CO2 laser surgery in osteomyelitis

Spirituality is a critical component of the holistic mind-body-spirit model embraced by Hospice. Hospice chaplains, as part of the caregiving team, must understand their abilities and limitations in providing spiritual guidance to others who may differ in religious and spiritual beliefs.     

Anesthesia in laparoscopic surgery

The use of laparoscopic techniques in general surgery is increasing in popularity. The anesthesiologist's goals during laparoscopic surgery are hemodynamic and respiratory stability, appropriate muscle relaxation, control of diaphragmatic excursion, intraoperative and postoperative patient analgesia. The implications are that the anesthesiologist must use a technique that not only allows for optimal surgical conditions but also provides intraoperative patient comfort and safety and a rapid postoperative anesthetic recovery. Laparoscopy is not a benign procedure. It is associated with major and minor surgical and non surgical complications, including death. Therefore, it is imperative that the anesthesiologist and surgeon thoroughly understand the physiopathology and immediate treatment of these potential complications and communicate effectively about their management.     

Changes in Seasonality in China under Enhanced Atmospheric CO2 Concentration

Seasonality changes in China under elevated atmospheric CO2 concentrations were simulated using nine global climate models, assuming a 1% per year increase in atmospheric CO2. Simulations of 20th century experiments of season changes in China from the periods 1961-80 to 1981-2000 were also assessed using the same models. The results show that the ensemble mean simulation of the nine models performs better than that of an individual model simulation. Compared the mean climatology of the last 20 years in the CO2-quadrupling experiments with that in the CO2-doubling ones, the ensemble mean results show that the hottest/coldest continuous-90-day (local summer/winter) mean temperature increased by 3.4/4.5℃, 2.7/2.9℃, and 2.9/4.1℃ in Northeast (NE), Southwest (SW), and Southeast (SE) China,respectively, indicating a weakening seasonal amplitude (SA), but by 4.4/4.0℃ in Northwest (NW) China, indicating an enlarging SA. The local summer lengthened by 37/30/66/54 days in NW, NE, SW, and SE China, respectively. In some models, the winter disappeared during the CO2-quadrupling period, judging by the threshold based on the CO2-doubling period. The average of the other model simulations show that the local winter shortened by 42/36/61/44 days respectively, in the previously mentioned regions.     

Robot arm in laparoscopic surgery

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.     

Measurements in emergency laparoscopic surgery

The paper deals with the advantages of the techniques of abdominal surgical interventions by using a laparoscope. It suggests that the diagnostic feasibilities of laparoscopy should be expanded by inserting the transducers that yield reliable data on the status of the viscera.     

Changes of cerebrovascular CO2 reactivity during normal aging

BACKGROUND AND PURPOSE: During the past decade, transcranial Doppler sonography has widely been used to assess blood flow velocities in the basal intracranial arteries and cerebrovascular reactivity (CR) to various stimuli. Although numerous studies have shown a decline of cerebral blood flow velocity with age, the age dependency of CR, including cerebrovascular CO2 reactivity, however, is controversial. Recently, we have reported a significant sex-related difference in CR, stressing the need to study the relation between normal aging and CR in both sexes separately. METHODS: By means of transcranial Doppler sonography, CR was determined in 100 healthy, nonsmoking volunteers (age 20 to 70 years, 10 men and 10 women per decade). RESULTS: In men, no change of CR with increasing age could be observed (P=0.98). In contrast, CR in women declined significantly, with a step decrease from the 4th to the 5th decades (F=4.413; P<0.01) and was significantly higher in the 3rd and 4th compared with the 5th, 6th, and 7th decades (P<0.05). Information on hormone replacement therapy (HRT) in women of the 6th and 7th decades was obtained retrospectively. HRT was associated with enhanced CR (HRT, n = 7 versus non-HRT, n = 13; P<0.001), with values similar to those found in premenopausal women. CONCLUSIONS: There are no changes of CR during normal aging in men, whereas CR declines significantly from the 4th to the 5th decades in women. HRT in postmenopausal women appears to enhance CR.     

Complications of laparoscopic surgery

The potential complications of a laparoscopic procedure include those related to laparoscopy and those related to the specific operative procedure. The majority of these complications occur during the early learning phase for laparoscopy. They also may occur, however, during procedures performed by surgeons who have considerable laparoscopic experience. As new applications for laparoscopy continue to emerge, it is important for the surgeon to be familiar with the possible complications associated with the various laparoscopic procedures. Only through an appreciation of the potential complications of a procedure can their overall incidence be reduced to a minimum.     

Port site recurrences after laparoscopic surgery. A review

The diagnosis of meningeal carcinomatosis hinges on the cytologic examination of cerebrospinal fluid (CSF), which has a known low sensitivity for the identification of malignant cells. Often only 'suspicious' or 'atypical' diagnoses can be rendered, and specimens are commonly unsatisfactory for evaluation due to poor morphologic preservation. Telomerase is widely expressed in most brain metastases, medulloblastomas, lymphomas, oligodendrogliomas, and is expressed focally in glioblastomas. Little is known about the level of telomerase expression in these tumors, except for brain metastases, where a four-fold variation in telomerase levels exists. In our laboratory, as few as ten carcinoma cells can be detected by a sensitive polymerase chain reaction-based assay, the telomeric repeat amplification protocol (TRAP), for telomerase, but it was unclear whether varying levels of telomerase expressed by different types of metastases would influence detection. Using the TRAP protocol, we studied 281 CSF samples from a wide variety of patients with neurologic and non-neurologic conditions for telomerase expression. An adjusted specificity of 90% and a sensitivity of 64% were achieved for detection of malignant cells in CSF by telomerase expression. The TRAP assay for telomerase detection may serve as an adjunct to the traditional examination of CSF. Neither previously documented four-fold variation in the levels of telomerase expression in brain metastases, high CSF protein levels nor high white blood cell counts precluded detection of malignant cells in CSF.     

Effects of CO2 on pulmonary air flow resistance in the duck

Effects of CO2 on pulmonary smooth muscle were assessed by measuring the air flow resistance of secondary bronchi and parabronchi in ducks unidirectionally ventilated with a constant gas flow through the parabronchial lung, the bypass of the primary bronchus being occluded by a blocking catheter. Pressure differences across the blocking balloon (deltaP), corresponding to the pressure drop in the gas flowing through the mediodorsal and medioventral secondary bronchi (MD and MV) and parabronchi, were measured at flow rates (V) varied from 0.5 to 3 L-min-1 and at CO2 concentrations of ventilating gas (FICO2) varied from 0 to 10%. 1) deltaP increased more than linearly with V. The resulting flow resistance R(= deltaP/V) averaged 43 and 95 cm H2O-L-1-sec at V = 0.5 and 3 L-min-1, respectively. 2) Step changes in FICO2 at constant V were followed within 0.5 to 5 sec by changes in R. 3) Lowering FICO2 from 5% resulted in marked increases in R, the value at FICO2 = 0% being more than twice the average value at 5%. Raising FICO2 from 5% up to 10% was followed by only slight changes in R. 4) Vagotomy did not consistently change R at any level of CO2; it did, however, slightly increase the delay time for changes in R on step changes of FICO2. 5)The medioventral secondary bronchi and their orifices into the primary bronchus appeared to be mainly responsible for the resistance measured and its changes with CO2. The resistance offered by the parabronchi appeared to be much smaller and much less dependent on CO2. The results suggest importance of lung gas CO2 in aerodynamic valving of respiratory flow in avian lungs during normal breathing and particularly during thermal panting to prevent alkalosis.     

Changes in pulmonary physiology after lung volume reduction surgery in a rabbit model of emphysema

BACKGROUND: We administered a specific, nonselective matrix metalloproteinase (MMP) inhibitor (RS-113,456) to examine the effect of MMP inhibition on flow-mediated arterial enlargement in a rodent arteriovenous fistula (AVF) model. METHODS: Four groups of male Sprague-Dawley rats were created: sham (sham operated; n = 10), control (2.0 mm left common femoral AVF alone; n = 16), vehicle (AVF plus 0.5 mL vehicle orally twice a day; n = 20), and treatment (AVF plus 25 mg/kg RS-113,456 in 0.5 mL vehicle orally twice a day; n = 16). Heart rate, mean arterial pressure, and body weight were recorded on postoperative days 0, 7, 14, and 21. On day 21, AVF patency was confirmed, the infrarenal aorta and common iliac arteries were exposed, blood flow velocity and external diameter were measured, and wall shear stress (WSS) was calculated. Analysis was performed by paired, two-tailed Student t test, one-way analysis of variance, and the Bonferroni/Dunn procedure for post hoc testing. RESULTS: Heat rate, mean arterial pressure, and weight did not vary at any time between groups. Aortic and left iliac diameter was larger in the AVF groups than in sham groups (P < .001), and control and vehicle groups were larger than treatment groups (P < .0001). Changes in aortic and left iliac flow were also significant (AVF was more than sham and control, and vehicle was more than treatment). No difference in aortic and left iliac artery velocity and WSS or right iliac diameter, velocity, flow, or WSS was observed between groups. CONCLUSIONS: MMP inhibition diminishes flow-mediated arterial enlargement in the rat AVF model.     

Standard means in laparoscopic surgery. The peculiar case of cholecystectomy

Legal suits against visceral surgeons have increased since the advent of laparoscopic surgery. The duties of physicians have not however changed with the development of laparoscopic techniques. Since the decree promulgated in 1936, physicians have a legal commitment to provide the means required for patient care. This obligation has been recalled in different court judgements and in the new deontology code. In addition, jurisprudence tends more and more towards responsibility without risk. Laparoscopic cholecystectomy is not risk-free. Although morbidity and mortality have not risen with laparoscopic procedures, the types of complications encountered have changed. Reported accidents have become more frequent. The number of suits against surgeons has also increased. Surgeons must therefore be highly prudent and diligent. Precautions concerning personnel management, the choice of material and its upkeep. Special care must be given to the peroperative pneumoperitoneum and the use of monopolar electrocoagulation. A peroperative cholangiogram should be obtained. A careful operative report is very important. The surgeon must be able to justify his competence. Finally, the surgical community should publish more results concerning the rate of complications in order to establish reference material for experts.     

Video laparoscopic surgery and rectal prolapse. Our experience in rectopexy

BACKGROUND: Laparoscopy is gaining an important role in the treatment of benign colorectal disorders. The aim of this study is the evaluation of clinical and functional results in 4 patients submitted to a laparoscopy rectopexy according to Wells. METHODS: Four females (22-76, mean 53.7 years) affected from a total rectal prolapse with fecal incontinence underwent this procedure from 1993 through 1995. Six months after surgery, at the end of a rehabilitation program consisting of kinesitherapy, bio-feedback and electrostimulations, all patients have been re-evaluated by means of a clinical exam, anorectal manometry, defecography. RESULTS AND CONCLUSIONS: Preliminary results seem satisfactory and may allow to prefer this approach instead of the traditional open one.     

Paraesophageal hernias in elderly patients. An indication for laparoscopic surgery

Paraesophageal hernias are uncommon conditions which appear mainly in elderly people, frequently associated with sliding hernias or gastric volvulus. Considered a high risk pathology, surgical management is preferred to avoid serious complications. Due to advanced age and operative risks, a laparoscopic approach was performed in the three patients with paraesophageal hernia. In mixed hernias, a Nissen or Toupet fundoplication and closure of the hiatal defect was carried out. In a case with gastric rotation, reduction of the herniated stomach and posterior partial fundoplication with gastropexy was performed. No postoperative complications occurred and recovery was satisfactory. Laparoscopic management seems to be a good choice for elective treatment of paraesophageal hernias in elderly patients.     

Microstructural Changes and Kinetics of Reduction of Hematite to Magnetite in CO/CO2 Gas Atmospheres

Metallurgical and Materials Transactions B - The microstructures of porous magnetite formed on gaseous reduction of dense hematite have been examined using high-resolution scanning electron...