Dislodged stent: a simple retrieval technique.

We report a technique for retrieval of a dislodged coronary stent using a stiff angioplasty wire positioned beside the initial stent guidewire. This two-wire technique provides a better platform to move and position the snare device without moving the dislodged stent and thus lessens the risk of embolization. If a larger femoral sheath is needed for stent removal, this method facilitates sheath exchange. Cathet. Cardiovasc. Intervent. 47:323-324, 1999.     

A simple technique for repair of distal limb prolapse of a loop colostomy

Several procedures have been proposed for the prolapse of a loop colostomy. However, most are associated with a high recurrence rate or are rather expensive. We have newly developed a simple, safe, and inexpensive method, which is a modification of Thiersch's method, for repair of distal limb prolapse of a loop colostomy.     

Ligation-anchored PCR: a simple amplification technique with single-sided specificity.

A simple, efficient, and sensitive technique has been developed for amplification of cDNAs encoding molecules with 5' regions of unknown sequence. In this ligation-anchored PCR, T4 RNA ligase is used to covalently link an "anchor" oligonucleotide to first-strand cDNAs. These anchored cDNAs are then amplified by using one PCR primer specific for the anchor and another specific for a sequence within the molecule of interest. The anchor oligonucleotide has been especially designed to facilitate subsequent analysis and cloning of the resultant PCR products. This three-stage procedure does not require purification of product between steps and avoids many of the technical difficulties associated with established anchored PCR protocols. The efficacy of ligation-anchored PCR was demonstrated by amplification of a specific IgG1 cDNA; total RNA equivalent to as few as 100 cells yielded the expected PCR product.     

改良革兰氏染色检测男性尿道细胞涂片诊断NGU的价值

目的寻找适合基层、简便快速、经济可代替免疫荧光法的检测男性非淋菌性尿道炎(NGU)尿道细胞涂片标本镜检衣原体的方法。方法取患者深部尿道粘膜柱状上皮细胞涂片采用改良革兰氏染色法镜检细胞内衣原体。结果30份标本,每份标本细胞涂片两张做改良革兰氏染色与衣原体经典的姬姆萨染色镜检,改良革兰氏染色涂片中细胞内有疑似衣原体始体颗粒和包涵体斑块的细胞百分数与姬姆萨染色涂片中衣原体感染细胞的百分数的相关系数r:0.98。部分标本的细胞涂片还做了两种染色法的原位对照,即改良革兰氏染色的胞内颗粒和斑块,脱色后再经姬姆萨染色呈现衣原体始体、包涵体的染色特征。又经与多种传统的检测衣原体的方法考核,我们认为这些形态是衣原体在细胞内不同生活阶段增殖的始体、包涵体。表明在基层单位没有经典的免疫荧光或胶体金免疫扩散条件时,可用简单的革兰氏染色法代替之。结论改良法简便快速、敏感特异,不仅可用来诊断衣原体感染,还可分析炎症轻重、观察疗效和预后。     

Demand pacemaker slowing: a simple bedside technique

We present a simple noninvasive bedside technique to slow gradually any R-wave inhibited ventricular demand pacemaker up to one-half its original rate for indefinite periods of time. Gradual pacemaker slowing allows accurate diagnostic observations and therapeutic interventions in pacemaker-induced arrhythmias and may possibly be used in the management of unstable angina in patients with ventricular demand pacemakers.     

Transseptal catheterization technique: a simple safety procedure

The major complication of transseptal catheterization, that of inadvertent perforation of other structures, can best be avoided by maintenance of the correct needle tip position during introduction and maneuvering of the assembly. The addition of a needle-stop to the transseptal needle shaft and a sterile ruler to check its present position assures the maintenance of the needle tip position, freeing the operator's concern for accurate location of landmarks. The method of utilizing and setting the needle-stop is described.     

Loop ileostomy fixation: a simple technique to minimise the risk of stomal volvulus

Turnbull's loop ileostomies is a routinely performed procedure in the management of a variety of colorectal problems. Mechanical and functional complications occur with both permanent and temporary ileottomies, however they are more common with the loop than with the end (Brooke) variety. With the advent of restorative proctocolectomy with pouch formation, and the documented benefit of simultaneous temporary faecal diversion, the incidence of such complications will rise. Bowel obstruction, requiring laparotomy in the interval before stoma closure, is more commonly associated with the loop ileostomy. A loop stoma is routinely brought out directly through the abdominal wall, with little or no fixation or closure of the lateral space. However, anti-mesenteric fixation, as described here, minimises the risk of volvulus by widening the attachment of the adjacent ileum to the parities, creating a broader fulcrum. Since adopting this simple technique, we report no complications in over 30 loop ileostomies, fixed by this technique and followed up for a minimum of 4 years. Where applicable, no difficulty was encountered with stoma closure, either by a transverse single layer serosubmucosal technique, or as a minimal resection with end to end anastomosis (sewn or stapled), following bowel mobilisation. This technique should minimise the frequency of obstructive events, and we recommend it's routine use.

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Résumé La confection d'une iléostomie latérale selon Turnbull est réalisée de principe dans le traitement d'un grand nombre de pathologies colorectales. Des complications mécaniques et fonctionnelles surviennent tant avec des iléostomies permanentes qu'avec des iléostomies temporaires mais plus fréquemment avec des iléostomies latérales quávec des iléostomies terminales selon Brooke. Le développement de techniques de colo-protectomie avec restauration de la continuité au moyen d'une poche et la mise en évidence de l'action bénéfique d'une diversion fécale temporaire réalisée simultanément à la proctocolectomie font que l'incidence de telles complications va aller en augmentant. Une occlusion intestinale nécessitant une laparotomie dans l'intervalle précédant le fermeture de la stomie survient plus fréquemment en cas d'iléostomie latérale. L'iléostomie latérale est extériorisée directement à travers la paroi abdominale avec peu ou pas de fixation ni de fermeture de l'espace latéral. Toutefois, la fixation anti-mésentérique telle que décrite dans cet article diminue le risque de volvulus en élargissant la zone d'attachement de l'iléon créant un pivot plus large. Depuis que nous avons adopté cette technique simple, nous n'avons pas observé de complications dans plus de 30 iléostomies latérales fixées par cette technique et suivies pendant un minimum de 4 ans. Lorsqu'elle a été réalisée, aucune difficulté secondaire n'est apparue au moment de la fermeture de la stomie, cette dernière étant réalisée soit par une suture transversale en un plan sérosous-muqueux ou au prix d'une résection minime avec confection d'une anastomose termino-terminale à la main ou à l'agrafeuse après mobilisation de l'intestin. Cette technique doit réduire le risque d'occlusion et nous en recommandons l'usage de routine.

     

Fluorescence to highlight the urethra: a human cadaveric study

Background

Urethral injury is a complication feared by surgeons performing transanal TME (TaTME) or abdominoperineal excision (APE) procedures. Injury during TaTME occurs when the prostate is inadvertently mobilised or as a direct injury similar to the direct injury during the perineal dissection of APE procedures. We performed a proof of principle study to assess the feasibility of using indocyanine green (ICG) to fluoresce the urethra in human cadavers.

Methods

Indocyanine green at varying doses was mixed with Instillagel and infiltrated into the urethra of male human cadavers. The urethra was exposed through either a perineal incision or by mobilisation of the prostate during a TaTME dissection and fluorescence observed using a PINPOINT laparoscope (NOVADAQ). Brightness was assessed on the images using ImageJ (National Institute of Health).

Results

Eight cadavers were included in the study. Fluorescence was visualised in the urethra in all eight cadavers. Minimal dissection was required to obtain fluorescence transperineally. In one cadaver, the urethra was demonstrated under fluorescence using a simulated TaTME with additional fluorescence also being observed in the prostate. There was no correlation between brightness and dosing.

Conclusions

This novel proof of principle study demonstrates a simple way in which the urethra may be easily identified preventing it from injury during surgery.

     

Digital polypectomy: a simple technique for rectal polyps in children

Excision, suture ligation and endoscopic snaring are the recommended methods of treatment for a juvenile rectal polyp. A successful experience of a simpler technique, digital polypectomy, in 218 cases is reported.     

Serosal imprint cytology in colonic cancer: a simple staging technique

Accurate staging of colonic cancer is essential in defining the rational use of adjuvant treatments. Recent studies have shown that prognostic accuracy can be significantly improved by recognition of primary tumour extension to the free serosal surface. This study compares the technical results of serosal imprint cytology with the results of histology in assessing serosal involvement. When analysed in terms of the modified Dukes' staging the results of cytology imprints taken from the peritoneum overlying the colonic primary were positive for tumour cells in 4/13 Dukes' B, 7/14 Dukes' C, and 5/9 metastatic cancers. Imprint cytology was positive in 6/7 Dukes' B and C cases with histological serosal invasion and was suspicious in the remaining case. However, a further 5/20 cases without identified invasion on routine histology also had positive cytology. Imprint cytology is an adjunct to routine histology which is easily performed and allows more precise staging of serosal involvement in Dukes' B and C colonic cancers. Final evaluation of this technique requires long-term follow-up of patients.

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Résumé Un staging précis des cancers coliques est essentiel pour préciser l'emploi rationnel de traitement adjuvants. Les études récentes ont montré que la valeur prognostique peut être significativement améliorée par l'identification d'une extension de la tumeur primaire à la surface séreuse libre. Cette étude compare les résultats d'empreintes cytologiques de la séreuse avec les résultats de l'examen histologique pour déterminer l'extension séreuse des tumeurs. En utilisant une classification de Dukes modifiée les résultats d'empreintes cytologiques prélevées sur le péritoine recouvrant des tumeurs primitives du colon ont montré la présence de cellules tumorales dans 4/13 Dukes B, dans 7/14 Dukes C et 5/9 cancers métastatiques. Les empreintes cytologiques ont été positives chez 6/7 Dukes B et C présentant une invasion histologique de la séreuse et l'empreinte était suspecte dans le dernier cas. Toutefois 5/20 cas sans identification d'une extension séreuse à l'examen histologique présentent une cytologie positive. L'empreinte cytologique est une investigation complémentaire à l'examen histologique de routine; cette empriente est de réalisation aisée et permet de préciser le staging d'extension séreuse dans les cancers coliques au stade de Dukes B et C. L'évaluation finale de cette technique nécessite un suivi à long terme des patients.

     

Superfusion of rat anterior pituitary cells attached to Cytodex beads: validation of a technique

A superfusion method consisting of fully recovered, dissociated pituitary cells adhering to Cytodex beads has proved useful in monitoring the dynamics of hormone secretion over time. Male rat anterior pituitaries were dissociated with collagenase and Viokase, then cultured in the presence of Cytodex beads for 3-5 days, during which time the cells attached firmly to the surface of the beads. The bead-attached cells were stable and could be transferred to any vessel without the need for centrifugation or further trypsinization. For this application, the bead-attached cells were packed in a column and superfused with a low bicarbonate buffer requiring no CO2 gassing. Viability was more than 95% after 48 h in the column. The cells responded in a normal physiological manner to hypothalamic releasing and inhibitory peptides. The ED50 was 0.3 nM for somatostatin and 1.2 nM for gonadotropin-releasing hormone. A postinhibitory rebound of GH secretion was observed after the discontinuation of large doses of somatostatin. LH secretion reached maximal levels within 6 min after 10 nM gonadotropin-releasing hormone, but started declining after 2 h of continuous stimulation and dropped close to baseline within 18 h. GH release was significantly increased by prostaglandin E2, 3-isobutyl-1-methylxanthine, and 8-bromo-cAMP. LH secretion increased 5-fold in response to 1 mM 8-bromo-cAMP, but showed little increase during prostaglandin E2 or 3-isobutyl-1-methylxanthine stimulation. The cocarcinogen phorbol myristate acetate (12-O-tetradecanoyl-phorbol-13-acetate) induced secretion of all pituitary hormones and continued to do so for hours after a short pulse. The superfusion system is simple to operate and has proven effective in studying transient phenomena, desensitization, and short term kinetics of secretagogues.     

Use of a nasal speculum for chest-drain insertion: a simple technique

Tube thoracostomy is a very commonly performed procedure in cardiothoracic surgery. Insertion of a chest drain requires expertise to minimize complications. We describe a simple technique of using a nasal speculum to perform this procedure.     

A simple new technique to measure the effective dead space of the face mask with a water volumeter in infants.

Measuring the effective dead space (EDS) of a face mask has been difficult in infants and the appropriate volume being deducted from lung volume measurements has varied between laboratories. This study measured EDS in 16 infants (age range, 5-36 months) who have cystic fibrosis, undergoing lung volume measurement by N2 washout. A thin plastic bladder, whose neck resided in the mask port, was shaped to fill a size 1 clear face mask. A water volumeter was made by inserting the body of a 20 mL plastic syringe into the neck of the bladder forming a tight seal with a snug fit against the inner surface of the mask port. The mask was placed on a horizontal surface and water was added until a level appeared in the syringe body (V1). At end-inspiration, the mask was briefly placed on the mouth and nose of the sleeping infant, causing the water level to rise in the syringe body (V2). The actual total dead space (V) of the mask when connected to the mouth port of the slide valve was 23 mL. EDS = V- (V2 - V1). Mean (95% confidence interval (95%CI)) EDS was 12.4 (95% CI 11.2, 13.6) mL. The smallest EDS was 8 mL since the connected ports (dead space, 8 mL) were unlikely to be penetrated by the infant's nose or lips. EDS decreased with increasing body weight and height, but seemed to be influenced by individual facial features too. In conclusion, a reliable noninvasive volumetric technique for the routine measurement of the effective dead space in infants has been developed.