Science.gov

Sample records for standard endoscopic instruments

  1. Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy

    PubMed Central

    Park, Hong Jun

    2016-01-01

    Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU. PMID:27399313

  2. Powered instrumentation in functional endoscopic sinus surgery. I: Surgical technique.

    PubMed

    Christmas, D A; Krouse, J H

    1996-01-01

    The use of the microdebrider provides an excellent, safe and thorough technique in functional endoscopic sinus surgery. It provides atraumatic dissection with minimal bleeding which enables decreased surgical time and faster postoperative healing. It is easily learned and requires minimal supplemental instrumentation. We feel that it is a superior technique in the practice of functional endoscopic sinus surgery.

  3. Powered instrumentation in functional endoscopic sinus surgery. II: A comparative study.

    PubMed

    Krouse, J H; Christmas, D A

    1996-01-01

    The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.

  4. Endoscopic vidian neurectomy assisted by power instrumentation and coblation.

    PubMed

    Hsu, Chao-Yuan; Shen, Ping-Hung; Weitzel, Erik Kent

    2013-09-01

    Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the introduction of endoscopic sinus surgery in the 1980s, transnasal endoscopic vidian neurectomy (EVN) was subsequently reported. The most common problem in performing EVN was excessive bleeding from the pterygopalatine fossa. The complexity and vascularity of the pterygopalatine fossa can cause bloody surgical fields and prevent complete neurectomy. In response to this surgical problem, a procedure was developed to use powered instrumentation and coblation during EVN. There were eight cases of EVNs (16 neurectomies) assisted by power instrumentation and coblation from December 2011 to May 2012. The average blood loss of these cases was 37.5 mL (range, 25-50 mL). The average surgical time of each neurectomy was 27.4 minutes (range, 20-35 minutes). No complications occurred in any of the eight cases. Very limited bleeding and less thermal damage were noted while achieving a complete neurectomy.

  5. [Video-endoscopic findings in playing various wind instruments].

    PubMed

    Miethe, E

    1991-11-01

    The function of the larynx and tongue of 15 subjects playing different wind instruments was examined. Whichever instrument was played, no variations of the vocal cord positions were found. A sustained note produced by the singing voice, or by playing an instrument, or by singing synchronously was observed by stroposcopy. Laryngeal functions did not change between these three types of use of the larynx. Vibrato was indirectly produced by the vocal cords. Laryngeal disorders influence the playing of wind instruments and the use of the singing voice. PMID:1769869

  6. Endoscopic sinus surgery in otorhinolaryngology nursing using powered instrumentation.

    PubMed

    Krouse, H J; Krouse, J H; Christmas, D A

    1997-01-01

    Powered instrumentation has gained increased popularity in otolaryngology because of its safety and effectiveness in sinus surgery. An understanding of the principles and techniques of powered dissection of the sinuses, setup and handling of instrumentation, and pre- and postoperative care is necessary for otolaryngology nurses in management of patients undergoing these procedures.

  7. 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

  8. Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization

    PubMed Central

    Shimamura, Yuto; Ishii, Naoki; Omata, Fumio; Imamura, Noriatsu; Okamoto, Takeshi; Ego, Mai; Nakano, Kaoru; Ikeya, Takashi; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2016-01-01

    Background and aims: Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding. Patients and methods: A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release. Results: A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 – 45) and 11 minutes (range 4 – 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered. Conclusion: EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time. PMID:26878056

  9. Pilot study of a device for measuring instrument forces during endoscopic sinus surgery.

    PubMed

    White, Paul S; Nassif, Ramez; Saleh, Hesham; Drew, Timothy

    2004-03-01

    ESS is a form of minimal access surgery that includes different tasks and manoeuvres requiring sophisticated psychomotor coordination with varying levels of force application. The avoidance of complications is partially dependent upon reducing surgical force application when operating against vital barriers such as the skull base and the medial orbital wall. The study of the surgical forces in endoscopic sinus surgery offers the potential for surgeons to identify the appropriate application of the instrument forces and torques necessary to conduct safe surgery. We have developed Sinoforce, a sinus surgery force-measuring instrument, which comprises modified Blakesley forceps fitted with specialized force sensors The instrument produces a real-time visual display of the various forces applied by the surgeon to the forceps during endoscopic ethmoidectomy. A pilot study was conducted using four cadaveric head specimens. We measured the force needed to break through the different parts of the ethmoidal bony labyrinth and skull base. Comparable forces were needed to break through the ethmoidal bulla and uncinate process. However, a force of > 2 kg, exceeding the forceps calibration, was needed to break through the different parts of the skull base. In this article we describe the new forceps, present our preliminary results and explore the potential benefits of this new instrument.

  10. Standard Endoscopic Approaches in Frontal Sinus Surgery: Technical Pearls and Approach Selection.

    PubMed

    Korban, Zeina R; Casiano, Roy R

    2016-08-01

    The mainstay of frontal sinus surgery for chronic rhinosinusitis is to achieve and maintain an adequate frontal outflow tract. Using a stepwise approach and identifying critical endoscopic anatomic landmarks, to minimize complications and obtain long-term good endoscopic surgical results, should achieve this. The goal is to relieve the patient's symptoms, restore functional mucociliary flow, achieve a wide frontal sinus ostium and prevent long-term scarring and stenosis. Meticulous dissection and appropriate use of instrumentation and techniques aids in preventing unnecessary damage to normal mucosa while achieving one's goal of an adequate surgical ostium.

  11. Standard Endoscopic Approaches in Frontal Sinus Surgery: Technical Pearls and Approach Selection.

    PubMed

    Korban, Zeina R; Casiano, Roy R

    2016-08-01

    The mainstay of frontal sinus surgery for chronic rhinosinusitis is to achieve and maintain an adequate frontal outflow tract. Using a stepwise approach and identifying critical endoscopic anatomic landmarks, to minimize complications and obtain long-term good endoscopic surgical results, should achieve this. The goal is to relieve the patient's symptoms, restore functional mucociliary flow, achieve a wide frontal sinus ostium and prevent long-term scarring and stenosis. Meticulous dissection and appropriate use of instrumentation and techniques aids in preventing unnecessary damage to normal mucosa while achieving one's goal of an adequate surgical ostium. PMID:27450617

  12. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

    PubMed Central

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

    2011-01-01

    Background Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). Objective To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. Design A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0–11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0–100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. Results There was 76% agreement for ‘severe’, but 27% agreement for ‘normal’ appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR2, Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). Conclusion The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall

  13. A virtual instrument ergonomics workstation for measuring the mental workload of performing video-endoscopic surgery.

    PubMed

    Smith, W D; Chung, Y H; Berguer, R

    2000-01-01

    The visual and physical interface imposed on the surgeon by video-endoscopic surgery (VES) increases the surgeon's mental workload. Ergonomic studies are needed to develop ways to reduce this workload. We used virtual instrumentation to devise a portable ergonomic workstation to compare the surgeon's mental workloads during simulated open surgery and VES. The system measures palmar tonic skin conductance level (SCL) and electrooculogram (EOG) and frontalis electrical activity to monitor mental stress and concentration levels. We used the system at a national surgery conference on volunteer subjects during a rest period and as they performed simulated surgery, consisting of typing knots using open and VES techniques. The subjects were asked to self-rate their levels of mental concentration and stress during these activities and reported that both progressively increased from rest to the open surgery task to the VES task. The subjects tied fewer knots during the VES than the open task, consistent with the increased demands of the VES task. The SCL progressively increased from rest to the open task to the VES task, correlating with the subjects' reported increase in mental stress level. Eye blinks and low frequency EOG activity decreased from rest to the open task, consistent with the subjects' reported increase in mental concentration level. From the open to the VES task, eye blinks and EOG activity increased, as expected given the greater demands of the VES task. High frequency frontalis activity merits further study as another indicator of the subjects' levels of mental concentration and stress.

  14. Root canal instruments are poorly standardized.

    PubMed

    Stenman, E; Spångberg, L S

    1993-07-01

    In an earlier study we demonstrated that root canal instruments vary greatly in their effectiveness in removing substrates. To further analyze the reason for this variation of results, the dimensions of the instruments used were considered of interest as their matching effectiveness may be size dependent. Nine different brands of Hedstrom files, seven brands of K files, and four brands of special files were examined. The measurements were done in a computerized measuring microscope and the data were compared with earlier reported data on machining. Although the dimensions of the instruments varied greatly, no correlation could be found between the machining and dimensions. Only one brand of files was completely within allowable size range. PMID:8245754

  15. [Voice control of endoscopic instruments by the operator--development and perspectives].

    PubMed

    Lobenhoffer, P; Mannss, J

    1996-01-01

    Present surgical techniques require the intraoperative control of an increasing number of technical devices (i.e. endoscopic surgery, fluoroscopy, laser systems). We present a system that allows direct command of medical devices by voice control. Practical testing of a voice-controlled arthroscopic fluid pump in the OR demonstrated safe and efficient function and a significantly improved control of the pump by the surgeon. PMID:9101955

  16. 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.

  17. High Availability Instrumentation Packaging Standards for the ILC and Detectors

    SciTech Connect

    Downing, R.W.; Larsen, R.S.; /SLAC

    2006-11-30

    ILC designers are exploring new packaging standards for Accelerator Controls and Instrumentation, particularly high-speed serial interconnect systems for intelligent instruments versus the existing parallel backplanes of VME, VXI and CAMAC. The High Availability Advanced Telecom Computing Architecture (ATCA) system is a new industrial open standard designed to withstand single-point hardware or software failures. The standard crate, controller, applications module and sub-modules are being investigated. All modules and sub-modules are hot-swappable. A single crate is designed for a data throughput in communications applications of 2 Tb/s and an Availability of 0.99999, which translates into a downtime of five minutes per year. The ILC is planning to develop HA architectures for controls, beam instrumentation and detector systems.

  18. 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.

  19. Endoscopically controlled hydraulic sinus lift in combination with rotary instruments: one-year follow-up of a case series.

    PubMed

    Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    The aim of this study was to evaluate a sinus lift via crestal approach (SLVCA) case series, performed with rotary instruments and hydraulic pressure, analyzed under endoscopic control. Sixteen patients (11 female, 5 male, mean age 47.13±8.07 years) candidates for SLVCA were enrolled in this study. Twenty-two cylindrical two-piece implants were placed. After a suitable period of time needed for the consolidation of the graft (mean value 5.78±1.49 months), the bone augmentation was assessed by means of intraoral X-ray exams before the surgical procedure of re-entry. After a functional load with temporary acrylic fixed prosthesis, on Peek abutments, for a span of 4 months, the cases were finalized with cemented metal-ceramic prosthesis (10 single crowns, 6 bridges). The post finalization follow-up was at 12 months. During the perforation of the sinus floor via rotary instruments no perforations of the sinus membrane were observed either during the hydraulic detachment or simultaneous filling of the subantral space with the graft material. Survival rate was 94.5% since one fixture was lost, but immediately replaced with a new one. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. The SLVCA performed with rotary instruments and hydraulic pressure is a reliable grafting procedure for oral rehabilitation of maxillary edentulous sites. PMID:27469544

  20. 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,…

  1. AZ State Profile. Arizona: Arizona's Instrument to Measure Standards (AIMS)

    ERIC Educational Resources Information Center

    Center on Education Policy, 2010

    2010-01-01

    This paper provides information about the Arizona's Instrument to Measure Standards (AIMS). The purpose of the test is to determine prospective high school graduates' mastery of the state curriculum and to meet a state mandate. [For the main report, "State High School Tests: Exit Exams and Other Assessments", see ED514155.

  2. Endoscopic therapy for early gastric cancer: Standard techniques and recent advances in ESD

    PubMed Central

    Kume, Keiichiro

    2014-01-01

    The technique of endoscopic submucosal dissection (ESD) is now a well-known endoscopic therapy for early gastric cancer. ESD was introduced to resect large specimens of early gastric cancer in a single piece. ESD can provide precision of histologic diagnosis and can also reduce the recurrence rate. However, the drawback of ESD is its technical difficulty, and, consequently, it is associated with a high rate of complications, the need for advanced endoscopic techniques, and a lengthy procedure time. Various advances in the devices and techniques used for ESD have contributed to overcoming these drawbacks. PMID:24914364

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

    PubMed

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

    2013-01-01

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

  4. 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...

  5. 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.

  6. 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. PMID:27541718

  7. Anesthesia for endoscopic retrograde cholangiopancreatography: target-controlled infusion versus standard volatile anesthesia

    PubMed Central

    Motiaa, Youssef; Bensghir, Mustapha; Jaafari, Abdelhamid; Meziane, Mohammed; Ahtil, Redouane; Kamili, Noureddine Drissi

    2016-01-01

    Background Endoscopic retrograde cholangiopancreatography (ERCP) is a technique used both for diagnosis and for the treatment of biliary and pancreatic diseases. ERCP has some anesthetic implications and specific complications. The primary outcome aim was to compare two protocols in terms of time of extubation. We also compared anesthetic protocols in terms of hemodynamic and respiratory instability, antispasmodics needs, endoscopist satisfaction, and recovery room stay. Methods Patients were randomized into two groups standard anesthesia group (Gr: SA) in whom induction was done by propofol, fentanyl and cisatracurium and maintenance was done by a mixture of oxygen, nitrousoxide (50%:50%) and sevoflurane; and intravenous anesthesia group to target concentration (Gr: TCI) in whom induction and maintenance of anesthesia were done with propofol with a target 0.5-2 μg/mL, and remifentanil with a target of 0.75-2 ng/mL. Results 90 patients were included. Extubation time was shorter in Gr: TCI, 15±2.6 vs. 27.4±7.1 min in Gr: SA (P<0.001). The incidence of hypotension was higher in GrL: SA (P=0.009). Satisfaction was better in Gr: TCI (P=0.003). Antispasmodic need was higher in Gr: SA (P=0.023). Six patients in Gr: SA group had desaturation in post-anesthesia care unit (PACU) versus one patient from Gr: TCI (P=0.049). Patients in Gr: TCI had shorter PACU stay 40.2±7.3 vs. 58.7±12.4 min (P<0.001). Conclusion The use of TCI mode allows better optimization of general anesthesia technique during ERCP. PMID:27708522

  8. 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.

  9. 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.

  10. Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

    PubMed Central

    Tomazic, Peter Valentin; Gellner, Verena; Koele, Wolfgang; Hammer, Georg Philipp; Braun, Eva Maria; Gerstenberger, Claus; Clarici, Georg; Holl, Etienne; Braun, Hannes; Stammberger, Heinz; Mokry, Michael

    2014-01-01

    Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study. Methods. On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2. Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures. Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap. PMID:24689037

  11. Arizona's Instrument to Measure Standards (AIMS DPA). Student Guide, Grade 8

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards (AIMS), a Standards-Based test, provides educators and the public with valuable information regarding the progress of Arizona's students toward mastering Arizona's reading, writing and mathematics Standards. This specific test, Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is…

  12. Endoscopic Cyclophotocoagulation

    PubMed Central

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

    2015-01-01

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

  13. Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

    PubMed

    Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver. PMID:27380571

  14. 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…

  15. DEBIE - first standard in-situ debris monitoring instrument

    NASA Astrophysics Data System (ADS)

    Kuitunen, J.; Drolshagen, G.; McDonnell, J. A. M.; Svedhem, H.; Leese, M.; Mannermaa, H.; Kaipiainen, M.; Sipinen, V.

    2001-10-01

    Objects larger than a few centimetres can be tracked with radar or with optical telescopes. The population of smaller particles can only be investigated by the analysis of retrieved spacecraft and passive detectors or by in-situ monitors in orbit. Patria Finavitec together with UniSpace Kent have developed the DEBIE (DEBris In-orbit Evaluator) instrument to determine the parameters of sub-millimetre sized space debris and micrometeoroids in-situ by their impact with a detecting surface. The main goal has been to develop an economical and low-resource instrument, easy to integrate into any spacecraft, while providing reliable real-time data for space debris modelling.

  16. 75 FR 32655 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-09

    ... 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... and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters...

  17. 76 FR 64006 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... 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...

  18. 75 FR 42310 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-21

    ... 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...

  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. PMID:23860931

  20. Endoscopic Microscopy

    PubMed Central

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

    2002-01-01

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

  1. Celiac Disease Diagnosis: Endoscopic Biopsy

    MedlinePlus

    ... This is done in a procedure called a biopsy: the physician eases a long, thin tube called ... the tissue using instruments passed through the endoscope. Biopsy of the small intestine is the only way ...

  2. 76 FR 16686 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-25

    ... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a... Minimums and Obstacle Departure Procedures; Miscellaneous Amendments AGENCY: Federal Aviation... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle...

  3. 76 FR 30536 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-26

    ... Minimums and Obstacle Departure Procedures; Miscellaneous Amendments AGENCY: Federal Aviation... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... commissioning of new navigational facilities, adding new obstacles, or changing air traffic requirements....

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY... storage of reagents and specimens, accurate and reliable test system operation, and test result reporting...) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions...

  5. [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.

  6. Endoscopic treatment of gastroparesis.

    PubMed

    McCarty, Thomas R; Rustagi, Tarun

    2015-06-14

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

  7. Endoscopic treatment of gastroparesis

    PubMed Central

    McCarty, Thomas R; Rustagi, Tarun

    2015-01-01

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

  8. Calibration standards and field instruments for the precision measurement of insolation

    NASA Technical Reports Server (NTRS)

    Reid, M. S.; Berdahl, C. M.; Kendall, J. M., Sr.

    1978-01-01

    The design of a fieldworthy survey instrument based on a developed radiation calibration standard is discussed. The radiometer system, a fieldworthy modification of Pacrad, is an all-weather solar radiometer, and a field test is described which demonstrates the instrument's stability in severe environments over an extended period of time. It is suggested that the instrument may be considered a transfer standard as well as a radiometer. It is hoped that future modifications might reduce the 15-deg view angle and improve the tracking system to eliminate weekly manual declination adjustments.

  9. 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

  10. Choledocholithiasis diagnostics - endoscopic ultrasound or endoscopic retrograde cholangiopancreatography?

    PubMed

    Leszczyszyn, Jarosław

    2014-06-01

    It is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis. For decades, endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis. The method is associated with a relatively high rate of complications, including acute pancreatitis, the incidence of which is estimated to range between 0.74% and 1.86%. The mechanism of this ERCP-induced complication is not fully understood, although factors increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction, previous acute pancreatitis, narrow bile ducts or difficult catheterization of Vater's ampulla are known. It has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications. Endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter, as opposed to magnetic resonance cholangiography. However, both of these parameters depend on the experience of the performing physician. The use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the Vater's ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is

  11. ANSI and IEC standards for, and evaluation of, radiation detection instrumentation

    SciTech Connect

    Chiaro Jr, Peter John

    2008-01-01

    During the last quarter of 2002, an effort was started to develop performance requirements for radiation instrumentation used for the detection of illicit trafficking of radioactive material. Coordinated by the US National Institute of Science and Technology (NIST), a team was formed to establish writing committees for the development of these requirements as American National Standards Institute (ANSI) standards. The core of the new area was developed as ANSI N42, Homeland Security Instruments. A series of standards were developed followed by testing and evaluation (T&E) protocols that would be used for specific testing. Four US National Laboratories provided T&E support and work commenced to test instruments provided by manufacturers at no cost. During this time, discussions began regarding the formation of a new work group within the International Electrotechnical Commission (IEC). This new work group would be located within technical committee (TC) 45 which addresses nuclear instrumentation. This new work group, 15B, also began developing international standards to address the same instrument types. Following development of ANSI standards, the testing and evaluation process began, running for two distinct rounds. The results of the work was consolidated by NIST and released back to individual companies as well as the user community in a controlled manner. This document will provide details regarding the standards and their basis and status, as well as some information regarding the T&E process used in the USA.

  12. 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.

  13. 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.

  14. Powered functional endoscopic sinus surgery.

    PubMed

    Krouse, H J; Parker, C M; Purcell, R; Krouse, J H; Christmas, D A

    1997-09-01

    The use of powered instrumentation in functional endoscopic sinus surgery has been a revolutionary development in the surgical treatment of chronic sinusitis. Several studies have demonstrated the safety, efficacy, and ease of use of this new technique. To provide support and coordinate the surgical process in powered functional endoscopic sinus surgery procedures, perioperative nurses must have an appreciation for its specific equipment handling and for appropriate patient care. This article describes a specific protocol that perioperative nurses can use to facilitate efficient and safe surgical environments for patients who undergo powered endoscopic sinus surgery procedures.

  15. 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.

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 30 CFR 243.100 - What standards must my MMS-specified surety instrument meet?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What standards must my MMS-specified surety instrument meet? 243.100 Section 243.100 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT SUSPENSIONS PENDING APPEAL AND BONDING-MINERALS REVENUE...

  1. Development and Standardization of Instruments Measuring Four Aspects of Sex-Roles in Primary Grade Children

    ERIC Educational Resources Information Center

    Newman, Robert C., II

    1977-01-01

    Two instruments were developed and standardized on first-, second-, and third-grade boys and girls. The Toy Preference Test (TPT) measures sex-role preference, and/or Stereotypic Sex-Role Concepts of masculinity (SRCm) and femininity (SCRf), depending upon the instructions used for administration. The Rating Scale for Children (RSC) taps sex-role…

  2. 14 CFR 1300.10 - General standards for Board issuance of Federal credit instruments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true 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...

  3. 75 FR 63712 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-18

    ... 1, 2010. John M. Allen, Director, Flight Standards Service. Adoption of the Amendment 0 Accordingly... Springs, WI, Solon Springs Muni, NDB RWY 19, Amdt 2A, CANCELLED On September 15, 2010 (75 FR 178) the FAA... under instrument flight rules at the affected airports. DATES: This rule is effective October 18,...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., reagents, materials, and supplies. 493.1252 Section 493.1252 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY..., instruments, reagents, materials, and supplies. (a) Test systems must be selected by the laboratory....

  5. Arizona's Instrument to Measure Standards (AIMS DPA). Student Guide. Grade 3

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is a combination of two separate tests. One test is AIMS, which measures how well the student knows the reading, writing , and mathematics content that all Arizona students at the third grade level are expected to know and be able to do. AIMS includes multiple-choice…

  6. Arizona's Instrument to Measure Standards (AIMS DPA). Student Guide. Grade 4

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is a combination of two separate tests. One test is AIMS, which measures how well the student knows the reading, writing, and mathematics content that all Arizona students in the student's grade level are expected to know and be able to do. AIMS DPA includes…

  7. Arizona?s Instrument to Measure Standards (AIMS DPA). Student Guide. Grade 5

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is a combination of two separate tests. One test is AIMS, which measures how well the student knows the reading, writing, and mathematics content that all Arizona students in the student's grade level are expected to know and be able to do. AIMS DPA includes…

  8. Arizona's Instrument to Measure Standards (AIMS DPA). Student Guide. Grade 6

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is a combination of two separate tests. One test is AIMS, which measures how well students know the reading, writing, and mathematics content that all Arizona students at the sixth grade level are expected to know and be able to do. AIMS DPA includes multiple-choice…

  9. Arizona's Instrument to Measure Standards (AIMS DPA). Student Guide. Grade 7

    ERIC Educational Resources Information Center

    Arizona Department of Education, 2006

    2006-01-01

    Arizona's Instrument to Measure Standards Dual Purpose Assessment (AIMS DPA) is a combination of two separate tests. One test is AIMS, which measures how well the student knows the reading, writing, and mathematics content that all Arizona students in the student's grade level are expected to know and be able to do. AIMS DPA includes…

  10. 30 CFR 1243.100 - What standards must my ONRR-specified surety instrument meet?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false What standards must my ONRR-specified surety instrument meet? 1243.100 Section 1243.100 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural Resources Revenue SUSPENSIONS PENDING APPEAL AND...

  11. Current Status of International Airborne Platform Data and Instrument Interface Standards

    NASA Astrophysics Data System (ADS)

    Freer, Matt; Webster, Chris; Freundinger, Larry

    2016-06-01

    Commission I of the International Society for Photogrammetric and Remote Sensing formed working group I/1 for the purpose of standardizing airborne platform interfaces. The primary mission of this working group is to promote the standardization of instrument interfaces, data formats, and supporting infrastructures; and to facilitate more efficient, flexible, and cost-effective international science flight operations. Within WGI/1 are a number of focused subgroups. This paper addresses the efforts of some of these subgroups having interdependent and overlapping interests; including the development of standard software interfaces for sensors, standardized approaches to management of information over potentially intermittent wireless data links, the development of standardized processing algorithms, and data archival format standards. The data in this report reflect the outcome of work-to-date in the current subgroups.

  12. 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.

  13. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

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

  14. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

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

  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. 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. PMID:25726490

  17. 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).

  18. Standard Reticle Slide To Objectively Evaluate Spatial Resolution and Instrument Performance in Imaging Mass Spectrometry.

    PubMed

    Zubair, Faizan; Prentice, Boone M; Norris, Jeremy L; Laibinis, Paul E; Caprioli, Richard M

    2016-07-19

    Spatial resolution is a key parameter in imaging mass spectrometry (IMS). Aside from being a primary determinant in overall image quality, spatial resolution has important consequences on the acquisition time of the IMS experiment and the resulting file size. Hardware and software modifications during instrumentation development can dramatically affect the spatial resolution achievable using a given imaging mass spectrometer. As such, an accurate and objective method to determine the working spatial resolution is needed to guide instrument development and ensure quality IMS results. We have used lithographic and self-assembly techniques to fabricate a pattern of crystal violet as a standard reticle slide for assessing spatial resolution in matrix-assisted laser desorption/ionization (MALDI) IMS experiments. The reticle is used to evaluate spatial resolution under user-defined instrumental conditions. Edgespread analysis measures the beam diameter for a Gaussian profile and line scans measure an "effective" spatial resolution that is a convolution of beam optics and sampling frequency. The patterned crystal violet reticle was also used to diagnose issues with IMS instrumentation such as intermittent losses of pixel data. PMID:27299987

  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 Resection of a Talocalcaneal Coalition Using a Posteromedial Approach

    PubMed Central

    Hayashi, Koji; Kumai, Tsukasa; Tanaka, Yasuhito

    2013-01-01

    Resection is a standard surgical procedure for a talocalcaneal coalition (TCC). A posterior approach is the representative technique for hindfoot endoscopy, and there is only 1 report of endoscopic resection of TCC using this approach. Disadvantages of the posterior approach for TCC are as follows: (1) the indication is limited to posterior-facet coalition, (2) the flexor hallucis longus can be an obstacle in approaching the coalition, (3) the acute insertion angle between the endoscope and instrument reduces operability, and (4) a position change and additional skin incision are essential for conversion to an open procedure. In contrast, a posteromedial approach for TCC with established portals at the entrance and exit of the flexor retinaculum is a useful technique because (1) the indication is allow to middle- and posterior-facet coalitions, (2) increased perfusion pressure allows the creation of sufficient working space, (3) operating the instrument only at the coalition site decreases the risk of tendon injury and neurovascular damage, (4) the obtuse insertion angle between the endoscope and instrument improves operability, and (5) a position change and additional skin incision are unnecessary for conversion to an open procedure. PMID:24749021

  1. Video. Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy.

    PubMed

    Bessler, Marc; Gumbs, Andrew A; Milone, Luca; Evanko, John C; Stevens, Peter; Fowler, Dennis

    2010-09-01

    Enthusiasm for natural orifice transluminal endoscopic surgery (NOTES) has been partly tempered by the reality that most NOTES procedures to date have been laparoscopically assisted. After safely performing transvaginal cholecystectomy in an IACUC-approved porcine model, the authors embarked on an institution review board (IRB)-approved protocol for ultimate performance of pure NOTES cholecystectomy in humans. They describe their experience performing a true NOTES transvaginal cholecystectomy after safely accomplishing three laparoscopically assisted or hybrid procedures in humans. One of the patients was a 35-year-old woman presenting with symptoms of biliary colic. Ultrasound confirmed gallstones, and her liver enzymes were normal. Pneumoperitoneum to 15 mmHg was obtained via a transvaginal trocar placed through a colpotomy made under direct vision. A double-channel endoscope then was advanced into the abdomen. To overcome the retracting limitations of currently available endoscopes, the authors used an extra-long 5-mm articulating retractor placed into the abdomen via a separate colpotomy made under direct vision using the flexible endoscope in a retroflexed position. Endoscopically placed clips were used for control of both the cystic duct and the artery. These techniques obviated the need for any transabdominally placed instruments or needles. This patient was the first to undergo a completely NOTES cholecystectomy at the authors' institution, and to their knowledge, in the United States. She was discharged on the day of surgery and at this writing has not experienced any complication after 1 month of follow-up evaluation. Performance of NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe for humans. Additional experience with this technique are required before studies comparing it with standard laparoscopy and hybrid techniques are appropriate.

  2. 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)…

  3. [Orientation of endoscopic images: rectification by gravity].

    PubMed

    Höller, Kurt; Schneider, Armin; Jahn, Jasper; Gutierrez, Javier; Wittenberg, Thomas; Meining, Alexander; von Delius, Stefan; Hornegger, Joachim; Feussner, Hubertus

    2010-08-01

    A known problem in endoscopic surgery (especially with flexible video endoscopes) is the absence of a stable horizon in endoscopic images displayed on a monitor. With our "ENDOrientation" approach, image rectification, even in non-rigid endoscopic surgery (particularly NOTES), can be realized with a tiny MEMS tri-axial inertial sensor placed on the tip of an endoscope. This sensor measures the impact of gravity on each of the three orthogonal accelerometer axes in real time. After an initial calibration and temporal filtering of these three data steams, the rotation angle of an endoscope can be estimated directly. The achievable sampling rate of the inertial sensor is above the usual endoscopic video frame rate of 25 Hz; the rotation accuracy is approximately one degree. The image rectification can be performed in real time by digitally rotating the endoscopic video signal. Improvements and benefits have been evaluated in animal studies: coordination and movement of different instruments was rated to be much more intuitive with a stable horizon on endoscopic images. The recorded time stamps and position tracks clearly support this observation.

  4. 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.

  5. Endoscopic Sinus Surgery

    MedlinePlus

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

  6. Funding opportunities in endoscopic imaging research.

    PubMed

    Hamilton, Frank A

    2005-07-01

    Advances in gastrointestinal endoscopy have greatly enhanced the clinicians' ability to diagnose and treat many digestive disorders. During the last 30 years, some new therapeutic endoscope techniques have become the standard of care, and other newer evolving technologies are being evaluated. Despite these endoscopic advances, there has been expressed concern that federal funding of endoscopic research has lagged behind other evolving technologic and scientific discoveries. This article provides an overview of the background of one federal agency's attempt to engage the endoscopy community in the research enterprise through a variety of mechanisms of career development, grant support, and endoscopic research and development.

  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

    2015-08-01

    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.

  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. Hemostasis in Endoscopic Sinus Surgery.

    PubMed

    Pant, Harshita

    2016-06-01

    Intraoperative bleeding during endoscopic sinus surgery poses an additional dimension to an already technically challenging surgical approach because of the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments. Poor visualization is one of the most important factors that increase the risk of intraoperative complications such as inadvertent injury to major vessels and nerves, and incomplete surgery. This article provide a logical approach to improving the surgical field, minimizing risk of inadvertent vascular injury, and managing intraoperative bleeding. PMID:27267017

  11. Novel Instrument for Automated pK(a) Determination by Internal Standard Capillary Electrophoresis.

    PubMed

    Cabot, Joan M; Fuguet, Elisabet; Rosés, Martí; Smejkal, Petr; Breadmore, Michael C

    2015-06-16

    The internal standard capillary electrophoresis method (IS-CE) has been implemented in a novel sequential injection-capillary electrophoresis instrument for the high-throughput determination of acidity constants (pK(a)) regardless of aqueous solubility, number of pK(a) values, or structure. This instrument comprises a buffer creation system that automatically mixes within a few seconds four reagents for in situ creation of the separation electrolyte with a pH range of 2-13, ionic strength of 10-100 mM and organic solvent content from 0% to 40%. Combined with 1.2 kV/cm and a short effective length (15 cm to the UV detector) fast 20 s electrophoretic separations can be obtained. The low standard deviation of the replicates and the low variation compared to reference values show that this system can accurately determine acidity constants of drugs by IS-CE. A single pK(a) can be determined in 2 min and a set of 20 measurements in half an hour, allowing rapid, simple, and flexible determination of pK(a) values of pharmaceutical targets.

  12. On-Orbit Absolute Radiance Standard for Future IR Remote Sensing Instruments

    NASA Astrophysics Data System (ADS)

    Best, F. A.; Adler, D. P.; Pettersen, C.; Revercomb, H. E.; Gero, P. J.; Taylor, J. K.; Knuteson, R. O.; Perepezko, J. H.

    2010-12-01

    Future NASA infrared remote sensing missions, including the climate benchmark CLARREO mission will require better absolute measurement accuracy than now available, and will most certainly rely on the emerging capability to fly SI traceable standards that provide irrefutable absolute measurement accuracy. As an example, instrumentation designed to measure spectrally resolved infrared radiances with an absolute brightness temperature error of better than 0.1 K will require high-emissivity (>0.999) calibration blackbodies with emissivity uncertainty of better than 0.06%, and absolute temperature uncertainties of better than 0.045K (3 sigma). Key elements of an On-Orbit Absolute Radiance Standard (OARS) meeting these stringent requirements have been demonstrated in the laboratory at the University of Wisconsin and are undergoing Technology Readiness Level (TRL) advancement under the NASA Instrument Incubator Program (IIP). We present the new technologies that underlie the OARS and the results of laboratory testing that demonstrate the required accuracy is being met. The underlying technologies include on-orbit absolute temperature calibration using the transient melt signatures of small quantities (<1g) of reference materials (gallium, water, and mercury) imbedded in the blackbody cavity; and on-orbit cavity spectral emissivity measurement using a heated halo. For these emissivity measurements, a carefully baffled heated cylinder is placed in front of a blackbody in the infrared spectrometer system, and the combined radiance of the blackbody and Heated Halo reflection is observed. Knowledge of key temperatures and the viewing geometry allow the blackbody cavity spectral emissivity to be calculated. This work will culminate with an integrated subsystem that can provide on-orbit end-to-end radiometric accuracy validation for infrared remote sensing instruments.

  13. 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.

  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. A new endoscopic hand drill for management of tracheal stenosis.

    PubMed

    Batzella, Sandro; Lucantoni, Gabriele; Fiorelli, Alfonso; Iacono, Raffaele Dello; Battistoni, Paolo; Caterino, Umberto; Santini, Mario; Galluccio, Giovanni

    2016-07-01

    Tracheal resection and primary anastomosis is the treatment of choice for the management of benign tracheal stenoses. Rigid endoscopy with laser-assisted mechanical dilatation is an alternative to surgery and helps to improve symptoms and quality of life in patients unfit for surgery. Here, we describe the treatment of a simple web-like stenosis, using a new endoscopic hand drill that was assembled by sharpening the blunt tip of a standard endoscopic cotton applicator. The bronchoscopy was positioned proximally to the stenotic lesion and radial holes were made at 12, 3 and 9 o'clock. The tip of instrument touched the target area of the stenotic scar. The proximal end was handily rotated and the force, applied on the instrument's tip, and the hole was drilled. Next, endoscopic scissors was placed in the drill holes and the stenotic scar was cut. Mechanical dilatation with rigid bronchoscopes of increasing diameters completed the procedure. This procedure was successfully applied in 5 patients with simple benign tracheal stenosis and unfit for surgery. No intraoperative and/or postoperative complications occurred. No recurrence of stenosis was detected after a mean follow-up of 26 ± 2 months.

  16. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment.

    PubMed

    Zhu, Linlin; Qin, Jinyu; Wang, Jin; Guo, Tianjiao; Wang, Zijing; Yang, Jinlin

    2016-01-01

    Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist's experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC). PMID:26884753

  17. Standard Imaging Techniques for Assessment of Portal Venous System and its Tributaries by Linear Endoscopic Ultrasound: A Pictorial Essay

    PubMed Central

    Rameshbabu, C. S.; Wani, Zeeshn Ahamad; Rai, Praveer; Abdulqader, Almessabi; Garg, Shubham; Sharma, Malay

    2013-01-01

    Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein. PMID:24949362

  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. 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.

  20. A randomized study comparing three groups of vein harvesting methods for coronary artery bypass grafting: endoscopic harvest versus standard bridging and open techniques

    PubMed Central

    Krishnamoorthy, Bhuvaneswari; Critchley, William R.; Glover, Alex T.; Nair, Janesh; Jones, Mark T.; Waterworth, Paul D.; Fildes, James E.; Yonan, Nizar

    2012-01-01

    OBJECTIVES The use of an open vein harvesting (OVH) technique for saphenous vein harvesting (SVH) is associated with wound complications and delayed patient mobilization. This has led to the development of minimally invasive vein harvesting (MIVH) techniques, such as standard bridging and endoscopic SVH (EVH). This randomized trial was established to assess immediate clinical outcome and patient satisfaction in our centre. METHODS A total of 150 consecutive patients were prospectively randomized into three groups. Group 1 consisted of 50 patients who underwent OVH, Group 2 consisted of 50 patients who underwent a standard bridging technique (SBT) and Group 3 consisted of 50 patients who underwent EVH. Each group was assessed for the incidence of wound infection, postoperative pain and satisfaction and the number of vein repairs using previously validated scoring systems. RESULTS The MIVH techniques reduced the pain at hospital (P < 0.001) and at 6 weeks (P < 0.001), and improved cosmesis (P < 0.001), compared with the OVH group. Patient satisfaction was greatest in the EVH group followed by the SBT and then the OVH group. The clinical markers of inflammation were reduced with an MIVHt. There were more vein repairs in the EVH compared with the OVH (P < 0.001) and the SBT (P = 0.04) groups. CONCLUSIONS This study demonstrates that MIVH reduces wound morbidity. We believe that each technique has advantages and disadvantages, which should be considered during the selection of a harvesting procedure by both the patient and the surgeon. PMID:22611182

  1. A miniature confocal Raman probe for endoscopic use

    NASA Astrophysics Data System (ADS)

    Day, J. C. C.; Bennett, R.; Smith, B.; Kendall, C.; Hutchings, J.; Meaden, G. M.; Born, C.; Yu, S.; Stone, N.

    2009-12-01

    Raman spectroscopy is a powerful tool for studying biochemical changes in the human body. We describe a miniature, confocal fibre optic probe intended to fit within the instrument channel of a standard medical endoscope. This probe has been optimized for the study of the carcinogenesis process of oesophageal malignancy. The optical design and fabrication of this probe is described including the anisotropic wet etching technique used to make silicon motherboards and jigs. Example spectra of PTFE reference samples are shown. Spectra with acquisition times as low as 2 s from resected oesophageal tissue are presented showing identifiable biochemical changes from various pathologies.

  2. Endoscopic lumbar foraminotomy.

    PubMed

    Evins, Alexander I; Banu, Matei A; Njoku, Innocent; Elowitz, Eric H; Härtl, Roger; Bernado, Antonio; Hofstetter, Christoph P

    2015-04-01

    Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy.

  3. Microbiological monitoring of endoscopes: 5-year review.

    PubMed

    Gillespie, Elizabeth E; Kotsanas, Despina; Stuart, Rhonda L

    2008-07-01

    Periodic microbiological monitoring of endoscopes is a recommendation of the Gastroenterological Society of Australia (GENSA). The aim of monitoring has been to provide quality assurance of the cleaning and disinfection of endoscopes; however, there is controversy regarding its frequency. This lack of consensus stimulated a review of the experience within our health service. At Southern Health, routine microbiological sampling has involved 4-weekly monitoring of bronchoscopes, duodenoscopes and automated flexible endoscope reprocessors (AFER), and 3-monthly monitoring of all other gastrointestinal endoscopes. Records of testing were reviewed from 1 January 2002 until 31 December 2006. A literature review was conducted, cost analysis performed and positive cultures investigated. There were 2374 screening tests performed during the 5-year period, including 287 AFER, 631 bronchoscopes for mycobacteria and 1456 endoscope bacterial screens. There were no positive results of the AFER or bronchoscopes for mycobacteria. Of the 1456 endoscopic bacterial samples, six were positive; however, retesting resulted in no growth. The overall cost of tests performed and cost in time for nursing staff to collect the samples was estimated at $AUD 100,400. Periodic monitoring of endoscopes is both time-consuming and costly. Our review demonstrates that AFER (Soluscope) perform well in cleaning endoscopes. Based on our 5-year experience, assurance of quality for endoscopic use could be achieved through process control as opposed to product control. Maintenance of endoscopes and AFER should be in accordance with the manufacturer's instructions and microbiological testing performed on commissioning, annually and following repair. Initial prompt manual leak testing and manual cleaning followed by mechanical leak testing, cleaning and disinfection should be the minimum standard in reprocessing of endoscopes. PMID:18086113

  4. 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..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall...

  5. [Workflow analysis to assess the efficiency of intraoperative technology using the example of functional endoscopic sinus surgery].

    PubMed

    Strauss, G; Fischer, M; Meixensberger, J; Falk, V; Trantakis, C; Winkler, D; Bootz, F; Burgert, O; Dietz, A; Lemke, H U

    2006-07-01

    Evaluation of the efficiency of surgical technology systems has to date been largely subjective. The aim of this study was to develop an ontology for surgical procedures usable workflow structures, and the evaluation of surgical workflow analysis using the example of functional endoscopic sinus surgery (FESS). A total of 38 procedures (20 patients) were included. Surgery was carried out by seven different surgeons with different degrees of training. Description of the surgical procedures and resources is based on the standard EN1828/2001 (Structure for Classification and Coding Systems for Surgical Procedures). In addition the requirements of the Workflow Reference Models (document no. Tc00-1003), Workflow Management Coalition (WfMC) were integrated. The workflow recorded the position, frequency of change of position, use time, cleaning time and concept based instrument changes. A total of 293 items were used to define FESS. A total of 1,029 different endoscopic positions were documented. These could be combined into five major endoscopic positions. The frequency of position changes was 27.1 per side, the period spent in an endoscopic position is about 1.31 min. Time for the concept-caused instrument changing was 6.44 min per side. This study demonstrates the need for assistance in guiding the endoscope in FESS. Using the workflow-data, the concept of an assistant system is possible. We offer a basis for discussion of the development of an ontology, recording and analysing surgical workflows and their practical application.

  6. [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.

  7. Correlation between Histopathological and Endoscopic Findings of Stomach Growth.

    PubMed

    Mahmuda, S; Bashar, M F; Yesmin, N; Khatun, M A

    2016-01-01

    This study was carried out in the Department of Pathology of Islami Bank Hospital, Barisal to correlate between histopathological and endoscopic diagnosis of suspected malignant gastric lesions. A total of sixty six endoscopic biopsies were studied retrospectively, during the period from February 2011 to January 2014. The biopsies were retrieved using video-endoscope. These were transferred to a bottle containing 10% neutral formalin, processed and stained routinely with Haematoxylin and Eosin. Out of 66(100%) gastric endoscopic biopsies, 29(44%) were malignant. The correlation of endoscopic and histopathological diagnosis of these gastric lesions was 44%. Endoscopic examination and biopsy is a convenient procedure for accurate objective assessment of patients with symptoms of gastrointestinal tract. Endoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of endoscopically detected lesions.

  8. 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

  9. Endoscopic Optical Coherence Tomography for Clinical Gastroenterology

    PubMed Central

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

    2014-01-01

    Optical coherence tomography (OCT) is a real-time optical imaging technique that is similar in principle to ultrasonography, but employs light instead of sound waves and allows depth-resolved images with near-microscopic resolution. Endoscopic OCT allows the evaluation of broad-field and subsurface areas and can be used ancillary to standard endoscopy, narrow band imaging, chromoendoscopy, magnification endoscopy, and confocal endomicroscopy. This review article will provide an overview of the clinical utility of endoscopic OCT in the gastrointestinal tract and of recent achievements using state-of-the-art endoscopic 3D-OCT imaging systems. PMID:26852678

  10. 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

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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

  16. 76 FR 56969 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-15

    ... Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a regulatory evaluation... Minimums and Obstacle Departure Procedures; Miscellaneous Amendments AGENCY: Federal Aviation... Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure Procedures...

  17. 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.

  18. 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.

  19. Endoscopically Based Endonasal and Transnasal Lasersurgery

    PubMed Central

    Scherer, Hans; Hopf, Juergen U. G.; Hopf, Marietta

    2001-01-01

    The endoscopically based endonasal and transnasal laser surgery is a surgical procedure, which offers the ENT-specialist a safe and effective method to cure or to improve a number of diseases of the upper and middle airways. Coagulative lasers are used in contact and noncontact mode. Their light is mainly absorbed by hemoglobin but rarely by water. The laser–tissue interaction is performed via flexible glass fibers. For the delivery of the laser beam we use specially designed applicator sheaths, which incorporate the endoscope, the laser fiber and the suction channel. The procedure is controlled online via the endoscopic image on the monitor (“video-endoscopy”). The patient suffers less trauma using this treatment compared to the standard endoscopic surgery and the procedure is much quicker. Pre- and post-operative rhinomanometric and rhinoresistometric measurements reveal that the air flow rate of the nose can be improved effectively. PMID:18493555

  20. 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

  1. 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…

  2. 77 FR 56762 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-14

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  3. 75 FR 5232 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-02

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective February 2,...

  4. 75 FR 54769 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective September 9,...

  5. 75 FR 915 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-07

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective January 7,...

  6. 77 FR 50014 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ... each SIAP is listed on the appropriate FAA ] Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  7. 78 FR 78714 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  8. 77 FR 9169 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-16

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  9. 77 FR 59738 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-01

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  10. 77 FR 24371 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  11. 77 FR 71495 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-03

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  12. 78 FR 37452 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-21

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  13. 75 FR 4487 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-28

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective January 28,...

  14. 78 FR 78713 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  15. 77 FR 31180 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  16. 78 FR 10060 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  17. 77 FR 5694 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-06

    ... description of each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  18. 76 FR 78810 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-20

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  19. 78 FR 14009 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-04

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  20. 77 FR 66535 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-06

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  1. 76 FR 1355 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective January 10,...

  2. 78 FR 68702 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  3. 76 FR 47988 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-08

    ... SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  4. 78 FR 54562 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-05

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  5. 78 FR 68704 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  6. 75 FR 39150 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective July 8, 2010....

  7. 77 FR 71499 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-03

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  8. 75 FR 5230 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-02

    ... amendments may have been issued previously by the FAA in a Flight Data Center (FDC) Notice to Airmen (NOTAM... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective February 2,...

  9. 78 FR 43781 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-22

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  10. 78 FR 5132 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-24

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  11. 77 FR 62427 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-15

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  12. 76 FR 43578 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-21

    ... SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  13. 78 FR 5253 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-25

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective January 25,...

  14. 75 FR 72940 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective November 29,...

  15. 77 FR 37799 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. ] DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  16. 77 FR 18679 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  17. 77 FR 71494 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-03

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  18. 78 FR 25384 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-01

    ... Takeoff Minimums and textual ODP amendments may have been issued previously by the FAA in a Flight Data... promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  19. 78 FR 64170 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  20. 76 FR 1354 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... amendments may have been issued previously by the FAA in a Flight Data Center (FDC) Notice to Airmen (NOTAM... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective January 10,...

  1. 77 FR 31178 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

    ... each SIAP is listed on the appropriate FAA Form 8260, as modified by the National Flight Data Center... flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  2. 75 FR 51666 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-23

    ... appropriate FAA Form 8260, as modified by the National Flight Data Center (FDC)/Permanent Notice to Airmen (P... to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective August 23,...

  3. 77 FR 62429 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-15

    ... changes are designed to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  4. 76 FR 40600 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-11

    ... navigational facilities, adding new obstacles, or changing air traffic requirements. These changes are designed to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective July 11, 2011....

  5. 76 FR 37263 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... changes are designed to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Regional Office of the region in which the affected airport is located; 3. The National Flight...

  6. 78 FR 48800 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-12

    ... changes are designed to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective... Office of the region in which the affected airport is located; 3. The National Flight Procedures...

  7. 75 FR 12979 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ... navigational facilities, adding new obstacles, or changing air traffic requirements. These changes are designed to provide safe and efficient use of the navigable airspace and to promote safe flight operations under instrument flight rules at the affected airports. DATES: This rule is effective March 18,...

  8. Endoscopic Evaluation of Swallowing (Endoscopy)

    MedlinePlus

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

  9. Endoscopic Suturing and Knot Tying: Theory Into Practice

    PubMed Central

    Murphy, Donald L.

    2001-01-01

    Objective To advance modern surgical techniques of endoscopic knot tying, encompassing a new appreciation of knot-tying theory and the application of second-generation, purpose-designed instruments. Summary Background Data During open surgery, surgeons automatically create the surgical half-hitch by using either instrument or hand/finger knot-tying methods (figure 4). Each of these methods, which are mirror images of each other, forms the same result, the half-hitch. Two opposing half-hitches are needed to form a square knot. There are many ways for new-generation instruments to create a secure square knot during endoscopic surgery. An overview of the current endoscopic knot-tying methods is presented. Methods The author presents a theoretical analysis of square knot-tying techniques as applied during instrument and hand/finger movements. The application of a mirror-image concept was considered in the analysis of these two contrasting methods. Results There are 12 ways to create a square knot, some of which have previously not been described or needed in open surgery. Some of these methods have particular application in endoscopic surgery. Conclusions A new understanding of knot-tying theory has been developed, with innovative methods being defined for tissue approximation during endoscopic surgery. These ergonomic, efficient, and contrasting methods of knot tying are described using second-generation endoscopic instruments. The new techniques have direct and broad application in many fields of minimally invasive surgery. PMID:11685022

  10. Endoscopic laser treatment for pediatric nasal allergy.

    PubMed

    Araki, S; Suzuki, N; Sato, H; Yamaguchi, T; Fujita, H; Umezawa, Y; Suzuki, M

    2000-01-01

    We have used the carbon dioxide (CO(2)) laser and the gallium aluminium arsenide (GaAlAs) diode laser with flexible fiber delivery instruments for vaporization of the inferior nasal turbinate in pediatric patients since 1993. Under endoscopic control, the whole inferior turbinate was vaporized by 5-10 W laser output delivered via an optical fiber. Generally, the nasal mucosa changes into normal mucosa, and symptoms improve. The greatest symptomatic improvement was in nasal obstruction. The results obtained by the two laser devices were similar although they have had different characteristics. Endoscopic laser surgery is effective in the treatment of pediatric nasal allergy.

  11. 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.

  12. 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

  13. Imaging of the pancreatic duct by linear endoscopic ultrasound

    PubMed Central

    Sharma, Malay; Rai, Praveer; Rameshbabu, Chittapuram Srinivasan; Arya, Shalini

    2015-01-01

    The current gold standard investigation for anatomic exploration of the pancreatic duct (PD) is endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography is a noninvasive method for exploration of the PD. A comprehensive evaluation of the course of PD and its branches has not been described by endoscopic ultrasound (EUS). In this article, we describe the techniques of imaging of PD using linear EUS. PMID:26374577

  14. External Versus Endoscopic Endonasal Dacryocystorhinostomy.

    PubMed

    Grob, Seanna R; Campbell, Ashley; Lefebvre, Daniel R; Yoon, Michael K

    2015-01-01

    DCR is the treatment of choice for NLDO. External DCR has remained the standard approach since the 1890s. With advances in technique and technology, and more otolaryngologists and ophthalmologists performing endoscopic DCR, more studies have been conducted, some with equivalent success rates between the 2 approaches. Endoscopic endonasal DCR offers the advantages of avoiding a skin incision with similar success rates with experienced surgeons. However, the technique necessitates more surgical equipment, and has a steep learning curve. Both approaches have low complication rates and serious complications are very rare. The decision for the type of approach to use depends on the surgeon’s experience, the patient’s preference or concerns, and the resources available within a particular health system.

  15. Endoscopic imaging of Barrett's esophagus.

    PubMed

    Naveed, Mariam; Dunbar, Kerry B

    2016-03-10

    The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett's esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE. PMID:26981177

  16. 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...

  17. 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...

  18. 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...

  19. 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

  20. 75 FR 35627 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-23

    ... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a..., 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...

  1. 42 CFR 493.1252 - Standard: Test systems, equipment, instruments, reagents, materials, and supplies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS Quality System for Nonwaived Testing Analytic Systems § 493.1252 Standard: Test systems, equipment... electrical current that adversely affect patient test results and test reports. (c) Reagents, solutions... proper use. (d) Reagents, solutions, culture media, control materials, calibration materials, and...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... REQUIREMENTS Quality System for Nonwaived Testing Analytic Systems § 493.1252 Standard: Test systems, equipment... electrical current that adversely affect patient test results and test reports. (c) Reagents, solutions... proper use. (d) Reagents, solutions, culture media, control materials, calibration materials, and...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... REQUIREMENTS Quality System for Nonwaived Testing Analytic Systems § 493.1252 Standard: Test systems, equipment... electrical current that adversely affect patient test results and test reports. (c) Reagents, solutions... proper use. (d) Reagents, solutions, culture media, control materials, calibration materials, and...

  4. 76 FR 52237 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-22

    ..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA..., Flight Standards Service, Federal Aviation Administration, Mike Monroney Aeronautical Center, 6500 South MacArthur Blvd., Oklahoma City, OK 73169 (Mail Address: P.O. Box 25082, Oklahoma City, OK...

  5. 78 FR 5130 - Standard Instrument Approach Procedures and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-24

    ..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA... Division, Flight Standards Service, Federal Aviation Administration, Mike Monroney Aeronautical Center, 6500 South MacArthur Blvd., Oklahoma City, OK 73169 (Mail Address: P.O. Box 25082 Oklahoma City,...

  6. 75 FR 39152 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... INFORMATION CONTACT: Harry J. Hodges, Flight Procedure Standards Branch (AFS-420), Flight Technologies and... Policies and Procedures (44 FR 11034; February 26,1979); and (3)does not warrant preparation of a... 1 Marianna, AR, Marianna/Lee County-Steve Edwards Field, RNAV (GPS) RWY 18, Orig Marianna,...

  7. 78 FR 75456 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a... 22, 2013. John Duncan, Director, Flight Standards Service. Adoption of the Amendment Accordingly... Addison 3/1617 11/15/13 RNAV (GPS) RWY 33, Amdt 1. 1/9/14 OH Cleveland Cleveland-Hopkins 3/4020...

  8. 76 FR 4064 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-24

    ... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a... 7, 2011. John McGraw, Deputy Director, Flight Standards Service. Adoption of the Amendment... Cleveland Cleveland-Hopkins 0/2702 12/23/10 ILS PRM RWY 24R (Sim. Close Parallel), Orig- Intl. B. ]...

  9. 77 FR 37801 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... ``significant rule '' under DOT Regulatory Policies and Procedures (44 FR 11034; February 26,1979) ; and (3...). Issued in Washington, DC on June 8, 2012. John Duncan, Deputy Director, Flight Standards Service... Niagara Intl, Takeoff Minimums and Obstacle DP, Amdt 6 Cleveland, OH, Cleveland-Hopkins Intl,...

  10. 75 FR 45049 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a regulatory evaluation.... John M. Allen, Director, Flight Standards Service. Adoption of the Amendment 0 Accordingly, pursuant to...-Aug-10 OH CLEVELAND CLEVELAND-HOPKINS 0/8648 7/6/10 RNAV (GPS) RWY 6L, AMDT 1 INTL. 26-Aug-10...

  11. Endoscopic Skull Base Surgery

    PubMed Central

    Senior, Brent A

    2008-01-01

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

  12. 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

  13. 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.

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

    PubMed Central

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

    2014-01-01

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

  15. Per-oral endoscopic myotomy: major advance in achalasia treatment and in endoscopic surgery.

    PubMed

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

    2014-12-21

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

  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. Current applications of endoscopic suturing

    PubMed Central

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

    2015-01-01

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

  18. 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.

  19. Comprehensive combinatory standard correction: a calibration method for handling instrumental drifts of gas chromatography-mass spectrometry systems.

    PubMed

    Deport, Coralie; Ratel, Jérémy; Berdagué, Jean-Louis; Engel, Erwan

    2006-05-26

    The current work describes a new method, the comprehensive combinatory standard correction (CCSC), for the correction of instrumental signal drifts in GC-MS systems. The method consists in analyzing together with the products of interest a mixture of n selected internal standards, and in normalizing the peak area of each analyte by the sum of standard areas and then, select among the summation operator sigma(p = 1)(n)C(n)p possible sums, the sum that enables the best product discrimination. The CCSC method was compared with classical techniques of data pre-processing like internal normalization (IN) or single standard correction (SSC) on their ability to correct raw data from the main drifts occurring in a dynamic headspace-gas chromatography-mass spectrometry system. Three edible oils with closely similar compositions in volatile compounds were analysed using a device which performance was modulated by using new or used dynamic headspace traps and GC-columns, and by modifying the tuning of the mass spectrometer. According to one-way ANOVA, the CCSC method increased the number of analytes discriminating the products (31 after CCSC versus 25 with raw data or after IN and 26 after SSC). Moreover, CCSC enabled a satisfactory discrimination of the products irrespective of the drifts. In a factorial discriminant analysis, 100% of the samples (n = 121) were well-classified after CCSC versus 45% for raw data, 90 and 93%, respectively after IN and SSC. PMID:16631179

  20. 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.

  1. 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.

  2. Gravimetric approach to the standard addition method in instrumental analysis. 1.

    PubMed

    Kelly, W Robert; MacDonald, Bruce S; Guthrie, William F

    2008-08-15

    A mathematical formulation for a gravimetric approach to the univariate standard addition method (SAM) is presented that has general applicability for both liquids and solids. Using gravimetry rather than volumetry reduces the preparation time, increases design flexibility, and makes increased accuracy possible. SAM has most often been used with analytes in aqueous solutions that are aspirated into flames or plasmas and determined by absorption, emission, or mass spectrometric techniques. The formulation presented here shows that the method can also be applied to complex matrixes, such as distillate and residual fuel oils, using techniques such as X-ray fluorescence (XRF) or combustion combined with atomic fluorescence or absorption. These techniques, which can be subject to matrix-induced interferences, could realize the same benefits that have been demonstrated for dilute aqueous solutions.

  3. Endoscopic Ultrasound Guided Embolization of a Pancreatic Pseudoaneurysm

    PubMed Central

    Robb, Paul M.; Yeaton, Paul; Bishop, Thomas; Wessinger, John

    2012-01-01

    Pseudoaneurysms are rare complications of chronic pancreatitis and are associated with a high mortality. In this article we demonstrate a novel utilization of endoscopic ultrasound (EUS) technology to embolize a large pancreatic pseudoaneurysm when gold standard therapies had proven futile.

  4. Endoscopic management of nonlifting colon polyps.

    PubMed

    Friedland, Shai; Shelton, Andrew; Kothari, Shivangi; Kochar, Rajan; Chen, Ann; Banerjee, Subhas

    2013-01-01

    Background and Study Aims. The nonlifting polyp sign of invasive colon cancer is considered highly sensitive and specific for cancer extending beyond the mid-submucosa. However, prior interventions can cause adenomas to become nonlifting due to fibrosis. It is unclear whether nonlifting adenomas can be successfully treated endoscopically. The aim of this study was to evaluate outcomes in a referral practice incorporating a standardized protocol of attempted endoscopic resection of nonlifting lesions previously treated by biopsy, polypectomy, surgery, or tattoo placement. Patients and Methods. Retrospective review of patients undergoing colonoscopy by one endoscopist at two hospitals found to have nonlifting lesions from prior interventions. Lesions with biopsy proven invasive cancer or definite endoscopic features of invasive cancer were excluded. Lesions ≥ 8 mm were routinely injected with saline prior to attempted endoscopic resection. Polypectomy was performed using a stiff snare, followed by argon plasma coagulation (APC) if necessary. Results. 26 patients each had a single nonlifting lesion with a history of prior intervention. Endoscopic resection was completed in 25 (96%). 22 required snare resection and APC. 1 patient had invasive cancer and was referred for surgery. The recurrence rate on follow-up colonoscopy was 26%. All of the recurrences were successfully treated endoscopically. There was 1 postprocedure bleed (4%), no perforations, and no other complications. Conclusions. The majority of adenomas that are nonlifting after prior interventions can be treated successfully and safely by a combination of piecemeal polypectomy and ablation. Although recurrence rates are high at 26%, these too can be successfully treated endoscopically. PMID:23761952

  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. 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)....

  7. 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)....

  8. 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)....

  9. 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)....

  10. Natural orifice transluminal endoscopic surgery: where are we going?

    PubMed

    Whang, Susan H; Thaler, Klaus

    2010-09-21

    The foundation for natural orifice transluminal endoscopic surgery (NOTES) is to access the peritoneal and other body cavities through the wall of the alimentary tract via natural orifices, with the goal of performing procedures within the peritoneum and other cavities, without the need to make incisions in the abdominal wall. We have made great progress in the field of NOTES since the publication of the White Paper in 2006. There are still major fundamental goals as outlined by the Society of American Gastrointestinal and Endoscopic Surgeons/American Society for Gastrointestinal Endoscopy joint committee that need to be evaluated and answered before NOTES is ready for widespread clinical use. These include prevention of infection, instrument development, creation of a multitasking platform, and the ability to recognize and treat intraperitoneal complications such as hemorrhage and other physiological adverse events. In response to this need, recent abstracts and papers have focused on the management of intraoperative complications. The next phase is to focus on controlled prospective multicenter clinical trials that compare defined NOTES procedure to standard laparoscopy. The goal is to produce reliable and convincing data for the United States Food and Drug Administration, insurance companies, the physician community and the general public. At the present time, we still have many important milestones that still need to be met. Most investigators agree that a hybrid technique and not a pure NOTES practice should be advocated until devices can meet the current and new challenges in this field.

  11. Endoscopic submucosal dissection.

    PubMed

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

    2015-01-01

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

  12. Duodenal angiolipoma -- endoscopic diagnosis and therapy.

    PubMed

    Mohl, W; Fischinger, J; Moser, C; Remberger, K; Zeuzem, S; Stallmach, A

    2004-12-01

    We report on two patients with upper gastrointestinal bleeding owing to duodenal angiolipomas, and their endoscopic diagnosis and therapy. In both cases the bleeding source was a pedunculated tumour. Diagnosis and definitive therapy was made by endoscopic snare polypectomy. After stopping the bleeding from the mucosal defect by injection therapy in one patient, the further course was uneventful in both. A colonic angiolipoma in one of the patients was also treated by polypectomy. Gastrointestinal angiolipomas are exceedingly rare, however, these case reports show that duodenal angiolipomas do exist and that they, as lipomas, may lead to substantial gastrointestinal bleeding and may be treated successfully by standard polypectomy techniques.

  13. 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 ...

  14. Understanding EUS (Endoscopic Ultrasonography)

    MedlinePlus

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

  15. [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. PMID:25990334

  16. Endoscopic management of benign biliary strictures.

    PubMed

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Benign biliary strictures are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has evolved over the last 2 decades as the current standard of care. The most common etiologies of strictures encountered are following surgery and those related to chronic pancreatitis. High-quality cross-sectional imaging provides a road map for endoscopic management. Currently, sequential placement of multiple plastic biliary stents represents the preferred approach. There is an increasing role for the treatment of these strictures using covered metal stents, but due to conflicting reports of efficacies as well as cost and complications, this approach should only be entertained following careful consideration. Optimal management of strictures is best achieved using a team approach with the surgeon and interventional radiologist playing an important role.

  17. 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.

  18. Endoscopic Techniques in Tympanoplasty.

    PubMed

    Anzola, Jesus Franco; Nogueira, João Flávio

    2016-10-01

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

  19. Are we meeting the standards set for endoscopy? Results of a large‐scale prospective survey of endoscopic retrograde cholangio‐pancreatograph practice

    PubMed Central

    Williams, Earl J; Taylor, Steve; Fairclough, Peter; Hamlyn, Adrian; Logan, Richard F; Martin, Derrick; Riley, Stuart A; Veitch, Peter; Wilkinson, Mark; Williamson, Paula R; on behalf of participating units, Martin Lombard

    2007-01-01

    Objective To examine endoscopic retrograde cholangio‐pancreatography (ERCP) services and training in the UK. Design Prospective multicentre survey. Setting Five regions of England. Participants Hospitals with an ERCP unit. Outcome measures Adherence to published guidelines, technical success rates, complications and mortality. Results Organisation questionnaires were returned by 76 of 81 (94%) units. Personal questionnaires were returned by 190 of 213 (89%) ERCP endoscopists and 74 of 91 (81%) ERCP trainees, of whom 45 (61%) reported participation in <50 ERCPs per annum. In all, 66 of 81 (81%) units collected prospective data on 5264 ERCPs, over a mean period of 195 days. Oximetry was used by all units, blood pressure monitoring by 47 of 66 (71%) and ECG monitoring by 37 of 66 (56%) units; 1484 of 4521 (33%) patients were given >5 mg of midalozam. Prothrombin time was recorded in 4539 of 5264 (86%) procedures. Antibiotics were given in 1021 of 1412 (72%) cases, where indicated. Patients' American Society of Anesthesiology (ASA) scores were 3–5 in 670 of 5264 (12.7%) ERCPs, and 4932 of 5264 (94%) ERCPs were scheduled with therapeutic intent. In total, 140 of 182 (77%) trained endoscopists demonstrated a cannulation rate ⩾80%. The recorded cannulation rate among senior trainees (with an experience of >200 ERCPs) was 222/338 (66%). Completion of intended treatment was done in 3707 of 5264 (70.4%) ERCPs; 268 of 5264 (5.1%) procedures resulted in a complication. Procedure‐related mortality was 21/5264 (0.4%). Mortality correlated with ASA score. Conclusion Most ERCPs in the UK are performed on low‐risk patients with therapeutic intent. Complication rates compare favourably with those reported internationally. However, quality suffers because there are too many trainees in too many low‐volume ERCP centres. PMID:17145737

  20. A comparison of methods for determining lead content in drinking water: a portable anodic stripping voltammetry instrument method versus the standard EPA 239.2 method.

    PubMed

    Savely, S M; Emery, R J; Connor, T H

    2000-01-01

    Lead levels in drinking water were measured by the standard U.S. Environmental Protection Agency (EPA)-approved atomic absorption spectroscopy-graphite furnace Method 239.2 and compared with determinations made with a newly available portable anodic stripping voltammetry (PASV) instrument. A standard curve was prepared at 2, 5, 10, 15, 20, 25, and 30 microg/L of lead. PASV instrument readings were lower than standard EPA method values, with a mean difference and standard error (SE) of the mean between the two of 1.538+/-0.588 microg/L (n = 7, p = 0.040, significant at the 95% confidence interval [CI]). First-flush drinking water samples collected from 144 water fountains/coolers were preserved with nitric acid. Total lead content was tested twice for 29 EPA method samples and 54 PASV instrument samples to determine the variation within each method; results were not significant at the 95% CI. Total lead content was determined for 144 samples by both methods. PASV instrument readings were lower than standard EPA method values (mean difference and SE of the mean 0.630+/-0.206 microg/L; n = 144, p = 0.0027, significant at the 95% CI). Mean and standard deviation of the 144 samples for the EPA method and the PASV instrument were 6.5+/-11.8 microg/L and 5.9+/-11.6 microg/L, respectively. Means were below the action level for lead of 15 ppb (microg/L), but some values were above the action level (18 [13%] using the EPA method; 20 [14%] using the PASV instrument). Retesting by EPA method showed two false positive PASV values. Results indicate that in some field situations the PASV instrument may prove useful due to its relatively low price, small size, ease of use, and quick readings.

  1. Technical innovations and the evolution of endoscopic sinus surgery.

    PubMed

    Kennedy, David W

    2006-09-01

    Since the introduction of endoscopic sinus surgery, a number of significant technological advances, as well as an improved understanding of disease pathogenesis and management, have enabled major evolutions in surgical techniques. Modifications to surgical instruments, imaging, the development of the microdebrider, and other newer instrumentation have all contributed to the current level of patient success associated with endoscopic intranasal techniques. At the same time, it has become evident that anatomic variations are less important in the pathogenesis of chronic rhinosinusitis than was previously thought, and that ventilation alone is insufficient to resolve well-established disease. This paper reviews the changes that have occurred in endoscopic sinus surgery over the past 20 years since the techniques were first introduced into the United States, and the technologies that have enabled these changes and the development of extended endoscopic techniques. Continuing developments of interactive computer-guided surgery, endoscopic 3-dimensional imagery, robotics, and improved adjunctive therapies will further extend the role of endoscopic transnasal approaches to an expanded number of skull base and intracranial lesions. PMID:17040012

  2. 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.

  3. 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…

  4. 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

  5. Development of an Automatic Endoscope Positioning System based on Biological Fluctuation

    NASA Astrophysics Data System (ADS)

    Yamada, Yasuo; Nishikawa, Atsushi; Sekimoto, Mitsugu; Toda, Shingo; Takiguchi, Shuji; Miyoshi, Norikatsu; Kobayashi, Takeharu; Kazuhara, Kouhei; Ichihara, Takaharu; Kurashita, Naoto; Doki, Yuichiro; Mori, Masaki; Miyazaki, Fumio

    In general endoscopic surgery, the surgeon operates instruments and the camera assistant operates an endoscope. Because of shortage of physicians, there are demands for transition to endoscopic solo surgery. For the purpose of this demand, the automatic endoscope positioning system which operates the endoscope instead of the camera assistant during surgery has been actively researched from home and abroad. Almost research of automatic endoscope positioning system has tried to make a model of camera assistant's endoscopic operation. However, there is no system which has enough performance as compared with the camera assistant. The difficulty of making an accurate model of camera assistant's endoscopic operation is the most significant factor. We propose a bio-inspired automatic endoscope positioning algorithm which is a nonmodel based approach and develop a system which was implemented the proposed algorithm. We assess the surgeon's procedure through gallbladder removal simulations using the automatic endoscope positioning system. We compare an algorithm which has been seen in previously research with the proposed algorithm. We validate the effectivity of the proposed method as compared with the surgeon's procedure.

  6. 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.

  7. 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. PMID:10355102

  8. Olecranon extrabursal endoscopic bursectomy.

    PubMed

    Tu, Chen G; McGuire, Duncan T; Morse, Levi P; Bain, Gregory I

    2013-09-01

    Olecranon bursitis is a common clinical problem. It is often managed conservatively because of the high rates of wound complications with the conventional open surgical technique. Conventional olecranon bursoscopy utilizes an arthroscope and an arthroscopic shaver, removing the bursa from inside-out. We describe an extrabursal endoscopic technique where the bursa is not entered but excised in its entirety under endoscopic vision. A satisfactory view is obtained with less morbidity than the open method, while still avoiding a wound over the sensitive point of the olecranon. PMID:23970201

  9. 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.

  10. 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.

  11. 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. PMID:26946312

  12. The endoscopic diagnosis of early gastric cancer

    PubMed Central

    Yao, Kenshi

    2013-01-01

    The aim of this article is to demonstrate the basic principles for the endoscopic diagnosis of early gastric cancer. The diagnostic process can be divided into two steps, detection and characterization. Detection requires good endoscopic technique, and thorough knowledge. With regard to technique, we should administer the optimum preparation to patients, including an antiperistaltic agent. Furthermore, in order to map the entire stomach we need to follow a standardized protocol, and we propose a systematic screening protocol for the stomach. With regard to knowledge, we should be able to identify high-risk background mucosa, and we should be aware of the indicators of a suspicious lesion. Chromoendoscopy and magnifying endoscopy are promising image-enhanced endoscopic techniques for characterization. The proposed criteria for a cancerous lesion are as follows: conventional endoscopic findings of 1) a well-demarcated lesion and 2) irregularity in color/surface pattern; vessel plus surface classification using magnifying endoscopy with narrow-band imaging findings of 1) irregular microvascular pattern with a demarcation line or 2) irregular microsurface pattern with a demarcation line. Conventional endoscopy and subsequent image-enhanced endoscopy can both contribute to the detection of early gastric cancer. PMID:24714327

  13. Visual SLAM for Handheld Monocular Endoscope.

    PubMed

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

    2014-01-01

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

  14. Visual SLAM for Handheld Monocular Endoscope.

    PubMed

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

    2014-01-01

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

  15. Endoscopic treatment of obesity

    PubMed Central

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

    2011-01-01

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

  16. School Principal Evaluation in Wyoming: Alignment between Instruments Used to Evaluate School Principals in Wyoming and the ISLLC 2008 Standards for School Leaders

    ERIC Educational Resources Information Center

    Woodford, Rick

    2012-01-01

    This study is premised on the discrepancy that exists in the standards used to train and credential school principals and the elements of principal evaluation found on evaluation instruments used to evaluate the performance of school principals in Wyoming school districts. The purpose of this study was to explore the alignment between the ISLLC…

  17. 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).

  18. Replacing Transanal Excision with Transanal Endoscopic Microsurgery and/or Transanal Minimally Invasive Surgery for Early Rectal Cancer

    PubMed Central

    Hakiman, Hekmat; Pendola, Michael; Fleshman, James W.

    2015-01-01

    The use of local resection of rectal polyps and early rectal cancer has progressed to become the standard of care in most institutions with a colorectal surgery specialist. The use of transanal excision (TAE) with anorectal retractors and standard instrumentation has been supplanted by the application of endoscopic techniques which allow direct video augmented visualization. The transanal endoscopic microsurgery method provides a 3D view and works under a constant flow of air to keep the rectal vault open. Instruments capable of accomplishing a surgical excision and suture closure work through a long 4 cm tube set at the anal canal. The newest version of TAE is transanal minimally invasive surgery which is similar to a single-site laparoscopic technique using a hand access port at the anal canal to maintain a seal for insufflation of the rectum, regular 2D video camera for visualization, and laparoscopic instrumentation through the port in the anus. Each of these techniques is described in detail and the outcomes compared, which show the progress being made in this area of colorectal surgery. PMID:25733972

  19. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis.

    PubMed

    Seifert, H; Wehrmann, T; Schmitt, T; Zeuzem, S; Caspary, W F

    2000-08-19

    Standard management of infected peripancreatic necrosis consists of open surgical debridement and lavage--a traumatic intervention with substantial morbidity and mortality. As an alternative and novel approach with minimum invasiveness, we present fenestration of the gastric wall and debridement of infected necrosis by direct retroperitoneal endoscopy. In three patients, this strategy led to rapid clinical improvement and no serious complications. Transgastric endoscopic therapy may be a less traumatic alternative to surgery and should be further assessed in prospective studies.

  20. 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.

  1. 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

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

    PubMed

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

    2016-01-25

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

  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. [Endoscopic Therapy for Esophageal Cancer].

    PubMed

    Sakai, Makoto; Kuwano, Hiroyuki

    2016-07-01

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

  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. PMID:24436926

  6. 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.

  7. Novel endoscopic over-the-scope clip system

    PubMed Central

    Armellini, Elia; Crinò, Stefano Francesco; Orsello, Marco; Ballarè, Marco; Tari, Roberto; Saettone, Silvia; Montino, Franco; Occhipinti, Pietro

    2015-01-01

    This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy’s lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in “difficult” scenarios, like recurrent bleeding and respiratory-oesophageal fistulas. PMID:26730172

  8. Novel endoscopic over-the-scope clip system.

    PubMed

    Armellini, Elia; Crinò, Stefano Francesco; Orsello, Marco; Ballarè, Marco; Tari, Roberto; Saettone, Silvia; Montino, Franco; Occhipinti, Pietro

    2015-12-28

    This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.

  9. 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

  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. 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

  12. Laparoscopic endoscopic cooperative surgery.

    PubMed

    Hiki, Naoki; Nunobe, Souya; Matsuda, Tatsuo; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Yamaguchi, Toshiharu

    2015-01-01

    Laparoscopic and endoscopic cooperative surgery (LECS) is a newly developed concept for tumor dissection of the gastrointestinal tract that was first investigated for local resection of gastric gastrointestinal stromal tumors (GIST). The first reported version of LECS for GIST has been named 'classical LECS' to distinguish it from other modified LECS procedures, such as inverted LECS, a combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). These modified LECS procedures were developed for dissection of malignant tumors which may seed tumor cells into the abdominal cavity. While these LECS-related procedures might prevent tumor seeding, their application is limited by several factors, such as tumor size, location and technical difficulty. Currently, classical LECS is a safe and useful procedure for gastric submucosal tumors without mucosal defects, independent of tumor location, such as proximity to the esophagogastric junction or pyloric ring. For future applications of LECS-related procedures for other malignant diseases with mucosal lesions such as GIST with mucosal defects and gastric cancer, some improvements in the techniques are needed.

  13. 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.

  14. 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

  15. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging. PMID:18044620

  16. Endoscopic imaging of Barrett’s esophagus

    PubMed Central

    Naveed, Mariam; Dunbar, Kerry B

    2016-01-01

    The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE. PMID:26981177

  17. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging.

  18. 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

  19. 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.

  20. Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review.

    PubMed

    Presutti, L; Gioacchini, F M; Alicandri-Ciufelli, M; Villari, D; Marchioni, D

    2014-06-01

    Traditional surgery for cholesteatoma of the middle ear is performed by microscopic approaches. However, in recent years endoscopic instrumentation, techniques and knowledge have greatly improved, and in our opinion endoscopic surgical techniques will gain increasing importance in otologic surgery in the future. The aim of this study was to focus on outcomes obtained using endoscopic surgery for the treatment of middle ear cholesteatoma. A systematic review of the literature was performed. A total of 7 articles comprising 515 patients treated exclusively with endoscope or with a combined technique were found. During post-surgical follow-up, 48 (9.3%) patients showed a residual or recurrent pathology. Despite the small number of patients analyzed in our review, the outcomes of this technique appear to be promising. In particular, concerning the rates of recurrences and residual disease, endoscopic middle ear surgery appears to guarantee similar results in comparison to classic microscopic approaches with the advantage of performing minimally invasive surgery.

  1. Maximizing the diagnostic utility of endoscopic biopsy in dogs and cats with gastrointestinal disease.

    PubMed

    Jergens, Albert E; Willard, Michael D; Allenspach, Karin

    2016-08-01

    Flexible endoscopy has become a valuable tool for the diagnosis of many small animal gastrointestinal (GI) diseases, but the techniques must be performed carefully so that the results are meaningful. This article reviews the current diagnostic utility of flexible endoscopy, including practical/technical considerations for endoscopic biopsy, optimal instrumentation for mucosal specimen collection, the correlation of endoscopic indices to clinical activity and to histopathologic findings, and new developments in the endoscopic diagnosis of GI disease. Recent studies have defined endoscopic biopsy guidelines for the optimal number and quality of diagnostic specimens from different regions of the gut. They also have shown the value of ileal biopsy in the diagnosis of canine and feline chronic enteropathies, and have demonstrated the utility of endoscopic biopsy specimens beyond routine hematoxylin and eosin histopathological analysis, including their use in immunohistochemical, microbiological, and molecular studies. PMID:27387727

  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. Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note.

    PubMed

    Felbaum, Daniel; Syed, Hasan R; Ryan, Joshua E; Jean, Walter C; Anaizi, Amjad

    2016-03-06

    Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal

  4. The Use of Client Surrogates in Determining the Reliability of a Standardized Assessment Instrument in Multiple, Diverse Settings.

    ERIC Educational Resources Information Center

    Peters, C. P.; Friedman, N.; Jacobs, S. S.; Jones, B. J.; Kelley, J. M.; Nazar, K. L.

    1999-01-01

    Studied the reliability of the Addiction Severity Index (1980) by using eight trained professional actors as client surrogates to examine the reliability of the instrument when administered in the field. With careful surrogate selection and training, the method proves to be an effective means of assessment. (SLD)

  5. 14 CFR 91.205 - Powered civil aircraft with standard category U.S. airworthiness certificates: Instrument and...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... chapter, as applicable, that were in effect on August 10, 1971, except that the color may be either... required for Category III operations are specified in paragraph (d) of this section. (h) Night vision goggle operations. For night vision goggle operations, the following instruments and equipment must...

  6. Endoscopic Management of Dieulafoy's Lesion

    PubMed Central

    Jeon, Hye Kyung

    2015-01-01

    A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions. PMID:25844338

  7. 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

  8. MINOP: development of a miniaturized endoscopic operation system for neurosurgery

    NASA Astrophysics Data System (ADS)

    Guber, Andreas E.; Wieneke, Paul

    1996-04-01

    Within the framework of R&D activities in the field of microsystems technology, the Institute for Microstructure Technology of Karlsruhe Research Center among others has started to improve the functionality of existing medicotechnical instruments by increased integration of microtechnical components. On the basis of microsystems fabrication techniques, completely novel medical endoscope systems have become feasible. In cooperation with clinical, technical and industrial partners, a novel endoscopic operation system based on microsystems technology is being developed by the Institute for Microstructure Technology and the Aesculap AG company, Tuttlingen within the framework of the MINOP joint project. This new system shall be applied above all in the field of neurosurgery. This newly conceived endosystem is characterized by a multitude of novelties. It can perform a number of both sensor and actor functions. Due to its extremely small outer diameter, it can be applied through minute openings. As a result of the integrated microfluidic control system, the flexible endoscope can be moved to the actual site of operation on a previously specified path. This will allow future bi- and triportal neuro-endoscopic interventions for critical operations in the brain area. The different lumina of the flexible endoscope fulfill various functions. Via the optical fibers, laser radiation may be led to the distal end of the endoscope. Using microtechnical fabrication methods, special plastic microlenses have been produced. The working channel can be applied for rinsing and removal. Furthermore, the cleaning of the optics or the taking of tissue samples are possible. If required, another laser fiber can be driven forward through the working channel for selective therapy. For the first time, high-performance microinstruments have been developed on the basis of novel materials. These instruments can be applied either through the working channel or through an additional trocar.

  9. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes

    PubMed Central

    Yue, James J.; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection. PMID:26114086

  10. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    PubMed

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

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures. PMID:25534058

  11. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes.

    PubMed

    Yue, James J; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection. PMID:26114086

  12. Hemostasis in Endoscopic Endonasal Skull Base Surgery

    PubMed Central

    Vaz-Guimaraes, Francisco; Su, Shirley Y.; Fernandez-Miranda, Juan C.; Wang, Eric W.; Snyderman, Carl H.; Gardner, Paul A.

    2015-01-01

    William Halsted established the basic principles of modern surgical technique highlighting the importance of meticulous hemostasis and careful tissue handling. These concepts hold true today and are even more critical for endoscopic visualization, making hemostasis one of the most relevant cornerstones for the safe practice of endoscopic endonasal surgery (EES) of the skull base. During preoperative assessment, patients at higher risk for serious hemorrhagic complications must be recognized. From an anatomical point of view, EES can be grossly divided in two major components: sinonasal surgery and sellar-cranial base surgery. This division affects the choice of appropriate technique for control of bleeding that relies mainly on the source of hemorrhage, the tissue involved, and the proximity of critical neurovascular structures. Pistol-grip or single-shaft instruments constitute the most important and appropriately designed instruments available for EES. Electrocoagulation and a variety of hemostatic materials are also important tools and should be applied wisely. This article describes the experience of our team in the management of hemorrhagic events during EES with an emphasis on technical nuances. PMID:26225320

  13. Endoscopic laser-urethroplasty

    NASA Astrophysics Data System (ADS)

    Gilbert, Peter

    2006-02-01

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

  14. 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.

  15. Endoscopic extraperitoneal lumbar sympathectomy.

    PubMed

    Hourlay, P; Vangertruyden, G; Verduyckt, F; Trimpeneers, F; Hendrickx, J

    1995-05-01

    From June 24, 1993, until November 9, 1993, eight sympathectomies were performed by extraperitoneal endoscopy for treatment of Sudeck atrophy. Seventy-five percent of the patients were satisfied with the result of the intervention. A follow-up after 4 months shows that four patients are free of pain. Two are satisfied, but some pain remains. In two cases, the intensity of the pain remains unchanged but the character of the pain has changed. This new technique is safe and offers the well-known advantages of minimal invasive surgery. Moreover, this endoscopic approach opens perspectives for the exploration of the entire retroperitoneum. PMID:7545831

  16. 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. PMID:27284515

  17. Therapeutic Endoscopic Ultrasound

    PubMed Central

    Cheriyan, Danny

    2015-01-01

    Endoscopic ultrasound (EUS) technology has evolved dramatically over the past 20 years, from being a supplementary diagnostic aid available only in large medical centers to being a core diagnostic and therapeutic tool that is widely available. Although formal recommendations and practice guidelines have not been developed, there are considerable data supporting the use of EUS for its technical accuracy in diagnosing pancreaticobiliary and gastrointestinal pathology. Endosonography is now routine practice not only for pathologic diagnosis and tumor staging but also for drainage of cystic lesions and celiac plexus neurolysis. In this article, we cover the use of EUS in biliary and pancreatic intervention, ablative therapy, enterostomy, and vascular intervention. PMID:27118942

  18. Development of a Pre-Service Teachers' Self-Efficacy Instrument Regarding Teacher Health Education Standards

    ERIC Educational Resources Information Center

    Clark, Jeffrey K.; Brey, Rebecca A.; Clark, Susan E.

    2013-01-01

    Background: Whereas many education programs expect students to use national standards in various content areas, few studies have been conducted that examine pre-service teachers' confidence in demonstrating their use of the professional teacher standards. Purpose: The purpose of this project was 2-fold: (1) To develop the Pre-service Health…

  19. Endoscopic detection of early upper GI cancers.

    PubMed

    Wong Kee Song, Louis-Michel; Wilson, Brian C

    2005-12-01

    The detection of early-stage neoplastic lesions in the upper GI tract is associated with improved survival and the potential for complete endoscopic resection that is minimally invasive and less morbid than surgery. Despite technological advances in standard white-light endoscopy, the ability of the endoscopist to reliably detect dysplastic and early cancerous changes in the upper GI tract remains limited. In conditions such as Barrett's oesophagus, practice guidelines recommend periodic endoscopic surveillance with multiple biopsies, a methodology that is hindered by random sampling error, inconsistent histopathological interpretation, and delay in diagnosis. Early detection may be enhanced by several promising diagnostic modalities such as chromoendoscopy, magnification endoscopy, and optical spectroscopic/imaging techniques, as these modalities offer the potential to identify in real-time lesions that are inconspicuous under conventional endoscopy. The combination of novel diagnostic techniques and local endoscopic therapies will provide the endoscopist with much needed tools that can considerably enhance the detection and management of early stage lesions in the upper GI tract.

  20. 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.

  1. Endoscopic radiofrequency ablation for malignant biliary strictures

    PubMed Central

    WANG, FEI; LI, QUANPENG; ZHANG, XIUHUA; JIANG, GUOBING; GE, XIANXIU; YU, HONG; NIE, JUNJIE; JI, GUOZHONG; MIAO, LIN

    2016-01-01

    Endoscopic radiofrequency ablation (RFA) is a novel palliation therapy for malignant biliary stricture; however, its feasibility and safety has not yet been clearly defined. The aim of the present study was to evaluate the feasibility and safety of endoscopic RFA for the treatment of malignant biliary strictures. A total of 12 patients treated by endoscopic RFA between December 2011 and October 2013 were retrospectively analyzed. Adverse events within 30 days post-intervention, stricture diameters prior to and following RFA, stent patency and survival time were investigated. A total of 12 patients underwent 20 RFA procedures as a treatment for malignant biliary strictures. Two patients required repeated elective RFA (4 and 6 times, respectively). All 20 RFA procedures were successfully performed without technical problems. During a 30 day period following each RFA procedure, two patients experienced fever (38.2 and 38.9°C, respectively) and another patient exhibited post-endoscopic retrograde cholangiopancreatography pancreatitis. The 30- and 90-day mortality rates were 0 and 8.3%, respectively. Mean stricture diameter prior to RFA was 5.3 mm (standard deviation (SD), 0.9 mm; range, 5–8 mm), and the mean diameter following RFA was 12.6 mm (SD, 3.1 mm; range, 8–15 mm). There was a significant increase of 7.3 mm in the bile duct diameter following RFA in comparison with prior to RFA (t=8.6; P≤0.001). Of the 11 patients with stents inserted following RFA, the median stent patency was 125.0 days [95% confidence interval (CI), 94.7–155.3 days]. Extrapolated median survival following the first RFA was 232 days (95% CI, 94.3–369.7 days). In conclusion, RFA appears to be an efficient and safe treatment strategy for the palliation of unresectable malignant biliary strictures. PMID:27284336

  2. [The recent news in endoscopic surgery: a review of the literature and meta-analysis].

    PubMed

    Klimenko, K É

    2012-01-01

    During a few recent years, endonasal surgery has become the principal tool for the operative treatment of many pathologies affecting the base of the skull. The present work was designed to estimate the possibilities of using endoscopic endonasal surgery to treat sinus and skull base lesions and illustrate the recent progress in the development of endoscopic equipment and instrumentation. The meta-analysis of the results of on-going research on the application of the endonasal endoscopic technology is described with the special emphasis on the plastic treatment of liquor fistulas, removal of juvenile nasopharyngeal angiofibromas, treatment of pathological changes in the clivial region and odontoid cervicomedullary junction. PMID:23304718

  3. Robotic control of a traditional flexible endoscope for therapy.

    PubMed

    Ruiter, J G; Bonnema, G M; van der Voort, M C; Broeders, I A M J

    2013-09-01

    In therapeutic flexible endoscopy a team of physician and assistant(s) is required to control all independent translations and rotations of the flexible endoscope and its instruments. As a consequence the physician lacks valuable force feedback information on tissue interaction, communication errors easily occur, and procedures are not cost-effective. Current tools are not suitable for performing therapeutic procedures in an intuitive and user-friendly way by one person. A shift from more invasive surgical procedures that require external incisions to endoluminal procedures that use the natural body openings could be expected if enabling techniques were available. This paper describes the design and evaluation of a robotic system which interacts with traditional flexible endoscopes to perform therapeutic procedures that require advanced maneuverability. The physician uses one multi-degree-of-freedom input device to control camera steering as well as shaft manipulation of the motorized flexible endoscope, while the other hand is able to manipulate instruments. We identified critical use aspects that need to be addressed in the robotic setup. A proof-of-principle setup was built and evaluated to judge the usability of our system. Results show that robotic endoscope control increases efficiency and satisfaction. Participants valued its intuitiveness, its accuracy, the feeling of being in control, and its single-person setup. Future work will concentrate on the design of a system that is fully functional and takes safety, cleanability, and easy positioning close to the patient into account.

  4. Problems in Endoscopic Sphincteropapillotomy

    PubMed Central

    Yang, Yeong Cheol; Myeong, Jae II; Yeo, Hyang Soon; Park, Hong Bae

    1987-01-01

    Since 1976, endoscopic retrograde cholangiopancreatography(ERCP) has been done in 2,185 cases at Kwangju Christian Hospital in Kwangju, Korea, Between November 1981 and September 1986, endoscopic sphincteropapillotomy(EST) was performed on 194 patients. The results are as follows: 1) Common bile duct stones were found in 171 patients, ascaris in the common bile ducts of 12 patients, ascaris and stones in the common bile duct of 1 patient, clonorchis in the bile ducts of 4 patients, fibrotic stenosis of the periampullary choledochoduodenal fistula in 1 patient, stenosis of the common bile duct in 1 patient and stones in the pancreatic ducts of 4 patients.2) In five cases the stones were extracted under direct vision, in 61 cases the stones were passed in the stool, while in 66 cases stone elimination was confirmed by repeated ERCP or T-tube cholangiography. In 46 cases the stones were not removed, but symptoms and laboratory findings showed marked improvement.3) Complications following EST included 5 cases of bleeding, 1 case of acute pancreatitis with a pancreatic pseudocyst, one death due to sepsis following cholangitis, 5 cases of recurrent cholangitis and 2 cases of recurrent pancreatitis.4) The conditions under which EST became difficult or did not succeed included periampullary diverticula, fibrotic stenosis of ampulla of Vater and stones in the intrahepatic ducts or a gallbladder.5) With improved EST technical maneuverability, we could prevent bleeding and acute pancreatitis with a pancreatic pseudocyst and perform EST successfully in cases with periampullary diverticula. PMID:3154824

  5. Guideline Implementation: Processing Flexible Endoscopes.

    PubMed

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  6. Guideline Implementation: Processing Flexible Endoscopes.

    PubMed

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:27568535

  7. Anterior endoscopic correction of scoliosis.

    PubMed

    Picetti, George D; Ertl, Janos P; Bueff, H Ulrich

    2002-04-01

    Our technique of anterior endoscopic scoliosis correction demonstrates the ability to perform an anterior approach through a minimally invasive technique with minimal disruption of the local biology. The initial results appear to equal curve correction and fusion rates to those of a formal open anterior approach. Additional benefits are: 1) shortened operative time, 2) lower blood loss, 3) shortened rehabilitation time, 4) less pain, and 5) shortened hospital stays. Endoscopic technique shows great promise in the management of scoliosis curves; however, this is a technically demanding procedure that requires cross-training in endoscopic discectomy and scoliosis management as well as familiarity with the anterior approach anatomy. PMID:12389288

  8. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    PubMed

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.

  9. Recent advances in endoscopic ultrasonography-guided biliary interventions

    PubMed Central

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-01-01

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  10. Comprehensive Postoperative Management After Endoscopic Skull Base Surgery.

    PubMed

    Tien, Duc A; Stokken, Janalee K; Recinos, Pablo F; Woodard, Troy D; Sindwani, Raj

    2016-02-01

    To maximize outcomes from endoscopic skull base surgery, careful early postoperative management is critically important. Standardized postoperative regimens are lacking. The type of reconstruction and presence and type of cerebrospinal fluid leak dictate management. If a leak is encountered intraoperatively, patients should avoid maneuvers that increase intracranial pressures for at least 1 month. Early postoperative care focuses on minimizing and managing nasal crusting. This article reviews the evidence in the literature on postoperative management, complications, and quality of life after surgery, and outlines our experience in the management of patients after endoscopic skull base surgery.

  11. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    PubMed

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  12. Comparison of Anterior Segment Optical Tomography Parameters Measured Using a Semi-Automatic Software to Standard Clinical Instruments

    PubMed Central

    Ang, Marcus; Chong, Wesley; Huang, Huiqi; Tay, Wan Ting; Wong, Tien Yin; He, Ming-Guang; Aung, Tin; Mehta, Jodhbir S.

    2013-01-01

    Objective To compare anterior segment parameters measured using a semi-automatic software (Zhongshan Angle Assessment Program, ZAP) applied to anterior segment optical coherence tomography (AS-OCT) images, with commonly used instruments. Methods Cross-sectional study of a total of 1069 subjects (1069 eyes) from three population-based studies of adults aged 40–80 years. All subjects underwent AS-OCT imaging and ZAP software was applied to determine anterior chamber depth (ACD), central corneal thickness (CCT), anterior and keratometry (K) – readings. These were compared to auto-refraction, keratometry and ocular biometry measured using an IOLMaster, ultrasound pachymeter and auto-refractor respectively. Agreements between AS-OCT (ZAP) and clinical instrument modalities were described using Bland-Altman, 95% limits of agreement (LOA). Results The mean age of our subjects was 56.9±9.5 years and 50.9% were male. The mean AS-OCT (ZAP) parameters of our study cohort were: ACD 3.29±0.35 mm, CCT 560.75±35.07 µm; K-reading 46.79±2.72 D. There was good agreement between the measurements from ZAP analysis and each instrument and no violations in the assumptions of the LOA; albeit with a systematic bias for each comparison: AS-OCT consistently measured a deeper ACD compared to IOLMaster (95% LOA −0.24, 0.55); and a thicker CCT for the AS-OCT compared to ultrasound pachymetry (16.8±0.53 µm 95% LOA −17.3, 50.8). AS-OCT had good agreement with auto-refractor with at least 95% of the measurements within the prediction interval (P value <0.001). Conclusion This study demonstrates that there is good agreement between the measurements from the AS-OCT (ZAP) and conventional tools. However, small systematic biases remain that suggest that these measurement tools may not be interchanged. PMID:23750265

  13. Endoscopic-assisted resection of peripheral osteoma using piezosurgery.

    PubMed

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

    2013-01-01

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

  14. USE OF FAST GC/TOFMS AS REFERENCE STANDARD FOR FIELD COMPARISON STUDIES WITH ON-SITE INSTRUMENTS

    EPA Science Inventory

    A faster reference standard for field comparison studies of portable gas chromatographs (PGC) is needed. A performance evaluation of a high-speed GCMS (FGC/MS) system conducted during 1998 demonstrated generally satisfactory performance, but it was evident that performance of b...

  15. 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…

  16. The NIST Robotic Optical Scatter Instrument (ROSI) and its application to BRDF measurements of diffuse reflectance standards for remote sensing

    NASA Astrophysics Data System (ADS)

    Patrick, Heather J.; Zarobila, Clarence J.; Germer, Thomas A.

    2013-09-01

    We describe the robotic optical scatter instrument (ROSI), a new robotic arm-based goniometer for in-plane and outof- plane reflectance and bidirectional reflectance distribution function (BRDF) measurements of surfaces. The goniometer enables BRDF measurements to be made at nearly any combination of incident and scattering angles, without obstruction from frames or cradles that occur in traditional goniometers made of nested rotation stages. We present exploratory measurements of in-plane and hemispherically-scanned out-of-plane BRDF on a sintered white polytetrafluoroethylene (PTFE) sample using a supercontinuum fiber laser-based tunable light source operated at a wavelength of 550 nm, in order to demonstrate the capabilities of the system. An initial assessment of uncertainties is presented.

  17. 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

  18. Combined Endoscopic and Laparoscopic Surgery

    PubMed Central

    Garrett, Kelly A.; Lee, Sang W.

    2015-01-01

    Benign colon polyps are best treated endoscopically. Colon polyps that are not amenable for endoscopic removals either because they are too large or situated in anatomically difficult locations can pose a clinical dilemma. Traditionally the most common recommendation for these patients has been to offer a colon resection. Although the laparoscopic approach has improved short-term outcomes, morbidities associated with bowel resection are still significant. We may be over treating majority of these patients because of the remote possibility that these polyps may be harboring a cancer. A combined approach using both laparoscopy and colonoscopy (combined endoscopic and laparoscopic surgery) has been described as an alternative to bowel resection in select patients with polyps that cannot be removed endoscopically. Polyp removal using this combined approach may be an effective alternative in select patients. PMID:26491405

  19. Endoscopic imaging of Cerenkov luminescence

    PubMed Central

    Kothapalli, Sri-Rajasekhar; Liu, Hongguang; Liao, Joseph C.; Cheng, Zhen; Gambhir, Sanjiv Sam

    2012-01-01

    We demonstrate feasibility of endoscopic imaging of Cerenkov light originated when charged nuclear particles, emitted from radionuclides, travel through a biological tissue of living subjects at superluminal velocity. The endoscopy imaging system consists of conventional optical fiber bundle/ clinical endoscopes, an optical imaging lens system, and a sensitive low-noise charge coupled device (CCD) camera. Our systematic studies using phantom samples show that Cerenkov light from as low as 1 µCi of radioactivity emitted from 18F-Fluorodeoxyglucose (FDG) can be coupled and transmitted through conventional optical fibers and endoscopes. In vivo imaging experiments with tumor bearing mice, intravenously administered with 18F-FDG, further demonstrated that Cerenkov luminescence endoscopy is a promising new tool in the field of endoscopic molecular imaging. PMID:22741069

  20. Endoscopic approach to achalasia

    PubMed Central

    Müller, Michaela; Eckardt, Alexander J; Wehrmann, Till

    2013-01-01

    Achalasia is a primary esophageal motor disorder. The etiology is still unknown and therefore all treatment options are strictly palliative with the intention to weaken the lower esophageal sphincter (LES). Current established endoscopic therapeutic options include pneumatic dilation (PD) or botulinum toxin injection. Both treatment approaches have an excellent symptomatic short term effect, and lead to a reduction of LES pressure. However, the long term success of botulinum toxin (BT) injection is poor with symptom recurrence in more than 50% of the patients after 12 mo and in nearly 100% of the patients after 24 mo, which commonly requires repeat injections. In contrast, after a single PD 40%-60% of the patients remain asymptomatic for ≥ 10 years. Repeated on demand PD might become necessary and long term remission can be achieved with this approach in up to 90% of these patients. The main positive predictors for a symptomatic response to PD are an age > 40 years, a LES-pressure reduction to < 15 mmHg and/or an improved radiological esophageal clearance post-PD. However PD has a significant risk for esophageal perforation, which occurs in about 2%-3% of cases. In randomized, controlled studies BT injection was inferior to PD and surgical cardiomyotomy, whereas the efficacy of PD, in patients > 40 years, was nearly equivalent to surgery. A new promising technique might be peroral endoscopic myotomy, although long term results are needed and practicability as well as safety issues must be considered. Treatment with a temporary self expanding stent has been reported with favorable outcomes, but the data are all from one study group and must be confirmed by others before definite recommendations can be made. In addition to its use as a therapeutic tool, endoscopy also plays an important role in the diagnosis and surveillance of patients with achalasia. PMID:23951393

  1. Endoscopic treatment of pancreatic calculi.

    PubMed

    Kim, Yong Hoon; Jang, Sung Ill; Rhee, Kwangwon; Lee, Dong Ki

    2014-05-01

    Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.

  2. Transanal polypectomy using single incision laparoscopic instruments

    PubMed Central

    Dardamanis, Dimitrios; Theodorou, Dimitrios; Theodoropoulos, George; Larentzakis, Andreas; Natoudi, Maria; Doulami, Georgia; Zoumpouli, Christina; Markogiannakis, Haridimos; Katsaragakis, Stylianos; Zografos, George C

    2011-01-01

    Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible. PMID:21528096

  3. Transanal polypectomy using single incision laparoscopic instruments.

    PubMed

    Dardamanis, Dimitrios; Theodorou, Dimitrios; Theodoropoulos, George; Larentzakis, Andreas; Natoudi, Maria; Doulami, Georgia; Zoumpouli, Christina; Markogiannakis, Haridimos; Katsaragakis, Stylianos; Zografos, George C

    2011-04-27

    Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.

  4. [Endoscopic surgery of vocal cord cancers].

    PubMed

    Kleinsasser, O; Glanz, H; Kimmich, T

    1988-10-01

    Controversy began in the last century as to whether endoscopic surgery for vocal cord carcinoma carries an unnecessary risk for the patient. This controversy has been renewed since microlaryngoscopy offered the possibility of precise endoscopic resection of a vocal cord carcinoma. The most decisive prerequisites are careful assessment and adherence to strict indications. We only remove small carcinomas arising on freely mobile vocal cords by endoscopy, if the tumour is fully visible through a larger calibre operating laryngoscope. We prefer to use conventional microsurgical instruments rather than the laser. The specimen should be taken in one piece and be subjected to histological examination. Every patient must be closely followed up. A total of 76 patients with carcinomata in situ (Tis a, Tis b) and microinvasive carcinomas (T 1a, T 1b) have been followed for up to 8 years. So far not a single patient has lost his life, his larynx or his voice, or needed an additional external operation or irradiation. The results of endolaryngeal microsurgery for smaller vocal cord tumours are achieved with a minimum cost in time and money, and the least possible burden for the patient. They are scarcely inferior to primary irradiation with respect to the voice and are definitely better with respect to cure. However such results are only achieved in very carefully selected cases.

  5. 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

  6. Advanced endoscopic submucosal dissection with traction

    PubMed Central

    Imaeda, Hiroyuki; Hosoe, Naoki; Kashiwagi, Kazuhiro; Ohmori, Tai; Yahagi, Naohisa; Kanai, Takanori; Ogata, Haruhiko

    2014-01-01

    Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early stage gastric cancer (EGC) in Japan and has spread worldwide. ESD has been used not only for EGC but also for early esophageal and colonic cancers. However, ESD is associated with several adverse events, such as bleeding and perforation, which requires more skill. Adequate tissue tension and clear visibility of the tissue to be dissected are important for effective and safe dissection. Many ESD methods using traction have been developed, such as clip-with-line method, percutaneous traction method, sinker-assisted method, magnetic anchor method, external forceps method, internal-traction method, double-channel-scope method, outerroute method, double-scope method, endoscopic-surgical-platform, and robot-assisted method. Each method has both advantages and disadvantages. Robotic endoscopy, enabling ESD with a traction method, will become more common due to advances in technology. In the near future, simple, noninvasive, and effective ESD using traction is expected to be developed and become established as a worldwide standard treatment for superficial gastrointestinal neoplasias. PMID:25031787

  7. Endoscopic Coblation for the treatment of advanced juvenile nasopharyngeal angiofibroma.

    PubMed

    Pierson, Brandon; Powitzky, Rosser; Digoy, G Paul

    2012-10-01

    We present 2 cases of advanced juvenile nasopharyngeal angiofibroma (JNA) to illustrate the advantages of endoscopic Coblation-assisted resection of intranasal extensions of these masses. Both patients-an 11-year-old boy and a 14-year-old boy-presented with a large, extensive mass (Radkowski stage IIIb and Fisch stage IVb in both cases). After embolization was performed on each patient, his JNA was partially ablated via an endoscopic approach with the Coblator II Surgery System with an EVac Xtra Plasma Wand in conjunction with an image-guided navigation system. Both patients experienced resolution of their nasal obstruction with removal of the intranasal extension of the tumor. Coblation allowed for a controlled debulking of the tumors with less blood loss and without the need for multiple instruments. To the best of our knowledge, our report is one of the first to describe image-guided endoscopic Coblation of advanced JNA tumors. Future studies in adequately sized populations are needed to determine the safety and effectiveness of Coblation-assisted endoscopic removal of both advanced and lower-stage JNAs.

  8. Endoscopic stapedotomy: our view point.

    PubMed

    Naik, Chetana; Nemade, Sanjana

    2016-01-01

    Use of endoscope in middle ear surgery is not new, yet there is resistance to its use in stapedotomy. This is due to perceived long learning curve in shifting from conventional microscope to the endoscope and fear of one-handed work. (1) to present a case series of endoscopic stapedotomies and analyze the operative findings. (2) Discuss the merits and demerits of same. 20 patients with otosclerosis underwent stapedotomy over 5 years using 0°, 4 mm nasal endoscope of 18 cm length. Visualization of middle ear structures, surgical steps, operative time, hearing results and complications were analyzed. In all 20 cases, (13 males, 7 females, age: 32.7 years) manipulation of endoscope within the canal was easy facilitating endomeatal incision and elevation of tympanomeatal flap. An optimum exposure of incudo-stapedial joint was obtained in 88.24 % cases. Adequate exposure of crura was obtained in 82.35 % and the footplate in 95 %. The removal of postero-superior bony wall was required in 30 % and chorda tympani mobilization in 25 % of cases. The average operative time was 31 min. Audiometry done at 6 weeks showed, complete air-bone gap closure in 55 %, mild conductive hearing loss (up to 20 dB) in 30 % and mixed hearing loss in 2 cases (BC up to 30 dB and air-bone gap up to 20 dB). In one patient who initially had hearing improvement post operatively, developed moderate conductive hearing loss at 10 weeks. Performing fully endoscopic stapedotomy using a 4 mm nasal endoscope is a feasible option giving excellent visualization with good results.

  9. Ensuring the Safety of Your Endoscopic Procedure

    MedlinePlus

    ... an endoscope are as follows: Mechanical cleaning The operating channels and external portions of the endoscope are ... that there are no leaks in its internal operating channels. This not only ensures peak performance of ...

  10. 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 %. PMID:24594906

  11. 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

  12. Clinical study using novel endoscopic system for measuring size of gastrointestinal lesion

    PubMed Central

    Oka, Kiyoshi; Seki, Takeshi; Akatsu, Tomohiro; Wakabayashi, Takao; Inui, Kazuo; Yoshino, Junji

    2014-01-01

    AIM: To verify the performance of a lesion size measurement system through a clinical study. METHODS: Our proposed system, which consists of a conventional endoscope, an optical device, an optical probe, and a personal computer, generates a grid scale to measure the lesion size from an endoscopic image. The width of the grid scale is constantly adjusted according to the distance between the tip of the endoscope and lesion because the lesion size on an endoscopic image changes according to the distance. The shape of the grid scale was corrected to match the distortion of the endoscopic image. The distance was calculated using the amount of laser light reflected from the lesion through an optical probe inserted into the instrument channel of the endoscope. The endoscopist can thus measure the lesion size without contact by comparing the lesion with the size of the grid scale on the endoscopic image. (1) A basic test was performed to verify the relationship between the measurement error eM and the tilt angle of the endoscope; and (2) The sizes of three colon polyps were measured using our system during endoscopy. These sizes were immediately measured by scale after their removal. RESULTS: There was no error at α = 0°. In addition, the values of eM (mean ± SD) were 0.24 ± 0.11 mm (α = 10°), 0.90 ± 0.58 mm (α = 20°) and 2.31 ± 1.41 mm (α = 30°). According to these results, our system has been confirmed to measure accurately when the tilt angle is less than 20°. The measurement error was approximately 1 mm in the clinical study. Therefore, it was concluded that our proposed measurement system was also effective in clinical examinations. CONCLUSION: By combining simple optical equipment with a conventional endoscope, a quick and accurate system for measuring lesion size was established. PMID:24744595

  13. 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.

  14. 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

  15. Results from recent vacuum testing of an on-orbit absolute radiance standard (OARS) intended for the next generation of infrared remote sensing instruments

    NASA Astrophysics Data System (ADS)

    Best, Fred A.; Adler, Douglas P.; Pettersen, Claire; Revercomb, Henry E.; Gero, P. Jonathan; Taylor, Joseph K.; Knuteson, Robert O.

    2014-11-01

    Future NASA infrared remote sensing missions will require better absolute measurement accuracies than now available, and will most certainly rely on the emerging capability to fly SI traceable standards that provide irrefutable absolute measurement accuracy. To establish a CLARRREO-type climate benchmark, instrumentation will need to measure spectrally resolved infrared radiances with an absolute brightness temperature error of better than 0.1 K, verified onorbit. This will require an independent high-emissivity (<0.999) verification blackbody with an emissivity uncertainty of better than 0.06%, an absolute temperature uncertainty of better than 0.045K (3 sigma), and the capability of operation over a wide range of (Earth scene) temperatures. Key elements of an On-Orbit Absolute Radiance Standard (OARS) meeting these stringent requirements have been demonstrated in the laboratory at the University of Wisconsin and have undergone further refinement under funding from NASA's Earth Science and Technology Office, culminating in an end-to-end demonstration under vacuum with a prototype climate benchmark instrument. We present the new technologies that underlie the OARS, and the results of testing that demonstrate the required accuracy is being met in a vacuum environment. The underlying technologies include: on-orbit absolute temperature calibration using the transient melt signatures of small quantities (<1g) of reference materials (gallium, water, and mercury) imbedded in the blackbody cavity; and on-orbit cavity spectral emissivity measurement using a carefully baffled heated halo placed in front of the OARS blackbody viewed by the infrared spectrometer system. Emissivity is calculated from the radiance measured from the blackbody combined with the knowledge of key temperatures and radiometric view factors.

  16. Percutaneous endoscopic treatment of cholelithiasis.

    PubMed

    Griffith, D P; Rubio, P A; Gleeson, M J

    1990-01-01

    Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

  17. 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.

  18. Endoscopic management of diverticular bleeding.

    PubMed

    Rustagi, Tarun; McCarty, Thomas R

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70-80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  19. Endoscopic Management of Diverticular Bleeding

    PubMed Central

    Rustagi, Tarun; McCarty, Thomas R.

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding. PMID:25548554

  20. Endoscopic Management of Bladder Diverticula.

    PubMed

    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

  1. 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

  2. Endoscopic Ganglionectomy of the Elbow

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    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. PMID:26870641

  3. Endoscopic therapy for chronic pancreatitis.

    PubMed

    Dumonceau, Jean-Marc

    2013-10-01

    Endoscopic therapy is recommended as the first-line therapy for painful chronic pancreatitis with an obstacle on the main pancreatic duct (MPD). The clinical response should be evaluated at 6 to 8 weeks. Calcified stones that obstruct the MPD are first treated by extracorporeal shockwave lithotripsy; dominant MPD strictures are optimally treated with a single, large, plastic stent that should be exchanged within 1 year even in asymptomatic patients. Pancreatic pseudocysts for which therapy is indicated and are within endoscopic reach should be treated by endoscopy.

  4. 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.

  5. 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. PMID:26737628

  6. Disposable sheath that facilitates endoscopic Raman spectroscopy.

    PubMed

    Wang, Wenbo; Short, Michael; Tai, Isabella T; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  7. Disposable sheath that facilitates endoscopic Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Wang, Wenbo; Short, Michael; Tai, Isabella T.; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  8. Endoscopic management of complications of chronic pancreatitis

    PubMed Central

    Dumonceau, Jean-Marc; Macias-Gomez, Carlos

    2013-01-01

    Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis (CP). For CP-related, uncomplicated, pancreatic pseudocysts (PPC), endoscopy is the first-choice therapeutic option. Recent advances have focused on endosonography-guided PPC transmural drainage, which tends to replace the conventional, duodenoscope-based coma immediately approach. Ancillary material is being tested to facilitate the endosonography-guided procedure. In this review, the most adequate techniques depending on PPC characteristics are presented along with supporting evidence. For CP-related biliary obstructions, endoscopy and surgery are valid therapeutic options. Patient co-morbidities (e.g., portal cavernoma) and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted option. Malignancy should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary strictures. In endoscopy, the gold standard technique consists of placing simultaneous, multiple, side-by-side, plastic stents for a one-year period. Fully covered self-expandable metal stents are challenging this method and have provided 50% mid-term success. PMID:24259962

  9. Repairers must relabel instruments, court rules.

    PubMed

    2002-08-01

    A federal appeals court decided that repair companies must be sure that endoscopic instruments they have worked on, especially those they have drastically altered, must be clearly identified as such. In some cases, that could mean that the original manufacturer's name must be removed, or the repairer's name added to the device's label. PMID:12232895

  10. Is endoscopic ultrasonography useful for endoscopic submucosal dissection?

    PubMed Central

    Han, Ye; Sun, Siyu; Guo, Jintao; Ge, Nan; Wang, Sheng; Liu, Xiang; Wang, Guoxin; Hu, Jinlong; Wang, Shupeng

    2016-01-01

    Endoscopic submucosal dissection (ESD) is an innovative advance in the treatment of early gastrointestinal (GI) cancer without lymph node metastases and precancerous lesions as it is an effective and safe therapeutic method. ESD has also been a promising therapeutic option for removal of submucosal tumors (SMTs) for improving the completeness of resection of a large lesion. Endoscopic ultrasonography (EUS) can be used to detect the depth of invasion during the preoperative evaluation because of its close proximity to the lesion. EUS-guided fine-needle aspiration can be used to increase the diagnostic accuracy of EUS in determining the malignant lymph node. EUS is considered to be a useful imaging procedure to characterize early GI cancer, which is suspicious for submucosal invasion, and the most accurate procedure for detecting and diagnosing SMTs for further treatment. In the process of ESD, EUS can also be used to detect surrounding blood vessels and the degree of fibrosis; this may be helpful for predicting procedure time and decreasing the risk of bleeding and perforation. EUS-guided injection before ESD renders the endoscopic resection safe and accurate. Therefore, EUS plays an important role in the use of ESD. However, compared to conventional endoscopic staging, EUS sometimes can under or overstage the lesion, and the diagnostic accuracy is controversial. In this review, we summarize the latest research findings regarding the role of EUS in ESD. PMID:27803900

  11. Endoscopic transnasal management of inverted papilloma involving frontal sinuses

    PubMed Central

    Krzeski, Antoni; Held-Ziółkowska, Marta; Niemczyk, Kazimierz

    2012-01-01

    Inverted papilloma is a benign locally aggressive tumor of paranasal sinuses which has been traditionally managed with external surgical approaches. Advances in tumor imaging, surgical instrumentation and intraoperative visualization have led to a gradual shift to endonasal attachment-oriented surgery. Involvement of both frontal sinuses by inverted papilloma is rare. There are scant reports in the literature regarding this topic. We present 2 cases of the tumor involving both frontal sinuses removed by median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. The whole cavity of both frontal sinuses was easily inspected at the end of the procedure. No early or late complications were observed. No recurrence was seen in 1-year or 2-year follow-up. Management of frontal sinus inverted papilloma with the endoscopic median drainage approach is feasible and seems to be effective. PMID:23362431

  12. 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. PMID:26339850

  13. 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

  14. Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note

    PubMed Central

    Syed, Hasan R; Ryan, Joshua E; Jean, Walter C; Anaizi, Amjad

    2016-01-01

    Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud’s syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal

  15. Excellence needs training "Certified programme in endoscopic surgery".

    PubMed

    Campo, R; Puga, M; Meier Furst, R; Wattiez, A; De Wilde, R L

    2014-01-01

    The complexity of modern surgery has increased the demands and challenges to surgical education and quality control. Today the endoscopic approach is preferred because it increases the surgical possibilities and decreases patient discomfort. Implementing endoscopic surgery without specific training leads to decrease in surgical performance and increase in patient morbidity and mortality. Research of the European Academy for Gynaecological Surgery (+he Academy) has resulted in the establishment of a structured certification and diploma programme with three levels of expertise. One level should be passed to obtain access to the next level. Furthermore one should first pass +he Academy skill exam before entering the clinical surgical competence programme. The European Society for Gynaecological Endoscopy (ESGE) has defined the different diplomas, whereas the Bachelor diploma is seen as a prerequisite to start the in OR one to one clinical training aiming to provide endoscopic skilled individuals to the clinical one to one training. Further diplomas are the Minimal invasive Gynaecological Surgeon (MIGS), master in hysteroscopy and the laparoscopic pelvic surgeon. This programme is based on the best available scientific evidence. It counteracts the problem of the traditional surgical apprentice tutor model and increases patient safety and surgical performance. It is seen as a major step toward standardization of endoscopic surgical training in general. PMID:25593700

  16. Excellence needs training "Certified programme in endoscopic surgery".

    PubMed

    Campo, R; Puga, M; Meier Furst, R; Wattiez, A; De Wilde, R L

    2014-01-01

    The complexity of modern surgery has increased the demands and challenges to surgical education and quality control. Today the endoscopic approach is preferred because it increases the surgical possibilities and decreases patient discomfort. Implementing endoscopic surgery without specific training leads to decrease in surgical performance and increase in patient morbidity and mortality. Research of the European Academy for Gynaecological Surgery (+he Academy) has resulted in the establishment of a structured certification and diploma programme with three levels of expertise. One level should be passed to obtain access to the next level. Furthermore one should first pass +he Academy skill exam before entering the clinical surgical competence programme. The European Society for Gynaecological Endoscopy (ESGE) has defined the different diplomas, whereas the Bachelor diploma is seen as a prerequisite to start the in OR one to one clinical training aiming to provide endoscopic skilled individuals to the clinical one to one training. Further diplomas are the Minimal invasive Gynaecological Surgeon (MIGS), master in hysteroscopy and the laparoscopic pelvic surgeon. This programme is based on the best available scientific evidence. It counteracts the problem of the traditional surgical apprentice tutor model and increases patient safety and surgical performance. It is seen as a major step toward standardization of endoscopic surgical training in general.

  17. Advanced shape tracking to improve flexible endoscopic diagnostics

    NASA Astrophysics Data System (ADS)

    Cao, Caroline G. L.; Wong, Peter Y.; Lilge, Lothar; Gavalis, Robb M.; Xing, Hua; Zamarripa, Nate

    2008-03-01

    Colonoscopy is the gold standard for screening for inflammatory bowel disease and colorectal cancer. Flexible endoscopes are difficult to manipulate, especially in the distensible and tortuous colon, sometimes leading to disorientation during the procedure and missed diagnosis of lesions. Our goal is to design a navigational aid to guide colonoscopies, presenting a three dimensional representation of the endoscope in real-time. Therefore, a flexible sensor that can track the position and shape of the entire length of the endoscope is needed. We describe a novel shape-tracking technology utilizing a single modified optical fiber. By embedding fluorophores in the buffer of the fiber, we demonstrated a relationship between fluorescence intensity and fiber curvature. As much as a 40% increase in fluorescence intensity was achieved when the fiber's local bend radius decreased from 58 mm to 11 mm. This approach allows for the construction of a three-dimensional shape tracker that is small enough to be easily inserted into the biopsy channel of current endoscopes.

  18. Stray light mitigation in a novel endoscope for fallopian tubes

    NASA Astrophysics Data System (ADS)

    Swan, Elizabeth; Tate, Tyler; Keenan, Molly; Black, John F.; Utzinger, Urs; Barton, Jennifer

    2015-03-01

    Stray light in an endoscope largely contributes to whether a signal can be detected or not. This FRED analysis used a novel endoscope designed for the fallopian tubes to show how common endoscope elements cause stray light contamination, and to offer suggestions on how to mitigate it. Standard and advanced optical raytracing was performed. Raytrace reports determined which ray paths caused the highest power and irradiance distributions after reflecting one or more times from an element in the system. The analysis revealed that the cover plate introduced significantly more stray light into the system than other endoscope components. The imaging lenses and variable stop reflectivity had a negligible impact on the signal. To obtain acceptable signal-to- noise ratio, the source numerical aperture (NA) was lowered to 0.35 and 0.25 to keep the stray light within the same order of magnitude and an order of magnitude lower, respectively than the desired signal. There was a single specular reflection off of the cover plate distal surface. This illumination reflected back into the imaging fiber without first scattering off the tissue, which resulted in high stray power at the back of the imaging lenses. The specular light appeared brighter at higher source NAs and saturated the desired signal at the edge of the imaging fiber. An NA between 0.25 and 0.35 provides maximum illumination to image the tissue, with minimal stray light degrading the desired signal.

  19. Facial Nerve Outcome after Vestibular Schwannoma Resection: A Comparative Meta-Analysis of Endoscopic versus Open Retrosigmoid Approach

    PubMed Central

    Alobaid, Abdullah; Aref, Mohammed; Bennardo, Michael Ross; Farrokhyar, Forough; Reddy, Kesava

    2014-01-01

    The minimal access retrosigmoid endoscopic approach to vestibular schwannoma (VS) resection has been used with promising results. However, it has not been compared with the standard open approach in the literature. We performed a meta-analysis review for all articles describing both approaches for VS from 1996 to 2011. We found 1861 articles. After review and discussion, we narrowed our study to 25 articles, 4 endoscopic and 21 open. The total number of patients was 3026 for open and 790 for endoscopic. The mean tumor sizes in the open and endoscopic series were 2.5 cm and 2.7 cm, respectively. Good facial nerve outcome was achieved in 67% of the open series patients and in 94% of the endoscopic series patients. Other outcomes in the open and endoscopic series were the following: gross total resection, 91% versus 97%; functional hearing, 22.6% versus 46%; wound infection, 1.3% versus 2.6%; and recurrence, 5.4% versus 2.2%. We acknowledge the limitations of our study, but we can state that the endoscopic approach is not inferior to the standard open approach. In expert hands the endoscopic approach can offer as good a result as the open, with potential benefits such as less pain and a shorter length of stay in the hospital. There is a need for more controlled studies for a definitive comparison. PMID:25844300

  20. 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.

  1. 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

  2. Transoral endoscopic thyroidectomy via the tri-vestibular routes: results of a preclinical cadaver feasibility study.

    PubMed

    Park, Jun-Ook; Kim, Choung Soo; Song, Jee-Nam; Kim, Ju-Eun; Nam, Inn-Chul; Lee, So-Yoon; Chun, Byung-Joon; Cho, Jung-Hae; Joo, Young-Hoon; Cho, Kwang-Jae; Park, Young Hak; Kim, Min-Sik; Sun, Dong-Il

    2014-12-01

    The concept of natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates skin incisions using an endoscope passed through a natural orifice (e.g., mouth, urethra, or anus). This study was designed to evaluate the feasibility and safety of thyroid resection via an entirely transoral tri-vestibular route using endoscopy, and to introduce NOTES to the head and neck area of medicine. We performed ten complete endoscopic thyroid lobectomies with central lymph node dissection via a tri-vestibular approach in fresh-frozen cadavers. A 5-mm endoscope with a deflectable tip was used to visualize the surgical field. Three cannulas were inserted through the midline and bilateral incision sites in the vestibule to position the instruments and endoscope. We refined and described the surgical technique in each step using video clips. We identified and preserved neighboring critical structures during surgery. We also confirmed that there were no obvious remnant thyroid tissues and no injury to the neighboring structures after exploration. The transoral tri-vestibular approach seems to provide a good view and surgical field for endoscopic thyroidectomy. However, the transoral approach for thyroidectomy remains experimental, and the detailed surgical technique should be refined via further clinical studies.

  3. 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. PMID:25210220

  4. [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.

  5. New trend in endoscopic surgery: transvaginal appendectomy NOTES (Natural Orifice Transluminal Endoscopic Surgery).

    PubMed

    Tabutsadze, T; Kipshidze, N

    2009-03-01

    Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery, which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen. Besides that the transluminal access is considered to be the most safe and feasible for clinical application. Here are discussed the two operations of Transvaginal Appendectomy performed in Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records. In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married, with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical clinical semiotics and laboratory records. Both operations were performed under general anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76 minutes and the second operation lasted for 88 minutes. The operations were made without any technical difficulties or complications. None of the patients had the need of non-narcotic analgesia during the post-operational period. No gynecological or surgical problems or any complications were detected during the observation period. The patients had superior postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30 hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar surgery with major advantages compared to the conventional - the NOTES takes endoscopic surgery one step further in

  6. 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

  7. Endoscopic ultrasound-guided intravascular therapy.

    PubMed

    Binmoeller, Kenneth F; Sendino, Oriol; Kane, Steven D

    2015-01-01

    The gastrointestinal tract provides a unique "window" to access vascular structures in the mediastinum and abdomen. The advent of interventional endoscopic ultrasound (EUS) has enabled access to these structures with a standard fine-needle aspiration (FNA) needle. Sclerosants, cyanoacrylate, and coils can be delivered through the lumen of the FNA needle. EUS-guided treatment of gastric varices has theoretical advantages over conventional endoscopy-guided treatment. Controlled studies are needed to determine the role of EUS-guided treatment for primary and secondary prevention of variceal bleeding. There is a growing list of novel indications for EUS-guided vascular therapy that include portal vein angiography and pressure measurements, intrahepatic portosystemic shunt placement, and micro coil embolization of vascular structures. Additionally, access and therapy of the heart and surrounding structures appears feasible. PMID:25366271

  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. Powered instrumentation in dissection of the frontal recess.

    PubMed

    Christmas, D A; Krouse, J H

    1996-06-01

    The use of powered instrumentation in functional endoscopic sinus surgery has become very popular due to its safety and thoroughness. An area which has been more problematic in the use of this technique has been the frontal recess, due to its anatomic location and associated risk of serious complications. We have done a number of powered dissections of the frontal recess as a surgical treatment of refractory frontal sinusitis, and find that it is extremely safe and effective. The ability of the powered devices to preserve normal mucosa allows an adequate surgical approach while significantly decreasing the postoperative risk of frontal recess stenosis and reocclusion. We feel that powered dissection of the frontal recess offers a significant advantage over standard techniques in this anatomic location.

  10. Expanded endonasal endoscopic approach for resection of a juvenile nasopharyngeal angiofibroma with skull base involvement.

    PubMed

    Gallia, Gary L; Ramanathan, Murugappan; Blitz, Ari M; Reh, Douglas D

    2010-11-01

    Juvenile nasopharyngeal angiofibromas (JNAs) are rare vascular tumors which arise in the nasopharynx of adolescent males. Patients with these tumors can be cured by surgery, which is the treatment of choice in the majority of patients. Traditional surgical techniques for patients with JNAs have been via open surgical approaches. Since 2000, however, the surgical management of JNAs has changed due to advances in endoscopic procedures and such approaches are standard for early stage lesions which are limited to the nasal cavity, nasopharynx and the paranasal sinuses. The role and limitations of endoscopic approaches for JNAs with skull base and intracranial involvement are being defined. In this report, we describe a patient with a JNA with skull base involvement who underwent an expanded endonasal endoscopic approach for a complete resection. Additionally, we review the literature of endoscopic approaches to JNAs with skull base involvement.

  11. 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

  12. Endoscopic treatment of juvenile nasopharyngeal angiofibroma.

    PubMed

    Newlands, S D; Weymuller, E A

    1999-01-01

    Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.

  13. Endoscopic goniotomy probe for holmium:YAG laser delivery

    NASA Astrophysics Data System (ADS)

    Joos, Karen M.; Shen, Jin-Hui; Ren, Qiushi

    1994-06-01

    Goniotomy is an effective treatment for primary infantile glaucoma. Because a cloudy cornea may prevent a clear view of the anterior chamber angle through the operating microscope, we investigated whether an endoscope can be combined with a cutting laser to perform laser goniotomy in a surgical model of primary infantile glaucoma. The anterior chambers of cadaver procine eyes were deepened with a viscoelastic material. A 300-micron-diameter silica fiber coupled to an Olympus 0.8-mm-diameter flexible fiber optic endoscope entered the anterior chambers through 4-mm corneal incisions. The anterior chamber angles were clearly observed on a videoscreen as the endoscopic fiber optic laser scalpel approached the pectinate ligaments. With the guidance of a He-Ne aiming beam, the anterior chamber angle pectinate ligaments were cut over a 160 degree arc with a pulsed Ho:YAG laser (2.1 micrometers wavelength, 50 mJ, 5 Hz repetition). The specimens were fixed in glutaraldehyde and processed for scanning electron microscopy, or fixed in formalin and processed for light microscopy. The treated area demonstrated incision of the pectinate ligaments with opening of the underlying trabecular meshwork. The edoscopic fiber optic laser scalpel is capable of cutting the pectinate ligaments in a surgical model of primary infantile glaucoma. Therefore, it may be a useful instrument for performing goniotomy when a cloudy cornea in primary infantile glaucoma prevents visualization of the anterior chamber angle with a goniotomy lens.

  14. 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.

  15. The endoscopic endonasal approach for the management of craniopharyngiomas.

    PubMed

    Solari, Domenico; Morace, Roberta; Cavallo, Luigi M; Amoroso, Francesca; Cennamo, Gilda; Del Basso DE Caro, Marialaura; Cappabianca, Paolo

    2016-12-01

    Craniopharyngiomas are disembryogenetic, benign, tumors that origin from squamous epithelial remnants of Rathke's pouch, developing from any segment of its course, virtually from rhino-pharynx to the hypothalamus. Historically, different microscopic transcranial routes, have been advocated as possible surgical options for the treatment of craniopharyngiomas. The endonasal technique offers a direct approach that permits access to the suprasellar, retrosellar and retroclival space, obviating brain retraction; it provides the advantage of appraoching cranioopharyngiomas without optic nerve manipulation and/or retraction. We herein present the surgical nuances of the endoscopic endonasal approach for the treatment of craniopharyngiomas, highlighting hints, advantages and drawbacks, also in regards of the anatomy dealt with. The endoscopic endonasal technique has been emerging as a viable approach/alternative for the treatment of this disease as the endoscope itself increased its safety and effectiveness. It allows the removal of both infra and supradiaphragmatic lesions - eventually involving the third ventricle chamber but not extending laterally off the ICA out of the visibility and maneuverability of the instruments - avoiding brain and optic nerve manipulation and retraction, with good visualization of the pituitary gland and stalk and the main neurovascular structures. PMID:27273221

  16. Current issues result in a paradigm shift in reprocessing medical and surgical instruments.

    PubMed

    Alfa, Michelle J

    2016-05-01

    The objective of this report is to review the available scientific data on reprocessing of medical and surgical instruments and discuss the current issues related to cleaning and disinfection of flexible endoscopes and intracavitary ultrasound probes.

  17. 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

  18. Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction.

    PubMed

    Michels, Frederick; Cordier, Guillaume; Guillo, Stéphane; Stockmans, Filip

    2016-09-01

    Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique. PMID:27524711

  19. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma.

    PubMed

    Kamel, R H

    1996-10-01

    A case of angiofibroma limited to the right posterior nasal cavity, nasopharynx and pterygopalatine fossa was operated upon transnasally under endoscopic control. The tumour was completely excised without complications. Endoscopic follow-up for the next two years and contrast computed tomography (CT) excluded any residual tumour or recurrence. The advantages, limitations and possible complications of this approach are discussed. It seems that in limited lesions of angiofibroma, the option of a transnasal endoscopic approach could be cautiously considered by experienced surgeons.

  20. 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

  1. Technique of transanal endoscopic microsurgery.

    PubMed

    Buess, G; Kipfmüller, K; Hack, D; Grüssner, R; Heintz, A; Junginger, T

    1988-01-01

    Sessile adenomas are predominantly localized in the rectum and lower sigma. Surgical removal is indicated but often implies an invasive surgical procedure. Using conventional transanal surgical techniques, only the lower rectum can be reached and there are high rates of recurrence. The new technique combines an endoscopic view of the rectum under gas insufflation via a stereoscopic telescope with conventional surgical preparation and suturing. Adenomas can be excised using the mucosectomy technique or full-thickness-excision, whereas carcinomas should be excised using full-thickness excision with a sufficient border of healthy mucosa. In carcinomas of the sacral cavity, we remove the retrorectal fat up to the fascia of Waldeyer, including the regional lymph nodes. Transanal endoscopic microsurgery is the most economical and tissue-saving surgical technique for the removal of rectal adenomas and early rectal carcinomas.

  2. Endoscopic ultrasonography-guided hepaticogastrostomy.

    PubMed

    Park, Do Hyun

    2012-04-01

    To date, percutaneous transhepatic biliary drainage (PTBD) has been considered as the usual biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP). Since endoscopic ultrasonography (EUS)-guided bile duct puncture was first described in 1996, sporadic case reports of EUS-guided biliary drainage (EUS-BD) have suggested it as an alternative to PTBD after failed ERCP. The potential benefits of EUS-BD include internal drainage, thus avoiding long-term external drainage in cases where external PTBD drainage catheters cannot be internalized. EUS-guided hepaticogastrostomy (EUS-HG) is one form of EUS-BD. This article describes the indications, techniques, and outcomes of published data on EUS-HG. PMID:22632949

  3. 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

  4. Biliary sequelae of endoscopic sphincterotomy.

    PubMed Central

    Greenfield, C.; Cleland, P.; Dick, R.; Masters, S.; Summerfield, J. A.; Sherlock, S.

    1985-01-01

    Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P less than 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear. PMID:2858846

  5. 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.

  6. ENT endoscopic surgical training simulator.

    PubMed

    Edmond, C V; Heskamp, D; Sluis, D; Stredney, D; Sessanna, D; Wiet, G; Yagel, R; Weghorst, S; Oppenheimer, P; Miller, J; Levin, M; Rosenberg, L

    1997-01-01

    This paper describes work in progress on the design and development of a prototype simulator for minimally invasive otolaryngology surgical training. The anatomy of the paranasal sinuses is geometrically complex and dangerously close to the brain and orbits, making this procedure challenging to practice and difficult to learn. We discuss the potential role of computer simulation to enhance and accelerate acquisition of surgical skills. The design goals of the prototype include high-fidelity simulation of the endoscopic imagery and haptic cues of surgical palpation. The prototype enables endoscopic navigation and limited interactive tissue manipulation and dissection tasks on a virtual patient using realistic replicas of surgical tools. We present an overview of the system architecture with a discussion of the technological challenges, design issues and current status of the efforts.

  7. 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.

  8. Endoscopic Anatomy of the Protympanum.

    PubMed

    Jufas, Nicholas; Marchioni, Daniele; Tarabichi, Muaaz; Patel, Nirmal

    2016-10-01

    The protympanum, a final common pathway between the tympanic cavity and external environment, is gaining relevance due to the ease and completeness of visualization with angled endoscopes. Two primary conformations are described, quadrangular and triangular, and new anatomic structures such as the protiniculum, subtensor recess, and protympanic spine are defined. Surgical relevance of the protympanum is described with respect to ventilation, cholesteatoma, cerebrospinal fluid leak, otic neuralgia, and surgical access to the eustachian tube. PMID:27565384

  9. Transoral endoscopic adenoidectomy: initial experience.

    PubMed

    Jong, Y H; Gendeh, B S

    2008-03-01

    Adenoidectomy is a common ENT procedure performed in hospitals in Malaysia. Adenoidectomy is indicated in patients with recurrent adenoiditis, nasal obstruction or sleep apnoea secondary to adenoid hypertrophy when conservative management has failed. Over the years, there are advances in the techniques of adenoidectomy, from the conventional transoral to endoscopic transnasal/transoral adenoidectomy. The purpose of this article is to describe the technique and emphasize the advantages of this procedure to that of the conventional technique.

  10. Barrett's esophagus: endoscopic treatments II

    PubMed Central

    Greenwald, Bruce D.; Lightdale, Charles J.; Abrams, Julian A.; Horwhat, John D.; Chuttani, Ram; Komanduri, Srinadh; Upton, Melissa P.; Appelman, Henry D.; Shields, Helen M.; Shaheen, Nicholas J.; Sontag, Stephen J.

    2013-01-01

    The following on endoscopic treatments of Barrett's esophagus includes commentaries on animal experiments on cryotherapy; indications for cryotherapy, choice of dosimetry, number of sessions, and role in Barrett's esophagus and adenocarcinoma; recent technical developments of RFA technology and long-term effects; the comparative effects of diverse ablation procedures and the rate of recurrence following treatment; and the indications for treatment of dysplasia and the role of radiofrequency ablation. PMID:21950812

  11. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    PubMed Central

    2012-01-01

    Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496 PMID:22970933

  12. 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.

  13. 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

  14. [Endoscopic therapy of acute and chronic pancreatitis].

    PubMed

    Veltzke-Schlieker, W; Adler, A; Abou-Rebyeh, H; Wiedenmann, B; Rösch, T

    2005-02-01

    Endoscopic therapy is valuable for both acute and chronic pancreatitis. Early endoscopic papillotomy appears, in the case of a severe course of acute biliary pancreatitis, to be advantageous. Endoscopic drainage can be considered in cases of acute fluid retention and necrosis as well as subacute, non-healing pancreatitis or cyst development. By acute chronic pancreatitis with strictures or bile duct stones, papillotomy, dilation and stent insertion can lead to an improvement in pain symptoms. An improvement in endo- or exocrine function, however, is not expected. Studies on the endoscopic therapy of pancreatitis are still very limited, and recommendations can usually only be made based on retrospective case series. PMID:15657718

  15. Endoscopic management of benign biliary strictures

    PubMed Central

    Visrodia, Kavel H; Tabibian, James H; Baron, Todd H

    2015-01-01

    Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography (ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography (EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures. PMID:26322153

  16. Endoscopic treatment of esophageal achalasia

    PubMed Central

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

    2016-01-01

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

  17. Endoscopic Resection of Vestibular Schwannomas

    PubMed Central

    Setty, Pradeep; D'Andrea, Kenneth P.; Stucken, Emily Z.; Babu, Seilesh; LaRouere, Michael J.; Pieper, Daniel R.

    2015-01-01

    Objective To report our results and the technical details of fully endoscopic resection of vestibular schwannomas. Design Prospective observational study. Setting A single academic institution involving neurosurgery and neurotology. Participants Twelve consecutive patients who underwent fully endoscopic resection of a vestibular schwannoma. Main Outcome Measures Hearing preservation, based on the American Association of Otolaryngology-Head and Neck Surgeons (AAO-HNS) score as well as the Gardener and Robertson Modified Hearing Classification (GR). Facial nerve preservation based on the House-Brackmann (HB) score. Results All patients successfully underwent gross total resection. Facial nerve preservation rate was 92% with 11 of 12 patients retaining an HB score of 1/6 postoperatively. Hearing preservation rate was 67% with 8 of 12 patients maintaining a stable AAO-HNS grade and GR score at follow-up. Mean tumor size was 1.5 cm (range: 1–2 cm). No patients experienced postoperative cerebrospinal fluid leak, infection, or cranial nerve palsy for a complication rate of 0%. Mean operative time was 261.6 minutes with an estimated blood loss of 56.3 mL and average length of hospital stay of 3.6 days. Conclusion A purely endoscopic approach is a safe and effective option for hearing preservation surgery for vestibular schwannomas in appropriately selected patients. PMID:26225307

  18. 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.

  19. 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

  20. 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

  1. 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

  2. Correlations Among Endoscopic, Histologic and Serologic Diagnoses for the Assessment of Atrophic Gastritis

    PubMed Central

    Lee, Ju Yup; Kim, Nayoung; Lee, Hye Seung; Oh, Jane C.; Kwon, Yong Hwan; Choi, Yoon Jin; Yoon, Ki Chul; Hwang, Jae Jin; Lee, Hyun Joo; Lee, AeRa; Jeong, Yeonsang; Jo, Hyun Jin; Yoon, Hyuk; Shin, Cheol Min; Park, Young Soo; Lee, Dong Ho

    2014-01-01

    Background: Atrophic gastritis is a precancerous condition, which can be diagnosed by several methods. However, there is no consensus for the standard method. The aim of this study was to evaluate the correlations among endoscopic, histologic, and serologic findings for the diagnosis of atrophic gastritis. Methods: From March 2003 to August 2013, a total of 2,558 subjects were enrolled. Endoscopic atrophic gastritis was graded by Kimura-Takemoto classification and histological atrophic gastritis was assessed by updated Sydney system. Serological assessment of atrophic gastritis was based on serum pepsinogen test. Results: The serum pepsinogen I/II ratio showed a significant decreasing nature when the extent of atrophy increased (R2=0.837, P<0.001) and the cut-off value for distinguishing between presence and absence of endoscopic atrophic gastritis was 3.2. The serum pepsinogen I and pepsinogen I/II ratio were significantly lower when the histological atrophic gastritis progressed and the cut-off value was 3.0 for a diagnosis of histological atrophic gastritis. A significant correlation between endoscopic and histological atrophic gastritis was noted and the sensitivity and specificity of endoscopic diagnosis were 65.9% and 58.0% for antrum, 71.3% and 53.7% for corpus, respectively. Conclusions: The endoscopic, histological, and serological atrophic gastritis showed relatively good correlations. However, as these three methods have a limitation, a multifactorial assessment might be needed to ameliorate the diagnostic accuracy of atrophic gastritis. PMID:25337572

  3. 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

  4. Master and slave transluminal endoscopic robot (MASTER) for natural orifice transluminal endoscopic surgery (NOTES).

    PubMed

    Phee, S J; Low, S C; Huynh, V A; Kencana, A P; Sun, Z L; Yang, K

    2009-01-01

    Although the flexible endoscopy has been widely used in the medical field for many years, there is still great potential in improving the endoscopist's capability to perform therapeutic tasks. Tentatively, tools for the flexible endoscope have poor maneuverability and limited Degree Of Freedom (DOF). In this paper, we propose a surgical robotic system MASTER (Master And Slave Transluminal Endoscopic Robot). MASTER is a dexterous and flexible master-slave device which can be used in tandem with a conventional flexible endoscope. Using this robotic system, ESD (Endoscopic Submucosal Dissection) and NOTES (Natural Orifice Transluminal Endoscopic Surgery) have been conducted on in vivo and ex vivo animal trials with promising results.

  5. 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.

  6. 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

  7. Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome)

    PubMed Central

    Rogart, Jason N.; Perkal, Melissa; Nagar, Anil

    2008-01-01

    Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques. PMID:18493330

  8. 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.

  9. An improved instrument mounting arm.

    PubMed

    Gendeh, B S; Khalid, B A; Alberti, P W

    2001-02-01

    Although some form of commercial instrument mounting arm is available, a paucity of information in the literature may cause problems in selecting the most appropriate model for an ENT department wishing to trial their invention for use in the clinic or operating theatre. The instrument mounting arm described here is based on existing designs used by hobbyists and model makers for many years but the main benefit of this innovation is its multi-purpose use in the operating theatre and cost effectiveness since it is made of aluminum alloy. It is compact, stable and easily adjustable and can incorporate an endoscope holder or an operating end piece to mount various ENT instruments that offers considerable advantages to the unassisted operator.

  10. 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.

  11. 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.

  12. Endoscopic shuffling, infection control, and the clinical practice of push enteroscopy.

    PubMed

    Muscarella, Lawrence F

    2007-01-01

    Failure to identify and diagnose the site and cause of obscure bleeding or some other gastrointestinal disorder may be an indication for push enteroscopy. During this procedure, a long, narrow, flexible gastrointestinal endoscope, known as a push enteroscope, is advanced into the upper gastrointestinal tract to examine and evaluate the proximal section (first one third) of the small bowel. Because of limited funding and inadequate instrument availability, some gastrointestinal endoscopy units may perform this procedure using a colonoscope instead of a push enteroscope. Although not specifically designed for push enteroscopy, colonoscopes are less expensive than push enteroscopes and readily available for clinical use in virtually every gastrointestinal endoscopy unit. The use of a colonoscope or other lower gastrointestinal endoscope to perform push enteroscopy or another upper gastrointestinal procedure (or the use of an upper gastrointestinal endoscope to perform a lower gastrointestinal procedure) is defined in this article as endoscopic shuffling. Although it is arguably efficient and cost effective (and in some instances may improve clinical outcomes), endoscopic shuffling raises a number of economic, legal, medical, and ethical questions and concerns, several of which are discussed in this article, with a particular focus on infection control. PMID:17440313

  13. Endoscopic Ultrasound: Indian Perspective.

    PubMed

    Vora, Agam

    2015-09-01

    Mediastinoscopy is a minimally invasive surgical procedure that allows visualization and tissue sampling of mediastinal nodes. Mediastinoscopy has been extremely valuable in the evaluation and staging of lung cancer and therefore has been considered the gold standard for this purpose for over 30 years. Historically, this procedure has been associated with a low morbidity and mortality and a high sensitivity for diagnosing lung cancer with certain procedural limitations. Recently, it has been reported that not only is mediastinoscopy use limited in community practice, concomitant biopsy rates are limited as well.1 While mediastinoscopy does provide a tissue diagnosis, the procedure has its limitations. Cervical mediastinoscopy allows access to nodal stations 2, 3, 4 and 7, leaving out commonly involved pulmonary ligament and aortopulmonary window nodes.1 It requires general anesthesia and has a morbidity of 1% and a mortality of 0.2%. The procedure adds considerable expense to the staging workup. The estimated current cost is $1,700 for the procedure alone and $7,500 for a mediastinoscopy with a 2-day hospital stay. This prompted the development of endobronchial ultrasound(EBUS) in the 1990s.2. PMID:27608860

  14. Endoscopic options for early stage esophageal cancer

    PubMed Central

    Shah, Pari M.

    2015-01-01

    Surgery has traditionally been the preferred treatment for early stage esophageal cancer. Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopists to remove small, superficial lesions, providing tumor specimen that can be examined for accurate pathologic tumor staging and assessment of adequacy of resection. Endoscopic ablation procedures, including photodynamic therapy (PDT) and radio frequency ablation (RFA), have also been shown to safely and effectively treat esophageal dysplasia and early stage neoplasia, with excellent long-term disease control. Both approaches are becoming more widely available around the world, and provide an alternative, safe, low risk strategy for treating early stage disease, making combined endoscopic therapy the recommended treatment of choice for early stage esophageal cancers. PMID:25642334

  15. Video capsule endoscopy completion and total transit times are similar with oral or endoscopic delivery

    PubMed Central

    Stanich, Peter P.; Guido, John; Kleinman, Bryan; Betkerur, Kavita; Porter, Kyle M.; Meyer, Marty M.

    2016-01-01

    Background and study aims: Video capsule endoscopy (VCE) is limited by incomplete procedures. There are also contraindications to the standard ingestion of the capsule that require endoscopic placement. Our aim was to compare the study completion rate of VCE after oral ingestion and endoscopic deployment. Patients and methods: We performed a review of all VCE from April 2010 through March 2013. Inpatient and outpatient cohorts grouped by the method of capsule delivery were formed and compared. Multivariable logistic regression modeling was utilized adjusting for variables with a P value ≤ 0.1 in group comparisons. Log-rank analysis was used to compare transit times. Results: A total of 687 VCE were performed, including 316 inpatient (36 endoscopic deployment, 280 oral ingestion) and 371 outpatient (20 endoscopic deployment, 351 oral ingestion). For VCE on hospitalized patients, the completion rates were similar after endoscopic deployment and oral ingestion (72 % vs 73 %, P = 0.94). The completion rates were also similar for ambulatory patients (90 % vs 87 %, P = 0.69). There remained no difference after multivariable modeling for inpatients (P = 0.71) and outpatients (P = 0.46). Total transit times were not significantly different. Conclusions: VCE completion rates and total transit times are similar after oral or endoscopic deployment for both hospitalized and ambulatory patients. Endoscopic placement is effective in patients with contraindications to standard oral ingestion, but should otherwise be avoided to limit unnecessary procedural risks and costs. PMID:26878055

  16. 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.

  17. [Endoscopic urethrotomy: indications and limitations].

    PubMed

    Miñana López, Bernardino

    2014-01-01

    Endoscopic urethrotomy is a simple, reproducible, highly widespread technique that enables an appropriate management of patients with urethral stenosis, if the indication is well established. Determinants of success of this procedure are stenosis length, site, number, degree of spongiofibrosis and previous treatments. The best results would be obtained in single, short bulbar stenoses with limited spongiofibrosis, in which it may be the first choice. Its main limitation is the fact that the procedure itself is a controlled intentional trauma the result of which depends on multiple variables, including the technique employed.

  18. 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

  19. Endoscopic management for congenital esophageal stenosis: A systematic review

    PubMed Central

    Terui, Keita; Saito, Takeshi; Mitsunaga, Tetsuya; Nakata, Mitsuyuki; Yoshida, Hideo

    2015-01-01

    Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography (EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation. PMID:25789088

  20. Cross-polarization endoscopic optical coherence tomography in urology

    NASA Astrophysics Data System (ADS)

    Zagaynova, E. V.; Gladkova, N. D.; Gelikonov, V. M.; Streltsova, O. S.; Ledayev, D. S.; Atduev, V. A.; Balandina, E. V.; Snopova, L. B.

    2009-02-01

    We present results obtained using a two-channel portable device for CP OCT based on the polarization-maintaining fiber. The device is capable of acquiring OCT images of the object in direct and orthogonal polarizations simultaneously. The OCT system has an endoscopic forward-looking probe (2.7 mm in diameter). The CP OCT imaging was done in 64 postoperative specimens, for 30 patients during cystoscopy with suspicion of urothelial neoplasia, and for 11 patients with prostatectomy due to cancer. After surgery in the tissue specimen we immediately introduced surgical suture and investigated a bladder wall by CP OCT. When comparing OCT images and histology slides we can distinguish tissue layers based on position of the suture material. CP OCT images were compared with histological data. Special staining - Sirius Red for collagen types was applied. OCT -visualization of sympathetic nerve was made during open surgery. We found, that a strong signal in orthogonal polarization is produced by structures consisting of Type I collagen. We demonstrated that endoscopic benign and early malignant pathological processes that cannot be detected by standard OCT may be differentiated by CP OCT. Sympathetic nerve of neurovascular bundle gives a strong signal in both polarizations: direct and orthogonal. Based on these CP OCT features we can visualize nerve during operation (open or endoscopic surgery) and thus preserve it.

  1. Endoscopic treatment of Barrett's esophagus: From metaplasia to intramucosal carcinoma.

    PubMed

    Chennat, Jennifer; Waxman, Irving

    2010-08-14

    The annual incidence of adenocarcinoma arising from Barrett's esophagus (BE) is approximately 0.5%. Through a process of gradual transformation from low-grade dysplasia to high-grade dysplasia (HGD), adenocarcinoma can develop in the setting of BE. The clinical importance of appropriate identification and treatment of BE in its various stages, from intestinal metaplasia to intramucosal carcinoma (IMC) hinges on the dramatically different prognostic status between early neoplasia and more advanced stages. Once a patient has symptoms of adenocarcinoma, there is usually locally advanced disease with an approximate 5-year survival rate of about 20%. Esophagectomy has been the gold standard treatment for BE with HGD, due to the suspected risk of harboring occult invasive carcinoma, which was traditionally estimated to be as high as 40%. In recent years, the paradigm of BE early neoplasia management has recently evolved, and endoscopic therapies (endoscopic mucosal resection, radiofrequency ablation, and cryotherapy) have entered the clinical forefront as acceptable non-surgical alternatives for HGD and IMC. The goal of endoscopic therapy for HGD or IMC is to ablate all BE epithelium (both dysplastic and non-dysplastic) due to risk of synchronous/metachronous lesion development in the remaining BE segment.

  2. 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.

  3. Minimally invasive endoscopic resection of benign tumours of the accessory parotid gland: an updated approach.

    PubMed

    Li, Biao; Zhang, Lei; Zhao, Zeliang; Shen, Guofang; Wang, Xudong

    2013-06-01

    The most common conventional approaches for the resection of benign tumours in the accessory parotid gland are a standard parotidectomy incision, a modified standard parotidectomy incision, or a face-lift incision. The resulting scars may severely affect the patient's postoperative appearance. The previously reported endoscopically assisted approach offers a less aesthetically invasive technique, but it may still leave a visible preauricular scar 4-5 cm long. We have used a modified endoscopic approach with minimal, and concealed, incisions for the resection of benign tumours in the accessory parotid gland. Five patients were diagnosed by physical examination, imaging, and preoperative fine-needle aspiration biopsy. They had endoscopically assisted resections using our modified approach, and we evaluated its feasibility. All the resections were successful. The mean operating time was 108 min (range 90-130). The postoperative scars were concealed and aesthetically satisfactory. There were no facial paralyses, salivary fistulas, or recurrences in the short term. Using endoscopically assisted resection we completely removed benign tumours from the accessory parotid gland and obtained good aesthetic results. Our updated endoscopic approach for these resections is successful with shorter, concealed incisions. It is a viable alternative to conventional approaches.

  4. 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.

  5. A novel method for endoscopic perforation management by using abdominal exploration and full-thickness sutured closure

    PubMed Central

    Kumar, Nitin; Thompson, Christopher C.

    2016-01-01

    Background Perforation of the GI tract during endoscopy can result in significant morbidity and mortality. Early recognition and immediate management of endoscopic perforation are essential to optimize outcome. Larger perforations, defects with complex geometry, and those complicated by leakage of luminal contents have traditionally required surgical management. Objective To assess the feasibility of a new method for managing complex perforations that incorporates abdominal exploration and endoscopic sutured closure. Design Case series. Setting Tertiary care center. Patients Two patients with large, complicated perforations and peritoneal contamination. Interventions Endoscopic exploration of abdomen with angiocatheter placement under direct visualization, management of leaked luminal contents, and full-thickness sutured defect closure. Results Endoscopic abdominal exploration through the perforation site allowed safe placement of an angiocatheter for management of pneumoperitoneum, inspection for injury that may warrant surgical management, and removal of leaked luminal contents. Endoscopic sutured closure allowed safe and robust perforation management. Repair of gastrojejunal anastomotic perforation required 2 sutures and 63 minutes. Repair of gastric perforation required 4 sutures and 48 minutes. Patients had successful endoscopic defect closure confirmed by an upper GI series and were discharged 1 day later. Limitations Report of a new method in 2 patients performed at tertiary care center. Conclusions We demonstrate successful management of complex perforations with peritoneal contamination by incorporating endoscopic exploration and sutured closure with standard treatment measures. Traditional practice would have directed these patients to surgical management, which introduces additional morbidity and cost. A means for safe and broad implementation of these techniques should be evaluated. PMID:24721517

  6. Novel Endoscopic Management of Obesity.

    PubMed

    Dargent, Jerome

    2016-01-01

    Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory. PMID:26855921

  7. Novel Endoscopic Management of Obesity

    PubMed Central

    Dargent, Jerome

    2016-01-01

    Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory. PMID:26855921

  8. 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

  9. Extracervical approaches to endoscopic thyroid surgery.

    PubMed

    Papaspyrou, Giorgos; Ferlito, Alfio; Silver, Carl E; Werner, Jochen A; Genden, Eric; Sesterhenn, Andreas M

    2011-04-01

    There is increasing demand for surgical procedures which avoid visible scars while maintaining optimal functional and ideal cosmetic results, without compromising the safety or effectiveness of the procedure. Endoscopic techniques have been adapted to abdominal and pelvic surgery and increasingly employed over the past three decades. Although hampered by the absence of a natural cavity, endoscopic techniques have been adapted to surgery in the neck for the past 15 years, particularly for the thyroid gland. While earlier attempts at endoscopic thyroid surgery were performed through incisions in or near the midline of the neck, recent techniques have been developed to place the incisions and endoscopic ports extracervically, or at least away from the midline region of the neck, rendering the cosmetic result more acceptable. Most of these approaches are through the axilla, breast, chest wall or a combination of approaches. Visualization of the thyroid and rate of complications with these approaches are equal to those attained with older endoscopic approaches. Careful patient selection is important for endoscopic surgery. Complications unique to the endoscopic approach are mostly related to insufflation of cervical tissues with pressurized CO(2). PMID:20844894

  10. Developments in flexible endoscopic surgery: a review

    PubMed Central

    Feussner, Hubertus; Becker, Valentin; Bauer, Margit; Kranzfelder, Michael; Schirren, Rebekka; Lüth, Tim; Meining, Alexander; Wilhelm, Dirk

    2015-01-01

    Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a “white spot” for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings. PMID:25565878

  11. Endoscopic sinus surgery: evolution and technical innovations.

    PubMed

    Govindaraj, S; Adappa, N D; Kennedy, D W

    2010-03-01

    Prior to the introduction of functional endoscopic sinus surgery, several surgeons had begun to use telescopes to perform surgical procedures in the nose and sinuses. However, the central concepts of functional endoscopic sinus surgery evolved primarily from Messerklinger's endoscopic study of mucociliary clearance and endoscopic detailing of intranasal pathology. The popularity of a combination of endoscopic ethmoidectomy plus opening of secondarily involved sinuses grew rapidly during the latter part of the twentieth century, and endoscopic intranasal techniques began to expand to deal with pathology other than inflammation. We present a review of the evolution of knowledge regarding the pathogenesis of inflammatory sinus disease since that point in time, and of the impact that this has had on the management of inflammatory sinus disease. We also detail the technological advances that have allowed endoscopic intranasal techniques to expand and successfully treat other pathology, including skull base and orbital disease. In addition, we describe evolving technologies which may further influence development within this field. PMID:19930748

  12. 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

  13. Visual design and verification tool for collision-free dexterous patient specific neurosurgical instruments

    NASA Astrophysics Data System (ADS)

    Hess, Maggie; Eastwood, Kyle; Linder, Bence; Bodani, Vivek; Lasso, Andras; Looi, Thomas; Fichtinger, Gabor; Drake, James

    2016-03-01

    PURPOSE: In many minimally invasive neurosurgical procedures, the surgical workspace is a small tortuous cavity that is accessed using straight, rigid instruments with limited dexterity. Specifically considering neuroendoscopy, it is often challenging for surgeons, using standard instruments, to reach multiple surgical targets from a single incision. To address this problem, continuum tools are under development to create highly dexterous minimally invasive instruments. However, this design process is not trivial, and therefore, a user-friendly design platform capable of easily incorporating surgeon input is needed. METHODS: We propose a method that uses simulation and visual verification to design continuum tools that are patient and procedure specific. Our software module utilizes pre-operative scans and virtual threedimensional (3D) patient models to intuitively aid instrument design. The user specifies basic tool parameters and the parameterized tools and trocar are modeled within the virtual patient. By selecting and dragging the instrument models, the tools are instantly reshaped and repositioned. The tool geometry and surgical entry points are then returned as outputs to undergo optimization. We have completed an initial validation of the software by comparing a simulation of a physical instrument's reachability to the corresponding virtual design. RESULTS AND CONCLUSION: The software was assessed qualitatively by two neurosurgeons, who design tools for an intraventricular endoscopic procedure. Further, validation experiments comparing the design of a virtual instrument to a physical tool demonstrate that the software module functions correctly. Thus, our platform permits user-friendly, application specific design of continuum instruments. These instruments will give surgeons much more flexibility in developing future minimally invasive procedures.

  14. The use of piezoelectric effect to improve instrument quality and patient safety in laparoscopic surgery.

    PubMed

    Glavić, Željko; Šantak, Goran; Cesarik, Marijan; Slišurić, Ferdinand; Raštegorac, Ile; Zukanović, Goran

    2014-12-01

    The piezoelectric properties of some natural crystals and polymers can also be used in surgery. For this purpose, a prototype of an endoscopic instrument was constructed with piezoelectric material attached to its working end with the aim of recognizing pulsating blood vessels during laparoscopic surgery. To test the properties of the new instrument in laboratory conditions, simulated blood circulation was used with the possibility of changing pressure and frequency. The instrument was tested in the pressure range of 40-180 mm Hg at constant frequency of 72/min and frequency range of 36-130 beats per minute at constant pressure of 120 mm Hg. Test results showed that the instrument with certainty recognized a pulsating "blood vessel" in the expected pressure ranges and at different blood pump frequencies. Given the piezoelectric material's very small dimensions and flexible form, it can be installed at the working end of most standard laparoscopic instruments and thus significantly increase certainty in the recognition of arteries during surgery, which would reduce the possibility of their injury or accidental ligation.

  15. 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

  16. 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.

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

    PubMed

    Moghissi, Keyvan

    2006-06-01

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

  18. [A short history of endoscopic neurosurgery].

    PubMed

    Wang, Long; Song, Zhi-Bin; Gao, Jian-Wei; Li, Xu-Guangl

    2013-11-01

    Since 1910, rigid cystoscopy was first applied in the lateral ventricular choroid plexus cauterization for the treatment of congenital hydrocephalus, thus, opening up a new window in the endoscopic neurosurgery, but poor surgical outcome and high mortality made the application of endoscopic neurosurgery in question. Latterly, because of the appearance of new microscope and optical fiber endoscope, neuroendoscopy has been applied adequately in neurosurgery, with the increase of its clinical indications. Along with it, the concept of neuroendoscopy in surgery has changed, as well as the expansion of clinical indications. At present, neuroendoscopy technology has become a significant branch of modern neurosurgery. PMID:24524639

  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. [Research progress of endoscopic submucosal dissection with traction].

    PubMed

    Wu, Wenming; Wei, Zhi; Sun, Ziqin

    2016-01-01

    Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastrointestinal cancer. However, the steep learning curve of standard ESD procedures makes it less widely applied in clinical practice. Therefore, various traction devices and techniques have been applied previously to facilitate ESD, such as clip-with-line method, Spring-assisted method, S-O clip method, magnetic anchor method, and robot-assisted method. These methods create a clear field of vision and allow dissections to be performed more quickly and safely. In this article, we will discuss various techniques for achieving tractions during ESD on clinical decision, and their advantages and disadvantages. PMID:26797847

  1. Endoscopic-assisted Enucleation of Radicular Cysts - A Case Report.

    PubMed

    Kahairi, Abdullah; Ahmed Khan, Shamim; Amirozi, Ahmad

    2010-01-01

    The standard management for the majority of benign jaw cysts is enucleation, marsupialisation, curettage and decompression. Enucleation has the advantage that the whole specimen is sent for microscopic evaluation so that more sinister pathological processes (i.e. squamous cell carcinoma) may not be missed. In a large cystic lesion, enucleation is still possible, but technical difficulties might be encountered. In such instances, inevitable damage can occur to the surrounding structures. We report a case of a large radicular cyst of the maxilla that was enucleated via endoscopic assistance through the Caldwell Luc approach.

  2. 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

  3. 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

  4. Effect of endoscopic third ventriculostomy on neuropsychological outcome in late onset idiopathic aqueduct stenosis: a prospective study

    PubMed Central

    Burtscher, J; Bartha, L; Twerdy, K; Eisner, W; Benke, T

    2003-01-01

    Objective: To undertake a prospective study of the long term neuropsychological outcome in patients with late onset idiopathic aqueduct stenosis (LIAS) after endoscopic third ventriculostomy. Methods: Six patients with LIAS were evaluated pre- and postoperatively using magnetic resonance imaging (MRI) and standardised psychometric testing procedures. Endoscopic third ventriculostomy was done using standard surgical techniques. The mean long term follow up was 81.2 weeks. Results: Preoperatively, all patients had cognitive impairment, four of them showing deficits in several cognitive domains. After endoscopic third ventriculostomy, all patients improved clinically and had ventricular size reduction on MRI. Postoperative neuropsychological testing showed that five patients achieved normal or near normal cognitive functions, and one improved moderately. Conclusions: Endoscopic third ventriculostomy caused a substantial improvement in the neuropsychological deficit of LIAS patients. This was also true for patients with enlarged ventricles that might be diagnosed radiologically as "arrested hydrocephalus." PMID:12531955

  5. Development of a Temporal Bone Model for Transcanal Endoscopic Ear Surgery.

    PubMed

    Dedmon, Matthew M; Kozin, Elliott D; Lee, Daniel J

    2015-10-01

    Transcanal endoscopic ear surgery (TEES) is being increasingly used in chronic ear disease for cholesteatoma removal and middle ear reconstruction, reducing the need for a postauricular incision and mastoidectomy. However, TEES is a challenging technique even for the most experienced otologist, requiring one-handed dissection using angled instrumentation. We have therefore developed a high-fidelity dissection model incorporating key aspects of TEES and cholesteatoma removal to facilitate the acquisition of these skills. Artificial cholesteatoma was implanted into middle ear spaces of a human temporal bone via a facial recess approach. A pilot study was conducted whereby surgeons endoscopically elevated a tympanomeatal flap with artificial bleeding and removed artificial cholesteatoma with angled instrumentation. Surgeons were uniformly satisfied with the experience and felt it would translate into improved performance in the operating room. This study suggests that the TEES dissection model could become an integral tool in the training of emerging TEES techniques.

  6. Advantages of disposable endoscopic accessories.

    PubMed

    Petersen, B T

    2000-04-01

    Despite the prevailing emphasis on falling reimbursements and cost containment, the use of disposable endoscopic accessories has grown tremendously. They offer simplicity of use, certain sterility, and reduced labor costs in exchange for higher purchase costs per procedure and the burden of waste disposal. Disposable accessories provide greater variety, complexity, and utility. They carry a cost burden that may be acceptable when the devices are difficult to reprocess, when they incorporate features that justify the added cost, or when their unit cost approaches purchase plus reprocessing costs for reusable alternatives, such as for biopsy forceps. Units with small volumes may prefer the ease of disposable accessories independent of relative cost issues, while large high-volume units may need to evaluate cost data more carefully to maintain sustainable practices.

  7. The role of endoscopic assessment in ulcerative colitis in the era of infliximab.

    PubMed

    Daperno, M; Sostegni, R; Pera, A; Rognone, D; Rigazio, C; Ercole, E; Crocellà, L; Lavagna, A; Rocca, R

    2008-07-01

    Endoscopic evaluation of mucosal appearance is important for the clinical management of ulcerative colitis patients, as it offers valuable prognostic tools and data useful to change the management and treatment strategies. In the field of severe ulcerative colitis, partial endoscopy and bioptic sampling allows to obtain additional and relevant prognostic information: if severe endoscopic lesions are present, response to standard treatment is less likely, and if CMV superinfection is detected, anti-viral treatment should be added to conventional treatments. When clinical remission is obtained with conventional treatments, distal colonoscopy may add valuable data: the occurrence of complete endoscopic healing is a major predictor of long-term remission with no clinical activity. Finally, biologic treatments, and mainly infliximab, were shown to induce remarkable and significant mucosal healing also in ulcerative colitis, and patients with complete endoscopic healing in response to infliximab were shown to be more likely to experience fewer clinical relapses during the follow-up. Therefore endoscopic evaluation has to be considered a major prognostic marker in ulcerative colitis. In this review data from the Literature supporting this role will be reviewed. PMID:18598992

  8. 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.

  9. Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

    PubMed Central

    Zhai, Ya-Qi; Li, Hui-Kai; Linghu, En-Qiang

    2016-01-01

    Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD. PMID:26755889

  10. Cutting edge of endoscopic full-thickness resection for gastric tumor

    PubMed Central

    Maehata, Tadateru; Goto, Osamu; Takeuchi, Hiroya; Kitagawa, Yuko; Yahagi, Naohisa

    2015-01-01

    Recently, several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors, such as gastrointestinal stromal tumors, gastric carcinoid tumors, and early gastric cancer (EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus, it is possible to minimize the resection area and subsequent deformity. Some of these methods include: (1) classical laparoscopic and endoscopic cooperative surgery (LECS); (2) inverted LECS; (3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and (4) non-exposed endoscopic wall-inversion surgery. Furthermore, a recent prospective multicenter trial of the sentinel node navigation surgery (SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future, the indications for these procedures for gastric tumors could be expanded. PMID:26566427

  11. Peroral endoscopic myotomy for esophageal achalasia

    PubMed Central

    Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

    2014-01-01

    Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

  12. Advances in endoscopic imaging in ulcerative colitis.

    PubMed

    Tontini, Gian Eugenio; Pastorelli, Luca; Ishaq, Sauid; Neumann, Helmut

    2015-01-01

    Modern strategies for the treatment of ulcerative colitis require more accurate tools for gastrointestinal imaging to better assess mucosal disease activity and long-term prognostic clinical outcomes. Recent advances in gastrointestinal luminal endoscopy are radically changing the role of endoscopy in every-day clinical practice and research trials. Advanced endoscopic imaging techniques including high-definition endoscopes, optical magnification endoscopy, and various chromoendoscopy techniques have remarkably improved endoscopic assessment of ulcerative colitis. More recently, optical biopsy techniques with either endocytoscopy or confocal laser endomicroscopy have shown great potential in predicting several histological changes in real time during ongoing endoscopy. Here, we review current applications of advanced endoscopic imaging techniques in ulcerative colitis and present the most promising upcoming headways in this field. PMID:26365308

  13. 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

  14. 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

  15. Reutilization of accessories in gastrointestinal endoscopic practice.

    PubMed

    Haber, G

    2000-10-01

    The key issues that determine the decision between reusable versus disposable accessories are cost and functionality. In most health-care systems the availability and dissemination of endoscopic services relates directly to the resources (i.e. budget) of that system. Given the limitations of health-care budgets, access to endoscopic services will depend upon the cost efficiency of endoscopic practice. The onus on endoscopists and health-care providers, therefore, is to meticulously evaluate the necessary steps for safe reutilization of accessories. This paper addresses the principles of reuse, quality assurance and particularly disinfection practices. Any change to a more costly disposable accessory policy must bear the responsibility of denied access to endoscopic services in a system with finite resources.

  16. 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

  17. 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

  18. Ultrasound-Assisted Endoscopic Carpal Tunnel Release.

    PubMed

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

    2016-06-01

    Various surgical procedures for carpal tunnel syndrome exist, such as open release, ultrasound-guided percutaneous release, and endoscopic release. Postoperative pain, scarring, and slow recovery to normal function are reported complications of open release. Damage to vessels and the median nerve and its branches underlying the transverse carpal ligament is a reported complication of ultrasound-guided percutaneous release. Damage to the superficial palmar arch and incomplete release are reported complications of endoscopic release. By performing endoscopic carpal tunnel release with ultrasound assistance, we could visualize neurovascular structures directly with the endoscope and also indirectly with ultrasound to minimize complications. We could also evaluate the morphologic changes of the median nerve dynamically before and after the release. We discuss the technique for this procedure and outline pearls and pitfalls for success. PMID:27656366

  19. Endoscopic resection of superficial gastrointestinal tumors

    PubMed Central

    Marc, Giovannini; Lopes, Cesar Vivian

    2008-01-01

    Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract. PMID:18698673

  20. 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

  1. Modelling of a laser-pumped light source for endoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

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

  2. 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

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

    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.; Snopova, Ludmila; Shakhov, Andrei; Kuznetzova, Irina N.; Denisenko, Arkady; Pochinko, Vitaly; Chumakov, Yuri; Almasov, Valentin

    1998-04-01

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

  4. 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.

  5. 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.

  6. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Kadosaka, Kumpei; Yoshikawa, Tomoe; Kudo, Masatoshi

    2016-01-01

    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. PMID:27122677

  7. Three-dimensional shape measurements using endoscopes

    NASA Astrophysics Data System (ADS)

    Su, Wei-Hung; Hsu, Tzu-Chien; Kuo, Cho-Yo

    2015-08-01

    We present a fringe projection system embedded into an endoscope to describe the absolute shape of an inspected object. A fringe pattern generated by launching incoherent light waves into a volume hologram is projected on the inspected surface. The endoscope observes the projected fringes at another point of view. Fringes on the obtained image are deformed both by the topography of the object, and are analyzable to retrieve the 3D shape.

  8. Correlation of endoscopic optical coherence tomography with histology

    NASA Astrophysics Data System (ADS)

    Westphal, Volker; Rollins, Andrew M.; Willis, Joseph; Sivak, Michael J., Jr.; Izatt, Joseph A.

    2000-04-01

    Optical Coherence Tomography (OCT) is a noninvasive optical imaging technique that allows high-resolution cross- sectional imaging of tissue microstructure. We have recently developed a system for endoscopic OCT (EOCT) to examine the gastrointestinal tract of humans in vivo. Compared to endoscopic ultrasonic devices it offers a higher resolution and does not require coupling gels or fluids. EOCT may lead to a versatile tool for biopsy site selection or optical biopsy itself. The EOCT unit is comprised of an interferometer unit with a high speed scanning reference arm and an endoscopically compatible radially scanning probe as the sample arm. Fast data acquisition allows real-time display. Temporal averaging for speckle reduction and a transformation to correct nonlinear scanning were included in the EOCT control software, both in real-time. During in vivo clinical trials, we have observe the structure of the mucosa and submucosa in several gastrointestinal organs as well as glands, blood vessels, pits, villi and crypts. The purpose of this study was to correlate images acquired in vitro with EOCT to corresponding histological sections. EOCT images were obtained on fresh specimens, which were then fixed in formalin and submitted for standard histology. Tissues examined were normal specimens, which were then fixed in formalin and submitted for standard histology. Tissues examined were normal specimens of stomach, ileum, colon and rectum. It was shown that he thickness of the mucosa correlates well with the first bright layer in EOCT. The R2-value was determined to be 0.69. The submucosa and the muscularis propria could be identified. Furthermore, we were able to show the effect of pressure on the tissue on the visible details in the EOCT images.

  9. Forehead Mass Removal by Endoscopic Approach.

    PubMed

    Jung, Soyeon; Jung, Sung Won; Koh, Sung Hoon; Lim, Hyoseob

    2016-03-01

    Patients with forehead mass have a cosmetic problem because the forehead is an important first impression. Conventional skin approach results in visible scar even though surgeons designed the incision along the relaxed skin tension line1. Since Onishi introduced the technique for endoscopic approach in 1995, endoscopic surgery has become rapidly popular in the field of plastic surgery. Endoscopic approach to the forehead mass by small incision on the scalp behind hair line is big advantageous for leaving less ugly scar on the forehead. All procedures need to be identified under the endoscopic visualization. When it was completed, the mass was pulled out. The authors also used the osteotome or rasp when it was the osteoma. The forehead and scalp were applied compressive dressing to prevent hematoma and swelling for 2 days. The cosmesis was excellent because they have no visible scar on the forehead. Endoscopic approaching technique is getting popular and commonly used during the cosmetic surgery because it has many advantages. This method also, however, has difficulties to remove large-sized mass and to perform caudal dissection, and for increased operative times. Furthermore, there are complication of incomplete removal, hematoma, and swelling. The proper candidate is the patient with smooth forehead, with a mobile and soft mass, with a propensity for keloid formation, or hypertrophic scarring. Endoscopic technique is not only advantageous but also disadvantageous. That is why surgeon's selection is more important. PMID:26967101

  10. Endoscopic Management of Gastrointestinal Leaks and Fistulae.

    PubMed

    Willingham, Field F; Buscaglia, Jonathan M

    2015-10-01

    Gastrointestinal leaks and fistulae can be serious acute complications or chronic morbid conditions resulting from inflammatory, malignant, or postsurgical states. Endoscopic closure of gastrointestinal leaks and fistulae represents major progress in the treatment of patients with these complex presentations. The main goal of endoscopic therapy is the interruption of the flow of luminal contents across a gastrointestinal defect. In consideration of the proper endoscopic approach to luminal closure, several basic principles must be considered. Undrained cavities and fluid collections must often first be drained percutaneously, and the percutaneous drain provides an important measure of safety for subsequent endoscopic luminal manipulations. The size and exact location of the leak/fistula, as well as the viability of the surrounding tissue, must be defined. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition, radiology, and surgery. Currently, gastrointestinal leaks and fistulae may be managed endoscopically by using 1 or more of the following modalities: stent placement, clip closure (including through-the-scope clips and over-the-scope devices), endoscopic suturing, and the injection of tissue sealants. In this article, we discuss these modalities and review the published outcomes data regarding each approach as well as practical considerations for successful closure of luminal defects.

  11. Endoscopically assisted excision of digital enchondroma.

    PubMed

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

    2007-06-01

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

  12. 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. PMID:19163033

  13. 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.

  14. Laparo-endoscopic single-site surgery hysterectomy using robotic lightweight endoscope assistants.

    PubMed

    Kane, Sarah; Stepp, Kevin J

    2010-01-01

    Current laparoscopic and robotic hysterectomy techniques require three to five small incisions in the abdominal wall. Each additional port contributes an additional risk for port site complications. Because of these risks, and in an effort to improve cosmesis, surgery through a single incision is being explored. New versatile robot devices can provide a less cumbersome and less expensive alternative to the conventional multi-arm robot devices. In the case reported here, that of a 37-year-old female undergoing hysterectomy, we combined the use of these two technologies in a novel way. By utilizing a single laparoscopic port site in addition to two lightweight robotic endoscope assistants, we were able to decrease risk and improve cosmesis while allowing single-operator control of all instrumentation. The novel use of this robotic device demonstrates a potential decrease in the need for surgical assistants and thus a decrease in cost. When combined with single-site laparoscopy, it also allows the surgeon complete control of the operative environment and may enable more surgeons to embrace the single-incision technique. PMID:27628640

  15. 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.

  16. Single-site video endoscopic inguinal lymphadenectomy: initial report.

    PubMed

    Tobias-Machado, Marcos; Correa, Walter F; Reis, Leonardo Oliveira; Starling, Eduardo S; de Castro Neves, Oseas; Juliano, Roberto V; Pompeo, Antonio C L

    2011-04-01

    Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization. PMID:21226622

  17. Quantitative size measurement of features viewed through a video endoscope

    NASA Astrophysics Data System (ADS)

    Bhatnagar, Vipul; Poret, Jay C.; Suter, Joseph J.; Ravich, William J.; Giannini, Judith A.

    1994-07-01

    Quantitative size measurements of gastrointestinal tract lesions (i.e., ulcers and polyps) viewed during endoscopy are helpful in assessing the rate of healing or growth. We report a novel technique for quantitatively measuring the two-dimensional size of a feature viewed remotely via a video imager. Our instrument's small size makes it a suitable candidate for use in endoscopes. Computing the size of a feature displayed on a two-dimensional video monitor necessitates measuring the distance between the imager and the surface under observation because an undistorted video image preserves the angular content of a scene. We have developed a prototype ranging system that exploits the tendency of light emerging from the tip of an optical fiber to diverge. Our device uses two fibers with different divergence characteristics. The separation between the imaging sensor and the viewed surface is determined by inspecting the relative sizes of the spots cast by each of the fibers. Our device, which measures distances between 2 and 8 cm, is sufficiently small to be accommodated in an endoscope's accessory channel.

  18. Cordless Instruments

    NASA Technical Reports Server (NTRS)

    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.

  19. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection.

    PubMed

    Yoshida, Naohisa; Fernandopulle, Nilesh; Inada, Yutaka; Naito, Yuji; Itoh, Yoshito

    2014-09-01

    Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments.

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. [Endoscopic ultrasonography elastography in gastroenterology].

    PubMed

    Rustemović, Nadan; Opacić, Milorad; Cuković-Cavka, Silvija

    2009-12-01

    Endoscopic ultrasonography (EUS) elastography is a new technique for detecting the elastic properties of examined tissues during real time ultrasonography. The method is a very valuable tool for the diagnosis and evaluation of pathologic processes affecting the gastrointestinal tract and its adjacent organs. It represents a major advance in the diagnosis and staging of gastrointestinal malignancies, especially pancreatic carcinoma. EUS also provides guidance for fine needle aspiration (FNA) of undiagnosed masses and lymph nodes. Establishing the diagnosis of Crohn's disease or ulcerative colitis is sometimes very difficult. When inflammatory bowel disease (IBD) is confined to the colon, there is a lack of diagnostic tools for distinction between Crohn's colitis and ulcerative colitis, which is especially important in definitive phenotyping before surgical decision. Our ongoing studies emphasize the role of EUS elastography in the diagnosis of inflammatory bowel disease phenotype and primary sclerosing cholangitis. As there are no literature data on this issue, we recommend further investigations in this promising new area of research. PMID:20235372

  8. 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. PMID:20521045

  9. 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

  10. Aeronautic Instruments. Section III : Aircraft Speed Instruments

    NASA Technical Reports Server (NTRS)

    Hunt, Franklin L; Stearns, H O

    1923-01-01

    Part 1 contains a discussion and description of the various types of air speed measuring instruments. The authors then give general specifications and performance requirements with the results of tests on air speed indicators at the Bureau of Standards. Part 2 reports methods and laboratory apparatus used at the Bureau of Standards to make static tests. Methods are also given of combining wind tunnel tests with static tests. Consideration is also given to free flight tests. Part 3 discusses the problem of finding suitable methods for the purpose of measuring the speed of aircraft relative to the ground.

  11. 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

  12. New thermal neutron prompt γ-ray activation analysis instrument at the National Institute of Standards and Technology Center for Neutron Research

    NASA Astrophysics Data System (ADS)

    Mackey, E. A.; Anderson, D. L.; Liposky, P. J.; Lindstrom, R. M.; Chen-Mayer, H.; Lamaze, G. P.

    2004-11-01

    A new thermal neutron prompt γ-ray activation analysis (PGAA) instrument was designed and built to replace the original PGAA system at the NIST Center for Neutron Research. By placing a sapphire filter in the neutron beam shutter assembly, the fast neutron fluence rate was reduced by a factor of 5 and low-energy (50-200 keV) γ-ray intensities were reduced by factors of 5-10. The thermal neutron fluence rate was reduced by only a factor of 1.13. A new external beam tube, sample chamber, beam stop, and support structure were built and a new detection system installed. The new beam tube is made of two cylindrical aluminum sections lined with a lithiated polymer. Both sections are kept under vacuum to reduce the number of neutrons scattered by air into the beam tube walls. The sample chamber is also fabricated from aluminum and lined with lithiated polymer, and may be evacuated to minimize the number of neutrons scattered and absorbed by air. The beam tube and sample chamber assembly is suspended from the aluminum support structure. The detection system consists of a 40% efficient (relative) germanium detector (resolution 2.0 at 1332.5 keV) and a bismuth germanate Compton suppressor. The detection system is shielded by lead, surrounded by borated and lithiated polyethylene, and placed on a table attached to the support structure. The new, more compact beam stop is welded to the support structure. Capture γ-ray photopeaks from H, B, C, N, Na, Al, Fe, Ge, I and Pb in the background spectrum were either of lower intensity or eliminated with the new PGAA instrument. The more efficient detection system, positioned closer to the sample, yielded element sensitivity increases of 5-50%. Limits of detection have been greatly reduced compared with those of the original instrument due to reduced Compton and scattered γ-ray backgrounds (especially in the low-energy region), increased sensitivities, and reduction of background γ-ray photopeak intensities.

  13. Improving patient and user safety during endoscopic investigation of the pancreatic and biliary ducts

    NASA Astrophysics Data System (ADS)

    Chandler, John E.; Melville, C. David; Lee, Cameron M.; Saunders, Michael D.; Burkhardt, Matthew R.; Seibel, Eric J.

    2011-03-01

    Endoscopic investigation of the main pancreatic duct and biliary ducts is called endoscopic retrograde cholangiopancreatography (ERCP), and carries a risk of pancreatitis for the patient. During ERCP, a metal guidewire is inserted into the pancreatobiliary duct from a side-viewing large endoscope within the duodenum. To verify correct placement of the ERCP guidewire, an injection of radiopaque dye is required for fluoroscopic imaging, which exposes the patient and clinical team to x-ray radiation. A safer and more effective means to access the pancreatobiliary system can use direct optical imaging, although the endoscope diameter and stiffness will be significantly larger than a guidewire's. To quantify this invasiveness before human testing, a synthetic force-sensing pancreas was fabricated and attached to an ERCP training model. The invasiveness of a new, 1.7-mm diameter, steerable scanning fiber endoscope (SFE) was compared to the standard ERCP guidewire of 0.89-mm (0.035") diameter that is not steerable. Although twice as large and significantly stiffer than the ERCP guidewire, the SFE generated lower or significantly less average force during insertion at all 4 sensor locations (P<0.05) within the main pancreatic duct. Therefore, the addition of steering and forward visualization at the tip of the endoscope reduced the invasiveness of the in vitro ERCP procedure. Since fluoroscopy is not required, risks associated with dye injection and x-ray exposure can be eliminated when using direct optical visualization. Finally, the SFE provides wide-field high resolution imaging for image-guided interventions, laser-based fluorescence biomarker imaging, and spot spectral analysis for future optical biopsy.

  14. 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…

  15. 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…

  16. Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.

    PubMed

    Rustagi, Tarun; McCarty, Thomas R; Aslanian, Harry R

    2015-01-01

    Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.

  17. Single-channel prototype terahertz endoscopic system

    NASA Astrophysics Data System (ADS)

    Doradla, Pallavi; Alavi, Karim; Joseph, Cecil; Giles, Robert

    2014-08-01

    We demonstrate the design and development of an innovative single-channel terahertz (THz) prototype endoscopic imaging system based on flexible metal-coated THz waveguides and a polarization specific detection technique. The continuous-wave (CW) THz imaging system utilizes a single channel to transmit and collect the reflected intrinsic THz signal from the sample. Since the prototype system relies on a flexible waveguide assembly that is small enough in diameter, it can be readily integrated with a conventional optical endoscope. This study aims to show the feasibility of waveguide enabled THz imaging. We image various objects in transmission and reflection modes. We also image normal and cancerous colonic tissues in reflectance mode using a polarization specific imaging technique. The resulting cross-polarized THz reflectance images showed contrast between normal and cancerous colonic tissues at 584 GHz. The level of contrast observed using endoscopic imaging correlates well with contrast levels observed in ex vivo THz reflectance studies of colon cancer. This indicates that the single-channel flexible waveguide-based THz endoscope presented here represents a significant step forward in clinical endoscopic application of THz technology to aid in in vivo cancer screening.

  18. 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

  19. 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

  20. 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

  1. 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

  2. Remote instrument telemaintenance.

    PubMed

    Laugier, A; Allahwerdi, N; Baudin, J; Gaffney, P; Grimson, W; Groth, T; Schilders, L

    1996-07-01

    In the past decade, great technological progress has been made in telemaintenance of mainframe and mini computers. As hardware technology is now available at an acceptable cost, computer aided trouble-shooting can be adapted to laboratory instrumentation in order to significantly improve repair time, avoid instrument downtime by taking advantage of predictive methods, and provide general diagnostic assistance. Depending on the size of the instrument, the telemaintenance facility can be dedicated to a single instrument or alternatively a telemaintenance server can manage multiple distributed small instruments through a Local Area Network. As complex failures can occur, the local diagnosis capabilities may be exceeded and automatic dialing for connection to computerized Remote Maintenance Centers is needed. The main advantages of such a centre, as compared to local diagnosis systems, are the increased access to more information and experience of failures from instrument installations, and consequently the provision of training data updates for Artificial Neural Networks and Knowledge Based Systems in general. When an abnormal situation is detected or anticipated by a diagnosis module, an automatic alert is given to the user, local diagnosis is activated, and for simple solutions, instructions are given to the operator. In the last resort, a human expert can be alerted who, with remote control tools, can attend to the failures. For both local and remote trouble-shooting, the data provided by the instrument and connected workstation is of paramount importance for the efficiency and accuracy of the diagnosis. Equally, the importance of standardization of telemaintenance communication protocols is addressed.

  3. 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)

  4. 14 CFR 23.1381 - 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. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 14 CFR 23.1381 - 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. 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...

  9. 14 CFR 23.1381 - 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. 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...

  10. 14 CFR 23.1381 - 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. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

    PubMed Central

    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. PMID:26273644

  17. 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

  18. Astronomical instruments.

    NASA Astrophysics Data System (ADS)

    Rai, R. N.

    Indian astronomers have devised a number of instruments and the most important of these is the armillary sphere. The earliest armillary spheres were very simple instruments. Ptolemy in his Almagest enumerates at least three. The simplest of all was the equinoctial armilla. They had also the solstitial armilla which was a double ring, erected in the plane of the meridian with a rotating inner circle. This was used to measure the solar altitude.

  19. Oceanographic Instrument

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Developed under NASA contract, the Fast Repetition Rate (FRR) fluorometer is a computer-controlled instrument for measuring the fluorescence of phytoplankton, microscopic plant forms that provide sustenance for animal life in the oceans. The fluorometer sensor is towed by ship through the water and the resulting printouts are compared with satellite data. The instrument is non-destructive and can be used in situ, providing scientific information on ocean activity and productivity.

  20. Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors

    PubMed Central

    2012-01-01

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