conceptually feasible. We will have to wait and see where these initial and ongoing attempts for applying EUS against cancer take us. PMID:12929056

  13. Field-Scale Modeling of Local Capillary Trapping During CO2 Injection into a Saline Aquifer

    NASA Astrophysics Data System (ADS)

    Ren, B.; Lake, L. W.; Bryant, S. L.

    2015-12-01

    Local capillary trapping is the small-scale (10-2 to 10+1 m) CO2 trapping that is caused by the capillary pressure heterogeneity. The benefit of LCT, applied specially to CO2 sequestration, is that saturation of stored CO2 is larger than the residual gas, yet these CO2 are not susceptible to leakage through failed seals. Thus quantifying the extent of local capillary trapping is valuable in design and risk assessment of geologic storage projects. Modeling local capillary trapping is computationally expensive and may even be intractable using a conventional reservoir simulator. In this paper, we propose a novel method to model local capillary trapping by combining geologic criteria and connectivity analysis. The connectivity analysis originally developed for characterizing well-to-reservoir connectivity is adapted to this problem by means of a newly defined edge weight property between neighboring grid blocks, which accounts for the multiphase flow properties, injection rate, and gravity effect. Then the connectivity is estimated from shortest path algorithm to predict the CO2 migration behavior and plume shape during injection. A geologic criteria algorithm is developed to estimate the potential local capillary traps based only on the entry capillary pressure field. The latter is correlated to a geostatistical realization of permeability field. The extended connectivity analysis shows a good match of CO2 plume computed by the full-physics simulation. We then incorporate it into the geologic algorithm to quantify the amount of LCT structures identified within the entry capillary pressure field that can be filled during CO2 injection. Several simulations are conducted in the reservoirs with different level of heterogeneity (measured by the Dykstra-Parsons coefficient) under various injection scenarios. We find that there exists a threshold Dykstra-Parsons coefficient, below which low injection rate gives rise to more LCT; whereas higher injection rate increases LCT

  14. Generation of a CW local oscillator signal using a stabilized injection locked semiconductor laser

    NASA Astrophysics Data System (ADS)

    Pezeshki, Jonah Massih

    In high speed-communications, it is desirable to be able to detect small signals while maintaining a low bit-error rate. Conventional receivers for high-speed fiber optic networks are Amplified Direct Detectors (ADDs) that use erbium-doped fiber amplifiers (EDFAs) before the detector to achieve a suitable sensitivity. In principle, a better method for obtaining the maximum possible signal to noise ratio is through the use of homodyne detection. The major difficulty in implementing a homodyne detection system is the generation of a suitable local oscillator signal. This local oscillator signal must be at the same frequency as the received data signal, as well as be phase coherent with it. To accomplish this, a variety of synchronization techniques have been explored, including Optical Phase-Lock Loops (OPLL), Optical Injection Locking (OIL) with both Fabry-Perot and DFB lasers, and an Optical Injection Phase-Lock Loop (OIPLL). For this project I have implemented a method for regenerating a local oscillator from a portion of the received optical signal. This regenerated local oscillator is at the same frequency, and is phase coherent with, the received optical signal. In addition, we show that the injection locking process can be electronically stabilized by using the modulation transfer ratio of the slave laser as a monitor, given either a DFB or Fabry-Perot slave laser. We show that this stabilization technique maintains injection lock (given a locking range of ˜1GHz) for laser drift much greater than what is expected in a typical transmission system. In addition, we explore the quality of the output of the slave laser, and analyze its suitability as a local oscillator signal for a homodyne receiver.

  15. New Endoscopic Hemostasis Methods

    PubMed Central

    Leung Ki, En-Ling

    2012-01-01

    Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension. PMID:22977807

  16. New endoscopic hemostasis methods.

    PubMed

    Leung Ki, En-Ling; Lau, James Y W

    2012-09-01

    Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension. PMID:22977807

  17. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    SciTech Connect

    Tok, Chung Hong Kaur, Shaleen; Gangi, Afshin

    2011-02-15

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  18. Endoscopic management of esophagogastric varices in Japan

    PubMed Central

    Ichikawa, Tatsuki; Taura, Naota; Miuma, Satoshi; Isomoto, Hajime; Nakao, Kazuhiko

    2014-01-01

    Esophagogastric varices are the most common complication in patients with portal hypertension, and endoscopy plays an important role in their diagnosis and in the prevention of acute bleeding from these structures. Recently, new modalities such as endoscopic ultrasonography (EUS) and narrow-band imaging have been introduced for the diagnosis of esophagogastric varices. In Japan, endoscopic therapy has become the first choice for the treatment of acutely bleeding esophageal or gastric varices. The two principal methods used to treat esophageal varices are endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). Recently, combinations of EIS plus EVL and EVL plus argon plasma coagulation were reported to be more effective than EVL or EIS alone. Additionally, endoscopic cyanoacrylate injection is superior to EIS and EVL for the treatment of acutely bleeding gastric varices. PMID:25333017

  19. Local mechanical properties of LFT injection molded parts: Numerical simulations versus experiments

    NASA Astrophysics Data System (ADS)

    Desplentere, F.; Soete, K.; Bonte, H.; Debrabandere, E.

    2014-05-01

    In predictive engineering for polymer processes, the proper prediction of material microstructure from known processing conditions and constituent material properties is a critical step forward properly predicting bulk properties in the finished composite. Operating within the context of long-fiber thermoplastics (LFT, length < 15mm) this investigation concentrates on the prediction of the local mechanical properties of an injection molded part. To realize this, the Autodesk Simulation Moldflow Insight 2014 software has been used. In this software, a fiber breakage algorithm for the polymer flow inside the mold is available. Using well known micro mechanic formulas allow to combine the local fiber length with the local orientation into local mechanical properties. Different experiments were performed using a commercially available glass fiber filled compound to compare the measured data with the numerical simulation results. In this investigation, tensile tests and 3 point bending tests are considered. To characterize the fiber length distribution of the polymer melt entering the mold (necessary for the numerical simulations), air shots were performed. For those air shots, similar homogenization conditions were used as during the injection molding tests. The fiber length distribution is characterized using automated optical method on samples for which the matrix material is burned away. Using the appropriate settings for the different experiments, good predictions of the local mechanical properties are obtained.

  20. Control of high-Z PFC erosion by local gas injection in DIII-D

    NASA Astrophysics Data System (ADS)

    Rudakov, D. L.; Stangeby, P. C.; Wong, C. P. C.; McLean, A. G.; Wampler, W. R.; Watkins, J. G.; Boedo, J. A.; Briesemeister, A.; Buchenauer, D. A.; Chrobak, C. P.; Elder, J. D.; Fenstermacher, M. E.; Guo, H. Y.; Lasnier, C. J.; Leonard, A. W.; Maingi, R.; Moyer, R. A.

    2015-08-01

    Reduced erosion of a high-Z PFC divertor surface was observed in DIII-D with local injection of methane and deuterium gases. Molybdenum-coated silicon samples were exposed in the lower divertor of DIII-D using DiMES under plasma conditions previously shown to cause significant net erosion of Mo. Three exposures with 13CH4 and one exposure with D2 gas injection about 12 cm upstream of the samples located within 1-2 cm of the attached strike point were performed. Reduction of Mo erosion was evidenced in-situ by the suppression of MoI line radiation at 386.4 nm once the gas injection started. Post-mortem ion beam analysis demonstrated that the net erosion of molybdenum near the center of the samples exposed with 13CH4 injection was below the measurement resolution of 0.5 nm, corresponding to a rate of ⩽0.04 nm/s. Compared to the previously measured erosion rates, this constitutes a reduction by a factor of >10.

  1. Impurity Ion Temperature and Flow Dynamics During Local Helicity Injection on the PEGASUS Toroidal Experiment

    NASA Astrophysics Data System (ADS)

    Burke, M. G.; Fonck, R. J.

    2013-10-01

    Anomalous energetic thermal and non-thermal minority ion distributions are observed during local helicity injection current startup. Energetic ions in significant numbers can transfer a large amount of power to plasma electrons during helicity injection, which can alter the helicity balance and consequent plasma startup via reduced resistive dissipation. Multi-spatial point spectra from a 1 m F/8.6 Czerny-Turner polychromator are recorded by an intensified high-speed camera with a time resolution of 500 μs. Te remains low during helicity injection, wherein the plasma experiences large magnetic fluctuations and strong reconnection activity near the injection region. Partially ionized low-Z impurities (CIII, NIII, and OIII) exist in the core plasma region, which allows core Ti measurements. Strong impurity ion heating (Ti ~ 1 . 2 keV, Te ~ 0 . 1 keV) correlates with n = 1 MHD activity. High frequency magnetic fluctuations are indicated at frequencies close to the impurity ion cyclotron frequencies and may act as the source of energy for the ions. These observations motivate the deployment of a neutral particle analyzer to measure the working gas ion distributions in these plasmas. In addition, a high-throughput polychromator with 2 μs resolution is being installed to more directly correlate the observed impurity ion heating and flows with MHD and reconnection activity. Work supported by US DOE Grant DE-FG02-96ER54375.

  2. [Possibilities and limits of endoscopic therapy in hemorrhage of the gastrointestinal tract].

    PubMed

    Fleig, W E

    1987-04-01

    Most of the hemostatic modalities currently used for endoscopic therapy of gastrointestinal bleeding are based on the principle of thermic coagulation of protein. Injection of vasoactive and sclerosing agents is also widely used, while the application of various other methods is rather limited. There are specific benefits and drawbacks inherent with each of the treatment modalities. The efficacy of laser photocoagulation in stopping upper gastrointestinal bleeding has been demonstrated in several controlled trials; however, effects on survival are controversial. None of the other methods used has been evaluated sufficiently by controlled clinical trials up to date. Depending on the availability at a local institution, each of the various methods may be used for an attempt of endoscopic hemostasis when Forrest type I and II (visible vessel) lesions are detected at emergency endoscopy. However, patients suffering from lesions, which are notable for their high risk of recurrent bleeding like ulcers with a spurting artery, with a visible vessel and lesions at the posterior wall of the duodenum, should be transferred to the surgeon for operative treatment in the absence of active bleeding immediately after successful endoscopic treatment. In the future, patients requiring surgery despite effective endoscopic hemostasis might be identified with high accuracy by checking the coagulated or injected ulcer base with an endoscopic Doppler device. PMID:3495714

  3. Predictive Power-balance Modeling of PEGASUS and NSTX-U Local Helicity Injection Discharges

    NASA Astrophysics Data System (ADS)

    Barr, J. L.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Hinson, E. T.; Perry, J. M.; Redd, A. J.; Schlossberg, D. J.

    2013-10-01

    Local helicity injection (LHI) with outer poloidal-field (PF) induction for solenoid-free startup is being studied on PEGASUS, reaching Ip <= 0 . 175 MA with 6 kA of injected current. A lumped-parameter circuit model for predicting the performance of LHI initiated plasmas is under development. The model employs energy and helicity balance, and includes applied PF ramping and the inductive effects of shape evolution. Low- A formulations for both the plasma external inductance and a uniform equilibrium-field are used to estimate inductive voltages. PEGASUS LHI plasmas are created near the outboard injectors with aspect ratio (A) ~ 5-6.5 and grow inward to fill the confinement region at A <= 1 . 3 . Initial results match experimental Ip (t) trajectories within 15 kA with a prescribed geometry evolution. Helicity injection is the largest driving term in the initial phase, but in the later phase is reduced to 20-45% of the total drive as PF induction and decreasing plasma inductance become dominant. In contrast, attaining ~1 MA non-solenoidal startup via LHI on NSTX-U will require operation in the regime where helicity injection drive exceeds inductive and geometric changes at full size. A large-area multi-injector array will increase available helicity injection by 3-4 times and allow exploration of this helicity-dominated regime at Ip ~ 0 . 3 MA in PEGASUS. Comparison of model predictions with time-evolving magnetic equilibria is in progress for model validation. Work supported by US DOE Grant DE-FG02-96ER54375.

  4. Injectable small molecule hydrogel as a potential nanocarrier for localized and sustained in vivo delivery of doxorubicin

    NASA Astrophysics Data System (ADS)

    Singh, Manish; Kundu, Somanath; Reddy M, Amarendar; Sreekanth, Vedagopuram; Motiani, Rajender K.; Sengupta, Sagar; Srivastava, Aasheesh; Bajaj, Avinash

    2014-10-01

    The majority of the localized drug delivery systems are based on polymeric or polypeptide scaffolds, as weak intermolecular interactions of low molecular weight hydrogelators (LMHGs, Mw <500 Da) are significantly perturbed in the presence of anticancer drugs. Here, we present l-alanine derived low molecular weight hydrogelators (LMHGs) that remain injectable even after entrapping the anticancer drug doxorubicin (DOX). These DOX containing nanoassemblies (DOX-Gel) showed promising anticancer activity in mice models. Subcutaneous injection of DOX-Gel near the tumor achieved a greater decrease in tumour load than by intravenous injection of DOX (DOX-IV), and local injection of DOX alone (DOX-Local) at the tumor site. We noticed that DOX-Gel nanocarriers are especially effective when injected during the early stage of tumor progression, and achieve a substantial decrease in tumor load in the long term.The majority of the localized drug delivery systems are based on polymeric or polypeptide scaffolds, as weak intermolecular interactions of low molecular weight hydrogelators (LMHGs, Mw <500 Da) are significantly perturbed in the presence of anticancer drugs. Here, we present l-alanine derived low molecular weight hydrogelators (LMHGs) that remain injectable even after entrapping the anticancer drug doxorubicin (DOX). These DOX containing nanoassemblies (DOX-Gel) showed promising anticancer activity in mice models. Subcutaneous injection of DOX-Gel near the tumor achieved a greater decrease in tumour load than by intravenous injection of DOX (DOX-IV), and local injection of DOX alone (DOX-Local) at the tumor site. We noticed that DOX-Gel nanocarriers are especially effective when injected during the early stage of tumor progression, and achieve a substantial decrease in tumor load in the long term. Electronic supplementary information (ESI) available: Scheme 1, Fig. S1-S6, synthesis of hydrogels; experimental section for gelation, rheology, MALDI, microscopy and

  5. Endoscopic treatment for early gastric cancer.

    PubMed

    Min, Yang Won; Min, Byung-Hoon; Lee, Jun Haeng; Kim, Jae J

    2014-04-28

    Gastric cancer remains one of the most common causes of cancer death. However the proportion of early gastric cancer (EGC) at diagnosis is increasing. Endoscopic treatment for EGC is actively performed worldwide in cases meeting specific criteria. Endoscopic mucosal resection can treat EGC with comparable results to surgery for selected cases. Endoscopic submucosal dissection (ESD) increases the en bloc and complete resection rates and reduces the local recurrence rate. ESD has been performed with expanded indication and is expected to be more widely used in the treatment of EGC through the technological advances in the near future. This review will describe the techniques, indications and outcomes of endoscopic treatment for EGC. PMID:24782609

  6. Endoscopic Sinus Surgery

    MedlinePlus

    ... The nasal endoscope is a small, lighted metal telescope placed into the nostril. The endoscope allows the ... sinus surgery involves the use of a small telescope (nasal endoscope) that is inserted through the nostril ...

  7. Ordering of young injection events within Saturnian SLS longitude and local time

    NASA Astrophysics Data System (ADS)

    Kennelly, T.; Leisner, J. S.; Hospodarsky, G. B.; Gurnett, D. A.

    2012-12-01

    The Saturnian SLS longitude systems are based on periodic radio emissions generated at high latitudes and relatively close to the planet. These periodicities have been observed throughout the magnetosphere in both the magnetic field and the plasma. While their presence in the outer magnetosphere has been understood, one outstanding question is how these periodicities are transmitted to the inner magnetosphere. The inner and outer magnetospheres are connected by inward-moving flux tubes, referred to as injection events, and it was postulated that they could carry the periodicities between the two regions. Early analysis of these phenomena, however, showed that there was no ordering in longitude. In this study, we reexamine this possibility by limiting our data set to the young injection events observed by the Cassini Radio and Plasma Wave Science instrument. We find that the young injection events are restricted to two local time sectors: post-noon and near-midnight. We find no structure in the post-noon sector, but the near-midnight events are strongly ordered by SLS longitude. Further, the longitudinal ordering varies with Saturnian season. Pre-equinox, the longitude system derived from the northern hemisphere's SKR emissions controls the event occurrence. Post-equinox, the events are ordered by the southern hemisphere-derived longitude system. We suggest that this may be an effect in the variations in the ionospheric conductivity or due to change in the magnetosphere's orientation relative to the solar wind.

  8. Persistence, localization, and external control of transgene expression after single injection of adeno-associated virus into injured joints.

    PubMed

    Lee, Hannah H; O'Malley, Michael J; Friel, Nicole A; Payne, Karin A; Qiao, Chunping; Xiao, Xiao; Chu, Constance R

    2013-04-01

    A single intra-articular injection of adeno-associated virus (AAV) results in stable and controllable transgene expression in normal rat knees. Because undamaged joints are unlikely to require treatment, the study of AAV delivery in joint injury models is crucial to potential therapeutic applications. This study tests the hypotheses that persistent and controllable AAV-transgene expression are (1) highly localized to the cartilage when AAV is injected postinjury and (2) localized to the intra-articular soft tissues when AAV is injected preinjury. Two AAV injection time points, postinjury and preinjury, were investigated in osteochondral defect and anterior cruciate ligament transection models of joint injury. Rats injected with AAV tetracycline response element (TRE)-luciferase received oral doxycycline for 7 days. Luciferase expression was evaluated longitudinally for 6 months. Transgene expression was persistent and controllable with oral doxycycline for 6 months in all groups. However, the location of transgene expression was different: postinjury AAV-injected knees had luciferase expression highly localized to the cartilage, while preinjury AAV-injected knees had more widespread signal from intra-articular soft tissues. The differential transgene localization between preinjury and postinjury injection can be used to optimize treatment strategies. Highly localized postinjury injection appears advantageous for treatments targeting repair cells. The more generalized and controllable reservoir of transgene expression following AAV injection before anterior cruciate ligament transection (ACLT) suggests an intriguing concept for prophylactic delivery of joint protective factors to individuals at high risk for early osteoarthritis (OA). Successful external control of intra-articular transgene expression provides an added margin of safety for these potential clinical applications. PMID:23496155

  9. Endoscopic hemostasis state of the art - Nonvariceal bleeding

    PubMed Central

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut

    2016-01-01

    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons. PMID:26962402

  10. Endoscopic hemostasis state of the art - Nonvariceal bleeding.

    PubMed

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut

    2016-02-25

    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons. PMID:26962402

  11. Endoscopic neurosurgery.

    PubMed

    Auer, L M; Holzer, P; Ascher, P W; Heppner, F

    1988-01-01

    This paper describes an ultrasound-guided, laser-assisted, and TV-controlled endoscopic technique which has been used so far in 133 patients for a variety of intracranial lesions. Following CT or MRI image reconstruction, and a decision on the placement of a 1 cm or a 2 cm burrhole, a 1 cm 5.0 mHz or 7.5 mHz intraoperative ultrasound probe is used to direct the endoscope from the burrhole to the target area. A 22.5 cm long rigid endoscope tube with an outer diameter of 6 mm with an inbuilt suction irrigation system, Neodymium Yag laser with 600 micron Quartz glass-fibre and an inlet for various microinstruments is then introduced. The attachment of a TV camera to the ocular lens allows the operator to control further surgical steps in the target area via the TV screen and thus warrants sterility in the operating field. The technique has been used for evacuation of 77 spontaneous intracerebral haematomas (lobar, putaminal, thalamic), 8 traumatic intracerebral haematomas, 13 ventricular haematomas, 8 cerebellar haematomas and 1 brainstem haematoma. Total or subtotal evacuation was achieved in 33% of intracerebral haematomas, removal of more than 50% of the clot in 55%. Twenty-four brain tumours (12 ventricular, 12 cystic cerebral or cerebellar tumours) were operated on for biopsy, evacuation of cyst, resection or removal of the cyst wall and/or laser irradiation of solid tumour or the inner cyst wall of cystic tumours. The complication rate probably related to surgery was 1.6%, morbidity 1.6%, mortality 0%. This high-tec endoscopic technique with its minimal surgical trauma and short operation time can be recommended as a low-risk alternative to conventional neurosurgical techniques. PMID:3278501

  12. Endoscopic Cyclophotocoagulation

    PubMed Central

    Seibold, Leonard K.; SooHoo, Jeffrey R.; Kahook, Malik Y.

    2015-01-01

    In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure. PMID:25624669

  13. Endoscopic cyclophotocoagulation.

    PubMed

    Seibold, Leonard K; SooHoo, Jeffrey R; Kahook, Malik Y

    2015-01-01

    In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure. PMID:25624669

  14. Alleviation of cisplatin nephrotoxicity: efficacy of local intra-arterial injection concomitant with hemodialysis.

    PubMed

    Yura, T; Badr, K F; Yuasa, S; Kurose, T; Ohkawa, M; Hando, T; Fukunaga, M; Matsuo, H

    1996-01-01

    Although cis-diamminedichloroplatinum (cisplatin) is widely used in the treatment of malignant tumors, the dose administered is limited because of side effects such as nephrotoxicity. The plasma levels of non-protein-bound platinum, which can be removed by dialysis, play an important role in the antitumor effects and the appearance of side effects. Selective intra-arterial injection of cisplatin during concomitant hemodialysis (HD) was performed in patients with gynecological malignancies. At a dose of 100 mg, about three times the non-protein-bound platinum excreted in the urine during the same period was removed by HD. The area under the time-concentration curve of plasma total platinum up to 5 h after intra-arterial injection was reduced by 46%. When doses of 200 or 250 mg were administered concomitantly with HD, the maximum plasma levels were suppressed to about the same degree as when 100 mg were injected without concomitant HD. A definite reduction in the incidence of side effects was seen, and a reduction in the severity of nephrotoxicity was also observed when 100 mg were given with HD. No severe side effects were found even when 200 or 250 mg were administered with concomitant HD. The antitumor effects were not reduced or possibly potentiated, but follow-up is still of short duration. These results indicate that chemotherapy with local intra-arterial injections of cisplatin using concomitant HD not only reduces systemic side effects, in particular nephrotoxicity, but also allows for increased doses at the tumor site and can be applied in patients with renal dysfunction. PMID:8785030

  15. INJECTABLE IN SITU CROSS-LINKING HYDROGELS FOR LOCAL ANTIFUNGAL THERAPY

    PubMed Central

    Hudson, Sarah; Langer, Robert; Fink, Gerald R.; Kohane, Daniel S.

    2009-01-01

    Invasive fungal infections can be devastating, particularly in immunocompromised patients, and difficult to treat with systemic drugs. Furthermore, systemic administration of those medications can have severe side effects. We have developed an injectable local antifungal treatment for direct administration into existing or potential sites of fungal infection. Amphotericin B (AmB), a hydrophobic, potent, and broad-spectrum antifungal agent, was rendered water-soluble by conjugation to a dextran-aldehyde polymer. The dextran-aldehyde-AmB conjugate retained antifungal efficacy against C. albicans. Mixing carboxymethylcellulose-hydrazide with dextran-aldehyde formed a gel that cross-linked in situ by formation of hydrazone bonds. The gel provided in vitro release of antifungal activity for 11 days, and contact with the gel killed Candida for three weeks. There was no apparent tissue toxicity in the murine peritoneum and the gel caused no adhesions. Gels produced by entrapment of a suspension of AmB in CMC-dextran without conjugation of drug to polymers did not release fungicidal activity, but did kill on contact. Injectable systems of these types, containing soluble or insoluble drug formulations, could be useful for treatment of local antifungal infections, with or without concurrent systemic therapy. PMID:19942285

  16. Periodontal ligament injection in the dog primary dentition: spread of local anaesthetic solution.

    PubMed

    Tagger, E; Tagger, M; Sarnat, H; Mass, E

    1994-09-01

    The spread of local anaesthetic solution administered with a pressure syringe has not been studied as extensively in young animals having primary or mixed dentitions as in adult animals. The purpose of this investigation was to study the distribution of local anaesthetic solution injected into the periodontal ligament of young dogs. India ink was added to carpules containing 2% lidocaine and 1:100,000 epinephrine, and the spread of solution was examined macroscopically and microscopically. Injections were made with a pressure syringe (Ligmaject) at 58 sites mesial and distal to primary teeth in five dogs aged 3-9 months. Three dogs were killed within 12 hours, the other two after 5 days. Spread of the ink was studied in non-decalcified slabs, in three-dimensional cleared specimens, and in histological sections. The solution usually reached the alveolar bone crest, seeped under the periosteum and alongside vascular channels into bone marrow, reaching natural cavities such as the crypts of tooth buds and the mandibular canal. The ink did not penetrate into the enamel organ or contact the permanent tooth buds. The solution appeared to spread along the path of least resistance, governed by the intricacies of anatomical structures and fascial planes. Therefore the risk of mechanical damage to permanent tooth germs appears to be minimal. PMID:7811670

  17. Ion Heating During Local Helicity Injection Plasma Startup in the Pegasus ST

    NASA Astrophysics Data System (ADS)

    Burke, M. G.; Barr, J. L.; Bongard, M. W.; Fonck, R. J.; Hinson, E. T.; Perry, J. M.; Reusch, J. A.

    2015-11-01

    Plasmas in the Pegasus ST are initiated either through standard, MHD stable, inductive current drive or non-solenoidal local helicity injection (LHI) current drive with strong reconnection activity, providing a rich environment to study ion dynamics. During LHI discharges, a large amount of impurity ion heating has been observed, with the passively measured impurity Ti as high as 800 eV compared to Ti ~ 60 eV and Te ~ 175 eV during standard inductive current drive discharges. In addition, non-thermal ion velocity distributions are observed and appear to be strongest near the helicity injectors. The ion heating is hypothesized to be a result of large-scale magnetic reconnection activity, as the amount of heating scales with increasing fluctuation amplitude of the dominant, edge localized, n =1 MHD mode. An approximate temporal scaling of the heating with the amplitude of higher frequency magnetic fluctuations has also been observed, with large amounts of power spectral density present at several impurity ion cyclotron frequencies. Recent experiments have focused on investigating the impurity ion heating scaling with the ion charge to mass ratio as well as the reconnecting field strength. The ion charge to mass ratio was modified by observing different impurity charge states in similar LHI plasmas while the reconnecting field strength was modified by changing the amount of injected edge current. Work supported by US DOE grant DE-FG02-96ER54375.

  18. Advancing High Current Startup via Localized Helicity Injection in the PEGASUS Toroidal Experiment

    NASA Astrophysics Data System (ADS)

    Hinson, E. T.; Barr, J. L.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Perry, J. M.; Redd, A. J.; Schlossberg, D. J.

    2013-10-01

    Non-solenoidal startup via local helicity injection (LHI) and poloidal field induction is used to produce Ip = 0 . 17 MA tokamak discharges. Impurity contamination has been reduced to negligible levels by use of conical frustum cathode geometry and local scraper limiters. Attainable currents are governed by global limits of helicity and energy balance, and Taylor relaxation. A simple lumped parameter model based on these limits is used to project discharge evolution, and indicates that attaining 1 MA in NSTX-U will require LHI-driven effective loop voltages to dominate contributions from dLp / dt . This regime contrasts with results to date and will be tested at 0.3 MA in PEGASUS with a new integrated multi-injector array. Injector impedance characteristics are consistent with magnetically-limited regimes observed in higher-power foilless diodes. Bursts of MHD are measured on time scales of order ~ 100 μ s, and correlate with rapid equilibrium changes, discrete rises in Ip, redistribution of the toroidal current, ion heating (Ti ~ 1 keV), transient drops in injector voltage, and apparent n = 1 line-tied kink activity at the injector. NIMROD simulations of high-field-side HI discharges in PEGASUS are in qualitative agreement, suggesting Ip buildup results from inward propagating toroidal current loops created by intermittent reconnection of injected current streams. Work supported by US DOE Grant DE-FG02-96ER54375.

  19. Radioguided occult lesion localization: better delineation of the injection site with a high-resolution collimator

    NASA Astrophysics Data System (ADS)

    Geissler, B.; De Freitas, D.; Cachin, F.; Mestas, D.; Lebouedec, G.; Maublant, J.

    2004-07-01

    Aim: Radioguided Occult Lesion Localization (ROLL) is a method for guiding the excision of occult breast lesions. A radiotracer is injected preoperatively in the tumor. The surgeon can locate the lesion with a gamma probe. It has been recommended that the tissue is resected where the activity falls rapidly. But this cut-off level can fluctuate depending on the user. The aim of this study was to compare the accuracy of two different types of collimation. Materials and methods: To simulate the detection of a radioactive "lesion", 0.2 ml of a solution of 99mTc labeled colloids (4 MBq) were deposited at 3 cm depth in a chunk of cow muscle. Detection was performed with a gamma probe (GammaSup, Clerad, F) equipped either with a regular or with an additional high-resolution collimator. The response curve was drawn moving laterally the probe on the chunk of cow by 5 mm steps. Edges of resection were determined with different cut-off levels (from 5 to 50% of maximum counts by 5% steps). Results: Without additional collimator, the mean distance between injection point and resection edge was 18 mm, standard deviation 7.8 mm with a range between 11 and 18 mm. With additional collimator, the mean distance decreased to 10 mm (-44%), standard deviation 4.2 mm (-46%) with a range between 6 and 10 mm. Conclusion: The results demonstrate that the additional collimator provides more precise and reproductive delineation of the injection site. It should be optimal for the ROLL technique.

  20. Laparoscopic Management of Abdominal Pregnancy with Local Injection of Vasopressin Solution: A Case Report.

    PubMed

    Hishikawa, Kenji; Fukuda, Takanori; Inoue, Hiromi; Kohata, Yutaka; Monma, Mika; Ochiai, Naomi; Kubo, Yuina; Watanabe, Remi; Ako, Shiho; Aihara, Yuri; Kusaka, Takeshi

    2016-01-01

    BACKGROUND Laparoscopic treatments of abdominal pregnancy have been reported; however, resection of an implanted gestational sac could lead to massive bleeding and treatment failure. Hemostasis of the resected stump is critical for the success of laparoscopic treatment. CASE REPORT A 32-year-old woman presented to the emergency department with severe abdominal pain. We suspected a ruptured ectopic pregnancy and performed urgent diagnostic laparoscopy. The gestational sac was implanted in the posterior wall of the uterus near the left uterosacral ligament, and bleeding from the gestational sac was noticed. We injected 3 ml of diluted vasopressin solution (0.4 U/ml) directly into the gestational sac and into the posterior uterine wall around the gestational sac. Thereafter, we could resect the gestational product using an ultrasonically activated scalpel. Additional hemostasis in the resected stump was not required. CONCLUSIONS We believe that a local injection of a diluted vasopressin solution helps in maintaining the hemostasis after the laparoscopic resection of the implanted gestational sac in cases of abdominal pregnancy. PMID:27587187

  1. Collimation system design for beam loss localization with slipstacking injection in the Fermilab Main Injector

    SciTech Connect

    Drozhdin, A.I.; Brown, B.C.; Johnson, D.E.; Koba, K.; Kourbanis, I.; Mokhov, N.V.; Rakhno, I.L.; Sidorov, V.I.; /Fermilab

    2007-06-01

    Results of modeling with the 3-D STRUCT and MARS15 codes of beam loss localization and related radiation effects are presented for the slipstacking injection to the Fermilab Main Injector. Simulations of proton beam loss are done using multi-turn tracking with realistic accelerator apertures, nonlinear fields in the accelerator magnets and time function of the RF manipulations to explain the results of beam loss measurements. The collimation system consists of one primary and four secondary collimators. It intercepts a beam power of 1.6 kW at a scraping rate of 5% of 5.5E+13 ppp, with a beam loss rate in the ring outside the collimation region of 1 W/m or less. Based on thorough energy deposition and radiation modeling, a corresponding collimator design was developed that satisfies all the radiation and engineering constraints.

  2. Endoscopic management of polypoid early colon cancer.

    PubMed

    Williams, C B; Saunders, B P; Talbot, I C

    2000-09-01

    Endoscopic management of polypoid early colonic cancer (malignant polyps and polypoid carcinomas) is no longer controversial. When the endoscopist is satisfied that excision is complete and histology is "favorable" (a resection margin of 2 mm and well or moderately well differentiated tumor), surgery is unnecessary. When histology show "unfavorable" characteristics (which a few histologists still take to include invasion into lymphatics), surgical or laparoscopic resection may be indicated, providing the patient is considered at suitable risk. Surgery kills some patients without finding residual cancer and cannot save others with metastases, so it should be recommended only with due clinical consideration. Sessile or broad-based polyps, especially those in the rectum, are more likely to be "high risk" and merit specialist management if local removal is to be attempted and to allow proper histologic assessment. Endoscopic approaches such as saline injection polypectomy, india-ink tattooing, and use of the argon beam coagulator are applicable in some cases. New approaches that still require trials include ultrasonographic probes, which occasionally clarify the degree of invasion, and prototype stapling devices to allow full-thickness histologic specimens to be obtained. PMID:11036280

  3. Edge localized mode characteristics during edge localized mode mitigation by supersonic molecular beam injection in Korea Superconducting Tokamak Advanced Research

    SciTech Connect

    Lee, H. Y.; Hong, J. H.; Jang, J. H.; Park, J. S.; Choe, Wonho; Hahn, S. H.; Bak, J. G.; Lee, J. H.; Ko, W. H.; Lee, K. D.; Lee, S. H.; Lee, H. H.; Juhn, J.-W.; Kim, H. S.; Yoon, S. W.; Han, H.; Ghim, Y.-C.

    2015-12-15

    It has been reported that supersonic molecular beam injection (SMBI) is an effective means of edge localized mode (ELM) mitigation. This paper newly reports the changes in the ELM, plasma profiles, and fluctuation characteristics during ELM mitigation by SMBI in Korea Superconducting Tokamak Advanced Research. During the mitigated ELM phase, the ELM frequency increased by a factor of 2–3 and the ELM size, which was estimated from the D{sub α} amplitude, the fractional changes in the plasma-stored energy and the line-averaged electron density, and divertor heat flux during an ELM burst, decreased by a factor of 0.34–0.43. Reductions in the electron and ion temperatures rather than in the electron density were observed during the mitigated ELM phase. In the natural ELM phase, frequency chirping of the plasma fluctuations was observed before the ELM bursts; however, the ELM bursts occurred without changes in the plasma fluctuation frequency in the mitigated ELM phase.

  4. Endoscopic Microscopy

    PubMed Central

    Sokolov, Konstantin; Sung, Kung-Bin; Collier, Tom; Clark, Anne; Arifler, Dizem; Lacy, Alicia; Descour, Michael; Richards-Kortum, Rebecca

    2002-01-01

    In vivo endoscopic optical microscopy provides a tool to assess tissue architecture and morphology with contrast and resolution similar to that provided by standard histopathology – without need for physical tissue removal. In this article, we focus on optical imaging technologies that have the potential to dramatically improve the detection, prevention, and therapy of epithelial cancers. Epithelial pre-cancers and cancers are associated with a variety of morphologic, architectural, and molecular changes, which currently can be assessed only through invasive, painful biopsy. Optical imaging is ideally suited to detecting cancer-related alterations because it can detect biochemical and morphologic alterations with sub-cellular resolution throughout the entire epithelial thickness. Optical techniques can be implemented non-invasively, in real time, and at low cost to survey the tissue surface at risk. Our manuscript focuses primarily on modalities that currently are the most developed: reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). However, recent advances in fluorescence-based endoscopic microscopy also are reviewed briefly. We discuss the basic principles of these emerging technologies and their current and potential applications in early cancer detection. We also present research activities focused on development of exogenous contrast agents that can enhance the morphological features important for cancer detection and that have the potential to allow vital molecular imaging of cancer-related biomarkers. In conclusion, we discuss future improvements to the technology needed to develop robust clinical devices. PMID:14646041

  5. [Endoscopic treatment in critically ill patients with upper gastrointestinal bleeding].

    PubMed

    Kheladze, Z S; Dzhaiani, S V; Tsutskiridze, B N; Kheladze, Zv Z; Chakhunashvili, G K; Chakhunashvili, D K

    2010-03-01

    The goal of the current research was to ascertain the optimal methods of an endoscopic haemostasis in critical care patients with GDB. The research was conducted on critically ill patients. The different endoscopic methods of treatment: injectional hemostasis, irrigation with local hemostatics, thermo coagulation, and combined method were used. Treatment with injectional hemostasis resulted in hemostasis in 75% of patients. Irrigation with local hemostatics was conducted using the local hemostatic agent caprofer and (or) 10% solution of epsylonaminocapronal acid. The final hemostasis was achieved in the 90% of the cases; bleeding was stopped in 85% of the cases when the hemorrhages occurred from chronic ulcers. The effect of thermo coagulation method was 80-85%. Combined method of treatment (combination of the irrigation with caprofer and thermo coagulation) helped to achieve 95% of the final hemostasis in critically ill patients. The achieved results certify that the combined use of caprofer and method of electro coagulation in critical care patients with GDB is very perspective. Simultaneously with this, it is also recommended to use anti-segregation therapy with blockers of proton pomp and boosting the defense of the mucous tissue with high doses of mucogen. PMID:20413810

  6. Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck.

    PubMed

    Haciyanli, Mehmet; Koruyucu, Melike Bedel; Erdoğan, Nezahat Karaca; Dere, Ozcan; Sarı, Erdem; Kumkumoğlu, Yusuf; Tavusbay, Cengiz; Kamer, Erdinc

    2015-12-01

    Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck. PMID:27011517

  7. Endoscopic mucosal resection.

    PubMed

    Hwang, Joo Ha; Konda, Vani; Abu Dayyeh, Barham K; Chauhan, Shailendra S; Enestvedt, Brintha K; Fujii-Lau, Larissa L; Komanduri, Sri; Maple, John T; Murad, Faris M; Pannala, Rahul; Thosani, Nirav C; Banerjee, Subhas

    2015-08-01

    EMR has become an established therapeutic option for premalignant and early-stage GI malignancies, particularly in the esophagus and colon. EMR can also aid in the diagnosis and therapy of subepithelial lesions localized to the muscularis mucosa or submucosa. Several dedicated EMR devices are available to facilitate these procedures. Adverse event rates, particularly bleeding and perforation, are higher after EMR relative to other basic endoscopic interventions but lower than adverse event rates for ESD. Endoscopists performing EMR should be knowledgeable and skilled in managing potential adverse events resulting from EMR. PMID:26077453

  8. Sustained Local Delivery of siRNA from an Injectable Scaffold

    PubMed Central

    Nelson, Christopher E.; Gupta, Mukesh K.; Adolph, Elizabeth J.; Shannon, Joshua M.; Guelcher, Scott A.; Duvall, Craig L.

    2011-01-01

    Controlled gene silencing technologies have significant, unrealized potential for use in tissue regeneration applications. The design described herein provides a means to package and protect siRNA within pH-responsive, endosomolytic micellar nanoparticles (si-NPs) that can be incorporated into nontoxic, biodegradable, and injectable polyurethane (PUR) tissue scaffolds. The si-NPs were homogeneously incorporated throughout the porous PUR scaffolds, and they were shown to be released via a diffusion-based mechanism for over three weeks. The siRNA-loaded micelles were larger but retained nano particulate morphology of approximately 100 nm diameter following incorporation into and release from the scaffolds. PUR scaffold releasate collected in vitro in PBS at 37°C for 1–4 days was able to achieve dose-dependent siRNA-mediated silencing with approximately 50% silencing achieved of the model gene GAPDH in NIH3T3 mouse fibroblasts. This promising platform technology provides both a research tool capable of probing the effects of local gene silencing and a potentially high-impact therapeutic approach for sustained, local silencing of deleterious genes within tissue defects. PMID:22061489

  9. Non-solenoidal Startup via Local Helicity Injection on Pegasus: Progress and Plans

    NASA Astrophysics Data System (ADS)

    Reusch, J. A.; Barr, J. L.; Bodner, G. M.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Hinson, E. T.; Lewicki, B. T.; Perry, J. M.; Schlossberg, D. J.

    2015-11-01

    Non-solenoidal plasma startup via local helicity injection (LHI) at the Pegasus toroidal experiment now provides routine operation at Ip ~ 0.17MA with Iinj ~ 5kA and Vinj ~ 1kV from four active arc injectors. Experiments in the past year have advanced the understanding of the governing physics of LHI and its supporting technology. Injector impedance scales as Vinj3/ 2 and is governed by two effects: a quasineutrality constraint on electron beam propagation, related to the tokamak edge density, and double-layer sheath expansion, related to narc. Injector design improvements permit operation at Vinj >= 1 kV without deleterious PMI or impurity generation. Discharges with varied shape, Ip(t), and helicity input test a predictive 0D power-balance model for LHI startup. Anomalous, reconnection-driven Ti >800 eV and strong MHD activity localized near the injectors are observed during LHI. Preliminary core Thomson scattering measurements indicate surprisingly high Te >300 eV, which if verified may indicate the dominance of high-energy electron fueling from the injector current streams. A new divertor injector system has been designed to substantially increase the available helicity input rate and support critical studies of confinement during LHI and reconnection activity at high Ip. A proposed upgrade to the Pegasus experiment will extend these studies to NSTX-U relevant parameters. Support: US DOE grants DE-FG02-96ER54375; and DE-SC0006928.

  10. Initial Thomson Scattering Survey of Local Helicity Injection and Ohmic Plasmas at the Pegasus Toroidal Experiment

    NASA Astrophysics Data System (ADS)

    Schlossberg, D. J.; Bodner, G. M.; Bongard, M. W.; Fonck, R. J.; Winz, G. R.

    2014-10-01

    A multipoint Thomson scattering diagnostic has recently been installed on the Pegasus ST. The system utilizes a frequency-doubled Nd:YAG laser (λ0 ~ 532 nm), spectrometers with volume phase holographic gratings, and a gated, intensified CCD camera. It provides measurements of Te and ne at 8 spatial locations for each spectrometer once per discharge. A new multiple aperture and beam dump system has been implemented to mitigate interference from stray light. This system has provided initial measurements in the core region of plasmas initiated by local helicity injection (LHI), as well as conventional Ohmic L- and H-mode discharges. Multi-shot averages of low-density (ne ~ 3 ×1018 m-3) , Ip ~ 0 . 1 MA LHI discharges show central Te ~ 75 eV at the end of the helicity injection phase. Ip ~ 0 . 13 MA Ohmic plasmas at moderate densities (ne ~ 2 ×1019 m-3) have core Te ~ 150 eV in L-mode. Generally, these plasmas do not reach transport equilibrium in the short 25 ms pulse length available. After an L-H transition, strong spectral broadening indicates increasing Te, to values above the range of the present spectrometer system with a high-dispersion VPH grating. Near-term system upgrades will focus on deploying a second spectrometer, with a lower-dispersion grating capable of measuring the 0.1-1.0 keV range. The second spectrometer system will also increase the available number of spatial channels, enabling study of H-mode pedestal structure. Work supported by US DOE Grant DE-FG02-96ER54375.

  11. Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus.

    PubMed

    Catalano, Louis W; Glickel, Steven Z; Barron, O Alton; Harrison, Richard; Marshall, Astrid; Purcelli-Lafer, Marissa

    2012-12-01

    Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. The purpose of this study was to examine the systemic impact of extra-articularly administered corticosteroids in the hand and wrist on serum glucose concentration in patients with diabetes mellitus.Twenty-three patients with diabetes mellitus received a 1-mL triamcinolone acetonide injection for de Quervain's tenosynovitis, trigger finger, flexor carpi ulnaris tendonitis, or carpal tunnel syndrome. Patients recorded their daily morning blood glucose levels for 1 week before injection and for 4 weeks after injection. Average blood glucose levels increased slightly from baseline after injection, reaching statistical significance 1, 5, and 6 days after injection, but were not clinically significant (average increase, 14.2, 9.7, and 32.7 mg/dL, respectively). Isolated increases more than 2 times the standard deviation of preinjection values occurred at least once in the majority of patients. The frequency of hyperglycemic episodes increased after injection, but the proportions of patients with at least 1 hyperglycemic episode before and after injection were not significantly different.These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk. PMID:23218632

  12. Lysosomal localization of β-fructofuranosidase-containing liposomes injected into rats. Some implications in the treatment of genetic disorders

    PubMed Central

    Gregoriadis, Gregory; Ryman, Brenda E.

    1972-01-01

    Yeast β-fructofuranosidase (invertase) or 131I-labelled albumin were entrapped into liposomes composed of phosphatidylcholine, cholesterol and phosphatidic acid. Of the β-fructofuranosidase activity in the liposomal preparations 96–100% was latent. The following observations were made in experiments with rats injected with protein-containing liposomes. 1. After injection of β-fructofuranosidase-containing liposomes (220 units or 1.5mg of β-fructofuranosidase and 17.5mg of lipid), β-fructofuranosidase activity in blood retained its latency but the activity declined to 50% of the injected dose in 1h. Within 6h much of this activity was recovered in the liver and spleen (respectively 45% and 10% of that injected). For up to 21h after injection, the mitochondrial–lysosomal fraction was the principal location of the hepatic β-fructofuranosidase activity. 2. Lysosomal localization of liposomal protein was supported by the observed increase in the trichloroacetic acid-soluble radioactivity during incubation of the lysosome-rich fraction of the liver of rats injected with liposomes containing 131I-labelled albumin. 3. Association of liposomal protein with lysosomes was demonstrated on subfractionation of the mitochondrial–lysosomal fraction of the liver of rats injected with β-fructofuranosidase-containing liposomes in a Ficoll–mannitol gradient. β-Fructofuranosidase, lysosomal and mitochondrial enzyme marker activities were found to exhibit similar distribution patterns along the gradient. However, in similar experiments with rats previously injected with Triton WR-1339 or dextran (known to alter the specific gravity of lysosomes), only β-fructofuranosidase and lysosomal marker moved along the gradient, in strikingly similar patterns. 4. The lysosomal localization of injected liposome-entrapped material can probably be utilized in the treatment of certain disorders in man. PMID:4646772

  13. Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers

    PubMed Central

    Noda, Hisatsugu; Ogasawara, Naotaka; Koshino, Akira; Fukuta, Shouko; Nagoya, Takuroh; Hoshino, Hironori; Nagao, Kazuhiro; Sugiyama, Tomoya; Kondo, Yoshihiro; Ito, Yoshitsugi; Izawa, Shinya; Ebi, Masahide; Funaki, Yasushi; Sasaki, Makoto; Kasugai, Kunio

    2016-01-01

    Although the thread-traction (TT) method has been found useful during endoscopic submucosal dissection (ESD) for early gastric cancers, the movement of the thread interferes with the movement of the endoscope, and the lesion can only be pulled to the mouth side. We have developed the novel TT method using a sheath of polypectomy snare (TTSPS). The TTSPS method enables free and independent movement of the thread and the endoscope and allows pulling the lesion towards the anal as well as oral side. The median dissection times, numbers of instances of arterial bleeding, and numbers of local injections into the submucosal layer were significantly lower for ESD with TTSPS than for conventional ESD. Countertraction ESD using the TTSPS method is straightforward, safe, easy, noninvasive, and cost effective, and it uses instruments readily available in most hospitals to enhance visualization of cutting lines. Therefore, the TTSPS method can be universally applied in conventional ESD. PMID:26843860

  14. Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma.

    PubMed

    van Vendeloo, Stefan N; Ettema, Harmen B

    2016-06-01

    Steroid injection is frequently used in the treatment of interdigital neuroma and has a high rate of success. We report the case of a patient who develops skin depigmentation at the injection site and linear streaks of depigmentation over the foot, the ankle and half way up to the knee after a steroid injection for interdigital neuroma. Minor disadvantages such as subcutaneous fat atrophy and depigmentation of the skin at the injection site are well known problems following steroid injection. Depigmentation of the skin with a lymphatic distribution in the foot after steroid injection for interdigital neuroma however, has not yet been reported before. This complication is a serious aesthetic problem and clinicians should be aware of this complication when treating patients with steroid injections for interdigital neuroma. PMID:27301735

  15. Effect of liposomes on rheological and syringeability properties of hyaluronic acid hydrogels intended for local injection of drugs.

    PubMed

    El Kechai, Naila; Bochot, Amélie; Huang, Nicolas; Nguyen, Yann; Ferrary, Evelyne; Agnely, Florence

    2015-06-20

    The aim of this work was to thoroughly study the effect of liposomes on the rheological and the syringeability properties of hyaluronic acid (HA) hydrogels intended for the local administration of drugs by injection. Whatever the characteristics of the liposomes added (neutral, positively or negatively charged, with a corona of polyethylene glycol chains, size), the viscosity and the elasticity of HA gels increased in a lipid concentration-dependent manner. Indeed, liposomes strengthened the network formed by HA chains due to their interactions with this polymer. The nature and the resulting effects of these interactions depended on liposome composition and concentration. The highest viscosity and elasticity were observed with liposomes covered by polyethylene glycol chains while neutral liposomes displayed the lowest effect. Despite their high viscosity at rest, all the formulations remained easily injectable through needles commonly used for local injections thanks to the shear-thinning behavior of HA gels. The present study demonstrates that rheological and syringeability tests are both necessary to elucidate the behavior of such systems during and post injection. In conclusion, HA liposomal gels appear to be a promising and versatile formulation platform for a wide range of applications in local drug delivery when an injection is required. PMID:25882015

  16. Power Balance Modeling and Validation for ST Startup Using Local Helicity Injection

    NASA Astrophysics Data System (ADS)

    Barr, J. L.; Bodner, G. M.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Hinson, E. T.; Perry, J. M.; Reusch, J. A.; Schlossberg, D. J.

    2015-11-01

    Local Helicity Injection (LHI) uses localized current injectors for routine Ip<0.18 MA non-solenoidal startup on the Pegasus ST. A power-balance model is under development for predictive Ip t using helicity-balance to quantify LHI's effective current drive, Veff. Analytic formulas for low-A plasma inductance and vertical field are used to account for the inductive effects of dynamic shape evolution. These formulas are being validated against magnetic reconstructions of LHI discharges with varied shape evolutions. Initial results match experimental Ip t within 20 kA with assumed shaping and average resistivity (Spitzer, Te = 60 eV). Geometric effects and inductive drive provide 2.0 V along with Veff = 0.3 V to balance 1.1 V of resistive losses and 1.2 V inductive reactance to ramping Ip. The model is especially sensitive to resistivity when Te<150 eV. Initial Thomson Scattering results give core Te = 72 +/-22 eV, and at times suggest higher central electron energies. Spatial and temporal scans are underway to quantify LHI plasma resistivity and transport. MA-class startup in NSTX-U will require increased area (Ainj >= 40 cm2) LHI systems that play a larger role in current drive than geometric effects, with Veff dropping from >10 V to on-par with inductive effects. This regime is accessed in Pegasus at Ip ≅ 300 kA. Work supported by US DOE grants DE-FG02-96ER54375 and DE-SC0006928.

  17. Non-local thermal spin injection to study spin diffusion in yttrium iron garnet

    NASA Astrophysics Data System (ADS)

    Giles, Brandon; Yang, Zihao; Jamison, John; Myers, Roberto

    Understanding the generation, detection, and manipulation of spin current is critical for the development of devices that depend on spin transport for information processing and storage. Recent studies have shown that spin transport over long distances is possible in the magnetic insulator yttrium iron garnet (YIG) through the diffusion of non-equilibrium magnons. Electrically excited magnons have been shown to diffuse up to 40um at room temperature, while thermally injected magnons were detected at ranges greater than 125um at 23K. However, much work is still required to fully understand the processes responsible for magnon diffusion. Here, we present an in-depth study of the diffusion of magnons in YIG. By using the non-local thermal spin detection method, we analyze spin transport as a function of temperature. Spin diffusion maps, which can be used to experimentally determine the spin diffusion length in YIG as a function of temperature, are presented Work supported by the Army Research Office MURI W911NF-14-1-0016.

  18. The Physics of Local Helicity Injection Non-Solenoidal Tokamak Startup

    NASA Astrophysics Data System (ADS)

    Redd, A. J.; Barr, J. L.; Bongard, M. W.; Fonck, R. J.; Hinson, E. T.; Jardin, S.

    2013-10-01

    Non-solenoidal startup via Local Helicity Injection (LHI) uses compact current injectors to produce toroidal plasma current Ip up to 170 kA in the PEGASUS Toroidal Experiment, driven by 4-8 kA injector current on timescales of 5-20 milliseconds. Increasing the Ip buildup duration enables experimental demonstration of plasma position control on timescales relevant for high-current startup. LHI-driven discharges exhibit bursty MHD activity, apparently line-tied kinking of LHI-driven field lines, with the bursts correlating with rapid equilibrium changes, sharp Ip rises, and sharp drops in the injector impedance. Preliminary NIMROD results suggest that helical LHI-driven current channels remain coherent, with Ip increases due to reconnection between adjacent helical turns forming axisymmetric plasmoids, and corresponding sharp drops in the bias circuit impedance. The DC injector impedance is consistent with a space charge limit at low bias current and a magnetic limit at high bias current. Internal measurements show the current density profile starts strongly hollow and rapidly fills in during Ip buildup. Simulations of LHI discharges using the Tokamak Simulation Code (TSC) will provide insight into the detailed current drive mechanism and guide experiments on PEFASUS and NSTX-U. Work supported by US DOE Grants DE-FG02-96ER54375 and DE-SC0006928.

  19. Infectious diseases linked to cross-contamination of flexible endoscopes

    PubMed Central

    Kenters, Nikki; Huijskens, Elisabeth G. W.; Meier, Corianne; Voss, Andreas

    2015-01-01

    Flexible endoscopes are widely used to examine, diagnose, and treat medical disorders. While the risk of endoscopy-related transmission of infection is estimated to be very low, more health care-associated infections are related to contaminated endoscopes than to any other medical device. Flexible endoscopes can get highly contaminated with microorganisms, secretions and blood during use. The narrow lumens and multiple internal channels make the cleaning of flexible endoscopes a complex and difficult task. Despite the availability of international, national and local endoscope reprocessing guidelines, contamination and transmission of microorganisms continue to occur. These transmissions are mostly related to the use of defective equipment, endoscope reprocessing failures, and noncompliance with recommended guidelines. This article presents an overview of publications about case reports and outbreaks related to contamination of flexible endoscopes. PMID:26355428

  20. Endoscopic photodynamic therapy (PDT) for oesophageal cancer.

    PubMed

    Moghissi, Keyvan

    2006-06-01

    Endoscopic photodynamic therapy (PDT) is undertaken only when tumour is visible endoscopically with malignancy biopsy confirmed. Patients will be either Group A: inoperable cases with locally advanced cancer when the aim is palliation of dysphagia, or Group E: patients with early stage I-II disease who are unsuitable for surgery or decline operation, when the intent is curative. Following assessment for suitability for PDT and counselling, Photofrin 2mg/(kgbw) is administered 24-72h before endoscopic illumination using a Diode 630nm laser. Illumination may be either interstitial or intraluminal at a dose of 100-200J/cm. PMID:25049097

  1. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    PubMed Central

    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

  2. A comparative study of efficacy of oral nonsteroidal antiinflammatory agents and locally injectable steroid for the treatment of plantar fasciitis

    PubMed Central

    Biswas, Chaitali; Pal, Anirban; Acharya, Amita

    2011-01-01

    Objectives: To compare the effectiveness of oral nonsteroidal antiinflammatory drugs (NSAIDs) and locally injectable steroid (methylprednisolone) in the treatment of plantar fasciitis. Materials and Methods: One hundred and twenty subjects with unilateral plantar fasciitis were recruited and randomly allocated to two study groups. Group I (NSAIDs group) (n=60) received oral tablet diclofenac (50 mg) and paracetamol (500 mg) twice a day (BD) along with tab. ranitidine 150 mg BD. Group II (injectable steroid group) (n=60) received injection of 1 ml of methylprednisolone (Depomedrol) (40 mg) and 2 ml of 0.5% bupivacaine into the inflammed plantar fascia. Pain intensity was measured using 10 cm visual analog scale (VAS). Subjects were evaluated clinically before, and 1 week, 2 weeks, 4 weeks, and 8 weeks (2 months) after the initiation of treatment in both the groups. The outcome was assessed in terms of VAS score and recurrence of the heel pain. Statistical Analysis Used: “Z” test and Chi-square test were used wherever applicable. Results: Pain relief was significant after steroid injection (P<0.001) and the improvement was sustained. The recurrence of heel pain was significantly higher in the oral NSAIDS group (P<0.001). Conclusion: Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs. PMID:25885380

  3. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    SciTech Connect

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  4. Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty

    PubMed Central

    Andersen, Karen V; Nikolajsen, Lone; Daugaard, Henrik; Andersen, Niels T; Haraldsted, Viggo; Søballe, Kjeld

    2015-01-01

    Background and purpose — The effect of postoperative intra-articular bolus injections after total hip arthroplasty (THA) remains unclear. We tested the hypothesis that intra-articular bolus injections administered every 6 hours after surgery during the first 24 hours would significantly improve analgesia after THA. Patients and methods — 80 patients undergoing THA received high-volume local infiltration analgesia (LIA; 200 mg ropivacaine and 30 mg ketorolac) followed by 4 intra-articular injections with either ropivacaine (100 mg) and ketorolac (15 mg) (the treatment group) or saline (the control group). The intra-articular injections were combined with 4 intravenous injections of either saline (treatment group) or 15 mg ketorolac (control group). All patients received morphine as patient-controlled analgesia (PCA). The primary outcome was consumption of intravenous morphine PCA and secondary outcomes were consumption of oral morphine, pain intensity, side effects, readiness for hospital discharge, length of hospital stay, and postoperative consumption of analgesics at 3, 6, and 12 weeks after surgery. Results — There were no statistically significant differences between the 2 groups regarding postoperative consumption of intravenous morphine PCA. Postoperative pain scores during walking were higher in the treatment group from 24–72 hours after surgery, but other pain scores were similar between groups. Time to readiness for hospital discharge was longer in the treatment group. Other secondary outcomes were similar between groups. Interpretation — Postoperative intra-articular bolus injections of ropivacaine and ketorolac cannot be recommended as analgesic method after THA. PMID:26312445

  5. Coronary artery rupture during balloon angioplasty, rescued with localized thrombin injection and coil embolization.

    PubMed

    Fischell, Tim A; Carter, Andrew J; Ashraf, Kamal; Birdsall, Joseph; Smoker, Sandy

    2006-08-01

    Distal intracoronary thrombin injection has been used successfully to seal very small, guidewire related, coronary artery perforations during percutaneous coronary intervention. This case report expands upon this therapeutic approach, by describing the use of high dose distal thrombin injection for the successful (non-surgical) management of balloon-induced coronary artery rupture, with an intrapericardial leak. PMID:16819769

  6. [Endoscopic management of luminal stenosis in inflammatory bowel disease].

    PubMed

    Lorenzo-Zúñiga, Vicente; García-Planella, Esther; Moreno De Vega, Vicente; Domènech, Eugeni; Boix, Jaume

    2012-01-01

    Luminal stenosis is frequent in Crohn's disease (CD) due to transmural involvement. Before any endoscopic treatment, the presence of neoplastic stenosis should always be excluded. Endoscopic balloon dilatation has been used in several series to treat benign stenosis, mainly in CD with involvement of the distal ileon, colon or surgical anastomosis, with success rates of 51% to 85%, although recurrence is high. The concomitant use of injected steroids (triamcinolone) after endoscopic dilatation produces longer-lasting results, but there are few published reports. In patients with luminal stenosis refractory to conventional endoscopy, three emerging techniques may be useful: self-expanding metallic stents, biodegradable endoprostheses and intralesional infliximab injection. PMID:22341673

  7. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.

    2015-01-01

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients

  8. Endoscopic mediastinal staging of lung cancer.

    PubMed

    Khoo, Kay-Leong; Ho, Khek-Yu

    2011-04-01

    The advent of endoscopic ultrasound-guided sampling procedures such as endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has lead to significant advances in the mediastinal diagnosis and staging of lung cancer. These endoscopic techniques can be performed in the outpatient setting under conscious sedation and local anesthesia, in contrast to the surgical standard, mediastinoscopy (MS), which requires operating theatre time and general anesthesia. Proponents of mediastinoscopy have always emphasized the advantages of mediastinoscopy, namely its sensitivity even with a low prevalence of mediastinal metastases and its low false negative rate. Newer endoscopic techniques such as EBUS-TBNA are showing sensitivities exceeding that of mediastinoscopy, even in the setting of an equally low prevalence of mediastinal metastases. However, endoscopic techniques have double the false negative rate of mediastinoscopy. As the tracheobronchial route and esophageal route provide almost complete access to mediastinal lymph nodes, these endoscopic techniques are complementary rather than competing. When used in combination, it is possible mediastinoscopy may be superseded. The challenge however, is how best to select the appropriate endoscopic procedures to accurately stage lung cancer in the most cost-effective manner. PMID:21130638

  9. Endoscopically assisted excision of digital enchondroma.

    PubMed

    Dietz, Jeffrey F; Kachar, Sergey M; Nagle, Daniel J

    2007-06-01

    We present 2 cases of endoscopically assisted curettage of enchondroma of the hand. After initial open curettage of the lesion, a 1.9-mm arthroscope was introduced through a small cortical window. Under arthroscopic guidance, residual pathologic material was freed from the cavity wall and evacuated with the aid of repeated saline lavage combined with suction. The saline was injected through an 18-gauge angiocatheter under direct endoscopic control. The endoscope was then used to observe the filling of the cavity with demineralized bone matrix (DBX; Synthes [USA], Paoli, PA). We believe that endoscopically assisted curettage presents several advantages over open curettage alone. First, direct visualization of the medullary canal permits accurate assessment of the extent of the enchondroma. Second, the endoscope permits accurate assessment of the adequacy of the curettage, thus avoiding the need to perform multiple, blind, and aggressive passes with a curette. Multiple passes can increase the risk of violation of the cortical shell and can prolong the procedure. Third, the ability to completely clear the medullary canal of all tumors should logically reduce the rate of recurrence. In conclusion, the addition of an endoscope is an inexpensive modification that promises to save time, decrease morbidity, and possibly improve long-term outcomes. PMID:17560488

  10. Maximization of ICRF power by SOL density tailoring with local gas injection

    NASA Astrophysics Data System (ADS)

    Jacquet, P.; Goniche, M.; Bobkov, V.; Lerche, E.; Pinsker, R. I.; Pitts, R. A.; Zhang, W.; Colas, L.; Hosea, J.; Moriyama, S.; Wang, S.-J.; Wukitch, S.; Zhang, X.; Bilato, R.; Bufferand, H.; Guimarais, L.; Faugel, H.; Hanson, G. R.; Kocan, M.; Monakhov, I.; Noterdaeme, J.-M.; Petrzilka, V.; Shaw, A.; Stepanov, I.; Sips, A. C. C.; Van Eester, D.; Wauters, T.; JET contributors, the; the ASDEX Upgrade Team; the DIII-D Team; ITPA ‘Integrated Operation Scenarios' members, the; experts

    2016-04-01

    Experiments have been performed under the coordination of the International Tokamak Physics Activity (ITPA) on several tokamaks, including ASDEX Upgrade (AUG), JET and DIII-D, to characterize the increased Ion cyclotron range of frequency (ICRF) antenna loading achieved by optimizing the position of gas injection relative to the RF antennas. On DIII-D, AUG and JET (with the ITER-Like Wall) a 50% increase in the antenna loading was observed when injecting deuterium in ELMy H-mode plasmas using mid-plane inlets close to the powered antennas instead of divertor injection and, with smaller improvement when using gas inlets located at the top of the machine. The gas injection rate required for such improvements (~0.7  ×  1022 el s-1 in AUG, ~1.0  ×  1022 el s-1 in JET) is compatible with the use of this technique to optimize ICRF heating during the development of plasma scenarios and no degradation of confinement was observed when using the mid-plane or top inlets compared with divertor valves. An increase in the scrape-off layer (SOL) density was measured when switching gas injection from divertor to outer mid-plane or top. On JET and DIII-D, the measured SOL density increase when using main chamber puffing is consistent with the antenna coupling resistance increase provided that the distance between the measurement lines of sight and the injection location is taken into account. Optimized gas injection was also found to be beneficial for reducing tungsten (W) sputtering at the AUG antenna limiters, and also to reduce slightly the W and nickel (Ni) content in JET plasmas. Modeling the specific effects of divertor/top/mid-plane injection on the outer mid-plane density was carried out using both the EDGE2D-EIRENE and EMC3-EIRENE plasma boundary code packages; simulations indeed indicate that outer mid-plane gas injection maximizes the density in the mid-plane close to the injection point with qualitative agreement with the AUG SOL density measurements

  11. Wide FOV wedge prism endoscope.

    PubMed

    Kim, Keri; Kim, Daeyoung; Matsumiya, Kiyoshi; Kobayashi, Etsuko; Dohi, Takeyoshi

    2005-01-01

    We.. have developed a novel robotic endoscope system. It can be used to observe a wide field of view without moving or bending the whole endoscope system. .. It consists of a rigid endoscope and two wedge prisms at the distal tip. Rotating each wedge prism respectively, we can change the direction of view. Accordingly it becomes possible to observe a wide field of view even in a small space, and suited to clinical uses because it does not damage body tissues or internal organs. .. Wedge prisms are designed to avoid vignetting which is caused by the refraction or the reflection at prisms. The endoscope has 10mm in diameter, and the drive unit is simply separable for the sterilization. In addition, since it has a simple and small drive unit, it does not obstruct surgeon or other surgery robots. The maximum movement of local field of view is 19degrees, and global field of view is 93degrees. In the evaluation experiment, we conformed that both of the image quality and the performance are acceptable. PMID:17281566

  12. Local heat transfer in turbine disk-cavities. II - Rotor cooling with radial location injection of coolant

    NASA Astrophysics Data System (ADS)

    Bunker, R. S.; Metzger, D. E.; Wittig, S.

    1990-06-01

    The detailed radial distributions of rotor heat-transfer coefficients for three basic disk-cavity geometries applicable to gas turbines are presented. The coefficients are obtained over a range of parameters including disk rotational Reynolds numbers of 200,000 to 50,000, rotor/stator spacing-to-disk ratios of 0.025 to 0.15, and jet mass flow rates between 0.10 and 0.40 times the turbulent pumped flow rate of a free disk. The effects of a parallel rotor are analyzed, and strong variations in local Nusselt numbers for all but the rotational speed are pointed out and compared with the associated hub-injection data from a previous study. It is demonstrated that the overall rotor heat transfer is optimized by either the hub injection or radial location injection of a coolant, dependent on the configuration.

  13. Endoscopic laser therapy in gastroenterology.

    PubMed Central

    Pritikin, J; Weinman, D; Harmatz, A; Young, H

    1992-01-01

    Endoscopic laser therapy has become an important and widely used tool in gastroenterology. It has become important for outpatient palliative therapy for ablating obstructing gastrointestinal neoplasms. This method has often circumvented the need for major palliative surgical resections. Caution must be applied to laser therapy for potentially curable malignant neoplasms because, with vaporization of the target tissue, no tissue specimen is available to assure that local or invasive residual carcinoma is excluded. Therefore, in good surgical candidates, surgical resection of potentially curable cancers is always recommended. In the future, however, the combination of refined endoscopic ultrasonography and laser fluorescence techniques may lead to earlier detection, more precise localization, and even curative ablation of gastrointestinal malignancy. Images PMID:1413743

  14. Simulation of Multi-Spacecraft Observed Energetic Electron Injection By the Electromagnetic Field of a Transient, Localized Dipolarizing Flux Bundle

    NASA Astrophysics Data System (ADS)

    Gabrielse, C.; Angelopoulos, V.; Runov, A.; Turner, D. L.

    2014-12-01

    Energetic particle injections in the near-Earth plasma sheet are critical for supplying particles and energy to the radiation belts and ring current. Their origin, however, has been elusive due to the lack of equatorial, multi-point observations. After the launch of NASA's Time History of Events and Macroscale Interactions during Substorms (THEMIS) mission in 2007, intense electric fields and elevated energetic particle fluxes have been observed to accompany localized (1-4 RE wide) bursty bulk flows and to propagate from the mid-tail regions (at geocentric radial distances R > 25RE) towards Earth, up to and at times inside of geosynchronous orbit (GEO, R=6.6RE). Motivated by these observations, we model simultaneous multi-point observations of electron injections using guiding center approximation in prescribed but realistic electric and magnetic fields to better understand the nature of their acceleration. Modeling of electron injections assuming a localized, impulsive, dipolarizing flux bundle and its accompanying electric field transported from mid-tail to near-Earth at bursty flow speeds successfully reproduces the observations at multiple spacecraft. The impulsive, localized nature of the earthward-propagating electromagnetic pulse with attending vortical/tailward flow is what makes this model particularly effective in reproducing both the injection and the dispersed decrease in energy flux often observed simultaneously with the injection but at lower energies (~10-30 keV). The results suggest that particle acceleration and transport towards the inner magnetosphere can be thought of as a superposition of individual bursts of varying intensity and cadence depending on global geomagnetic activity levels.

  15. Short-term muscle atrophy caused by botulinum toxin-A local injection impairs fracture healing in the rat femur.

    PubMed

    Hao, Yongqiang; Ma, Yongcheng; Wang, Xuepeng; Jin, Fangchun; Ge, Shengfang

    2012-04-01

    Damaged bone is sensitive to mechanical stimulation throughout the remodeling phase of bone healing. Muscle damage and muscular atrophy associated with open fractures and subsequent fixation are not beneficial to maintaining optimum conditions for mechanical stability. The aim of this study was to investigate whether local muscle atrophy and dysfunction affect fracture healing in a rat femur fracture model. We combined the rat model of a short period atrophy of the quadriceps with femur fracture. Forty-four-month-old male Wistar rats were adopted for this study. Two units of botulinum toxin-A (BXTA) were administered locally into the right side of the quadriceps of each rat, while the same dose of saline was injected into the contralateral quadriceps. After BXTA had been fully absorbed by the quadriceps, osteotomy was performed in both femurs with intramedullary fixation. Gross observation and weighing of muscle tissue, X-ray analysis, callus histology, and bone biomechanical testing were performed at different time points up to 8 weeks post-surgery. Local injection of BXTA led to a significant decrease in the volume and weight of the quadriceps compared to the control side. At the eighth week, the left side femurs of the saline-injected quadriceps almost reached bony union, and fibrous calluses were completely calcified into woven bone. However, a gap was still visible in the BXTA-treated side on X-ray images. As showed by bone histology, there were no mature osseous calluses or woven bone on the BXTA-treated side, but a resorption pattern was evident. Biomechanical testing indicated that the femurs of the BXTA-treated side exhibited inferior mechanical properties compared with the control side. The inferior outcome following BXTA injection, compared with saline injection, in terms of callus resistance may be the consequence of unexpected load and mechanical unsteadiness caused by muscle atrophy and dysfunction. PMID:21919046

  16. Localization of exogenous DNA to mitochondria in skeletal muscle following hydrodynamic limb vein injection.

    PubMed

    Yasuzaki, Yukari; Yamada, Yuma; Kanefuji, Tsutomu; Harashima, Hideyoshi

    2013-12-28

    Mitochondrial genetic disorders are a major cause of mitochondrial diseases. It is therefore likely that mitochondrial gene therapy will be useful for the treatment of such diseases. Here, we report on the possibility of mitochondrial gene delivery in skeletal muscle using hydrodynamic limb vein (HLV) injection. The HLV injection procedure, a useful method for transgene expression in skeletal muscle, involves the rapid injection of a large volume of naked plasmid DNA (pDNA) into the distal vein of a limb. We hypothesized that the technique could be used to deliver pDNA not only to nuclei but also to mitochondria, since cytosolic pDNA that is internalized by the method may be able to overcome mitochondrial membrane. We determined if pDNA could be delivered to myofibrillar mitochondria by HLV injection by PCR analysis. Mitochondrial toxicity assays showed that the HLV injection had no influence on mitochondrial function. These findings indicate that HLV injection promises to be a useful technique for in vivo mitochondrial gene delivery. PMID:24100263

  17. A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Rivera, Jose J; Pampati, Vidya Sagar; Damron, Kim S; McManus, Carla D; Brandon, Doris E; Wilson, Sue R

    2005-01-01

    Background Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. Methods A prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid. Results Among the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status. Conclusion Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects. PMID:16000173

  18. Endoscopic treatment of esophageal varices in patients with liver cirrhosis.

    PubMed

    Triantos, Christos; Kalafateli, Maria

    2014-09-28

    Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or large-sized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers (NSBBs) or endoscopic variceal ligation (EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene (PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events. PMID:25278695

  19. Endoscopic treatment of esophageal varices in patients with liver cirrhosis

    PubMed Central

    Triantos, Christos; Kalafateli, Maria

    2014-01-01

    Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or large-sized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers (NSBBs) or endoscopic variceal ligation (EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene (PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events. PMID:25278695

  20. Local retention of antibodies in vivo with an injectable film embedded with a fluorogen-activating protein.

    PubMed

    Liu, Wen; Saunders, Matthew J; Bagia, Christina; Freeman, Eric C; Fan, Yong; Gawalt, Ellen S; Waggoner, Alan S; Meng, Wilson S

    2016-05-28

    Herein we report an injectable film by which antibodies can be localized in vivo. The system builds upon a bifunctional polypeptide consisting of a fluorogen-activating protein (FAP) and a β-fibrillizing peptide (βFP). The FAP domain generates fluorescence that reflects IgG binding sites conferred by Protein A/G (pAG) conjugated with the fluorogen malachite green (MG). A film is generated by mixing these proteins with molar excess of EAK16-II, a βFP that forms β-sheet fibrils at high salt concentrations. The IgG-binding, fluorogenic film can be injected in vivo through conventional needled syringes. Confocal microscopic images and dose-response titration experiments showed that loading of IgG into the film was mediated by pAG(MG) bound to the FAP. Release of IgG in vitro was significantly delayed by the bioaffinity mechanism; 26% of the IgG were released from films embedded with pAG(MG) after five days, compared to close to 90% in films without pAG(MG). Computational simulations indicated that the release rate of IgG is governed by positive cooperativity due to pAG(MG). When injected into the subcutaneous space of mouse footpads, film-embedded IgG were retained locally, with distribution through the lymphatics impeded. The ability to track IgG binding sites and distribution simultaneously will aid the optimization of local antibody delivery systems. PMID:27038493

  1. Modeling of local co-deposition rates near Tore Supra gas injection sources

    NASA Astrophysics Data System (ADS)

    Loarer, Th.; Hogan, J.; Tsitrone, E.; Brosset, C.; Bucalossi, J.; Gunn, J.; Pegourie, B.

    2003-10-01

    Using the Tore Supra Composants Internes et Limiteurs (CIEL) configuration, long discharges (>4 mins), with high extracted energy (>0.7 GJ) have been demonstrated. Examination after periods of long duration operation has revealed a high level of retention of injected deuterium, a result which has important implications for tritium retention in ITER [1, 2]. The zone near the neutral gas injection port at the outboard midplane is a high redeposition area. To understand the retention mechanism, and to evaluate alternative injection methods which could reduce it, we have modeled this process with the neutral deuterium version of the 3-D Monte Carlo code, BBQ and the 1-D WDIFFUSE wall transport code. Transport of neutral atoms and molecules is calculated, to determine the expected codeposition rate stimulated by the charge exchange cascade process near the injection port. Retention is estimated from WDIFFUSE using the results of W. Jakob [3] for the increased range of energetic particles in soft films. The reduction in retained levels which could be achieved by using an alternative injection location (diagnostic port in the toroidal limiter) is predicted from the validated model. [1] E. Tsitrone et al, , EPS 2003, St Peterburg [2] Th. Loarer et al, EPS 2003, St Peterburg [3] W. Jakob, J. Thin Films, 1998

  2. Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.

    PubMed

    Tatari, H; Kosay, C; Baran, O; Ozcan, O; Ozer, E

    2001-06-01

    The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon. PMID:11482466

  3. Possibilities of interventional endoscopic ultrasound

    PubMed Central

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-01-01

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other “interventional EUS” procedures. In this review, we have summarized the new possibilities offered by “interventional EUS”. PMID:22816010

  4. Endoscopic treatment of esophageal achalasia.

    PubMed

    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. PMID:26839644

  5. Endoscopic treatment of esophageal achalasia

    PubMed Central

    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

  6. Possibilities of interventional endoscopic ultrasound.

    PubMed

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-07-16

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other "interventional EUS" procedures. In this review, we have summarized the new possibilities offered by "interventional EUS". PMID:22816010

  7. [Achalasia: role of endoscopic therapy and surgery].

    PubMed

    Abbes, Leila; Leconte, Mahaut; Coriat, Romain; Dousset, Bertrand; Chaussade, Stanislas; Gaudric, Marianne

    2013-05-01

    Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia. PMID:22959337

  8. Diffusion and Controlled Localized Drug Release from an Injectable Solid Self-Assembling Peptide Hydrogel

    NASA Astrophysics Data System (ADS)

    Sun, Jessie E. P.; Stewart, Brandon; Langhans, Sigrid; Stewart, Joel P.; Pochan, Darrin J.

    2014-03-01

    We use an injectable solid peptide hydrogel (first assembled into a solid hydrogel, can shear-thin flow and immediately reheal on cessation of shear) as a drug delivery vehicle for sustained and active drug release. The triggered intramolecular peptide folding into a beta-hairpin leads to intermolecular assmebly of the peptides into the entangled and branched nanofibrillar hydrogel network responsible for its advantageous rheological properties. The hydrogel is used to encapsulate a highly effective chemotherapeutic, vincristine, with hydrophobic behavior. We show that we are able to constantly maintain drug release in low but still potent concentrations after the shear-thinning injection process. Similarly, the mechanical and morphoogical properties of the gels remains identical after injection. Characterization of the hydrogel construct is through tritiated vincristine release, TEM, confocal microscopy, and in vitro methods.

  9. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography.

    PubMed

    Timor-Tritsch, I E; Monteagudo, A; Mandeville, E O; Peisner, D B; Anaya, G P; Pirrone, E C

    1994-03-01

    We evaluated the feasibility of transvaginal methotrexate injection of viable cervical pregnancies to avoid complications of the "classic" surgical procedures in use and to preserve future fertility. Five viable cervical pregnancies, at 6 to 8 weeks, were treated. In three patients a spring-loaded automated puncture device and in two a manually operated simple needle guide mated to and guided by a transvaginal ultrasonography probe were used with 21-gauge needles. The puncture and injection treatment was successful and without complications in all five cases presented. This procedure may become a useful alternative to other, more radical or complex surgical approaches. PMID:8141192

  10. Endoscopic Evaluation of Swallowing (Endoscopy)

    MedlinePlus

    ... the Public / Speech, Language and Swallowing / Swallowing Endoscopic Evaluation of Swallowing (Endoscopy) Do you have problems swallowing? ... Some names you might hear are: Endoscopy Endoscopic Evaluation of swallowing FEES (Fiberoptic Endoscopic Evaluation of Swallowing) ...

  11. Poly(ortho ester) nanoparticles targeted for chronic intraocular diseases: ocular safety and localization after intravitreal injection.

    PubMed

    Li, Huiling; Palamoor, Mallika; Jablonski, Monica M

    2016-10-01

    Treatment of posterior eye diseases is more challenging than the anterior segment ailments due to a series of anatomical barriers and physiological constraints confronted by drug delivery to the back of the eye. In recent years, concerted efforts in drug delivery have been made to prolong the residence time of drugs injected in the vitreous humor of the eye. Our previous studies demonstrated that poly(ortho ester) (POE) nanoparticles were biodegradable/biocompatible and were capable of long-term sustained release. The objective of the present study was to investigate the safety and localization of POE nanoparticles in New Zealand white rabbits and C57BL/6 mice after intravitreal administration for the treatment of chronic posterior ocular diseases. Two concentration levels of POE nanoparticles solution were chosen for intravitreal injection: 1.5 mg/ml and 10 mg/ml. Our results demonstrate that POE nanoparticles were distributed throughout the vitreous cavity by optical coherence tomography (OCT) examination 14 days post-intravitreal injection. Intraocular pressure was not changed from baseline. Inflammatory or adverse effects were undetectable by slit lamp biomicroscopy. Furthermore, we demonstrate that POE nanoparticles have negligible toxicity assessed at the cellular level evidenced by a lack of glia activation or apoptosis estimation after intravitreal injection. Collectively, POE nanoparticles are a novel and nontoxic as an ocular drug delivery system for the treatment of posterior ocular diseases. PMID:27108911

  12. High frequency pacing of edge localized modes by injection of lithium granules in DIII-D H-mode discharges

    DOE PAGESBeta

    Bortolon, A.; Maingi, R.; Mansfield, D. K.; Nagy, A.; Roquemore, A. L.; Baylor, L. R.; Commaux, N.; Jackson, G. L.; Gilson, E. P.; Lunsford, R.; et al

    2016-04-08

    A newly installed Lithium Granule Injector (LGI) was used to pace edge localized modes (ELM) in DIII-D. ELM pacing efficiency was studied injecting lithium granules of nominal diameter 0.3–0.9mm, speed of 50–120 m s-1 and average injection rates up to 100 Hz for 0.9mm granules and up to 700 Hz for 0.3mm granules. The efficiency of ELM triggering was found to depend strongly on size of the injected granules, with triggering efficiency close to 100% obtained with 0.9mm diameter granules, lower with smaller sizes, and weakly depending on granule velocity. Robust ELM pacing was demonstrated in ITER-like plasmas for themore » entire shot length, at ELM frequencies 3–5 times larger than the ‘natural’ ELM frequency observed in reference discharges. Within the range of ELM frequencies obtained, the peak ELM heat flux at the outer strike point was reduced with increasing pacing frequency. The peak heat flux reduction at the inner strike point appears to saturate at high pacing frequency. Lithium was found in the plasma core, with a concurrent reduction of metallic impurities and carbon. Altogether, high frequency ELM pacing using the lithium granule injection appears to be compatible with both H-mode energy confinement and attractive H-mode pedestal characteristics, but further assessment is need« less

  13. Treatment of localized Langerhans' cell histiocytosis of the mandible with intralesional steroid injection: report of a case.

    PubMed

    Esen, Alparslan; Dolanmaz, Doğan; Kalayci, Abdullah; Günhan, Omer; Avunduk, Mustafa Cihat

    2010-02-01

    Localized Langerhans cell histiocytosis (LLCH), formerly known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, and ribs in children and the long bones of adults. Symptoms range from none to pain, swelling, and tenderness over the site of the lesion. General malaise and fever occasionally are present. Radiographically, lesions appear as radiolucent areas with well demarcated borders. LLCH may resolve spontaneously after biopsy in a period of months to years. However, if features include continuous pain, decrease of function, pathologic fractures, migration and resorption of teeth, or rapid progression, then active treatment needs to be considered. Treatment approaches include surgery, radiotherapy, chemotherapy, and intralesional injection of corticosteroids. In children with mandibular LLCH, 1 dose of methyprednisolone succinate injection has proven to be adequate. However, injections have not been performed in cases involving pathologic fracture. We report a new case of LLCH of the mandible that caused a pathologic fracture in an adult patient. Repeated intralesional corticosteroid injections resulted in fracture line disappearance within 14 months and lesion healing by the end of the 36-month follow-up. PMID:20123398

  14. High frequency pacing of edge localized modes by injection of lithium granules in DIII-D H-mode discharges

    NASA Astrophysics Data System (ADS)

    Bortolon, A.; Maingi, R.; Mansfield, D. K.; Nagy, A.; Roquemore, A. L.; Baylor, L. R.; Commaux, N.; Jackson, G. L.; Gilson, E. P.; Lunsford, R.; Parks, P. B.; Chrystal, C.; Grierson, B. A.; Groebner, R.; Haskey, S. R.; Makowski, M. J.; Lasnier, C. J.; Nazikian, R.; Osborne, T.; Shiraki, D.; Van Zeeland, M. A.

    2016-05-01

    A newly installed Lithium Granule Injector (LGI) was used to pace edge localized modes (ELM) in DIII-D. ELM pacing efficiency was studied injecting lithium granules of nominal diameter 0.3–0.9 mm, speed of 50–120 m s‑1 and average injection rates up to 100 Hz for 0.9 mm granules and up to 700 Hz for 0.3 mm granules. The efficiency of ELM triggering was found to depend strongly on size of the injected granules, with triggering efficiency close to 100% obtained with 0.9 mm diameter granules, lower with smaller sizes, and weakly depending on granule velocity. Robust ELM pacing was demonstrated in ITER-like plasmas for the entire shot length, at ELM frequencies 3–5 times larger than the ‘natural’ ELM frequency observed in reference discharges. Within the range of ELM frequencies obtained, the peak ELM heat flux at the outer strike point was reduced with increasing pacing frequency. The peak heat flux reduction at the inner strike point appears to saturate at high pacing frequency. Lithium was found in the plasma core, with a concurrent reduction of metallic impurities and carbon. Overall, high frequency ELM pacing using the lithium granule injection appears to be compatible with both H-mode energy confinement and attractive H-mode pedestal characteristics, but further assessment is needed to determine whether the projected heat flux reduction required for ITER can be met.

  15. Endoscopic Management of Vesicoureteral Reflux in Children in Kosova

    PubMed Central

    Berisha, Murat; Hyseni, Nexhmi; Statovci, Sejdi; Grajqevci, Salih; Xhiha, Butrint

    2014-01-01

    Introduction: Vesicoureteral reflux (VUR) in children has been treated with subureteric deflux injection of Deflux (dextranomer hyaluronic acid copolymer) since 2009. The aim of this study was to analyze the results of endoscopic treatment of VUR in our clinic. Methods: Between March 2009 and December 2013, fifty-five children underwent endoscopic subureteral injection of Deflux in 78 ureters. Two months postoperatively voiding cystourethrogram (VCUG) was performed. This study examined the disappearance of VUR and urinary tract infection (UTI) as well as the quality of life during long-term follow-up. Results: The study included 55 patients (40 females and 15 males) with 78 refluxing ureters. There were 22 refluxed ureters altogether and 33 children had a unilateral reflux (two duplicated systems). All patients were treated, from the age 6 months up to 12 years old. The mean age of patients was 5.2 years. There has been no complications, but with few recurrences. In 6 patients (16.6%), endoscopic treatment with deflux was done twice, while in three patients (8.5%), the endoscopic treatment with deflux was performed three times, because of recurrence. Conclusion: We recommend the use of endoscopic Deflux injection as first line treatment for children with VUR. Endoscopic subureteral injection of Deflux is a minimally invasive method for VUR treatment in pediatric patients and is associated with low morbidity. PMID:25132708

  16. Endoscopic repair of post-surgical gastrointestinal complications.

    PubMed

    Manta, Raffaele; Magno, Luca; Conigliaro, Rita; Caruso, Angelo; Bertani, Helga; Manno, Mauro; Zullo, Angelo; Frazzoni, Marzio; Bassotti, Gabrio; Galloro, Giuseppe

    2013-11-01

    Complications following gastrointestinal surgery may require re-intervention, can lead to prolonged hospitalization, and significantly increase health costs. Some complications, such as anastomotic leakage, fistula, and stricture require a multidisciplinary approach. Therapeutic endoscopy may play a pivotal role in these conditions, allowing minimally invasive treatment. Different endoscopic approaches, including fibrin glue injection, endoclips, self-expanding stents, and endoscopic vacuum-assisted devices have been introduced for both anastomotic leakage and fistula treatment. Similarly endoscopic treatments, such as endoscopic dilation, incisional therapy, and self-expanding stents have been used for anastomotic strictures. All these techniques can be safely performed by skilled endoscopists, and may achieve a high technical success rate in both the upper and lower gastrointestinal tract. Here we will review the endoscopic management of post-surgical complications; these techniques should be considered as first-line approach in selected patients, allowing to avoid re-operation, reduce hospital stay, and decrease costs. PMID:23623147

  17. Fluorescence endoscopic imaging study of anastomotic recurrence of Crohn's disease after right ileocolonic resection

    NASA Astrophysics Data System (ADS)

    Mordon, Serge R.; Maunoury, Vincent; Klein, Olivier; Colombel, Jean-Frederic

    1995-12-01

    Crohn's disease is an inflammatory bowel disease of unknown etiology. Vasculitis is hypothesized but it was never demonstrated in vivo. This study aimed to evaluate the vascular mucosa perfusion using fluorescence imaging in 13 patients who had previously undergone eileocolonic resection and who agreed to participate in a prospective endoscopic study of anastomotic recurrence. This anastomotic recurrence rate is known to be high (73% after 1 year follow-up) and is characterized by ulcerations. The fluorescence study was started with an I.V. bolus injection of sodium fluorescein. The pre-anastomotic mucosa was endoscopically examined with blue light that stimulates fluorescein fluorescence. Fluorescence emission was recorded with an ultra-high-sensitivity camera connected to the endoscope via an interference filter (520 - 560 nm). A uniform fluorescence was observed a few seconds after the injection and lasted for 15 min in healthy subjects. In case of recurrence, the centers of the ulcerations displayed a very low fluorescence indicating localized ischemia. In contrast, the rims of the ulcers revealed brighter fluorescent images than those of normal mucosa. The anastomotic ulcerations of Crohn's disease recurrence exhibit a high fluorescence intensity at their margins indicating an increased mucosal blood flow and/or enhanced transcapillary diffusion. These findings support the hypothesis of a primary vasculitis in Crohn's disease.

  18. Local cooling, plasma reheating and thermal pinching induced by single aerosol droplets injected into an inductively coupled plasma

    NASA Astrophysics Data System (ADS)

    Chan, George C.-Y.; Hieftje, Gary M.

    2016-07-01

    The injection of a single micrometer-sized droplet into an analytical inductively coupled plasma (ICP) perturbs the plasma and involves three sequential effects: local cooling, thermal pinching and plasma reheating. Time-resolved two-dimensional monochromatic imaging of the load-coil region of an ICP was used to monitor this sequence of plasma perturbations. When a microdroplet enters the plasma, it acts as a local heat sink and cools the nearby plasma region. The cooling effect is considered local, although the cooling volume can be large and extends 6 mm from the physical location of the vaporizing droplet. The liberated hydrogen, from decomposition of water, causes a thermal pinch effect by increasing the thermal conductivity of the bulk plasma and accelerating heat loss at the plasma periphery. As a response to the heat loss, the plasma shrinks in size, which increases its power density. Plasma shrinkage starts around the same time when the microdroplet enters the plasma and lasts at least 2 ms after the droplet leaves the load-coil region. Once the vaporizing droplet passes through a particular plasma volume, that volume is reheated to an even higher temperature than under steady-state conditions. Because of the opposing effects of plasma cooling and reheating, the plasma conditions are different upstream (downward) and downstream (upward) from a vaporizing droplet - cooling dominates the downstream region whereas reheating controls in the upstream domain. The boundary between the local cooling and reheating zones is sharp and is only ~ 1 mm thick. The reheating effect persists a relatively long time in the plasma, at least up to 4 ms after the droplet moves out of the load-coil region. The restoration of plasma equilibrium after the perturbation induced by microdroplet injection is slow. Microdroplet injection also induces a momentary change in plasma impedance, and the impedance change was found to correlate qualitatively with the different stages of plasma

  19. Single-Dose Local Simvastatin Injection Improves Implant Fixation via Increased Angiogenesis and Bone Formation in an Ovariectomized Rat Model

    PubMed Central

    Tan, Jie; Yang, Ning; Fu, Xin; Cui, Yueyi; Guo, Qi; Ma, Teng; Yin, Xiaoxue; Leng, Huijie; Song, Chunli

    2015-01-01

    Background Statins have been reported to promote bone formation. However, taken orally, their bioavailability is low to the bones. Implant therapies require a local repair response, topical application of osteoinductive agents, or biomaterials that promote implant fixation. Material/Methods The present study evaluated the effect of a single local injection of simvastatin on screw fixation in an ovariectomized rat model of osteoporosis. Results Dual-energy X-ray absorptiometry, micro-computed tomography, histology, and biomechanical tests revealed that 5 and 10 mg simvastatin significantly improved bone mineral density by 18.2% and 22.4%, respectively (P<0.05); increased bone volume fraction by 51.0% and 57.9%, trabecular thickness by 16.4% and 18.9%, trabeculae number by 112.0% and 107.1%, and percentage of osseointegration by 115.7% and 126.3%; and decreased trabeculae separation by 34.1% and 36.6%, respectively (all P<0.01). Bone mineral apposition rate was significantly increased (P<0.01). Furthermore, implant fixation was significantly increased (P<0.05), and bone morphogenetic protein 2 (BMP2) expression was markedly increased. Local injection of a single dose of simvastatin also promoted angiogenesis. Vessel number, volume, thickness, surface area, and vascular volume per tissue volume were significantly increased (all P<0.01). Vascular endothelial growth factor (VEGF), VEGF receptor-2, von Willebrand factor, and platelet endothelial cell adhesion molecule-1 expression were enhanced. Conclusions A single local injection of simvastatin significantly increased bone formation, promoted osseointegration, and enhanced implant fixation in ovariectomized rats. The underlying mechanism appears to involve enhanced BMP2 expression and angiogenesis in the target bone. PMID:25982481

  20. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

    PubMed Central

    Martinez, Juan Carlos; Thomas, Jamie L.; Lukaszczyk, John J.

    2014-01-01

    INTRODUCTION Traditionally, localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. Advances in the field of endoscopy with the introduction of capsule endoscopy and radiographic imaging with computed tomography angiography and visceral angiography have facilitated more accurate visualization of the small intestine. If a bleeding lesion is identified on angiography and surgery is indicated, the use of methylene blue for enteric mapping is very effective to aid intraoperative localization of the culprit. However, when this is not an option, more invasive surgical techniques are required. PRESENTATION OF CASE We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT) guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit. PMID:25460480

  1. Spin transport in non-magnetic nano-structures induced by non-local spin injection

    NASA Astrophysics Data System (ADS)

    Idzuchi, Hiroshi; Fukuma, Yasuhiro; Otani, YoshiChika

    2015-04-01

    We review our recent achievements on optimization of spin injection from ferromagnetic into non-magnetic metals and characterization of spin transport properties in the non-magnetic nano-structures. We have realized the efficient spin injection by solving spin resistance mismatch problem in spin diffusion process across the interface between ferromagnetic and nonmagnetic metals. We analyzed temperature dependent spin relaxation length and time in Ag within the framework of the Elliot-Yafet mechanism based on spin-orbit interaction and momentum relaxation. The spin relaxation length in a light metal Mg is found comparable to that of Ag due to its peculiar electronic band structure in which so called spin-hotspots dramatically enhance spin relaxation. Spin relaxation properties in various metals are also quantitatively discussed. We employed commonly used Hanle effect measurements to characterize spin relaxation of spin current and reexamined both theoretically and experimentally the effect of spin absorption at the interface. The affected spatial profile of chemical potential due to the longitudinal and transverse spin absorption results in the broadened Hanle curve. All the Hanle curves both in metallic and semi-conductive materials including graphene fall into the universal scaling plot. Anatomy of spin injection properties of the junction and spin transport properties in non-magnetic metal is shown in tables.

  2. Robust feature tracking for endoscopic pose estimation and structure recovery

    NASA Astrophysics Data System (ADS)

    Speidel, S.; Krappe, S.; Röhl, S.; Bodenstedt, S.; Müller-Stich, B.; Dillmann, R.

    2013-03-01

    Minimally invasive surgery is a highly complex medical discipline with several difficulties for the surgeon. To alleviate these difficulties, augmented reality can be used for intraoperative assistance. For visualization, the endoscope pose must be known which can be acquired with a SLAM (Simultaneous Localization and Mapping) approach using the endoscopic images. In this paper we focus on feature tracking for SLAM in minimally invasive surgery. Robust feature tracking and minimization of false correspondences is crucial for localizing the endoscope. As sensory input we use a stereo endoscope and evaluate different feature types in a developed SLAM framework. The accuracy of the endoscope pose estimation is validated with synthetic and ex vivo data. Furthermore we test the approach with in vivo image sequences from da Vinci interventions.

  3. Endoscopic Devices for Obesity.

    PubMed

    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. PMID:27115879

  4. Endoscopic Skull Base Surgery

    PubMed Central

    Senior, Brent A

    2008-01-01

    Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field. PMID:19434274

  5. New Electron Temperature Measurements During Local Helicity Injection and H-mode Plasmas at the Pegasus Toroidal Experiment

    NASA Astrophysics Data System (ADS)

    Schlossberg, D. J.; Bodner, G. M.; Fonck, R. J.; Reusch, J. A.; Winz, G. R.

    2015-11-01

    Extrapolation of non-solenoidal startup via local helicity injection (LHI) to larger devices depends critically on confinement during the injection process. To begin quantifying confinement regimes, the Thomson scattering diagnostic on the Pegasus ST was upgraded to include 12 radial positions and high temperature (0.1 injection potential. The upgraded Thomson scattering diagnostic will also be applied to Ohmic H-mode plasmas in Pegasus. Work supported by US DOE grant DE-FG02-96ER54375.

  6. Current applications of endoscopic suturing

    PubMed Central

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

    2015-01-01

    Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo OverStitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty. PMID:26191342

  7. Effectiveness of splinting and splinting plus local steroid injection in severe carpal tunnel syndrome: A Randomized control clinical trial

    PubMed Central

    Khosrawi, Saeid; Emadi, Masoud; Mahmoodian, Amir Ebrahim

    2016-01-01

    Background: The Study aimed to compare the effectiveness of two commonly used conservative treatments, splinting and local steroid injection in improving clinical and nerve conduction findings of the patients with severe carpal tunnel syndrome (CTS). Materials and Methods: In this randomized control clinical trial, the patients with severe CTS selected and randomized in two interventional groups. Group A was prescribed to use full time neutral wrist splint and group B was injected with 40 mg Depo-Medrol and prescribed to use the full time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients was evaluated at baseline, 4 and 12 weeks after interventions. Results: Twenty-two and 21 patients were allocated in group A and B, respectively. Mean of clinical symptoms and functional status scores, nerve conduction variables and patients’ satisfaction score were not significant between group at baseline and 4 and 12 weeks after intervention. Within the group comparison, there was significant improvement in the patients’ satisfaction, clinical and nerve conduction items between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). The difference was significant for functional status score between 4 and 12 weeks after intervention in group B (P = 0.02). Conclusion: considering some findings regarding the superior effect of splinting plus local steroid injection on functional status scale and median nerve distal motor latency, it seems that using combination therapy could be more effective for long-term period specially in the field of functional improvement of CTS. PMID:26962518

  8. Nonlinear response of magnetic islands to localized electron cyclotron current injection

    SciTech Connect

    Borgogno, D.; Comisso, L.; Grasso, D.; Lazzaro, E.

    2014-06-15

    The magnetic island evolution under the action of a current generated externally by electron cyclotron wave beams is studied using a reduced resistive magnetohydrodynamics plasma model. The use of a two-dimensional reconnection model shows novel features of the actual nonlinear evolution as compared to the zero-dimensional model of the generalized Rutherford equation. When the radio frequency control is applied to a small magnetic island, the complete annihilation of the island width is followed by a spatial phase shift of the island, referred as “flip” instability. On the other hand, a current-drive injection in a large nonlinear island can be accompanied by the occurrence of a Kelvin-Helmholtz instability. These effects need to be taken into account in designing tearing mode control systems based on radio frequency current-drive.

  9. Effects of Single Injection of Local Anesthetic Agents on Intervertebral Disc Degeneration: Ex Vivo and Long-Term In Vivo Experimental Study

    PubMed Central

    Iwasaki, Koji; Sudo, Hideki; Yamada, Katsuhisa; Higashi, Hideaki; Ohnishi, Takashi; Tsujimoto, Takeru; Iwasaki, Norimasa

    2014-01-01

    Background Analgesic discography (discoblock) can be used to diagnose or treat discogenic low back pain by injecting a small amount of local anesthetics. However, recent in vitro studies have revealed cytotoxic effects of local anesthetics on intervertebral disc (IVD) cells. Here we aimed to investigate the deteriorative effects of lidocaine and bupivacaine on rabbit IVDs using an organotypic culture model and an in vivo long-term follow-up model. Methods For the organotypic culture model, rabbit IVDs were harvested and cultured for 3 or 7 days after intradiscal injection of local anesthetics (1% lidocaine or 0.5% bupivacaine). Nucleus pulposus (NP) cell death was measured using confocal microscopy. Histological and TUNEL assays were performed. For in vivo study, each local anesthetic was injected into rabbit lumbar IVDs under a fluoroscope. Six or 12 months after the injection, each IVD was prepared for magnetic resonance imaging (MRI) and histological analysis. Results In the organotypic culture model, both anesthetic agents induced time-dependent NP cell death; when compared with injected saline solution, significant effects were detected within 7 days. Compared with the saline group, TUNEL-positive NP cells were significantly increased in the bupivacaine group. In the in vivo study, MRI analysis did not show any significant difference. Histological analysis revealed that IVD degeneration occurred to a significantly level in the saline- and local anesthetics-injected groups compared with the untreated control or puncture-only groups. However, there was no significant difference between the saline and anesthetic agents groups. Conclusions/Significance In the in vivo model using healthy IVDs, there was no strong evidence to suggest that discoblock with local anesthetics has the potential of inducing IVD degeneration other than the initial mechanical damage of the pressurized injection. Further studies should be performed to investigate the deteriorative effects of

  10. Systemic effects of locally injected platelet rich plasma in a rat model: an analysis on muscle and bloodstream.

    PubMed

    Borrione, P; Grasso, L; Racca, S; Abbadessa, G; Carriero, V; Fagnani, F; Quaranta, F; Pigozzi, F

    2015-01-01

    Abundant evidence suggests that growth factors, contained in platelets alpha granules, may play a key role in the early stages of the muscle healing process with particular regard to the inflammatory phase. Although the contents of the platelet-rich plasma preparations have been extensively studied, the biological mechanisms involved as well as the systemic effects and the related potential doping implications of this approach are still largely unknown. The aim of the present study was to investigate whether local platelet-rich plasma administration may modify the levels of specific cytokines and growth factors both in treated muscle and bloodstream in rats. An additional aim was to investigate more deeply whether the local platelet-rich plasma administration may exert systemic effects by analyzing contralateral lesioned but untreated muscles. The results showed that platelet-rich plasma treatment induced a modification of certain cytokines and growth factor levels in muscle but not in the bloodstream, suggesting that local platelet-rich plasma treatment influenced directly or, more plausibly, indirectly the synthesis or recruitment of cytokines and growth factors at the site of injury. Moreover, the observed modifications of cytokine and growth factor levels in contralateral injured but not treated muscles, strongly suggested a systemic effect of locally injected platelet-rich plasma. PMID:25864767

  11. [Endoscopic modified technique of ureteral resection during nephroureterectomy].

    PubMed

    Aguirre Benites, F; Blanco Carballo, O; Pamplona Casamayor, M; Díaz González, R; Leiva Galvis, O

    2007-01-01

    We show a technical modification of the ureteral endoscopic resection with which we try to avoid comunication between urine and surgical bed in order to prevent tumor local spread of upper urotelial tumor. PMID:17902476

  12. Endoscopic Bariatric Therapies.

    PubMed

    Goyal, Deepinder; Watson, Rabindra R

    2016-06-01

    Obesity and its associated cardio-metabolic comorbidities have emerged as a global pandemic. The efficacy of various hypo-caloric diets and prescription drugs has been poor with respect to sustained weight loss. Recent advancements in endoscopic technology and techniques have opened a new field of minimally invasive endoscopic treatment options for combatting obesity both as a first line and adjunctive therapy. Presently, two endoscopic space-occupying devices in the form of intragastric balloons have received FDA approval for 6-month implantation in patients within a BMI range of 30-40 kg/m(2). Furthermore, full-thickness suturing has led to the development of primary endoscopic sleeve gastroplasty and Roux-en-Y gastric bypass revision as viable endoscopic alternatives to surgical approaches. These techniques have the potential to reduce adverse events, cost, and recovery times. Looking forward, a variety of promising and novel medical devices and endoscopic platforms that target obesity and diabetes are in various phases of development and investigation. The present review aims to discuss the current and forthcoming endoscopic bariatric therapies with emphasis on relevant procedural technique and review of available evidence. PMID:27098813

  13. Endoscopic mucosal resection and endoscopic submucosal dissection for early gastric cancer: Current and original devices

    PubMed Central

    Kume, Keiichiro

    2009-01-01

    Compared with endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) is easier to perform and requires less time for treatment. However, EMR has been replaced by ESD, because achieving en bloc resection of specimens > 20 mm in diameter is difficult with EMR. The technique of ESD was introduced to resect large specimens of early gastric cancer in a single piece. ESD can provide precise histological diagnosis and can also reduce the rate of recurrence, but has a high level of technical difficulty, and is consequently associated with a high rate of complications, a need for advanced endoscopic techniques, and a lengthy procedure time. To overcome disadvantages in both EMR and ESD, various advances have been made in submucosal injections, knives, other accessories, and in electrocoagulation systems. PMID:21160647

  14. Endoscopic submucosal dissection.

    PubMed

    Maple, John T; Abu Dayyeh, Barham K; Chauhan, Shailendra S; Hwang, Joo Ha; Komanduri, Sri; Manfredi, Michael; Konda, Vani; Murad, Faris M; Siddiqui, Uzma D; Banerjee, Subhas

    2015-01-01

    ESD is an established effective treatment modality for premalignant and early-stage malignant lesions of the stomach, esophagus, and colorectum. Compared with EMR, ESD is generally associated with higher rates of en bloc, R0, and curative resections and a lower rate of local recurrence. Oncologic outcomes with ESD compare favorably with competing surgical interventions, and ESD also serves as an excellent T-staging tool to identify noncurative resections that will require further treatment. ESD is technically demanding and has a higher rate of adverse events than most endoscopic procedures including EMR. As such,sufficient training is critical to ensure safe conduct and high-quality resections. A standardized training model for Western endoscopists has not been clearly established,but will be self-directed and include courses, animal model training, and optimally an observership at an expert center.Numerous dedicated ESD devices are now available in the United States from different manufacturers. Although the use of ESD in the United States is increasing, issues related to technical difficulty, limited training opportunities and mentors, risk of adverse events, long procedure duration,and suboptimal reimbursement may limit ESD adoption in the United States to a modest number of academic referral centers for the foreseeable future. PMID:25796422

  15. Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors

    PubMed Central

    2012-01-01

    Endoscopic ultrasound (EUS) is an advanced endoscopic technique currently used in the staging and diagnosis of many gastrointestinal neoplasms. The proximity of the echoendoscope to the gastrointestinal tract lends itself to a detailed view of the luminal pathology and the pancreas. This unique ability enables endoscopists to use EUS in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Diagnostic EUS allows previously unidentified NETs to be localized. EUS also determines tumor management by staging the GEP-NETS, enabling the clinicians to choose the appropriate endoscopic or surgical management. The ability to obtain a tissue diagnosis with EUS guidance enables disease confirmation. Finally, recent developments suggest that EUS may be used to deliver therapeutic agents for the treatment of NETs. This review will highlight the advances in our knowledge of EUS in the clinical management of these tumors. PMID:23170141

  16. Therapeutic aspects of endoscopic ultrasound

    NASA Astrophysics Data System (ADS)

    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.

  17. Understanding EUS (Endoscopic Ultrasonography)

    MedlinePlus

    ... Certification (MOC) Course Calendar GI Outlook (GO) Practice Management Conference Endoscopic Learning Library IT&T Hands-On Training Training and ... ASGE Endorsed Activities Ambassador Program Trainee Resources Traveling Learning ... MANAGEMENT GI Outlook (GO) Practice Management Conference Featured Courses ...

  18. Pain Control after Total Knee Arthroplasty: Comparing Intra-Articular Local Anesthetic Injection with Femoral Nerve Block

    PubMed Central

    Kao, Shengchin; Lee, Hungchen; Cheng, Chihwen; Lin, Chingfeng; Tsai, Hsini

    2015-01-01

    Background. Direct intra-articular injection of low doses of local anesthetic (IALA) after closure of the joint capsule remains controversial for pain control after total knee arthroplasty (TKA). Methods. A retrospective study comparing patients receiving IALA with high doses (0.5% bupivacaine 60 mL) of local anesthetics or FNB in addition to intravenous patient-controlled analgesia with opioids for pain management after TKA was conducted. The primary end point was to compare the analgesic efficacy and early ambulation between the two groups. Results. No significant differences between the two groups in pain intensity, cumulative opioid consumption, incidences of opioid-related side effects, the time interval from the end of operation to the first time the patient could walk assisted with a walker postoperatively, and postoperative hospital stay were identified. Three patients in the IALA group but none in the FNB group walked within 12 hours after the end of operation. Summary. IALA with high doses of local anesthetics provides comparable analgesic efficacy as single-shot FNB after TKA and might be associated with earlier ambulation than FNB postoperatively. PMID:26064937

  19. Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection

    PubMed Central

    Stearns, Vered; Blackford, Amanda; Kessler, Jill; Sbaity, Eman; Habibi, Mehran; Khouri, Nagi; Lee, Cindy S.; May, Evelyn; Jeter, Stacie; Sahebi, Camila; Shehata, Christina; Tarpinian, Karineh; Jacobs, Lisa

    2015-01-01

    Preoperative sentinel node localization (SNL) using a subareolar injection of radiotracer technetium-99m-sulfur colloid (Tc99mSC) is associated with significant pain. Lidocaine use during SNL is not widely adopted partly due to a concern that it can obscure sentinel node identification and reduce its diagnostic accuracy. We prospectively identified women with a biopsy-proven infiltrating breast cancer who were awaiting a SNL. The women completed the McGill pain questionnaire, Visual Analog Scale, and Wong–Baker FACES Pain Rating Scale prior to and following SNL. We identified a retrospective cohort of women with similar demographic and tumor characteristics who did not receive lidocaine before SNL. We compared sentinel lymph node identification rates in the two cohorts. We used Wilcoxon rank sum tests to compare continuous measures and Fisher's exact test for categorical measures. Between January 2011 to July 2012, 110 women consented, and 105 were eligible for and received lidocaine prior to Tc99mSC injection. The post-lidocaine identification rate of SNL was 95 % with Tc99mSC, and 100 % with the addition of intraoperative methylene blue dye/saline. Pain range prior to and following the SNL was unchanged (P = 0.703). We identified 187 women from 2005 to 2009 who did not receive lidocaine during preoperative SNL. There was no significant difference in the success rate of SNL, with or without lidocaine (P = 0.194). The administration of lidocaine during SNL prevents pain related to isotope injection while maintaining the success rate. We have changed our practice at our center to incorporate the use of lidocaine during all SNL. PMID:25788225

  20. Endoscopic Techniques in Tympanoplasty.

    PubMed

    Anzola, Jesus Franco; Nogueira, João Flávio

    2016-10-01

    The endoscope has transformed the way we observe, understand, and treat chronic ear disease. Improved view, exclusive transcanal techniques, assessment of ventilation routes and mastoid tissue preservation have led to decreased morbidity and functional enhancement of minimally invasive reconstruction of the middle ear. The philosophical identity of endoscopic ear surgery is evolving; new research, long-term results, and widespread acknowledgement of its postulates will undoubtedly define its role in otology. PMID:27565390

  1. Local oscillator free all optical OOK signal frequency up conversion enabled by injection locking of Fabry-Pérot laser

    NASA Astrophysics Data System (ADS)

    Han, Bing-chen; Yu, Jin-long; Wang, Wen-rui; Wang, Ju; Shi, Yun-long

    2014-08-01

    We demonstrate an all optical up-conversion system by injecting low bitrates baseband OOK signal directly into a conventional Fabry-Pérot laser diode (FP-LD). Radio frequency (RF) carrier is generated due to period-one (P1) oscillation state of nonlinear dynamics system (NDS) in the FP-LD with the injection of external optical signal. No extra high speed and expensive local oscillator is required for the up-conversion. Based on this approach, we experimentally achieved the up-conversion of 2 Gbps RZ-OOK baseband signal to 12 GHz and 14.28 GHz RF carriers, and 2.5 Gbps NRZ-OOK baseband signal to 10 GHz, 18.2 GHz and 20.88 GHz RF carriers respectively. The obtained 20.88 GHz RF carriers have a signal to side mode suppression ratio of 29 dB, and phase noise of -84.2 dBc/Hz@10 kHz.

  2. A novel injectable borate bioactive glass cement for local delivery of vancomycin to cure osteomyelitis and regenerate bone.

    PubMed

    Cui, Xu; Zhao, Cunju; Gu, Yifei; Li, Le; Wang, Hui; Huang, Wenhai; Zhou, Nai; Wang, Deping; Zhu, Yi; Xu, Jun; Luo, Shihua; Zhang, Changqing; Rahaman, Mohamed N

    2014-03-01

    Osteomyelitis (bone infection) is often difficult to cure. The commonly-used treatment of surgical debridement to remove the infected bone combined with prolonged systemic and local antibiotic treatment has limitations. In the present study, an injectable borate bioactive glass cement was developed as a carrier for the antibiotic vancomycin, characterized in vitro, and evaluated for its capacity to cure osteomyelitis in a rabbit tibial model. The cement (initial setting time = 5.8 ± 0.6 min; compressive strength = 25.6 ± 0.3 MPa) released vancomycin over ~25 days in phosphate-buffered saline, during which time the borate glass converted to hydroxyapatite (HA). When implanted in rabbit tibial defects infected with methicillin-resistant Staphylococcus aureus (MRSA)-induced osteomyelitis, the vancomycin-loaded cement converted to HA and supported new bone formation in the defects within 8 weeks. Osteomyelitis was cured in 87 % of the defects implanted with the vancomycin-loaded borate glass cement, compared to 71 % for the defects implanted with vancomycin-loaded calcium sulfate cement. The injectable borate bioactive glass cement developed in this study is a promising treatment for curing osteomyelitis and for regenerating bone in the defects following cure of the infection. PMID:24477872

  3. Local innate immune responses in the vaccine adjuvant-injected muscle.

    PubMed

    Liang, Frank; Loré, Karin

    2016-04-01

    Inducing a high magnitude of antibodies, possibly in combination with T-cell responses that offer epitope breadth over prolonged periods of time is likely a prerequisite for effective vaccines against severe diseases such as HIV-1 infection, malaria and tuberculosis. A much better understanding of the innate immune mechanisms that are critical for inducing desired responses to vaccination would help in the design of novel vaccines. The majority of human vaccines are administered into the muscle. In this brief review, we focus on the initial innate immune events that occur locally at the site of intramuscular vaccine delivery, and how they are influenced by clinically approved vaccine adjuvants. In particular, the effects on cell mobilization, cell activation and vaccine antigen uptake are reviewed. Understanding how distinct adjuvants enhance and tailor vaccine responses would facilitate the selection of the best-suited adjuvant to improve vaccine efficacy to a given pathogen. PMID:27195117

  4. Local innate immune responses in the vaccine adjuvant-injected muscle

    PubMed Central

    Liang, Frank; Loré, Karin

    2016-01-01

    Inducing a high magnitude of antibodies, possibly in combination with T-cell responses that offer epitope breadth over prolonged periods of time is likely a prerequisite for effective vaccines against severe diseases such as HIV-1 infection, malaria and tuberculosis. A much better understanding of the innate immune mechanisms that are critical for inducing desired responses to vaccination would help in the design of novel vaccines. The majority of human vaccines are administered into the muscle. In this brief review, we focus on the initial innate immune events that occur locally at the site of intramuscular vaccine delivery, and how they are influenced by clinically approved vaccine adjuvants. In particular, the effects on cell mobilization, cell activation and vaccine antigen uptake are reviewed. Understanding how distinct adjuvants enhance and tailor vaccine responses would facilitate the selection of the best-suited adjuvant to improve vaccine efficacy to a given pathogen. PMID:27195117

  5. Local heat transfer in turbine disk-cavities. I - Rotor and stator cooling with hub injection of coolant

    NASA Astrophysics Data System (ADS)

    Bunker, R. S.; Metzger, D. E.; Wittig, S.

    1990-06-01

    Detailed radial heat-transfer coefficient distributions applicable to the cooling of disk-cavity regions of gas turbines are obtained experimentally from local heat-transfer data on both the rotating and stationary surfaces of a parallel-geometry disk-cavity system. Attention is focused on the hub injection of a coolant over a wide range of parameters including disk rotational Reynolds numbers of 200,000 to 50,000, rotor/stator spacing-to-disk ratios of 0.025 to 0.15, and jet mass flow rates between 0.10 and 0.40 times the turbulent pumped flow rate of a free disk. It is shown that rotor heat transfer exhibits regions of impingement and rotational domination with a transition region between, while stator heat transfer displays flow reattachment and convection regions with an inner recirculation zone.

  6. EMC3-EIRENE modeling of toroidally-localized divertor gas injection experiments on Alcator C-Mod

    NASA Astrophysics Data System (ADS)

    Lore, J. D.; Reinke, M. L.; LaBombard, B.; Lipschultz, B.; Churchill, R. M.; Pitts, R. A.; Feng, Y.

    2015-08-01

    Experiments on Alcator C-Mod with toroidally and poloidally localized divertor nitrogen injection have been modeled using the three-dimensional edge transport code EMC3-EIRENE to elucidate the mechanisms driving measured toroidal asymmetries. In these experiments five toroidally distributed gas injectors in the private flux region were sequentially activated in separate discharges resulting in clear evidence of toroidal asymmetries in radiated power and nitrogen line emission as well as a ∼50% toroidal modulation in electron pressure at the divertor target. The pressure modulation is qualitatively reproduced by the modeling, with the simulation yielding a toroidal asymmetry in the heat flow to the outer strike point. Toroidal variation in impurity line emission is qualitatively matched in the scrape-off layer above the strike point, however kinetic corrections and cross-field drifts are likely required to quantitatively reproduce impurity behavior in the private flux region and electron temperatures and densities directly in front of the target

  7. EMC3-EIRENE modelling of toroidally-localized divertor gas injection experiments on Alcator C-Mod

    SciTech Connect

    Lore, Jeremy D.; Reinke, M. L.; LaBombard, Brian; Lipschultz, B.; Churchill, R. M.; Pitts, R. A.; Feng, Y.

    2014-09-30

    Experiments on Alcator C-Mod with toroidally and poloidally localized divertor nitrogen injection have been modeled using the three-dimensional edge transport code EMC3-EIRENE to elucidate the mechanisms driving measured toroidal asymmetries. In these experiments five toroidally distributed gas injectors in the private flux region were sequentially activated in separate discharges resulting in clear evidence of toroidal asymmetries in radiated power and nitrogen line emission as well as a ~50% toroidal modulation in electron pressure at the divertor target. The pressure modulation is qualitatively reproduced by the modelling, with the simulation yielding a toroidal asymmetry in the heat flow to the outer strike point. Finally, toroidal variation in impurity line emission is qualitatively matched in the scrape-off layer above the strike point, however kinetic corrections and cross-field drifts are likely required to quantitatively reproduce impurity behavior in the private flux region and electron temperatures and densities directly in front of the target.

  8. Standardized endoscopic reporting.

    PubMed

    Aabakken, Lars; Barkun, Alan N; Cotton, Peter B; Fedorov, Evgeny; Fujino, Masayuki A; Ivanova, Ekaterina; Kudo, Shin-Ei; Kuznetzov, Konstantin; de Lange, Thomas; Matsuda, Koji; Moine, Olivier; Rembacken, Björn; Rey, Jean-Francois; Romagnuolo, Joseph; Rösch, Thomas; Sawhney, Mandeep; Yao, Kenshi; Waye, Jerome D

    2014-02-01

    The need for standardized language is increasingly obvious, also within gastrointestinal endoscopy. A systematic approach to the description of endoscopic findings is vital for the development of a universal language, but systematic also means structured, and structure is inherently a challenge when presented as an alternative to the normal spoken word. The efforts leading to the "Minimal Standard Terminology" (MST) of gastrointestinal endoscopy offer a standardized model for description of endoscopic findings. With a combination of lesion descriptors and descriptor attributes, this system gives guidance to appropriate descriptions of lesions and also has a normative effect on endoscopists in training. The endoscopic report includes a number of items not related to findings per se, but to other aspects of the procedure, formal, technical, and medical. While the MST sought to formulate minimal lists for some of these aspects (e.g. indications), they are not all well suited for the inherent structure of the MST, and many are missing. Thus, the present paper offers a recommended standardization also of the administrative, technical, and other "peri-endoscopic" elements of the endoscopic report; important also are the numerous quality assurance initiatives presently emerging. Finally, the image documentation of endoscopic findings is becoming more obvious-and accessible. Thus, recommendations for normal procedures as well as for focal and diffuse pathology are presented. The recommendations are "minimal," meaning that expansions and subcategories will likely be needed in most centers. Still, with a stronger common grounds, communication within endoscopy will still benefit. PMID:24329727

  9. Endoscopic video manifolds.

    PubMed

    Atasoy, Selen; Mateus, Diana; Lallemand, Joe; Meining, Alexander; Yang, Guang-Zhong; Navab, Nassir

    2010-01-01

    Postprocedural analysis of gastrointestinal (GI) endoscopic videos is a difficult task because the videos often suffer from a large number of poor-quality frames due to the motion or out-of-focus blur, specular highlights and artefacts caused by turbid fluid inside the GI tract. Clinically, each frame of the video is examined individually by the endoscopic expert due to the lack of a suitable visualisation technique. In this work, we introduce a low dimensional representation of endoscopic videos based on a manifold learning approach. The introduced endoscopic video manifolds (EVMs) enable the clustering of poor-quality frames and grouping of different segments of the GI endoscopic video in an unsupervised manner to facilitate subsequent visual assessment. In this paper, we present two novel inter-frame similarity measures for manifold learning to create structured manifolds from complex endoscopic videos. Our experiments demonstrate that the proposed method yields high precision and recall values for uninformative frame detection (90.91% and 82.90%) and results in well-structured manifolds for scene clustering. PMID:20879345

  10. Endoscopic treatment for esophageal varices complicated by Isaacs' syndrome involving difficulty with conventional sedation.

    PubMed

    Suzuki, Yuhei; Yamazaki, Yuichi; Hashizume, Hiroaki; Kobayashi, Takeshi; Ohyama, Tatsuya; Horiguchi, Norio; Sato, Ken; Kakizaki, Satoru; Kusano, Motoyasu; Yamada, Masanobu

    2016-02-01

    A 54-year-old male consulted a local doctor with a chief complaint of systemic convulsions and muscle stiffness and was diagnosed with Isaacs' syndrome based on positive findings for antibodies against voltage-gated potassium channels in 2009. He subsequently experienced repeated hematemesis in 2013, at which time he was taken to our hospital by ambulance. Emergent endoscopy revealed esophageal varices with spurting bleeding. The bleeding was stopped with urgent endoscopic variceal ligation. Three days later, the patient developed sudden dyspnea with stridor during inspiration under sedation with an intravenous injection of low-dose flunitrazepam prior to receiving additional treatment and was aroused with intravenous flumazenil, after which his dyspnea immediately improved. Dyspnea may be induced by muscle cramps associated with Isaacs' syndrome exacerbated by sedation. Endoscopic variceal ligation was performed safely using multiple ligation devices in an awake state following pre-medication with hydroxyzine, without sudden dyspnea. Endoscopists should be cautious of the use of sedatives in patients with diseases associated with muscle twitching or stiffness, as in the current case. In addition, it is necessary to administer endoscopic treatment in an awake state or under conscious sedation in patients with a high risk of dyspnea. PMID:26862027

  11. Systemic and local immune response in pigs intradermally and intramuscularly injected with inactivated Mycoplasma hyopneumoniae vaccines.

    PubMed

    Martelli, P; Saleri, R; Cavalli, V; De Angelis, E; Ferrari, L; Benetti, M; Ferrarini, G; Merialdi, G; Borghetti, P

    2014-01-31

    The systemic and respiratory local immune response induced by the intradermal administration of a commercial inactivated Mycoplasma hyopneumoniae whole-cell vaccine (Porcilis(®) MHYO ID ONCE - MSD AH) in comparison with two commercial vaccines administered via the intramuscular route and a negative control (adjuvant only) was investigated. Forty conventional M. hyopneumoniae-free pigs were randomly assigned to four groups (ten animals each): Group A=intradermal administration of the test vaccine by using the needle-less IDAL(®) vaccinator at a dose of 0.2 ml; Group B=intramuscular administration of a commercially available vaccine (vaccine B); Group C=intramuscular administration of the adjuvant only (2 ml of X-solve adjuvant); Group D=intramuscular administration of a commercially available vaccine (vaccine D). Pigs were vaccinated at 28 days of age. Blood and bronchoalveolar lavage (BAL) fluid samples were collected at vaccination (blood only), 4 and 8 weeks post-vaccination. Serum and BAL fluid were tested for the presence of antibodies by ELISA test. Peripheral blood monomorphonuclear cells (PBMC) were isolated to quantify the number of IFN-γ secreting cells by ELISpot. Moreover, cytokine gene expression from the BAL fluid was performed. Total antibodies against M. hyopneumoniae and specific IgG were detected in serum of intradermally and intramuscularly (vaccine B only) vaccinated pigs at 4 and 8 weeks post-vaccination. M. hyopneumoniae specific IgA were detected in BAL fluid from vaccinated animals (Groups A and B) but not from controls and animals vaccinated with the bacterin D (p<0.05). Significantly higher gene expression of IL-10 was observed in the BAL fluid at week 8 post-vaccination in the intradermally vaccinated pigs (p<0.05). The results support that the intradermal administration of an adjuvanted bacterin induces both systemic and mucosal immune responses. Moreover, the intramuscularly administered commercial vaccines each had a different

  12. Local gas injection as a scrape-off layer diagnostic on the Alcator C-Mod tokamak

    SciTech Connect

    Jablonski, D.F.

    1996-05-01

    A capillary puffing array has been installed on Alcator C-Mod which allows localized introduction of gaseous species in the scrape-off layer. This system has been utilized in experiments to elucidate both global and local properties of edge transport. Deuterium fueling and recycling impurity screening are observed to be characterized by non-dimensional screening efficiencies which are independent of the location of introduction. In contrast, the behavior of non-recycling impurities is seen to be characterized by a screening time which is dependent on puff location. The work of this thesis has focused on the use of the capillary array with a camera system which can view impurity line emission plumes formed in the region of an injection location. The ionic plumes observed extend along the magnetic field line with a comet-like asymmetry, indicative of background plasma ion flow. The flow is observed to be towards the nearest strike-point, independent of x-point location, magnetic field direction, and other plasma parameters. While the axes of the plumes are generally along the field line, deviations are seen which indicate cross-field ion drifts. A quasi-two dimensional fluid model has been constructed to use the plume shapes of the first charge state impurity ions to extract information about the local background plasma, specifically the temperature, parallel flow velocity, and radial electric field. Through comparisons of model results with those of a three dimensional Monte Carlo code, and comparisons of plume extracted parameters with scanning probe measurements, the efficacy of the model is demonstrated. Plume analysis not only leads to understandings of local edge impurity transport, but also presents a novel diagnostic technique.

  13. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures

    PubMed Central

    Davoudi, Amin; Rismanchian, Mansour; Akhavan, Ali; Nosouhian, Saeid; Bajoghli, Farshad; Haghighat, Abbas; Arbabzadeh, Farahnaz; Samimi, Pouran; Fiez, Atiyeh; Shadmehr, Elham; Tabari, Kasra; Jahadi, Sanaz

    2016-01-01

    Dental anxiety and fear of needle injection is one of the most common problems encountered by dental practitioners, especially in the pediatric patient. In consequences, it might affect the patient's quality of life. Several methods are suggested to lower the discomfort of local anesthesia injection during dental procedures. Desensitization of injection site is one of the recommended strategies. Among chemical anesthetic topical agents that are effective but might have allergic side effects, using some nonpharmacological and safe techniques might be useful. This study aimed to overview the efficacy of using cooling techniques, mostly by ice or popsicles, warming or pH buffering of drug, and using modern devices to diminish the discomfort of local anesthesia injection during dental procedures. PMID:26957683

  14. The 'difficult' polyp: pitfalls for endoscopic removal.

    PubMed

    Jung, M

    2012-01-01

    Adenomatous polyps are early neoplasias of colorectal cancer (adenoma-carcinoma sequence). The majority of adenomas or early invasive cancers (T1sm1) can be resected by endoscopy. Endoscopic resection techniques include classic loop polypectomy, endoscopic mucosectomy with preceding lifting of the (almost flat) lesion, endoscopic submucosal dissection and transanal microsurgical resection, an alternative to endoscopic submucosal dissection in the rectum. Endoscopic polyp removal should always aim to resect the lesion in 'one piece' and avoid, whenever possible, 'piecemeal resection'. One-piece polypectomy is the basis for a precise histopathological analysis and for proving complete removal of the lesion. Preceding injection of saline solution into the submucosa to lift the targeted polyp is a therapeutic modality to remove even-flat and flat-depressed adenomas. In addition, a positive lifting sign is regarded as a criterion of lower superficial malignancy. Lifting of a polyp can be negatively influenced by an already advanced cancer (T1sm3/T2) in the deep parts of the submucosa as well as by scars and connective tissue in the upper two layers of the colorectal wall. Hence, a negative lifting sign may lead to incorrect macroscopic evaluation of the lesion before removal. Endoscopic submucosal dissection is mostly performed in large laterally spreading tumors in the rectum and in the preanal region. The technique has a relatively long learning curve and is somewhat time consuming. A 'difficult polyp' may be characterized by: (1) the size (>3 cm), pedunculated or sessile (Ip/Is); (2) morphological type (classification of Paris 2003), in particular the flat type II lesions IIa-c flat, flat depressed; laterally spreading tumors and the large sessile-serrated lesions; and (3) the difficult assessment of the grade of malignancy before removal [e.g. dysplasia-associated lesions or masses (DALMs), sporadic adenoma, colitis carcinoma]. Chromoendoscopy (with indigo carmine

  15. Endoscopic parathyroidectomy in primary hyperparathyroidism.

    PubMed

    Prades, Jean-Michel; Asanau, Alexander; Timoshenko, Andrei P; Gavid, Marie; Martin, Christian

    2011-06-01

    During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice. PMID:21046411

  16. Spatially localized self-injection of electrons in a self-modulated laser-wakefield accelerator by using a laser-induced transient density ramp.

    PubMed

    Chien, T-Y; Chang, C-L; Lee, C-H; Lin, J-Y; Wang, J; Chen, S-Y

    2005-03-25

    By using a laser-induced transient density ramp, we demonstrate self-injection of electrons in a self-modulated laser-wakefield accelerator with spatial localization. The number of injected electrons reaches 1.7 x 10(8). The transient density ramp is produced by a prepulse propagating transversely to drill a density depression channel via ionization and expansion. The same mechanism of injection with comparable efficiency is also demonstrated with a transverse plasma waveguide driven by Coulomb explosion. PMID:15903867

  17. Recent trends in endoscopic management of achalasia

    PubMed Central

    Tolone, Salvatore; Limongelli, Paolo; del Genio, Gianmattia; Brusciano, Luigi; Russo, Antonio; Cipriano, Lorenzo; Terribile, Marco; Docimo, Giovanni; Ruggiero, Roberto; Docimo, Ludovico

    2014-01-01

    Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter (LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar medium-term efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes. PMID:25228942

  18. Sparse aperture endoscope

    DOEpatents

    Fitch, J.P.

    1999-07-06

    An endoscope is disclosed which reduces the volume needed by the imaging part, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases it's utility. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing. 7 figs.

  19. Sparse aperture endoscope

    DOEpatents

    Fitch, Joseph P.

    1999-07-06

    An endoscope which reduces the volume needed by the imaging part thereof, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases the utility thereof. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing.

  20. Endoscopic submucosal dissection for gastrointestinal neoplasms

    PubMed Central

    Kakushima, Naomi; Fujishiro, Mitsuhiro

    2008-01-01

    Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en-bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics. PMID:18494043

  1. Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

    PubMed Central

    Nojkov, Borko; Cappell, Mitchell S

    2015-01-01

    Although relatively uncommon, Dieulafoy’s lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy’s lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy’s lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration (visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30

  2. Transvaginal endoscopic appendectomy.

    PubMed

    Shin, Eung Jin; Jeong, Gui Ae; Jung, Jun Chul; Cho, Gyu Seok; Lim, Chul Wan; Kim, Hyung Chul; Song, Ok Pyung

    2010-12-01

    Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis. PMID:21221245

  3. Dulaglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Dulaglutide injection also works by slowing the movement ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  4. Liraglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Liraglutide injection also slows the emptying of the ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  5. Albiglutide Injection

    MedlinePlus

    ... other body tissues where it is used for energy. Albiglutide injection also works by slowing the movement ... In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at ...

  6. Technicalities of endoscopic biopsy.

    PubMed

    Tytgat, G N; Ignacio, J G

    1995-11-01

    Despite the wealth of biopsy forceps currently available, it is obvious that there are sufficient drawbacks and shortcomings to reconsider the overall design of the endoscopic biopsy depth, the short lifespan of reusable forceps, damage to the working channel, excessive time consumption, cleaning and disinfection difficulties, etc. Improvements should be possible that approach the same degree of sophistication as is currently available in endoscopic equipment. Fully-automated, repetitive, quickly targeted biopsy sampling should be possible, but it will require the utmost technical ingenuity and expertise to achieve. PMID:8903983

  7. Endoscopic Facial Nerve Surgery.

    PubMed

    Marchioni, Daniele; Soloperto, Davide; Rubini, Alessia; Nogueira, João Flávio; Badr-El-Dine, Mohamed; Presutti, Livio

    2016-10-01

    Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route. PMID:27468633

  8. Endoscopic Sedation: Medicolegal Considerations.

    PubMed

    Kralios, Andreas A; Feld, Kayla A; Feld, Andrew D

    2016-07-01

    Goals of endoscopic sedation are to provide patients with a successful procedure, and ensure that they remain safe and are relieved from anxiety and discomfort; agents should provide efficient, appropriate sedation and allow patients to recover rapidly. Sedation is usually safe and effective; however, complications may ensue. This paper outlines some medicolegal aspects of endoscopic sedation, including informed consent, possible withdrawal of consent during the procedure, standard of care for monitoring sedation, use of anesthesia personnel to deliver sedation, and new agents and devices. PMID:27372770

  9. A novel localized co-delivery system with lapatinib microparticles and paclitaxel nanoparticles in a peritumorally injectable in situ hydrogel.

    PubMed

    Hu, Hongxiang; Lin, Zhiqiang; He, Bing; Dai, Wenbing; Wang, Xueqing; Wang, Jiancheng; Zhang, Xuan; Zhang, Hua; Zhang, Qiang

    2015-12-28

    The combination of high dose of oral lapatinib (LAPA), a HER2 tyrosine kinase inhibitor, with intravenous paclitaxel (PTX) exhibited a clinical survival advantage compared with PTX alone against HER2 positive breast cancer. However, localized delivery system with high regional drug level may greatly decrease the dose of drug, leading to higher safety and lower cost. In an attempt to imitate the fast and slow exposure of these two drugs in clinic use, we incorporated PTX nanoparticles and LAPA microparticles into a thermosensitive hydrogel (PL-gel) for peritumoral injection, using PTX-gel plus LAPA-oral (P-gel+L-oral) and so on as controls. To visually study in vitro or in vivo, PTX/DID and LAPA/DIR hybrid crystals were prepared. In vitro and in vivo studies demonstrated the fast and short-term release of PTX, as well as the slow and long-term release of LAPA from the PL-gel. The most synergistic effect was found between LAPA and PTX on the cell line overexpressing both HER2 and P-gp, and the mechanisms related to LAPA-induced inhibition on P-gp expression, more G2/M phase arrest of PTX and more uptake of PTX in tumor cells. With a dose of LAPA in PL-gel group only less than 5% of that in P-gel+L-oral group, PL-gel demonstrated significant tumor suppression similar to P-gel+L-oral group, and showed longer mice survival time. Besides, PL-gel achieved more steady LAPA accumulation in tumors and revealed significantly less toxicity compared with P-gel+L-oral group. To summarize, this localized co-delivery system with good synergistic effects between LAPA and PTX might offer a potential strategy for HER2 and P-gp positive breast cancer. PMID:26474677

  10. Outcomes Following Endoscopic Stapes Surgery.

    PubMed

    Hunter, Jacob B; Rivas, Alejandro

    2016-10-01

    There are limited studies describing the surgical and hearing outcomes following endoscopic stapes surgeries, despite the burgeoning interest and excitement in endoscopic ear surgery. Current studies have demonstrated that endoscopic stapes surgery is safe and has similar audiologic outcomes when compared with microscopic stapes procedures. However, preliminary studies show decreased postoperative pain in endoscopic cases compared with microscopic controls. In regards to possible endoscopic advantages, these few studies demonstrate mixed results when comparing the need to remove the bony medial external auditory canal wall to improve visualization and access to the oval window niche. PMID:27565387

  11. Intravitreal injection

    MedlinePlus

    Retinal vein occlusion-intravitreal injection; Triamcinolone-intravitreal injection; Dexamethasone-intravitreal injection; Lucentis-intravitreal injection; Avastin-intravitreal injection; Bevacizumab-intravitreal injection; Ranibizumab- ...

  12. Local distribution and concentration of intravenously injected sup 131 I-9. 2. 27 monoclonal antibody in human malignant melanoma

    SciTech Connect

    Del Vecchio, S.; Reynolds, J.C.; Carrasquillo, J.A.; Blasberg, R.G.; Neumann, R.D.; Lotze, M.T.; Bryant, G.J.; Farkas, R.J.; Larson, S.M. )

    1989-05-15

    Regional measurements of {sup 131}I-9.2.27 distribution in human melanoma tumors were obtained using quantitative autoradiography. Tumors were removed from patients 72-96 h after they had received an i.v. injection of 9.15 mCi (100 mg) of {sup 131}I-9.2.27. The autoradiographic images showed that the radioactivity reaching the tumor was heterogeneously distributed. Areas of relative high and low uptake were selected in each tumor. Regions of high activity contained from 51 to 1371 nCi/g, while areas with low uptake had radioactivity ranging from 12 to 487 nCi/g. The reliability of the autoradiographic measurements was demonstrated by the strong positive correlation with direct tissue sample counting (r = 0.994 P less than 0.001). Since comparative immunocytochemistry showed a homogeneous and diffuse staining of target antigen on viable tumor cells, variability of monoclonal antibody uptake within individual tumors was not primarily due to heterogeneity of antigen expression in these cases. However, antigen levels accounted for some of the variation from tumor to tumor. When immunoperoxidase staining was repeated on adjacent sections without the addition of 9.2.27, it confirmed the nonuniform distribution of monoclonal antibody found at autoradiography. Thus, quantitative autoradiography gives information about the distribution and the local concentration of radioactive antibody in tumors allowing calculation of the radiation dose delivered to small regions within tumors.

  13. EMC3-EIRENE modelling of toroidally-localized divertor gas injection experiments on Alcator C-Mod

    DOE PAGESBeta

    Lore, Jeremy D.; Reinke, M. L.; LaBombard, Brian; Lipschultz, B.; Churchill, R. M.; Pitts, R. A.; Feng, Y.

    2014-09-30

    Experiments on Alcator C-Mod with toroidally and poloidally localized divertor nitrogen injection have been modeled using the three-dimensional edge transport code EMC3-EIRENE to elucidate the mechanisms driving measured toroidal asymmetries. In these experiments five toroidally distributed gas injectors in the private flux region were sequentially activated in separate discharges resulting in clear evidence of toroidal asymmetries in radiated power and nitrogen line emission as well as a ~50% toroidal modulation in electron pressure at the divertor target. The pressure modulation is qualitatively reproduced by the modelling, with the simulation yielding a toroidal asymmetry in the heat flow to the outermore » strike point. Finally, toroidal variation in impurity line emission is qualitatively matched in the scrape-off layer above the strike point, however kinetic corrections and cross-field drifts are likely required to quantitatively reproduce impurity behavior in the private flux region and electron temperatures and densities directly in front of the target.« less

  14. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care

    PubMed Central

    Hay, E; Thomas, E; Paterson, S; Dziedzic, K; Croft, P

    2003-01-01

    Objectives: To compare the long term effectiveness of local steroid injections administered by general practitioners with practice based physiotherapy for treating patients presenting in primary care with new episodes of unilateral shoulder pain. Methods: Adults consulting with shoulder pain were recruited by their general practitioner. Patients were randomly allocated to receive either corticosteroid injections or community based physiotherapy. Primary outcome was self reported disability from shoulder problems at six months. Secondary outcomes included participant's global assessment of change; pain; function; "main complaint"; range of shoulder movement; co-interventions. A study nurse unaware of the treatment allocation performed baseline and follow up assessments. Analysis was by intention to treat. Results: Over 22 months 207 participants were randomised, 103 to physiotherapy and 104 to injection. Prognostic variables were similar between the two groups at baseline. Mean (SD) improvements in disability scores at six weeks were 2.56 (5.4) for physiotherapy and 3.03 (6.3) for injection (mean difference=-0.5, 95% confidence interval (95% CI): -2.1 to 1.2) and at six months were 5.97 (5.4) for physiotherapy and 4.55 (5.9) for injection (mean difference=1.4, 95% CI -0.2 to 3.0). A "successful outcome" (a minimum 50% drop in the disability score from baseline) at six months was achieved by 59/99 (60%) in the physiotherapy group and 51/97 (53%) in the injection group (percentage difference=7%, 95% CI -6.8% to 20.4%). Co-interventions were more common in the injection group during follow up. Conclusion: Community physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain in primary care, but those receiving physiotherapy had fewer co-interventions. PMID:12695148

  15. Histopathological and ultra-structural characterization of local neuromuscular damage induced by repeated phosphatidylcholine/deoxycholate injection.

    PubMed

    El-Gowelli, Hanan M; El Sabaa, Bassma; Yosry, Emad; El-Saghir, Hisham

    2016-01-01

    Phosphatidylcholine/deoxycholate (PC/DC) combination is frequently used for injection lipolysis in body contouring and size reduction of subcutaneous lipomas. Nonetheless, studies that assess possible injurious effects of PC/DC combination on tissues at injection sites are inadequate. The current work attempts to evaluate the effects of repeated PC/DC injection on skeletal muscles and neural tissues at the injection site. For this purpose, female Wistar rats were randomly assigned into 2 groups, 10 rats each, and injected percutaneously via either normal saline (control group) or PC/DC (treated group) in the groin area for 4 consecutive days. Biopsies were harvested on the 4(th) day for histopathological studies. The results of the present work demonstrated that repeated injection of PC/DC caused neural damage and intense inflammation at the injection site leading to skeletal muscle degeneration, necrosis and fibrosis. Electron microscopic examination of the neural tissues in the injected area showed intra-neural fibroblasts, deposition of intra-neural collagen fibers and marked myelin degeneration. In addition, PC/DC injection caused thickening of intra-neural blood vessel walls and evident endo-neural mast cells. The current data highlight the attendant risk of neuromuscular injury associated with repeated PC/DC injection during the treatment of undesirable fat deposits and lipomas. PMID:26404917

  16. Rare gastrointestinal lymphomas: The endoscopic investigation

    PubMed Central

    Vetro, Calogero; Bonanno, Giacomo; Giulietti, Giorgio; Romano, Alessandra; Conticello, Concetta; Chiarenza, Annalisa; Spina, Paolo; Coppolino, Francesco; Cunsolo, Rosario; Raimondo, Francesco Di

    2015-01-01

    Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease. PMID:26265987

  17. Visual SLAM for Handheld Monocular Endoscope.

    PubMed

    Grasa, Óscar G; Bernal, Ernesto; Casado, Santiago; Gil, Ismael; Montiel, J M M

    2014-01-01

    Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences. PMID:24107925

  18. Effectiveness of Endoscopic Treatment for Gastrointestinal Neuroendocrine Tumors

    PubMed Central

    Sun, Weili; Wu, Siyuan; Han, Xiao; Yang, Chuanhua

    2016-01-01

    Abstract Several recent studies have explored efficacy and safety of different endoscopic treatments for gastrointestinal neuroendocrine tumors (GI-NETs). However, there is no definitive consensus regarding the best endoscopic approach for GI-NETs treatment. Therefore, the present study was conducted to investigate the application of various endoscopic techniques for the treatment of GI-NETs according to the previous conclusions and to summarize the optimal endoscopic modalities for GI-NETs. Ninety-eight patients with 100 GI-NETs removed by endoscopic therapies were reviewed. The pathological complete resection rate (PCRR), complication, local recurrence, and factors possibly associated with the pathological complete resection were analyzed. Twenty-two patients were treated by conventional polypectomy (including 6 cold biopsy forceps polypectomy and 16 snare polypectomy with electrocauterization), 41 by endoscopic mucosal resection (EMR), and 35 by endoscopic submucosal dissection (ESD). The PCRRs of conventional polypectomy, EMR, and ESD were 86.4%, 75.6%, and 85.7%, respectively. Sixteen GI-NETs that had a polypoid appearance, with a mean tumor size of 5.2 mm, were removed by snare polypectomy (PCRR 93.8%). The complication rates of conventional polypectomy, EMR, and ESD were 0.0% (0/22), 2.4% (1/41), and 2.9% (1/35), respectively. There were 2 local recurrences after cold biopsy forceps polypectomy treatment and no local recurrences in the EMR and ESD groups (P = 0.049). The results showed that PCRR was only associated with the depth of invasion (P = 0.038). Endoscopic resection of GI-NETs is safe and effective in properly selected patients. For submucosal GI-NETs, ESD was a feasible modality, with a higher PCRR compared with EMR. For ≤5 mm polypoid-like NETs, snare polypectomy with electrocauterization was a simple procedure with a high PCRR. PMID:27082572

  19. Extra flat, flexible and disposable endoscope for lateral imaging

    NASA Astrophysics Data System (ADS)

    Basset, G.; Marinov, D.; Hofer, C.; Cattaneo, S.; Volet, P.; Gallinet, B.; Schnieper, M.; Ferrini, R.

    2016-03-01

    We present an innovative disposable endoscope based on extra flat flexible polymer slabs used as multimode waveguides. The waveguides are compatible with low-cost roll-to-roll production technologies and can be easily customized by patterning, coating and printing techniques according to the specifications of the target application. In order to couple the light (i.e. the illumination beam and the imaging beam) in and out of the waveguide, diffractive subwavelength gratings are used. These nano-scale optical structures enable an efficient and controlled light trapping by total internal reflection, thus minimizing the distortion effects generated by the rough edges. Nano-patterning is obtained using established techniques (i.e. hot embossing and/or UV casting) that are compatible with industrial roll-to-roll production lines or plastic injection molding. Unique features of these innovative endoscopes are i) the achievable very thin form that can be reduced to thicknesses below 200 μm, ii) the ability to record lateral images with respect to the endoscope direction, iii) the ability to image samples (e.g. tissues, tiny objects) in direct contact with the polymer slab, with a minimum imaging distance equal to zero, and iv) the access to high volume fabrication techniques that can enable the production of low-cost disposable endoscopes. A possible device implementation is demonstrated and tested, which consists of a flat line-scanning endoscope enabling the acquisition of 1D images in monochromatic illumination and the reconstruction of 2D images by scanning. Images taken with such a disposable endoscope are discussed and the related technological constraints such as manufacturing tolerances, image distortion, scattered light and signal to noise ratio are further described. Finally, advantages and disadvantages with respect to other endoscopic techniques will be discussed, thus demonstrating the potential of this innovative approach for endoscopic applications in very

  20. Endoscopic Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Zhou, Chao; Fujimoto, James G.; Tsai, Tsung-Han; Mashimo, Hiroshi

    New gastrointestinal (GI) cancers are expected to affect more than 290,200 new patients and will cause more than 144,570 deaths in the United States in 2013 [1]. When detected and treated early, the 5-year survival rate for colorectal cancer increases by a factor of 1.4 [1]. For esophageal cancer, the rate increases by a factor of 2 [1]. The majority of GI cancers begin as small lesions that are difficult to identify with conventional endoscopy. With resolutions approaching that of histopathology, optical coherence tomography (OCT) is well suited for detecting the changes in tissue microstructure associated with early GI cancers. Since the lesions are not endoscopically apparent, however, it is necessary to survey a relatively large area of the GI tract. Tissue motion is another limiting factor in the GI tract; therefore, in vivo imaging must be performed at extremely high speeds. OCT imaging can be performed using fiber optics and miniaturized lens systems, enabling endoscopic OCT inside the human body in conjunction with conventional video endoscopy. An OCT probe can be inserted through the working channel of a standard endoscope, thus enabling depth-resolved imaging of tissue microstructure in the GI tract with micron-scale resolution simultaneously with the endoscopic view (Fig. 68.1).

  1. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

    Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques. PMID:24628672

  2. Endoscopic treatment of obesity

    PubMed Central

    Swidnicka-Siergiejko, Agnieszka; Wróblewski, Eugeniusz; Dabrowski, Andrzej

    2011-01-01

    BACKGROUND: The increasing incidence of obesity and overweight among children and adolescents will be reflected by the imminent increase in the number of obese patients who require more definitive methods of treatment. There is great interest in new, safe, simple, nonsurgical procedures for weight loss. OBJECTIVE: To provide an overview of new endoscopic methods for the treatment of obesity. METHODS: An English-language literature search on endoscopic interventions, endoscopically placed devices and patient safety was performed in the MEDLINE and Cochrane Library databases. RESULTS: The literature search yielded the following weight loss methods: space-occupying devices (widely used), gastric capacity reduction, modifying gastric motor function and malabsorptive procedures. A commercially available intragastric balloon was the most commonly used device for weight loss. In specific subgroups of patients, it improved quality of life, decreased comorbidities and served as a bridge to surgery. More evidence regarding the potential benefits and safety of other commercially available intragastric balloons is needed to clarify whether they are superior to the most commonly used one. Moreover, early experiences with transoral gastroplasty, the duodenaljejunal bypass sleeve and an adjustable, totally implantable intragastric prosthesis, indicate that they may be viable options for obesity treatment. Other agents, such as botulinum toxin and a device known as the ‘butterfly’, are currently at the experimental stage. CONCLUSION: New endoscopic methods for weight loss may be valuable in the treatment of obesity; however, more clinical experience and technical improvements are necessary before implementing their widespread use. PMID:22059171

  3. Automated endoscope reprocessors.

    PubMed

    Desilets, David; Kaul, Vivek; Tierney, William M; Banerjee, Subhas; Diehl, David L; Farraye, Francis A; Kethu, Sripathi R; Kwon, Richard S; Mamula, Petar; Pedrosa, Marcos C; Rodriguez, Sarah A; Wong Kee Song, Louis-Michel

    2010-10-01

    The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through February 2010 for articles related to automated endoscope reprocessors, using the words endoscope reprocessing, endoscope cleaning, automated endoscope reprocessors, and high-level disinfection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. PMID:20883843

  4. Development of a long-acting, protein-loaded, redox-active, injectable gel formed by a polyion complex for local protein therapeutics.

    PubMed

    Ishii, Shiro; Kaneko, Junya; Nagasaki, Yukio

    2016-04-01

    Although cancer immunotherapies are attracting much attention, it is difficult to develop bioactive proteins owing to the severe systemic toxicity. To overcome the issue, we designed new local protein delivery system by using a protein-loaded, redox-active, injectable gel (RIG), which is formed by a polyion complex (PIC) comprising three components, viz., cationic polyamine-poly(ethylene glycol)-polyamine triblock copolymer possessing ROS-scavenging moieties as side chains; anionic poly(acrylic acid); and a protein. The mixture formed the protein-loaded PIC flower micelles at room temperature, which immediately converted to a gel with high mechanical strength upon exposure to physiological conditions. Because the protein electrostatically interacts with the PIC gel network, RIG provided a sustained release of the protein without a significant initial burst, regardless of the types of proteins in vitro, and much longer retention of the protein at the local injection site in mice than that of the naked protein. Subcutaneous injections of IL-12@RIG in the vicinity of tumor tissue showed remarkable tumor growth inhibition in tumor-bearing mice, compared to that observed with injection of IL-12 alone, suppressing adverse events caused by IL-12-induced ROS. Our results indicate that RIG has potential as a platform technology for an injectable sustained-release carrier for proteins. PMID:26828685

  5. Critical Assessment of Endoscopic Techniques for Gastroesophageal Reflux Disease.

    PubMed

    Lo, Wai-Kit; Mashimo, Hiroshi

    2015-10-01

    Over the past 2 decades, a number of new endoscopic techniques have been developed for management of gastroesophageal (GE) reflux disease symptoms as alternatives to medical management and surgical fundoplication. These devices include application of radiofrequency treatment (Stretta), endoscopic plication (EndoCinch, Plicator, Esophyx, MUSE), and injection of bulking agents (Enteryx, Gatekeeper, Plexiglas, Duragel). Their goal was symptom relief through reduction of tissue compliance and enhancement of anatomic resistance at the GE junction. In this review, we critically assess the research behind the efficacy, safety, and durability of these treatments to better understand their roles in contemporary GE reflux disease management. PMID:26241152

  6. Novel Use of Endoscopic Clips as Fiducials for Radiotherapy in Small Bowel Lymphoma.

    PubMed

    Mendez, Vanessa; Martinez, Fernando J; Soriano, Frederick B; Markoe, Arnold M; Lossos, Izidore S; Saigal, Kunal; Sussman, Daniel A

    2014-07-01

    A 31-year-old woman was diagnosed with duodenal grade 1 follicular lymphoma. The patient underwent radiotherapy and on surveillance enteroscopy, the lymphoma was persistently identified in the duodenum and jejunum. Endoscopic clips were used as fiducials to better localize the tumor during radiotherapy. Endoscopic clips are increasingly used as tumor localization tools because of their favorable risk-benefit ratio. In our case, endoscopic clipping was necessary to properly localize the tumor after prior treatment failure, and the patient now has no evidence of disease. Larger studies are needed to demonstrate the efficacy of clips in tumor localization and improved disease-related morbidity. PMID:26157870

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

    PubMed

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

    2016-01-25

    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

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

    PubMed Central

    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

  9. Endoscopic photodynamic therapy with hematoporphyrin derivative in the treatment of malignant tumors: report of 120 cases

    NASA Astrophysics Data System (ADS)

    Tian, Mao-en; Liu, Fa-wen; Qian, Jia-ping; Ji, Qing; Feng, Yun-qiu

    1993-03-01

    One-hundred-twenty cases of malignant tumors treated by endoscopic photodynamic therapy with hematoporphyrin derivative from August 1982 - July 1990 are reported. Of the 120 cases, including 97 males and 23 females ages varying from 39 to 77 years old, 40 cases were primary tumors and 80 cases were local residual or recurrent after surgery or radiotherapy or chemotherapy. All cases were confirmed in pathological biopsy, including 58 squamous cell carcinoma, 28 various adenocarcinoma, and 34 transitional cell carcinoma. Twenty-four, 48 and/or 72 hours after intravenous injection of HpD 2.0 - 3.0 mg/kg, or DHE 1.5 - 2.0 mg/kg, or Y-HpD 5.0 mg/kg, the tumor was irradiated with 630 nm wavelength of argon dye laser via a quartz light fiber inserted through the forceps channel of the endoscope. Of the 120 cases treated, CR was obtained in 38 cases, PR in 25 cases, MR in 52 cases, and NR in 5 cases. Total response rate was 95.8%; significant response rate 52.5%; and tumor eradicated rate 31.7%. The 38 cases included: 14 cases of early esophageal carcinoma, 3 cases of early cardiac carcinoma, 1 case of early lung cancer, 1 case of early gastric carcinoma, 15 cases of superficial bladder carcinoma, 3 cases of local residual recurrent micro lung cancer, and 1 case of cardiac carcinoma. The longest cancer-free survival was over eight years. Endoscopic photodynamic therapy is, therefore, curative effective in the treatment of early and superficial carcinoma, and palliative effective in the treatment of advanced carcinoma. Standardized and controlled trials are required to assess its place in combined treatment of malignant tumors.

  10. Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

    PubMed Central

    Jin, Kwang Nam; Kim, Tae Jung; Song, Yong Sub; Kim, Dong Il

    2014-01-01

    Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue. PMID:24431917