Science.gov

Sample records for standard endoscopic instruments

  1. Catheter-based photoacoustic endoscope for use in the instrument channel of a clinical video endoscope

    NASA Astrophysics Data System (ADS)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. K.; Wang, Lihong V.

    2015-03-01

    We have successfully developed a fully-sheathed, flexible shaft-based, mechanical scanning photoacoustic endoscopy (PAE) system for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The endoscopic system uses a single element ultrasonic transducer and flexible shaft-based proximal actuation mechanism, and it has a 2.5 m long and 3.2 mm diameter catheter section, which can be accommodated in the 3.7 mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo imaging capability of the PAE system.

  2. Towards standardized assessment of endoscope optical performance: geometric distortion

    NASA Astrophysics Data System (ADS)

    Wang, Quanzeng; Desai, Viraj N.; Ngo, Ying Z.; Cheng, Wei-Chung; Pfefer, Joshua

    2013-12-01

    Technological advances in endoscopes, such as capsule, ultrathin and disposable devices, promise significant improvements in safety, clinical effectiveness and patient acceptance. Unfortunately, the industry lacks test methods for preclinical evaluation of key optical performance characteristics (OPCs) of endoscopic devices that are quantitative, objective and well-validated. As a result, it is difficult for researchers and developers to compare image quality and evaluate equivalence to, or improvement upon, prior technologies. While endoscope OPCs include resolution, field of view, and depth of field, among others, our focus in this paper is geometric image distortion. We reviewed specific test methods for distortion and then developed an objective, quantitative test method based on well-defined experimental and data processing steps to evaluate radial distortion in the full field of view of an endoscopic imaging system. Our measurements and analyses showed that a second-degree polynomial equation could well describe the radial distortion curve of a traditional endoscope. The distortion evaluation method was effective for correcting the image and can be used to explain other widely accepted evaluation methods such as picture height distortion. Development of consensus standards based on promising test methods for image quality assessment, such as the method studied here, will facilitate clinical implementation of innovative endoscopic devices.

  3. Contrast harmonic endoscopic ultrasound: Instrumentation, echoprocessors, and echoendoscopes

    PubMed Central

    Iglesias-Garcia, Julio; Lariño-Noia, Jose; Domínguez-Muñoz, J. Enrique

    2017-01-01

    Endoscopic ultrasound (EUS) has become as one the best diagnostic and therapeutic methods for the management of several intraintestinal and extraintestinal diseases, among them to highlight pancreaticobiliary indications, mediastinal evaluation, and the analysis of gastrointestinal lesions. Over the years, there has been an enormous evolution in the systems available to perform EUS. Newer processors and echoendoscopes are available nowadays, with the ability to perform new imaging analysis, such as elastography and contrast enhancement. In the present article, we will review which systems are available nowadays, focusing also in the technical advances associated. PMID:28218199

  4. Endoscopic Removal of Ingested Dentures and Dental Instruments: A Retrospective Analysis

    PubMed Central

    Takahashi, Kazuya; Tominaga, Kentaro; Nishigaki, Yuki; Sato, Hiroki; Ikarashi, Satoshi; Hayashi, Kazunao; Yamamoto, Takashi; Honda, Yutaka; Hashimoto, Satoru; Kamimura, Kenya; Takeuchi, Manabu; Yokoyama, Junji; Sato, Yuichi; Kobayashi, Masaaki; Terai, Shuji

    2016-01-01

    Background. Dentures and dental instruments are frequently encountered ingested foreign bodies. The aim of the present study was to assess the safety and efficacy of endoscopically removing ingested dental objects. Methods. Twenty-nine consecutive patients with 29 dental objects who were treated at the Niigata University Medical and Dental Hospital from August 2009 to December 2015 were retrospectively reviewed. Characteristics of the patients and the ingested dental objects, the clinical features and findings of radiological imaging tests, and outcomes of endoscopic removal were analyzed. Results. Patients' mean age was 62.9 ± 21.0 years. The ingested dental objects included 23 dentures (13 crowns, 4 bridges, 4 partial dentures, and 2 other dentures) and 6 dental instruments. Twenty-seven upper gastrointestinal endoscopies and 2 colonoscopies were performed, and their success rates were 92.6% and 100%, respectively. There were 2 cases of removal failure; one case involved an impacted partial denture in the cervical esophagus, and this case required surgical removal. Conclusions. Endoscopic removal of ingested dentures and dental instruments is associated with a favorable success rate and acceptable complications. The immediate intervention and appropriate selection of devices are essential for managing ingested dental objects. PMID:27738426

  5. Path to the Interpeduncular Fossa: Anatomical Comparison of Endoscopic-Assisted versus Standard Subtemporal Approach

    PubMed Central

    Lamki, Tariq; Salma, Asem; Baidya, Nishanta; Ammirati, Mario

    2012-01-01

    Objective The aim of this study was to assess the assumed advantage of endoscopic assistance to the standard subtemporal approach. The idea was to measure qualitatively and quantitatively visibility versus operability. Design We performed eight subtemporal dissections on four cadaver heads. Our dissections integrated an operating microscope, endoscope, and neuronavigation. Comparison was made between visibility and operability afforded by the microscope alone or by the microscope–endoscope combination. Visibility was recorded as complete or incomplete and was quantified for key structures using linear measurements taken by the navigation system. Operability was determined by whichever maneuvers could be safely and comfortably accomplished in the space afforded. Results From our survey, the structures whose visibility most benefitted from the addition of the endoscope include: contralateral third nerve, posterior perforated substance, mammillary bodies, and contralateral superior cerebellar artery. With regard to quantitative evaluation, we found increased visibility of both basilar artery and posterior cerebral artery. With regard to the operability, no objective advantage was afforded by the addition of the endoscope. Subjectively, the maneuvers were easier to perform while using the endoscope. Conclusion Using the endoscope as an assistance tool during conducting classical subtemporal approach can help in overcome a lot of the classical subtemporal approach limitations. PMID:23905002

  6. National Health Education Standards: Developing an "Exit Competencies" Assessment Instrument

    ERIC Educational Resources Information Center

    Garman, J. F.; Hayduk, D. M.; Posey, N. L.; Teske, C. J.; Crider, D. A.

    2004-01-01

    Purpose: To develop an evaluation instrument that assessed health literacy competencies, specific to the national health education standards, that would provide less variability in response interpretation and greater speed of scoring than available in existing instruments. Methodology: Content was developed by professional practitioners with…

  7. 77 FR 37409 - Request for Domains, Instruments, and Measures for Development of a Standardized Instrument for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-21

    ... HUMAN SERVICES Request for Domains, Instruments, and Measures for Development of a Standardized... domains, instruments, and measures is occurring now because of the multi-phased survey development and... consistency, test-retest, etc) and validity (content, construct, criterion-related). Results of...

  8. Standardization of near infrared spectra measured on multi-instrument.

    PubMed

    Liu, Yan; Cai, Wensheng; Shao, Xueguang

    2014-07-11

    Calibration model transfer is essential for practical applications of near infrared (NIR) spectroscopy because the measurements of the spectra may be performed on different instruments and the difference between the instruments must be corrected. An approach for calibration transfer based on alternating trilinear decomposition (ATLD) algorithm is proposed in this work. From the three-way spectral matrix measured on different instruments, the relative intensity of concentration, spectrum and instrument is obtained using trilinear decomposition. Because the relative intensity of instrument is a reflection of the spectral difference between instruments, the spectra measured on different instruments can be standardized by a correction of the coefficients in the relative intensity. Two NIR datasets of corn and tobacco leaf samples measured with three instruments are used to test the performance of the method. The results show that, for both the datasets, the spectra measured on one instrument can be correctly predicted using the partial least squares (PLS) models built with the spectra measured on the other instruments.

  9. Evolution of the VLT instrument control system toward industry standards

    NASA Astrophysics Data System (ADS)

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

    2010-07-01

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

  10. Job Grading Standard for Instrument Maker, WG-4712.

    ERIC Educational Resources Information Center

    Civil Service Commission, Washington, DC. Bureau of Policies and Standards.

    The standard is used to grade all nonsupervisory jobs involved inplanning and fabricating complex research and prototype instruments, made from a variety of materials, which are used to detect, measure, record, and regulate heat, pressure, speed, vibration, sound, illumination, biomedical phenomena, and other areas of interest to scientific,…

  11. Terminology and global standardization of endoscopic information: Minimal Standard Terminology (MST).

    PubMed

    Fujino, Masayuki A; Bito, Shigeru; Takei, Kazuko; Mizuno, Shigeto; Yokoi, Hideto

    2006-01-01

    Since 1994, following the leading efforts by the European Society for Gastrointestinal Endoscopy, Organisation Mondiale d'Endoscopie Digestive (OMED) has succeeded in compiling minimal number of terms required for computer generation of digestive endoscopy reports nicknamed MST (Minimal Standard Terminology). Though with some insufficiencies, and though developed only for digestive endoscopy, MST has been the only available terminology that is globally standardized in medicine. By utilizing the merits of a unified, structured terminology that can be used in multiple languages we can utilize the data stored in different languages as a common database. For this purpose, a standing, terminology-managing organization that manages and maintains and, when required, expands the terminology on a global level, is absolutely necessary. Unfortunately, however, the organization that performs version control of MST (OMED terminology, standardization and data processing committee) is currently suspending its activity. Medical practice of the world demands more and more specialization, with resultant needs for information exchange among specialized territories. As the cooperation between endoscopy and pathology has become currently the most important problem in the Endoscopy Working Group of Integrating Healthcare Enterprise-Japan (IHE-J,) the cooperation among different specialties is essential. There are DICOM or HL7 standards as the protocols for storage, and exchange (communication) of the data, but there is yet no organization that manages the terminology itself astride different specialties. We hereby propose to establish, within IEEE, for example, a system that promotes standardization of the terminology that can transversely describe a patient, and that can control different societies and groups, as far as the terminology is concerned.

  12. Experimental telemanipulation in endoscopic surgery.

    PubMed

    Schurr, M O; Breitwieser, H; Melzer, A; Kunert, W; Schmitt, M; Voges, U; Buess, G

    1996-06-01

    Today's rigid endoscopic instruments limit the intracorporeal mobility of the surgical tool and are a severe impediment for the further spread of endoscopic techniques in operative medicine. Since 1992 flexible, steerable instruments with additional links for pivoting and rotating the tip have been developed and experimentally evaluated. The latest versions of this series of instruments are equipped with electromotors for better handling. The next aim in this development is a fully mobile telemanipulator with six motion axes dedicated to use in endoscopic surgery. Its first tests are planned for 1995. For successful operation of an electric telemanipulator, the man-machine interface (MMI) is of cardinal importance. For the definition of surgical requirements for the MMI, a conventional master-slave manipulator designed for technical application was modified for use in guiding a laparoscopic instrument. Master and slave sites of the system were 1.3 km apart and linked by means of a fiber-optic cable. Using this modified telepresence system, remote laparoscopic cholecystectomy was feasible in a phantom model. In a standardized test series using a test parcours, different parameters of the control system were modified, and their influence on the execution time of the parcours tasks was recorded. Well-suited parameter configurations were found and allowed experimental verification and completion of the important aspects of our concepts for development of an endoscopic manipulator MMI.

  13. 76 FR 28173 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-16

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... flight operations under instrument flight rules at the affected airports. DATES: This rule is...

  14. 78 FR 64172 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... flight operations under instrument flight rules at the affected airports. DATES: This rule is...

  15. 77 FR 5693 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-06

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... flight operations under instrument flight rules at the affected airports. DATES: This rule is...

  16. The EndoHand: comparison with standard laparoscopic instrumentation.

    PubMed

    Jackman, S V; Jarzemski, P A; Listopadzki, S M; Lee, B R; Stoianovici, D; Demaree, R; Jarrett, T W; Kavoussi, L R

    1999-06-01

    Laparoscopic instrumentation is constantly being refined in an attempt to achieve the proficiency, flexibility, and tactile feedback that would be available if the human hand were small enough to be used in laparoscopic surgery. The EndoHand (DAUM GmbH, Schwerin, Germany) is a novel laparoscopic three-fingered hand developed as an advancement over standard laparoscopic tools. Grasping and manipulation ability, dexterity, and tactile feedback were compared with those of current laparoscopic instrumentation. Experiments included measurement of achievable angles of approach to a fixed point behind a 2-cm-tall obstruction, completion time and error rates during a pelvic trainer dexterity task, and tactile feedback using a device invented to simulate tissue resistance. Subjectively, the EndoHand was able to pick up a range of objects similar to those graspable by a Babcock clamp. More complex types of manipulation were possible with the EndoHand because of its wrist joint. The range of approach angles to the fixed point was 35 degrees to 90 degrees with the EndoHand and 70 degrees to 90 degrees with the straight instruments. The dexterity of the EndoHand was significantly less than that of the other two instruments, as measured by time (P = 0.0002) and errors (P = 0.02). Standard instruments were also more accurate in the tactile feedback trials (P = 0.02). The EndoHand is a prototype of a unique new generation of laparoscopic instruments. Although it falls short in both dexterity and tactile feedback, significant promise is shown in its ability to perform sophisticated manipulation of objects and its flexibility to work at a larger range of angles to the target tissue. The EndoHand may be most useful on the nondominant hand of the surgeon to assist with positioning and holding tissue in a specific orientation. Clinical trials will determine its eventual role in laparoscopic surgery.

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

    SciTech Connect

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

    1997-04-01

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

  18. Standardization of Observatories, Instruments and Reference Frames for Planetary Sciences

    NASA Astrophysics Data System (ADS)

    Cecconi, Baptiste; Erard, Stéphane; Le Sidaner, Pierre

    2015-08-01

    The recent developments on planetary science interoperability showed that a standardization of naming conventions was required for observatories (including ground based facilities and space mission), instruments (types and names) as well as reference frames used to describe planetary observations. A review of existing catalogs and naming for those entities is presented. We also report on the discussions that occurred within the IVOA (International Virtual Observatory Alliance), IPDA (International Planetary Data Alliance) and VESPA (Virtual European Solar and Planetary Access) working groups. A proposal for standard lists, possibly to be endorsed by IAU, is presented and discussed.

  19. Standardization of Observatories, Instruments and Reference Frames for Planetary Sciences

    NASA Astrophysics Data System (ADS)

    Cecconi, B.; Erard, S.; Le Sidaner, P.

    2015-10-01

    The recent developments on planetary science interoperability showed that a standardization of naming conventions was required for observatories (including ground based facilities and space mission), instruments (types and names) as well as reference frames used to describe planetary observations. A review of existing catalogs and naming for those entities is presented. We also report on the discussions that occurred within the IVOA (International Virtual Observatory Alliance), IPDA (International Planetary Data Alliance) and VESPA (Virtual European Solar and Planetary Access) working groups. A proposal for standard lists, possibly to be endorsed by IAU, is presented and discussed.

  20. Instrumentation Standard Architectures for Future High Availability Control Systems

    SciTech Connect

    Larsen, R.S.; /SLAC

    2005-10-13

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

  1. A STERILIZATION STANDARD FOR ENDOSCOPES AND OTHER DIFFICULT TO CLEAN MEDICAL DEVICES

    EPA Science Inventory

    An array of difficult to clean devices are used for diagnostic and surgical procedures involving various degrees of invasiveness. These range from prophylaxis angles used for cleaning and polishing teeth to flexible fiberoptic endoscopes for surgical procedures that penetrate the...

  2. The Use of Standard Gastrointestinal Endoscopic Ultrasound to Assess Cardiac Anatomy.

    PubMed

    Sentissi, Kinza; Sawhney, Mandeep S; Pleskow, Douglas; Sepe, Paul; Mella, Jose M; Kwittken, Benjamin; Ketwaroo, Gyanprakash; Subramaniam, Balachundhar

    2016-09-01

    In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist. Eight of the 20 standard views of cardiovascular structures per the 1999 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists guidelines for TEE could be obtained using the linear echoendoscope. The following cardiac valvular structures were visualized: aortic valve (100%), mitral valve (100%), tricuspid valve (33%), and pulmonic valve (11%). Left ventricular and right ventricular systolic function could be assessed in 89% and 67% of patients, respectively. Other structures such as the ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum were identified in 100% of patients. Doppler-dependent functions could not be assessed. Given that the EUS images were not directly compared with TEE in these patients, we cannot comment definitively on the quality of these assessments and further studies would need to be performed to make a formal comparison. Based on this study, EUS technology can consistently assess the mitral valve, aortic valve, aorta, pericardium, and left ventricular function. Given its limitations, EUS technology, although not a substitute for formal echocardiography, could be a helpful early diagnostic tool in an emergency setting.

  3. Explosive Microsphere Particle Standards for Trace Explosive Detection Instruments

    NASA Astrophysics Data System (ADS)

    Staymates, Matthew; Fletcher, Robert; Gillen, Greg

    2007-11-01

    Increases in Homeland Security measures have led to a substantial deployment of trace explosive detection systems within the United States and US embassies around the world. One such system is a walk-through portal which aerodynamically screens people for trace explosive particles. Another system is a benchtop instrument that can detect explosives from swipes used to collect explosive particles from surfaces of luggage and clothing. The National Institute of Standards and Technology is involved in a chemical metrology program to support the operational deployment and effective utilization of trace explosive and narcotic detection devices and is working to develop a measurement infrastructure to optimize, calibrate and standardize these instruments. Well characterized test materials are essential for validating the performance of these systems. Particle size, chemical composition, and detector response are particularly important. Here, we describe one method for producing monodisperse polymer microspheres encapsulating trace explosives, simulants, and narcotics using a sonicated co-flow Berkland nozzle. The nozzle creates uniform droplets that undergo an oil/water emulsion process and cure to form hardened microspheres containing the desired analyte. Issues such as particle size, particle uniformity and levels of analyte composition will be discussed.

  4. Neutron cross section standards and instrumentation. Annual report

    SciTech Connect

    Wasson, O.A.

    1993-07-01

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

  5. 75 FR 69331 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-12

    ... Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle...: Final rule. SUMMARY: This establishes, amends, suspends, or revokes Standard Instrument Approach... Center (APA-200), FAA Headquarters Building, 800 Independence Avenue, SW., Washington, DC 20591; or...

  6. 78 FR 28135 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-14

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters Building, 800 Independence Avenue...

  7. 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

  8. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope,...

  9. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope,...

  10. Test of optical fiber grating based new-type wavelength standard instrument

    NASA Astrophysics Data System (ADS)

    Li, Jianwei-wei; Xu, Nan; Li, Jian; Zhang, Zhi-xin

    2013-08-01

    In this paper, a kind of special optical fiber bonding high-temperature aging plan is raised. The armored optical fiber technology is applied to guarantee the long-term stability of the optical properties of the standard instrument itself. The temperature compensation encapsulation technology is adopted for optical fiber grating, that is, the wavelength will remain constant under the standard atmosphere pressure and chamber temperature. It becomes the optical fiber grating sensing wavelength standard instrument. The optical fiber grating standard instrument based upon this kind of new-type structure is tested, and the result has its word that the temperature shift of this optical fiber grating standard instrument after encapsulation is less than 0.5pm/℃. Coupled with the simple temperature control, the wavelength accuracy of the optical fiber grating standard instrument will be controlled below ±1pm and its long-term stability will be smaller than 2pm/℃. Differ from F-P standard instrument, this optical fiber grating standard instrument is one without mechanical device and is purely physical. So, it features more reliable performance and is applicable to mass production. The costs of this kind of optical fiber grating standard instrument is under control and will see an important application in the optical fiber grating sensing technology.

  11. An Instrument to Assess Beliefs about Standardized Testing: Measuring the Influence of Epistemology on the Endorsement of Standardized Testing

    ERIC Educational Resources Information Center

    Magee, Robert G.; Jones, Brett D.

    2012-01-01

    This article describes the development of an instrument to assess beliefs about standardized testing in schools, a topic of much heated debate. The Beliefs About Standardized Testing scale was developed to measure the extent to which individuals support high-stakes standardized testing. The 9-item scale comprises three subscales which measure…

  12. 76 FR 1355 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure.... SUMMARY: This rule establishes, amends, suspends, or revokes Standard Instrument Approach Procedures... Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA-200),...

  13. 78 FR 7652 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-04

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center...

  14. 78 FR 50326 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center...

  15. 77 FR 56762 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-14

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center...

  16. 75 FR 72940 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure.... SUMMARY: This rule establishes, amends, suspends, or revokes Standard Instrument Approach Procedures... Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA-200), FAA...

  17. 78 FR 5253 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-25

    ... Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle...: Final rule. SUMMARY: This rule establishes, amends, suspends, or revokes Standard Instrument Approach... Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA-200), FAA...

  18. Results of testing and evaluating a health physics instrument performance standard

    SciTech Connect

    Kenoyer, J.L.; Swinth, K.L.; Kathren, R.L.; Fleming, D.M.; Selby, J.M.; Vallario, E.J.; Federline, M.V.

    1983-09-01

    This paper presents data taken during testing of health physics instrumentation that provides information for the evaluation of the applicability and practicality of the proposed ANSI standard (N42.17) and the determination of the degree of conformance of currently available instruments to the proposed standard. The instruments tested included ionization chambers, Geiger Mueller detectors, alpha survey meters, neutron dose equivalent survey meters, and air monitors. (ACR)

  19. Vagus nerve stimulation for standardized monitoring: technical notes for conventional and endoscopic thyroidectomy.

    PubMed

    Dionigi, Gianlorenzo; Kim, Hoon Yub; Wu, Che-Wei; Lavazza, Matteo; Ferrari, Cesare; Leotta, Andrea; Spampatti, Sebastiano; Rovera, Francesca; Rausei, Stefano; Boni, Luigi; Chiang, Feng-Yu

    2013-09-01

    Standardization of the intraoperative neuromonitoring (IONM) technique is an essential aspect of modern monitored thyroid surgery. The standardized technique involves vagal nerve stimulation. VN stimulation is useful for technical problem solving, detecting non-recurrent laryngeal nerve (non-RLN), recognizing any recurrent laryngeal nerve (RLN) lesions, and precisely predicting RLN postoperative function. Herein, we present technical notes for the VN identification to achieve the critical view of safety of the VN stimulation with or without dissection.

  20. Endoscopic ultrasound

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007646.htm Endoscopic ultrasound To use the sharing features on this page, please enable JavaScript. Endoscopic ultrasound is a type of imaging test. It is ...

  1. The Use of Standardized Instruments with Urban and Minority-Group Pupils.

    ERIC Educational Resources Information Center

    Fitzgibbon, Thomas J.

    The position of the Harcourt Brace Jovanovich Test Department is set forth for the use of standardized instruments with urban and minority group pupils. Concern is with the effectiveness and usability of the instruments by the organization that published them. Renewed and intensified attention is given to certain aspects of the traditional…

  2. 42 CFR 493.1252 - Standard: Test systems, equipment, instruments, reagents, materials, and supplies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., instruments, reagents, materials, and supplies. (a) Test systems must be selected by the laboratory. The... 42 Public Health 5 2012-10-01 2012-10-01 false Standard: Test systems, equipment, instruments, reagents, materials, and supplies. 493.1252 Section 493.1252 Public Health CENTERS FOR MEDICARE &...

  3. 42 CFR 493.1252 - Standard: Test systems, equipment, instruments, reagents, materials, and supplies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., instruments, reagents, materials, and supplies. (a) Test systems must be selected by the laboratory. The... 42 Public Health 5 2010-10-01 2010-10-01 false Standard: Test systems, equipment, instruments, reagents, materials, and supplies. 493.1252 Section 493.1252 Public Health CENTERS FOR MEDICARE &...

  4. 42 CFR 493.1252 - Standard: Test systems, equipment, instruments, reagents, materials, and supplies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., instruments, reagents, materials, and supplies. (a) Test systems must be selected by the laboratory. The... 42 Public Health 5 2011-10-01 2011-10-01 false Standard: Test systems, equipment, instruments, reagents, materials, and supplies. 493.1252 Section 493.1252 Public Health CENTERS FOR MEDICARE &...

  5. 30 CFR 243.100 - What standards must my MMS-specified surety instrument meet?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... INTERIOR MINERALS REVENUE MANAGEMENT SUSPENSIONS PENDING APPEAL AND BONDING-MINERALS REVENUE MANAGEMENT Bonding Requirements § 243.100 What standards must my MMS-specified surety instrument meet? (a) An...

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

    PubMed

    Yu, Kaijun

    2010-07-01

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

  7. Standardization of ground and flight data interfaces for spaceflight instrument support. [for Gamma Ray Observatory

    NASA Technical Reports Server (NTRS)

    Felice, R.

    1985-01-01

    Instrument Ground Support Equipment (IGSE) will be used for instrument support on both the ground and flight phases of the Gamma-Ray Observatory (GRO) program. These mission phases include instrument development, observatory integration and test, prelaunch processing at the Kennedy Space Center (KSC) end-to-end testing, and in-orbit operations. The data interfaces between each of the IGSE's and the ground and flight systems have been evaluated to determine whether they should be standardized, and, if so, to what standard and why? Standardization, in this concept, provides for the capability to use the same IGSE without change as these systems are used throughout the various phases of the mission listed above. This evaluation has shown that there is a cost savings associated with standardization. In addition, several other intrinsic benefits have been identified. Based on this evaluation, the international standard protocol X.25 was selected to interface each of the IGSE's to the ground and flight systems.

  8. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

    PubMed Central

    Cheriyan, Danny G; Byrne, Michael F

    2014-01-01

    Compared to standard endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are often lengthier and more complex, thus requiring higher doses of sedatives for patient comfort and compliance. The aim of this review is to provide the reader with information regarding the use, safety profile, and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS, based on the current literature. PMID:24833847

  9. 76 FR 1354 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Administration (FAA), DOT. ACTION: Final rule. SUMMARY: This establishes, amends, suspends, or revokes Standard... Center (APA-200), FAA Headquarters Building, 800 Independence Avenue, SW., Washington, DC 20591; or...

  10. Standardization of Raman spectra for transfer of spectral libraries across different instruments.

    PubMed

    Rodriguez, Jason D; Westenberger, Benjamin J; Buhse, Lucinda F; Kauffman, John F

    2011-10-21

    In this paper we evaluate methods for standardization of Raman spectra that are required to improve spectral correlation computations between spectra measured on different instruments. Five commercially-available 785 nm Raman spectrometers from different vendors were included in the study. These spectrometers have diverse specifications and performance levels and range in size from laboratory-based instruments to field-deployable portable and handheld platforms. Since each Raman spectrometer has different characteristics, spectra obtained on one instrument cannot readily be compared to a library acquired on a different instrument without performing various types of spectral corrections (standardization). We outline a procedure that combines previously established Raman shift and intensity correction protocols with a resolution matching step to facilitate the comparison of a centralized master library with spectra acquired on different geographically distributed Raman spectrometers. The standardization procedure is effective in reducing the inherent instrument-to-instrument variability so that spectra from different spectrometers can be compared and reliable results obtained using library-based spectral correlation methods. The findings have important implications for the ability to transfer Raman spectral libraries between instruments.

  11. Transanal Endoscopic Microsurgery

    PubMed Central

    Saclarides, Theodore John

    2015-01-01

    Transanal endoscopic microsurgery (TEM) was developed by Professor Gerhard Buess 30 years ago at the dawn of minimally invasive surgery. TEM utilizes a closed proctoscopic system whereby endoluminal surgery is accomplished with high-definition magnification, constant CO2 insufflation, and long-shafted instruments. The end result is a more precise excision and closure compared to conventional instrumentation. Virtually any benign lesion can be addressed with this technology; however, proper patient selection is paramount when using it for cancer. PMID:26491409

  12. Technologic Papers of the Bureau of Standards. Number 237. Aeronautic Instruments,

    DTIC Science & Technology

    2007-11-02

    astronomical methods are employed, the requisite observations are almost always made with sextants (see Figs. 45 to 48) which the observer uses to determine...time equation and declination, as determined from the Nautical Almanac, the position can be determined. The sextants used differ from marine sextants ...8217 Hlunt Aeronautic Instrumen~ts. 495 496 Technologic Papers of the Bureau of Standards. [Vol.1 7 on which the instrument is set. Sextants have also been

  13. Endoscopic mucosectomy: an alternative treatment for superficial esophageal cancer.

    PubMed

    Lambert, R

    2000-01-01

    Recent trends in the management of superficial esophageal cancer consist of improved detection, pretherapeutic staging and reliable criteria for curative endoscopic therapy. The endoscopic treatment is legitimate when the cancer is at an early stage, intra-epithelial or microinvasive (m1 or m2) and N0. Submucosal cancer should not be treated with a curative intent by endotherapy. Concerning squamous cell cancer, the oriental and occidental pathologists include high-grade dysplasia in the same group as intramucosal cancer. The distinction is however maintained for adenocarcinoma in the Barrett's esophagus. Indications of endoscopic rather than surgical treatment rely on: (1) the small size of the tumor (not more than 2 cm in diameter); (2) the endoscopic morphology in the type 0 of the Japanese classification with the flat subtypes IIa and IIb rather than type IIc--there is high risk of submucosal invasion for the polypoid (type I) or ulcerated superficial cancer (type III); and (3) the endoscopic ultrasound staging, with confirmed integrity of the hyperechoic submucosal layer. The high-frequency (20 MHz) miniprobe is preferred to the standard (7.5 MHz) instrument. The elective procedure for tumor eradication is endoscopic mucosectomy. The technique is associated with a 6.8% risk of severe complications (hemorrhage or perforation) and a recurrence rate of 3%-7%. The 5-year survival rate is similar to that of surgery (over 80%). In the small group of patients with superficial esophageal cancer (less than 10% of the disease) endoscopic treatment may now be proposed in about 30% of cases, surgery is preferred for submucosal cancer and for neoplasia with a large surface. Areas of high-grade dysplasia in the Barrett's esophagus offer a new and increasing sector of indications. The concurrent endoscopic procedure of destruction--photodynamic therapy--is preferred for the destruction of lesions with poorly delineated limits.

  14. Histopathological standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: a report from the World Small Animal Veterinary Association Gastrointestinal Standardization Group.

    PubMed

    Day, M J; Bilzer, T; Mansell, J; Wilcock, B; Hall, E J; Jergens, A; Minami, T; Willard, M; Washabau, R

    2008-01-01

    The characterization of inflammatory change in endoscopic biopsy samples of the gastrointestinal mucosa is an increasingly important component in the diagnosis and management of canine and feline gastrointestinal disease. Interpretation has hitherto been limited by the lack of standard criteria that define morphological and inflammatory features, and the absence of such standardization has made it difficult, if not impossible, to compare results of retrospective or prospective studies. The World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group was established, in part, to develop endoscopic and microscopical standards in small animal gastroenterology. This monograph presents a standardized pictorial and textual template of the major histopathological changes that occur in inflammatory disease of the canine and feline gastric body, gastric antrum, duodenum and colon. Additionally, a series of standard histopathological reporting forms is proposed, to encourage evaluation of biopsy samples in a systematic fashion. The Standardization Group believes that the international acceptance of these standard templates will advance the study of gastrointestinal disease in individual small companion animals as well as investigations that compare populations of animals.

  15. Colonic Foreign Body Retrieval Using a Modified TAMIS Technique with Standard Instruments and Trocars

    PubMed Central

    Cawich, Shamir O.; Mohammed, Fawwaz; Spence, Richard; Albert, Matthew; Naraynsingh, Vijay

    2015-01-01

    Background. Reports of retained colorectal foreign bodies (CFBs) are no longer considered uncommon. We present a case where a retained CFB was retrieved using a modified TAMIS technique using standard instruments and trocars. Case Report. A 52-year-old man presented with a CFB. We report our technique of extraction with standard laparoscopic instruments without specialized access platforms. Conclusions. This modified TAMIS technique is well suited for resource poor environments because it requires no specialized equipment, platforms, or additional skill sets compared to conventional laparoscopy. PMID:25945267

  16. 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.

  17. 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.

  18. Biomedical communications centers--a profile/evaluation instrument study of underlying standards.

    PubMed

    Glickman, J T; Eicholzer, W A

    1987-01-01

    The "ABCD Profile/Evaluation Instrument" offers directors of individual biomedical communications centers a way to measure their own progress towards meeting standards of excellence. It provides guidelines for review of biomedical communications centers in a model similar to the clinical and basic medical science departments' review. Based on the results of this study, many of the directors seemed to be looking for more formal structure of biomedical communications centers involvement. Use of the Profile/Evaluation Instrument helps address this need and allows discussion in areas such as the department's existence and function in relation to its host institution. In March of 1985, the ABCD used the Profile/Evaluation Instrument standards as parameters of responsibility and service provided by biomedical communications units in its analysis and response to the AAMC GPEP report (Allan and Bradford 1985). The instrument also triggers discussion of new areas of review needed within departments. The process of matching biomedical communications job requirements and assessment training criteria will be explored in the future expansion of the personnel section of the instrument. These and other areas are crucial to the survival and well-being of biomedical communications centers. The "ABCD Profile/Evaluation Instrument" establishes a concrete reference for external review by outside agencies and internal review by administration or the department directors themselves. It offers a continuing body of information that provides the basis for future planning in the field of biomedical communications.

  19. Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard.

    PubMed

    Bolton, P

    2001-04-01

    The objective of this study was to assess the cross-culture validity and reliability of a standard psychiatric assessment instrument without the usual "gold standards." Normally criterion validity testing requires comparison with such a standard--usually another instrument or a professional diagnosis. Instead local informants identified persons with and without "agahinda gakabije" (a locally described grief syndrome) who were then asked if they thought they had this syndrome and also interviewed using the depression section of the Hopkins Symptom Checklist (DHSCL). To assess criterion validity, interviews where respondent and informant agreed on the presence or absence of agahinda gakabije were compared with depression diagnosis using the DHSCL. We also assessed construct validity (using factor analysis), internal reliability (Cronbach's alpha), and test-retest reliability using results from a subsequent community-based survey employing the DHSCL. We found a similar relationship between depression and agahinda gakabije as between depression and grief in western countries, which supports criterion validity. Construct validity and internal reliability were good (Cronbach's alpha = 0.87). Test-retest reliability of a DHSCL-based scale was less adequate (0.67). Although not replacing the usual gold standards for testing criterion validity, this approach may prove useful where these standards are unavailable. As this includes much of the developing world, this could result in more accurate mental health assessments among populations for whom this has hitherto not been possible.

  20. Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note.

    PubMed

    Wolinsky, Jean-Paul; Sciubba, Daniel M; Suk, Ian; Gokaslan, Ziya L

    2007-02-01

    Symptomatic irreducible basilar invagination has traditionally been approached through a transoral-transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination. Three consecutive patients (age range 42-74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae. The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.

  1. 14 CFR 1300.10 - General standards for Board issuance of Federal credit instruments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false General standards for Board issuance of Federal credit instruments. 1300.10 Section 1300.10 Aeronautics and Space AIR TRANSPORTATION SYSTEM STABILIZATION OFFICE OF MANAGEMENT AND BUDGET AVIATION DISASTER RELIEF-AIR CARRIER GUARANTEE LOAN...

  2. 30 CFR 1243.100 - What standards must my ONRR-specified surety instrument meet?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 3 2012-07-01 2012-07-01 false What standards must my ONRR-specified surety instrument meet? 1243.100 Section 1243.100 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE SUSPENSIONS PENDING APPEAL AND BONDING-OFFICE OF...

  3. 30 CFR 1243.100 - What standards must my ONRR-specified surety instrument meet?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 3 2013-07-01 2013-07-01 false What standards must my ONRR-specified surety instrument meet? 1243.100 Section 1243.100 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE SUSPENSIONS PENDING APPEAL AND BONDING-OFFICE OF...

  4. 30 CFR 1243.100 - What standards must my ONRR-specified surety instrument meet?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 3 2014-07-01 2014-07-01 false What standards must my ONRR-specified surety instrument meet? 1243.100 Section 1243.100 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE SUSPENSIONS PENDING APPEAL AND BONDING-OFFICE OF...

  5. 78 FR 75456 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ...This rule establishes, amends, suspends, or revokes Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure Procedures for operations at certain airports. These regulatory actions are needed because of the adoption of new or revised criteria, or because of changes occurring in the National Airspace System, such as the commissioning of new......

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

    NASA Astrophysics Data System (ADS)

    Kerr, Patricia Reda

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

  7. Catheter-based photoacoustic endoscope

    NASA Astrophysics Data System (ADS)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  8. Minimally invasive (endoscopic-computer assisted) surgery: Technique and review

    PubMed Central

    Kumar, Anand; Yadav, Nirma; Singh, Shipra; Chauhan, Neha

    2016-01-01

    Endoscopic or minimally invasive surgery popular as keyhole surgery is a medical procedure in which endoscope (a camera) is used, and it has gained broad acceptance with popularity in several surgical specialties and has heightened the standard of care. Oral and maxillofacial surgery is a modern discipline in the field of dentistry in which endoscopy has developed as well as widely used in surgeries and is rapidly gaining importance. The use of different visual as well as standard instruments such as laparoscopic and endoscopic instruments, and high-powered magnification devices, has allowed physicians to decrease the morbidity of many surgical procedures by eliminating the need for a large surgical incision. Minimally invasive techniques have evolved through the development of surgical microscopes equipped with a camera to get visual images for maxillofacial surgeries, endodontic procedures, and periodontal surgical procedures. Nevertheless, current experiences and reviewing the literature have intimated that the use of endoscopes, as in different minimally invasive methods, may permit complicated surgeries with less complications, for example, in reconstruction of facial fractures through smaller incisions with less extensive exposure. PMID:28299251

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

    PubMed Central

    Mokkink, LB; Terwee, CB; Knol, DL; Stratford, PW; Alonso, J; Patrick, DL; Bouter, LM; de Vet, HCW

    2006-01-01

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

  10. PC based PLCs and ethernet based fieldbus: the new standard platform for future VLT instrument control

    NASA Astrophysics Data System (ADS)

    Kiekebusch, Mario J.; Lucuix, Christian; Erm, Toomas M.; Chiozzi, Gianluca; Zamparelli, Michele; Kern, Lothar; Brast, Roland; Pirani, Werther; Reiss, Roland; Popovic, Dan; Knudstrup, Jens; Duchateau, Michel; Sandrock, Stefan; Di Lieto, Nicola

    2014-07-01

    ESO is currently in the final phase of the standardization process for PC-based Programmable Logical Controllers (PLCs) as the new platform for the development of control systems for future VLT/VLTI instruments. The standard solution used until now consists of a Local Control Unit (LCU), a VME-based system having a CPU and commercial and proprietary boards. This system includes several layers of software and many thousands of lines of code developed and maintained in house. LCUs have been used for several years as the interface to control instrument functions but now are being replaced by commercial off-the-shelf (COTS) systems based on BECKHOFF Embedded PCs and the EtherCAT fieldbus. ESO is working on the completion of the software framework that enables a seamless integration into the VLT control system in order to be ready to support upcoming instruments like ESPRESSO and ERIS, that will be the first fully VLT compliant instruments using the new standard. The technology evaluation and standardization process has been a long and combined effort of various engineering disciplines like electronics, control and software, working together to define a solution that meets the requirements and minimizes the impact on the observatory operations and maintenance. This paper presents the challenges of the standardization process and the steps involved in such a change. It provides a technical overview of how industrial standards like EtherCAT, OPC-UA, PLCOpen MC and TwinCAT can be used to replace LCU features in various areas like software engineering and programming languages, motion control, time synchronization and astronomical tracking.

  11. Instrumentation, metrology, and standards: key elements for the future of nanomanufacturing

    NASA Astrophysics Data System (ADS)

    Postek, Michael T.; Lyons, Kevin

    2007-09-01

    Nanomanufacturing is the essential bridge between the discoveries of nanoscience and real world nanotech products and is the vehicle by which the Nation and the World will realize the promise of major technological innovation across a spectrum of products that will affect virtually every industrial sector. For nanotech products to achieve the broad impacts envisioned, they must be manufactured in market-appropriate quantities in a reliable, repeatable, economical and commercially viable manner. In addition, they must be manufactured so that environmental and human health concerns are met, worker safety issues are appropriately assessed and handled, and liability issues are addressed. Critical to this realization of robust nanomanufacturing is the development of the necessary instrumentation, metrology, and standards. Integration of the instruments, their interoperability, and appropriate information management are also critical elements that must be considered for viable nanomanufacturing. Advanced instrumentation, metrology and standards will allow the physical dimensions, properties, functionality, and purity of the materials, processes, tools, systems, products, and emissions that will constitute nanomanufacturing to be measured and characterized. This will in turn enable production to be scaleable, controllable, predictable, and repeatable to meet market needs. If a nano-product cannot be measured it cannot be manufactured; additionally if that product cannot be made safely it should not be manufactured. This presentation introduces the Instrumentation, Metrology, and Standards for Nanomanufacturing Conference at the 2007 SPIE Optics and Photonics. This conference will become the leading forum for the exchange of foundational information and discussion of instrumentation, metrology and standards which are key elements for the success of nanomanufacturing.

  12. Endoscopic Endonasal Odontoidectomy.

    PubMed

    Zoli, Matteo; Mazzatenta, Diego; Valluzzi, Adelaide; Mascari, Carmelo; Pasquini, Ernesto; Frank, Giorgio

    2015-07-01

    Odontoidectomy is the treatment of choice for irreducible ventral cervical-medullary compression. The endonasal endoscopic approach is an innovative approach for odontoidectomy. The aim of this article is to identify in which conditions this approach is indicated, discussing variants of the technique for selected cases of craniovertebral malformation with platybasia. We believe that the technical difficulties of this approach are balanced by the advantages for patients. Some conditions related to the patient and to the anatomy of the craniovertebral junction may favor adoption of the endoscopic endonasal approach, which should be considered complementary and not alternative to standard approaches.

  13. Endoscope Reprocessing: Update on Controversial Issues

    PubMed Central

    Choi, Hyun Ho

    2015-01-01

    Several issues concerning endoscope reprocessing remain unresolved based on currently available data. Thus, further studies are required to confirm standard practices including safe endoscope shelf life, proper frequency of replacement of some accessories including water bottles and connecting tubes, and microbiological surveillance testing of endoscopes after reprocessing. The efficacy and cost-effectiveness of newer technology that allows automated cleaning and disinfection is one such controversial issue. In addition, there are no guidelines on whether delayed reprocessing and extended soaking may harm endoscope integrity or increase the bioburden on the external or internal device surfaces. In this review, we discuss the unresolved and controversial issues regarding endoscope reprocessing. PMID:26473115

  14. Catheter-based photoacoustic endoscope

    PubMed Central

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-01-01

    Abstract. We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique’s benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument’s flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system. PMID:24887743

  15. [Endoscopic approaches to the orbit].

    PubMed

    Cebula, H; Lahlou, A; De Battista, J C; Debry, C; Froelich, S

    2010-01-01

    During the last decade, the use of endoscopic endonasal approaches to the pituitary has increased considerably. The endoscopic endonasal and transantral approaches offer a minimally invasive alternative to the classic transcranial or transconjunctival approaches to the medial aspect of the orbit. The medial wall of the orbit, the orbital apex, and the optic canal can be exposed through a middle meatal antrostomy, an anterior and posterior ethmoidectomy, and a sphenoidotomy. The inferomedial wall of the orbit can be also perfectly visualized through a sublabial antrostomy or an inferior meatal antrostomy. Several reports have described the use of an endoscopic approach for the resection or the biopsy of lesions located on the medial extraconal aspect of the orbit and orbital apex. However, the resection of intraconal lesions is still limited by inadequate instrumentation. Other indications for the endoscopic approach to the orbit are the decompression of the orbit for Graves' ophthalmopathy and traumatic optic neuropathy. However, the optimal management of traumatic optic neuropathy remains very controversial. Endoscopic endonasal decompression of the optic nerve in case of tumor compression could be a more valid indication in combination with radiation therapy. Finally, the endoscopic transantral treatment of blowout fracture of the floor of the orbit is an interesting option that avoids the eyelid or conjunctive incision of traditional approaches. The collaboration between the neurosurgeon and the ENT surgeon is mandatory and reduces the morbidity of the approach. Progress in instrumentation and optical devices will certainly make this approach promising for intraconal tumor of the orbit.

  16. Primary endoscopic management of the frontal sinus.

    PubMed

    Kuhn, F A; Javer, A R

    2001-02-01

    Surgical treatment of the frontal sinus continues to be an area of much interest and controversy. The complex anatomy and confined space of this region require the endoscopic surgeon to be knowledgeable and delicate to obtain a positive result. Proper instrumentation is crucial and continues to evolve over time. Postoperative endoscopic care is integral to the success of endoscopic frontal sinusotomy and the availability of proper office equipment to perform this care is critical. In most instances, the intranasal endoscopic approach can be accomplished successfully without the need for an external procedure.

  17. Pragmatics of Policy: The Compliance of Dutch Environmental Policy Instruments to European Union Standards

    NASA Astrophysics Data System (ADS)

    Kruitwagen, Sonja; Reudink, Melchert; Faber, Albert

    2009-04-01

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

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

    PubMed

    Kruitwagen, Sonja; Reudink, Melchert; Faber, Albert

    2009-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-08-01

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

  20. Endoscopic calcaneoplasty.

    PubMed

    Jerosch, Joerg

    2015-03-01

    Opinions differ regarding the surgical treatment of posterior calcaneal exostosis. After failure of conservative treatment, open surgical bursectomy and resection of the calcaneal prominence is indicated by many investigators. Clinical studies have shown high rates of unsatisfactory results and complications. Endoscopic calcaneoplasty (ECP) is a minimally invasive surgical option that can avoid some of these obstacles. ECP is an effective procedure for the treatment of patients with posterior calcaneal exostosis. The endoscopic exposure is superior to the open technique and has less morbidity, less operating time, fewer complications, and the disorders can be better differentiated.

  1. Endoscopic retrograde cholangio pancreatography (ERCP) - series (image)

    MedlinePlus

    Gallstones usually form in the gallbladder. Gallstones sometimes pass from the gallbladder into the common bile duct, ... viewed through the endoscope. Next, the surgeon can pass a special instrument on the end of the ...

  2. Multivariate calibration and instrument standardization for the rapid detection of diethylene glycol in glycerin by Raman spectroscopy.

    PubMed

    Gryniewicz-Ruzicka, Connie M; Arzhantsev, Sergey; Pelster, Lindsey N; Westenberger, Benjamin J; Buhse, Lucinda F; Kauffman, John F

    2011-03-01

    The transfer of a multivariate calibration model for quantitative determination of diethylene glycol (DEG) contaminant in pharmaceutical-grade glycerin between five portable Raman spectrometers was accomplished using piecewise direct standardization (PDS). The calibration set was developed using a multi-range ternary mixture design with successively reduced impurity concentration ranges. It was found that optimal selection of calibration transfer standards using the Kennard-Stone algorithm also required application of the algorithm to multiple successively reduced impurity concentration ranges. Partial least squares (PLS) calibration models were developed using the calibration set measured independently on each of the five spectrometers. The performance of the models was evaluated based on the root mean square error of prediction (RMSEP), calculated using independent validation samples. An F-test showed that no statistical differences in the variances were observed between models developed on different instruments. Direct cross-instrument prediction without standardization was performed between a single primary instrument and each of the four secondary instruments to evaluate the robustness of the primary instrument calibration model. Significant increases in the RMSEP values for the secondary instruments were observed due to instrument variability. Application of piecewise direct standardization using the optimal calibration transfer subset resulted in the lowest values of RMSEP for the secondary instruments. Using the optimal calibration transfer subset, an optimized calibration model was developed using a subset of the original calibration set, resulting in a DEG detection limit of 0.32% across all five instruments.

  3. 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).

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  5. Performance-based standards: safety instrumented functions and safety integrity levels.

    PubMed

    Stavrianidis, P; Bhimavarapu, K

    2000-01-07

    This paper discusses two international performance-based standards, ANSI/ISA S84.01 and IEC d61508 and the requirements they place upon companies that rely on electrical, electronic and programmable electronic systems to perform safety functions. Performance-based regulations are also discussed and common safety elements between the standards and regulations are identified. Several risk analysis techniques that can be used to comply with the aforementioned requirements are discussed and a simple example is used to illustrate the use, advantages and disadvantages of the techniques. The evaluation of safety integrity level (SIL) of the Safety Instrumented System (SIS) in terms of the probability to fail to function is outside the scope of this paper.

  6. Fluorescence Instrument Response Standards in Two-Photon Time-Resolved Spectroscopy

    PubMed Central

    LUCHOWSKI, RAFAL; SZABELSKI, MARIUSZ; SARKAR, PABAK; APICELLA, ELISA; MIDDE, KRISHNA; RAUT, SANGRAM; BOREJDO, JULIAN; GRYCZYNSKI, ZYGMUNT; GRYCZYNSKI, IGNACY

    2011-01-01

    We studied the fluorescence properties of several potential picosecond lifetime standards suitable for two-photon excitation from a Ti : sapphire femtosecond laser. The fluorescence emission of the selected fluorophores (rose bengal, pyridine 1, and LDS 798) covered the visible to near-infrared wavelength range from 550 to 850 nm. We suggest that these compounds can be used to measure the appropriate instrument response functions needed for accurate deconvolution of fluorescence lifetime data. Lifetime measurements with multiphoton excitation that use scatterers as a reference may fail to properly resolve fluorescence intensity decays. This is because of the different sensitivities of photodetectors in different spectral regions. Also, detectors often lose sensitivity in the near-infrared region. We demonstrate that the proposed references allow a proper reconvolution of measured lifetimes. We believe that picosecond lifetime standards for two-photon excitation will find broad applications in multiphoton spectroscopy and in fluorescence lifetime imaging microscopy (FLIM). PMID:20719056

  7. Advances in the use of odour as forensic evidence through optimizing and standardizing instruments and canines

    PubMed Central

    Furton, Kenneth G.; Caraballo, Norma Iris; Cerreta, Michelle M.; Holness, Howard K.

    2015-01-01

    This paper explores the advances made in identifying trace amounts of volatile organic compounds (VOCs) that originate from forensic specimens, such as drugs, explosives, live human scent and the scent of death, as well as the probative value for detecting such odours. The ability to locate and identify the VOCs liberated from or left by forensic substances is of increasing importance to criminal investigations as it can indicate the presence of contraband and/or associate an individual to a particular location or object. Although instruments have improved significantly in recent decades—with sensitivities now rivalling that of biological detectors—it is widely recognized that canines are generally still more superior for the detection of odourants due to their speed, versatility, ruggedness and discriminating power. Through advancements in the detection of VOCs, as well as increased standardization efforts for instruments and canines, the reliability of odour as evidence has continuously improved and is likely to continue to do so. Moreover, several legal cases in which this novel form of evidence has been accepted into US courts of law are discussed. As the development and implementation of best practice guidelines for canines and instruments increase, their reliability in detecting VOCs of interest should continue to improve, expanding the use of odour as an acceptable form of forensic evidence. PMID:26101287

  8. Advances in the use of odour as forensic evidence through optimizing and standardizing instruments and canines.

    PubMed

    Furton, Kenneth G; Caraballo, Norma Iris; Cerreta, Michelle M; Holness, Howard K

    2015-08-05

    This paper explores the advances made in identifying trace amounts of volatile organic compounds (VOCs) that originate from forensic specimens, such as drugs, explosives, live human scent and the scent of death, as well as the probative value for detecting such odours. The ability to locate and identify the VOCs liberated from or left by forensic substances is of increasing importance to criminal investigations as it can indicate the presence of contraband and/or associate an individual to a particular location or object. Although instruments have improved significantly in recent decades-with sensitivities now rivalling that of biological detectors-it is widely recognized that canines are generally still more superior for the detection of odourants due to their speed, versatility, ruggedness and discriminating power. Through advancements in the detection of VOCs, as well as increased standardization efforts for instruments and canines, the reliability of odour as evidence has continuously improved and is likely to continue to do so. Moreover, several legal cases in which this novel form of evidence has been accepted into US courts of law are discussed. As the development and implementation of best practice guidelines for canines and instruments increase, their reliability in detecting VOCs of interest should continue to improve, expanding the use of odour as an acceptable form of forensic evidence.

  9. Using the World Primary Standard Dobson Spectrometer to Monitor the Stability of a Multi-Instrument Satellite Ozone Dataset

    NASA Technical Reports Server (NTRS)

    McPeters, R.D.; Oltmans, Samuel J.

    2000-01-01

    NASA is creating a long term satellite ozone time series by combining data from multiple instruments: Nimbus 7 Total Ozone Mapping Spectrometer (TOMS) (1978 - 1993), Meteor 3 TOMS (1991 - 1994), Earth Probe TOMS (1996 - present), Nimbus 7 SB-JV (1978 - 1990), NOAA-9 Solar Backscatter UV Spectrometer (SBUV/2) (1984 - 1997), NOAA-11 SBUV/2 (1989 - 1994), and NOAA-14 SBUV/2 (1995 - present). The stability of individual data sets and possible instrument-to-instrument differences are best checked by comparison with ground-based measurements. We have examined the time dependence of the calibrations of these instruments by comparing satellite derived ozone with that measured by the world primary standard Dobson spectrometer No. 83. This instrument has been maintained since 1962 as a standard for total ozone to an uncertainty of plus or minus 0.5%. Measurements of AD pair ozone made with instrument No. 83 at Mauna Loa observatory most summers since 1979 were compared with coincident TOMS and SBUV(/2) ozone measurements. The comparison shows that the various instruments were stable relative to instrument No. 83 to within about plus or minus 1%, but that there are instrument-to-instrument biases of as much as 3%. Earth Probe TOMS, for example, is 1% to 2% high relative to Nimbus 7 TOMS when the world standard instrument is used as a transfer standard. Similar results are seen when comparisons are made with an ensemble of 41 Dobson stations throughout the world, demonstrating that the ensemble as a whole is stable despite the fact that many instruments within the ensemble have clear calibration changes.

  10. The Ability of Standardized Test Instruments to Predict Training Success and Employment Success. Project MINI-SCORE, Final Technical Report.

    ERIC Educational Resources Information Center

    Pucel, David J.; And Others

    Using post-secondary vocational and technical education students as the populations, the objectives of this project were to determine: (1) the ability of standardized instruments to predict the various criteria of success, (2) the relative ability of the different instruments to predict each criterion of success, and (3) which sub-set of all of…

  11. Implementation of real-time digital endoscopic image processing system

    NASA Astrophysics Data System (ADS)

    Song, Chul Gyu; Lee, Young Mook; Lee, Sang Min; Kim, Won Ky; Lee, Jae Ho; Lee, Myoung Ho

    1997-10-01

    Endoscopy has become a crucial diagnostic and therapeutic procedure in clinical areas. Over the past four years, we have developed a computerized system to record and store clinical data pertaining to endoscopic surgery of laparascopic cholecystectomy, pelviscopic endometriosis, and surgical arthroscopy. In this study, we developed a computer system, which is composed of a frame grabber, a sound board, a VCR control board, a LAN card and EDMS. Also, computer system controls peripheral instruments such as a color video printer, a video cassette recorder, and endoscopic input/output signals. Digital endoscopic data management system is based on open architecture and a set of widely available industry standards; namely Microsoft Windows as an operating system, TCP/IP as a network protocol and a time sequential database that handles both images and speech. For the purpose of data storage, we used MOD and CD- R. Digital endoscopic system was designed to be able to store, recreate, change, and compress signals and medical images. Computerized endoscopy enables us to generate and manipulate the original visual document, making it accessible to a virtually unlimited number of physicians.

  12. [Endoscopic surgery].

    PubMed

    Rushfeldt, Christian; Pham, Khanh Do-Cong; Aabakken, Lars

    2016-05-01

    Endoscopic surgery of the stomach/gastrointestinal tract was developed in the 1990s in Japan as a minimally invasive method of removing early-stage tumours, using a gastro-/coloscope instead of open or laparoscopic surgery. Its advantages are obvious, in that the patient is spared more major surgery, the hospital saves on resources as well as admission to a ward, and society is spared the costs of days of sickness absence. Endoscopic submucosal dissection is considered the most difficult technique, but it allows for the accurate dissection of large tumours. In 1999, Japanese surgeon Takuji Gotoda and his team were the first to perform these types of dissections of early cancers in the rectum using a diathermic needle and a flexible scope.

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

    PubMed

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

    2016-01-13

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

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

  15. Complications of endoscopic ultrasonography.

    PubMed

    Fabbri, C; Luigiano, C; Cennamo, V; Ferrara, F; Pellicano, R; Polifemo, A M; Tarantino, I; Barresi, L; Morace, C; Consolo, P; D'Imperio, N

    2011-06-01

    Since its development in the 1980s, endoscopic ultrasonography (EUS) has undergone a great deal of technological modifications. EUS has become an important tool in the evaluation of patients with various clinical disorders and is increasingly being utilized in many centers. EUS has been evolving over the years; EUS-guided fine needle aspiration (FNA) for cytological and/or histological diagnosis has become standard practice and a wide array of interventional and therapeutic procedures are performed under EUS guidance for diseases which otherwise would have needed surgery, with its associated morbidities. EUS shares the risks and complications of other endoscopic procedures. This article addresses the specific adverse effects and risks associated with EUS, EUS-FNA and interventional EUS, namely perforation, bleeding, pancreatitis and infection. Measures to help minimizing these risks will also be discussed.

  16. Pilot performance during a simulated standard instrument procedure turn with and without a predictor display

    NASA Technical Reports Server (NTRS)

    Kreifeldt, J. G.; Wempe, T.

    1973-01-01

    A simulator study was conducted to measure the effectiveness of predictor information incorporated into a CRT display of a computer simulated aircraft's horizontal and vertical situation. Professional pilots served as subjects for the task of executing a standard instrument procedure turn at constant altitude in constant crosswinds with and without their predicted ground track displayed. The results show that the display with the predicted ground track was markedly and significantly superior to the display without this information and that the subjects were generally satisfied with this type of information. Mean rms lateral path error was independent of the crosswind velocity with the predictor information, and increased without it with increasing wind velocity. Rms stick activity decreased with the predictor display which also uncoupled aileron and elevator activity.

  17. Pilot performance during a simulated standard instrument procedure turn with and without a predictor display

    NASA Technical Reports Server (NTRS)

    Kreifeldt, J. G.; Wempe, T.

    1973-01-01

    A simulator study was conducted to measure the effectiveness of predictor information incorporated into a CRT display of a computer simulated aircraft's horizontal and vertical situation. Professional pilots served as subjects for the task of executing a standard instrument procedure turn at constant altitude in constant crosswinds with and without their predicted ground track displayed. The results showed that the display with the predicted ground track was markedly and significantly superior to the display without this information and that the subjects were generally satisfied with this type of information. Mean rms lateral path error was independent of the crosswind velocity with the predictor information, and increased without it and with increasing wind velocity. Rms stick activity decreased with the predictor display which also uncoupled aileron and elevator activity.

  18. Development of silicon microforce sensors integrated with double meander springs for standard hardness test instruments

    NASA Astrophysics Data System (ADS)

    Wasisto, Hutomo Suryo; Doering, Lutz; Daus, Alwin; Brand, Uwe; Frank, Thomas; Peiner, Erwin

    2015-05-01

    Silicon microforce sensors, to be used as a transferable standard for micro force and depth scale calibrations of hardness testing instruments, are developed using silicon bulk micromachining technologies. Instead of wet chemical etching, inductively coupled plasma (ICP) cryogenic deep reactive ion etching (DRIE) is employed in the sensor fabrication process leading to more precise control of 300 μm deep structures with smooth sidewall profiles. Double meander springs are designed flanking to the boss replacing the conventional rectangular springs and thereby improving the system linearity. Two full p-SOI piezoresistive Wheatstone bridges are added on both clamped ends of the active sensors. To realize passive force sensors two spring-mass elements are stacked using glue and photoresist as joining materials. Correspondingly, although plastic deformation seems to occur when the second spring is contacted, the kink effect (i.e., abrupt increase of stiffness) is obviously observed from the first test of the passive stack sensor.

  19. ISO 18812--a worldwide standard for the online-connection of analytical instruments to laboratory information systems.

    PubMed

    Fraterman, Arno

    2004-01-01

    In the past there were many attempts to standardize the interface from analytical instruments to laboratory-information-systems. Most of these attempts were national. The international standardisation bodies CEN and ISO have now developed an international standard that is presented here.

  20. Recent development in multifunctional endoscope

    NASA Astrophysics Data System (ADS)

    Gono, Kazuhiro

    2008-02-01

    We have developed the novel video endoscope imaging techniques; Narrow band imaging (NBI), Auto-Fluorescence Imaging (AFI), Infra-Red Imaging (IRI) and Endo-Cytoscopy System (ECS). The purpose of these imaging techniques is to emphasize the important tissue features associated with early stage of lesions. We have already launched the new medical endoscope system including NBI, AFI and IRI (EVIS LUCERA SPECTRUM, OLYMPUS MEDICAL SYSTEMS Co., Ltd., Fig.1). Moreover ECS, which has enough magnification to observe cell nuclei on a superficial mucosa under methylene blue dye staining, is the endoscopic instrument with ultra-high optical zoom. In this paper we demonstrate the concepts and the medical efficacy of each technology.

  1. Comparison between blinded and partially blinded detection of gastric cancer with multidetector CT using surgery and endoscopic submucosal dissection as reference standards.

    PubMed

    Kim, H J; Lee, D H; Ko, Y T

    2010-08-01

    The aim of this study is to compare blinded with partially blinded detection of gastric cancer with multidetector (MD) CT by using surgery and endoscopic submucosal dissection (ESD) as reference standards. 44 patients with gastric cancer underwent MDCT with air as an oral contrast agent. Surgery was performed on 37 patients, ESD on six and surgery after ESD on one. To provide comparison cases of blinded evaluation, 38 MDCT examinations were added for cases where no focal gastric lesion was seen on endoscopy. Two radiologists, blinded to the presence, number and location of the tumours, evaluated axial and axial plus multiplanar reformation (MPR) images of 82 MDCT examinations with or without gastric cancer. For partially blinded evaluation, the same radiologists, blinded to the location and number of tumours, evaluated axial and axial plus MPR images of 44 MDCT examinations of gastric cancer. Differences in assessment were resolved by consensus. 45 gastric cancers were found in surgical and ESD specimens. Detection rates of gastric cancer from axial and axial plus MPR images during blinded evaluation and from axial and axial plus MPR images during partially blinded evaluation were 62% (28/45), 64% (29/45), 64% (29/45) and 71% (32/45), respectively. There was no statistical significance for the comparison between blinded and partially blinded detection rates of gastric cancer. The detection rate of gastric cancer with MDCT during blinded evaluation showed no specific difference compared with the detection rate of gastric cancer with MDCT during partially blinded evaluation.

  2. Standardized assessment instruments for minimally-responsive, brain-injured patients.

    PubMed

    O'Dell, M W; Jasin, P; Lyons, N; Stivers, M; Meszaros, F

    1996-01-01

    Among the most significant advances in the care and rehabilitation of severely brain injured, minimally-responsive patients (MRP) has been the development of standardized assessment scales. Currently available instruments include the Coma/Near Coma Scale (CNC), Coma Recovery Scale (CRS), Sensory Stimulation Assessment Measure (SSAM), and the Western Neuro Sensory Stimulation Profile (WNSSP). Each scale is reviewed in terms of content, psychometric properties, and clinical attributes. Data is then presented comparing converted, percentile admission scores for the CRS, WNSSP, and CNC in a group of ten MRP at Rancho Levels II-IV, with a mean age of 31 years and mean time from injury of 37.5 days. Admission CNC and CRS scores tended to group in the middle range, while WNSSP scores tended to group in the lower quartile. This suggests the potential concern for 'floor effect' with the WNSSP. At admission, none of the three scales was able to effectively distinguish between dichotomized outcome variables: disposition (home vs. nursing home), advancement to active rehabilitation, or discharge Functional Independence Measure score (> 80 vs. < 80). The data indicate the CRS demonstrates moderately strong relationships with both the CNC and WNSSP. Full delineation of how these scales relate to one another awaits both cross-sectional and longitudinal analyses in larger samples and should include the SSAM.

  3. Endoscopic egomotion computation

    NASA Astrophysics Data System (ADS)

    Bergen, Tobias; Ruthotto, Steffen; Rupp, Stephan; Winter, Christian; Münzenmayer, Christian

    2010-03-01

    Computer assistance in Minimally Invasive Surgery is a very active field of research. Many systems designed for Computer Assisted Surgery require information about the instruments' positions and orientations. Our main focus lies on tracking a laparoscopic ultrasound probe to generate 3D ultrasound volumes. State-of-the-art tracking methods such as optical or electromagnetic tracking systems measure pose with respect to a fixed extra-body coordinate system. This causes inaccuracies of the reconstructed ultrasound volume in the case of patient motion, e.g. due to respiration. We propose attaching an endoscopic camera to the ultrasound probe and calculating the camera motion from the video sequence with respect to the organ surface. We adapt algorithms developed for solving the relative pose problem to recreate the camera path during the ultrasound sweep over the organ. By this image-based motion estimation camera motion can only be determined up to an unknown scale factor, known as the depth-speed-ambiguity. We show, how this problem can be overcome in the given scenario, exploiting the fact, that the distance of the camera to the organ surface is fixed and known. Preprocessing steps are applied to compensate for endoscopic image quality deficiencies.

  4. 78 FR 23260 - Request for Measures and Domains To Use in Development of a Standardized Instrument for Use in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-18

    ... Development of a Standardized Instrument for Use in Public Reporting of the Quality of Transition From Child... development of this survey and its dissemination for AHRQ purposes. The statement must also address the... development AHRQ will request that the submitter execute a license granting all of the above-referenced...

  5. A standardized non-instrumental tool for characterizing workstations concerned with exposure to engineered nanomaterials

    NASA Astrophysics Data System (ADS)

    Canu I, Guseva; C, Ducros; S, Ducamp; L, Delabre; S, Audignon-Durand; C, Durand; Y, Iwatsubo; D, Jezewski-Serra; Bihan O, Le; S, Malard; A, Radauceanu; M, Reynier; M, Ricaud; O, Witschger

    2015-05-01

    The French national epidemiological surveillance program EpiNano aims at surveying mid- and long-term health effects possibly related with occupational exposure to either carbon nanotubes or titanium dioxide nanoparticles (TiO2). EpiNano is limited to workers potentially exposed to these nanomaterials including their aggregates and agglomerates. In order to identify those workers during the in-field industrial hygiene visits, a standardized non-instrumental method is necessary especially for epidemiologists and occupational physicians unfamiliar with nanoparticle and nanomaterial exposure metrology. A working group, Quintet ExpoNano, including national experts in nanomaterial metrology and occupational hygiene reviewed available methods, resources and their practice in order to develop a standardized tool for conducting company industrial hygiene visits and collecting necessary information. This tool, entitled “Onsite technical logbook”, includes 3 parts: company, workplace, and workstation allowing a detailed description of each task, process and exposure surrounding conditions. This logbook is intended to be completed during the company industrial hygiene visit. Each visit is conducted jointly by an industrial hygienist and an epidemiologist of the program and lasts one or two days depending on the company size. When all collected information is computerized using friendly-using software, it is possible to classify workstations with respect to their potential direct and/or indirect exposure. Workers appointed to workstations classified as concerned with exposure are considered as eligible for EpiNano program and invited to participate. Since January 2014, the Onsite technical logbook has been used in ten company visits. The companies visited were mostly involved in research and development. A total of 53 workstations with potential exposure to nanomaterials were pre-selected and observed: 5 with TiO2, 16 with single-walled carbon nanotubes, 27 multiwalled

  6. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  7. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  8. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  9. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  10. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  11. A noncontact laser-guided system for endoscopic computer-assisted sinus surgery.

    PubMed

    Khan, Martin; Kosmecki, Barotsz; Reutter, Andreas; Ozbek, Christopher; Keeve, Erwin; Olze, Heidi

    2012-09-01

    The limited size of the nose leads to frequent instrument changes in navigated endonasal sinus surgery. Tracked instruments provide limited accuracy, and the pointer gives no navigation information during tissue removal. To overcome information loss, laser triangulation was integrated into navigation information. Accuracy and reliability of the laser-assisted distance-measuring system were evaluated within the distance of 0 and 20 mm. System accuracy of the laser endoscope was compared with a standard pointer using registration via bone screws and surface matching. Accuracy of the laser was 0.12 mm ± 0.12 mm with a reliability of 0.2 mm. The system accuracy of the laser endoscope was 0.59 mm ± 0.16 mm using bone screw registration and 0.64 mm ± 0.22 mm using surface matching. Additionally, laser endoscope is more accurate compared with the pointer using bone screw registration. Overall, navigation information was successfully integrated into an endoscope by laser triangulation with encouraging results.

  12. Endoscopic thyroidectomy: the transoral approach

    PubMed Central

    Hellinger, Achim; Kaminski, Cornelia; Benhidjeb, Tahar

    2016-01-01

    Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques—so called hybrid techniques—might be useful for our patients. PMID:27294042

  13. [Preventive effect of postoperative disinfection of endoscope on bacterial adhesion to endoscope].

    PubMed

    Uwagawa, T; Okabe, N; Matsumoto, T; Kurihara, H; Miyamoto, S; Tujihara, Y; Takahashi, T; Sakurai, I; Matsumoto, F; Yamazaki, Y

    1999-10-01

    We took culture of throat swab from 77 subjects who were negative for infection of HBV, HCV, HIV and syphilis infection before and after endoscopy. Moreover, the existence of bacterium including Helicobacter pylori at overcoat of endoscopic instrument was investigated right after examination and after disinfection of endoscope. Povidoneiodine, 70% alcohol and 1% benzalkonium chloride was used as a disinfectant for endoscope, and it took less than 10 minutes to wash by hand to disinfection. alpha-haemolytic streptococci, Staphylococcus epidermids, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida, Pseudomonas aeruginosa and MRSA were cultured in throat swab. The rate of adhesion of bacterium especially such as Candida, K. pneumoniae and S. epidermids to endoscope was considerably high. 23 of 77 subjects had H. pylori infection, and the adhesion of H. pylori to endoscope was found to be 65.2% of the subjects. On the contrast, no bacterium was detected from the endoscopic instrument after careful disinfection. These findings stress the importance of postoperative disinfection of the endoscope to prevent the chance to acquire bacterial infection.

  14. Endoscopic Endonasal Transsphenoidal Approach

    PubMed Central

    Cappabianca, Paolo; Alfieri, Alessandra; Colao, Annamaria; Ferone, Diego; Lombardi, Gaetano; de Divitiis, Enrico

    1999-01-01

    The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach (TTA) in 20 subjects. Among the 10 individuals subjected to “pure endoscopy,” 2 had a microadenoma, 1 an intrasellar macroadenoma, 4 had a macroadenoma with suprasellar expansion, 2 had a macroadenoma with supra-parasellar expansion, and 1 a residual tumor; 5 had acromegaly and 5 had a nonfunctioning adenoma (NFA). Among the patients subjected to TTA, 4 had a microadenoma, 2 had an intrasellar macroadenoma, 6 had a macroadenoma with suprasellar expansion, 4 had a macroadenoma with supra-parasellar expansion, and 4 had a residual tumor; 9 patients had acromegaly, 1 hyperprolactinemia, 1 Cushing's disease, and 9 a NFA. At the macroscopic evaluation, tumor removal was total (100%) after endoscopy in 9 patients and after TTA in 14 patients. Six months after surgery, magnetic resonance imaging (MRI) confirmed the total tumor removal in 21 of 23 patients (91.3%). Circulating growth hormone (GH) and insulin-like growth factor-I (IGF-I) significantly decreased 6 months after surgery in all 14 acromegalic patients: normalization of plasma IGF-I levels was obtained in 4 of 5 patients after the endoscopic procedure and in 4 of 9 patients after TTA. Before surgery, pituitary hormone deficiency was present in 14 out of 30 patients: pituitary function improved in 4 patients, remaining unchanged in the other 10 patients. Visual field defects were present before surgery in 4 patients, and improved in all. Early surgical results in the group of 10 patients who underwent endoscopic pituitary tumor removal were at least equivalent to those of standard TTA, with excellent postoperative course. Postsurgical hospital stay was significantly shorter (3.1 ± 0.4 vs. 6.2 ± 0.3 days, p < 0.001) after endoscopy as compared to TTA. ImagesFigure 1Figure 2 PMID:17171126

  15. Motion control solution for new PLC-based standard development platform for VLT instrument control systems

    NASA Astrophysics Data System (ADS)

    Popovic, D.; Brast, R.; Di Lieto, N.; Kiekebusch, M.; Knudstrup, J.; Lucuix, C.

    2014-07-01

    More than a decade ago, due to obsolescence issues, ESO initiated the design and implementation of a custom-made CANbus based motion controller (CAN-RMC) to provide, together with a tailor-made software library (motor library), the motion control capabilities for the VME platform needed for the second generation VLT/VLTI instruments. The CAN-RMC controller has been successfully used in a number of VLT instruments but it has high production costs compared to the commercial off-the-shelf (COTS) industrial solutions available on the market today. In the scope of the selection of a new PLC-based platform for the VLT instrument control systems, ESO has evaluated motion control solutions from the company Beckhoff. This paper presents the investigation, implementation and testing of the PLC/TwinCAT/EtherCAT motion controllers for DC and stepper motors and their adaptation and integration into the VLT instrumentation framework. It reports functional and performance test results for the most typical use cases of astronomical instruments like initialization sequences, tracking, switch position detections, backslash compensation, brake handling, etc. In addition, it gives an overview of the main features of TwinCAT NC/PTP, PLCopen MC, EtherCAT motion control terminals and the engineering tools like TwinCAT Scope that are integrated into the development environment and simplify software development, testing and commissioning of motorized instrument functions.

  16. Endoscopic submucosal dissection for early esophageal cancer associated with achalasia.

    PubMed

    Ohkura, Yu; Iizuka, Toshiro; Kikuchi, Daisuke; Yamashita, Satoshi; Nakamura, Masanori; Matsui, Akira; Mitani, Toshifumi; Hoteya, Shu; Kaise, Mitsuru; Yahagi, Naohisa

    2013-01-01

    Esophageal achalasia is often associated with esophageal cancer. However, in many cases, esophageal cancer tends to be found in an advanced stage, with a poor prognosis. However, early-stage cancer was detected recently due to the advances in endoscopic instruments. In those cases, it is important to facilitate successful treatment by endoscopic submucosal dissection. We analyzed a total of six cases of esophageal cancer with achalasia in four patients treated with endoscopic submucosal dissection. Three features common to all six cases had a bearing on how endoscopic submucosal dissection was performed. First, esophageal dilatation and diminished peristalsis facilitated the performance of successful endoscopic submucosal dissection. Second, the esophageal wall was thickened, primarily with muscular tissue. Third, the submucosal layer contained abundant blood vessels that made it difficult to minimize bleeding during dissection. Those findings suggest that endoscopic submucosal dissection for early esophageal cancer associated with achalasia is a safe and potentially curative procedure. It is important, therefore, to detect esophageal cancer early.

  17. Endoscopic simple prostatectomy

    PubMed Central

    Borkowski, Tomasz; Chłosta, Piotr; Dobruch, Jakub; Fiutowski, Marek; Jaskulski, Jarosław; Słojewski, Marcin; Szydełko, Tomasz; Szymański, Michał; Demkow, Tomasz

    2014-01-01

    Introduction Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH. Material and methods We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH. Results Laparoscopic adenomectomy (LA) and robotic–assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work. Conclusions Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH. PMID:25667758

  18. A concha bullosa crusher for use in endoscopic sinus surgery.

    PubMed

    Woolford, T J; Jones, N S

    2000-03-01

    A concha bullosa may require surgical reduction to facilitate access to the middle meatus during endoscopic sinus surgery. Here we describe an original instrument which enables this procedure to be performed simply with minimal mucosal damage.

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

    ERIC Educational Resources Information Center

    Martinez, Edwin E.

    2012-01-01

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

  20. Orbital endoscopic surgery.

    PubMed

    Prabhakaran, Venkatesh C; Selva, Dinesh

    2008-01-01

    Minimally invasive "keyhole" surgery performed using endoscopic visualization is increasing in popularity and is being used by almost all surgical subspecialties. Within ophthalmology, however, endoscopic surgery is not commonly performed and there is little literature on the use of the endoscope in orbital surgery. Transorbital use of the endoscope can greatly aid in visualizing orbital roof lesions and minimizing the need for bone removal. The endoscope is also useful during decompression procedures and as a teaching aid to train orbital surgeons. In this article, we review the history of endoscopic orbital surgery and provide an overview of the technique and describe situations where the endoscope can act as a useful adjunct to orbital surgery.

  1. Analysis of the color rendition of flexible endoscopes

    NASA Astrophysics Data System (ADS)

    Murphy, Edward M.; Hegarty, Francis J.; McMahon, Barry P.; Boyle, Gerard

    2003-03-01

    Endoscopes are imaging devices routinely used for the diagnosis of disease within the human digestive tract. Light is transmitted into the body cavity via incoherent fibreoptic bundles and is controlled by a light feedback system. Fibreoptic endoscopes use coherent fibreoptic bundles to provide the clinician with an image. It is also possible to couple fibreoptic endoscopes to a clip-on video camera. Video endoscopes consist of a small CCD camera, which is inserted into gastrointestinal tract, and associated image processor to convert the signal to analogue RGB video signals. Images from both types of endoscope are displayed on standard video monitors. Diagnosis is dependent upon being able to determine changes in the structure and colour of tissues and biological fluids, and therefore is dependent upon the ability of the endoscope to reproduce the colour of these tissues and fluids with fidelity. This study investigates the colour reproduction of flexible optical and video endoscopes. Fibreoptic and video endoscopes alter image colour characteristics in different ways. The colour rendition of fibreoptic endoscopes was assessed by coupling them to a video camera and applying video colorimetric techniques. These techniques were then used on video endoscopes to assess how the colour rendition of video endoscopes compared with that of optical endoscopes. In both cases results were obtained at fixed illumination settings. Video endoscopes were then assessed with varying levels of illumination. Initial results show that at constant luminance endoscopy systems introduce non-linear shifts in colour. Techniques for examining how this colour shift varies with illumination intensity were developed and both methodology and results will be presented. We conclude that more rigorous quality assurance is required to reduce colour error and are developing calibration procedures applicable to medical endoscopes.

  2. Foveated endoscopic lens

    PubMed Central

    Hagen, Nathan

    2012-01-01

    Abstract. We present a foveated miniature endoscopic lens implemented by amplifying the optical distortion of the lens. The resulting system provides a high-resolution region in the central field of view and low resolution in the outer fields, such that a standard imaging fiber bundle can provide both the high resolution needed to determine tissue health and the wide field of view needed to determine the location within the inspected organ. Our proof of concept device achieves 7∼8  μm resolution in the fovea and an overall field of view of 4.6 mm. Example images and videos show the foveated lens’ capabilities. PMID:22463022

  3. 78 FR 68702 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... Administration (NARA). For information on the availability of this material at NARA, call 202-741- 6030, or go to.... FOR FURTHER INFORMATION CONTACT: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420), Flight Technologies and Programs Divisions, Flight Standards Service, Federal Aviation...

  4. 78 FR 78713 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... Administration (NARA). For information on the availability of this material at NARA, call 202-741- 6030, or go to.... FOR FURTHER INFORMATION CONTACT: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420), Flight Technologies and Programs Divisions, Flight Standards Service, Federal Aviation...

  5. Recent traction methods for endoscopic submucosal dissection

    PubMed Central

    Tsuji, Kunihiro; Yoshida, Naohiro; Nakanishi, Hiroyoshi; Takemura, Kenichi; Yamada, Shinya; Doyama, Hisashi

    2016-01-01

    Endoscopic mucosal resection (EMR) is problematic with regard to en bloc and curable resection rates. Advancements in endoscopic techniques have enabled novel endoscopic approaches such as endoscopic submucosal dissection (ESD), which has overcome some EMR problems, and has become the standard treatment for gastrointestinal tumors. However, ESD is technically difficult. Procedure time is longer and complications such as intraoperative perforation and bleeding occur more frequently than in EMR. Recently various traction methods have been introduced to facilitate ESD procedures, such as clip with line, external forceps, clip and snare, internal traction, double scope, and magnetic anchor. Each method must be used appropriately according to the anatomical characteristics. In this review we discuss recently proposed traction methods for ESD based on the characteristics of various anatomical sites. PMID:27468186

  6. National Institute of Standards and Technology - Texas instruments industrial collaboratory testbed.

    SciTech Connect

    Postek, M. T.

    1998-10-29

    A portion of the mission of the NIST Manufacturing Engineering Laboratory (MEL) is to improve and advance length metrology in aid of U.S. Industry. This responsibility is found within the Precision Engineering Division (PED). The successful development of a ''Collaborator'' for TelePresence Microscopy provides an important new tool to promote technology transfer in the area of length metrology and measurement technology. NIST and Texas Instruments under the auspices of the National Automated Manufacturing Testbed (NAMT) and in collaboration with the University of Illinois are developing a microscopy collaborator testbed to demonstrate the value of telepresence microscopy within a large distributed manufacturing facility such as Texas Instruments and between organizations such as NET, Texas Instruments and Universities. Telepresence Microscopy is an application of the state-of-the-art Internet based technology to long-distance scientific endeavors. Long distance can refer to across the country or from one site within a company to another. Telepresence is currently being applied to electron microscopy in several locations where unique analytical facilities (such as those at NIST) can be utilized via Internet connection. Potentially this can provide tremendous savings to a company where asset sharing can now be rapidly and effectively accessed or remote unique facilities can be utilized without the requirement of expensive and time consuming travel. This methodology is not limited to electron microscopy, but its power is currently exemplified by its application to that form of microscopy.

  7. Correlation between sensory and instrumental measurements of standard and crisp-texture southern highbush blueberries (Vaccinium corymbosum L. interspecific hybrids)

    PubMed Central

    Blaker, Kendra M; Plotto, Anne; Baldwin, Elizabeth A; Olmstead, James W

    2014-01-01

    BACKGROUND Fruit texture is a primary selection trait in southern highbush blueberry (SHB) breeding to increase fresh fruit postharvest quality and consumer acceptance. A novel crisp fruit texture has recently been identified among SHB germplasm. In this study, we developed a common set of descriptors that align sensory evaluation of blueberry fruit texture with instrumental measures that could be used for quantitative measurements during pre- and postharvest evaluation. RESULTS Sensory and instrumental characteristics were measured in 36 and 49 genotypes in 2010 and 2011, respectively. A trained sensory panel evaluated fresh fruit based on five common textural attributes in 2010 and 2011: bursting energy, flesh firmness, skin toughness, juiciness and mealiness. Instrumental measures of compression and bioyield forces were significantly different among cultivars and correlated with sensory scores for bursting energy, flesh firmness and skin toughness (R > 0.7, except skin toughness in 2011), but correlations with sensory scores for juiciness and mealiness were low (R < 0.4). CONCLUSION The results of sensory and instrumental measures supported the use of both compression and bioyield force measures in distinguishing crisp from standard-texture genotypes, and suggest that crisp texture in SHB is related to the sensory perception of bursting energy, flesh firmness and skin toughness. PMID:24619938

  8. 30 CFR 1243.100 - What standards must my ONRR-specified surety instrument meet?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural Resources Revenue SUSPENSIONS PENDING APPEAL AND BONDING-MINERALS REVENUE MANAGEMENT Bonding Requirements § 1243.100 What standards must my ONRR-specified...

  9. 75 FR 60304 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-30

    .... John M. Allen, Director, Flight Standards Service. Adoption of the Amendment Accordingly, pursuant to..., Takeoff Minimums and Obstacle DP, Amdt 2 Minden, LA, Minden-Webster, Takeoff Minimums and Obstacle...

  10. 76 FR 65951 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-25

    ...: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420) Flight Technologies and Programs.../6/11 RNAV (GPS) RWY Taylor Field. 18, Amdt 2. 17-Nov-11 VA Norfolk Norfolk Intl..... 1/3530...

  11. 78 FR 18803 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-28

    ...: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420), Flight Technologies and Programs..., Amdt 2. 2-May-13 AZ Taylor Taylor 3/0203 3/6/2013 GPS RWY 21, Orig-A. 2-May-13 LA Shreveport...

  12. 76 FR 55233 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-07

    .... John M. Allen, Director, Flight Standards Service. Adoption of the Amendment Accordingly, pursuant to..., CANCELLED Ballinger, TX, Bruce Field, Takeoff Minimums and Obstacle DP, Orig Effective 20 OCT 2011...

  13. 30 CFR 250.1490 - What standards must my BOEM-specified surety instrument meet?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Outer Continental Shelf Civil Penalties Bonding Requirements § 250.1490 What standards must my BOEM-specified...

  14. 30 CFR 250.1490 - What standards must my BOEM-specified surety instrument meet?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Outer Continental Shelf Civil Penalties Bonding Requirements § 250.1490 What standards must my BOEM-specified...

  15. 30 CFR 250.1490 - What standards must my BOEM-specified surety instrument meet?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Outer Continental Shelf Civil Penalties Bonding Requirements § 250.1490 What standards must my BOEM-specified...

  16. SOLAR/SOLSPEC: Scientific Objectives, Instrument Performance and Its Absolute Calibration Using a Blackbody as Primary Standard Source

    NASA Astrophysics Data System (ADS)

    Thuillier, G.; Foujols, T.; Bolsée, D.; Gillotay, D.; Hersé, M.; Peetermans, W.; Decuyper, W.; Mandel, H.; Sperfeld, P.; Pape, S.; Taubert, D. R.; Hartmann, J.

    2009-06-01

    SOLAR is a set of three solar instruments measuring the total and spectral absolute irradiance from 16 nm to 3080 nm for solar, atmospheric and climatology physics. It is an external payload for the COLUMBUS laboratory launched on 7 February 2008. The mission’s primary objective is the measurement of the solar irradiance with the highest possible accuracy, and its variability using the following instruments: SOL-ACES (SOLar Auto-Calibrating EUV/UV Spectrophotometers) consists of four grazing incidence planar gratings measuring from 16 nm to 220 nm; SOLSPEC (SOLar SPECtrum) consists of three double gratings spectrometers, covering the range 165 nm to 3080 nm; and SOVIM (SOlar Variability Irradiance Monitor) is combining two types of absolute radiometers and three-channel filter - radiometers. SOLSPEC and SOL-ACES have been calibrated by primary standard radiation sources of the Physikalisch-Technische Bundesanstalt (PTB). Below we describe SOLSPEC, and its performance.

  17. Endoscopic facelift: two years' experience.

    PubMed

    Chajchir, A

    1997-01-01

    In the upcoming Twenty-first Century, we will find many surgical methods and devices that come to fulfill one of the main objectives of the aesthetic plastic surgery: to reduce scars, especially in facial surgery. Endoscopy is one of those methods. In my experience of the last two years, I have used this technique, sometimes combined with CO2 laser to partially remove glabellar muscles and the platysma fibers of the middle part of the neck. This work shows the results from 160 patients undergoing endoscopic forehead lift and neck contouring, using specially designed instruments. The results are highly significant and satisfactory.

  18. Transnasal ethmoidectomy under endoscopical control.

    PubMed

    Wigand, M E

    1981-03-01

    Endonasal sinus surgery aims at the preservation of a lining mucosa in the reventilated and redrained cavities. It can, therefore, be confined to the removal of narrowing bone at the "isthmus" of the ducts or windows. Transnasal ethmoidectomy for diffuse polyposis consists of the removal of the ethmoidal cell septa, including the middle turbinate, and a broad fenestration of both the sphenoid sinus and the frontal infundibulum. A consequent postoperative care provided, transnasal ethmoidectomy offers excellent clinical results. A new suction-irrigation endoscope and refined instruments contribute to improved surgical exposure and to the avoidance of complications.

  19. The role of equipment in endoscopic complications.

    PubMed

    Suchanek, Stepan; Grega, Tomas; Zavoral, Miroslav

    2016-10-01

    The role of the surrounding equipment in endoscopic complications has not been published widely. However, an adequate understanding of the advantages and disadvantages of such devices might be helpful to avoid unnecessary problems during endoscopy. This is an overview of the basic principles, benefits and possible harms of electrical power units, medical gases and vital sign monitoring equipment. The aim of this review is to summarize current knowledge about the approach to the electrosurgical unit settings; periprocedural precautions, minimizing the risk of interference between endoscopic equipment and other electrical devices; the appropriate selection of instruments regarding the electrosurgical outcome and the role of carbon dioxide, argon plasma coagulation, pulse oximetry and capnography.

  20. 78 FR 40383 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-05

    .... FOR FURTHER INFORMATION CONTACT: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420... Natchez-Adams County, ILS OR LOC RWY 13, Amdt 2 Natchez, MS, Hardy-Anders Field Natchez-Adams County, RNAV (GPS) RWY 13, Amdt 1 Natchez, MS, Hardy-Anders Field Natchez-Adams County, RNAV (GPS) RWY 18, Amdt...

  1. 78 FR 68704 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... Administration (NARA). For information on the availability of this material at NARA, call 202-741- 6030, or go to... Regional Office of the region in which the affected airport is located. FOR FURTHER INFORMATION CONTACT: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420)Flight Technologies and...

  2. 77 FR 51894 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-28

    .... FOR FURTHER INFORMATION CONTACT: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420...), ILS RWY 20R (SA CAT II), Amdt 24 Fairbanks, AK, Fairbanks Intl, RNAV (GPS) Y RWY 2L, Orig-B Fairbanks...)-A, Orig Apopka, FL, Orlando Apopka, RNAV (GPS)-B, Orig Apopka, FL, Orlando Apopka, Takeoff...

  3. 77 FR 59738 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-01

    ...: Richard A. Dunham III, Flight Procedure Standards Branch (AFS-420) Flight Technologies and Programs....S.C. 552(a), 1 CFR part 51, and Sec. 97.20 of Title 14 of the Code of Federal Regulations. The large number of SIAPs, their complex nature, and the need for a special format make their verbatim...

  4. 77 FR 37801 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ...), Flight Technologies and Programs Divisions, Flight Standards Service, Federal Aviation Administration..., Dothan Rgnl, RNAV (GPS) RWY 36, Amdt 1 Dothan, AL, Dothan Rgnl, VOR OR TACAN-A, Amdt 13 Mobile, AL, Mobile Rgnl, ILS OR LOC RWY 14, Amdt 31 Mobile, AL, Mobile Rgnl, ILS OR LOC RWY 32, Amdt 7 Mobile,...

  5. 75 FR 35627 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-23

    ..., 2010. John M. Allen, Director, Flight Standards Service. Adoption of the Amendment 0 Accordingly... Field. 29-Jul-10 GA Dalton Dalton Muni......... 0/2418 5/26/10 RNAV (GPS) RWY 14, ORIG-A. 29-Jul-10 GA Dalton Dalton Muni......... 0/2419 5/26/10 ILS OR LOC RWY 14, ORIG-A. 29-Jul-10 GA Dalton Dalton...

  6. Using standardized diagnostic instruments to classify children with autism in the study to explore early development.

    PubMed

    Wiggins, Lisa D; Reynolds, Ann; Rice, Catherine E; Moody, Eric J; Bernal, Pilar; Blaskey, Lisa; Rosenberg, Steven A; Lee, Li-Ching; Levy, Susan E

    2015-05-01

    The Study to Explore Early Development (SEED) is a multi-site case-control study designed to explore the relationship between autism spectrum disorder (ASD) phenotypes and etiologies. The goals of this paper are to (1) describe the SEED algorithm that uses the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to classify children with ASD, (2) examine psychometric properties of different ASD classification methods, including the SEED method that incorporates rules for resolving ADI-R and ADOS discordance, and (3) determine whether restricted interests and repetitive behaviors were noted for children who had instrument discordance resolved using ADI-R social and communication scores. Results support the utility of SEED criteria when well-defined groups of children are an important clinical or research outcome.

  7. Laboratory Evaluation of Air Flow Measurement Methods for Residential HVAC Returns for New Instrument Standards

    SciTech Connect

    Walker, Iain; Stratton, Chris

    2015-08-01

    This project improved the accuracy of air flow measurements used in commissioning California heating and air conditioning systems in Title 24 (Building and Appliance Efficiency Standards), thereby improving system performance and efficiency of California residences. The research team at Lawrence Berkeley National Laboratory addressed the issue that typical tools used by contractors in the field to test air flows may not be accurate enough to measure return flows used in Title 24 applications. The team developed guidance on performance of current diagnostics as well as a draft test method for use in future evaluations. The study team prepared a draft test method through ASTM International to determine the uncertainty of air flow measurements at residential heating ventilation and air conditioning returns and other terminals. This test method, when finalized, can be used by the Energy Commission and other entities to specify required accuracy of measurement devices used to show compliance with standards.

  8. Targeted Endoscopic Imaging

    PubMed Central

    Li, Meng; Wang, Thomas D

    2011-01-01

    Summary Endoscopy has undergone explosive technological growth in over recent years, and with the emergence of targeted imaging, its truly transformative power and impact in medicine lies just over the horizon. Today, our ability to see inside the digestive tract with medical endoscopy is headed toward exciting crossroads. The existing paradigm of making diagnostic decisions based on observing structural changes and identifying anatomical landmarks may soon be replaced by visualizing functional properties and imaging molecular expression. In this novel approach, the presence of intracellular and cell surface targets unique to disease are identified and used to predict the likelihood of mucosal transformation and response to therapy. This strategy can result in the development of new methods for early cancer detection, personalized therapy, and chemoprevention. This targeted approach will require further development of molecular probes and endoscopic instruments, and will need support from the FDA for streamlined regulatory oversight. Overall, this molecular imaging modality promises to significantly broaden the capabilities of the gastroenterologist by providing a new approach to visualize the mucosa of the digestive tract in a manner that has never been seen before. PMID:19423025

  9. Ultrasound-Assisted Endoscopic Partial Plantar Fascia Release

    PubMed Central

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

    2013-01-01

    Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure. PMID:24265989

  10. A single instrument: engineering and engineering technology students demonstrating competence in ethics and professional standards.

    PubMed

    Feldhaus, Charles R; Wolter, Robert M; Hundley, Stephen P; Diemer, Tim

    2006-04-01

    This paper details efforts by the Purdue School of Engineering and Technology at Indiana University Purdue University Indianapolis (IUPUI) to create a single instrument for honors science, technology, engineering and mathematics (STEM) students wishing to demonstrate competence in the IUPUI Principles of Undergraduate Learning (PUL's) and Accreditation Board for Engineering and Technology (ABET) Engineering Accreditation Criterion (EAC) and Technology Accreditation Criterion (TAC) 2, a through k. Honors courses in Human Behavior, Ethical Decision-Making, Applied Leadership, International Issues and Leadership Theories and Processes were created along with a specific menu of activities and an assessment rubric based on PUL's and ABET criteria to evaluate student performance in the aforementioned courses. Students who complete the series of 18 Honors Credit hours are eligible for an Honors Certificate in Leadership Studies from the Department of Organizational Leadership and Supervision. Finally, an accounting of how various university assessment criteria, in this case the IUPUI Principles of Undergraduate Learning, can be linked to ABET outcomes and prove student competence in both, using the aforementioned courses, menu of items, and assessment rubrics; these will be analyzed and discussed.

  11. Development of a hand- transmitted vibration measurement instrument to perform tests in medical equipment according to the international standard IEC 60601-1-2005 Ed.3

    NASA Astrophysics Data System (ADS)

    de Lima, F. F.; Moriya, H. T.; Moraes, J. C. T. B.

    2016-07-01

    According to the sub clause 9.6.3 of the international standard IEC 60601-1-2005, medical electrical equipment must provide means of protection against hazardous hand- transmitted vibrations. Compliance of this sub clause is checked by using a vibration measurement instrument in accordance with ISO 5349-1-2001 standard. The present article describes the development of a vibration measurement instrument to perform vibration measurements tests in medical equipments.

  12. Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire.

    PubMed

    Bhasin, Deepak K; Rana, Surinder S; Chandail, Vijant S; Nanda, Mohit; Nadkarni, Nikhil; Masoodi, Ibrahim; Sinha, Saroj K; Nagi, Birinder

    2006-01-01

    Upper gastrointestinal (UGI) endoscopy is an important diagnostic modality in evaluation of patients with upper gastrointestinal (GI) disorders. However, lesions located in the cricopharyngeal area and upper esophagus can be missed, as this area may not be well visualized during endoscopy. This study was conducted to study the utility of a new technique of endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire in diagnosing esophageal disorders. Patients with suspected upper esophageal disorders on history and radiological investigations were assessed using guide wire assisted endoscopic examination during withdrawal of the endoscope. In this technique, endoscope is inserted into the esophagus under vision and thereafter the whole of esophagus, stomach and proximal duodenum is examined. The endoscope is then withdrawn into the mid-esophagus, a guide wire is fed into the biopsy channel, and thereafter inserted into the esophagus. Once guide wire has been advanced into the esophagus, the endoscope is withdrawn gently over the guide wire into esophagus carefully examining for lesions in upper esophagus and cricopharyngeal area. Twenty cases of various abnormalities localized to the upper esophagus were studied. The final diagnosis in these patients was cervical esophageal web (10), post transhiatal esophagectomy leak (4), heterotopic gastric mucosa (3), posttraumatic esophageal perforation (2), and Zenker's diverticulum (1). Intact web was detected in 2 patients and in 8 patients fractured web was seen. Guide wire assisted examination of upper esophagus improved the ability to visualize and characterize these lesions and no complications were encountered as a result of this procedure. Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire is safe and effective in diagnosing anatomical abnormalities of the upper esophagus that may be missed or poorly characterized during standard endoscopy.

  13. Integrated Multipoint-Laser Endoscopic Airway Measurements by Transoral Approach

    PubMed Central

    Neitsch, Marie; Horn, Iris-Susanne; Hofer, Mathias; Dietz, Andreas; Fischer, Miloš

    2016-01-01

    Objectives. Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods. The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5 mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results. The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (p = 0.01) was calculated for the laryngeal measurements and of 0.93 (p < 0.01) for the tracheal measurements compared to the CT. Using the Bland-Altman-Plot, the 95% limits of agreement for the laryngeal measurements were satisfactory: −0.76 and 0.93. Conclusions. Integrated multipoint-laser endoscopic measurement is a promising technical supplement, with potential use in diagnostic endoscopy and transoral endoscopic surgery in daily practice. PMID:27022612

  14. 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

  15. Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video

    PubMed Central

    Bacuzzi, Alessandro; Lavazza, Matteo; Inversini, Davide; Pappalardo, Vincenzo; Boni, Luigi; Rausei, Stefano; Barczynski, Marcin; Tufano, Ralph P.; Kim, Hoon Yub; Anuwong, Angkoon

    2016-01-01

    In this video we describe transoral endoscopic thyroidectomy vestibular approach (TOETVA). Inclusion criteria are (I) patients who had a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US estimated gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring (IONM). PMID:28149809

  16. Ultrahigh-resolution endoscopic optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Chen, Yu; Herz, Paul R.; Hsiung, Pei-Lin; Aguirre, Aaron D.; Mashimo, Hiroshi; Desai, Saleem; Pedrosa, Macos; Koski, Amanda; Schmitt, Joseph M.; Fujimoto, James G.

    2005-01-01

    Early detection of gastrointestinal cancer is essential for the patient treatment and medical care. Endoscopically guided biopsy is currently the gold standard for the diagnosis of early esophageal cancer, but can suffer from high false negative rates due to sampling errors. Optical coherence tomography (OCT) is an emerging medical imaging technology which can generate high resolution, cross-sectional images of tissue in situ and in real time, without the removal of tissue specimen. Although endoscopic OCT has been used successfully to identify certain pathologies in the gastrointestinal tract, the resolution of current endoscopic OCT systems has been limited to 10 - 15 m for clinical procedures. In this study, in vivo imaging of the gastrointestinal tract is demonstrated at a three-fold higher resolution (< 5 m), using a portable, broadband, Cr4+:Forsterite laser as the optical light source. Images acquired from the esophagus, gastro-esophageal junction and colon on animal model display tissue microstructures and architectural details at high resolution, and the features observed in the OCT images are well-matched with histology. The clinical feasibility study is conducted through delivering OCT imaging catheter using standard endoscope. OCT images of normal esophagus, Barrett's esophagus, and esophageal cancers are demonstrated with distinct features. The ability of high resolution endoscopic OCT to image tissue morphology at an unprecedented resolution in vivo would facilitate the development of OCT as a potential imaging modality for early detection of neoplastic changes.

  17. The assessment of scientific reasoning skills of high school science students: A standardized assessment instrument

    NASA Astrophysics Data System (ADS)

    Haberl, Nicholas

    strategy is most successful with less number of VAV zones and proper control of AHU supply air temperature. One recommendation is to recommission heating or cooling airflow setpoints so the VAV zone damper is not left wide open when under the control of the TTR strategy. Static pressure control was as expected on 3 of the 5 sites studied. The TTR strategy was able to respond to building loads while minimizing or eliminating issues with static pressure oscillation. However, the TTR strategy displayed numerous instances of frequent static pressure oscillation, especially at sites that had difficulty in controlling zone temperatures from inactive boiler or chiller service. The results from the TTR and TR comparison showed that temperature control with a radiant in-floor heating system was difficult for both static pressure reset strategies studied. In future studies, boiler and chiller data including: operation, temperature, setpoints, etc. should be trended. A comparison of the TTR strategy with fixed supply air temperature and an outside air based supply air temperature reset strategy would be insightful. Parameters such as the TM and RP rates, Step Timer and damper position thresholds could be refined to maintain a quick response to changing building loads. Lastly, as industries and professional standards progress with improved building standards, the focus of future studies should shift from comparing against fixed static pressure strategies to existing static pressure reset strategies in not only fan energy savings, but whole building energy savings as well.

  18. National standards and code compliance for electrical equipment and instruments installed in hazardous locations for the cone penetrometer

    SciTech Connect

    Bussell, J.H.

    1996-03-01

    The cone penetrometer is designed to measure the material properties of waste tank contents at the Hanford Site. The penetrometer system consists of a skid-mounted assembly, a penetrometer assembly (composed of a guide tube and a push rod), an active neutron moisture measurement probe, decontamination unit, and a support trailer containing a diesel-engine-driven hydraulic pump and a generator. The skid-mounted assembly is about 8 feet wide by 23 feet long and 15 feet high. Its nominal weight is about 40,000 pounds with the provisions to add up to 54,500 pounds of additional ballast. This document describes the cone penetrometer electrical instruments and how it complies with national standards.

  19. Development of automated endoscopes for dimensional micro-measurements

    NASA Astrophysics Data System (ADS)

    Hrebabetzky, Frank

    2013-04-01

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

  20. Endoscopic Management of Esthesioneuroblastoma.

    PubMed

    Roxbury, Christopher R; Ishii, Masaru; Gallia, Gary L; Reh, Douglas D

    2016-02-01

    Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.

  1. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  2. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  3. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  4. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  5. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  6. Outcomes in Endoscopic Ear Surgery.

    PubMed

    Kiringoda, Ruwan; Kozin, Elliott D; Lee, Daniel J

    2016-10-01

    Endoscopic ear surgery (EES) provides several advantages compared with traditional binocular microscopy, including a wide-field view, improved resolution with high magnification, and visual access to hidden corridors of the middle ear. Although binocular microscopic-assisted surgical techniques remain the gold standard for most otologists, EES is slowly emerging as a viable alternative for performing otologic surgery at several centers in the United States and abroad. In this review, we evaluate the current body of literature regarding EES outcomes, summarize our EES outcomes at the Massachusetts Eye and Ear Infirmary, and compare these results with data for microscopic-assisted otologic surgery.

  7. Endoscopic thoracic sympathectomy

    MedlinePlus

    Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition ... hyperhidrosis . Usually the surgery is used to treat sweating in the palms or face. The sympathetic nerves ...

  8. Endoscopic cubital tunnel release.

    PubMed

    Cobb, Tyson K

    2010-10-01

    A minimally invasive endoscopic approach has been successfully applied to surgical treatment of cubital tunnel syndrome. This procedure allows for smaller incisions with faster recovery time. This article details relevant surgical anatomy, indications, contraindications, surgical technique, complications, and postoperative management.

  9. Overdiagnosis of gastric cancer by endoscopic screening

    PubMed Central

    Hamashima, Chisato

    2017-01-01

    Gastric cancer screening using endoscopy has recently spread in Eastern Asian countries showing increasing evidence of its effectiveness. However, despite the benefits of endoscopic screening for gastric cancer, its major harms include infection, complications, false-negative results, false-positive results, and overdiagnosis. The most serious harm of endoscopic screening is overdiagnosis and this can occur in any cancer screening programs. Overdiagnosis is defined as the detection of cancers that would never have been found if there is no cancer screening. Overdiagnosis has been estimated from randomized controlled trials, observational studies, and modeling. It can be calculated on the basis of a comparison of the incidence of cancer between screened and unscreened individuals after the follow-up. Although the estimation method for overdiagnosis has not yet been standardized, estimation of overdiagnosis is needed in endoscopic screening for gastric cancer. To minimize overdiagnosis, the target age group and screening interval should be appropriately defined. Moreover, the balance of benefits and harms must be carefully considered to effectively introduce endoscopic screening in communities. Further research regarding overdiagnosis is warranted when evaluating the effectiveness of endoscopic screening. PMID:28250897

  10. Overdiagnosis of gastric cancer by endoscopic screening.

    PubMed

    Hamashima, Chisato

    2017-02-16

    Gastric cancer screening using endoscopy has recently spread in Eastern Asian countries showing increasing evidence of its effectiveness. However, despite the benefits of endoscopic screening for gastric cancer, its major harms include infection, complications, false-negative results, false-positive results, and overdiagnosis. The most serious harm of endoscopic screening is overdiagnosis and this can occur in any cancer screening programs. Overdiagnosis is defined as the detection of cancers that would never have been found if there is no cancer screening. Overdiagnosis has been estimated from randomized controlled trials, observational studies, and modeling. It can be calculated on the basis of a comparison of the incidence of cancer between screened and unscreened individuals after the follow-up. Although the estimation method for overdiagnosis has not yet been standardized, estimation of overdiagnosis is needed in endoscopic screening for gastric cancer. To minimize overdiagnosis, the target age group and screening interval should be appropriately defined. Moreover, the balance of benefits and harms must be carefully considered to effectively introduce endoscopic screening in communities. Further research regarding overdiagnosis is warranted when evaluating the effectiveness of endoscopic screening.

  11. [Per-oral endoscopic myotomy in achalasia].

    PubMed

    Ponds, Fraukje A M; Smout, André J P M; Bredenoord, Albert J; Fockens, Paul

    2015-01-01

    The treatment of patients with achalasia is complex due to a considerably high recurrence rate and risk of treatment-related complications. The per-oral endoscopic myotomy (POEM) is a new endoscopic technique that combines the benefits of a minimally invasive endoscopic procedure with the efficacy of a surgical myotomy. Implementation of the POEM technique may lead to fewer complications, a lower recurrence rate and reduced costs. During the procedure, a myotomy of the circular muscle layer of the oesophagus is performed after creating a submucosal tunnel in the oesophagus. The first studies of this new technique show promising results. Experienced therapeutic endoscopists can learn to perform the POEM technique relatively easily. Further studies are needed to compare this technique with the current standard treatments and to evaluate long-term effects.

  12. Current GI endoscope disinfection and QA practices.

    PubMed

    Moses, Frank M; Lee, Jennifer S

    2004-01-01

    High-level disinfection (HLD) of GI endoscopes is readily achieved when published guidelines are observed. Contamination is linked to breakdowns in accepted procedure. However, there is no recognized method of verifying adequacy of endoscope reprocessing in routine practice and no data regarding current quality assurance (QA) practice. Prior reports have demonstrated a wide variation in routine clinical practice of GI endoscopy HLD. The goal of this study was to determine current practice at regional endoscopy centers with regard to endoscope cleaning and HLD, maintenance, and QA practice. An anonymous multiple-choice questionnaire was mailed to 367 SGNA members in Pennsylvania, Delaware, Virginia, Maryland, and District of Columbia and completed by 230 (63%). The majority of responders were hospital-based and 59% of the units performed over 3000 procedures per year. After use the endoscope was hand-carried or transported in a dry container (97%) to a separate cleaning room (85%) for HLD by technicians (40%). Wide variations existed in manual step procedures including use of disposable (50%) brushes and number of times channel brushed: once (21%), twice (35%), or three to five times (37%). Soaking duration in disinfectant (70% gluteraldehyde) was for <10 min (8%), 10-20 min (35%), 20-30 min (38%), 30-40 min (7%), and >40 min (3%). Sixty-seven percent had an active unit infection control (IC) service and 98% had a QA program. Monitoring of cleaning effectiveness was by visual inspection (50%) and culturing endoscopes (17%). Culture was done weekly (1%) and endoscope end (5%) or rinsing the biopsy channel (8%). If culture positive, most would remove the instrument from clinical use and reevaluate the protocol and personnel for technique lapses. Two respondents were aware of a procedure-related infection. Wide practice variations were noted in manual cleaning and in soaking time during automated HLD in this community

  13. [Robotic and systems technology for advanced endoscopic procedures].

    PubMed

    Arezzo, A; Testa, T; Schurr, M O; Buess, G F; De Gregori, M

    2001-01-01

    The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in other fields of endoscopic surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. This consists of a system of devices for endoscopic surgery (HF, light source, etc...) with which the surgeon interacts directly, positioning systems for optic and instruments that the surgeon drives as the likes without assistance, and a chair to increase the comfort of the surgeon during surgery. The system of endoscopic devices named OREST (Dornier, München) designed already in 1992 opened the way to a number of systems available today that allow to the surgeon a direct control of the instrumentation. A considerable step ahead in endoscopic technology is the introduction of robotic technology to design assisting systems for solo-surgery and microsurgical instrument manipulators. Results of a number of experimental trials on combinations of different positioning devices are presented and commented. A further step in the employment of robotic technology is the design of "master-slave manipulators" to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system, named ARTEMIS, designed in cooperation with the Research Center in Karlsruhe, could be used in experimental applications. Clinical use of the system, however, will require further development of the arm mechanics and the control system. The combination with the implementation of telecommunication technology will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

  14. Applying the APA/AERA/NCME "Standards": Evidence for the Validity and Reliability of Three Statewide Teaching Assessment Instruments.

    ERIC Educational Resources Information Center

    Rothenberg, Lori; Hessling, Peter A.

    The statewide teaching performance assessment instruments being used in Georgia, North Carolina, and Florida were examined. Forty-one reliability and validity studies regarding the instruments in use in each state were collected from state departments and universities. Georgia uses the Georgia Teacher Performance Assessment Instrument. North…

  15. Miniaturization of photoacoustic cell for smart endoscope to improve sensitivity.

    PubMed

    Wadamori, Naoki

    2014-01-01

    Ultrathin endoscopes, such as transnasal endo-scopes, have been developed to alleviate discomfort during diagnosis and therapy. However, their application to optional diagnostics is limited since many optional diagnostic instruments are designed to fit through larger side channels. The aim of this study was to develop a smart endoscope that can obtain various diagnoses based on photoacoustic spectroscopy. The photoacoustic process comprises complex energy conversions involving optical, thermal, and elastic processes. This work focused on the scaling potential of photoacoustic sensors. Photoacoustic sensors with two different volumes were developed, and the amplitudes and frequency responses of the photoacoustic signals for silicone rubbers with six different Young's moduli were investigated. The results showed that photoacoustic signals can be enhanced by reducing the volumes of the sensors. Embedding a miniaturized photoacoustic sensor in an endoscope was confirmed to improve the sensitivity.

  16. Q and B values are critical measurements required for inter-instrument standardization and development of multicolor flow cytometry staining panels.

    PubMed

    Perfetto, Stephen P; Chattopadhyay, Pratip K; Wood, James; Nguyen, Richard; Ambrozak, David; Hill, Juliane P; Roederer, Mario

    2014-12-01

    Much of the complexity of multicolor flow cytometry experiments lies within the development of antibody staining panels and the standardization of instruments. In this article, we propose a theoretical metric and describe how measurements of sensitivity and resolution can be used to predict the success of panels, and ensure that performance across instruments is standardized (i.e., inter-instrument standardization). Sensitivity can be determined by summing two major contributors of background, background originating from the instrument (optical noise and electronic noise) and background due to the experimental conditions (i.e., Raman scatter, and spillover spreading arising from other fluorochromes in the panel). The former we define as Bcal and the latter we define as Bsos . The combination of instrument and experiment background is defined as Btot . Importantly, the Btot will affect the degree of panel separation, therefore the greater the degree of Btot the lower the separation potential. In contrast, resolution is a measure of separation between populations. Resolution is directly proportional to the number of photoelectrons generated per molecule of excited fluorochrome and is known as the "Q" value. Q and Btot values can be used to define the performance of each detector on an instrument and together they can be used to calculate a separation index. Hence, detectors with known Q and Btot values can be used to evaluate panel success based on the detector specific separation index. However, the current technologies do not enable measurements of Q and Btot values for all parameters, but new technology to allow these measurements will likely be introduced in the near future. Nonetheless, Q and Btot measurements can aid in panel development, and reveal sources of instrument-to-instrument variation in panel performance. In addition, Q and B values can form the basis for a comprehensive and versatile quality assurance program.

  17. Intraoperative imaging of tumors with indo-cyanine green fluorescence with an endoscope

    NASA Astrophysics Data System (ADS)

    Parthasarathy, Ashwin B.; Chong, Sang Hoon; Moscatelli, Frank A.; Singhal, Sunil; Yodh, Arjun G.

    2015-03-01

    Surgery is the most effective treatment strategy for solid tumors. Intraoperative imaging of tumors helps detect tumor margins and establish the most appropriate surgical margins. Endoscopic surgery is a standard of care procedure for the resection of tumors, and is applicable for a wide range of solid tumors. While several imaging methodologies can be used for intraoperative imaging, optical imaging is promising for clinical application because it can detect microscopic disease, is minimally invasive, is inexpensive, does not require advance training for surgeons and can provide real-time images. Fluorescence from an injected contrast agent (Indo-cyanine green, ICG) has been effectively used for the identification of tumors in humans. In this study, we adapt a commercially available endoscope for intraoperative imaging of solid tumors. Our instrument utilizes light from a near-infrared 780nm LED to illuminate the surgical field of view and two CCD cameras for imaging the reflected fluorescence as well as the background tissue. We show that our instrument can simultaneously image fluorescence from the tumor as well as the background tissue. We characterize our instrument in tissue simulating phantoms, with tumor simulating `targets'.

  18. Multielement analysis of human hair and kidney stones by instrumental neutron activation analysis with the k0-standardization method.

    PubMed

    Abugassa, I; Sarmani, S B; Samat, S B

    1999-06-01

    This paper focuses on the evaluation of the k0 method of instrumental neutron activation analysis in biological materials. The method has been applied in multielement analysis of human hair standard reference materials from IAEA, No. 085, No. 086 and from NIES (National Institute for Environmental Sciences) No. 5. Hair samples from people resident in different parts of Malaysia, in addition to a sample from Japan, were analyzed. In addition, human kidney stones from members of the Malaysian population have been analyzed for minor and trace elements. More than 25 elements have been determined. The samples were irradiated in the rotary rack (Lazy Susan) at the TRIGA Mark II reactor of the Malaysian Institute for Nuclear Technology and Research (MINT). The accuracy of the method was ascertained by analysis of other reference materials, including 1573 tomato leaves and 1572 citrus leaves. In this method the deviation of the 1/E1+ alpha epithermal neutron flux distribution from the 1/E law (P/T ratio) for true coincidence effects of the gamma-ray cascade and the HPGe detector efficiency were determined and corrected for.

  19. HelixFlex: bioinspired maneuverable instrument for skull base surgery.

    PubMed

    Gerboni, Giada; Henselmans, Paul W J; Arkenbout, Ewout A; van Furth, Wouter R; Breedveld, Paul

    2015-12-01

    Endoscopic endonasal surgery is currently regarded as the 'gold standard' for operating on pituitary gland tumors, and is becoming more and more accepted for treatment of other skull base lesions. However, endoscopic surgical treatment of most skull base pathologies, including certain pituitary tumors, is severely impaired by current instruments lack of maneuverability. Especially, gaining access to, and visibility of, difficult-to-reach anatomical corners without interference with surrounding neurovascular structures or other instruments, is a challenge. In this context there is the need for instruments that are able to provide a stable shaft position, while both the orientation and the position of the end-effector can be independently controlled. Current instruments that allow for this level of maneuverability are usually mechanically complex, and hence less suitable for mass production. This study therefore focuses on the development of a new actuation technique that allows for the required maneuverability while reducing the construction complexity. This actuation technique, referred to as multi-actuation, integrates multiple cable routings into a single steerable structure. Multi-actuation has been successfully integrated and tested in a handheld prototype instrument called HelixFlex. HelixFlex contains a 4 degrees of freedom maneuverable 5.8 mm (diameter) tip and shows promising results concerning its maneuverability and potential rigidity.

  20. Endoscopic resection of esthesioneuroblastoma.

    PubMed

    Gallia, Gary L; Reh, Douglas D; Lane, Andrew P; Higgins, Thomas S; Koch, Wayne; Ishii, Masaru

    2012-11-01

    Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.

  1. Improved Techniques for Endoscopic Mucosal Resection (EMR) in Colorectal Adenoma

    PubMed Central

    Sold, Moritz; Kähler, Georg

    2014-01-01

    Summary Background Endoscopic therapy of colorectal adenomas and early cancers is a standard method. Besides oncological criteria, the method is limited by polyp location, size, and texture. Method Based on the current literature, technical modifications and developments in endoscopic mucosal resection are described. Results Numerous approaches exist to improve the conditions of resection, including optimisation of mucosal elevation and modification of techniques, tools, and devices. Conclusion Endoscopic therapy of sessile and flat colorectal polyps remains a challenge. Some of the presented modifications can help to address this challenge. PMID:26286120

  2. Robotic-surgical instrument wrist pose estimation.

    PubMed

    Fabel, Stephan; Baek, Kyungim; Berkelman, Peter

    2010-01-01

    The Compact Lightweight Surgery Robot from the University of Hawaii includes two teleoperated instruments and one endoscope manipulator which act in accord to perform assisted interventional medicine. The relative positions and orientations of the robotic instruments and endoscope must be known to the teleoperation system so that the directions of the instrument motions can be controlled to correspond closely to the directions of the motions of the master manipulators, as seen by the the endoscope and displayed to the surgeon. If the manipulator bases are mounted in known locations and all manipulator joint variables are known, then the necessary coordinate transformations between the master and slave manipulators can be easily computed. The versatility and ease of use of the system can be increased, however, by allowing the endoscope or instrument manipulator bases to be moved to arbitrary positions and orientations without reinitializing each manipulator or remeasuring their relative positions. The aim of this work is to find the pose of the instrument end effectors using the video image from the endoscope camera. The P3P pose estimation algorithm is used with a Levenberg-Marquardt optimization to ensure convergence. The correct transformations between the master and slave coordinate frames can then be calculated and updated when the bases of the endoscope or instrument manipulators are moved to new, unknown, positions at any time before or during surgical procedures.

  3. Integrated biophotonics in endoscopic oncology

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  4. Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

    PubMed Central

    Al Furajii, Hazar; Kennedy, Niall; Cahill, Ronan A.

    2017-01-01

    PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature. METHODS: Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally. RESULTS: Of the 13 patients (median age 55 years, median BMI 28.75 kg/m2, median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up. CONCLUSION: Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and

  5. Advances in balloon endoscopes.

    PubMed

    Araki, Akihiro; Tsuchiya, Kiichiro; Watanabe, Mamoru

    2014-06-01

    In September 2003, a double-balloon endoscope (DBE) composed of balloons attached to a scope and an overtube was released in Japan prior to becoming available in other parts of the world. The DBE was developed by Dr. Yamamoto (1), and 5 different types of scopes with different uses have already been marketed. In April 2007, a single-balloon small intestinal endoscope was released with a balloon attached only to the overtube as a subsequent model. This article presents a detailed account of the development of these scopes up to the present time.

  6. 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.

  7. Ground-based intercomparisons of SBUV/2 flight instruments the world standard Dobson spectrophotometer 83 and overpass observations from Nimbus-7 TOMS and NOAA-11 SBUV/2

    NASA Technical Reports Server (NTRS)

    Heath, D. F.; Ahmad, Z.; Torres, O.; Evans, R. D.; Grass, R. D.; Komhyr, W. A.; Nelson, W.

    1994-01-01

    Total ozone data obtained during summers at Mauna Loa Observatory, Hawaii, with Dobson Spectrophotometer 83 are routinely compared with overpass total ozone data from the Total Ozone Mapping Spectrometer (TOMS) and the Solar Backscatter Ultraviolet (SBUV) spectrometer launched aboard the Nimbus 7 satellite in 1978. Results from the TOMS/Dobson instrument comparisons through 1990 have been presented by McPeters and Komhyr (1991). Dobson spectrophotometer 83 was established as the standard instrument for the U.S.A. Dobson instrument station network in 1962. In 1980, the instrument was designated by the World Meteorological Organization (WMO) as the Standard Dobson Spectrophotometer for the World. Long-term ozone measurement precision of the instrument has been maintained at plus or minus 0.5 percent (Komhyr et al., 1989). On an absolute scale, the ozone measurement accuracy of the instrument is estimated to plus or minus 3 percent. In early April, 1990, comparison of total ozone and vertical distribution (Umkehr) observations were made for the first time with Dobson spectrophotometer 8.3. The work was conducted at the NOAA Climate Monitoring and Diagnostics Laboratory (CMDL) in Boulder, Colorado, and at the research and instrument manufacturing facility of the Ball Aerospace System Division located about 2 km east of Boulder. (The SBUV-2 S/N-2 instrument, built by Ball Aerospace Systems Division, is scheduled for launch aboard the NOAA-13 satellite). We present results of the comparisons which include ozone vertical distribution data obtained with a balloon-borne electrochemical concentration cell (ECC) ozonesonde (Komhyr, 1969).

  8. Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities.

    PubMed

    Hamashima, Chisato; Fukao, Akira

    2016-09-02

    The Japanese government introduced endoscopic screening for gastric cancer in 2015 as a public policy based on the Japanese guidelines on gastric cancer screening. To provide appropriate endoscopic screening for gastric cancer in Japanese communities, we developed a quality assurance manual of endoscopic screening and recommend 10 strategies with their brief descriptions as follows: (i) Formulation of a committee responsible for implementing and managing endoscopic screening, and for deciding the suitable implementation methods in consideration of the local context; (ii) Development of an interpretation system that leads to a final judgement to standardize endoscopic examination and improve its accuracy; (iii) Preparation of management and reporting systems for adverse effects by the committee for safety management; (iv) Obtaining informed consent before operation following adequate explanations regarding the benefits and harms of endoscopic screening; (v) Avoidance of frequent screenings to reduce false-positive results and overdiagnosis. As a reference, the target age group is ≥50 years, and the screening interval is 2 years; (vi) Keeping the biopsy rate within 10% as post-biopsy bleeding may occur. Before endoscopic screening, any history of antithrombotic drug usage should be checked; (vii) Nonadministration of sedation in endoscopic screening for safety management; (viii) Adherence to proper endoscopic cleaning and disinfection to reduce infection; (ix) Use of a checklist to achieve optimal program preparation when municipal governments introduce endoscopic screening; (x) Identification of the aims and roles by referring to a checklist if primary care physicians decide to participate in endoscopic screening.

  9. Fundus imaging with a nasal endoscope.

    PubMed

    Shanmugam, P Mahesh; Ramanjulu, Rajesh; Mishra, K C Divyansh

    2015-01-01

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

  10. Fundus imaging with a nasal endoscope

    PubMed Central

    Shanmugam, P Mahesh; Ramanjulu, Rajesh; Mishra, KC Divyansh

    2015-01-01

    Wide field fundus imaging is needed to diagnose, treat, and follow-up patients with retinal pathology. This is more applicable for pediatric patients as repeated evaluation is a challenge. The presently available imaging machines though provide high definition images, but carry the obvious disadvantages of either being costly or bulky or sometimes both, which limits its usage only to large centers. We hereby report a technique of fundus imaging using a nasal endoscope coupled with viscoelastic. A regular nasal endoscope with viscoelastic coupling was placed on the cornea to image the fundus of infants under general anesthesia. Wide angle fundus images of various fundus pathologies in infants could be obtained easily with readily available instruments and without the much financial investment for the institutes. PMID:25686069

  11. 76 FR 81945 - Request for Measures and Domains To Use in Development of a Standardized Instrument for Use in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-29

    ... Act of 2009 (CHIPRA), Public Law 111-3, amended the Social Security Act (the Act) to enact section... soliciting the submission of instruments or domains (for example, key concepts) measuring aspects of families... Principles and will develop implementation instructions based on those for CAHPS instruments (...

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

    PubMed

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

    2016-04-01

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

  13. Protein standardization III: Method optimization basic principles for quantitative determination of human serum proteins on automated instruments based on turbidimetry or nephelometry.

    PubMed

    Blirup-Jensen, S

    2001-11-01

    Quantitative protein determinations in routine laboratories are today most often carried out using automated instruments. However, slight variations in the assay principle, in the programming of the instrument or in the reagents may lead to different results. This has led to the prerequisite of method optimization and standardization. The basic principles of turbidimetry and nephelometry are discussed. The different reading principles are illustrated and investigated. Various problems are identified and a suggestion is made for an integrated, fast and convenient test system for the determination of a number of different proteins on the same instrument. An optimized test system for turbidimetry and nephelometry should comprise high-quality antibodies, calibrators, controls, and buffers and a protocol with detailed parameter settings in order to program the instrument correctly. A good user program takes full advantage of the optimal reading principles for the different instruments. This implies--for all suitable instruments--sample preincubation followed by real sample blanking, which automatically corrects for initial turbidity in the sample. Likewise it is recommended to measure the reagent blank, which represents any turbidity caused by the antibody itself. By correcting all signals with these two blank values the best possible signal is obtained for the specific analyte. An optimized test system should preferably offer a wide measuring range combined with a wide security range, which for the user means few re-runs and maximum security against antigen excess. A non-linear calibration curve based on six standards is obtained using a suitable mathematical fitting model, which normally is part of the instrument software.

  14. National standard and code compliance for electrical equipment installed in hazardous locations for the void fraction instrument

    NASA Astrophysics Data System (ADS)

    Bussell, J. H.; Martin, J. D.; Stokes, T. I.

    1994-09-01

    The hazardous area classification is evaluated and defined for the void fraction instrument (VFI). The void fraction instrument is an instrument that is used to measure gas bubble concentration in tank waste. It is a 18.3 m (60-foot) long pipe with swivel sampling head. The assembly is lowered into tank waste via an available riser and waste sample is obtained. The sample is obtained and the sample chamber is pressurized from a fixed volume chamber. The pressure is then measured and then the VFI is moved to the next sample elevation.

  15. Combined Endoscopic Laparoscopic Surgery Procedures for Colorectal Surgery.

    PubMed

    Placek, Sarah B; Nelson, Jeffrey

    2017-04-01

    Colonoscopy is the standard of care for screening and surveillance of colorectal cancers. Removal of adenomatous polyps prevents the transformation of adenomas to potential adenocarcinoma. While most polyps are amenable to simple endoscopic polypectomy, difficult polyps that are large, broad-based, or located in haustral folds or in tortuous colon segments can present a challenge for endoscopists. Traditionally, patients with endoscopically unresectable polyps have been referred for oncologic surgical resection due to the underlying risk of malignancy within the polyp; however, the majority of these polyps are benign on final pathology. Combined endoscopic laparoscopic surgery can help facilitate endoscopic removal of difficult lesions, or allow the surgeon to select the correct laparoscopic approach for polyp excision. Current literature suggests that these procedures are safe and effective and can potentially save patients from the morbidity of laparotomy and segmental colectomy.

  16. Various applications of endoscopic scissors in difficult endoscopic interventions.

    PubMed

    Kee, Won-Ju; Park, Chang-Hwan; Chung, Kyoung-Myeun; Park, Seon-Young; Jun, Chung-Hwan; Ki, Ho-seok; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2014-05-01

    Endoscopic scissors offer a benefit over other devices by avoiding potential complications related to thermal and mechanical injury of surrounding structures. We describe our experience with endoscopic scissors in three difficult endoscopic interventions. A fishbone embedded in the esophageal wall penetrated very close to the pulsating aorta and the bronchus. The fishbone was cut in half by endoscopic scissors and removed without injury to adjacent organs. A gastric submucosal tumor with an insulated core that could not be resected by electrosurgical devices was cut using endoscopic scissors following endoloop placement. Extravascular coil migration after transcatheter arterial embolization resulted in a duodenal ulcer. The metallic coil on the duodenal ulcer was cut by endoscopic scissors without mechanical or thermal injury.

  17. Disposable Bronchoscope Model for Simulating Endoscopic Reprocessing and Surveillance Cultures.

    PubMed

    Yassin, Mohamed H; Hariri, Rahman; Hamad, Yasir; Ferrelli, Juliet; McKibben, Leeanna; Doi, Yohei

    2017-02-01

    BACKGROUND Endoscope-associated infections are reported despite following proper reprocessing methods. Microbiological testing can confirm the adequacy of endoscope reprocessing. Multiple controversies related to the method and interpretation of microbiological testing cultures have arisen that make their routine performance a complex target. OBJECTIVE We conducted a pilot study using disposable bronchoscopes (DBs) to simulate different reprocessing times and soaking times and to compare high-level disinfection versus ethylene oxide sterilization. We also reviewed the time to reprocessing and duration of the procedures. METHODS Bronchoscopes were chosen because an alternative disposable scope is commercially available and because bronchoscopes are more prone to delays in processing. Disposable bronchoscopes were contaminated using a liquid bacterial suspension and were then incubated for 1-4 hours. Standard processing and high-level disinfection were performed on 36 endoscopes. Ethylene oxide sterilization was performed on 21 endoscopes. Endoscope cultures were performed using the standard "brush, flush, brush" technique. RESULTS After brushing was performed, a final water-flush culture procedure was the most effective method of detecting bacterial persistence on the disposable scopes. Klebsiella pneumoniae was the most commonly recovered organism after reprocessing. Ethylene oxide sterilization did not result in total elimination of viable bacteria. CONCLUSION Routine endoscopy cultures may be required to assess the adequacy of endoscopic processing. Infect Control Hosp Epidemiol 2017;38:136-142.

  18. Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

    PubMed Central

    Galzio, Renato J.; Di Cola, Francesco; Raysi Dehcordi, Soheila; Ricci, Alessandro; De Paulis, Danilo

    2013-01-01

    Background: The endovascular techniques has widely changed the treatment of intracranial aneurysms. However surgery still represent the best therapeutic option in case of broad-based and complex lesions. The combined use of endoscopic and microsurgical techniques (EAM) may improve surgical results. Objective: The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms. Methods: Between January 2002 and December 2012, 173 patients, harboring 206 aneurysms were surgically treated in our department with the EAM technique. One hundred and fifty-seven aneurysms were located in the anterior circulation and 49 were in the posterior circulation. Standard tailored approaches, based on skull base surgery principles, were chosen. The use of the endoscope included three steps: initial inspection, true operative time, and final inspection. For each procedure, an intraoperative video and an evaluation schedule were prepared, to report surgeons’ opinions about the technique itself. In the first cases, we always used the endoscope during surgical procedures in order to get an adequate surgical training. Afterwards we became aware in selecting cases in which to apply the endoscopy, as we started to become familiar with its advantages and limits. Results: After clipping, all patients were undergone postoperative cerebral angiography. No surgical mortality related to EAM were observed. Complications directly related to endoscopic procedures were rare. Conclusion: Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt–Hess grade), surgical timing, presence of blood in the cisterns (Fisher grade) and/or hydrocephalus. However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions. Furthermore, the advantages are especially evident using dedicated scopes and holders, after an

  19. Effect of Mirrored Views on Endoscopic and Arthroscopic Skill Performance

    PubMed Central

    Benninger, Emanuel; Meier, Christoph; Wirth, Stefan; Koch, Peter Philipp; Meyer, Dominik

    2017-01-01

    Background: Arthroscopic procedures may be technically challenging because of impaired vision, limited space, and the 2-dimensional vision of a 3-dimensional structure. Spatial orientation may get more complicated when the camera is pointing toward the surgeon. Hypothesis: Spatial orientation and arthroscopic performance may be improved by simply mirroring the image on the monitor in different configurations regarding the position and orientation of camera and instrument. Study Design: Descriptive laboratory study. Methods: Thirty volunteers from an orthopaedic department were divided into 3 equal groups according to their arthroscopic experience (beginners, intermediates, seniors). All subjects were asked to perform a standardized task in a closed box mimicking an endoscopic space. The same task had to be performed in 4 different configurations regarding camera and instrument position and orientation (pointing toward or away from the subject) with either the original or mirrored image on the monitor. Efficiency (time per stick; TPS), precision (successful completion of the task), and difficulty rating using a visual analog scale (VAS) were analyzed. Results: Mirroring the image demonstrated no advantage over the original images in any configuration regarding TPS. Successful completion of the task was significantly better when the image was mirrored in the configuration with the camera pointing toward and the instrument away from the surgeon. There was a positive correlation between TPS and subjective VAS difficulty rating (r = 0.762, P = .000) and a negative correlation between the successful completion of the task and VAS (r = −0.515, P = .000). Conclusion: Mirroring the image may have a positive effect on arthroscopic performance of surgeons in certain configurations. A significantly improved performance was seen when the arthroscope was pointing toward and the grasping instrument pointing away from the subject. Mirroring the image may facilitate surgery in

  20. Lunar Spectral Irradiance and Radiance (LUSI): New Instrumentation to Characterize the Moon as a Space-Based Radiometric Standard.

    PubMed

    Smith, Allan W; Lorentz, Steven R; Stone, Thomas C; Datla, Raju V

    2012-01-01

    The need to understand and monitor climate change has led to proposed radiometric accuracy requirements for space-based remote sensing instruments that are very stringent and currently outside the capabilities of many Earth orbiting instruments. A major problem is quantifying changes in sensor performance that occur from launch and during the mission. To address this problem on-orbit calibrators and monitors have been developed, but they too can suffer changes from launch and the harsh space environment. One solution is to use the Moon as a calibration reference source. Already the Moon has been used to remove post-launch drift and to cross-calibrate different instruments, but further work is needed to develop a new model with low absolute uncertainties capable of climate-quality absolute calibration of Earth observing instruments on orbit. To this end, we are proposing an Earth-based instrument suite to measure the absolute lunar spectral irradiance to an uncertainty(1) of 0.5 % (k=1) over the spectral range from 320 nm to 2500 nm with a spectral resolution of approximately 0.3 %. Absolute measurements of lunar radiance will also be acquired to facilitate calibration of high spatial resolution sensors. The instruments will be deployed at high elevation astronomical observatories and flown on high-altitude balloons in order to mitigate the effects of the Earth's atmosphere on the lunar observations. Periodic calibrations using instrumentation and techniques available from NIST will ensure traceability to the International System of Units (SI) and low absolute radiometric uncertainties.

  1. Lunar Spectral Irradiance and Radiance (LUSI): New Instrumentation to Characterize the Moon as a Space-Based Radiometric Standard

    PubMed Central

    Smith, Allan W.; Lorentz, Steven R.; Stone, Thomas C.; Datla, Raju V.

    2012-01-01

    The need to understand and monitor climate change has led to proposed radiometric accuracy requirements for space-based remote sensing instruments that are very stringent and currently outside the capabilities of many Earth orbiting instruments. A major problem is quantifying changes in sensor performance that occur from launch and during the mission. To address this problem on-orbit calibrators and monitors have been developed, but they too can suffer changes from launch and the harsh space environment. One solution is to use the Moon as a calibration reference source. Already the Moon has been used to remove post-launch drift and to cross-calibrate different instruments, but further work is needed to develop a new model with low absolute uncertainties capable of climate-quality absolute calibration of Earth observing instruments on orbit. To this end, we are proposing an Earth-based instrument suite to measure the absolute lunar spectral irradiance to an uncertainty1 of 0.5 % (k=1) over the spectral range from 320 nm to 2500 nm with a spectral resolution of approximately 0.3 %. Absolute measurements of lunar radiance will also be acquired to facilitate calibration of high spatial resolution sensors. The instruments will be deployed at high elevation astronomical observatories and flown on high-altitude balloons in order to mitigate the effects of the Earth’s atmosphere on the lunar observations. Periodic calibrations using instrumentation and techniques available from NIST will ensure traceability to the International System of Units (SI) and low absolute radiometric uncertainties. PMID:26900523

  2. Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy

    PubMed Central

    Eret, Viktor; Stránský, Petr; Trávníček, Ivan; Ürge, Tomáš; Ferda, Jiří; Petersson, Fredrik; Hes, Ondřej

    2014-01-01

    Introduction One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise. Aim To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE). Material and methods In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) – 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007–8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m2, less advanced tumour). Results We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m2 vs. 29.2 kg/m2 (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher. Conclusions The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m2 and with low-stage tumours. The LESS NE is more expensive compared

  3. 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

  4. 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.

  5. Chicken wing training model for endoscopic microsurgery.

    PubMed

    Jusue-Torres, Ignacio; Sivakanthan, Sananthan; Pinheiro-Neto, Carlos Diogenes; Gardner, Paul A; Snyderman, Carl H; Fernandez-Miranda, Juan C

    2013-10-01

    Objectives To present and validate a chicken wing model for endoscopic endonasal microsurgical skill development. Setting A surgical environment was constructed using a Styrofoam box and measurements from radiological studies. Endoscopic visualization and instrumentation were utilized in a manner to mimic operative setting. Design Five participants were instructed to complete four sequential tasks: (1) opening the skin, (2) exposing the main artery in its neurovascular sheath, (3) opening the neurovascular sheath, and (4) separating the nerve from the artery. Time to completion of each task was recorded. Participants Three junior attendings, one senior resident, and one medical student were recruited internally. Main Outcome Measures Time to perform the surgical tasks measured in seconds. Results The average time of the first training session was 48.8 minutes; by the 10th training session, the average time was 22.4 minutes. The range of improvement was 25.7 minutes to 72.4 minutes. All five participants exhibited statistically significant decrease in time after 10 trials. Kaplan-Meier analysis revealed that an improvement of 50% was achieved by an average of five attempts at the 95% confidence interval. Conclusions The ex vivo chicken wing model is an inexpensive and relatively realistic model to train endoscopic dissection using microsurgical techniques.

  6. Automatic fusion of freehand endoscopic brain images to three-dimensional surfaces: creating stereoscopic panoramas.

    PubMed

    Dey, Damini; Gobbi, David G; Slomka, Piotr J; Surry, Kathleen J M; Peters, Terence M

    2002-01-01

    A major limitation of the use of endoscopes in minimally invasive surgery is the lack of relative context between the endoscope and its surroundings. The purpose of this work was to fuse images obtained from a tracked endoscope to surfaces derived from three-dimensional (3-D) preoperative magnetic resonance or computed tomography (CT) data, for assistance in surgical planning, training and guidance. We extracted polygonal surfaces from preoperative CT images of a standard brain phantom and digitized endoscopic video images from a tracked neuro-endoscope. The optical properties of the endoscope were characterized using a simple calibration procedure. Registration of the phantom (physical space) and CT images (preoperative image space) was accomplished using fiducial markers that could be identified both on the phantom and within the images. The endoscopic images were corrected for radial lens distortion and then mapped onto the extracted surfaces via a two-dimensional 2-D to 3-D mapping algorithm. The optical tracker has an accuracy of about 0.3 mm at its centroid, which allows the endoscope tip to be localized to within 1.0 mm. The mapping operation allows multiple endoscopic images to be "painted" onto the 3-D brain surfaces, as they are acquired, in the correct anatomical position. This allows panoramic and stereoscopic visualization, as well as navigation of the 3-D surface, painted with multiple endoscopic views, from arbitrary perspectives.

  7. Therapeutic endoscopic ultrasound

    PubMed Central

    Venkatachalapathy, Suresh; Nayar, Manu K

    2017-01-01

    Endoscopic ultrasound (EUS) is now firmly established as one of the essential tools for diagnosis in most gastrointestinal MDTs across the UK. However, the ability to provide therapy with EUS has resulted in a significant impact on the management of the patients. These include drainage of peripancreatic collections, EUS-guided endoscopic retrograde cholangiopancreatogram, EUS-guided coeliac plexus blocks, etc. The rapid development of this area in endoscopy is a combination of newer tools and increasing expertise by endosonographers to push the boundaries of intervention with EUS. However, the indications are limited and we are at the start of the learning curve for these high-risk procedures. These therapies should, therefore, be confined to centres with a robust multidisciplinary team, including interventional endoscopists, radiologists and surgeons. PMID:28261439

  8. Peroral endoscopic myotomy.

    PubMed

    Kumbhari, Vivek; Khashab, Mouen A

    2015-05-16

    Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited.

  9. Peroral endoscopic myotomy

    PubMed Central

    Kumbhari, Vivek; Khashab, Mouen A

    2015-01-01

    Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited. PMID:25992188

  10. Endoscopic septoplasty: Tips and pearls.

    PubMed

    Pons, Y; Champagne, C; Genestier, L; Ballivet de Régloix, S

    2015-12-01

    This article is designed to provide a step-by-step description of our endoscopic septoplasty technique and discuss its difficulties and technical tips. Endoscopic septoplasty comprises 10 steps: diagnostic endoscopy, subperichondral infiltration, left mucosal incision, dissection of the left subperichondral flap, cartilage incision (0.5 centimetre posterior to the mucosal incision), dissection of the right subperichondral flap, anterior cartilage resection, perpendicular plate dissection, dissection and resection of the maxillary crest, endoscopic revision, mucosal suture and Silastic stents. A satisfactory postoperative result was observed at 3 months in 97% of cases in this series. The main contraindication to endoscopic septoplasty is anterior columellar deviation of the nasal septum requiring a conventional procedure.

  11. Endoscopic transmission of Helicobacter pylori.

    PubMed

    Tytgat, G N

    1995-01-01

    The contamination of endoscopes and biopsy forceps with Helicobacter pylori occurs readily after endoscopic examination of H. pylori-positive patients. Unequivocal proof of iatrogenic transmission of the organism has been provided. Estimates for transmission frequency approximate to 4 per 1000 endoscopies when the infection rate in the endoscoped population is about 60%. Iatrogenic transmission has also been shown to be the cause of the so-called 'acute mucosal lesion' syndrome in Japan. Traditional cleaning and alcohol rinsing is insufficient to eliminate endoscope/forceps contamination. Only meticulous adherence to disinfection recommendations guarantees H. pylori elimination.

  12. 14 CFR 91.205 - Powered civil aircraft with standard category U.S. airworthiness certificates: Instrument and...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... goggle operations. For night vision goggle operations, the following instruments and equipment must be... paragraph (c) of this section; (2) Night vision goggles; (3) Interior and exterior aircraft lighting system required for night vision goggle operations; (4) Two-way radio communications system; (5) Gyroscopic...

  13. 14 CFR 91.205 - Powered civil aircraft with standard category U.S. airworthiness certificates: Instrument and...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... goggle operations. For night vision goggle operations, the following instruments and equipment must be... paragraph (c) of this section; (2) Night vision goggles; (3) Interior and exterior aircraft lighting system required for night vision goggle operations; (4) Two-way radio communications system; (5) Gyroscopic...

  14. 14 CFR 91.205 - Powered civil aircraft with standard category U.S. airworthiness certificates: Instrument and...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... goggle operations. For night vision goggle operations, the following instruments and equipment must be... paragraph (c) of this section; (2) Night vision goggles; (3) Interior and exterior aircraft lighting system required for night vision goggle operations; (4) Two-way radio communications system; (5) Gyroscopic...

  15. Comprehensive review on endonasal endoscopic sinus surgery

    PubMed Central

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

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

  16. Compact laser illumination system for endoscopic interventions.

    PubMed

    Blase, Bastian

    2015-08-01

    External cold light sources as well as LEDs are commonly used for abdominal illumination in minimally invasive surgery. Still, both feature certain disadvantages. A new illumination system for endoscopes based on laser diodes is placed in the handle. No external light cables are needed. High conversion and coupling efficiencies and small package size allow for several diodes to be integrated, enabling color mixing and the adjustment of color temperatures. An optical module to collimate and combine the light is described. The heat to be dissipated is stored in a passive latent heat storage based on phase change materials surrounding the optical module. Thereby, operation time is considerably extended, as the handle's temperature is stabilized. To reduce the negative effect of coherent light on optical rough surfaces leading to patterns of spots, several devices for speckle reduction are developed and tested. By combining these components, an assembly of a powerful RGB laser light module for the integration in standard sized endoscopes is formed.

  17. Endoscopic resection of subcutaneous lipoma and tumor-like lesion of the foot.

    PubMed

    Lui, Tun Hing

    2016-03-01

    Open resection is the standard surgical treatment for subcutaneous lipoma. However, it may result in cosmetically non-desirable scars in case of large lesion. Endoscopic resection of subcutaneous lipoma and tumor-like lesions may result in better cosmetic result and patient satisfaction. The basis of the endoscopic technique is described.

  18. Navigation system for flexible endoscopes

    NASA Astrophysics Data System (ADS)

    Hummel, Johann; Figl, Michael; Birkfellner, Wolfgang; Häfner, Michael; Kollmann, Christian; Bergmann, Helmar

    2003-05-01

    Endoscopic Ultrasound (EUS) features flexible endoscopes equipped with a radial or linear array scanhead allowing high resolution examination of organs adjacent to the upper gastrointestinal tract. An optical system based on fibre-glass or a CCD-chip allows additional orientation. However, 3-dimensional orientation and correct identification of the various anatomical structures may be difficult. It therefore seems desirable to merge real-time US images with high resolution CT or MR images acquired prior to EUS to simplify navigation during the intervention. The additional information provided by CT or MR images might facilitate diagnosis of tumors and, ultimately, guided puncture of suspicious lesions. We built a grid with 15 plastic spheres and measured their positions relatively to five fiducial markers placed on the top of the grid. For this measurement we used an optical tracking system (OTS) (Polaris, NDI, Can). Two sensors of an electromagnetic tracking system (EMTS) (Aurora, NDI, Can) were mounted on a flexible endoscope (Pentax GG 38 UX, USA) to enable a free hand ultrasound calibration. To determine the position of the plastic spheres in the emitter coordinate system of the EMTS we applied a point-to-point registration (Horn) using the coordinates of the fiducial markers in both coordinate systems (OTS and EMTS). For the transformation between EMTS to the CT space the Horn algorithm was adopted again using the fiducial markers. Visualization was enabled by the use of the AVW-4.0 library (Biomedical Imaging Resource, Mayo Clinic, Rochester/MN, USA). To evaluate the suitability of our new navigation system we measured the Fiducial Registration Error (FRE) of the diverse registrations and the Target Registration Error (TRE) for the complete transformation from the US space to the CT space. The FRE for the ultrasound calibration amounted to 4.3 mm +/- 4.2 mm, resulting from 10 calibration procedures. For the transformation from the OTS reference system to the

  19. Endoscopic optical coherence tomography based on a microelectromechanical mirror

    NASA Astrophysics Data System (ADS)

    Pan, Yingtian; Xie, Huikai; Fedder, Gary K.

    2001-12-01

    An endoscopic optical coherence tomography (OCT) system based on a microelectromechanical mirror to facilitate lateral light scanning is described. The front-view OCT scope, adapted to the instrument channel of a commercial endoscopic sheath, allows real-time cross-sectional imaging of living biological tissue via direct endoscopic visual guidance. The transverse and axial resolutions of the OCT scope are roughly 20 and 10.2 μm, respectively. Cross-sectional images of 500 × 1000 pixels covering an area of 2.9 mm × 2.8 mm can be acquired at ~5 frames/s and with nearly 100-dB dynamic range. Applications in thickness measurement and bladder tissue imaging are demonstrated.

  20. Endoscopic surgery in children - the challenge goes on.

    PubMed

    van der Zee, David C

    2017-02-01

    Paediatric endoscopic surgery is greatly indebted to Karl Storz for developing paediatric endoscopic instruments. In more recent years, there is an increasing interest in endoscopic surgery in neonates. Now more complex procedures are being performed, although it will take another generation before these will be more generally applied. One of the key factors to success is training. More sophisticated training models are becoming available, allowing practicing in a safe environment before putting the procedure to practice. A key question in performing complex procedures is whether such procedures should not be concentrated into centres of expertise. Finally, a critical appraisal is warranted in regard to safety of surgery in neonates, as they fail to have cerebral autoregulation. As endoscopy may add additional risk factors, close monitoring is obligatory.

  1. Novel endoscopic imaging system for early cancer diagnosis

    NASA Astrophysics Data System (ADS)

    Igarashi, Makoto; Gono, Kazuhiro

    2007-02-01

    We have developed the novel video endoscope imaging techniques; Narrow band imaging (NBI), Auto-Fluorescence Imaging (AFI), Infra-Red Imaging (IRI) and Endo-Cytoscopy System (ECS). The purpose of these imaging techniques is to emphasize the important tissue features associated with early stage of lesions. We have already launched the new medical endoscope system including NBI, AFI and IRI (EVIS LUCERA SPECTRUM, OLYMPUS MEDICAL SYSTEMS Co., Ltd., Fig.1). Moreover ECS, which has enough magnification to observe cell nuclei on a superficial mucosa under methylene blue dye staining, is the endoscopic instrument with ultra-high optical zoom. In this paper we demonstrate the concepts and the medical efficacy of each technology.

  2. Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations

    PubMed Central

    Cheon, Jae Hee

    2015-01-01

    Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD. PMID:26018512

  3. Endoscopic Gastrocnemius Intramuscular Aponeurotic Recession

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Gastrocnemius aponeurotic recession is the surgical treatment for symptomatic gastrocnemius contracture. Endoscopic gastrocnemius recession procedures has been developed recently and reported to have fewer complications and better cosmetic outcomes. Classically, this is performed at the aponeurosis distal to the gastrocnemius muscle attachment. We describe an alternative endoscopic approach in which the intramuscular portion of the aponeurosis is released. PMID:26900563

  4. [Endoscopic treatments for Barrett oesophagus].

    PubMed

    Vienne, Ariane; Prat, Frédéric

    2011-05-01

    High grade dysplasia and superficial carcinomas (with no extension under muscularis mucosae) can be indications for endoscopic treatments of Barrett oesophagus. When an endoscopic treatment is considered, a gastroscopy with use of acetic acid and planimetry and the confirmation of high-grade dysplasia by a new examination after PPI treatment and a pathologic second confirmation is needed. For high-grade dysplasia in focalised and visible lesions, an endoscopic resection by EMR or ESD should be proposed: it allows a more accurate pathologic examination and can be an effective curative treatment. After endoscopic resection of visible high grade dysplasia lesions, a complete eradication of Barrett oesophagus may be proposed to prevent dysplasia recurrence. In case of extensive high-grade dysplasia or to eradicate Barrett oesophagus residual lesions, radiofrequency ablation is the preferred endoscopic technique. Photodynamic therapy may also be proposed for more invasive lesions or after other endoscopic techniques with mucosal scars. Surgical oesophagus resection is still recommended for diffuse high-grade dysplasia in young patients or in case of pathologic pejorative criteria in endoscopic resection specimen. In case of Low-grade dysplasia, either endoscopic surveillance should be performed every six or 12 months or radiofrequency ablation could be proposed in the yield of prospective studies.

  5. Endoscopic Gastrocnemius Intramuscular Aponeurotic Recession.

    PubMed

    Lui, Tun Hing

    2015-10-01

    Gastrocnemius aponeurotic recession is the surgical treatment for symptomatic gastrocnemius contracture. Endoscopic gastrocnemius recession procedures has been developed recently and reported to have fewer complications and better cosmetic outcomes. Classically, this is performed at the aponeurosis distal to the gastrocnemius muscle attachment. We describe an alternative endoscopic approach in which the intramuscular portion of the aponeurosis is released.

  6. Endoscopic ultrasound in mediastinal tuberculosis

    PubMed Central

    Sharma, Malay; Ecka, Ruth Shifa; Somasundaram, Aravindh; Shoukat, Abid; Kirnake, Vijendra

    2016-01-01

    Background: Tubercular lymphadenitis is the commonest extra pulmonary manifestation in cervical and mediastinal locations. Normal characteristics of lymph nodes (LN) have been described on ultrasonography as well as by Endoscopic Ultrasound. Many ultrasonic features have been described for evaluation of mediastinal lymph nodes. The inter and intraobserver agreement of the endosonographic features have not been uniformly established. Methods and Results: A total of 266 patients underwent endoscopic ultrasound guided fine needle aspiration and 134 cases were diagnosed as mediastinal tuberculosis. The endoscopic ultrasound location and features of these lymph nodes are described. Conclusion: Our series demonstrates the utility of endoscopic ultrasound guided fine needle aspiration as the investigation of choice for diagnosis of mediastinal tuberculosis and also describes various endoscopic ultrasound features of such nodes. PMID:27051097

  7. [Endoscopic vacuum-assisted closure].

    PubMed

    Wedemeyer, J; Lankisch, T

    2013-03-01

    Anastomotic leakage in the upper and lower intestinal tract is associated with high morbidity and mortality. Within the last 10 years endoscopic treatment options have been accepted as sufficient treatment option of these surgical complications. Endoscopic vacuum assisted closure (E-VAC) is a new innovative endoscopic therapeutic option in this field. E-VAC transfers the positive effects of vacuum assisted closure (VAC) on infected cutaneous wounds to infected cavities that can only be reached endoscopically. A sponge connected to a drainage tube is endoscopically placed in the leakage and a continuous vacuum is applied. Sponge and vacuum allow removal of infected fluids and promote granulation of the leakage. This results in clean wound grounds and finally allows wound closure. Meanwhile the method was also successfully used in the treatment of necrotic pancreatitis.

  8. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  9. Design of the new rigid endoscope distortion measurement system

    NASA Astrophysics Data System (ADS)

    Zhai, Xiaohao; Liu, Xiaohua; Liu, Ming; Hui, Mei; Dong, Liquan; Zhao, Yuejin; Wang, Yakun; Li, Yonghui; Zhou, Peng

    2015-08-01

    Endoscopic imaging quality affects industrial safety and medical security. Rigid endoscope distortion is of great signification as one of optical parameters to evaluate the imaging quality. This paper introduces a new method of rigid endoscope distortion measurement, which is different from the common methods with low accuracy and fussy operation. It contains a Liquid Crystal Display (LCD) to display the target, a CCD to obtain the images with distortion, and a computer to process the images. The LCD is employed instead of common white screen. The autonomous control system of LCD makes it showing the test target designed for distortion, and its parameter is known. LCD control system can change the test target to satisfy the different demand for accuracy, which avoids replacing target frequently. The test system also contains a CCD to acquire images in the exit pupil position of rigid endoscope. Rigid endoscope distortion is regarded as centrosymmetric, and the MATLAB software automatically measures it by processing the images from CCD. The MATLAB software compares target images with that without distortion on LCD and calculates the results. Relative distortion is obtained at different field of view (FOV) radius. The computer plots the curve of relative distortion, abscissa means radius of FOV, ordinate means relative distortion. The industry standard shows that, the distortion at 70% field of view is pointed on the curve, which can be taken as an evaluation standard. This new measuring method achieves advantages of high precision, high degree of intelligence, excellent repeatability and gets calculation results quickly.

  10. Endoscopic management of upper tract transitional cell carcinoma.

    PubMed

    Forster, James A; Palit, Victor; Browning, Anthony J; Biyani, Chandra Shekhar

    2010-04-01

    Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The "gold standard" management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (<1.5cm), low grade and noninvasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.

  11. Deconstructing Institutionalisation of the European Standards for Quality Assurance: From Instrument Mixes to Quality Cultures and Implications for International Research

    ERIC Educational Resources Information Center

    Kohoutek, Jan

    2016-01-01

    The paper enquires into the implementation of the European Standards and Guidelines for Internal Quality Assurance of Higher Education Institutions (ESG 1). The enquiry uses data from universities in the Czech Republic and compares them against those obtained in the relevant pan-European survey. The aims are to empirically deconstruct ESG 1…

  12. The Standardized Assessment of Personality-Abbreviated Scale as a screening instrument for personality disorders in substance-dependent criminal offenders.

    PubMed

    Jansen, Brigitte P M; Damen, Katinka F M; Hoffman, Tonko O; Vellema, Sietske L

    2013-05-01

    Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

  13. Endoscopic management of esophageal varices.

    PubMed

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

    2012-07-16

    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.

  14. Complications of endoscopic intranasal ethmoidectomy.

    PubMed

    Stankiewicz, J A

    1987-11-01

    A consecutive series of 90 patients undergoing endoscopic intranasal ethmoidectomy was reviewed. There were 26 complications (29%) in 19 patients in this group. Eight complications (8%) including CSF leak, temporary blindness, and hemorrhage were considered major with the latter occurring most commonly. Synechiae were the most commonly occurring minor complications. Endoscopic nasal sinus surgery performed by inexperienced operators carries with it the same risks and complications as traditional intranasal sinus surgery. Any surgeon who does not routinely perform traditional intranasal ethmoidectomy should accrue endoscopic experience through appropriate didactic training and multiple cadaver dissections (akin to otologic training).

  15. Advanced endoscopic imaging in gastric neoplasia and preneoplasia

    PubMed Central

    Lee, Jonathan W J; Lim, Lee Guan; Yeoh, Khay Guan

    2017-01-01

    Conventional white light endoscopy remains the current standard in routine clinical practice for early detection of gastric cancer. However, it may not accurately diagnose preneoplastic gastric lesions. The technological advancements in the field of endoscopic imaging for gastric lesions are fast growing. This article reviews currently available advanced endoscopic imaging modalities, in particular chromoendoscopy, narrow band imaging and confocal laser endomicroscopy, and their corresponding evidence shown to improve diagnosis of preneoplastic gastric lesions. Raman spectrometry and polarimetry are also introduced as promising emerging technologies. PMID:28176895

  16. Final Report: Part 1. In-Place Filter Testing Instrument for Nuclear Material Containers. Part 2. Canister Filter Test Standards for Aerosol Capture Rates.

    SciTech Connect

    Brown, Austin Douglas; Runnels, Joel T.; Moore, Murray E.; Reeves, Kirk Patrick

    2014-11-02

    A portable instrument has been developed to assess the functionality of filter sand o-rings on nuclear material storage canisters, without requiring removal of the canister lid. Additionally, a set of fifteen filter standards were procured for verifying aerosol leakage and pressure drop measurements in the Los Alamos Filter Test System. The US Department of Energy uses several thousand canisters for storing nuclear material in different chemical and physical forms. Specialized filters are installed into canister lids to allow gases to escape, and to maintain an internal ambient pressure while containing radioactive contaminants. Diagnosing the condition of container filters and canister integrity is important to ensure worker and public safety and for determining the handling requirements of legacy apparatus. This report describes the In-Place-Filter-Tester, the Instrument Development Plan and the Instrument Operating Method that were developed at the Los Alamos National Laboratory to determine the “as found” condition of unopened storage canisters. The Instrument Operating Method provides instructions for future evaluations of as-found canisters packaged with nuclear material. Customized stainless steel canister interfaces were developed for pressure-port access and to apply a suction clamping force for the interface. These are compatible with selected Hagan-style and SAVY-4000 storage canisters that were purchased from NFT (Nuclear Filter Technology, Golden, CO). Two instruments were developed for this effort: an initial Los Alamos POC (Proof-of-Concept) unit and the final Los Alamos IPFT system. The Los Alamos POC was used to create the Instrument Development Plan: (1) to determine the air flow and pressure characteristics associated with canister filter clogging, and (2) to test simulated configurations that mimicked canister leakage paths. The canister leakage scenarios included quantifying: (A) air leakage due to foreign material (i.e. dust and hair

  17. Endoscopic third ventriculostomy

    PubMed Central

    Yadav, Yad Ram; Parihar, Vijay; Pande, Sonjjay; Namdev, Hemant; Agarwal, Moneet

    2012-01-01

    Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow

  18. Endoscopic surgery - exploring the modalities

    PubMed Central

    Lee, Daniel Jin Keat; Tan, Kok-Yang

    2015-01-01

    The adoption of endoscopic surgery continues to expand in clinical situations with the recent natural orifice transluminal endoscopic surgery technique enabling abdominal organ resection to be performed without necessitating any skin incision. In recent years, the development of numerous devices and platforms have allowed for such procedures to be carried out in a safer and more efficient manner, and in some ways to better simulate triangulation and surgical tasks (e.g., suturing and dissection). Furthermore, new novel techniques such as submucosal tunneling, endoscopic full-thickness resection and hybrid endo-laparoscopic approaches have further widened its use in more advanced diseases. Nevertheless, many of these new innovations are still at their pre-clinical stage. This review focuses on the various innovations in endoscopic surgery, with emphasis on devices and techniques that are currently in human use. PMID:26649156

  19. ABSOLUTE FLUX CALIBRATION OF THE IRAC INSTRUMENT ON THE SPITZER SPACE TELESCOPE USING HUBBLE SPACE TELESCOPE FLUX STANDARDS

    SciTech Connect

    Bohlin, R. C.; Gordon, K. D.; Deustua, S.; Ferguson, H. C.; Flanagan, K.; Kalirai, J.; Meixner, M.; Rieke, G. H.; Engelbracht, C.; Su, K. Y. L.; Ardila, D.; Tremblay, P.-E.

    2011-05-15

    The absolute flux calibration of the James Webb Space Telescope (JWST) will be based on a set of stars observed by the Hubble and Spitzer Space Telescopes. In order to cross-calibrate the two facilities, several A, G, and white dwarf stars are observed with both Spitzer and Hubble and are the prototypes for a set of JWST calibration standards. The flux calibration constants for the four Spitzer IRAC bands 1-4 are derived from these stars and are 2.3%, 1.9%, 2.0%, and 0.5% lower than the official cold-mission IRAC calibration of Reach et al., i.e., in agreement within their estimated errors of {approx}2%. The causes of these differences lie primarily in the IRAC data reduction and secondarily in the spectral energy distributions of our standard stars. The independent IRAC 8 {mu}m band-4 fluxes of Rieke et al. are about 1.5% {+-} 2% higher than those of Reach et al. and are also in agreement with our 8 {mu}m result.

  20. Advances in endoscopic surgery for small animal reproduction.

    PubMed

    Katic, N; Dupré, G

    2016-09-01

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

  1. Endoscopic transoral surgery for craniovertebral junction anomalies. Technical note.

    PubMed

    Husain, Mazhar; Rastogi, Manu; Ojha, Bal Krishna; Chandra, Anil; Jha, Deepak K

    2006-10-01

    Craniovertebral junction (CVJ) anomalies continue to be challenging for neurosurgeons because of the complex anatomy of this region. To date, microsurgical decompression via a transoral route is the standard treatment for anteriorly located compressive lesions of the cervicomedullary junction (CMJ). The results obtained by minimizing surgical trauma are fewer complications, shorter hospital stays, and reduced overall psychological burden. Endoscopic surgery is becoming a leading modality in minimally invasive neurosurgical treatment. The authors performed surgery in 11 patients with irreducible osseous dislocations resulting from CVJ abnormality during a 2-year period. Anterior CMJ decompression was achieved in all patients by performing neuroendoscopically controlled transoral excision of bone and soft tissues. The surgical technique and results will be discussed. The use of the endoscope offers several advantages in cases requiring a transoral approach to the lower clivus and atlantoaxial region. The use of minimally invasive endoscopic techniques has the potential to reduce the need for a wider cranial base opening and to decrease postoperative complications.

  2. Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis.

    PubMed

    Lui, Tun Hing

    2016-04-01

    Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion.

  3. Endoscopic Closure of Duodenal Perforation with the Over-the-scope-clipping System

    PubMed Central

    Furukawa, Kazuhiro; Miyahara, Ryoji; Funasaka, Kohei; Yamamura, Takeshi; Ohno, Eizaburo; Nakamura, Masanao; Kawashima, Hiroki; Watanabe, Osamu; Hirooka, Yoshiki; Goto, Hidemi

    2016-01-01

    Endoscopic treatment for superficial non-ampullary duodenal tumors is technically difficult and challenging due to the anatomical characteristics of the duodenum. It is frequently complicated by procedural accidents, such as perforation. Surgical repair has long been the standard treatment for acute iatrogenic gastrointestinal perforation. However, endoscopic closure has recently emerged as an attractive alternative. In the patient presented herein, the over-the-scope-clipping system (OTSC system) was found to be useful for closing a duodenal perforation that had occurred during endoscopic submucosal dissection. For endoscopists who perform endoscopic treatment of the duodenum, endoscopic closure with the OTSC system is considered to be a technique that is necessary to master. PMID:27803406

  4. Endoscopic Septoplasty-Two Handed Technique with Endoscope Holder: A Novel Approach.

    PubMed

    Khan, Mubarak M; Parab, Sapna R

    2016-12-01

    The popularity of endoscopes has been expanding not only in diagnostics but also in therapeutics. The traditional septal surgery also has come under the purview of endoscopic surgery in the last few decades. Endoscopic septoplasty has definitely many advantages over the conventional procedure. But the only disadvantage of endoscopic surgery is that it is a single handed technique as the other hand is used for holding the endoscope which may compromise the overall surgical time as the hemostasis and suctioning of the surgical field off the blood cannot be done simultaneously, in addition to the surgeon fatigue associated with holding the endoscope in the left hand. Endoscope holder allows both hands of the surgeon to be free for surgical manipulation and also imitates more or less same actions of the left hand. To report the preliminary use of Khan's endoscope holder for endoscopic septoplasty. Prospective Non Randomized Clinical Study. Khan's Endoscope Holder, which was primarily designed for endoscopic ear surgery, has been used for two handed technique of endoscopic septoplasty. The design of the Endoscope holder is described in detail. A total of 49 endoholder assisted endoscopic septoplasties were operated from Nov 2014 to Jan 2015 in MIMER Medical College and Sushrut ENT Hospital, Talegaon D, Pune, India. Our Endoscope Holder is a good option for two handed technique in Endoscopic Septoplasty due to its advantages. The study reports the successful usage and applicability of the endo holder for endoscopic Septoplasty. Level of evidence IV.

  5. Development of a µ-TPC detector as a standard instrument for low-energy neutron field characterisation.

    PubMed

    Maire, D; Billard, J; Bosson, G; Bourrion, O; Guillaudin, O; Lamblin, J; Lebreton, L; Mayet, F; Médard, J; Muraz, J F; Richer, J P; Riffard, Q; Santos, D

    2014-10-01

    In order to measure the energy and fluence of neutron fields, in the energy range of 8 to 1 MeV, a new primary standard is being developed at the Institute for Radioprotection and Nuclear Safety (IRSN). This project, Micro Time Projection Chamber (µ-TPC), carried out in collaboration with the Laboratoire de Physqique Subatomique et de Cosmologie (LPSC), is based on the nucleus recoil detector principle. The measurement strategy requires track reconstruction of recoiling nuclei down to a few kiloelectronvolts, which can be achieved using a micro-pattern gaseous detector. A gas mixture, mainly isobutane, is used as an n-p converter to detect neutrons within the detection volume. Then electrons, coming from the ionisation of the gas by the proton recoil, are collected by the pixelised anode (2D projection). A self-triggered electronics system is able to perform the anode readout at a 50-MHz frequency in order to give the third dimension of the track. Then, the scattering angle is deduced from this track using algorithms. The charge collection leads to the proton energy, taking into account the ionisation quenching factor. This article emphasises the neutron energy measurements of a monoenergetic neutron field produced at 127 keV. The fluence measurement is not shown in this article. The measurements are compared with Monte Carlo simulations using realistic neutron fields and simulations of the detector response. The discrepancy between experiments and simulations is 5 keV mainly due to the calibration uncertainties of 10 %.

  6. Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy

    PubMed Central

    Alkhateeb, Harith M.; Aljanabi, Thaer J.; Al-azzawi, Khairallh H.; Alkarboly, Taha A.

    2015-01-01

    Background Biliary leak can occur as a complication of biliary surgery, endoscopic retrograde cholangiopancreatography manipulations and endoscopic biliary sphincterotomy. Consequently, bile may collect in the abdominal cavity, a condition called biloma. Rarely, it may reach a massive size. Case presentation A 72-year-old man presented with gastric upset with gradual abdominal distension reaching a large size due to intra-abdominal bile collection (biloma) after endoscopic retrograde cholangiopancreatography plus endoscopic biliary sphincterotomy and stenting for post laparoscopic cholecystectomy common bile duct stricture. This huge biloma was treated by percutaneous insertion of a tube drain for a few days, evacuating the collection successfully without recurrence. Discussion This patient might sustain injury to the common bile duct either by the guide wire or stent, or the injury occurred at the angle between the common bile duct and duodenum during sphincterotomy of the ampulla. Although any of these rents may lead to a bile leak, causing a huge biloma, they could be successfully treated by percutaneous drainage. Conclusions (1) Following endoscopic retrograde cholangiopancreatography, a patient’s complaints should not be ignored. (2) A massive biloma can occur due to such procedures. (3) Conservative treatment with minimal invasive technique can prove to be effective. PMID:26402876

  7. MathWorks Simulink and C++ integration with the new VLT PLC-based standard development platform for instrument control systems

    NASA Astrophysics Data System (ADS)

    Kiekebusch, Mario J.; Di Lieto, Nicola; Sandrock, Stefan; Popovic, Dan; Chiozzi, Gianluca

    2014-07-01

    ESO is in the process of implementing a new development platform, based on PLCs, for upcoming VLT control systems (new instruments and refurbishing of existing systems to manage obsolescence issues). In this context, we have evaluated the integration and reuse of existing C++ libraries and Simulink models into the real-time environment of BECKHOFF Embedded PCs using the capabilities of the latest version of TwinCAT software and MathWorks Embedded Coder. While doing so the aim was to minimize the impact of the new platform by adopting fully tested solutions implemented in C++. This allows us to reuse the in house expertise, as well as extending the normal capabilities of the traditional PLC programming environments. We present the progress of this work and its application in two concrete cases: 1) field rotation compensation for instrument tracking devices like derotators, 2) the ESO standard axis controller (ESTAC), a generic model-based controller implemented in Simulink and used for the control of telescope main axes.

  8. Clinical Practice Guidelines for Endoscope Reprocessing

    PubMed Central

    Oh, Hyun Jin

    2015-01-01

    Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process. PMID:26473117

  9. Recent Update on Microbiological Monitoring of Gastrointestinal Endoscopes after High-Level Disinfection

    PubMed Central

    Shin, Suk Pyo

    2015-01-01

    Endoscopy-related infections are important contributors to nosocomial infections. Endoscope reprocessing according to standard guidelines ensures high-level disinfection and prevents endoscopy-related infections. Microbiological surveillance may help in monitoring the effectiveness of gastrointestinal endoscope disinfection. The process involves microbial cultures and non-culture methods such as bioburden assays, adenosine triphosphate (ATP) bioluminescence, and quantitative polymerase chain reactions (PCRs). Surveillance culturing to monitor endoscopes after reprocessing has been recommended by a majority of organizations. Bioburden assays, ATP bioluminescence, and quantitative PCRs provide rapid and reliable measures. Each institution will have to try to establish its own surveillance guidelines. PMID:26473118

  10. Shape memory alloy-based biopsy device for active locomotive intestinal capsule endoscope.

    PubMed

    Le, Viet Ha; Hernando, Leon-Rodriguez; Lee, Cheong; Choi, Hyunchul; Jin, Zhen; Nguyen, Kim Tien; Go, Gwangjun; Ko, Seong-Young; Park, Jong-Oh; Park, Sukho

    2015-03-01

    Recently, capsule endoscopes have been used for diagnosis in digestive organs. However, because a capsule endoscope does not have a locomotive function, its use has been limited to small tubular digestive organs, such as small intestine and esophagus. To address this problem, researchers have begun studying an active locomotive intestine capsule endoscope as a medical instrument for the whole gastrointestinal tract. We have developed a capsule endoscope with a small permanent magnet that is actuated by an electromagnetic actuation system, allowing active and flexible movement in the patient's gut environment. In addition, researchers have noted the need for a biopsy function in capsule endoscope for the definitive diagnosis of digestive diseases. Therefore, this paper proposes a novel robotic biopsy device for active locomotive intestine capsule endoscope. The proposed biopsy device has a sharp blade connected with a shape memory alloy actuator. The biopsy device measuring 12 mm in diameter and 3 mm in length was integrated into our capsule endoscope prototype, where the device's sharp blade was activated and exposed by the shape memory alloy actuator. Then the electromagnetic actuation system generated a specific motion of the capsule endoscope to extract the tissue sample from the intestines. The final biopsy sample tissue had a volume of about 6 mm(3), which is a sufficient amount for a histological analysis. Consequently, we proposed the working principle of the biopsy device and conducted an in-vitro biopsy test to verify the feasibility of the biopsy device integrated into the capsule endoscope prototype using the electro-magnetic actuation system.

  11. Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

    PubMed Central

    Shimatani, Masaaki; Takaoka, Makoto; Tokuhara, Mitsuo; Miyoshi, Hideaki; Ikeura, Tsukasa; Okazaki, Kazuichi

    2015-01-01

    The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices. PMID:26078830

  12. Total extraperitoneal endoscopic hernioplasty (TEP).

    PubMed

    Kuthe, A; Mainik, F; Flade-Kuthe, R

    2014-04-01

    One can no longer think about modern hernia surgery without mentioning endoscopic techniques. But due to their high technical demands the learning curve is comparatively long. And by technical mistakes and their consequences (pain, recurrence, complications) the benefits of the endoscopic techniques can easily be turned to drawbacks. The following text explains the steps of the total extraperitoneal endoscopic hernioplasty (TEP) technique in detail pointing out alternatives and risks. From preparation, indication and positioning, from trocar placement to extraperitoneal dissection and mesh placement, the principles of TEP are elucidated in respect of local anatomy and possible complications. The text as well as the accompanying video in the Mediathek are based on the authors' 20 years of experience in the TEP technique. Both of them may help in safe TEP application to minimise the complication rate as well as recurrences. Then patients can benefit from the advantages of this technique.

  13. Endoscopic Management of Bladder Diverticula

    PubMed Central

    Pham, Khanh N.; Jeldres, Claudio; Hefty, Thomas; Corman, John M.

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  14. Motion magnification for endoscopic surgery

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Baxter, John S. H.; de Ribaupierre, Sandrine; Peters, Terry M.

    2014-03-01

    Endoscopic and laparoscopic surgeries are used for many minimally invasive procedures but limit the visual and haptic feedback available to the surgeon. This can make vessel sparing procedures particularly challenging to perform. Previous approaches have focused on hardware intensive intraoperative imaging or augmented reality systems that are difficult to integrate into the operating room. This paper presents a simple approach in which motion is visually enhanced in the endoscopic video to reveal pulsating arteries. This is accomplished by amplifying subtle, periodic changes in intensity coinciding with the patient's pulse. This method is then applied to two procedures to illustrate its potential. The first, endoscopic third ventriculostomy, is a neurosurgical procedure where the floor of the third ventricle must be fenestrated without injury to the basilar artery. The second, nerve-sparing robotic prostatectomy, involves removing the prostate while limiting damage to the neurovascular bundles. In both procedures, motion magnification can enhance subtle pulsation in these structures to aid in identifying and avoiding them.

  15. Quality of Life Following Endoscopic Resection of Skull Base Tumors

    PubMed Central

    Cavel, Oren; Abergel, Avraham; Margalit, Nevo; Fliss, Dan M.; Gil, Ziv

    2012-01-01

    The objective of the study is to evaluate patients' quality of life (QOL) after endoscopic resection of skull base tumors. We estimated the QOL of 41 patients who underwent surgery for removal of skull base tumors via the expanded endonasal approach (EEA). The Anterior Skull Base Surgery Questionnaire (ASBS-Q), a multidimensional, disease-specific instrument containing 36 items was used. The rate of meningitis and cerebrospinal fluid leak was 1.4 and 0%, respectively. There was one case of uniocular visual impairment. The internal consistency of the instrument had a correlation coefficient (α-Cronbach score) of 0.8 to 0.92. Of 41 patients, 30 (75%) reported improvement or no change in overall QOL. Improved scores were reported in the physical function domain and worse scores in the specific symptoms domain. The most significant predictor of poor QOL was female gender, which led to a significant decrease in scores of all domains. Site of surgery, histology, age and comorbidity were not significant predictors of outcome. This paper further validates the use of the ASBS-Q for patients undergoing endoscopic skull base resection. The overall QOL of patients following endoscopic extirpation of skull base tumors is good. Female patients experience a significant decline in QOL compared with males. PMID:23542557

  16. Endoscopic foraminotomy for recurrent lumbar radiculopathy after TLIF: Technical report

    PubMed Central

    Telfeian, Albert E.

    2015-01-01

    Background: Transforaminal lumbar interbody fusion (TLIF) is a well-accepted fusion technique that uses unilateral facet removal as an oblique corridor for inserting an interbody spacer. This manuscript focused on five cases of endoscopic foraminotomy for patients presenting with recurrent radiculopathy after TLIF procedures. Methods: After Institutional Review Board approval, charts from five patients with lumbar radiculopathy and instrumented TLIF procedures who underwent subsequent endoscopic procedures between 2011 and 2013 were reviewed. Results: The average pain relief 1 year postoperatively was reported to be 63.8%, good results as defined by MacNab. The average preoperative visual analog scale (VAS) score was 9.5, indicated in our questionnaire as severe and constant pain. The average 1 year postoperative VAS score was 3.5, indicated in our questionnaire as mild and intermittent pain. Conclusion: Transforaminal endoscopic discectomy and foraminotomy could be used as a safe, yet, minimally invasive and innovative technique for the treatment of lumbar radiculopathy in the setting of previous instrumented lumbar fusion. IRB approval: Lifespan: IRB Study # 600415 PMID:25949850

  17. VALIDATION OF ANSI N42.34 AMERICAN NATIONAL STANDARD PERFORMANCE CRITERIA FOR HAND-HELD INSTRUMENTS FOR THE DETECTION AND IDENTIFICATION OF RADIONUCLIDES

    SciTech Connect

    Lorier, T.

    2014-09-03

    SRNL’s validation of ANSI N42.34-D6 for the Domestic Nuclear Detection Office (DNDO) was performed utilizing one hand-held instrument (or RID) – the FLIR identiFINDER 2. Each section of the standard was evaluated via a walk-through or test. NOTE: In Table 1, W = walk-through and T = test, as directed by the Domestic Nuclear Detection Office (DNDO). For a walk-through, the experiment was either setup or reviewed for setup; for a test, the N42.34-D6 procedures were followed with some exceptions and comments noted. SRNL is not fully able to evaluate a RID against Sections 7 (Environmental), 8 (Electromagnetic), and 9 (Mechanical) of N42.34, so those portions of this validation were done in collaboration with Qualtest, Inc. in Orlando, Florida. The walk-throughs and tests of Sections 7, 8, and 9 were performed in Qualtest, Inc. facilities with SRNL providing radiological sources as necessary. Where applicable, assessment results and findings of the walk-throughs and tests were recorded on datasheets and a validation summary is provided. A general comment pertained to test requirements found in another standard and referenced in N42.34-D6. For example, step 1 of the test method in section 8.1.2 states “RF test set up information can be found in IEC 61000-4-3.” It is recommended that any information from other standards necessary for conducting the tests within N42.34 should be posted in N42.34 for simplicity and to prevent the user from having to peruse other documents. Another general comment, as noted by Qualtest, is that a tolerance reference is not listed for each test in sections 7-9. Overall, the N42.34-D6 was proven to be practicable, but areas for improvement and recommendations were identified for consideration prior to final ballot submittal.

  18. Endoscopic brow lifts uber alles.

    PubMed

    Patel, Bhupendra C K

    2006-12-01

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

  19. Endoscopic surgery of pituitary tumors.

    PubMed

    Dhepnorrarat, Rataphol Chris; Ang, Beng Ti; Sethi, Dharambir Singh

    2011-08-01

    Endoscopic pituitary surgery has been gaining wide acceptance as the first-line treatment of most functional pituitary adenomas. This technique has many advantages over traditional procedures, and growing evidence supports its use for endocrine control of functioning tumors. This article reviews data on the different modalities of treatment of functioning pituitary adenomas and compares the results. Endoscopic pituitary surgery controls tumor growth and endocrinopathy as well as or better than other treatment modalities. Complication rates are low and patient recovery is fast. Furthermore, surgery provides a means of achieving prompt decompression of neurologic structures and endocrine remission.

  20. Training for advanced endoscopic procedures.

    PubMed

    Feurer, Matthew E; Draganov, Peter V

    2016-06-01

    Advanced endoscopy has evolved from diagnostic ERCP to an ever-increasing array of therapeutic procedures including EUS with FNA, ablative therapies, deep enteroscopy, luminal stenting, endoscopic suturing and endoscopic mucosal resection among others. As these procedures have become increasingly more complex, the risk of potential complications has also risen. Training in advanced endoscopy involves more than obtaining a minimum number of therapeutic procedures. The means of assessing a trainee's competence level and ability to practice independently continues to be a matter of debate. The use of quality indicators to measure performance levels may be beneficial as more advanced techniques and procedures become available.

  1. Endoscopic Ganglionectomy of the Elbow.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning.

  2. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy.

    PubMed

    Thaker, Adarsh M; Sedarat, Alireza

    2016-09-01

    There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.

  3. Experimental measurement on movement of spiral-type capsule endoscope

    PubMed Central

    Yang, Wanan; Dai, Houde; He, Yong; Qin, Fengqing

    2016-01-01

    Wireless capsule endoscope achieved great success, however, the maneuvering of wireless capsule endoscope is challenging at present. A magnetic driving instrument, including two bar magnets, a stepper motor, a motor driver, a motor controller, and a power supplier, was developed to generate rotational magnetic fields. Permanent magnet ring, magnetized as S and N poles radially and mounted spiral structure on the surface, acted as a capsule. The maximum torque passing to the capsule, rotational synchronization of capsule and motor, and the translational speed of capsule, were measured in ex vivo porcine large intestine. The experimental results illustrate that the rotational movement of the spiral-type capsule in the intestine is feasible and the cost of the magnetic driving equipment is low. As a result, the solution is promising in the future controllability. PMID:26848279

  4. Experimental measurement on movement of spiral-type capsule endoscope.

    PubMed

    Yang, Wanan; Dai, Houde; He, Yong; Qin, Fengqing

    2016-01-01

    Wireless capsule endoscope achieved great success, however, the maneuvering of wireless capsule endoscope is challenging at present. A magnetic driving instrument, including two bar magnets, a stepper motor, a motor driver, a motor controller, and a power supplier, was developed to generate rotational magnetic fields. Permanent magnet ring, magnetized as S and N poles radially and mounted spiral structure on the surface, acted as a capsule. The maximum torque passing to the capsule, rotational synchronization of capsule and motor, and the translational speed of capsule, were measured in ex vivo porcine large intestine. The experimental results illustrate that the rotational movement of the spiral-type capsule in the intestine is feasible and the cost of the magnetic driving equipment is low. As a result, the solution is promising in the future controllability.

  5. A physical simulator for endoscopic endonasal drilling techniques: technical note.

    PubMed

    Tai, Bruce L; Wang, Anthony C; Joseph, Jacob R; Wang, Page I; Sullivan, Stephen E; McKean, Erin L; Shih, Albert J; Rooney, Deborah M

    2016-03-01

    In this paper, the authors present a physical model developed to teach surgeons the requisite drilling techniques when using an endoscopic endonasal approach (EEA) to the skull base. EEA is increasingly used for treating pathologies of the ventral and ventrolateral cranial base. Endonasal drilling is a unique skill in terms of the instruments used, the long reach required, and the restricted angulation, and gaining competency requires much practice. Based on the successful experience in creating custom simulators, the authors used 3D printing to build an EEA training model from post-processed thin-cut head CT scans, formulating the materials to provide realistic haptic feedback and endoscope handling. They performed a preliminary assessment at 2 institutions to evaluate content validity of the simulator as the first step of the validation process. Overall results were positive, particularly in terms of bony landmarks and haptic response, though minor refinements were suggested prior to use as a training device.

  6. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism

    PubMed Central

    Li, Zhen; Van Den Heede, Klaas; Cuny, Thomas; Van Slycke, Sam

    2016-01-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations. PMID:27294044

  7. Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Advanced Robotic Telemanipulator for Minimally Invasive Surgery.

    PubMed

    Schurr, M O; Buess, G; Neisius, B; Voges, U

    2000-04-01

    In endoscopic surgery, the ability to guide the instrument is significantly decreased compared with open surgery. Rigid laparoscopic instruments offer only four of the six degrees of freedom required for the free handling of objects in space. Robotics technology can be used to restore full mobility of the endoscopic instrument. Therefore, we designed a master-slave manipulator system (ARTEMIS) for laparoscopic surgery as a prototype. The system consists of two robotic arms holding two steerable laparoscopic instruments. These two work units are controlled from a console equipped with two master arms operated by the surgeon. The systems and its components were evaluated experimentally. Laparoscopic manipulations were feasible with the ARTEMIS system. The placement of ligatures and sutures and the handling of catheters were possible in phantom models. The surgical practicability of the system was demonstrated in animal experiments. We conclude that robotic manipulators are feasible for experimental endoscopic surgery. Their clinical application requires further technical development.

  8. Instrument performance evaluation

    SciTech Connect

    Swinth, K.L.

    1993-03-01

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

  9. Stereo Imaging Miniature Endoscope

    NASA Technical Reports Server (NTRS)

    Bae, Youngsam; Manohara, Harish; White, Victor; Shcheglov, Kirill V.; Shahinian, Hrayr

    2011-01-01

    Stereo imaging requires two different perspectives of the same object and, traditionally, a pair of side-by-side cameras would be used but are not feasible for something as tiny as a less than 4-mm-diameter endoscope that could be used for minimally invasive surgeries or geoexploration through tiny fissures or bores. The proposed solution here is to employ a single lens, and a pair of conjugated, multiple-bandpass filters (CMBFs) to separate stereo images. When a CMBF is placed in front of each of the stereo channels, only one wavelength of the visible spectrum that falls within the passbands of the CMBF is transmitted through at a time when illuminated. Because the passbands are conjugated, only one of the two channels will see a particular wavelength. These time-multiplexed images are then mixed and reconstructed to display as stereo images. The basic principle of stereo imaging involves an object that is illuminated at specific wavelengths, and a range of illumination wavelengths is time multiplexed. The light reflected from the object selectively passes through one of the two CMBFs integrated with two pupils separated by a baseline distance, and is focused onto the imaging plane through an objective lens. The passband range of CMBFs and the illumination wavelengths are synchronized such that each of the CMBFs allows transmission of only the alternate illumination wavelength bands. And the transmission bandwidths of CMBFs are complementary to each other, so that when one transmits, the other one blocks. This can be clearly understood if the wavelength bands are divided broadly into red, green, and blue, then the illumination wavelengths contain two bands in red (R1, R2), two bands in green (G1, G2), and two bands in blue (B1, B2). Therefore, when the objective is illuminated by R1, the reflected light enters through only the left-CMBF as the R1 band corresponds to the transmission window of the left CMBF at the left pupil. This is blocked by the right CMBF. The

  10. Endoscopic excision of cheek lipomas.

    PubMed

    Pyon, Jai-Kyong; Park, Bum-Jin; Mun, Goo-Hyun; Cha, Myung-Kyu; Lim, So-Young; Bang, Sa-Ik; Oh, Kap-Sung

    2008-10-01

    Although the removal of forehead and brow benign tumors using an endoscopic technique has proven to be valuable, the efficacy of an endoscopic excision for cheek masses is unclear. A retrospective review was performed on 8 patients with a lipoma (7) and a foreign body granuloma (1) located at the cheek region. There were 7 men and 1 woman with a mean age of 34.8 years (range, 22-54 years). All the excisional procedures were performed with an endoscope through 2 small incisions, one on the hair-bearing sideburns and the other behind the earlobe. The masses varied from 0.7 x 0.7 cm to 4.0 x 3.0 cm in size. There were no intraoperative or postoperative complications, and no recurrence was detected after a 5- to 61-month follow-up. An endoscopically assisted excision of cheek lipomas is an effective procedure and might be a good alternative to the more conventional procedures.

  11. Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

    PubMed

    Schurr, M O; Arezzo, A; Buess, G F

    1999-11-01

    The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

  12. Trace elements determination in seawater by ICP-MS with on-line pre-concentration on a Chelex-100 column using a 'standard' instrument setup.

    PubMed

    Søndergaard, Jens; Asmund, Gert; Larsen, Martin M

    2015-01-01

    Trace element determination in seawater is analytically challenging due to the typically very low concentrations of the trace elements and the potential interference of the salt matrix. A common way to address the challenge is to pre-concentrate the trace elements on a chelating resin, then rinse the matrix elements from the resin and subsequently elute and detect the trace elements using inductively coupled plasma mass spectrometry (ICP-MS). This technique typically involves time-consuming pre-treatment of the samples for 'off-line' analyses or complicated sample introduction systems involving several pumps and valves for 'on-line' analyses. As an alternative, the following method offers a simple method for 'on-line' analyses of seawater by ICP-MS. As opposed to previous methods, excess seawater was pumped through the nebulizer of the ICP-MS during the pre-concentration step but the gas flow was adjusted so that the seawater was pumped out as waste without being sprayed into the instrument. Advantages of the method include: •Simple and convenient analyses of seawater requiring no changes to the 'standard' sample introduction system except from a resin-filled micro-column connected to the sample tube. The 'standard' sample introduction system refers to that used for routine digest-solution analyses of biota and sediment by ICP-MS using only one peristaltic pump; and•Accurate determination of the elements V, Mn, Co, Ni, Cu, Zn, Cd and Pb in a range of different seawater matrices verified by participation in 6 successive rounds of the international laboratory intercalibration program QUASIMEME.

  13. [Natural orifice transluminal endoscopic surgery: current situation].

    PubMed

    Delgado, Salvadora; Ibarzábal, Ainitze; Fernández-Esparrach, Glòria

    2008-10-01

    Natural orifice transluminal endoscopic surgery (NOTES) is the paradigm of the evolution of minimally invasive surgery. The laparoscopic has introduced new ideas in general surgery, one of them being that modern surgery is the work of multidisciplinary teams. A clear example of this is provided by NOTES. The aim of this type of surgery is to perform conventional laparoscopic procedures without incision, using flexible endoscopic technology usually employed in the diagnosis and treatment of intraluminal lesions and reaching the inside of the abdominal cavity through natural orifices (mouth, anus, vagina and even urethra). This type of access opens a highly interesting field for certain types of patients, such as those with high surgical risk, the morbidly obese, and those with multiple prior abdominal interventions or surgical wound infections. Animal models have shown that a wide variety of interventions (cholecystectomy, appendicectomy, splenectomy, hysterectomy, tubal ligations, gastroenteroanastomosis, peritoneoscopy, liver biopsy and herniorrhaphy, among others) can be performed. However, before use in humans, this new technique must be shown to be safe and to provide real advantages for patients. To do this, a series of issues, including safe methods for closure of the gastric incision and the avoidance of infections, among others, must be solved. Another critical element for the development of this new type of surgery is the creation of appropriate instrumentation, requiring input not only from medical professionals but also from engineers and industry. The present article describes the major advances made in NOTES since this technique was first described and analyzes the risks and potential benefits associated with this novel procedure.

  14. Video endoscopic oro-nasal visualisation of the anterior wall of maxillary sinus: a new technique.

    PubMed

    Trimarchi, M; Tomazic, P V; Bertazzoni, G; Rathburn, A; Bussi, M; Stammberger, H

    2014-08-01

    The anterior wall of the maxillary sinus represents a blind spot in maxillary sinus endoscopic surgery because of the absence of proper visualisation and instrumentation to reach it. The aim of this study was to validate a new approach through the oral cavity into the nose with a flexible video endoscope (oro-nasal endoscopic approach; ONEA) to visualise the entire anterior maxillary wall including the anteromedial angle. We started from a dried bone cadaver model, and then dissected fresh-frozen cadavers. The maxillary sinus was explored with a rigid and a flexible endoscope entering from the nose. Next, a flexible endoscope was introduced through the mouth and back up through the choana, it accessed the maxillary middle antrostomy, entering inside the sinus and looking at the anterior wall. A small ruler inserted inside the sinus demonstrated all the angles visualised. The new ONEA technique allows complete visualisation of the anterior wall of the maxillary sinus with inspection of all blind spots. It is therefore possible to detect lesions that would normally not be visible with a normal rigid endoscope. We demonstrate the validity of a novel technique that allows visualisation of the infero-medial angle of the anterior wall of the maxillary sinus.

  15. Decontamination of minimally invasive surgical endoscopes and accessories.

    PubMed

    Ayliffe, G

    2000-08-01

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

  16. A single-imager stereoscopic endoscope

    NASA Astrophysics Data System (ADS)

    Keller, Kurtis; State, Andrei

    2011-03-01

    We have developed a 5.5mm and 10mm dual optical channel laparoscope that combines both exit channels into a single, standard, endoscopic eye cup which attaches directly to a single, conventional HD camera head. We have also developed image processing software that auto-calibrates, aligns, enhances and processes the image so that it can be displayed on a stereo/3D display to achieve a true 3D effect. The advantages to the end user for such a 3D system are that they do not have to purchase a new camera system, all of their existing scopes are still available to use, as are all integrated OR features. They will be able to add 3D capability to current HD system by purchasing only stereo scopes and a small video processing computer box and adding a 2D/3D HD capable monitor.

  17. Endoscopic optical diagnosis provides high diagnostic accuracy of esophageal squamous cell carcinoma

    PubMed Central

    2014-01-01

    Background Recent technological advances have stimulated the development of endoscopic optical biopsy technologies. This study compared the accuracy of endoscopic diagnosis using magnifying narrow-band imaging (NBI) and histologic diagnosis of esophageal squamous lesions. Methods Patients at high risk for esophageal squamous cell carcinoma were examined with endoscopy and subsequent biopsy. The lesions diagnosed as cancer on NBI and the lesions diagnosed as cancer on biopsy were resected endoscopically or surgically. Histological diagnoses of resected specimens, the reference standards in this study, were made by a pathologist who was blind to both the endoscopic and biopsy diagnoses. The primary outcome was the accuracy of endoscopic and biopsy diagnosis. A noninferiority trial design with a noninferiority margin of −10% was chosen to investigate the accuracy of endoscopic diagnosis using magnifying NBI. Results Between November 2010 and October 2012, a total of 111 lesions in 85 patients were included in the analysis. The accuracy of endoscopic diagnosis and biopsy diagnosis for all lesions was 91.0% (101/111) and 85.6% (95/111), respectively. The difference in diagnostic accuracy was 5.4% (95% confidence interval: −2.9%–13.7%). The accuracy of endoscopic diagnosis and biopsy diagnosis of invasive cancers was 94.9% (74/78) and 84.6% (66/78), respectively. The difference was 10.3% (95% confidence interval: 1.6%–19.0%) for invasive cancers. The lower bound of the 95% confidence interval was above the prestated −10% in both cases. Conclusion Noninferiority of endoscopic diagnosis by magnifying NBI to histologic diagnosis by biopsy was established in this study (p = 0.0001). Trial registration The study was registered on 9th November 2010 in the University Hospital Medical Network Clinical Trials Registry as number: UMIN000004529. PMID:25108624

  18. Combined Conventional and Endoscopic Microdebrider-Assisted Adenoidectomy: A Tertiary Centre Experience

    PubMed Central

    Prakash, S.B.; Priyadarshini, V.

    2017-01-01

    Introduction Adenoidectomy is one of the most commonly performed surgical procedures in children. Conventional adenoidectomy is associated with incomplete adenoid tissue removal with persistence of symptoms. The advent of rigid nasal endoscopes, cold light source, fiber optics and powered instruments used in functional endoscopic sinus surgery helped in the development of endoscopic microdebrider-assisted adenoidectomy. Aim To establish the safety and efficacy of combined conventional and endoscopic microdebrider-assisted adenoidectomy procedure. Materials and Methods This is a prospective study of 60 child patients who underwent combined conventional and endoscopic microdebrider-assisted adenoidectomy. The study was conducted from September 2013 to September 2015. Only child patients with grade 3 and grade 4 Adenoid Hypertrophy (AH) was included in the study. At the end of conventional adenoidectomy and after combined procedure, the AH was graded again. Post-operative complications like neck pain, hypernasality and swallowing problems were noted. Their symptom score was reviewed before surgery and after one month and one year of surgery. The duration of surgery and amount of blood loss was recorded. Results By this technique, complete clearance of adenoid tissue was obtained in all 60 (100%) cases. The mean pre-operative symptom score for AH was 3.7, which improved to 0 after one month of combined conventional and endoscopic microdebrider-assisted adenoidectomy. All child patients were symptom-free at the end of one month and one year. The duration of conventional adenoidectomy was 5 minutes 12 seconds while total duration of the combined conventional and endoscopic microdebrider-assisted adenoidectomy was 14 minutes 45 seconds. There was no significant blood loss (15±3 ml approximately). There were no major complications in this study. Conclusion The combined approach of conventional curette along with endoscopic microdebrider-assisted adenoidectomy is a safe

  19. Minimal Endoscope-assisted Thyroidectomy Through a Retroauricular Approach: An Evolving Solo Surgery Technique

    PubMed Central

    Ban, Myung Jin; Chang, Jae Won; Kim, Won Shik; Byeon, Hyung Kwon; Koh, Yoon Woo

    2016-01-01

    This study aimed to evaluate the feasibility and efficacy of minimal endoscope-assisted thyroidectomy (MEAT) through a retroauricular (RA) approach. Most of the thyroidectomy operative time was accounted for by direct visualization through the RA window, minimizing interference between surgical instruments. Endoscope use was minimized and limited to critical surgical aspects, including preservation of the recurrent laryngeal nerve and parathyroid glands. The recurrent laryngeal nerve was neuromonitored throughout the procedure. MEAT through an RA approach was performed in 8 patients with papillary thyroid carcinoma (mean tumor size, 1.2±0.5 cm). The mean patient age was 41.1±7.5 years. The endoscopic operating time was 19±3.4 minutes, and no postoperative hematoma, seroma, or vocal cord paralysis was observed. MEAT through an RA approach was feasible and safe. Solo thyroidectomy through the RA approach is possible without depending on an endoscopic view, overcoming limited working space and minimizing instrument interference during endoscopic RA thyroidectomy. PMID:27846184

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

    PubMed

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

    2017-04-03

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

  1. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

    PubMed Central

    Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were

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

    PubMed

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

    2013-10-01

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

  3. Endoscopic laser scalpel for head and neck cancer surgery

    NASA Astrophysics Data System (ADS)

    Patel, Snehal; Rajadhyaksha, Milind; Kirov, Stefan; Li, Yongbiao; Toledo-Crow, Ricardo

    2012-02-01

    Minimally invasive surgical (MIS) techniques, such as laparoscopic surgery and endoscopy, provide reliable disease control with reduced impact on the function of the diseased organ. Surgical lasers can ablate, cut and excise tissue while sealing small blood vessels minimizing bleeding and risk of lymphatic metastases from tumors. Lasers with wavelengths in the IR are readily absorbed by water causing minimal thermal damage to adjacent tissue, ideal for surgery near critical anatomical structures. MIS techniques have largely been unable to adopt the use of lasers partly due to the difficulty in bringing the laser into the endoscopic cavity. Hollow waveguide fibers have been adapted to bring surgical lasers to endoscopy. However, they deliver a beam that diverges rapidly and requires careful manipulation of the fiber tip relative to the target. Thus, the principal obstacle for surgical lasers in MIS procedures has been a lack of effective control instruments to manipulate the laser in the body cavity and accurately deliver it to the targeted tissue. To overcome this limitation, we have designed and built an endoscopic laser system that incorporates a miniature dual wedge beam steering device, a video camera, and the control system for remote and /or robotic operation. The dual wedge Risley device offers the smallest profile possible for endoscopic use. Clinical specifications and design considerations will be presented together with descriptions of the device and the development of its control system.

  4. Endoscopic laser reshaping of rabbit tracheal cartilage: preliminary investigations

    NASA Astrophysics Data System (ADS)

    Tsang, Walter; Lam, Anthony; Protsenko, Dmitry; Wong, Brian J.

    2005-04-01

    Background: Tracheal cartilage deformities due to trauma, prolonged endotracheal intubation or infection are difficult to correct. Current treatment options such as dilation, laser ablation, stent placement, and segmental resection are only temporary or carry significant risks. The objectives of this project were to design and test a laser activated endotracheal stent system that can actively modify the geometry of tracheal cartilage, leading to permanent retention of a new and desirable tracheal geometry. Methods: Ex vivo rabbit tracheal cartilage (simulating human neonate trachea) were irradiated with an Er: Glass laser, (λ= 1.54um, 0.5W-2.5W, 1 sec to 5 sec). Shape change and gross thermal injury were assessed visually to determine the best laser power parameters for reshaping. A rigid endoscopic telescope and hollow bronchoscope were used to record endoscopic images. The stent was constructed from nitinol wire, shaped into a zigzag configuration. An ex vivo testing apparatus was also constructed. Results: The best laser power parameter to produce shape change was 1 W for 6-7 seconds. At this setting, there was significant shape change with only minimal thermal injury to the tracheal mucosa, as assessed by visual inspection. The bronchoscopy system functioned adequately during testing in the ex vivo testing apparatus. Conclusion: We have successfully designed instrumentation and created the capability to endoscopically reshape tracheal cartilage in an ex vivo rabbit model. The results obtained in ex vivo tracheal cartilage indicated that reshaping using Er: Glass laser can be accomplished.

  5. Transmission of Salmonella enteritidis after endoscopic retrograde cholangiopancreatography because of inadequate endoscope decontamination.

    PubMed

    Robertson, Paul; Smith, Andrew; Anderson, Margaret; Stewart, Jackie; Hamilton, Kate; McNamee, Sandra; Curran, Evonne T

    2017-04-01

    We report a historic nosocomial outbreak of Salmonella enteritidis affecting 4 inpatients who underwent endoscopic retrograde cholangiopancreatography. The cause was attributed to inadequate decontamination of an on-loan endoscope used over a weekend. This report highlights the risks of using on-loan endoscopes, particularly regarding their commissioning and adherence to disinfection protocols. In an era of increasing antibiotic resistance, transmission of Enterobacteriaceae by endoscopes remains a significant concern.

  6. Representing flexible endoscope shapes with hermite splines

    NASA Astrophysics Data System (ADS)

    Chen, Elvis C. S.; Fowler, Sharyle A.; Hookey, Lawrence C.; Ellis, Randy E.

    2010-02-01

    Navigation of a flexible endoscope is a challenging surgical task: the shape of the end effector of the endoscope, interacting with surrounding tissues, determine the surgical path along which the endoscope is pushed. We present a navigational system that visualized the shape of the flexible endoscope tube to assist gastrointestinal surgeons in performing Natural Orifice Translumenal Endoscopic Surgery (NOTES). The system used an electromagnetic positional tracker, a catheter embedded with multiple electromagnetic sensors, and graphical user interface for visualization. Hermite splines were used to interpret the position and direction outputs of the endoscope sensors. We conducted NOTES experiments on live swine involving 6 gastrointestinal and 6 general surgeons. Participants who used the device first were 14.2% faster than when not using the device. Participants who used the device second were 33.6% faster than the first session. The trend suggests that spline-based visualization is a promising adjunct during NOTES procedures.

  7. Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety.

    PubMed

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2016-10-07

    Most pancreatic cancers and extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis, and even in case of a resectable cancer, for elderly or patients with coexistent comorbidities, surgery is not an option. Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment of biliary obstruction due to unresectable pancreatic cancer or cholangiocarcinoma. Nevertheless, more than 50% of SEMS become occluded after 6 mo due to tumour over- and ingrowth, leading to hospital readmissions and reinterventions that significantly impair quality of life. Regimes of chemotherapy or chemoradiotherapy also provide minimal survival benefits. Therefore, novel therapies are eagerly awaited. Radiofrequency (RF) energy causes coagulative necrosis leading to local destruction of the accessed malignant tissue and has an established role in the treatment of malignancies in several solid organs, especially liver cancers. However, pancreatic and extrahepatic biliary cancers are not easily accessed by a percutaneous route, making the procedure dangerous. Over the past five years, the development of dedicated devices compatible with endoscopic instruments has offered a minimally invasive option for RF energy delivery in biliopancreatic cancers. Emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature, but little is known about its feasibility, efficacy and safety. A literature review makes it clear that RFA in biliopancreatic tumours is feasible with high rates of technical success and acceptable safety profile. Although available data suggest a benefit of survival with RFA, there is not enough evidence to draw a firm conclusion about its efficacy. For this reason, prospective randomized trials comparing RFA with standard palliative treatments with quality-of-life and survival endpoints are required. Anecdotal reports have also

  8. Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety

    PubMed Central

    Alvarez-Sánchez, María-Victoria; Napoléon, Bertrand

    2016-01-01

    Most pancreatic cancers and extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis, and even in case of a resectable cancer, for elderly or patients with coexistent comorbidities, surgery is not an option. Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment of biliary obstruction due to unresectable pancreatic cancer or cholangiocarcinoma. Nevertheless, more than 50% of SEMS become occluded after 6 mo due to tumour over- and ingrowth, leading to hospital readmissions and reinterventions that significantly impair quality of life. Regimes of chemotherapy or chemoradiotherapy also provide minimal survival benefits. Therefore, novel therapies are eagerly awaited. Radiofrequency (RF) energy causes coagulative necrosis leading to local destruction of the accessed malignant tissue and has an established role in the treatment of malignancies in several solid organs, especially liver cancers. However, pancreatic and extrahepatic biliary cancers are not easily accessed by a percutaneous route, making the procedure dangerous. Over the past five years, the development of dedicated devices compatible with endoscopic instruments has offered a minimally invasive option for RF energy delivery in biliopancreatic cancers. Emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature, but little is known about its feasibility, efficacy and safety. A literature review makes it clear that RFA in biliopancreatic tumours is feasible with high rates of technical success and acceptable safety profile. Although available data suggest a benefit of survival with RFA, there is not enough evidence to draw a firm conclusion about its efficacy. For this reason, prospective randomized trials comparing RFA with standard palliative treatments with quality-of-life and survival endpoints are required. Anecdotal reports have also

  9. Mineralogy and instrumental neutron activation analysis of seven National Bureau of Standards and three Instituto de Pesquisas Tecnologicas clay reference samples

    USGS Publications Warehouse

    Hosterman, John W.; Flanagan, F.J.; Bragg, Anne; Doughten, M.W.; Filby, R.H.; Grimm, Catherine; Mee, J.S.; Potts, P.J.; Rogers, N.W.

    1987-01-01

    The concentrations of 3 oxides and 29 elements in 7 National Bureau of Standards (NBS) and 3 Instituto de Pesquisas Techno16gicas (IPT) reference clay samples were etermined by instrumental neutron activation analysis. The analytical work was designed to test the homogeneity of constituents in three new NBS reference clays, NBS-97b, NBS-98b, and NBS-679. The analyses of variance of 276 sets of data for these three standards show that the constituents are distributed homogeneously among bottles of samples for 94 percent of the sets of data. Three of the reference samples (NBS-97, NBS-97a, and NBS-97b) are flint clays; four of the samples (NBS-98, NBS-98a, NBS-98b, and IPT-32) are plastic clays, and three of the samples (NBS-679, IPT-28, and IPT-42) are miscellaneous clays (both sedimentary and residual). Seven clays are predominantly kaolinite; the other three clays contain illite and kaolinite in the approximate ratio 3:2. Seven clays contain quartz as the major nonclay mineral. The mineralogy of the flint and plastic clays from Missouri (NBS-97a and NBS-98a) differs markedly from that of the flint and plastic clays from Pennsylvania (NBS-97, NBS-97b, NBS-98, and NBS-98b). The flint clay NBS-97 has higher average chromium, hafnium, lithium, and zirconium contents than its replacement, reference sample NBS-97b. The differences between the plastic clay NBS-98 and its replacement, NBS-98b, are not as pronounced. The trace element contents of the flint and plastic clays from Missouri, NBS-97a and NBS-98a, differ significantly from those of the clays from Pennsylvania, especially the average rare earth element (REE) contents. The trace element contents of clay sample IPT-32 differ from those of the other plastic clays. IPT-28 and IPT-42 have some average trace element contents that differ not only between these two samples but also from all the other clays. IPT-28 has the highest summation of the average REE contents of the 10 samples. The uranium content of NBS-98a, 46

  10. Endoscopic septoplasty: technique and outcomes.

    PubMed

    Durr, Dory G

    2003-02-01

    Recent literature has already embraced the topic of endoscopic septoplasty, with several published articles on the subject. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. It allows improved evaluation of the posterior nasal septal deformities, identification of the degree of mucosal involvement of the posterior ends of the inferior turbinates, and concomitant assessment of the middle meatus. It permits objective documentation of the cause of nasal obstruction with possible use in outcome assessment. It is also an effective teaching method and a motivating approach for the nursing team. We present our experience in a series of 47 patients performed during a 1 1/2-year period and discuss the surgical technique and patients' outcomes. We systematically used the endoscope for all septal and turbinate surgery. We evaluated outcomes using a telephone survey along with a validated disease-specific health status measure and a global rating questionnaire.

  11. Endoscopic-Assisted Craniosynostosis Surgery

    PubMed Central

    Honeycutt, Johnnie Harrel

    2014-01-01

    Over the last decade, endoscopy has been increasingly utilized in craniosynostosis surgery. In 2006, the author added endoscopy followed by helmet therapy to the treatment of young craniosynostosis patients. Since then, 73 children have been successfully treated utilizing endoscopic techniques with a transfusion rate of 23%. Most children are discharged on the first postoperative day; helmet therapy begins one week later. A helmet is worn for 4 to 6 months with one helmet replacement. Complications were limited to three reoperations to address suboptimal results, and one reoperation for a persisting skull defect. One sagittal sinus injury was addressed successfully, with resolution of a small intrasinus thrombus and no adverse brain sequelae. Although not applicable to every craniosynostosis patient, properly applied endoscopic-assisted craniosynostosis surgery is safe and effective, adding another option to the treatment armamentarium for craniosynostosis. PMID:25210508

  12. Endoscopic Palliation of Pancreatic Cancer

    PubMed Central

    Coté, Gregory A.; Sherman, Stuart

    2012-01-01

    Endoscopy has an increasingly important role in the palliation of patients with pancreatic ductal adenocarcinoma. Endoscopic biliary drainage is still requested in the majority of patients who present with obstructive jaundice, and the increased use of self-expandable metallic stents has reduced the incidence of premature stent occlusion. First-line use of metallic stents is expected to be utilized more frequently as neoadjuvant protocols are improved. The efficacy of endoscopy for palliating gastroduodenal obstruction has advanced with the development of through-the-scope, self-expandable gastroduodenal stents. There have been advances in pain management, with endoscopic ultrasound-guided celiac plexus neurolysis reducing opiate requirements and pain for patients with unresectable malignancy. Future applications of endoscopy in pancreatic cancer may include fine needle injection of chemotherapeutic and other agents into the lesion itself. This review will summarize the evidence of endoscopy in the management of patients with pancreatic cancer. PMID:23187846

  13. Barrett Esophagus: When to Endoscope

    PubMed Central

    Butt, Joshua

    2014-01-01

    Increasing interest in identifying an effective strategy for decreasing the burden of esophageal adenocarcinoma (EAC) has been fuelled by the rising EAC rates worldwide, the morbidity associated with esophagectomy, and the development of endoscopic methods for curing early-stage EAC. In the face of this enthusiasm, however, we should be cautious about continuing our current evidence-free approach to screening and one with unclear benefits and unclear costs to the community. The literature is increasingly recognizing that the value of traditional endoscopy for screening and surveillance of Barrett esophagus may be more limited than initially believed. A better understanding of the risk factors for Barrett esophagus and progression to dysplasia and a more individualized risk calculation will be useful in defining populations to consider for Barrett screening. The development of novel, nonendoscopic screening techniques and of less expensive endoscopic techniques holds promise for a cost-effective screening and surveillance method to curtail the increasing rates of EAC. PMID:24570882

  14. Endoscopic subsurface imaging in tissues

    SciTech Connect

    Demos, S G; Staggs, M; Radousky, H B

    2001-02-12

    The objective of this work is to develop endoscopic subsurface optical imaging technology that will be able to image different tissue components located underneath the surface of the tissue at an imaging depth of up to 1 centimeter. This effort is based on the utilization of existing technology and components developed for medical endoscopes with the incorporation of the appropriate modifications to implement the spectral and polarization difference imaging technique. This subsurface imaging technique employs polarization and spectral light discrimination in combination with image processing to remove a large portion of the image information from the outer layers of the tissue which leads to enhancement of the contrast and image quality of subsurface tissue structures.

  15. Endoscopic laser therapy in gastroenterology.

    PubMed

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

    1992-07-01

    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.

  16. 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

  17. Where next for the endoscope?

    PubMed

    Natalin, Ricardo A; Landman, Jaime

    2009-11-01

    The concept of examining the body's interior and its organs dates back to ancient times. The roots of modern endoscopy lie in early nineteenth century Europe, and the intervening centuries have seen a steady evolution of devices and techniques. Nowadays, a wide variety of urinary tract disorders are successfully managed in a minimally invasive manner thanks to the endoscope and related technologies. Distal-sensor, 'digital', endoscopes have the potential to revolutionize the field, and change the way in which we use and think about endoscopy. Virtual endoscopy, capsule endoscopy, and a range of other techniques derived from physics and molecular biology all promise great improvements in visualization of the urinary tract and other urologic structures. Ultimately, the continued improvement of these minimally invasive technologies will enhance the quality of care that we can offer our patients.

  18. Instrument for Curriculum Evaluation.

    ERIC Educational Resources Information Center

    Huetteman, Julie Doidge; Benson, RoseAnn

    A comprehensive Instrument for Curriculum Evaluation (ICE) was developed to qualitatively and quantitatively evaluate curriculum materials. The instrument contains 115 statements for assessing 11 aspects of curriculum: philosophy, needs assessment, theme, goals, learning objectives and standards, scope and sequence, field testing, instructor…

  19. Fast full 4x4 Mueller polarimeter for endoscopic applications

    NASA Astrophysics Data System (ADS)

    Rivet, Sylvain; Bradu, Adrian; Podoleanu, Adrian

    2016-03-01

    A new set-up is proposed to measure the full polarimetric properties of a sample through an optical fiber, paving the way to full-Mueller endoscopic imaging. The technique combines a channeled spectrum polarimeter and an interferometer. This permits high-speed measurement of two Mueller matrices simultaneoulsy. The first matrix characterizes only the fiber while the second characterizes both fiber and sample. The instrument is validated on vacuum, a quarter-wave plate and a linear polarizer for single-point measurements. Insensitivity of the polarimetric measurement to fiber disturbances is proven while manipulating the fiber.

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

    PubMed

    Andersen, Michelle Fog; Trolle, Waldemar; Anthonsen, Kristian; Nielsen, Hans Ulrik; Homøe, Preben

    2017-04-01

    The purpose of the present study was to evaluate the long-term results and patient's satisfaction of a new approach using the LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum (ZD) and to compare with other long-term results using traditional treatment modalities. Between December 2011 and August 2013, a total of 23 patients with ZD underwent endoscopic surgery using the LigaSure™ technique in our department. A retrospective evaluation of the surgery was based on medical records and additionally a long-term follow-up was performed using a standardized questionnaire that was send to all patients. The questions dealt with complaints according to a visual analog scale (VAS) and were sent a minimum of one year after the surgery (mean time 22 months, range 12-32 month). The overall response rate was 91%. The mean age of the patients was 69 years (range 37-89 years). The patients reported nine for overall satisfaction on the VAS (range 0-10: 10 being very content and 0 very uncontent, 25 and 75% quartiles: 7 and 10) regarding the final outcome of their surgery, although several of the patients had continuous symptoms within the first postoperative year. Eight patients (38%) reported no symptoms at all. Our results suggest that endoscopic management of ZD with the LigaSure™ 5 mm instrument is a minimally invasive, fast and safe method with solid long-term outcome with relief of symptoms and patient satisfaction. This new operative instrument was not found inferior to traditional endoscopic techniques and is now the standard treatment method for ZD in our departments.

  1. Cecal Leiomyoma: Can We Attempt Endoscopic Resection?

    PubMed Central

    Badipatla, Kanthi Rekha; Kamireddy, Chandana; Niazi, Masooma; Nayudu, Suresh Kumar

    2016-01-01

    Gastrointestinal leiomyomas are smooth muscle tumors arising from the muscularis mucosae, muscularis propriae and possibly from smooth muscle of the vessel wall. Management depends on the size, location and the clinical scenario. Endoscopic snare cauterization with or without saline lift has been described in literature for tumors involving the left colon. To the best of our knowledge, endoscopic resection of right colon leiomyoma was never attempted in the past. We present a case of cecal leiomyoma which was resected endoscopically. PMID:28058080

  2. Portable electronic endoscopic imaging system

    NASA Astrophysics Data System (ADS)

    Du, Lihui; Wang, Liqiang; Ye, Bin; Duan, Huilong

    2010-11-01

    The paper presents a low-power, inexpensive and portable endoscopic imaging system. A 1.3 million pixels CMOS sensor is considered as an image capture. The sensor and the lens system are designed to minify the cannula diameter of the endoscope and therefore minimize the incision size for insertion. LVDS is used for image data transmission between the sensor and CPU to realize a long distance, high speed and low noise system. An ARM 920T based microcontroller is employed as the control core for the image transmission module, display module and other modules. The camera interface and LCD controller are integrated in the microcontroller and both have a dedicated DMA supports to transmit image data though AHB to or from frame buffer located in system memory without CPU intervention. The image is displayed on an 8 inch LCD screen with 800 × 600 resolution and 16 bits of color depth. With the maximum capture and display rate of 15 fps, this system can provide a clear image enough for laparoscopy or industrial application. And with integrated camera, light source and video display function, it can also be used as a portable, miniature and inexpensive endoscope.

  3. [Laser in gastroenterologic endoscopic therapy].

    PubMed

    Naveau, S; Chaput, J C

    1991-01-21

    Endoscopic gastrointestinal laser therapy was originally inspired by the haemostatic properties of the laser beam and was subsequently used to destroy tumours. In endoscopic gastroenterology, the most commonly used type of laser is the neodyme+-doped yttrium aluminium garnet (Nd:YAG) laser. Endoscopic Nd:YAG laser therapy of obstructive cancers of the oesophagus and cardia rapidly reduces dysphagia in 70 to 100% of the patients. In the treatment of colorectal cancers, the intestinal transit returns to normal in 57 to 83% of the cases, and rectal haemorrhages are controlled in 38 to 92% of the cases. However, sustained results can only be obtained by a maintenance treatment with at least one application every 4 weeks. The Nd:YAG laser makes it possible to destroy villose tumours in patients who cannot, or will not, be operated upon; the number of applications depends on the size of the tumour. Finally, the Nd:YAG laser seems to be able to control bleeding due to gastrointestinal angiodysplasia and to stabilize the course of Rendu-Osler-Weber disease.

  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.

  5. Optic for an endoscope/borescope having high resolution and narrow field of view

    DOEpatents

    Stone, Gary F.; Trebes, James E.

    2003-10-28

    An optic having optimized high spatial resolution, minimal nonlinear magnification distortion while at the same time having a limited chromatic focal shift or chromatic aberrations. The optic located at the distal end of an endoscopic inspection tool permits a high resolution, narrow field of view image for medical diagnostic applications, compared to conventional optics for endoscopic instruments which provide a wide field of view, low resolution image. The image coverage is over a narrow (<20 degrees) field of view with very low optical distortion (<5% pin cushion or barrel distortion. The optic is also optimized for best color correction as well as to aid medical diagnostics.

  6. Endoscopic full-thickness resection: Current status

    PubMed Central

    Schmidt, Arthur; Meier, Benjamin; Caca, Karel

    2015-01-01

    Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices. PMID:26309354

  7. A Raman-based endoscopic strategy for multiplexed molecular imaging.

    PubMed

    Zavaleta, Cristina L; Garai, Ellis; Liu, Jonathan T C; Sensarn, Steven; Mandella, Michael J; Van de Sompel, Dominique; Friedland, Shai; Van Dam, Jacques; Contag, Christopher H; Gambhir, Sanjiv S

    2013-06-18

    Endoscopic imaging is an invaluable diagnostic tool allowing minimally invasive access to tissues deep within the body. It has played a key role in screening colon cancer and is credited with preventing deaths through the detection and removal of precancerous polyps. However, conventional white-light endoscopy offers physicians structural information without the biochemical information that would be advantageous for early detection and is essential for molecular typing. To address this unmet need, we have developed a unique accessory, noncontact, fiber optic-based Raman spectroscopy device that has the potential to provide real-time, multiplexed functional information during routine endoscopy. This device is ideally suited for detection of functionalized surface-enhanced Raman scattering (SERS) nanoparticles as molecular imaging contrast agents. This device was designed for insertion through a clinical endoscope and has the potential to detect and quantify the presence of a multiplexed panel of tumor-targeting SERS nanoparticles. Characterization of the Raman instrument was performed with SERS particles on excised human tissue samples, and it has shown unsurpassed sensitivity and multiplexing capabilities, detecting 326-fM concentrations of SERS nanoparticles and unmixing 10 variations of colocalized SERS nanoparticles. Another unique feature of our noncontact Raman endoscope is that it has been designed for efficient use over a wide range of working distances from 1 to 10 mm. This is necessary to accommodate for imperfect centering during endoscopy and the nonuniform surface topology of human tissue. Using this endoscope as a key part of a multiplexed detection approach could allow endoscopists to distinguish between normal and precancerous tissues rapidly and to identify flat lesions that are otherwise missed.

  8. Endoscopic quadricepsplasty: A new surgical technique.

    PubMed

    Blanco, C E; Leon, H O; Guthrie, T B

    2001-05-01

    We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.

  9. [Endoscopic use of the water jet dissector in the cerebral ventricle system--an experimental study].

    PubMed

    Jakob, S; Kehler, U; Reusche, E; Friedrich, H J; Arnold, H

    2000-01-01

    Endoscopic surgery in the cerebral ventricle is limited by the small number of suitable instruments and bleedings obscuring the visibility. The water jet cutter allows the dissection of tissue, generally leaving vessels intact. Therefore it could be an additional instrument for neuroendoscopic purposes. In this preclinical study the employment of the water jet dissector under endoscopic conditions was evaluated. Incision-experiments (n = 80) on the ventricular system of fresh porcine brain were carried out under endoscopic view. To achieve similarity to the ventricular system, specimens were dissected in liquid medium (Ringer's-lactate, 37 degrees C). The depths of incision were measured digitally and histological examination of the tissue was performed. Depending on the applied pressure, distance from cutting nozzle to tissue and cutting velocity, the depths of incision ranged from 0.12 mm up to 2.4 mm. The water jet dissector is good to handle under endoscopic conditions and vessels are preserved. Based on these factors, this instrument is predestinated for further neuroendoscopic application. Prior to clinical application our results will have to be tested on living, perfused cerebral tissue.

  10. Robotic Neuro-Endoscope with Concentric Tube Augmentation.

    PubMed

    Butler, Evan J; Hammond-Oakley, Robert; Chawarski, Szymon; Gosline, Andrew H; Codd, Patrick; Anor, Tomer; Madsen, Joseph R; Dupont, Pierre E; Lock, Jesse

    2012-01-01

    Surgical robots are gaining favor in part due to their capacity to reach remote locations within the body. Continuum robots are especially well suited for accessing deep spaces such as cerebral ventricles within the brain. Due to the entry point constraints and complicated structure, current techniques do not allow surgeons to access the full volume of the ventricles. The ability to access the ventricles with a dexterous robot would have significant clinical implications. This paper presents a concentric tube manipulator mated to a robotically controlled flexible endoscope. The device adds three degrees of freedom to the standard neuroendoscope and roboticizes the entire package allowing the operator to conveniently manipulate the device. To demonstrate the improved functionality, we use an in-silica virtual model as well as an ex-vivo anatomic model of a patient with a treatable form of hydrocephalus. In these experiments we demonstrate that the augmented and roboticized endoscope can efficiently reach critical regions that a manual scope cannot.

  11. Endoscopic ultrasound guided vascular access and therapy (with videos)

    PubMed Central

    Saxena, Payal; Lakhtakia, Sundeep

    2015-01-01

    The continued need to develop minimally invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. EUS has now stepped into the therapeutic arena. EUS provides the unique advantage of both real-time imaging and access to structures within and adjacent to the gastrointestinal (GI) tract. Hence, EUS-guided therapeutic techniques continue to evolve in several directions enabling a variety of minimally invasive therapies for pancreatic and biliary pathologies. Furthermore, the close proximity of the GI tract to vascular structures in the mediastinum and abdomen permits EUS-guided vascular access and therapy. Studies have demonstrated several EUS-guided vascular interventions by using standard endoscopic accessories and available tools from the interventional radiology armamentarium. This article provides an overview of the literature including clinical and nonclinical studies for the management of nonvariceal and variceal GI bleeding, formation of intrahepatic portosystemic shunts (IPSS), and EUS-guided cardiac access and therapy. PMID:26374574

  12. Compact dual-view endoscope without field obscuration.

    PubMed

    Katkam, Rajender; Banerjee, Bhaskar; Huang, Chih Yu; Zhu, Xiaoyin; Ocampo, Luis; Kincade, Jerri-Lynn; Liang, Rongguang

    2015-07-01

    We have developed a compact dual-view endoscopic probe without field obscuration to address the need of simultaneously observing forward and backward fields of view (FOVs) in the colon. The objective is compact with the forward-view and rear-view optical paths sharing the same optical elements. The compact objective is new in that no FOV is blocked. The illumination for forward-view imaging is provided by the cylindrical light guide and backward illumination is achieved with a reflector. We have designed, prototyped, and tested the endoscope by comparing it to a standard clinical colonoscope. We will discuss the system concept, objective design, fabrication of the freeform lens, and test results.

  13. Endoscopic Treatment of Stump Leakage Related to the Ileal Conduit

    PubMed Central

    Odemis, Bulent; Oztas, Erkin; Akpinar, Muhammet Yener; Olcucuoglu, Erkan; Kayacetin, Ertugrul

    2016-01-01

    Abstract Background: Ileal conduit with leakage from either the anastomotic site or the stump is associated with high morbidity and mortality rates. The standard treatment of stump leakage is surgery. Case Presentation: A 60-year-old male patient was admitted to our hospital with complaint of hematuria and bladder carcinoma was diagnosed. After performing radical cystectomy and ileal conduit, he developed fever with abdominal pain within the first week of surgery. Stump leakage was diagnosed by endoscopic examination performed through a gastroscope. After two over-the-scope clips (OTSCs) were applied to the stump, vinyl mesh was inserted into the space between the OTSCs. Later, cyanoacrylat and lipiodol were repelled on the OTSCs and vinyl mesh. Subsequently, stump leakage was resolved. Conclusion: This is the first case of stump leakage related to ileal conduit that has been treated endoscopically, according to the current literature. PMID:27579432

  14. Aeronautic instruments

    NASA Technical Reports Server (NTRS)

    Everling, E; Koppe, H

    1924-01-01

    The development of aeronautic instruments. Vibrations, rapid changes of the conditions of flight and of atmospheric conditions, influence of the air stream all call for particular design and construction of the individual instruments. This is shown by certain examples of individual instruments and of various classes of instruments for measuring pressure, change of altitude, temperature, velocity, inclination and turning or combinations of these.

  15. Image-guided transorbital procedures with endoscopic video augmentation

    PubMed Central

    DeLisi, Michael P.; Mawn, Louise A.; Galloway, Robert L.

    2014-01-01

    Purpose: Surgical interventions to the orbital space behind the eyeball are limited to highly invasive procedures due to the confined nature of the region along with the presence of several intricate soft tissue structures. A minimally invasive approach to orbital surgery would enable several therapeutic options, particularly new treatment protocols for optic neuropathies such as glaucoma. The authors have developed an image-guided system for the purpose of navigating a thin flexible endoscope to a specified target region behind the eyeball. Navigation within the orbit is particularly challenging despite its small volume, as the presence of fat tissue occludes the endoscopic visual field while the surgeon must constantly be aware of optic nerve position. This research investigates the impact of endoscopic video augmentation to targeted image-guided navigation in a series of anthropomorphic phantom experiments. Methods: A group of 16 surgeons performed a target identification task within the orbits of four skull phantoms. The task consisted of identifying the correct target, indicated by the augmented video and the preoperative imaging frames, out of four possibilities. For each skull, one orbital intervention was performed with video augmentation, while the other was done with the standard image guidance technique, in random order. Results: The authors measured a target identification accuracy of 95.3% and 85.9% for the augmented and standard cases, respectively, with statistically significant improvement in procedure time (Z = −2.044, p = 0.041) and intraoperator mean procedure time (Z = 2.456, p = 0.014) when augmentation was used. Conclusions: Improvements in both target identification accuracy and interventional procedure time suggest that endoscopic video augmentation provides valuable additional orientation and trajectory information in an image-guided procedure. Utilization of video augmentation in transorbital interventions could further minimize

  16. Initial Results of Endoscopic Gastrocutaneous Fistula Closure in Children Using an Over-the-Scope Clip

    PubMed Central

    Wright, Robert; Abrajano, Claire; Koppolu, Raji; Stevens, Megan; Nyznyk, Sarah; Chao, Stephanie; Bruzoni, Matias

    2015-01-01

    Abstract Gastrocutaneous fistula (GCF) occurs commonly in pediatric patients after removal of long-term gastrostomy tubes. Although open repair is generally successful, endoscopic approaches may offer benefits in terms of incisional complications, postoperative pain, and procedure time. In addition, endoscopic approaches may offer particular benefit in patients with varied degrees of skin irritation or erosion surrounding a GCF, making surgical repair difficult, or patients with significant comorbidities, making minimal intervention and anesthesia time preferable. Over-the-scope (OSC) clips are a new technology that enables endoscopic closure of intestinal fistulas up to 2 cm in diameter. Six pediatric patients underwent endoscopic GCF closure using OSC clips under Institutional Review Board approval. The procedure was technically successful in 5 of 6 cases with an average operating time of 29 minutes. The technical failure required an open revision, whereas all other patients reported full healing of the GCF site at 1 month. All successful cases were performed as outpatients without postoperative narcotics. In addition, all patients reported high satisfaction with the procedure and cosmetic results. Endoscopic GCF closure using an OSC clip is technically feasible in the pediatric population. Based on limited cases with a 1-month follow-up, the functional and cosmetic results of technically successful cases are excellent. Endoscopic GCF closure is a potential alternative to standard surgical closure in patients with skin irritation or erosion and/or significant comorbidities. PMID:25531644

  17. Space applications instrumentation systems

    NASA Technical Reports Server (NTRS)

    Minzner, R. A.; Oberholtzer, J. D.

    1972-01-01

    A compendium of resumes of 158 instrument systems or experiments, of particular interest to space applications, is presented. Each resume exists in a standardized format, permitting entries for 26 administrative items and 39 scientific or engineering items. The resumes are organized into forty groups determined by the forty spacecraft with which the instruments are associated. The resumes are followed by six different cross indexes, each organized alphabetically according to one of the following catagories: instrument name, acronym, name of principal investigator, name of organization employing the principal investigator, assigned experiment number, and spacecraft name. The resumes are associated with a computerized instrument resume search and retrieval system.

  18. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

    PubMed

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc; Meisner, Søren; Repici, Alessandro; Saunders, Brian P; Vezakis, Antonios; Gonzalez, Jean Michel; Turino, Stine Ydegaard; Tsiamoulos, Zacharias P; Fockens, Paul; Hassan, Cesare

    2014-08-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforation, including the definition of procedures that carry a high risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 In the case of an endoscopically identified perforation, ESGE recommends that the endoscopist reports: its size and location with a picture; endoscopic treatment that might have been possible; whether carbon dioxide or air was used for insufflation; and the standard report information. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be carefully evaluated and documented, possibly with a computed tomography (CT) scan, in order to prevent any diagnostic delay. 4 ESGE recommends that endoscopic closure should be considered depending on the type of perforation, its size, and the endoscopist expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done. 5 After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of the iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

  19. Endoscopic surgery for tumors of the pineal region via a paramedian infratentorial supracerebellar keyhole approach (PISKA).

    PubMed

    Thaher, Firas; Kurucz, Peter; Fuellbier, Lars; Bittl, Markus; Hopf, Nikolai J

    2014-10-01

    The tumors of the pineal region represent a significant challenge in terms of patient selection and surgical approach. Traditional surgical options were commonly used to approach this area causing considerable surgical morbidity and mortality. We report for the first time on a series of endoscopic procedures for lesions of the pineal region performed via an infratentorial supracerebellar keyhole approach (PISKA) in the prone position using endoscope-assisted and endoscope-controlled technique. A single-institution series of 11 consecutive patients (five male and six female patients [11 total cases]; mean age 21 years, range 1-75 years) treated via the endoscope-assisted and endoscope-controlled PISKA for a pathological entity in the pineal region was retrospectively reviewed. The mean follow-up time was 24 months. The endoscopic PISKA was successfully used to approach a variety of pineal lesions, including pineocytoma (three patients), pineal cysts (four patients), germinoma, lipoma, medulloblastoma, and glioblastoma (one patient each). Gross total resection was achieved in ten cases and subtotal resection in one case. The mean preoperative tumor volumes were approximately 2 × 2 cm. Five patients developed postoperatively transient Parinaud's syndrome. One patient underwent surgical revision for cerebrospinal fluid leak. There was no mortality. Ten patients had an uneventful postoperative course with restitutio ad integrum after a mean follow-up duration of 13.5 months. The endoscopically PISKA is a safe and effective minimally invasive approach that enables endoscopic treatment of different lesions of the pineal region with comparable results to standard microsurgical technique but less morbidity.

  20. A novel multipurpose mini-endoscope for frontal sinus endoscopy "sinus view".

    PubMed

    Al Kadah, Basel; Bozzato, Victoria; Bozzato, Alessandro; Papaspyrou, George; Schick, Bernhard

    2015-07-01

    Endoscopic frontal sinus surgery has been proven to enable the treatment of most frontal sinus pathologies but may be challenging for the surgeon in regard to the variable frontal sinus anatomy. Frontal sinus drainage identification and frontal sinus visualization are an essential part of successful frontal sinus surgery. We demonstrate a novel modular mini-endoscopic system for frontal sinus surgery. Fifty-two patients (37 male, 15 female) with a chronic rhino-sinusitis were enrolled. In this study, all patients were subjected to standard endonasal endoscopic sinus surgery with use of the fibre optic endoscope "Sinus View" (1.1 mm diameter, 10,000 pixels, irrigation channel and additional working channel) accessing the frontal sinus. A frontal sinus drainage type I in 38 cases, a frontal sinus drainage type IIa in 9 cases and a frontal sinus drainage type IIb in 5 cases according to Draf were performed. The modular mini-endoscopic system "Sinus view" was used to identify frontal sinus drainage in ten patients before ethmoidectomy and in the remaining patients (N = 42) after ethmoidectomy. Visualization of the frontal sinus drainage or the frontal sinus itself was easily carried out after irrigation. A clear identification of the frontal sinus by illumination was achieved in all cases. In addition the working channel of the endoscope was successfully used to perform visualized balloon dilatation at the frontal sinus drainage or for biopsy. The endonasal visualization of the frontal sinus drainage and frontal sinus itself is facilitated by also using a modular mini-endoscope with the option to use the working channel of the endoscope for biopsy or balloon dilatation.

  1. Fluorescence-Raman Dual Modal Endoscopic System for Multiplexed Molecular Diagnostics

    PubMed Central

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

    2015-01-01

    Optical endoscopic imaging, which was recently equipped with bioluminescence, fluorescence, and Raman scattering, allows minimally invasive real-time detection of pathologies on the surface of hollow organs. To characterize pathologic lesions in a multiplexed way, we developed a dual modal fluorescence-Raman endomicroscopic system (FRES), which used fluorescence and surface-enhanced Raman scattering nanoprobes (F-SERS dots). Real-time, in vivo, and multiple target detection of a specific cancer was successful, based on the fast imaging capability of fluorescence signals and the multiplex capability of simultaneously detected SERS signals using an optical fiber bundle for intraoperative endoscopic system. Human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) on the breast cancer xenografts in a mouse orthotopic model were successfully detected in a multiplexed way, illustrating the potential of FRES as a molecular diagnostic instrument that enables real-time tumor characterization of receptors during routine endoscopic procedures. PMID:25820115

  2. Fluorescence-Raman Dual Modal Endoscopic System for Multiplexed Molecular Diagnostics

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  3. Gyroscopic Instruments for Instrument Flying

    NASA Technical Reports Server (NTRS)

    Brombacher, W G; Trent, W C

    1938-01-01

    The gyroscopic instruments commonly used in instrument flying in the United States are the turn indicator, the directional gyro, the gyromagnetic compass, the gyroscopic horizon, and the automatic pilot. These instruments are described. Performance data and the method of testing in the laboratory are given for the turn indicator, the directional gyro, and the gyroscopic horizon. Apparatus for driving the instruments is discussed.

  4. Patient and staff exposure to glutaraldehyde from KeyMed Auto-Disinfector endoscope washing machine.

    PubMed

    Lynch, D A; Parnell, P; Porter, C; Axon, A T

    1994-05-01

    Activated glutaraldehyde (2%) is the recommended agent for disinfection of endoscopic equipment. Exposure to the disinfectant is associated with side-effects and guidelines have been set to avoid these complications. Endoscope washing machines are used to provide automated high level disinfection of endoscopes as well as reduce exposure to the irritant aldehyde. We report a design fault in an endoscope washing machine which results in patients and staff being exposed to activated glutaraldehyde. The Auto-Disinfector (KeyMed) comprises a washing chamber supplied by three separate reservoirs (detergent, disinfectant, and rinse water) via a common channel. After the first cycle endoscopes are processed using previously used detergent and rinse water. Rinse water glutaraldehyde concentrations were measured in four machines during routine endoscopy lists on at least two occasions and showed a progressive rise in glutaraldehyde concentration up to 0.1% after two to six cycles. This results in staff being exposed to glutaraldehyde present on the processed instrument and the disinfectant being pumped from the internal channels of the endoscope into direct contact with the gastrointestinal mucosa during endoscopy at concentrations of 200-1000 ppm. The present atmospheric limit for glutaraldehyde is 0.2 ppm. Skin and mucosal irritation occur at concentrations of 0.3 ppm and severe synovitis in experimental animals at 100 pm. Tongue swelling and bloody diarrhoea with characteristic mucosal histological changes have been reported in patients exposed to activated glutaraldehyde on inadequately rinsed equipment. To reduce this problem the rinse water should be changed after every cycle and the endoscope should be dried thoroughly before use.

  5. Care and sterilization of endourologic instruments.

    PubMed

    Gregory, E; Simmons, D; Weinberg, J J

    1988-08-01

    All endourologic instruments must be handled properly if they are to continue to function properly. Care must be taken in washing and sterilizing of this equipment, as not all endoscopic equipment can endure all methods, and people who are working with these instruments must be taught the proper care and sterilization methods of each. For example, fiberoptic telescopes and light cables must never be autoclaved; ethylene oxide is the method of choice. Disinfectant is an alternative. Loops, sheaths, high-frequency cables, resectoscopes, and working elements should be sterilized by ethylene oxide. Loops and high-frequency cables should not be soaked in a disinfectant, but other instruments may be soaked. All instruments should be dried before sterilization. Too much emphasis cannot be placed on the importance of proper storage of these very fragile fiberoptic instruments. With proper care and sterilization, these instruments will need fewer repairs and function properly for a longer time.

  6. Endoscopic-assisted infraorbital nerve release

    PubMed Central

    Sosin, Michael; De La Cruz, Carla; Christy, Michael R.

    2014-01-01

    Abstract Endoscopic-assisted techniques in plastic and craniofacial surgeries are limited. We present a patient with infraorbital nerve entrapment following traumatic facial injury that failed conservative management. Compression of the nerve was treated with an endoscopic-assisted nerve release of the surrounding soft tissue with a circumferential foraminal osteotomy. PMID:27252952

  7. VIRUS instrument enclosures

    NASA Astrophysics Data System (ADS)

    Prochaska, T.; Allen, R.; Mondrik, N.; Rheault, J. P.; Sauseda, M.; Boster, E.; James, M.; Rodriguez-Patino, M.; Torres, G.; Ham, J.; Cook, E.; Baker, D.; DePoy, Darren L.; Marshall, Jennifer L.; Hill, G. J.; Perry, D.; Savage, R. D.; Good, J. M.; Vattiat, Brian L.

    2014-08-01

    The Visible Integral-Field Replicable Unit Spectrograph (VIRUS) instrument will be installed at the Hobby-Eberly Telescope† in the near future. The instrument will be housed in two enclosures that are mounted adjacent to the telescope, via the VIRUS Support Structure (VSS). We have designed the enclosures to support and protect the instrument, to enable servicing of the instrument, and to cool the instrument appropriately while not adversely affecting the dome environment. The system uses simple HVAC air handling techniques in conjunction with thermoelectric and standard glycol heat exchangers to provide efficient heat removal. The enclosures also provide power and data transfer to and from each VIRUS unit, liquid nitrogen cooling to the detectors, and environmental monitoring of the instrument and dome environments. In this paper, we describe the design and fabrication of the VIRUS enclosures and their subsystems.

  8. Review of Instrumented Indentation

    PubMed Central

    VanLandingham, Mark R.

    2003-01-01

    Instrumented indentation, also known as depth-sensing indentation or nanoindentation, is increasingly being used to probe the mechanical response of materials from metals and ceramics to polymeric and biological materials. The additional levels of control, sensitivity, and data acquisition offered by instrumented indentation systems have resulted in numerous advances in materials science, particularly regarding fundamental mechanisms of mechanical behavior at micrometer and even sub-micrometer length scales. Continued improvements of instrumented indentation testing towards absolute quantification of a wide range of material properties and behavior will require advances in instrument calibration, measurement protocols, and analysis tools and techniques. In this paper, an overview of instrumented indentation is given with regard to current instrument technology and analysis methods. Research efforts at the National Institute of Standards and Technology (NIST) aimed at improving the related measurement science are discussed. PMID:27413609

  9. Geometric estimation of intestinal contraction for motion tracking of video capsule endoscope

    NASA Astrophysics Data System (ADS)

    Mi, Liang; Bao, Guanqun; Pahlavan, Kaveh

    2014-03-01

    Wireless video capsule endoscope (VCE) provides a noninvasive method to examine the entire gastrointestinal (GI) tract, especially small intestine, where other endoscopic instruments can barely reach. VCE is able to continuously provide clear pictures in short fixed intervals, and as such researchers have attempted to use image processing methods to track the video capsule in order to locate the abnormalities inside the GI tract. To correctly estimate the speed of the motion of the endoscope capsule, the radius of the intestinal track must be known a priori. Physiological factors such as intestinal contraction, however, dynamically change the radius of the small intestine, which could bring large errors in speed estimation. In this paper, we are aiming to estimate the radius of the contracted intestinal track. First a geometric model is presented for estimating the radius of small intestine based on the black hole on endoscopic images. To validate our proposed model, a 3-dimentional virtual testbed that emulates the intestinal contraction is then introduced in details. After measuring the size of the black holes on the test images, we used our model to esimate the radius of the contracted intestinal track. Comparision between analytical results and the emulation model parameters has verified that our proposed method could preciously estimate the radius of the contracted small intestine based on endoscopic images.

  10. Endoscopic management of biliary hydatid disease

    PubMed Central

    Akkiz, Hikmet; Akinoglu, Alper; Çolakoglu, Salih; Demiryürek, Haluk; Yagmur, Özgür

    1996-01-01

    Objective To determine the effect of endoscopic sphincterotomy in the management of biliary hydatid disease. Design A case study between January 1992 and December 1994. Setting A university-affiliated hospital in Adana, Turkey. Patients Five patients with biliary hydatid disease, in which the cyst had ruptured into the biliary tree. The follow-up ranged from 3 to 12 months. Intervention Endoscopic sphincterotomy. Main Outcome Measures Morbidity, mortality and recurrence of the disease. Results All patients underwent successful endoscopic sphincterotomy, including removal of daughter cysts. During the follow-up period, ultrasonography and laboratory investigations showed complete cure in all patients. There were no complications due to endoscopic sphincterotomy. Conclusion Endoscopic sphincterotomy is the treatment of choice for the management of hydatid cysts that have ruptured into the biliary tract causing obstructive jaundice. PMID:8697318

  11. 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

  12. Percutaneous endoscopic gastrostomy following previous abdominal surgery.

    PubMed Central

    Stellato, T A; Gauderer, M W; Ponsky, J L

    1984-01-01

    During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy. PMID:6428334

  13. Endoscopic palliation of tracheobronchial malignancies.

    PubMed Central

    Hetzel, M R; Smith, S G

    1991-01-01

    The prognosis for tracheobronchial tumours remains poor. Most patients can be offered only palliation. When the main symptom is breathlessness or refractory haemoptysis from a large airway tumour endoscopic treatment may be very effective. Over the last decade most attention has focused on the neodymium YAG laser. This often produces dramatic effects but has some important limitations. In the last few years better techniques for stenting and intrabronchial radiotherapy (brachytherapy) have also been developed. This article discusses the range of techniques now available and aims to help clinicians decide which patients may benefit from referral to centres providing these techniques. Images PMID:1712516

  14. Modified trocar with laser diode for instrument guidance.

    PubMed

    Rajab, Taufiek Konrad

    2013-12-01

    Laparoscopic instruments that are newly inserted into trocars are initially outside the surgeon's endoscopic field of view. This can make it difficult to accurately position the instrument at the operative site and presents a potential risk to patients since the tip of the instrument could potentially perforate organs and blood vessels while it is advanced blindly. To solve this problem, I have designed a trocar that incorporates a laser pointer to guide laparoscopic instruments while they are outside the endoscopic field of view. The laser dot is projected along the long axis of the trocar. This allows the surgeon to instantly determine the direction and target of the introduced instrument. Furthermore, the projected laser dot serves as evidence of an unobstructed path from the trocar to the target. This modification improves safety in laparoscopic surgery.

  15. Endoscopic modalities for upper gastrointestinal leaks, fistulae and perforations

    PubMed Central

    Yee, Gary; Saxena, Payal

    2015-01-01

    Abstract Background Endotherapy techniques are a recent addition to the suite of non‐surgical and minimally invasive strategies to manage patients with perforations, leaks and fistulae. The emergency nature of these conditions and the heterogeneity of pathologies encountered create difficulties when trying to select appropriate tools in these complex situations. The purpose of this article is to review experience at a tertiary academic centre, describe the various endoscopic tools available and the situations where they can be considered for use. Methods Single‐centre series and review of the published literature. Results Of 64 patients, 57 were successfully treated using endoscopic therapy, with surgery used only to provide drainage and suture fully covered metal stents in place to prevent migration. Discussion Selection of an appropriate endotherapy or stent for a patient with an oesophago‐gastric perforation or fistula requires an understanding of the anatomy and physiology underlying the patient's presentation and an understanding of the strengths and weaknesses of the available methods. Standard surgical principles of drainage, avoidance of distal obstruction and nutrition remain central to successful outcomes. A combination of surgical and endoscopic treatments may reduce the number of required treatments and can provide the ability to anchor fully covered stents to prevent them from migrating. PMID:26525773

  16. Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

    PubMed Central

    Kataoka, Yosuke; Tsuji, Yosuke; Sakaguchi, Yoshiki; Minatsuki, Chihiro; Asada-Hirayama, Itsuko; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

    2016-01-01

    Endoscopic submucosal dissection (ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection (EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD. PMID:27468187

  17. Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

    PubMed Central

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

    2017-01-01

    Abstract Rationale: Ectopic variceal bleeding is a rare (2–5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. Patient concerns: We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. Diagnoses: All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. Interventions: All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Outcomes: Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. Lessons: EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery. PMID:28072750

  18. Endoscopic retrograde cholangiopancreatography associated pancreatitis: A 15-year review

    PubMed Central

    Woods, Kevin E; Willingham, Field F

    2010-01-01

    The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. We searched for and evaluated all articles describing the diagnosis, epidemiology, pathophysiology, morbidity, mortality and prevention of post-ERCP pancreatitis (PEP) in adult patients using the PubMed database. Search terms included endoscopic retrograde cholangiopancreatography, pancreatitis, ampulla of vater, endoscopic sphincterotomy, balloon dilatation, cholangiography, adverse events, standards and utilization. We limited our review of articles to those published between January 1, 1994 and August 15, 2009 regarding human adults and written in the English language. Publications from the reference sections were reviewed and included if they were salient and fell into the time period of interest. Between the dates queried, seventeen large (> 500 patients) prospective and four large retrospective trials were conducted. PEP occurred in 1%-15% in the prospective trials and in 1%-4% in the retrospective trials. PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis. Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last fifteen years in 63 trials. Although 22 of 63 trials published during our period of review suggested a reduction in PEP, no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP. In conclusion, PEP is a well-recognized complication of ERCP. Medical treatment for prevention has been disappointing. Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials. PMID:21160744

  19. 14 CFR 25.1337 - Powerplant instruments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Powerplant instruments. 25.1337 Section 25... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Instruments: Installation § 25.1337 Powerplant instruments. (a) Instruments and instrument lines. (1) Each powerplant and auxiliary power unit...

  20. Endoscopic retrieval of gastric trichophytobezoar

    PubMed Central

    Zhao, Jiu-ling; Zhao, Wei-chuan; Wang, Yu-shui

    2017-01-01

    Abstract Rationale: Trichophytobezoars, which are composed of hair and plant fibers, are usually located in the stomach. They are often associated with trichophagia and trichotillomania. The most commonly reported methods of trichophytobezoar treatment are open surgery and laparoscopic retrieval; there are few reports of endoscopic removal of trichophytobezoars. Patient concerns and Diagnoses: Twelve-year-old girl presented with a 3-day history of increasing upper abdominal pain, anorexia, and postprandial emesis. She had a 3-year history of pulling out and eating her own hair. Endoscopic examination showed a large intragastric trichophytobezoar measuring 10.5 cm × 3.5 cm in size, with extension of a few hairs through the pylorus. Interventions and Outcomes: The trichophytobezoar was packed with hair fibers and contained a hard core of mixed hair and vegetable fibers. After the core was cut, the trichophytobezoar was fragmented into pieces with the alternating use of a polypectomy snare and argon plasma coagulation. A small amount of hair and nondigestible food fibers was removed with grasping forceps during the initial procedure. The remaining hairball was loosened with biopsy forceps and was injected with sodium bicarbonate solution. The trichophytobezoar was removed completely at repeat endoscopy 5 days later. After 6 months of psychological intervention, the patient had no recurrence of trichophagia or trichophytobezoar. Lessons: Endoscopy with sodium bicarbonate injection is an effective and minimally invasive method of retrieving a gastric trichophytobezoar. PMID:28099364

  1. [Endoscopic diagnosis of Barrett's adenocarcinoma].

    PubMed

    Yoshio, H; Takashi, Y; Mitsuyo, H; Nobuhiko, Y; Tatsurou, T; Kazuhiko, S; Yoko, H; Shigemasa, I; Hisanaga, M; Osamu, H; Katsuyoshi, S; Seishi, U; Matsushita, H; Masahiko, T

    1999-03-01

    Biopsy specimens can reveal that esophageal cancer is an adenocarcinoma but they cannot show that its origin is Barrett's mucosa. Therefore we must show during endoscopy that the tumor exists in Barrett's mucosa. We reported that Barrett's esophagus could be clearly diagnosed at endoscopy as the columnar mucosa lying on the longitudinal vessels in the lower esophagus. We define Barrett's esophagus as "the columnar mucosa in the esophagus which exists continuously more than 2 cm in circumference from the stomach." Short-segment Barrett's esophagus (SSBE) is "the columnar mucosa which exists in the esophagus continuously from the stomach but its length has a part under 2 cm in length." Endoscopically Barrett's adenocarcinoma is visualized as a lesion with a reddish and uneven mucosal surface. Barrett's adenocarcinomas occur in the SSBE as well. Endoscopic observation at periodic intervals is necessary not only for cases with Barrett's esophagus but also with SSBE. A further examination is necessary to determine the application of EMR for superficial Barrett's adenocarcinoma.

  2. Optomechanical medical devices (instruments)

    NASA Astrophysics Data System (ADS)

    Reiss, Roger S.

    2004-03-01

    Optomechanical Medical Devices (Instruments) use lightwaves (UV, Visible, IR) for one or more of the following functions; to observe, to measure, to record, to test (align) and or to cut/repair. The evolution of Optomechanical Medical Devices probably started when the first torch or candle or petrochemical lamp used a polished reflector (possibly with a concave configuration) to examine a part of a patient's body (possibly a wound).Once the glass lens was invented, light sources of any type could be forcussed to increase illuminating power on a selected area. Medical Devices have come a great distance since these early items. Skipping across time to three rather significant inventions and advancements, we are well into the era of Laser and Fiber Optics and Advanced Photodetectors, all being integrated into Medical Devices. The most notable fields have been Ophthalmology, Dermatology, and Surgery. All three fields have been able to incorporate both the use of the Laser and the use of Fiber Optics (and at times the use of Photodetectors), into a single device (instrument). Historical: Philipp Bozzini (a Doctor, maybe) in the early 1800's used a hollow tube (tube material not identified) to project the light of a candle through the tube to view a patient's 'what ever'. Only Philipp, the patient and G-d knows what was being viewed. This ws the first recorded information on what could be considered the very first 'Endoscope examination'

  3. Flexible percutaneous endoscopic retroperitoneal necrosectomy (PEN) as rescue therapy for pancreatic necroses beyond the reach of EUS: A case series.

    PubMed

    Jürgensen, Christian; Brückner, Stefan; Reichel, Stephanie; Kilian, Maik; Pannach, Sven; Distler, Marius; Weitz, Jürgen; Neser, Frank; Hampe, Jochen; Will, Uwe

    2017-01-23

    Minimally invasive or endoscopic transluminal drainage and necrosectomy are the standard of care for infected pancreatic fluid collections and necroses after pancreatitis. In an endoscopic treatment algorithm, necroses beyond the reach of safe endoscopic access are typically treated by percutaneous drainage. We aimed to evaluate percutaneous minimally invasive necrosectomy using a purely endoscopic technique in patients with extensive necrosis. In patients with necroses beyond safe transluminal reach, the percutaneous drainage canal was used for flexible endoscopic access and dilatation of the tract to 20mm. Percutaneous endoscopic necrosectomy (PEN) was performed through this canal. We present a case series of 14 patients in whom between 1 and 4 necrosectomy (median 2) sessions were performed to remove solid necroses successfully in 13 out of 14 patients. There were no major complications apart from one patient with abdominal compartment syndrome secondary to delayed arrosion of the splenic artery. Percutaneous flexible necrosectomy might evolove to an alternative to surgical minimally invasive necrosectomy in anatomic sites beyond transluminal endoscopic reach. This article is protected by copyright. All rights reserved.

  4. IPEM guidelines on dosimeter systems for use as transfer instruments between the UK primary dosimetry standards laboratory (NPL) and radiotherapy centres.

    PubMed

    Morgan, A M; Aird, E G; Aukett, R J; Duane, S; Jenkins, N H; Mayles, W P; Moretti, C; Thwaites, D I

    2000-09-01

    United Kingdom dosimetry codes of practice have traditionally specified one electrometer for use as a secondary standard, namely the Nuclear Enterprises (NE) 2560 NPL secondary standard therapy level exposure meter. The NE2560 will become obsolete in the foreseeable future. This report provides guidelines to assist physicists following the United Kingdom dosimetry codes of practice in the selection of an electrometer to replace the NE2560 when necessary. Using an internationally accepted standard (BS EN 60731:1997) as a basis, estimated error analyses demonstrate that the uncertainty (one standard deviation) in a charge measurement associated with the NE2560 alone is approximately 0.3% under specified conditions. Following a review of manufacturers' literature, it is considered that modern electrometers should be capable of equalling this performance. Additional constructural and operational requirements not specified in the international standard but considered essential in a modern electrometer to be used as a secondary standard are presented.

  5. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  6. Endoscopic approaches to treatment of achalasia

    PubMed Central

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

    2013-01-01

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

  7. Endoscopic Management of Peptic Ulcer Bleeding

    PubMed Central

    Kim, Joon Sung; Park, Sung Min

    2015-01-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods. PMID:25844337

  8. Endoscopic management of peptic ulcer bleeding.

    PubMed

    Kim, Joon Sung; Park, Sung Min; Kim, Byung-Wook

    2015-03-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods.

  9. Robotic endoscope motor module and gearing design.

    PubMed

    Oliveira, Jillian M; Chen, Yi; Hunter, Ian W

    2011-01-01

    Actuation of a robotic endoscope with increased torque output is presented. This paper will specifically focus on the motor module section of a robotic endoscope, which comprises of a pair of motors and gear reduction assemblies. The results for the endoscope and biopsy tool stiffness, as well as the stall force and force versus speed characteristics of the motor module assembly are shown. The scope stiffness was found to be 0.006 N/degree and additional stiffness of the biopsy tools were found to be in the range of 0.09 to 0.13 N/degree. Calculations for worm gearing and efficiency are discussed.

  10. Fluorescence video endoscopic system for early cancer detection

    NASA Astrophysics Data System (ADS)

    Lytle, A. Charles; Dunn, J. B.; Paspa, Paul M.; Doiron, Daniel R.; Balchum, Oscar J.

    1990-06-01

    A video system is being developed to allow the detection of cancerous lesions that are too small to be accurately identified visually or with x-ray. The system makes use of standard endoscopes and provides a video display of both the color image and a false color fluorescence image, with automated switching between the two views. Excitation of the fluorescence marker, Heinatoporphyrin Derivative (HpD) , or it ' 5 purified form , diheinatoporphyrin ether! ester (DHE) , is provided by a krypton ion laser operating in the violet. A brief discussion of fluorescence diagnostic theory and a description of the prototype system, its clinical use , and performance is reviewed.

  11. Dynamic contrast-enhanced endoscopic ultrasound: A quantification method

    PubMed Central

    Dietrich, Christoph F.; Dong, Yi; Froehlich, Eckhart; Hocke, Michael

    2017-01-01

    Dynamic contrast-enhanced ultrasound (DCE-US) has been recently standardized by guidelines and recommendations. The European Federation of Societies for US in Medicine and Biology position paper describes the use for DCE-US. Comparatively, little is known about the use of contrast-enhanced endoscopic US (CE-EUS). This current paper reviews and discusses the clinical use of CE-EUS and DCE-US. The most important clinical use of DCE-US is the prediction of tumor response to new drugs against vascular angioneogenesis. PMID:28218195

  12. Endoscopic Optical Coherence Tomography in Urology

    NASA Astrophysics Data System (ADS)

    Pan, Yingtian; Waltzer, Wayne; Ye, Zhangqun

    Clinical statistics has shown a stable prevalence of bladder cancer in recent years, which by far remains among the most common types of malignancy in the USA. With smoking as the most well-established risk factor, bladder cancer is the fourth most common cancer occurrences in male population [1]. In the year of 2014, an estimated 74,690 new cases are expected to occur with estimated 15,580 deaths. Bladder cancer often refers to transitional cell carcinoma (TCC) as it originates primarily from the epithelial cell layer (i.e., urothelium) of the bladder. Unlike prostate-specific antigen (PSA) for prostate cancer screening, there is currently no effective screening technique approved or recommended for the population at average risk [2-5]. As a result, hematuria (i.e., blood in the urine) is often the first clinical symptom of bladder cancer. Fortunately, urinary bladder is more accessible than prostate glands endoscopically; thus cytology following white-light cystoscopy has been the gold standard for current clinical detection of bladder cancer. This is important because bladder cancer if diagnosed prior to muscle invasion (e.g., superficial or at

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

    PubMed Central

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

    2015-01-01

    Background and Aims: To determine whether clinical information influences endoscopic scoring by central readers using the Ulcerative Colitis Endoscopic Index of Severity [UCEIS; comprising ‘vascular pattern’, ‘bleeding’, ‘erosions and ulcers’]. Methods: Forty central readers performed 28 evaluations, including 2 repeats, from a library of 44 video sigmoidoscopies stratified by Mayo Clinic Score. Following training, readers were randomised to scoring with [‘unblinded’, n = 20, including 4 control videos with misleading information] or without [‘blinded’, n 20] clinical information. A total of 21 virtual Central Reader Groups [CRGs], of three blinded readers, were created. Agreement criteria were pre-specified. Kappa [κ] statistics quantified intra- and inter-reader variability. Results: Mean UCEIS scores did not differ between blinded and unblinded readers for any of the 40 main videos. UCEIS standard deviations [SD] were similar [median blinded 0.94, unblinded 0.93; p = 0.97]. Correlation between UCEIS and visual analogue scale [VAS] assessment of overall severity was high [r blinded = 0.90, unblinded = 0.93; p = 0.02]. Scores for control videos were similar [UCEIS: p ≥ 0.55; VAS: p ≥ 0.07]. Intra- [κ 0.47–0.74] and inter-reader [κ 0.40–0.53] variability for items and full UCEIS was ‘moderate’-to-‘substantial’, with no significant differences except for intra-reader variability for erosions and ulcers [κ blinded: 0.47 vs unblinded: 0.74; p 0.047]. The SD of CRGs was lower than for individual central readers [0.54 vs 0.95; p < 0.001]. Correlation between blinded UCEIS and patient-reported symptoms was high [stool frequency: 0.76; rectal bleeding: 0.82; both: 0.81]. Conclusions: The UCEIS is minimally affected by knowledge of clinical details, strongly correlates with patient-reported symptoms, and is a suitable instrument for trials. CRGs performed better than individuals. PMID:25956538

  14. Medical instrument data exchange.

    PubMed

    Gumudavelli, Suman; McKneely, Paul K; Thongpithoonrat, Pongnarin; Gurkan, D; Chapman, Frank M

    2008-01-01

    Advances in medical devices and health care has been phenomenal during the recent years. Although medical device manufacturers have been improving their instruments, network connection of these instruments still rely on proprietary technologies. Even if the interface has been provided by the manufacturer (e.g., RS-232, USB, or Ethernet coupled with a proprietary API), there is no widely-accepted uniform data model to access data of various bedside instruments. There is a need for a common standard which allows for internetworking with the medical devices from different manufacturers. ISO/IEEE 11073 (X73) is a standard attempting to unify the interfaces of all medical devices. X73 defines a client access mechanism that would be implemented into the communication controllers (residing between an instrument and the network) in order to access/network patient data. On the other hand, MediCAN technology suite has been demonstrated with various medical instruments to achieve interfacing and networking with a similar goal in its open standardization approach. However, it provides a more generic definition for medical data to achieve flexibility for networking and client access mechanisms. In this paper, a comparison between the data model of X73 and MediCAN will be presented to encourage interoperability demonstrations of medical instruments.

  15. Aircraft Speed Instruments

    NASA Technical Reports Server (NTRS)

    Beij, K Hilding

    1933-01-01

    This report presents a concise survey of the measurement of air speed and ground speed on board aircraft. Special attention is paid to the pitot-static air-speed meter which is the standard in the United States for airplanes. Air-speed meters of the rotating vane type are also discussed in considerable detail on account of their value as flight test instruments and as service instruments for airships. Methods of ground-speed measurement are treated briefly, with reference to the more important instruments. A bibliography on air-speed measurement concludes the report.

  16. SNR 1E 0102.2-7219 as an X-ray calibration standard in the 0.5-1.0 keV bandpass and its application to the CCD instruments aboard Chandra, Suzaku, Swift and XMM-Newton

    NASA Astrophysics Data System (ADS)

    Plucinsky, Paul P.; Beardmore, Andrew P.; Foster, Adam; Haberl, Frank; Miller, Eric D.; Pollock, Andrew M. T.; Sembay, Steve

    2017-01-01

    Context. The flight calibration of the spectral response of charge-coupled device (CCD) instruments below 1.5 keV is difficult in general because of the lack of strong lines in the on-board calibration sources typically available. This calibration is also a function of time due to the effects of radiation damage on the CCDs and/or the accumulation of a contamination layer on the filters or CCDs. Aims: We desire a simple comparison of the absolute effective areas of the current generation of CCD instruments onboard the following observatories: Chandra ACIS-S3, XMM-Newton (EPIC-MOS and EPIC-pn), Suzaku XIS, and Swift XRT and a straightforward comparison of the time-dependent response of these instruments across their respective mission lifetimes. Methods: We have been using 1E 0102.2-7219, the brightest supernova remnant in the Small Magellanic Cloud, to evaluate and modify the response models of these instruments. 1E 0102.2-7219 has strong lines of O, Ne, and Mg below 1.5 keV and little or no Fe emission to complicate the spectrum. The spectrum of 1E 0102.2-7219 has been well-characterized using the RGS gratings instrument on XMM-Newton and the HETG gratings instrument on Chandra. As part of the activities of the International Astronomical Consortium for High Energy Calibration (IACHEC), we have developed a standard spectral model for 1E 0102.2-7219 and fit this model to the spectra extracted from the CCD instruments. The model is empirical in that it includes Gaussians for the identified lines, an absorption component in the Galaxy, another absorption component in the SMC, and two thermal continuum components with different temperatures. In our fits, the model is highly constrained in that only the normalizations of the four brightest lines/line complexes (the O vii Heα triplet, O viii Lyα line, the Ne ix Heα triplet, and the Ne x Lyα line) and an overall normalization are allowed to vary, while all other components are fixed. We adopted this approach to

  17. Endoscopic abdominoplasty: an alternative approach.

    PubMed

    Iglesias, Martin; Bravo, Leonardo; Chavez-Muñoz, Claudia; Barajas-Olivas, Alexandra

    2006-11-01

    We describe a technique for endoscopic abdominoplasty in which we used 3 incisions, following the triangulation principles. To maintain the subcutaneous cavity, CO2 was insufflated at 8 mm Hg, and Esmarch bandages were placed at the submammary fold in a circumferential way to prevent subcutaneous emphysema. The aponeurosis plication was done with interrupted "8" figure sutures, with extracorporeal knots tied up in a double fisherman knot. The rest of the technique is similar to those previously described. Seven patients were treated, with an average age of 35.7 years (range, 25-60), and the mean length of surgery was of 197.11 minutes (range, 129-240). After surgery, 2 patients had mild pulmonary hypoventilation treated only with oxygen through a nasal mask for 24 hours. There were other complications such as seromas, inadequate implantation of the navel, and superficial periumbilical necrosis. According to the patients' opinion, the esthetic results have been satisfactory so far.

  18. Endoscopic Accessory Navicular Synchondrosis Fusion.

    PubMed

    Lui, Tun Hing

    2016-12-01

    The accessory navicular bone is one of the most common accessory ossicles of the foot. Fewer than 1% of accessory navicular bones are symptomatic, and most of these are type II accessory navicular bones. A separation of the synchondrosis is considered one of the main causes of pain. After an injury to the synchondrosis has resulted in a chondro-osseous disruption, the combined forces of tension and shear from the posterior tibial tendon and the foot aggravate the injury and prevent it from healing. Fusion of the synchondrosis is a logical surgical treatment option if the pain is recalcitrant to conservative measures. The purpose of this technical note is to report an endoscopic approach to achieve fusion. It has the advantages of better cosmesis, less scar pain, less risk of nonunion, and potential to examine the tibialis posterior tendon and the talonavicular joint.

  19. Anatomical landmarks for transnasal endoscopic skull base surgery.

    PubMed

    Sandu, Kishore; Monnier, Philippe; Pasche, Philippe

    2012-01-01

    Resection of midline skull base lesions involve approaches needing extensive neurovascular manipulation. Transnasal endoscopic approach (TEA) is minimally invasive and ideal for certain selected lesions of the anterior skull base. A thorough knowledge of endonasal endoscopic anatomy is essential to be well versed with its surgical applications and this is possible only by dedicated cadaveric dissections. The goal in this study was to understand endoscopic anatomy of the orbital apex, petrous apex and the pterygopalatine fossa. Six cadaveric heads (3 injected and 3 non injected) and 12 sides, were dissected using a TEA outlining systematically, the steps of surgical dissection and the landmarks encountered. Dissection done by the "2 nostril, 4 hands" technique, allows better transnasal instrumentation with two surgeons working in unison with each other. The main surgical landmarks for the orbital apex are the carotid artery protuberance in the lateral sphenoid wall, optic nerve canal, lateral optico-carotid recess, optic strut and the V2 nerve. Orbital apex includes structures passing through the superior and inferior orbital fissure and the optic nerve canal. Vidian nerve canal and the V2 are important landmarks for the petrous apex. Identification of the sphenopalatine artery, V2 and foramen rotundum are important during dissection of the pterygopalatine fossa. In conclusion, the major potential advantage of TEA to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, as against the open transcranial approaches which involve more neurovascular manipulation and brain retraction. Obviously, these approaches require close cooperation and collaboration between otorhinolaryngologists and neurosurgeons.

  20. Cordless Instruments

    NASA Astrophysics Data System (ADS)

    1981-01-01

    Black & Decker's new cordless lightweight battery powered precision instruments, adapted from NASA's Apollo Lunar Landing program, have been designed to give surgeons optimum freedom and versatility in the operating room. Orthopedic instrument line includes a drill, a driver/reamer and a sagittal saw. All provide up to 20 minutes on a single charge. Power pack is the instrument's handle which is removable for recharging. Microprocessor controlled recharging unit can recharge two power packs together in 30 minutes. Instruments can be gas sterilized, steam-sterilized in an autoclave or immersed for easy cleaning.

  1. Endoscopic ultrasound guided interventional procedures

    PubMed Central

    Sharma, Vishal; Rana, Surinder S; Bhasin, Deepak K

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS. PMID:26078831

  2. Endoscopic findings in uninvestigated dyspepsia

    PubMed Central

    2014-01-01

    Background It is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in São Paulo. Methods Outpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Results Three hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs. Conclusions The endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status. PMID:24499444

  3. Advanced endoscopic imaging to improve adenoma detection

    PubMed Central

    Neumann, Helmut; Nägel, Andreas; Buda, Andrea

    2015-01-01

    Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection rates. Those include high-definition imaging, dye-less chromoendoscopy techniques and novel, highly flexible endoscopes, some of them equipped with balloons or multiple lenses in order to improve adenoma detection rates. In this review we will focus on the newest developments in the field of colonoscopic imaging to improve adenoma detection rates. Described techniques include high-definition imaging, optical chromoendoscopy techniques, virtual chromoendoscopy techniques, the Third Eye Retroscope and other retroviewing devices, the G-EYE endoscope and the Full Spectrum Endoscopy-system. PMID:25789092

  4. 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

  5. A simple device for disinfecting endoscopes.

    PubMed

    Wagenvoort, J H; van Blankenstein, M; Kooyman-Op de Hoek, G; Boks, A L; van Oudenaarde, P H

    1986-01-01

    A method for disinfecting fibreoptic endoscopes with povidone-iodine and a simple cleaning device, consisting of a curved glass pipe and a peristaltic pump is described. If properly employed the system produces satisfactory results.

  6. Advanced endoscopic imaging of indeterminate biliary strictures

    PubMed Central

    Tabibian, James H; Visrodia, Kavel H; Levy, Michael J; Gostout, Christopher J

    2015-01-01

    Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs. PMID:26675379

  7. [Advances on endoscopic treatment of intestinal fistulas].

    PubMed

    Wu, X W; Ren, J A; Li, J S

    2016-03-01

    Intestinal fistulas are severe complications after abdominal surgical procedures. The endoscopic therapy makes it possible to close fistulas without surgical interventions. When patients achieved stabilization and had no signs of systemic sepsis or inflammation, these therapies could be conducted, which included endoscopic vacuum therapy, fibrin glue sealing, stents, fistula plug, suture, and Over The Scope Clip (OTSC). Various techniques may be combined. Endoscopy vacuum therapy could be applied to control systemic inflammation and prevent continuing septic contamination by active drainage. Endoscopic stent is placed over fistulas and gastrointestinal continuity is recovered. The glue sealing is applied for enterocutaneous fistulas, and endoscopy suture has the best results seen in fistulas <1 cm in diameter. Insertion of the fistula plug is used to facilitate fistula healing. The OTSC is effective to treat leaks with large defects. Endoscopic treatment could avoid reoperation and could be regarded as the first-line treatment for specific patients.

  8. Esophageal papilloma: Flexible endoscopic ablation by radiofrequency

    PubMed Central

    del Genio, Gianmattia; del Genio, Federica; Schettino, Pietro; Limongelli, Paolo; Tolone, Salvatore; Brusciano, Luigi; Avellino, Manuela; Vitiello, Chiara; Docimo, Giovanni; Pezzullo, Angelo; Docimo, Ludovico

    2015-01-01

    Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation (RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for BarrxTM RFA in patients with esophageal papilloma. PMID:25789102

  9. Outcomes and safety of endoscopic tarsal tunnel decompression: a systematic review.

    PubMed

    Gkotsoulias, Efthymios N; Simonson, Devin C; Roukis, Thomas S

    2014-02-01

    Open surgical decompression of the tarsal tunnel is the standard surgical approach for compression of the tibial nerve within the tarsal tunnel. Complications associated with this approach can be significant and periods of non-weight bearing are required. An alternative approach allowing for minimal soft tissue trauma and reduced time to ambulation is therefore desirable. Endoscopic tarsal tunnel decompression may provide such an alternative. The authors performed a systematic review of electronic databases and other relevant sources to identify material regarding the safety of endoscopic tarsal tunnel decompression. Only articles that included clear information concerning the safety of endoscopic tarsal tunnel decompression with a follow-up of at least 12 months were included. Three studies were identified involving 37 feet, with a weighted mean follow-up of 27 months. There were no permanent complications relating to iatrogenic nerve injury, deep infection, or prolonged wound healing problems documented despite initiating ambulation within one week of surgery. Two patients (5.6%) developed recurrence more than 2 years postoperative and one (2.7%) showed no improvement. Endoscopic tarsal tunnel decompression is a safe procedure with a low rate of recurrence or failure and allows for near-immediate ambulation. However, additional prospective investigations comparing open and endoscopic approaches to tarsal tunnel decompression are warranted.

  10. 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.

  11. Endoscopic and retrograde cholangiographic appearance of hepaticojejunostomy strictures: A practical classification

    PubMed Central

    Mönkemüller, Klaus; Jovanovic, Ivan

    2011-01-01

    AIM: To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy (HJ) and propose a practical HJ stricture classification. METHODS: In a retrospective observational study, a balloon-assisted enteroscopy (BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal (GI) anatomy. BAE-endoscopic retrograde cholangio pancreatography (ERCP) was performed 23 times in 18 patients with HJ. The HJ was carefully studied with the endoscope and using cholangiography. RESULTS: The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classified based on endoscopic and cholangiographic appearances: the HJ orifice aspect may appear as small (type A) or large (type B) and the stricture may be short (type 1), long (type 2) and type 3, intrahepatic biliary strictures not associated with anastomotic stenosis. In total, 7 patients had type A1, 4 patients A2, one patient had B1, one patient had B (large orifice without stenosis) and one patient had type B3. CONCLUSION: This practical classification allows for an accurate initial assessment of the HJ, thus potentially allowing for adequate therapeutic planning, as the shape, length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and therapeutic accessories to be used. Of additional importance, a standardized classification may allow for better comparison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy. PMID:22110837

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

    NASA Astrophysics Data System (ADS)

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

    1998-01-01

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

  13. Danger points, complications and medico-legal aspects in endoscopic sinus surgery.

    PubMed

    Hosemann, W; Draf, C

    2013-12-13

    Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5-1%. A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education.

  14. Danger points, complications and medico-legal aspects in endoscopic sinus surgery

    PubMed Central

    Hosemann, W.; Draf, C.

    2013-01-01

    Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5–1%. A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education. PMID:24403974

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

    NASA Astrophysics Data System (ADS)

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

    1997-12-01

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

  16. Craniofacial ballpoint pen injury: endoscopic management.

    PubMed

    LaFrentz, J R; Mair, E A; Casler, J D

    2000-02-01

    Penetrating facial injuries are not infrequent. There have been isolated case reports of unusual penetrating craniofacial trauma. We describe an unusual case of a 22-month-old child who suffered an external orbital injury from a ballpoint pen that penetrated the orbit, lamina papyracea, posterior ethmoid sinuses, and sphenoid sinus. Endoscopic sinus surgery was performed to extract the ballpoint pen nib after localization with computed tomography. Careful pediatric endoscopic sinus surgery techniques permitted safe foreign body extraction with minimal morbidity.

  17. Modified endoscopic release of gastrocnemius aponeurosis.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Recession of the gastrocnemius aponeurosis is the operation of choice in the case of isolated gastrocnemius contracture, because it addresses the major deforming force without weakening the entire musculotendinous unit. Endoscopic recession of the gastrocnemius aponeurosis has been proved to be effective but can be associated with the wrong level of release, incomplete release, sural nerve injury, or a palpable gap at the aponeurosis. A modification of the endoscopic technique is described to provide solutions to these potential problems.

  18. Potential capacity of endoscopic screening for gastric cancer in Japan.

    PubMed

    Hamashima, Chisato; Goto, Rei

    2017-01-01

    In 2016, the Japanese government decided to introduce endoscopic screening for gastric cancer as a national program. To provide endoscopic screening nationwide, we estimated the proportion of increase in the number of endoscopic examinations with the introduction of endoscopic screening, based on a national survey. The total number of endoscopic examinations has increased, particularly in clinics. Based on the national survey, the total number of participants in gastric cancer screening was 3 784 967. If 30% of the participants are switched from radiographic screening to endoscopic screening, approximately 1 million additional endoscopic examinations are needed. In Japan, the participation rates in gastric cancer screening and the number of hospitals and clinics offering upper gastrointestinal endoscopy vary among the 47 prefectures. If the participation rates are high and the numbers of hospitals and clinics are small, the proportion of increase becomes larger. Based on the same assumption, 50% of big cities can provide endoscopic screening with a 5% increase in the total number of endoscopic examinations. However, 16.7% of the medical districts are available for endoscopic screening within a 5% increase in the total number of endoscopic examinations. Despite the Japanese government's decision to introduce endoscopic screening for gastric cancer nationwide, its immediate introduction remains difficult because of insufficient medical resources in rural areas. This implies that endoscopic screening will be initially introduced to big cities. To promote endoscopic screening for gastric cancer nationwide, the disparity of medical resources must first be resolved.

  19. Novel design for a confocal endoscope

    NASA Astrophysics Data System (ADS)

    Pillers, Russell B.; Publicover, Nelson G.

    2006-02-01

    Confocal imaging in an endoscopic format is currently under-utilized as a clinical investigative tool. This is due mainly to the complex, sensitive and costly scanning systems required to produce images. We hypothesize that design potential exists for an endoscope without any type of scanning system and that consequently can simultaneously acquire an entire confocal image frame. Our design exploits the parallel structure of fiber-optic image guides to eliminate all scanning hardware. The design is based upon developing a novel method to form a miniscule aperture on the end of each fiber in an image bundle. This process creates out-of-focus light rejection space between each fiber without changing the fiber spacing or the original outer diameter of the image guide. Our modified image guide can then be incorporated into an essentially typical endoscopic system. Using parallel apertures, a confocal endoscope or "conscope" can acquire images at a rate limited only by light intensity and the acquisition rate of a camera. The research presented in this paper shows the effects of adjusting pinhole diameter on confocal performance. The marriage of endoscopes, confocal imaging, parallel optical fibers, and the conscope design offers life science an ability to quickly observe deep, in-vivo cellular structures in their natural state. Although originally intended for endoscope applications, our design may benefit other forms of microscopy as well.

  20. SURVEY INSTRUMENT

    DOEpatents

    Borkowski, C J

    1954-01-19

    This pulse-type survey instrument is suitable for readily detecting {alpha} particles in the presence of high {beta} and {gamma} backgrounds. The instruments may also be used to survey for neutrons, {beta} particles and {gamma} rays by employing suitably designed interchangeable probes and selecting an operating potential to correspond to the particular probe.

  1. LED-based endoscopic light source for spectral imaging

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

    Colorectal cancer is the United States 3rd leading cancer in death rates.1 The current screening for colorectal cancer is an endoscopic procedure using white light endoscopy (WLE). There are multiple new methods testing to replace WLE, for example narrow band imaging and autofluorescence imaging.2 However, these methods do not meet the need for a higher specificity or sensitivity. The goal for this project is to modify the presently used endoscope light source to house 16 narrow wavelength LEDs for spectral imaging in real time while increasing sensitivity and specificity. The process to do such was to take an Olympus CLK-4 light source, replace the light and electronics with 16 LEDs and new circuitry. This allows control of the power and intensity of the LEDs. This required a larger enclosure to house a bracket system for the solid light guide (lightpipe), three new circuit boards, a power source and National Instruments hardware/software for computer control. The results were a successfully designed retrofit with all the new features. The LED testing resulted in the ability to control each wavelength's intensity. The measured intensity over the voltage range will provide the information needed to couple the camera for imaging. Overall the project was successful; the modifications to the light source added the controllable LEDs. This brings the research one step closer to the main goal of spectral imaging for early detection of colorectal cancer. Future goals will be to connect the camera and test the imaging process.

  2. Interventional sialendoscopy with endoscopic sialolith removal without fragmentation.

    PubMed

    Dabirmoghaddam, Payman; Hosseinzadehnik, Rima

    2013-04-01

    We performed a retrospective analysis to review the results and complications of sialendoscopy and to identify the overall success rate of mechanical stone retrieval without fragmentation in our patients with sialolithiasis. Between 2009 and 2011, 33 patients with sialolithiasis underwent interventional sialendoscopy. Patients with sialoliths larger than 7 mm in the Wharton's duct and 5 mm in the Stensen's duct or intraparenchymal stones were not included in this study. Grasping forceps, wire baskets and graspers was used for stone removal. The mean age at presentation was 41.7 (range, 29-62) years with a male to female ratio of approximately 1:2. The average size of the stones ranged from 2 to 6 mm. The overall success rate for endoscopic stone retrieval was 78 % (26 of 33) and three patients required a combined approach with intraoral incisions for stone removal. The major complication rate was 3 % (1 of 33) caused by submandibular duct perforation. The endoscopic retrieval of salivary stones is a safe and effective technique in selected cases. As instruments for stone fragmentation are expensive and not available everywhere, selecting patients with small and medium sized stones could lead to successful results in majority of cases.

  3. Visual tracking of da Vinci instruments for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

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

    SciTech Connect

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

    2015-06-15

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

  5. Results from the commissioning of a multi-modal endoscope for ultrasound and time of flight PET

    SciTech Connect

    Bugalho, Ricardo

    2015-07-01

    The EndoTOFPET-US collaboration has developed a multi-modal imaging system combining Ultrasound with Time-of-Flight Positron Emission Tomography into an endoscopic imaging device. The objective of the project is to obtain a coincidence time resolution of about 200 ps FWHM and to achieve about 1 mm spatial resolution of the PET system, while integrating all the components in a very compact detector suitable for endoscopic use. This scanner aims to be exploited for diagnostic and surgical oncology, as well as being instrumental in the clinical test of new biomarkers especially targeted for prostate and pancreatic cancer. (authors)

  6. A Procedure for Implementing Detailed Grade Level Analysis by Local Curriculum Objectives Utilizing Standardized Instruments of Measure: A Comprehensive Case Study.

    ERIC Educational Resources Information Center

    DuVall, Charles R.; Rueff, Joseph A.

    This document traces the development of the testing and reporting system used in the Elkhart Community Schools (ECS), Indiana, from 1981 through 1985. Performance objectives were established when the program was initiated. Analyses of standardized test results were provided for teachers, principals, and central administrative staff. All school…

  7. Curriculum Based Functional Vocational Assessment Guide. Correlation of the Life Centered Career Education Curriculum with Specific Occupational Programs, Standards of Work Performance, and Campus Assessment Instruments.

    ERIC Educational Resources Information Center

    Quinones, William A.

    This document is a guide developed for the Dallas Independent School District's (DISD's) Multiple Careers Magnet Center, which provides special education students with training in standards of work performance and specific occupational skills for successful transition to community life and employment. The document also provides information for…

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

    PubMed

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

    2015-03-01

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

  9. Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding

    PubMed Central

    Lee, Mu-Hsien; Tsou, Yung-Kuan; Lin, Cheng-Hui; Lee, Ching-Song; Liu, Nai-Jen; Sung, Kai-Feng; Cheng, Hao-Tsai

    2016-01-01

    AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy (ES) bleeding. METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, co-morbidities, endoscopic diagnosis, presence of peri-ampullary diverticulum, occurrence of immediate post-ES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy. RESULTS: A total of 35 patients (21.7%) had re-bleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/dL, initial bleeding severity, and bleeding diathesis were significant predictors of re-bleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/dL and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single (n = 23) or multiple (range, 2-7; n = 6) sessions in 29 of the 35 patients (82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding. CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/dL are predictors of re-bleeding. PMID:27003996

  10. Consensus of the Present and Prospects on Endoscopic Diagnosis and Treatment in East Asian Countries

    PubMed Central

    Kamiya, Takeshi; Joh, Takashi; Sollano, Jose D.; Zhu, Qi; Kachintorn, Udom; Aziz Rani, Abdul; Hahm, Ki-Baik; Takahashi, Shin'ichi; Kinoshita, Yoshikazu; Matsumoto, Takayuki; Naito, Yuji; Takeuchi, Koji; Arakawa, Tetsuo; Terano, Akira

    2012-01-01

    Background and Aim. New diagnostic or therapeutic methods in endoscopy have been used. Current clinical application of these procedures is not well known. The aim of this study is to investigate the present situation on endoscopic diagnosis and treatment of gastrointestinal disorders in East Asian countries. Method. A representative member from the International Gastrointestinal Consensus Symposium Committee provided a questionnaire to physicians in China, Indonesia, Japan, Korea, the Philippines, and Thailand. Results. In total, 514 physicians including gastroenterologists, surgeons, and general practitioners enrolled. The most frequently occurring disorder as the origin of upper gastrointestinal bleeding is gastric ulcer. Capsule endoscopy is selected as the first choice for the diagnosis of small intestine bleeding. The second choice was double-balloon endoscopy or angiography. For patients with gastric adenoma, the number of physicians who choose endoscopic mucosal resection is larger than those selecting endoscopic submucosal dissection (ESD) in China, Indonesia, the Philippines, and Thailand. ESD is chosen first in Japan and Korea. Conclusion. New instruments or techniques on endoscopy have not come into wide use yet, and there is diversity in the situation on it in Asian countries. We should unify the endoscopic diagnostic criteria or treated strategy in patients with GI disease. PMID:23093833

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

    PubMed

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

    2014-04-01

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

  12. Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

    PubMed Central

    Jung, Je-Tea; Lee, Sang-Jin; Kim, Young-Sang; Jang, Han-Jin; Yoo, Bang

    2016-01-01

    The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH. PMID:27583117

  13. Combined Endoscopic Optical Coherence Tomography and Laser Induced Fluorescence

    NASA Astrophysics Data System (ADS)

    Barton, Jennifer K.; Tumlinson, Alexandre R.; Utzinger, Urs

    Optical coherence tomography (OCT) and laser-induced fluorescence (LIF) are promising modalities for tissue characterization in human patients and animal models. OCT detects coherently backscattered light, whereas LIF detects fluorescence emission of endogenous biochemicals, such as reduced nicotinamide adenine dinucleotide (NADH), flavin adenine dinucleotide (FAD), collagen, and fluorescent proteins, or exogenous substances such as cyanine dyes. Given the complementary mechanisms of contrast for OCT and LIF, the combination of the two modalities could potentially provide more sensitive and specific detection of disease than either modality alone. Sample probes for both OCT and LIF can be implemented using small diameter optical fibers, suggesting a particular synergy for endoscopic applications. In this chapter, the mechanisms of contrast and diagnostic capability for both OCT and LIF are briefly examined. Evidence of complementary capability is described. Example published combined OCT-LIF systems are reviewed, one successful commercial instrument is discussed, and example applications are provided.

  14. Instrumentation '79.

    ERIC Educational Resources Information Center

    Chemical and Engineering News, 1979

    1979-01-01

    Surveys the state of commerical development of analytical instrumentation as reflected by the Pittsburgh Conference on Analytical Chemistry and Applied Spectroscopy. Includes optical spectroscopy, liquid chromatography, magnetic spectrometers, and x-ray. (Author/MA)

  15. 14 CFR 23.1381 - Instrument lights.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Instrument lights. 23.1381 Section 23.1381... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Equipment Lights § 23.1381 Instrument lights. The instrument lights must— (a) Make each instrument and control easily readable and...

  16. 14 CFR 25.1381 - Instrument lights.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Instrument lights. 25.1381 Section 25.1381... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Lights § 25.1381 Instrument lights. (a) The instrument lights must— (1) Provide sufficient illumination to make each instrument, switch and other...

  17. 14 CFR 25.1381 - Instrument lights.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Instrument lights. 25.1381 Section 25.1381... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Lights § 25.1381 Instrument lights. (a) The instrument lights must— (1) Provide sufficient illumination to make each instrument, switch and other...

  18. 14 CFR 25.1381 - Instrument lights.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Instrument lights. 25.1381 Section 25.1381... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Lights § 25.1381 Instrument lights. (a) The instrument lights must— (1) Provide sufficient illumination to make each instrument, switch and other...

  19. 14 CFR 25.1381 - Instrument lights.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Instrument lights. 25.1381 Section 25.1381... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Lights § 25.1381 Instrument lights. (a) The instrument lights must— (1) Provide sufficient illumination to make each instrument, switch and other...

  20. 14 CFR 25.1381 - Instrument lights.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Instrument lights. 25.1381 Section 25.1381... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Lights § 25.1381 Instrument lights. (a) The instrument lights must— (1) Provide sufficient illumination to make each instrument, switch and other...

  1. 14 CFR 29.1333 - Instrument systems.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Instrument systems. 29.1333 Section 29.1333... STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Equipment Instruments: Installation § 29.1333 Instrument systems. For systems that operate the required flight instruments which are located at each pilot's...

  2. 14 CFR 25.1333 - Instrument systems.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Instrument systems. 25.1333 Section 25.1333... STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Instruments: Installation § 25.1333 Instrument systems. For systems that operate the instruments required by § 25.1303(b) which are located at each...

  3. Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope

    PubMed Central

    Chiu, Philip WaiYan; Phee, Soo Jay; Bhandari, Pradeep; Sumiyama, Kazuki; Ohya, Tomohiko; Wong, Jennie; Poon, Carmen CY; Tajiri, Hisao; Nakajima, Kiyokazu; Ho, Khek Yu

    2015-01-01

    Background and study aims: One of the challenges in performing endoscopic submucosal dissection (ESD) is the lack of counter traction during submucosal dissection. MASTER (Master and Slave Transluminal Endoscopic Robot) was designed to allow performance of complex endoluminal procedures using two arms with excellent control. This study aimed to compare the performance of ESD between endoscopists and novices using MASTER. Methods: This is a prospective study comparing the differences in performing ESD using MASTER in an ex vivo porcine stomach model among individuals with or without experience in surgery and endoscopy. Multiple standardized lesions of 20 mm2 were pre-marked on an ex vivo porcine stomach. Each participant received basic training in controlling MASTER before the ESD procedure. The operative time and size of specimen obtained by each participant were noted. Results: Nine individuals (three ESD expert endoscopists, three ESD non-expert endoscopists, and three non-clinician novices) participated in the experiment. All participants completed the ESD procedure for en bloc resection of standardized lesions using EndoMASTER without perforation. The mean times (mean ± SD) taken by ESD expert endoscopists, ESD non-expert endoscopists, and novices to complete Robotic ESD were 122 ± 58 s, 203 ± 150 s, and 561 ± 496 s, respectively. There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242). When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085). Conclusions: There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER. The use of MASTER enabled the novice without endoscopy experience to complete the ESD

  4. Endoscopic treatment of prepatellar bursitis.

    PubMed

    Huang, Yu-Chih; Yeh, Wen-Lin

    2011-03-01

    Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.

  5. Anatomy of the ethmoid: CT, endoscopic, and macroscopic

    SciTech Connect

    Terrier, F.; Weber, W.; Ruefenacht, D.; Porcellini, B.

    1985-03-01

    The authors illustrate the normal CT anatomy of the ethmoid region and correlate it with the endoscopic and macroscopic anatomy to define landmarks that can be recognized on CT and during endoscopically controlled transnasal ethmoidectomy.

  6. Implementation of the Simple Endoscopic Activity Score in Crohn's Disease

    PubMed Central

    Koutroumpakis, Efstratios; Katsanos, Konstantinos H.

    2016-01-01

    Simple Endoscopic Score for Crohn's Disease (SES-CD) was developed as an attempt to simplify Crohn's Disease Endoscopic Index of Severity (CDEIS). Since it was constructed from CDEIS, SES-CD performs comparably but also carries similar limitations. Several studies have utilized SES-CD scoring to describe disease severity or response to therapy. Some of them used SES-CD score as a continuous variable while others utilized certain cutoff values to define severity grades. All SES-CD cutoff values reported in published clinical trials were empirically selected by experts. Although in most of the studies that used SEC-CD scoring to define disease severity, a score <3 reflected inactive disease, no study is using score 0 to predefine inactivity. Studies applying SES-CD to define response to treatment used score 0. There is no optimal SES-CD cut-off for endoscopic remission. The quantification of mucosal healing using SES-CD scoring has not been standardized yet. As the definition of mucosal healing by SES-CD is unset, the concept of deep remission is also still evolving. Serum and fecal biomarkers as well as new radiologic imaging techniques are complementary to SES-CD. Current practice as well as important changes in endoscopy should be taken into consideration when defining SES-CD cutoffs. The optimal timing of SES-CD scoring to assess mucosal healing is not defined yet. To conclude, SES-CD represents a valuable tool. However, a consensus agreement on its optimal use is required. PMID:27184635

  7. Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature

    PubMed Central

    Borejsza-Wysocki, Maciej; Bobkiewicz, Adam; Malinger, Stanisław; Świrkowicz, Józef; Hermann, Jacek; Drews, Michał; Banasiewicz, Tomasz

    2015-01-01

    Negative pressure wound therapy (NPWT) has become a standard in the treatment of chronic and difficult healing wounds. Negative pressure wound therapy is applied to the wound via a special vacuum-sealed sponge. Nowadays, the endoscopic vacuum-assisted wound closure system (E-VAC) has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding to standard endoscopic and/or surgical treatment procedures. Endoscopic vacuum-assisted wound closure system provides perfect wound drainage and closure of various kinds of defect and promotes tissue granulation. Our experience has shown that E-VAC may significantly improve the morbidity and mortality rate. Moreover, E-VAC may be useful in a multidisciplinary approach – from upper gastrointestinal to rectal surgery complications. On the other hand, major limitations of the E-VAC system are the necessity of repeated endoscopic interventions and constant presence of well-trained staff. Further, large-cohort studies need to be performed to establish the applicability and effectiveness of E-VAC before routine widespread use can be recommended. PMID:26240633

  8. Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature.

    PubMed

    Borejsza-Wysocki, Maciej; Szmyt, Krzysztof; Bobkiewicz, Adam; Malinger, Stanisław; Świrkowicz, Józef; Hermann, Jacek; Drews, Michał; Banasiewicz, Tomasz

    2015-07-01

    Negative pressure wound therapy (NPWT) has become a standard in the treatment of chronic and difficult healing wounds. Negative pressure wound therapy is applied to the wound via a special vacuum-sealed sponge. Nowadays, the endoscopic vacuum-assisted wound closure system (E-VAC) has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding to standard endoscopic and/or surgical treatment procedures. Endoscopic vacuum-assisted wound closure system provides perfect wound drainage and closure of various kinds of defect and promotes tissue granulation. Our experience has shown that E-VAC may significantly improve the morbidity and mortality rate. Moreover, E-VAC may be useful in a multidisciplinary approach - from upper gastrointestinal to rectal surgery complications. On the other hand, major limitations of the E-VAC system are the necessity of repeated endoscopic interventions and constant presence of well-trained staff. Further, large-cohort studies need to be performed to establish the applicability and effectiveness of E-VAC before routine widespread use can be recommended.

  9. Technical tips and troubleshooting of endoscopic biliary drainage for unresectable malignant hilar biliary obstruction.

    PubMed

    Kawakami, Hiroshi; Itoi, Takao; Kuwatani, Masaki; Kawakubo, Kazumichi; Kubota, Yoshimasa; Sakamoto, Naoya

    2015-04-01

    Unresectable malignant hilar biliary obstruction (MHBO) occurs in various diseases, such as cholangiocarcinoma, gallbladder carcinoma, hepatocellular carcinoma, pancreatic cancer, and lymph node metastasis of the hilum of the liver. The majority of patients with advanced MHBO are not candidates for surgical resection because of the tumor location in the hepatic hilum and adjacent areas, advanced tumor stage, or comorbidities. Therefore, these patients often have a poor prognosis in terms of survival and quality of life. Most of these patients will require non-surgical, palliative biliary drainage. To date, various biliary drainage techniques for unresectable MHBO (UMHBO) have been reported. Of these techniques, endoscopic biliary drainage is currently considered to be the most safe and minimally invasive procedure. However, endoscopic biliary drainage for UMHBO is still not standardized regarding the optimal stent, drainage area, stenting method, and reintervention technique. Recently, towards standardization of this technique for UMHBO, clinical research and trials including randomized controlled trials have been performed. In this article, we reviewed the most important issues regarding endoscopic biliary drainage for UMHBO, focusing on prospective studies. We also described in detail the techniques and future perspectives of endoscopic biliary drainage in patients with UMHBO.

  10. 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

  11. Future directions of duodenal endoscopic submucosal dissection

    PubMed Central

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-01-01

    Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure. PMID:25901218

  12. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

    Dimofte, Mihail-Gabriel; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel

    2014-01-01

    Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt. PMID:25489214

  13. Endoscopic management of pain in pancreatic cancer.

    PubMed

    Mekaroonkamol, Parit; Willingham, Field F; Chawla, Saurabh

    2015-01-31

    Pancreatic cancer is the fourth leading cause of cancer-related death in the United States and one of the leading causes of cancer mortality in the United States. Due to its aggressive behavior and lack of effective therapies, palliation plays a critical role in the management of the disease. Most patients with pancreatic cancer suffer from severe pain, which adversely predicts prognosis and significantly impacts the quality of life. Therefore pain management plays a central role in palliation. Non-steroidal anti-inflammatory drugs and opioid agents are often first line medications in pain management, but they do not target the underlying pathophysiology of pain and their use is limited by adverse effects and dependence. The proposed mechanisms of pain development in pancreatic cancer include neurogenic inflammation and ductal hypertension which may be targeted by endoscopic therapies. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and pancreatic duct stent placement are the two primary endoscopic modalities for palliative management in pancreatic cancer patients with refractory pain.  Other endoscopic treatments such as biliary stent placement and enteral stent placement for biliary and duodenal obstruction may also help palliate pain in addition to their role in decompression. This article reviews the existing evidence for these endoscopic interventions for pain management in pancreatic cancer.

  14. Endoscopic Management of Gastroesophageal Reflux Disease: Revisited

    PubMed Central

    Nabi, Zaheer; Reddy, D. Nageshwar

    2016-01-01

    Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD. PMID:27744659

  15. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    PubMed

    Watson, David I; Immanuel, Arul

    2010-04-01

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

  16. Endoscopic submucosal dissection for superficial Barrett’s esophageal cancer in the Japanese state and perspective

    PubMed Central

    Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Iishi, Hiroyasu

    2014-01-01

    The incidence of Barrett’s esophageal cancer is one of the most rapidly increasing among all cancers in the West, and it is also expected to increase in Japan. The optimal treatment for early Barrett’s esophageal cancer remains controversial. En bloc esophagectomy with regional lymph node dissection has been considered the standard therapy. Endoscopic therapies are currently being evaluated as alternatives to esophagectomy because they can provide the least postoperative morbidity and the best quality of life. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow for removal of visible lesions and histopathologic review of resected tissue, which help in diagnostic staging of the disease. EMR is limited with respect to resection size, and large lesions must be resected in several fragments. Piecemeal resection of lesions is associated with high local recurrence rates, probably because of minor remnants of neoplastic tissue being left in situ. ESD provides larger specimens than does EMR in patients with early Barrett’s neoplasia. This in turn allows for more precise histological analysis and higher en bloc and curative resection rates, potentially reducing the incidence of recurrence. Detailed endoscopic examination to determine the invasion depth and spread of Barrett’s esophageal cancer is essential before ESD. The initial inspection is usually conducted with white-light imaging followed by narrow-band imaging. The ESD procedure is similar to that for lesions in other parts of the gastrointestinal tract. However, the narrow space of the esophagogastric junction and contraction of the lower esophageal sphincter sometimes disturb the visual field and endoscopic control. Skilled endoscope handling, sometimes including retroflexion, is required during ESD for Barrett’s esophageal cancer. Previous reports have shown that ESD achieves en bloc resection in >80% of lesions. Although promising short-term results are reported, a long

  17. 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

  18. Residual bioburden in reprocessed side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP)

    PubMed Central

    Ubhayawardana, D. L. N. L.; Kottahachchi, J.; Weerasekera, M. M.; Wanigasooriya, I. W. M. P.; Fernando, S. S. N.; De Silva, M.

    2013-01-01

    Background and study aim: Worldwide some endoscopy units routinely continue to use manual reprocessing techniques for disinfection of side-view endoscopes. The aim of this study was to evaluate the outcome quality of manual reprocessing techniques for removal and inactivation of the bioburden from side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral endotherapy unit in Sri Lanka. Methods: 102 samples obtained from two different flexible side-view endoscopes (Olympus TJF Q 180V and Olympus TJF 160 R) were tested for microbial growth. Three samples were collected each time; one swab from the tip before and another after manual reprocessing. The third sample was collected by flushing the working channel with sterile normal saline after manual reprocessing. Microorganisms were identified by culturing the samples. Result:: After reprocessing, culture-positive rates were 20 % and 9 % for the samples obtained from the tip and the working channel of the side-view endoscopes, respectively. Klebsiella spp. and Candida spp. were found to be the commonest microorganisms in the samples from the tips and from the working channels, respectively, of the reprocessed side-view endoscopes. Conclusion: There is a high culture-positive rate after reprocessing of the side-view endoscopes using the manual reprocessing procedure, despite strict adherence to the protocol for reprocessing. PMID:26135507

  19. Esthesioneuroblastoma: Good Local Control of Disease by Endoscopic and Endoscope Assisted Approach. Is it Possible?

    PubMed

    Mohindra, Satyawati; Dhingra, Shruti; Mohindra, Sandeep; Kumar, Narendra; Gupta, Bhumika

    2014-09-01

    To present a short report on nine patients of esthesioneuroblastoma, managed endoscopically or endoscope assisted. To describe the technique and discuss the results at an average of 36.7 months of follow up. A retrospective study in a tertiary care centre. The present communication describes a series of 9 cases harbouring esthesioneuroblastoma, 6 managed endoscopically and 3 endoscope assisted between January 2005 and December 2009. All the nine patients remained free of disease at the primary site by endoscopic and radiological evaluation on an average of 36.7 months of follow up. One of the patients developed cutaneous and systemic metastasis for which she received chemotherapy and another one died during post-operative period due to unrelated causes. None of the patients showed recurrence or residual disease locally. Endoscopic and endoscope assisted approach provides a cosmetically better and surgically comparable outcome for local control of disease in early stages of esthesioneuroblastoma in expert hands without significant complications.

  20. 15/16 ips Operation of the Precision Instrument Company Model P15100 tape recorder to record the standard (30 Hz) NCER seismic data multiplex system

    USGS Publications Warehouse

    Eaton, Jerry P.

    1976-01-01

    In recent months the need has arisen to record special seismic networks consisting of a dozen or more standard NCER seismic systems telemetered to a central collection point on a reliable, portable, low-power tape recorder. Because of its simplicity and the ease with which it can be adapted for the purpose, the PI 5100 field recorder should be considered for such use. In the tests described here, a PI 5100 was speeded up to run at 15/16 inches per second (ips) and signals from the standard multiplex system test modulator bank were recorded on one tape track by means of a simple, improvised AM record amplifier. The results of these tests are extremely encouraging: the dynamic range of the system when played back on the Bell and Howell Model 3700 B reproduce machine, with subtractive compensation, is nearly as high as for the system employing the B&H 3700 B for recording. These notes indicate the principle employed to speed up the recorder, outline the circuit required to drive the tape heads in the AM record mode, and describe the tests carried out to evaluate the system's performance.

  1. Virtual Sensor Test Instrumentation

    NASA Technical Reports Server (NTRS)

    Wang, Roy

    2011-01-01

    Virtual Sensor Test Instrumentation is based on the concept of smart sensor technology for testing with intelligence needed to perform sell-diagnosis of health, and to participate in a hierarchy of health determination at sensor, process, and system levels. A virtual sensor test instrumentation consists of five elements: (1) a common sensor interface, (2) microprocessor, (3) wireless interface, (4) signal conditioning and ADC/DAC (analog-to-digital conversion/ digital-to-analog conversion), and (5) onboard EEPROM (electrically erasable programmable read-only memory) for metadata storage and executable software to create powerful, scalable, reconfigurable, and reliable embedded and distributed test instruments. In order to maximize the efficient data conversion through the smart sensor node, plug-and-play functionality is required to interface with traditional sensors to enhance their identity and capabilities for data processing and communications. Virtual sensor test instrumentation can be accessible wirelessly via a Network Capable Application Processor (NCAP) or a Smart Transducer Interlace Module (STIM) that may be managed under real-time rule engines for mission-critical applications. The transducer senses the physical quantity being measured and converts it into an electrical signal. The signal is fed to an A/D converter, and is ready for use by the processor to execute functional transformation based on the sensor characteristics stored in a Transducer Electronic Data Sheet (TEDS). Virtual sensor test instrumentation is built upon an open-system architecture with standardized protocol modules/stacks to interface with industry standards and commonly used software. One major benefit for deploying the virtual sensor test instrumentation is the ability, through a plug-and-play common interface, to convert raw sensor data in either analog or digital form, to an IEEE 1451 standard-based smart sensor, which has instructions to program sensors for a wide variety of

  2. Endoscopic Resection of the Tarsal Tunnel Ganglion.

    PubMed

    Lui, Tun Hing

    2016-10-01

    The tarsal tunnel ganglion is a cause of posterior tarsal tunnel syndrome. Open resection of the ganglion calls for release of the flexor retinaculum and dissection around the tibial neurovascular bundle. This can induce fibrosis around the tibial nerve. We report the technique of endoscopic resection of the tarsal tunnel ganglion. It is indicated for tarsal tunnel ganglia arising from the adjacent joints or tendon sheaths and compressing the tibial nerve from its deep side. It is contraindicated if there is other pathology of the tarsal tunnel that demands open surgery; if the ganglion compresses the tibial nerve from its superficial side, which calls for a different endoscopic approach using the ganglion portal; or if an intraneural ganglion of the tibial nerve is present. The purpose of this technical note is to describe a minimally invasive approach for endoscopic resection of the tarsal tunnel ganglion.

  3. [The endoscopic management of postoperative biliary fistulae].

    PubMed

    Uribarrena, R; Simón, M A; Sebastián, J J; Gomollón, F; Bajador, E; Botella, M T; Cabrera, T

    1994-10-01

    We report a series of 15 patients with a postoperative biliary fistula treated by endoscopic sphincterotomy. The exact location of the bile leak was revealed by ERCP in 13 cases (87%): cystic duct remnant in 6 (39%), intrahepatic biliary tree in 4 (26%), and main bile duct in 3 (20%). In all cases a distal obstacle (ie: retained stones, hydatid material) to bile flow was also found in ERCP. Treatment consisted of endoscopic sphincterotomy and subsequent removal of the distal obstacle, and could be completed in 13 (87%) cases. In our experience the treatment of postoperative biliary fistula with a distal obstruction bile flow by endoscopic sphincterotomy is a safe and effective procedure, and should be recommended as the first option in those patients.

  4. Development of 3D holographic endoscope

    NASA Astrophysics Data System (ADS)

    Özcan, Meriç; Önal Tayyar, Duygu

    2016-03-01

    Here we present the development of a 3D holographic endoscope with an interferometer built around a commercial rigid endoscope. We consider recording the holograms with coherent and incoherent light separately without compromising the white light imaging capacity of the endoscope. In coherent light based recording, reference wave required for the hologram is obtained in two different ways. First, as in the classical holography, splitting the laser beam before the object illumination, and secondly creating the reference beam from the object beam itself. This second method does not require path-length matching between the object wave and the reference wave, and it allows the usage of short coherence length light sources. For incoherent light based holographic recordings various interferometric configurations are considered. Experimental results on both illumination conditions are presented.

  5. The Roles of Endoscope in Aneurysmal Surgery

    PubMed Central

    YOSHIOKA, Hideyuki; KINOUCHI, Hiroyuki

    The neuroendoscope, with its higher magnification, better observation, and additional illumination, can provide us information that may not be available with the microscope in aneurysm surgery. Furthermore, recent advancement of the holding systems for the endoscope allows surgeons to perform microsurgical manipulation using both hands under the simultaneous endoscopic and microscopic monitoring. With this procedure, surgeons can inspect hidden structures, dissect perforators at the back of the aneurysm, identify important vessel segments without retraction of the aneurysm or arteries, and check for completion of clipping. In addition, we have recently applied endoscopic indocyanine green video angiography to aneurysm surgery. This newly developed technique can offer real-time assessment of the blood flow of vasculatures in the dead angles of the microscope, and will reduce operative morbidity related to vascular occlusion, improve the durability of aneurysm surgery by reducing incomplete clipping, and thus promote the outcome of aneurysm surgery. PMID:26041623

  6. Endoscopic anatomy of the pediatric middle ear.

    PubMed

    Isaacson, Glenn

    2014-01-01

    Traditionally, otologists have aimed to produce a clean, dry, safe ear with the best possible hearing result. More recently, "less invasively" has been added to this list of goals. The development of small-diameter, high-quality rigid endoscopes and high-definition video systems has made totally endoscopic, transcanal surgery a reality in adult otology and a possibility in pediatric otology. This article reviews the anatomy of the pediatric middle ear and its surrounding airspaces and structures based on the work of dozens of researchers over the past 50 years. It will focus on the developmental changes in ear anatomy from birth through the first decade, when structure and function change most rapidly. Understanding the limits and possibilities afforded by new endoscopic technologies, the pediatric otologist can strive for results matching or exceeding those achieved by more invasive surgical approaches.

  7. HARMONI instrument control electronics

    NASA Astrophysics Data System (ADS)

    Gigante, José V.; Rodríguez Ramos, Luis F.; Zins, Gerard; Schnetler, Hermine; Pecontal, Arlette; Herreros, José Miguel; Clarke, Fraser; Bryson, Ian; Thatte, Niranjan

    2014-07-01

    HARMONI is an integral field spectrograph working at visible and near-infrared wavelengths over a range of spatial scales from ground layer corrected to fully diffraction-limited. The instrument has been chosen to be part of the first-light complement at the European Extremely Large Telescope (E-ELT). This paper describes the instrument control electronics to be developed at IAC. The large size of the HARMONI instrument, its cryogenic operation, and the fact that it must operate with enhanced reliability is a challenge from the point of view of the control electronics design. The present paper describes a design proposal based on the current instrument requirements and intended to be fully compliant with the ESO E-ELT standards, as well as with the European EMC and safety standards. The modularity of the design and the use of COTS standard hardware will benefit the project in several aspects, as reduced costs, shorter schedule by the use of commercially available components, and improved quality by the use of well proven solutions.

  8. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients.

    PubMed

    Chen, Hsin-Chuan; Huang, Teng-Le; Chen, Yen-Jen; Tsou, Hsi-Kai; Lin, Wei-Ching; Hung, Chih-Hung; Tsai, Chun-Hao; Hsu, Horng-Chaung; Chen, Hsien-Te

    2015-01-01

    This study evaluates the safety and effectiveness of computed tomography- (CT-) assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.

  9. The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: A 2014 perspective

    PubMed Central

    Lobo, Bjorn; Heng, Annie; Barkhoudarian, Garni; Griffiths, Chester F.; Kelly, Daniel F.

    2015-01-01

    Background: The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery. Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through the transsphenoidal microscopic approach. Methods: This review article looks at many of the articles from 2011 to 2014 citing endonasal endoscopic surgery with regard to approaches and reconstructive techniques, pathologies treated and outcomes, and new technologies under consideration. Results: Refinements in approach and closure techniques have reduced the risk of cerebrospinal fluid leak and infection. This has allowed surgeons to more aggressively treat a variety of pathologies. Four main pathologies with outcomes after treatment were identified for discussion: pituitary adenomas, craniopharyngiomas, anterior skull base meningiomas, and chordomas. Within all four of these tumor types, articles have demonstrated the efficacy, and in certain cases, the advantages over more traditional microscope-based techniques, of the endonasal endoscopic technique. Conclusions: The endonasal endoscopic approach is a necessary tool in the modern skull base surgeon's armamentarium. Its efficacy for treatment of a wide variety of skull base pathologies has been repeatedly demonstrated. In the experienced surgeon's hands, this technique may offer the advantage of greater tumor removal with reduced overall complications over traditional craniotomies for select tumor pathologies centered near the midline skull base. PMID:26015870

  10. Research Instruments

    NASA Technical Reports Server (NTRS)

    1992-01-01

    The GENETI-SCANNER, newest product of Perceptive Scientific Instruments, Inc. (PSI), rapidly scans slides, locates, digitizes, measures and classifies specific objects and events in research and diagnostic applications. Founded by former NASA employees, PSI's primary product line is based on NASA image processing technology. The instruments karyotype - a process employed in analysis and classification of chromosomes - using a video camera mounted on a microscope. Images are digitized, enabling chromosome image enhancement. The system enables karyotyping to be done significantly faster, increasing productivity and lowering costs. Product is no longer being manufactured.

  11. Geoscience instrumentation

    NASA Technical Reports Server (NTRS)

    Wolff, E. A. (Editor); Mercanti, E. P.

    1974-01-01

    Geoscience instrumentation systems are considered along with questions of geoscience environment, signal processing, data processing, and design problems. Instrument platforms are examined, taking into account ground platforms, airborne platforms, ocean platforms, and space platforms. In situ and laboratory sensors described include acoustic wave sensors, age sensors, atmospheric constituent sensors, biological sensors, cloud particle sensors, electric field sensors, electromagnetic field sensors, precision geodetic sensors, gravity sensors, ground constituent sensors, horizon sensors, humidity sensors, ion and electron sensors, magnetic field sensors, tide sensors, and wind sensors. Remote sensors are discussed, giving attention to sensing techniques, acoustic echo-sounders, gamma ray sensors, optical sensors, radar sensors, and microwave radiometric sensors.

  12. Instrumented SSH

    SciTech Connect

    Campbell, Scott; Campbell, Scott

    2009-05-27

    NERSC recently undertook a project to access and analyze Secure Shell (SSH) related data. This includes authentication data such as user names and key fingerprints, interactive session data such as keystrokes and responses, and information about noninteractive sessions such as commands executed and files transferred. Historically, this data has been inaccessible with traditional network monitoring techniques, but with a modification to the SSH daemon, this data can be passed directly to intrusion detection systems for analysis. The instrumented version of SSH is now running on all NERSC production systems. This paper describes the project, details about how SSH was instrumented, and the initial results of putting this in production.

  13. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification

    NASA Astrophysics Data System (ADS)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas

    2015-03-01

    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

  14. Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

    PubMed Central

    Kamal, Saurabh; Ali, Mohammad Javed; Nair, Akshay Gopinathan

    2016-01-01

    Aim: The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR). Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow-up period. Conclusions: Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform

  15. Endoscopic evidence of ventricular and cisternal inflammatory changes after intraoperative cysticercal rupture during endoscopic third-ventriculostomy removal.

    PubMed

    Jiménez-Vázquez, Oscar H; Nagore, Norma

    2013-02-01

    Two patients who suffered recurrent hydrocephalus after cysticercal removal by means of endoscopic transventricular (ETV) approach are presented. Severe inflammatory lesions within the ventricular system and basal cisterns, with a patent third-ventriculostomy were demonstrated during a second endoscopic observation. Mandatory shunting with prolonged steroid therapy may be indicated after intraoperative cysticercal rupture after ETV removal, as showed by sequential endoscopic observations.

  16. Use of water jet instruments in gastrointestinal endoscopy

    PubMed Central

    Nakano, Toru; Sato, Chiaki; Sakurai, Tadashi; Kamei, Takashi; Nakagawa, Atsuhiro; Ohuchi, Noriaki

    2016-01-01

    In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects. PMID:26862362

  17. Use of water jet instruments in gastrointestinal endoscopy.

    PubMed

    Nakano, Toru; Sato, Chiaki; Sakurai, Tadashi; Kamei, Takashi; Nakagawa, Atsuhiro; Ohuchi, Noriaki

    2016-02-10

    In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects.

  18. Recent Update of Gastrointestinal Endoscope Reprocessing

    PubMed Central

    Hong, Kyong Hee

    2013-01-01

    As infection-related issues have become one of the most important concerns in endoscopy centers, proper reprocessing of endoscopes has attracted great interest. Compliance with established guidelines for reprocessing is critical to prevent pathogen transmission. However, hospital compliance with guidelines has not been satisfactory. To increase compliance, efforts have focused on developing new and more innovative disinfectants and an automated endoscope reprocessor. Reprocessing must be performed by appropriately trained personnel and regular monitoring of reprocessing is essential for quality assurance to improve compliance. PMID:23767038

  19. Current Status of Interventional Endoscopic Ultrasound.

    PubMed

    Ryozawa, Shomei; Fujita, Naotaka; Irisawa, Atsushi; Hirooka, Yoshiki; Mine, Tetsuya

    2017-03-20

    Endoscopic ultrasound (EUS) is being used increasingly in the management of pancreatic fluid collection, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of the gallbladder, and other conditions. The role of interventional EUS is rapidly expanding and new interventions are continuously emerging. The development of devices could be a major breakthrough in the field of interventional EUS. New devices would enable the expansion of its role even further and prompt its widespread use in clinical practice. This review focuses on the current status of interventional EUS, especially highlighting the topics that are drawing endoscopists' interest at present. This article is protected by copyright. All rights reserved.

  20. Endoscopic management of acute peptic ulcer bleeding.

    PubMed

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.

  1. Endoscopic Surgery for Arterial Occlusive Disease.

    PubMed

    Ahn, Samuel S; Wieslander, Cecilia K

    2000-10-01

    Endoscopic surgery is not a recent development. In fact, the application of the Edison light bulb to the cystoscope in 1883 was followed by widespread use of endoscopy. In 1910, Jacobeaus proposed the diagnostic use of the cystoscope for investigation of serous cavities, and in 1922, he reported lysis of pleural adhesions to promote artificial pneumothorax in 40 patients with pulmonary tuberculosis. For the next 30 years, the thoracoscope was widely used for pneumolysis in tuberculosis patients, but its use waned considerably after the development of effective antibiotic treatment for tuberculosis. With the advent of laparoscopy, endoscopy has become popular again and here we review the application of endoscopic techniques in cardiovascular surgery.

  2. Endoscopic surgery for arterial occlusive disease.

    PubMed

    Ahn, S S; Wieslander, C K

    2000-01-01

    Endoscopic surgery is not a recent development. In fact, the application of the Edison light bulb to the cystoscope in 1883 was followed by widespread use of endoscopy. In 1910, Jacobeaus proposed the diagnostic use of the cystoscope for investigation of serous cavities, and in 1922, he reported lysis of pleural adhesions to promote artificial pneumothorax in 40 patients with pulmonary tuberculosis. For the next 30 years, the thoracoscope was widely used for pneumolysis in tuberculosis patients, but its use waned considerably after the development of effective antibiotic treatment for tuberculosis. With the advent of laparoscopy, endoscopy has become popular again and here we review the application of endoscopic techniques in cardiovascular surgery.

  3. Transoral endoscopic thyroidectomy via the trivestibular route

    PubMed Central

    Kim, Mi-Ra; Kim, Do Hun; Lee, Dong Kun

    2016-01-01

    We recently experienced a case of transoral endoscopic thyroidectomy via the trivestibular approach. We identified and preserved all neighboring critical structures during surgery. The patient was discharged on postoperative day 3. There were no complications in thyroid function, vocal cord function, or lower lip sense. Transoral endoscopic thyroidectomy via a trivestibular approach provides a short and direct route to the thyroid and an adequate workspace without a skin incision. Therefore, it is worthwhile to develop and refine the surgical techniques of this promising new surgical approach. PMID:27847801

  4. Endoscopic palliation of malignant biliary strictures

    PubMed Central

    Salgado, Sanjay M; Gaidhane, Monica; Kahaleh, Michel

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies. PMID:26989459

  5. Complications in endoscopic intranasal ethmoidectomy: an update.

    PubMed

    Stankiewicz, J A

    1989-07-01

    A previous publication by this author discussing complications of endoscopic intranasal ethmoidectomy indicated an overall complication rate of 29% in 90 patients (17% in 150 ethmoidectomies). Compared to published complications rates for traditional intranasal ethmoidectomy (2.7% to 3.7%), 17% is alarming and of concern. The complication results in 300 ethmoidectomies performed on 180 patients are presented. The overall complication rate was 9.3%. Only two further complications have occurred since the first reported series: a cerebrospinal fluid leak and one case of subcutaneous emphysema. Methods and techniques that have led to the reduction of complications are briefly discussed. Endoscopic ethmoidectomy is a valid, safe procedure in experienced hands.

  6. Aeronautic Instruments. Section II : Altitude Instruments

    NASA Technical Reports Server (NTRS)

    Mears, A H; Henrickson, H B; Brombacher, W G

    1923-01-01

    This report is Section two of a series of reports on aeronautic instruments (Technical Report nos. 125 to 132, inclusive). This section discusses briefly barometric altitude determinations, and describes in detail the principal types of altimeters and barographs used in aeronautics during the recent war. This is followed by a discussion of performance requirements for such instruments and an account of the methods of testing developed by the Bureau of Standards. The report concludes with a brief account of the results of recent investigations. For accurate measurements of altitude, reference must also be made to thermometer readings of atmospheric temperature, since the altitude is not fixed by atmospheric pressure alone. This matter is discussed in connection with barometric altitude determination.

  7. Reduction of persistent air leak with endoscopic valve implants.

    PubMed

    Toma, Tudor P; Kon, Onn Min; Oldfield, William; Sanefuji, Reina; Griffiths, Mark; Wells, Frank; Sivasothy, Siva; Dusmet, Michael; Geddes, Duncan M; Polkey, Michael I

    2007-09-01

    The standard management of air leaks due to persistent bronchopleural fistula involves chest drainage and occasionally pleurodesis, with intractable cases requiring surgical decortication or surgical repair. However, some of these patients may be at high risk for surgery, particularly if they have already had thoracic surgery or have other medical problems; for this group there is a need for less invasive methods of stopping or reducing air leaks. Emphasys endobronchial valves (EBV) are occlusive devices designed primarily for endoscopic lung volume reduction in emphysema. Because the device is a one-way inspiratory airway blocker, it is possible that it could be used in controlling persistent air leaks while maintaining the drainage of secretions. Two cases are reported of persistent air leaks that were managed by endoscopic occlusion with EBV. In one case complete stoppage of the air leak was achieved with immediate clinical benefits. The second patient died 5 days after treatment from additional complications apparently not related to the procedure. Endobronchial blockage may be a useful salvage procedure for patients with persistent air leak for whom there is no other treatment available.

  8. [A current perspective of natural orifices transluminal endoscopic surgery (NOTES)].

    PubMed

    Montalvo-Javé, Eduardo E; Crisanto-Campos, Braulio A; Tapia-Jurado, Jesús; Montes de Oca-Duran, Edgar; Ortega-León, Luis Humberto; Alcántara-Medina, Stefany; Mendoza-Barrera, German Eduardo; Athie Gutierrez, César

    2016-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) represents an alternative in surgical approach, combined with the progress and experience gained from conventional and endoscopic surgery. Bibliographic research in PubMed, Medline database from 2000 to 2015 and analysis of the literature reviews found. NOTES provides vision and natural orifice approach, it has optimized operating times as well as reduced complications and better cosmetic results. Small series of patients have been reported, but there is not a valid clinical multicenter study by evidence-based medicine. NOTES can help to improve the standard operations, complemented with laparoscopic surgery rather than replace it and thus develop tools for the resolution of various diseases that require surgical treatment. This option in current surgery is safe and presents satisfactory results in the reported cases. The development of this new approach of performing surgical procedures requires further study and development of new technology in order to increase the accessibility of these procedures and represent in a practical and sustained way, a better option to approach surgical pathology.

  9. Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection

    PubMed Central

    Shi, Ke-Da; Ji, Feng

    2017-01-01

    Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasive and has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient’s quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture. PMID:28246466

  10. Flexible waveguide enabled single-channel terahertz endoscopic system

    NASA Astrophysics Data System (ADS)

    Doradla, Pallavi; Alavi, Karim; Joseph, Cecil S.; Giles, Robert H.

    2015-03-01

    Colorectal cancer is the third most commonly diagnosed cancer in the world. The current standard of care for colorectal cancer is the conventional colonoscopy, which relies exclusively on the Physician's experience. Continuous wave terahertz (THz) imaging has the potential to offer a safe, noninvasive medical imaging modality for detecting cancers. The current study demonstrates the design and development of a prototype terahertz endoscopic system based on flexible metal-coated terahertz waveguides. A CO2 pumped Far-Infrared molecular gas laser operating at 584 GHz frequency was used for illuminating the tissue, while the reflected signals were detected using liquid Helium cooled silicon bolometer. The continuous-wave terahertz imaging system utilizes a single waveguide channel to transmit the radiation and collect the back reflected intrinsic terahertz signal from the sample and is capable of operation in both transmission and reflection modalities. The two dimensional reflectance images obtained using a prototype terahertz endoscopic system showed intrinsic contrast between cancerous and normal regions of the colorectal tissue, thereby demonstrating the potential impact of terahertz imaging for in vivo cancer detection.

  11. Endoscopic management of combined malignant biliary and gastric outlet obstruction.

    PubMed

    Nakai, Yousuke; Hamada, Tsuyoshi; Isayama, Hiroyuki; Itoi, Takao; Koike, Kazuhiko

    2017-01-01

    Patients with periampullary cancer or gastric cancer often develop malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), and combined MBO and GOO is not rare in these patients. Combined MBO and GOO is classified by its location and sequence, and treatment strategy can be affected by this classification. Historically, palliative surgery, hepaticojejunostomy and gastrojejunostomy were carried out, but the current standard treatment is combined transpapillary stent and duodenal stent placement. Although a high technical success rate is reported, the procedure can be technically difficult and duodenobiliary reflux with subsequent cholangitis is common after double stenting. Recent development of endoscopic ultrasound (EUS)-guided procedures enables the management of MBO as well as GOO under EUS guidance. EUS-guided biliary drainage is now increasingly reported as an alternative to percutaneous transhepatic biliary drainage in failed endoscopic retrograde cholangiopancreatography (ERCP), and GOO is one of the major reasons for failed ERCP. In addition to EUS-guided biliary drainage, the feasibility of EUS-guided double-balloon-occluded gastrojejunostomy bypass for MBO was recently reported, and EUS-guided double stenting can potentially become the treatment of choice in the future. However, as each procedure has its advantages and disadvantages, treatment strategy should be selected based on the type of obstruction and the prognosis and performance status of the patient.

  12. [Transabdominal ultrasound examination, contrast-enhanced ultrasound examination and endoscopic ultrasound scanning in the determination of the aetiology and the degree of severity in acute pancreatitis].

    PubMed

    Møller Andersen, Anders; Malmstrøm, Marie Louise; Novovic, Srdan; Jørgensen, Lars Nannestad; Nissen, Flemming Helge; Hansen, Mark Berner

    2013-05-20

    A transabdominal ultrasound examination is part of the standard work-up for patients with acute pancreatitis. Transabdominal ultrasound examination displays a high sensitivity for the detection of gallbladder stones. With the recent introduction of contrast enhancement in ultrasound it has become possible to determine the severity of acute pancreatitis. Endoscopic ultrasound has shown a high sensitivity in the diagnosis of stones in the common bile duct and is an important peroperative surgical tool in endoscopic transgastric necrosectomi as well.

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

    SciTech Connect

    Weersink, R. A.; Qiu, J.; Hope, A. J.; Daly, M. J.; Cho, B. C. J.; DaCosta, R. S.; Sharpe, M. B.; Breen, S. L.; Chan, H.; Jaffray, D. A.

    2011-12-15

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

  14. Weather Instruments.

    ERIC Educational Resources Information Center

    Brantley, L. Reed, Sr.; Demanche, Edna L.; Klemm, E. Barbara; Kyselka, Will; Phillips, Edwin A.; Pottenger, Francis M.; Yamamoto, Karen N.; Young, Donald B.

    This booklet presents some activities to measure various weather phenomena. Directions for constructing a weather station are included. Instruments including rain gauges, thermometers, wind vanes, wind speed devices, humidity devices, barometers, atmospheric observations, a dustfall jar, sticky-tape can, detection of gases in the air, and pH of…

  15. Hepatic applications of endoscopic ultrasound: Current status and future directions.

    PubMed

    Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S; Menachery, John; Vilmann, Peter

    2015-11-28

    The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various studies have established its role in gastrointestinal malignancies and pancreatic conditions, its potential in the field of hepatic lesions still remains vastly untapped. In this paper the authors attempt to review important and landmark trials, case series and case studies involving hepatic applications of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role.

  16. Role of Malabsorptive Endoscopic Procedures in Obesity Treatment

    PubMed Central

    Park, Jae Myung

    2017-01-01

    The incidence of obesity is increasing, and more definitive treatment modalities are needed. Endoluminal procedures, including restrictive endoscopic procedures, endoscopic gastroplasty, and malabsorptive endoscopic procedures, can reduce weight in obese patients and control obesity-related comorbidities. Malabsorptive endoscopic interventions also offer the potential for an ambulatory procedure that may be safer and more cost-effective compared with laparoscopic surgery. Malabsorptive endoscopic intervention can induce weight reduction and improve obesity-related metabolic parameters, despite complications such as device migration, obstruction, and abdominal pain. Improvement in technique will follow the development of new devices. PMID:28147470

  17. Hepatic applications of endoscopic ultrasound: Current status and future directions

    PubMed Central

    Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S; Menachery, John; Vilmann, Peter

    2015-01-01

    The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various studies have established its role in gastrointestinal malignancies and pancreatic conditions, its potential in the field of hepatic lesions still remains vastly untapped. In this paper the authors attempt to review important and landmark trials, case series and case studies involving hepatic applications of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role. PMID:26640331

  18. Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel.

  19. Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis: Can endoscopic evaluation predict outcomes?

    PubMed Central

    Mohammed, Noor; Subramanian, Venkataraman

    2016-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel condition characterised by a relapsing and remitting course. Symptom control has been the traditional mainstay of medical treatment. It is well known that histological inflammatory activity persists despite adequate symptom control and absence of endoscopic inflammation. Current evidence suggests that presence of histological inflammation poses a greater risk of disease relapse and subsequent colorectal cancer risk. New endoscopic technologies hold promise for developing endoscopic markers of mucosal inflammation. Achieving endoscopic and histological remission appears be the future aim of medical treatments for UC. This review article aims to evaluate the use of endoscopy as a tool in assessment of mucosal inflammation UC and its correlation with disease outcomes. PMID:27895420

  20. A New Irrigation System (Endosplash) for a Rigid Endoscope in Trans-sphenoidal Endoscopic Surgery

    PubMed Central

    KURODA, Rintarou; NAKAJIMA, Takeshi; YAMAGUCHI, Takashi; WATANABE, Eiju

    2016-01-01

    Obstruction of the visual field by blood is a major hindrance during endonasal endoscopic surgery, and a rapid and effective method for cleaning the lens is needed. We developed a new lens-cleaning system that does not employ a sheath or an irrigation-suction system. It is a 20-mm long cylinder with side holes that is attached to the barrel of the endoscope and is connected to a syringe containing saline. When the syringe is pressed, saline flows down to the tip along the barrel and washes the lens without requiring a sheath. We report the use of the system in six cases of endonasal endoscopic surgery. The lens was wiped significantly less often than during similar surgery performed without the use of this system. The Endosplash is simple and enables the surgeon to clean the lens with a single press of a syringe, thereby greatly enhancing the efficacy of endoscopic surgery. PMID:27063147

  1. RHIC instrumentation

    NASA Astrophysics Data System (ADS)

    Shea, T. J.; Witkover, R. L.

    1998-12-01

    The Relativistic Heavy Ion Collider (RHIC) consists of two 3.8 km circumference rings utilizing 396 superconducting dipoles and 492 superconducting quadrupoles. Each ring will accelerate approximately 60 bunches of 1011 protons to 250 GeV, or 109 fully stripped gold ions to 100 GeV/nucleon. Commissioning is scheduled for early 1999 with detectors for some of the 6 intersection regions scheduled for initial operation later in the year. The injection line instrumentation includes: 52 beam position monitor (BPM) channels, 56 beam loss monitor (BLM) channels, 5 fast integrating current transformers and 12 video beam profile monitors. The collider ring instrumentation includes: 667 BPM channels, 400 BLM channels, wall current monitors, DC current transformers, ionization profile monitors (IPMs), transverse feedback systems, and resonant Schottky monitors. The use of superconducting magnets affected the beam instrumentation design. The BPM electrodes must function in a cryogenic environment and the BLM system must prevent magnet quenches from either fast or slow losses with widely different rates. RHIC is the first superconducting accelerator to cross transition, requiring close monitoring of beam parameters at this time. High space-charge due to the fully stripped gold ions required the IPM to collect magnetically guided electrons rather than the conventional ions. Since polarized beams will also be accelerated in RHIC, additional constraints were put on the instrumentation. The orbit must be well controlled to minimize depolarizing resonance strengths. Also, the position monitors must accommodate large orbit displacements within the Siberian snakes and spin rotators. The design of the instrumentation will be presented along with results obtained during bench tests, the injection line commissioning, and the first sextant test.

  2. RHIC instrumentation

    SciTech Connect

    Shea, T. J.; Witkover, R. L.

    1998-12-10

    The Relativistic Heavy Ion Collider (RHIC) consists of two 3.8 km circumference rings utilizing 396 superconducting dipoles and 492 superconducting quadrupoles. Each ring will accelerate approximately 60 bunches of 10{sup 11} protons to 250 GeV, or 10{sup 9} fully stripped gold ions to 100 GeV/nucleon. Commissioning is scheduled for early 1999 with detectors for some of the 6 intersection regions scheduled for initial operation later in the year. The injection line instrumentation includes: 52 beam position monitor (BPM) channels, 56 beam loss monitor (BLM) channels, 5 fast integrating current transformers and 12 video beam profile monitors. The collider ring instrumentation includes: 667 BPM channels, 400 BLM channels, wall current monitors, DC current transformers, ionization profile monitors (IPMs), transverse feedback systems, and resonant Schottky monitors. The use of superconducting magnets affected the beam instrumentation design. The BPM electrodes must function in a cryogenic environment and the BLM system must prevent magnet quenches from either fast or slow losses with widely different rates. RHIC is the first superconducting accelerator to cross transition, requiring close monitoring of beam parameters at this time. High space-charge due to the fully stripped gold ions required the IPM to collect magnetically guided electrons rather than the conventional ions. Since polarized beams will also be accelerated in RHIC, additional constraints were put on the instrumentation. The orbit must be well controlled to minimize depolarizing resonance strengths. Also, the position monitors must accommodate large orbit displacements within the Siberian snakes and spin rotators. The design of the instrumentation will be presented along with results obtained during bench tests, the injection line commissioning, and the first sextant test.

  3. RHIC instrumentation

    SciTech Connect

    Shea, T.J.; Witkover, R.L.

    1998-12-01

    The Relativistic Heavy Ion Collider (RHIC) consists of two 3.8 km circumference rings utilizing 396 superconducting dipoles and 492 superconducting quadrupoles. Each ring will accelerate approximately 60 bunches of 10{sup 11} protons to 250 GeV, or 10{sup 9} fully stripped gold ions to 100 GeV/nucleon. Commissioning is scheduled for early 1999 with detectors for some of the 6 intersection regions scheduled for initial operation later in the year. The injection line instrumentation includes: 52 beam position monitor (BPM) channels, 56 beam loss monitor (BLM) channels, 5 fast integrating current transformers and 12 video beam profile monitors. The collider ring instrumentation includes: 667 BPM channels, 400 BLM channels, wall current monitors, DC current transformers, ionization profile monitors (IPMs), transverse feedback systems, and resonant Schottky monitors. The use of superconducting magnets affected the beam instrumentation design. The BPM electrodes must function in a cryogenic environment and the BLM system must prevent magnet quenches from either fast or slow losses with widely different rates. RHIC is the first superconducting accelerator to cross transition, requiring close monitoring of beam parameters at this time. High space-charge due to the fully stripped gold ions required the IPM to collect magnetically guided electrons rather than the conventional ions. Since polarized beams will also be accelerated in RHIC, additional constraints were put on the instrumentation. The orbit must be well controlled to minimize depolarizing resonance strengths. Also, the position monitors must accommodate large orbit displacements within the Siberian snakes and spin rotators. The design of the instrumentation will be presented along with results obtained during bench tests, the injection line commissioning, and the first sextant test. {copyright} {ital 1998 American Institute of Physics.}

  4. Magnetic instrumentation and other applications of magnets in NOTES

    PubMed Central

    Grymek, Szymon; Wojanowska, Magdalena; Łubniewski, Marek; Makarewicz, Wojciech; Dobrowolski, Sebastian; Łachiński, Andrzej J.; Śledziński, Zbigniew

    2011-01-01

    Modern surgery is developing towards a minimally invasive approach. To minimize the trauma the number of ports is either limited as in single incision laparoscopic procedures or ports are introduced through natural orifices as in natural orifice translumenal endoscopic surgery (NOTES). To provide surgeons with appropriate instrumentation novel technologies are employed involving magnets. This article summarizes the theoretical background, technology and currently developed magnetic instrumentation for NOTES, laparoscopic surgery and endoscopy. Moreover, current limitations and future goals are addressed to outline the prospects for use of magnetic instrumentation in the surgery of tomorrow. PMID:23256005

  5. Wide-field near-infrared fluorescence endoscope for real-time in vivo imaging

    NASA Astrophysics Data System (ADS)

    Liu, Zhongyao; Miller, Sharon J.; Joshi, Bishnu P.; Wang, Thomas D.

    2012-02-01

    A diode-pumped solid state laser is used to deliver excitation at λex = 671 nm. The beam is expanded by a pair of relay lenses (f1 = 30 and f2 = 50 mm) to 3 mm diameter, filling the aperture of a fluid light cable that is coupled to a Hopkins II rigid endoscope. Near-infrared fluorescence images are collected by the endoscope and transmitted by another set of relay lenses onto a CCD detector that has dimensions of 8.7x6.9 mm2 (1388x1040 pixels). A zoom lens system (F#1.6-16 aperture) with a tunable focal length (20-100 mm) magnifies the image to fill the dimensions of the CCD. A band pass filter allows fluorescence with spectral range λem = 696 to 736 nm to be collected. The system achieves a resolution of 9.8 μm and field-of-view of 3.6 mm at a distance of 2.5 mm between the distal end of the endoscope and the tissue. Images are collected at a rate of 10 frames per second. A filter wheel is incorporated into the handle of the instrument housing to rapidly switch between reflectance and fluorescence images. Cy5.5-labeled peptides were delivered through the 1 mm diameter instrument channel in the endoscope. Near-infrared fluorescence images demonstrated specific peptide binding to spontaneous adenomas that developed beginning at 2 months of age in a genetically-engineered mouse with mutation of one allele in the APC gene. This integrated methodology represents a powerful tool that can achieve real time detection of disease in the colon and other hollow organs.

  6. Technology for Psychomotor Skills Testing in Endoscopic Surgery.

    PubMed

    Hanna; Drew; Cuschieri

    1997-06-01

    Psychomotor research is essential for aptitude-based selection of surgical trainees and sound surgical practice. Two microprocessor-controlled psychomotor testers were developed to evaluate psychomotor skills related to endoscopic surgery. Dundee Endoscopic Psychomotor Tester (DEPT) measures single-handed performance in an endoscopic environment and therefore it can be used to evaluate differing abilities between the right and left hand. Advanced Dundee endoscopic Psychomotor Tester (ADEPT) measures two-handed performance, and consequently it can be used to assess coordinated bimanual endoscopic manipulations. Psychomotor testers provide real-time objective scoring systems that have several aspects of face validity to real endoscopic environment. Studies on medical students have confirmed that objective evaluation of task performance in an endoscopic field is feasible and have documented differences in psychomotor abilities between subjects.

  7. Automatic feature detection for 3D surface reconstruction from HDTV endoscopic videos

    NASA Astrophysics Data System (ADS)

    Groch, Anja; Baumhauer, Matthias; Meinzer, Hans-Peter; Maier-Hein, Lena

    2010-02-01

    A growing number of applications in the field of computer-assisted laparoscopic interventions depend on accurate and fast 3D surface acquisition. The most commonly applied methods for 3D reconstruction of organ surfaces from 2D endoscopic images involve establishment of correspondences in image pairs to allow for computation of 3D point coordinates via triangulation. The popular feature-based approach for correspondence search applies a feature descriptor to compute high-dimensional feature vectors describing the characteristics of selected image points. Correspondences are established between image points with similar feature vectors. In a previous study, the performance of a large set of state-of-the art descriptors for the use in minimally invasive surgery was assessed. However, standard Phase Alternating Line (PAL) endoscopic images were utilized for this purpose. In this paper, we apply some of the best performing feature descriptors to in-vivo PAL endoscopic images as well as to High Definition Television (HDTV) endoscopic images of the same scene and show that the quality of the correspondences can be increased significantly when using high resolution images.

  8. Have we Comprehensively Evaluated the Effectiveness of Endoscopic Screening for Gastric Cancer?

    PubMed

    Hamashima, Chisato

    2015-01-01

    Endoscopy has been increasingly used in clinical practice and as a standardized examination procedure for gastrointestinal diseases. However, only a few studies on endoscopic screening for evaluating mortality reduction from gastric cancer have been carried out. Even if a high detection rate is obtained in clinical practice, such a rate cannot be directly accepted as evidence providing the effectiveness of cancer screening. Endoscopic screening for gastric cancer is not an exception of possibility to detect overdiagnosis. If detection rate is used for the evaluation of the effectiveness of cancer screening, the possibility of overestimating the effectiveness of cancer screening cannot be ruled out. To avoid the effect of overdiagnosis and confirm the effectiveness of endoscopic screening, mortality reduction from gastric cancer must be carefully evaluated by conducting reliable studies. The burden of gastric cancer remains real and this cannot be ignored in Eastern Asian countries. To determine the best available method for gastric cancer screening, evaluation of its effectiveness is a must. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further comprehensive evaluation to reliably confirm its effectiveness and how its optimal use can be strategically promoted.

  9. Endoscopic Endonasal Approaches to the Craniovertebral Junction: A Systematic Review of the Literature

    PubMed Central

    Fujii, Tatsuhiro; Platt, Andrew; Zada, Gabriel

    2015-01-01

    Background We reviewed the current literature pertaining to extended endoscopic endonasal approaches to the craniovertebral junction. Methods A systematic literature review was utilized to identify published surgical cases of endoscopic endonasal approaches to the craniovertebral junction. Full-text manuscripts were examined for various measures of surgical indications, patient characteristics, operative technique, and surgical outcomes. Results We identified 71 cases involving endoscopic endonasal approaches for surgical management of a variety of pathologies located within the craniovertebral junction. Patient ages ranged from 3 to 87 years, with 40 females and 31 males. Five patients required tracheostomy, two were reintubated, and all others experienced an average intubation duration of 0.54 days following surgery. Fifty-eight patients (81.7%) underwent an additional posterior decompression or fusion either before or after the endonasal procedure. A complete resection of the pathologic lesion was reported in 57 cases (83.8%), another five were successful biopsies, and four resulted in partial resection. The follow-up time ranged from 0.5 to 57 months. Conclusion Although the transoral approach has been the standard for anterior surgical management for the past several decades, our systematic review illustrates that the extended endoscopic endonasal approach is a safe and effective alternative for most pathologies affecting the craniovertebral junction. PMID:26682128

  10. Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts.

    PubMed

    Iacoangeli, Maurizio; di Somma, Lucia Giovanna Maria; Di Rienzo, Alessandro; Alvaro, Lorenzo; Nasi, Davide; Scerrati, Massimo

    2014-06-01

    Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.

  11. Transpedicular endoscopic surgery for lumbar spinal synovial cyst—report of two cases

    PubMed Central

    Krzok, Guntram; Wagner, Ralf; Iprenburg, Menno

    2016-01-01

    Background Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet. Methods Two patient cases are described where the lumbar 4–5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization. Results Following surgery, the patients’ symptoms showed immediate regression with complete relief of one patient’s foot drop by 6 months. Conclusions Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle. PMID:28097248

  12. High-resolution imaging using endoscopic holography

    NASA Astrophysics Data System (ADS)

    Bjelkhagen, Hans I.

    1990-08-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help to their control. 1.

  13. Holographic high-resolution endoscopic image recording

    NASA Astrophysics Data System (ADS)

    Bjelkhagen, Hans I.

    1991-03-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help

  14. Update on the endoscopic treatments for achalasia

    PubMed Central

    Uppal, Dushant S; Wang, Andrew Y

    2016-01-01

    Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. High-resolution manometry allows for definitive diagnosis and classification of achalasia, with type II being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation (PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy (POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient’s clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible. PMID:27818585

  15. Update on the endoscopic treatments for achalasia.

    PubMed

    Uppal, Dushant S; Wang, Andrew Y

    2016-10-21

    Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. High-resolution manometry allows for definitive diagnosis and classification of achalasia, with type II being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation (PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy (POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

  16. [ENDOSCOPIC LUNG VOLUME REDUCTION IN PULMONARY EMPHYSEMA].

    PubMed

    Duysinx, B; Heinen, V; Louis, R; Corhay, J-L

    2015-12-01

    Emphysema is characterized by an irreversible alveolar destruction, a progressive lung hyperinflation and a dysfunction of respiratory muscles. It induces a respiratory functional limitation and a decrease of quality of life. Endoscopic lung volume reduction represents a potential alternative to surgical treatments for advanced heterogeneous emphysema without concomitant surgical morbidity. The different bronchoscopic systems for lung volume reduction currently under evaluation are presented.

  17. Peroral Endoscopic Myotomy: Establishing a New Program

    PubMed Central

    Kumta, Nikhil A.; Mehta, Shivani; Kedia, Prashant; Weaver, Kristen; Sharaiha, Reem Z.; Fukami, Norio; Minami, Hitomi; Casas, Fernando; Gaidhane, Monica; Lambroza, Arnon

    2014-01-01

    Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure. PMID:25324996

  18. Anesthesia for Endoscopic Third Ventriculostomy in Children

    PubMed Central

    Rajesh, M. C.

    2017-01-01

    Neuroendoscopy has established itself as a routine neurosurgical procedure in pediatric population. To have an uneventful smooth perioperative course, it is important for anesthesiologist to know about the key steps, possible complications, and specific anesthetic requirements. Among neuroendoscopies, endoscopic third ventriculostomy is the commonly performed one. PMID:28298748

  19. 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

  20. Dual-channel spectrally encoded endoscopic probe

    PubMed Central

    Engel, Guy; Genish, Hadar; Rosenbluh, Michael; Yelin, Dvir

    2012-01-01

    High quality imaging through sub-millimeter endoscopic probes provides clinicians with valuable diagnostics capabilities in hard to reach locations within the body. Spectrally encoded endoscopy (SEE) has been shown promising for such task; however, challenging probe fabrication and high speckle noise had prevented its testing in in vivo studies. Here we demonstrate a novel miniature SEE probe which incorporates some of the recent progress in spectrally encoded technology into a compact and robust endoscopic system. A high-quality miniature diffraction grating was fabricated using automated femtosecond laser cutting from a large bulk grating. Using one spectrally encoded channel for imaging and a separate channel for incoherent illumination, the new system has large depth of field, negligible back reflections and well controlled speckle noise which depends on the core diameter of the illumination fiber. Moreover, by using a larger imaging channel, higher groove density grating, shorter wavelength and broader spectrum, the new endoscopic system now allow significant improvements in almost all imaging parameter compared to previous systems, through an ultra-miniature endoscopic probe. PMID:22876349

  1. Dual-channel spectrally encoded endoscopic probe.

    PubMed

    Engel, Guy; Genish, Hadar; Rosenbluh, Michael; Yelin, Dvir

    2012-08-01

    High quality imaging through sub-millimeter endoscopic probes provides clinicians with valuable diagnostics capabilities in hard to reach locations within the body. Spectrally encoded endoscopy (SEE) has been shown promising for such task; however, challenging probe fabrication and high speckle noise had prevented its testing in in vivo studies. Here we demonstrate a novel miniature SEE probe which incorporates some of the recent progress in spectrally encoded technology into a compact and robust endoscopic system. A high-quality miniature diffraction grating was fabricated using automated femtosecond laser cutting from a large bulk grating. Using one spectrally encoded channel for imaging and a separate channel for incoherent illumination, the new system has large depth of field, negligible back reflections and well controlled speckle noise which depends on the core diameter of the illumination fiber. Moreover, by using a larger imaging channel, higher groove density grating, shorter wavelength and broader spectrum, the new endoscopic system now allow significant improvements in almost all imaging parameter compared to previous systems, through an ultra-miniature endoscopic probe.

  2. Portal hypertensive gastric mucosa: an endoscopic study.

    PubMed Central

    Papazian, A; Braillon, A; Dupas, J L; Sevenet, F; Capron, J P

    1986-01-01

    The endoscopic features of the gastric mucosa in patients with cirrhosis have not been systematically investigated. In these patients, we observed an endoscopic aspect, consisting of multiple small erythematous areas, outlined by a subtle yellowish network (resembling a mosaic), mainly located in the proximal part of the stomach. We tested the value of this sign by comparing two groups: 100 patients with portal hypertension due to cirrhosis, and 300 control patients without signs of liver disease or portal hypertension. This endoscopic pattern was observed in 94 of the patients with cirrhosis, whereas oesophageal varices were seen in 78 only. In contrast, only one patient of the control group had this aspect. Moreover, this sign was also found in seven of eight patients with non cirrhotic portal hypertension, but was seen neither in 100 patients with chronic alcoholism but without liver disease, nor in 10 cirrhotic patients with end-to-side portacaval shunts. These endoscopic changes might be because of mucosal and/or submucosal oedema and congestion highlighting the normal areae gastricae pattern and related to raised portal pressure. We conclude that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause. Images Figure PMID:3781334

  3. Update on Natural Orifice Translumenal Endoscopic Surgery

    PubMed Central

    Bingener, Juliane; Gostout, Christopher J.

    2012-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has moved from the realm of laboratory experiments to the realm of human clinical trials. This paper reviews the spectrum of NOTES procedures currently available in the United States and worldwide. It also discusses the limitations and avenues for further development of these procedures, particularly those involving the transgastric approach. PMID:22933874

  4. Esophageal carcinoid tumor treated by endoscopic resection.

    PubMed

    Yagi, Makoto; Abe, Yasuhiko; Sasaki, Yu; Nomura, Eiki; Sato, Takeshi; Iwano, Daisuke; Yoshizawa, Kazuya; Sakuta, Kazuhiro; Kanno, Nana; Nishise, Syouichi; Ueno, Yoshiyuki

    2015-05-01

    The present report describes a rare case of esophageal carcinoid tumor that was treated by endoscopic resection. A 43-year-old woman underwent esophagogastroduodenoscopy at her family clinic for screening of the upper digestive tract and a small lesion resembling a submucosal tumor was detected in the lower esophagus. A biopsy sample from the lesion was diagnosed as esophageal carcinoid tumor and the patient visited our hospital for detailed examination. The tumor was approximately 3 mm in diameter and its surface appeared to be covered with normal squamous epithelium. The tumor had a shiny reddish surface without ulceration or erosion. Magnifying endoscopy with narrow-band imaging showed structures resembling reticular vessels under the epithelium. Endoscopic ultrasonography depicted the tumor as a low-echoic mass within the lamina propria. Computed tomography did not detect the tumor and no metastatic lesions were evident in other organs. With the patient's informed consent, the tumor was resected using endoscopic submucosal dissection, with a sufficient free margin in both the vertical and horizontal directions. Magnifying endoscopic examination showed the resected tumor to have abundant reticular vessels. Finally, the tumor was diagnosed immunopathologically as an esophageal carcinoid tumor (neuroendocrine cell tumor, grade 1), without lymphatic or vascular invasion.

  5. [Duodenal complications of rheumatoid purpura. Endoscopic aspects].

    PubMed

    Chapoy, P; Guidon, M J; Louchet, E

    1984-01-01

    The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

  6. Benign pneumoperitoneum after percutaneous endoscopic gastrostomy (PEG) feeding tube placement: do not be afraid!

    PubMed

    Zippi, M; Pica, R; Marzano, C; Cassieri, C; Avallone, E V; Traversa, G

    2014-01-01

    In order to ensure enteral feeding, placement of a percutaneous endoscopic gastrostomy (PEG) is considered a standard care for patients with oropharyngeal malignancies. Benign pneumoperitoneum is a complication of PEG feeding tube placement and it is usually an incidental finding that arises, generally, immediately following the procedure. We report a case of a benign pneumoperitoneum, developed 48 hours after the procedure, which was treated conservatively.

  7. Dual instrument for in vivo and ex vivo OCT imaging in an ENT department

    PubMed Central

    Cernat, Ramona; Tatla, Taran S.; Pang, Jingyin; Tadrous, Paul J.; Bradu, Adrian; Dobre, George; Gelikonov, Grigory; Gelikonov, Valentin; Podoleanu, Adrian Gh.

    2012-01-01

    A dual instrument is assembled to investigate the usefulness of optical coherence tomography (OCT) imaging in an ear, nose and throat (ENT) department. Instrument 1 is dedicated to in vivo laryngeal investigation, based on an endoscope probe head assembled by compounding a miniature transversal flying spot scanning probe with a commercial fiber bundle endoscope. This dual probe head is used to implement a dual channel nasolaryngeal endoscopy-OCT system. The two probe heads are used to provide simultaneously OCT cross section images and en face fiber bundle endoscopic images. Instrument 2 is dedicated to either in vivo imaging of accessible surface skin and mucosal lesions of the scalp, face, neck and oral cavity or ex vivo imaging of the same excised tissues, based on a single OCT channel. This uses a better interface optics in a hand held probe. The two instruments share sequentially, the swept source at 1300 nm, the photo-detector unit and the imaging PC. An aiming red laser is permanently connected to the two instruments. This projects visible light collinearly with the 1300 nm beam and allows pixel correspondence between the en face endoscopy image and the cross section OCT image in Instrument 1, as well as surface guidance in Instrument 2 for the operator. The dual channel instrument was initially tested on phantom models and then on patients with suspect laryngeal lesions in a busy ENT practice. This feasibility study demonstrates the OCT potential of the dual imaging instrument as a useful tool in the testing and translation of OCT technology from the lab to the clinic. Instrument 1 is under investigation as a possible endoscopic screening tool for early laryngeal cancer. Larger size and better quality cross-section OCT images produced by Instrument 2 provide a reference base for comparison and continuing research on imaging freshly excised tissue, as well as in vivo interrogation of more superficial skin and mucosal lesions in the head and neck patient

  8. Dual instrument for in vivo and ex vivo OCT imaging in an ENT department.

    PubMed

    Cernat, Ramona; Tatla, Taran S; Pang, Jingyin; Tadrous, Paul J; Bradu, Adrian; Dobre, George; Gelikonov, Grigory; Gelikonov, Valentin; Podoleanu, Adrian Gh

    2012-12-01

    A dual instrument is assembled to investigate the usefulness of optical coherence tomography (OCT) imaging in an ear, nose and throat (ENT) department. Instrument 1 is dedicated to in vivo laryngeal investigation, based on an endoscope probe head assembled by compounding a miniature transversal flying spot scanning probe with a commercial fiber bundle endoscope. This dual probe head is used to implement a dual channel nasolaryngeal endoscopy-OCT system. The two probe heads are used to provide simultaneously OCT cross section images and en face fiber bundle endoscopic images. Instrument 2 is dedicated to either in vivo imaging of accessible surface skin and mucosal lesions of the scalp, face, neck and oral cavity or ex vivo imaging of the same excised tissues, based on a single OCT channel. This uses a better interface optics in a hand held probe. The two instruments share sequentially, the swept source at 1300 nm, the photo-detector unit and the imaging PC. An aiming red laser is permanently connected to the two instruments. This projects visible light collinearly with the 1300 nm beam and allows pixel correspondence between the en face endoscopy image and the cross section OCT image in Instrument 1, as well as surface guidance in Instrument 2 for the operator. The dual channel instrument was initially tested on phantom models and then on patients with suspect laryngeal lesions in a busy ENT practice. This feasibility study demonstrates the OCT potential of the dual imaging instrument as a useful tool in the testing and translation of OCT technology from the lab to the clinic. Instrument 1 is under investigation as a possible endoscopic screening tool for early laryngeal cancer. Larger size and better quality cross-section OCT images produced by Instrument 2 provide a reference base for comparison and continuing research on imaging freshly excised tissue, as well as in vivo interrogation of more superficial skin and mucosal lesions in the head and neck patient.

  9. Treatment of Barrett's esophagus: update on new endoscopic surgical modalities.

    PubMed

    Kristo, I; Asari, R; Rieder, E; Riegler, V; Schoppmann, S F

    2015-04-01

    Barrett's esophagus represents a premalignant condition, which is strongly associated with the incidence of esophageal adenocarcinoma. Currently, there are no validated markers to extract exactly that certain patient that will proceed to neoplastic progression. Therefore, therapeutic options have to include a larger population to provide prophylaxis for affected patients. Recently developed endoscopic therapeutic approaches offer treatment options for prevention or even treatment of limited esophageal adenocarcinoma. At present, high eradication rates of intestinal metaplasia as well as dysplasia are observed, whereas low complication rates offer a convenient safety profile. These striking new methods symbolize a changing paradigm in a field, where minimal-invasive tissue ablating methods and tissue preserving techniques have led to modified regimens. This review will focus on current standards and newly emerging methods to treat Barrett's esophagus and its progression to cancer and will highlight their evolution, potential benefits and their limitations.

  10. [Novel endoscopic techniques to image the upper gastrointestinal tract].

    PubMed

    Quénéhervé, Lucille; Neunlist, Michel; Bruley des Varannes, Stanislas; Tearney, Guillermo; Coron, Emmanuel

    2015-01-01

    Novel endoscopic techniques for the analysis of the digestive wall have recently been developed to allow investigating digestive diseases beyond standard "white-light" macroscopic imaging of the mucosal surface. Among innovative techniques under clinical evaluation, confocal endomicroscopy and optical frequency domain imaging (OFDI) are the most promising. Indeed, these techniques allow performing in vivo microscopy with different levels in terms of depths and magnification, as well as functional assessment of structures. Some of these techniques, such as capsule-based OFDI, are also less invasive than traditional endoscopy and might help screening large groups of patients for specific disorders, for instance oesophageal precancerous diseases. In this review, we will focus on the results obtained with these techniques in precancerous, inflammatory and neuromuscular disorders.

  11. Learning curve for peroral endoscopic myotomy

    PubMed Central

    El Zein, Mohamad; Kumbhari, Vivek; Ngamruengphong, Saowanee; Carson, Kathryn A.; Stein, Ellen; Tieu, Alan; Chaveze, Yamile; Ismail, Amr; Dhalla, Sameer; Clarke, John; Kalloo, Anthony; Canto, Marcia Irene; Khashab, Mouen A.

    2016-01-01

    Background and study aims: Although peroral endoscopic myotomy (POEM) is being performed more frequently, the learning curve for gastroenterologists performing the procedure has not been well studied. The aims of this study were to define the learning curve for POEM and determine which preoperative and intraoperative factors predict the time that will be taken to complete the procedure and its different steps. Patients and methods: Consecutive patients who underwent POEM performed by a single expert gastroenterologist for the treatment of achalasia or spastic esophageal disorders were included. The POEM procedure was divided into four steps: mucosal entry, submucosal tunneling, myotomy, and closure. Nonlinear regression was used to determine the POEM learning plateau and calculate the learning rate. Results: A total of 60 consecutive patients underwent POEM in an endoscopy suite. The median length of procedure (LOP) was 88 minutes (range 36 – 210), and the mean (± standard deviation [SD]) LOP per centimeter of myotomy was 9 ± 5 minutes. The total operative time decreased significantly as experience increased (P < 0.001), with a “learning plateau” at 102 minutes and a “learning rate” of 13 cases. The mucosal entry, tunneling, and closure times decreased significantly with experience (P < 0.001). The myotomy time showed no significant decrease with experience (P = 0.35). When the mean (± SD) total procedure times for the learning phase and the corresponding comparator groups were compared, a statistically significant difference was observed between procedures 11 – 15 and procedures 16 – 20 (15.5 ± 2.4 min/cm and 10.1 ± 2.7 min/cm, P = 0.01) but not thereafter. A higher case number was significantly associated with a decreased LOP (P < 0.001). Conclusion: In this single-center retrospective study, the minimum threshold number of cases required for an expert interventional endoscopist performing POEM to reach a

  12. Clinical, biological, and endoscopic picture of attacks of Crohn's disease. Evolution on prednisolone. Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives.

    PubMed

    Modigliani, R; Mary, J Y; Simon, J F; Cortot, A; Soule, J C; Gendre, J P; Rene, E

    1990-04-01

    One hundred forty-two patients with active colonic or ileocolonic Crohn's disease were included in a multicenter prospective study. Data collection included 28 clinical, biological, and endoscopic items; the latter were recorded according to a standardized colonoscopic protocol; a previously validated endoscopic index of severity was calculated. Oral prednisolone (1 mg/kg body wt per day) was started and maintained until clinical remission and for at least 3 and at most 7 wk. A second clinical biological and endoscopic evaluation was then performed. At initial colonoscopy, mucosal lesions were, by decreasing order of frequency, superficial ulcerations, deep ulcerations, mucosal edema, erythema, pseudopolyps, aphthoid ulcers, ulcerated stenosis, and nonulcerated stenosis (93%, 74%, 48%, 44%, 41%, 35%, 10%, 8%, and 2% of cases, respectively). No correlation was found between the clinical activity index and any of the endoscopical data (lesion frequency and surface, endoscopic severity index). Ninety-two percent of patients underwent clinical remission within 7 wk of treatment. None of the 28 clinical biological and endoscopical items collected just before treatment could predict clinical response to steroids. Only 38 of the 131 patients in clinical remission were also in endoscopic remission. In conclusion, (a) the description and severity of colonoscopic lesions in active Crohn's disease have been quantified; (b) no correlation exists between clinical severity and nature, surface, or severity of endoscopic lesions; (c) Oral prednisolone (1 mg/kg body wt per day) induces a clinical remission in 92% of patients within 7 wk; (d) resistance to steroids cannot be predicted from the data collected before treatment onset; and (e) only 29% of patients in clinical remission also achieve endoscopic remission.

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

    PubMed Central

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

    2016-01-01

    ABSTRACT Objective: to elaborate and apply a method to assess the efficacy of automated flexible endoscope reprocessors at a time when there is not an official method or trained laboratories to comply with the requirements described in specific standards for this type of health product in Brazil. Method: the present methodological study was developed based on the following theoretical references: International Organization for Standardization (ISO) standard ISO 15883-4/2008 and Brazilian Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA) Collegiate Board Resolution (Resolução de Diretoria Colegiada - RDC) no. 35/2010 and 15/2012. The proposed method was applied to a commercially available device using a high-level 0.2% peracetic acid-based disinfectant. Results: the proposed method of assessment was found to be robust when the recommendations made in the relevant legislation were incorporated with some adjustments to ensure their feasibility. Application of the proposed method provided evidence of the efficacy of the tested equipment for the high-level disinfection of endoscopes. Conclusion: the proposed method may serve as a reference for the assessment of flexible endoscope reprocessors, thereby providing solid ground for the purchase of this category of health products. PMID:27508915

  14. Management of a large mucosal defect after duodenal endoscopic resection

    PubMed Central

    Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Masaki, Tsutomu

    2016-01-01

    Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. PMID:27547003

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

    PubMed Central

    Jitpratoom, Pornpeera; Ketwong, Khwannara; Sasanakietkul, Thanyawat

    2016-01-01

    Background Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves’ disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. Methods From January 2014 to November 2016, a total of 97 patients with Graves’ disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. Results TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05). Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed. Conclusions TOETVA is a feasible and safe treatment for Graves’ disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results. PMID

  16. Developments in neuroendoscopy: trial of a miniature rigid endoscope with a multidirectional steerable tip camera in the anatomical lab.

    PubMed

    Ebner, Florian H; Marquardt, Jakob S; Hirt, Bernhard; Honegger, Juergen; Herlan, Stephan; Tatagiba, Marcos; Schuhmann, Martin U

    2012-01-01

    The aim of this study is to assess field of view, usability and applicability of a rigid, multidirectional steerable video endoscope (EndActive) in various intracranial regions relevant to neurosurgical practice. In four cadaveric specimens, frontolateral, pterional, transnasal (to sella and clivus), interhemispheric (transcallosal and retrocallosal) and retrosigmoid approaches as well as precoronal burr holes for ventriculoscopy were performed. Anatomical target structures were defined in each region. We assessed field of view as well as optical and ergonomic features of the prototype. The EndActive is a 4-mm-diameter rigid video (endo)scope with an integral image sensor comprising an embedded light source. The viewing direction in a range of 160° can either be controlled by the computer keyboard or a four-way joystick mounted to the handle section of the endoscope. The endoscopic imaging system allows the operator to simultaneously see both a 160° wide-angle view of the site and an inset of a specific region of interest. The surgeon can hold the device like a microsurgical instrument in one hand and control movements precisely due to its reduced weight and ergonomic shape. The multiplanar variable-view rigid endoscope proved to be useful for following anatomical structures (cranial nerves I-XII). The device is effective in narrow working spaces where movements jeopardize the delicate surrounding structures. The multiplanar variable viewing mechanism in a compact device offers advantages in terms of safety and ergonomics. Improving the usability will probably optimize the applicability of endoscopic techniques in neurosurgery.

  17. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

    PubMed Central

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

  18. Comparison of the measurements of an experimental endoscope tester with the Dovideq MDE endoscope test system for two hospitals

    NASA Astrophysics Data System (ADS)

    Noordmans, Herke Jan; Nelisse, Martin W.; de Braak, Menno; Dommerholt, Bert; van den Brink, Henk

    2012-03-01

    In minimal invasive surgery, rigid endoscopes are used to view inside the body through natural or artificial made orifices. As the price of a rigid endoscope is high, they are being constantly re-used after a cleaning and steam sterilization procedure at the Department of Central Sterilization. However, due to mechanical, chemical and thermal stresses, endoscopes degrade over time. To determine whether an endoscope still provides sufficient quality, personnel of the Department of Central Sterilization visually inspect the outside and inside of an endoscope. In practice this check is hard as it appears difficult to tell whether an image is good enough as it should be compared to the image of an new endoscope of the same type. Because of the large diversity in endoscopes, the variation of image quality of new endoscope is already so large, that it is difficult to perform this manual check objectively. In this paper we describe the results of using an experimental test bench to measure the optical quality of endoscopes over the years 2007-2011. The system is based on measuring the illumination pathway using a white LED and photo cell and the viewing pathway using a LCD generated test pattern and high resolution camera. The measurements show that endoscopes roughly degrade 20% per year, but also that the variation in degradation is so high and uncorrelated to the type of endoscope that structural measurement of the quality of endoscopes may be a prerequisite. Looking at the system itself, it appeared that although the system had sufficient stability over these years to allow conclusions, it has too much drawbacks to be used at the Department of Central Sterilization, like the stability of the LCD screen, loosing track of endoscopes when they are placed in another basket and the large number of manual steps needed to perform a measurement. For this reasons we present a new design of an endoscope measurement system, called the MDE, a Measurement Device for Endoscopes. It

  19. [Endoscopes in urology: disinfection, sterilization, labeling and tracking. Circulars and decrees. Modes of application and commentary. The Committee of Infectious Diseases of the French Association of Urology. Congressional forum UFA--Paris, November 1996. DGS Circular 20 October 1997].

    PubMed

    Lobel, B; Blitz, M; Anidjar, M; Sachot, J L; Abbou, C; Mignard, J P; Latrive, J P; Leroux, P; Lepoutre, A; Dumartin, C

    1998-02-01

    Administrative texts published in 1995, 1996 and 1997, have reinforced materiovigilance and impose disinfection precautions for endoscopes. The steps of disinfection of non-sterilizable endoscopes are: preliminary treatment, rinsing, actual disinfection, final rinsing, storage (see: Progrès en Urologie, 1997, 7, 505-507). Each procedure from collection of the endoscope until storage must be defined by written standard operating procedures validated by CLIN. The risk of transmission of Creutzfeld-Jakob disease requires autoclaving, which is only possible, at the present time, with the most recent rigid endoscopes. Until disinfection has become generalized, the traceability of endoscopes (labelling, utilization files) must be established on the model recommended for haemovigilance (circular of 02/04/96).

  20. 14 CFR 27.1381 - Instrument lights.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Instrument lights. 27.1381 Section 27.1381 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Equipment Lights § 27.1381 Instrument lights. The instrument...