A thermal appraisal of the ablation process in canine aorta in vivo using a 100 μm pulsed Nd-YAG laser

A model has been developed to calculate distal tissue necrosis in vascular tissue after application of a 100 laser pulse from a Nd-YAG laser (5 kW peak pulse power on a 0.13 mm² spot size). The model assumes that the temperature profile in the tissue is proportional to the laser light fluence rate and that the distal tissue necrosis depth is that depth in the tissue where there is a temperature increase of 42 °C minus the etch rate (ablation depth per laser pulse). The fluence rate has been calculated using the diffusion approximation to the radiative transport equation. The tissue optical parameters (absorption and reduced scattering coefficients) have been derived from published data. The etch rate used (10m per pulse) is derived from in vivo experimental results. The model predicts a damage depth varying between 0 and 2.33 mm (mean 1.10 mm) and this is compared with an experimental result (0.77 mm) in dog aorta.     

Preliminary experience with the 1.32 μm neodymium-YAG laser in the treatment of tracheobronchial malignancy

Endoscopic laser treatment for tracheobronchial malignancy is usually given with the neodymium-YAG laser using the 1.064m output beam. However, recent experimental work suggests that the 1.32m output beam of this laser has more desirable tissue effects. We have now treated 55 patients with the 1.32m Nd-YAG laser (MBB-Medizintechnic) under general anaesthesia, using power settings of 10–20 W and pulse durations of up to 1 s. The indications for treatment were localized airway obstruction in each case. Airway calibre was improved in 46 (84%) patients and this was associated with an improvement in symptoms of cough and breathlessness. Patients with tracheal and carinal obstruction exhibited the most striking clinical improvements with up to four-fold increases in peak expiratory flow. In patients with more peripheral endobronchial obstruction, treatment improved airway calibre less frequently and resulted in a smaller clinical improvement. Of 11 patients with obstruction of a main bronchus and lung collapse, treatment led to partial or complete re-expansion in 10 cases (91%). The 1.32m wavelength allows treatment to be conducted efficiently and safely but at a considerably lower power than is required for the 1.064mwavelength. The ability to use low powers has the apparent advantage of generating only negligible quantities of smoke. Our experience with this new laser system demonstrates its considerable potential in the management of tracheobronchial malignancy.     

In comparison: 1.064 μm-1.318 μm Nd-YAG continuous wave lasers. In vitro and in vivo experiments for endoscopic tumour therapy in the gastrointestinal tract

In in vitro and animal experiments the tissue effects of the 1.318m Nd-YAG laser were compared to those of the standard 1.064m Nd-YAG laser in order to evaluate the advantages of the new wavelength with a ten times higher absorption in water for gastroenterological tumour treatment. Under irradiation parameters related to clinical endoscopic practice, the laser of the wavelength 1.318m needs for both vaporization and coagulation significantly less energy than the 1.064m laser. Since vaporization at 1.318m is always accompanied by a higher coagulation effect compared to 1.064m the risk of late necrosis and resulting perforation appears to be increased.     

A μCT analysis of the femoral bone stock in osteonecrosis of the femoral head compared to osteoarthrosis

Introduction  Long-term results of resurfacing in osteonecrosis of the femoral head (ONFH) are lacking and migration of the femoral component, necrosis of the femoral head and fracture of the femoral neck or head have been depicted. The aim of this study was to analyse the bone quality and 3-dimensional microarchitecture of the femoral head and neck in patients with ONFH compared to a group of patients with primary osteoarthritis (OA). Materials and methods  μCT was used to compare the microarchitecture of the femoral head and neck in patients with ONFH (n = 10) and a control group of patients with primary OA (n = 10). Results  No statistical significant differences were found for bone volume and the bone volume fraction, the connectivity density and the structure model index in patients with ONFH and those with OA (P > 0.05). Patients with ONFH and those with OA had a similar trabecular number, thickness and separation (P > 0.05). Conclusion  Based on our findings, we might conclude that hip resurfacing arthroplasty is a possible therapeutic option in the treatment of ONFH of the young and active patient and that an insufficient bone stock in ONFH seems not to be the deciding factor for failure. However, we just focussed on one of probably various factors. Further studies are needed to support these findings.     

Mesodermal (müllerian) adenosarcoma of the ovary: a clinicopathologic analysis of 40 cases and a review of the literature

Forty cases of mesodermal adenosarcoma of the ovary occurred in women 30-84 years of age (mean 54 years). Abdominal discomfort and distension were the usual complaints. All the patients were treated with an oophorectomy, which was accompanied by a hysterectomy in 85%, a contralateral oophorectomy in 65%, and nonsurgical therapy in 28%. Tumor rupture occurred at or before the operation in 67% of the cases. Twenty-six tumors were stage I, 11 stage II, and 3 stage III. The tumors were unilateral in 97.5% of the cases and 5.5-50 cm (mean 14 cm) in greatest dimension; most of the tumors were predominantly solid but contained numerous small cysts. Microscopic examination revealed sarcomatous overgrowth in 12 tumors. Sex cord-like elements were present in six tumors (including four with sarcomatous overgrowth) and heterologous elements in five (including two with sarcomatous overgrowth). The highest mitotic index of the sarcomatous component was 1-25 (mean 6) mitotic figures per 10 high power fields. Only 6 of 26 women (23%) who were followed postoperatively for > or=5 years were free of tumor. In the other 20 patients recurrent tumor appeared at 0.4-6.6 years (mean 2.6 years) after operation as pure sarcoma (low grade or high grade) or adenosarcoma (with or without sarcomatous overgrowth). Eight women had additional recurrences, and four women had blood-borne metastases. One patient was alive at 15.7 years after the excision of pulmonary metastases. The 5-, 10-, and 15-year survival rates were 64%, 46%, and 30%, respectively. Age <53 years, tumor rupture, a high grade, and the presence of high-grade sarcomatous overgrowth appeared to be associated with recurrence or extraovarian spread. Ovarian adenosarcomas have a worse prognosis than uterine adenosarcomas, presumably because of the greater ease of peritoneal spread. Many of the tumors caused problems in differential diagnosis.     

Comparison of 50 μg and 25 μg doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia

Study ObjectiveTo compare the efficacy of 50 μg and 25 μg doses of intrathecal morphine on postoperative pain in patients undergoing transurethral resection of the prostate (TURP) with low-dose bupivacaine.DesignRandomized, double-blinded study.SettingKonya Hospital.Patients70 ASA physical status I, II, and III patients.InterventionsPatients were randomized to two groups: Group A patients received 5 mg of 0.5% hyperbaric bupivacaine (one mL) and 50 μg of morphine (0.5 mL). Group B patients received 5 mg of 0.5% hyperbaric bupivacaine (one mL) and 25 μg of morphine (0.5 mL).MeasurementsPostoperative pain scores, patient and surgeon satisfaction, and side effects such as emesis, pruritus, and respiratory depression, were recorded.Main ResultsPostoperative pain characteristics were similar between the two groups. Frequency of emesis was similar between the groups, while pruritus was significantly higher in Group A. No antipruritic medication was required in any patient. Patient and surgeon satisfaction was evaluated as good or excellent in both groups.ConclusionsIntrathecal morphine at a dose of 25 μg provides similar postoperative analgesia and less pruritus than the 50 μg dose in patients undergoing TURP.     

A case of clear cell adenocarcinoma of the müllerian duct in persistent müllerian duct syndrome: the first reported case

We report a case of a 67-year-old man with clear cell adenocarcinoma of the remnant uterus in persistent Müllerian duct syndrome. He had a normal penis, urethra, and scrotum, and there was also a vagina and uterus. He died in a traffic accident, and clear cell adenocarcinoma was discovered incidentally at autopsy. Clear cell adenocarcinoma of the remnant uterus metastasized to the retroperitoneal lymph nodes and bilateral lungs. Persistent Müllerian duct syndrome is characterized by the persistence of Müllerian derivatives in otherwise normally virilized males. A variety of germ cell tumors of the testis have been reported in association with persistent Müllerian duct syndrome. However, no malignant change of the persistent Müllerian duct structures has been reported. This represents the first reported case of malignant change of the persistent Müllerian duct structures in persistent Müllerian duct syndrome.     

RevoLix 2 μm激光治疗高龄高危良性前列腺增生症(附36例报告)

目的 探讨高龄高危前列腺增生症患者采用RevoLix 2μm激光汽化切割术的疗效.方法 本组36例,年龄70～82岁.均伴有内科疾病,于内科疾病治疗稳定后手术.手术应用RevoL-ix 2μm激光系统,激光输出功率70 W,冲洗液为0.9%氯化钠溶液.术中确定精阜位置及到膀胱颈距离后进行激光汽化切割.结果 手术时间65～135 min,平均时间(83.6±10.6)min.术中术后无大量出血,无输血事件及电切综合症发生.术后拔除尿管时间为术后2～4 d,拔出导尿管后均能自行排尿,2例患者发生-过性尿失禁,其余患者无尿失禁.3～6个月随访IPSS评分由(24.26±2.70)分下降为(8.47±4.32)分;QOL评分由(4.51±0.56)分下降为(1.34±0.53)分;最大尿流率由(6.37±1.31)mL/s上升为(17.24±2.32)mL/s.结论 RevoLix 2μm激光汽化切割术对高龄高危前列腺增生患者来说,是一种安全有效、创伤小、恢复快的治疗方法.     

经尿道2 μm激光脐尿管囊肿切除1例

<正>患者,女,62岁,尿频伴无痛性镜下血尿1个月余,无腰痛,发热,乏力,消瘦。查体:腹软,稍膨隆,无压痛及反跳痛,未触及明显包块,脐部未见异常分泌物,双肾区未及膨隆,肋脊角无压痛及叩击痛;输尿管走行区无压痛点,膀胱区无压痛。双侧腹股沟区无肿大淋巴结。尿道外口未见明显异常。尿常规:潜血1+,RBC 6个/HP,WBC 5个/HP。尿细胞学:未见肿瘤细胞。B超:膀胱充盈可,容量约200ml,前壁肌层可见直径约1.1cm近似无回     

RevoLix 2 μm激光治疗浅表膀胱肿瘤的疗效观察

目的:探讨采用RevoLix2μm激光手术系统治疗浅表性膀胱肿瘤的疗效。方法:采用RevoLix2μm激光手术系统治疗浅表性膀胱肿瘤42例,行骶管或连续硬膜外麻醉,其中单发肿瘤20例,多发肿瘤22例,肿瘤直径0.5～2.3cm,全部肿瘤均为膀胱移行细胞癌,肿瘤病理分级为G1～G2,临床分期为T1～T2。结果:全部手术均成功,手术时间10～40min,平均15min,术中出血0～5ml,所有患者均未输血,无闭孔神经反射及膀胱穿孔、尿外渗,无水中毒。尿管留置1～10天,平均5天,术后住院5～14天,平均7天。术后随访半年,仅3例非原手术区复发。结论:RevoLix2μm激光手术系统治疗浅表性膀胱肿瘤是有效和安全的,术中、术后并发症少,术后复发率低,但对其长远疗效还需进一步观察。     

Predictability of the progress of secondary osteoarthritis after developmental dislocation of the hip, utilizing inferior edge (of the teardrop) – center (of the femoral head) distance

We followed-up a group of patients in their youth and then in middle age after they had been treated for developmental dislocation of the hip, and studied whether we could predict the progress of osteoarthritis of the hip when the patients were in the "youth" stage. We studied 21 hips of 21 patients with unilateral dislocation that could be examined twice, in 1975 and 1995, in patients who were treated at our hospital between 1953 and 1963. We measured the acetabular-head index (AHI), center-edge angle (CE angle), and the Sharp angle, and our created index (inferior edge of the teardrop — center of the femoral head distance), and we divided this index by the distance of the inferior edges of the teardrops on both sides. Using these measured values, we studied whether we could predict changes in clinical and radiographic evaluation after a follow-up of 20 years. There was no significant correlation of clinical and radiographic results and AHI, CE angle, and the Sharp angle; however, there was a significant correlation with our created index. The index we created is relatively easily measured and enables us to make a more precise prognosis, in comparison with previously developed indices. Received for publication on Oct. 1, 1998; accepted on July 5, 1999     

Endoscopic Vaporesection of the Prostate Using the Continuous-Wave 2-μm Thulium Laser: Outcome and Demonstration of the Surgical Technique

Background

The potential of a new continuous-wave (CW) 70-W, 2.013-μm thulium-doped yttrium aluminium garnet (Tm:YAG) laser for the endoscopic treatment of benign prostatic hyperplasia (BPH) is investigated.

Objective

The simultaneous combination of vaporisation and resection of prostatic tissue in a retrograde fashion is the main characteristic of this new laser technique. We provide a DVD that shows the main steps of this procedure.

Design, setting, and participants

We retrospectively evaluated 56 nonconsecutive patients who were treated by thulium laser vaporesection of the prostate in our institution between 2005 and 2007.

Surgical procedure

Vaporesection of the prostate is performed by moving the fibre semicircumferentially from the verumontanum towards the bladder neck, thereby undermining tissue and cutting chips.

Measurements

Blood loss, postvoiding residual urine (PVRU), maximum flow rate (Q_max), and the International Prostate Symptom Score (IPSS) were measured as well as prostate volume and prostate-specific antigen (PSA). The duration of the procedure, need for postoperative irrigation, duration of catheterisation, and hospital stay were recorded.

Results and limitations

The median procedure time was 60 min, postoperative irrigation was necessary in 19 out of 56 patients, and the median duration of catheterisation was 23 hr. At the day of discharge, the mean haemoglobin value decreased by 0.2 mg/dl (p = 0.13), the average Q_max improved from 8.1 to 19.3 ml/s (p < 0.001), and the PVRU decreased from 152 ml to 57 ml (p < 0.05). The blood transfusion rate was 3.6%, and two patients needed a recatheterisation postoperatively (3.6%). After a median follow-up of 9 mo, the IPSS improved from 19.8 at baseline to 8.6 (p < 0.001). Four patients had a repeat transurethral resection of the prostate (TURP) during the learning curve, but this was not necessary in any of the later patients. One patient developed a urethral stricture, and another developed a bladder neck contracture.

Conclusions

The thulium laser seems to be a suitable tool for the endoscopic treatment of BPH.     

Effect of μ-opioid receptor A118G polymorphism on the ED50 of epidural sufentanil for labor analgesia

BackgroundA common polymorphism of the μ-opioid receptor gene (OPRM1, p.118A/G), which has been shown to effect the response to neuraxial opioids, occurs in 30% of Caucasian women. This double-blind up-down sequential allocation study was designed to examine the effect of p.118A/G on the ED50 of epidural sufentanil for labor analgesia.MethodsNulliparous women were recruited at 35 weeks of gestation (n = 77) and genotyped for p.118A/G. Those subsequently requesting epidural labor analgesia were enrolled. Each woman received epidural sufentanil diluted with 0.9% saline to a volume of 5 mL. The initial sufentanil dose was 21 μg, with subsequent doses determined by the response of the previous patient (testing interval 1 μg). Efficacy was accepted if the visual analogue score decreased to <10 mm on a 100-mm scale within 30 min of drug administration.ResultsTwenty patients were excluded, leaving 57 women from whom data were analyzed: 33 in Group A (wild-type A118 homozygotes) and 24 in Group G (heterozygotes and homozygotes G118). The ED50 for epidural sufentanil was 25.2 μg in Group A (95% CI 23.2–26.4) and 20.2 μg in Group G (95% CI 14.2–23.6) (P = 0.03). The potency ratio for epidural sufentanil in Group G compared to Group A was 1.25 (95% CI 1.00–1.64).ConclusionWomen carrying the variant allele of p.118A/G of OPRM1 (G118) had a lower ED50 for epidural sufentanil given for early labor analgesia than women homozygous for the wild-type allele.     

RevoLix 2 μm激光宫腔镜子宫中隔切除术27例

目的探讨应用Revo Lix 2μm激光手术系统切除子宫中隔的安全性及疗效。方法 2011年2月~2012年2月,采用Revo Lix 2μm激光手术系统行宫腔镜子宫中隔切除术27例。激光功率40~80 W,汽化切除中隔,使宫腔形态恢复正常且内壁平整。观察手术时间、出血量、并发症,术后宫腔粘连及妊娠结果。结果手术时间(15.5±8.0)min,出血量5ml,未出现子宫穿孔、电切综合征、电解质紊乱、大出血等并发症。术后3个月均复查宫腔镜,提示宫腔形态恢复正常,无宫腔粘连。27例均有妊娠要求,术后随访12~25个月,(17.5±6.0)月,22例妊娠,妊娠率81.5%,妊娠距手术时间5~19个月,(10.2±5.2)月,其中自然流产4例,早产1例,足月产15例,正在妊娠2例。结论宫腔镜下应用Revo Lix 2μm手术系统治疗中隔子宫安全、有效,术中出血极少,视野清晰,且操作简单,术中对组织破坏少,术后宫腔粘连发生率低,内膜修复好,值得临床推广应用。