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The craft of surgery has always relied on the use of instruments. Innovations in surgery have paralleled innovations in instrumentation.
Advances in surgical instrumentation continue today and have enabled huge strides in surgical procedures and outcomes during
this generation. Computers and related technology are now changing the interface between the surgeon and the patient, and
are poised to improve patient outcomes by enhancing the surgeon’s skills and training. The application of computer enhanced
telemanipulators, or “robots”, may specifically enhance operations, for example Heller myotomy, that require good visualization
and precise careful dissection of delicate structures. This review covers the pathophysiology of achalasia and its history
of medical and surgical treatment, leading to modern robotic telesurgical approaches. Improvements in outcome from medical
to standard surgical to robotic telesurgical approaches are discussed. Current operative technique for robotic telesurgical
treatment of achalasia is described and the authors conclude with a glimpse of where, in the future, current research endeavors
will lead us in the treatment of achalasia. 相似文献
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Z Yilmaz T Renton Y Yiangou J Zakrzewska I P Chessell C Bountra P Anand 《Journal of clinical neuroscience》2007,14(9):864-871
Burning mouth syndrome (BMS) is often an idiopathic chronic and intractable pain condition, affecting 1.5-5.5% of middle-aged and elderly women. We have studied the heat and capsaicin receptor TRPV1, and its regulator nerve growth factor (NGF), in BMS. Patients with BMS (n=10) and controls (n=10) were assessed for baseline and post-topical capsaicin pain scores, and their tongue biopsies immunostained for TRPV1, NGF, and structural nerve markers neurofilament and peripherin. Nerve fibres penetrating the epithelium were less abundant in BMS (p<0.0001), indicating a small fibre neuropathy. TRPV1-positive fibres were overall significantly increased in BMS (p=0.0011), as were NGF fibres (p<0.0001) and basal epithelial cell NGF staining (p<0.0147). There was a significant correlation between the baseline pain score and TRPV1 (p=0.0143) and NGF fibres (p=0.0252). A significant correlation was observed between baseline and post-capsaicin pain (p=0.0006). Selective TRPV1 and NGF blockers may provide a new therapy for BMS. 相似文献
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Anterior lumbar fusion using a hybrid interbody graft 总被引:3,自引:0,他引:3
Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels)
utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft
bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years).
Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion
combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior
fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar
facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence
of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest
follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS
fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation
was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected
for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative
values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of
the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the
73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing
anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be
required to assess the behaviour of the allograft until incorporation is complete. 相似文献
6.
Gordon Winocur Fergus I M Craik Brian Levine Ian H Robertson Malcolm A Binns Michael Alexander Sandra Black Deirdre Dawson Heather Palmer Tara McHugh Donald T Stuss 《Journal of the International Neuropsychological Society》2007,13(1):166-171
This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed. 相似文献
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To evaluate capillary filtration a group of normal subjects and two groups of subjects with venous incompetence (50 with deep and 50 with superficial incompetence) were studied with the vacuum suction chamber (VSC) device applied onto the internal perimalleolar region. This method was compared with straingauge plethysmography rate of ankle swelling (RAS). By the VSC the time taken for the weal to disappear (VSC time) was considered indicative of capillary filtration. The values obtained with the two methods were well related (r < 0.742) and there was a good separation between patients and normals. The separation between the two groups of patients was significantly better (p < 0.05) with the VSC time. In conclusion VSC time is a good indication of capillary filtration in comparison with straingauge plethysmography RAS. It may be used to assess variations in capillary filtration in venous hypertension and possibly to follow up the effects of treatments. 相似文献