作者要感谢弗雷德李，小，他与临床肿瘤消融方案的领导和莉萨桑普森，扬Ketzler和马尔西中心为协助他们在威斯康星州麦迪逊大学的研究和临床方案。

1。简介/病例报告： 例如：腹膜后平滑肌肉瘤S / P的主要切除岁女性50岁。在化疗的肝脏和肺转移性疾病的证据。有一个单一的化疗难治性肝损伤。多学科讨论导致消融作为一种可能的治疗方案，病人的年龄小，缺乏的合并症和替代化疗的治疗方案缺乏。病变活检治疗前确认转移性疾病。规划超声显示病变在肝左叶下和后方。鉴于其邻近胰腺和肠道，水分离需要在协商的时间与病人进行了审查。 2。病人选择<ol><li>的过程中最重要的方面之一，是确保病人是一个合适的人选。这就牵涉到一个多因素的相关因素，包括肿瘤和病人的评估： <ol><li>肿瘤的类型，大小，位置和focality（图1）。 </li><li>患者发病率和整体健康。 </li></ol></li><li>患者应在一个多学科的肿瘤板讨论，​​以确定可用的治疗方案，并选择最有效和最适当的选项。 </li><li>最合适的消融方式是可变的，取决于许多不同的因素，如：内器官的肿瘤的位置，接近邻近结构和精度相关的需要，运营商的经验，存在潜在的肝脏疾病或出血diatheses。所有这些因素，更必须考虑，以确定和选择最合适的消融的方式。 </li><li>患者必须告知有关程序，预期的风险，一个完整的治疗的可能性，以及可能带来的好处。因此，我们每一位病人的咨询程序之前，通常在如下规划超声波的时间。 </li><li>一个病人和程序的整体评估，将确定的镇静/麻醉的程度，是既安全又有效的情况下。 </li></ol> 3。预处理规划<ol><li>我们执行前消融规划的超声检查，以确定最佳患者定位和approach.This也可以帮助我们确定是否有其他成像方式为指导，更值得注意的是，监测需要。它往往是有帮助的消融术为目标肿瘤，消融区和邻近结构的概述评价的时间可用的CT。 </li><li>我们也评估在这个时候强调安全性和有效性（图2）为辅助技术的需要。 </li><li>在此期间，我们确定喷头的数量很可能需要完成的治疗，以及他们的最佳位置。 </li></ol> 4。消融术<ol><li>病人准备<ol><li>要考虑/评估的因素包括：肠道准备，前/围手术期抗生素，肾/肝功能，静脉通路，动脉血压监测线等需要在逐案基础上作出的这些决定，但有一些可以遵循的一般原则，将讨论这些。 </li><li>全身麻醉是很常见的，但往往可以消融深度镇静，或在某些情况下甚至镇静执行。应个别病人进行了优化。 </li></ol></li><li>设备安装（注意，安装的许多方面都依赖于供应商） <ol><li>将显示射频，冷冻治疗，和MW消融设备和设置，包括地垫放置，连接和测试的一个例子。对于这种情况，将利用射频消融。 </li></ol></li><li>消融会议<ol><li>指导<ol><li>准确和适当的影像引导撒施安置是关键。由于这往往包括多个撒施位置，特别是对较大的肿瘤，有要考虑的因素很多，有几个“招数”，可受聘（图3）。 </li></ol></li><li>辅助技术<ol><li>执行经皮消融时，经常有可能受到热损伤邻近结构。这导致了水分离和其他位移技术，它允许时，适当地应用物理，热和电气保护的发展。我们会检讨这些技术的使用。 </li><li>我们还将讨论其他治疗方法/技术已被证明，或在理论上可以提高治疗的疗效和安全性。 </li></ol></li><li>监测<ol><li>美国，CT和MRI都有特定的长处和短处，对自己的能力，有效和准确的监测日益增长的消融区。正因为如此，我们经常利用多种模式的方法，与美国和CT。这使我们能够安全和有效执行过程。 </li><li>消融后评估<ol><li>消融后评估，使该疗法的疗效的决心。当和它是如何执行的是可变的，将取决于可用性的资源，管理美国或CT造影的实用性，和技术治疗成功（图4）的不确定性。在我们的机构，我们对合适的病人进行一个对比增强CT后，立即消融会议已经结束。这让我们完整的治疗评估（立即重新处理，而病人仍然是在麻醉状态下如有必要），建立POST过程基线，并确定任何早期并发症。然而，许多机构进行初步评估消融会议后一个月或更多。 </li></ol></li></ol></li></ol></li><li>后续<ol><li>间隔和跟进评估最佳方式取决于肿瘤的类型和患者因素而有所不同。我们将讨论各种因素影响这一决定，并描述了一个接受的协议（图5）。 </li></ol></li></ol> 5。结果： 程序是成功地进行了使用超声与CT和超声监测指导相结合。一个直接注射5％葡萄糖水（D5W）用于水分离（图2）。指导，因为超声是利用超声显像观察肿瘤很容易，但不与非造影CT（往往与肝脏病变的情况下）。根据我们的经验，与超声引导下放置喷头比CT快。超声波不使用电离辐射，因此，为病人和人员的安全，并提供实时反馈肿瘤和撒施的位置，允许准确和一致的安置。由于准确的定位是手术成功的关键，涂药指导往往决定与否的过程会导致在一个完整的治疗。 利用超声和CT监测相结合。允许实时超声发展消融的评价，而CT相邻结构，提供了一个全球涂药安置和邻近概述，使优越的评估撒施安置的安全和附近结构的附带损害的可能性。因此，结合超声和CT成像效果，在一个更​​安全的治疗。 D5W是利用水分离主要有两个原因：它作为一个物理和电气加热的障碍，因此，防止损伤邻近结构（即胰腺和肠道），和腹腔D5W行为已被证明是减少程序后疼痛患者接受肝肿瘤射频消融。因此，这种干预使病人更安全，更舒适的过程。后续成像显示，该程序在完成治疗的肿瘤没有相关的并发症，只有最小的患者的不适感。 肝肿瘤消融术是最常见的应用在肝硬化患者的肝细胞癌，在有限的肝转移疾病与结肠癌，乳腺癌或神经内分泌肿瘤的患者。肝转移疾病与其他类型的肿瘤患者往往有全身性疾病，可能不利于从消融;这些患者考虑在逐案基础。转移性肉瘤患者的长期数据有一个相对贫乏。在这种情况下进行消融的决定作出回应与一个单一的难治性肝损伤疾病的所有其他网站在这个年轻的病人化疗。虽然这可能在短期内控制她的病，并给她这种类型的肿瘤化疗从死缓，治愈是不可能的。病人后来发展了一个额外的肝脏病变和两个肺结节。所有与消融治疗。病人目前正在继续监测。 6。代表性的成果： <img src="/files/ftp_upload/2596/2596fig1.jpg" alt="图1" /> 图1。前置程序的CT表现出低衰减病变在肝左叶毗邻，位于刚刚伪劣和胃外侧胰腺与十二指肠（P）（箭头） 。 <img src="/files/ftp_upload/2596/2596fig2.jpg" alt="图2" /> 图2规划与患者在仰卧位超声显示低回声病变（箭头），紧密毗连相邻的胃（STAR）和胰腺（不可见）。因此，在作出决定NG管减压，在过程ND使用水分离，以保护后的结构。 <img src="/files/ftp_upload/2596/2596fig3.jpg" alt="图3" /> 图3。超声图像（左）演示水分离针（箭头），通过肝左叶，延长到肝脏和胰腺输液之间的空间。腹部CT（右）与流体之间的肝脏和胰腺与胃后位移（STAR）（P）的积累到位针（箭头）。 <img src="/files/ftp_upload/2596/2596fig4.jpg" alt="图4" /> 图4。超声图像在消融，表明在左外侧叶（箭头）的气体云。可以观察到一层薄薄的流体之间的肝脏和胰腺（P）的。 <img src="/files/ftp_upload/2596/2596fig5.jpg" alt="图5" /> 图5程序后立即 CT（左）表明消融带（箭头）。消融区已签约在为期一个月的后续CT（右箭头）。

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CLB：NeuWave医药公司，发展消融技术的股东和顾问。 Triagenics，LLC顾问。

热肿瘤消融术是一种安全有效的治疗为许多难治性手术或放疗/化疗治疗失败的腹部肿瘤。此外，它正迅速成为公认的第一线治疗对某些病人。的好处包括：一个特殊的安全性，比传统的手术疗法，降低了成本，并在适当分流病人良好的局部控制率更快速的疗养。经皮手术一般都是可行的，尤其是当使用诸如水分离技术，以提高安全性和定位的肿瘤，从而限制了进一步的发病率。在几十年的实践已经利用这种技术现在的长期成果和肿瘤疗效问题，许多人正在回答了可喜的成果。热消融必将在肿瘤病人的管理，在未来几年内的一个重要和越来越大的作用。

Covidien公司/的Valleylab在Boulder，CO冷提示射频消融系统

thermal ablation for the treatment of abdominal tumors

经皮热消融术是一种新兴许多不适合常规治疗腹部肿瘤的治疗方案。在消融过程中，薄薄的敷贴指导下成像制导到目标肿瘤。能源，然后应用到组织，直至温度上升到细胞毒性水平（50-60℃）。各种能源，生物组织，包括射频（RF）电流，微波，激光灯和超声波加热。其中，射频和微波消融是最常用的全世界。 在射频消融术，交变电流（〜500千赫）周围的间质电极产生的电阻加热。皮肤表面电极（接地垫）用于完整的电路。射频消融已使用近20年来，与肿瘤局部控制，延长生存期和低并发症发生率 1,2的良好效果。最近的研究表明，射频消融可能是一个小肝癌和肾细胞癌 3-5的一线治疗方案。然而，RF加热是由于局部血流量和高电阻抗的组织（如肺，骨，干燥或烧焦的组织 ） 6,7。微波炉可能会减轻生产速度更快，体积加热8-10，其中的一些问题。要创造较大或形消融，多个微波天线，可同时使用，而射频电极需要的顺序操作，这限制了他们的效率。与微波系统的早期经验表明，疗效和安全性相似或优于RF 器件 11-13 。 另外，冷冻治疗冻结目标组织到致命的水平（-20至-40 ° C）。经皮冷冻治疗已被证明可以有效地对肾癌和许多转移性肿瘤，14日至16日在肝脏，尤其是大肠癌。冷冻治疗也可能是相关的程序后疼痛和更快地恢复一些迹象表明 17 。冷冻治疗原发性肝癌，由于潜在的凝血功能障碍和肝硬化患者经常看到的，相关的出血风险往往是禁忌。此外，肿瘤细胞内容的突然释放冰冻组织解冻时可导致一个潜在的严重状况， 称为 cryoshock 16。 热肿瘤消融可以进行开腹手术，腹腔镜或使用经皮方法。当进行经皮消融术依赖影像学诊断，规划，撒施指导，治疗监测和后续。超声指导和治疗监测全球最流行的方式，但计算机断层扫描（CT）和磁共振成像（MRI），以及普遍使用。通常采用的诊断和后续成像对比增强CT或MRI。

Watch this Scientific Journal Video about Thermal Ablation for the Treatment of Abdominal Tumors at JoVE.com

Thermal Ablation for the Treatment of Abdominal Tumors

一个热的肿瘤消融过程的描述。整个过程很详细，包括预处理规划和影像学，麻醉，辅助技术，以方便经皮穿刺方法，成像制导消融设备肿瘤热治疗，治疗后护理和后续。

热消融治疗腹部肿瘤

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

thermal-ablation-for-the-treatment-of-abdominal-tumors

Research

JoVE Journal

Medicine

34.2K 次观看.  University of Wisconsin-Madison. 一个热的肿瘤消融过程的描述。整个过程很详细，包括预处理规划和影像学，麻醉，辅助技术，以方便经皮穿刺方法，成像制导消融设备肿瘤热治疗，治疗后护理和后续。

视频: Thermal Ablation for the Treatment of Abdominal Tumors

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7. 
The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis8. Furthermore, some anastomoses may be insufficient from the start due to technical failure.
Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.
The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.
The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.
Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.

The C-seal is a biofragmentable drain protecting the stapled colorectal anastomosis. In this video, details of the manufacturing, deployment and use are shown.

C密封：一个Biofragmentable漏漏电保护吻合结直肠吻合

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL ...

科研

医学

Quantitative Visualization and Detection of Skin Cancer Using Dynamic Thermal Imaging

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment for melanoma remains surgical excision, therefore, the key to extended survival is early detection 2,3. Considering the large numbers of patients diagnosed every year and the limitations in accessing specialized care quickly, the development of objective in vivo diagnostic instruments to aid the diagnosis is essential. New techniques to detect skin cancer, especially non-invasive diagnostic tools, are being explored in numerous laboratories. Along with the surgical methods, techniques such as digital photography, dermoscopy, multispectral imaging systems (MelaFind), laser-based systems (confocal scanning laser microscopy, laser doppler perfusion imaging, optical coherence tomography), ultrasound, magnetic resonance imaging, are being tested. Each technique offers unique advantages and disadvantages, many of which pose a compromise between effectiveness and accuracy versus ease of use and cost considerations. Details about these techniques and comparisons are available in the literature 4.
Infrared (IR) imaging was shown to be a useful method to diagnose the signs of certain diseases by measuring the local skin temperature. There is a large body of evidence showing that disease or deviation from normal functioning are accompanied by changes of the temperature of the body, which again affect the temperature of the skin 5,6. Accurate data about the temperature of the human body and skin can provide a wealth of information on the processes responsible for heat generation and thermoregulation, in particular the deviation from normal conditions, often caused by disease. However, IR imaging has not been widely recognized in medicine due to the premature use of the technology 7,8 several decades ago, when temperature measurement accuracy and the spatial resolution were inadequate and sophisticated image processing tools were unavailable. This situation changed dramatically in the late 1990s-2000s. Advances in IR instrumentation, implementation of digital image processing algorithms and dynamic IR imaging, which enables scientists to analyze not only the spatial, but also the temporal thermal behavior of the skin 9, allowed breakthroughs in the field.
In our research, we explore the feasibility of IR imaging, combined with theoretical and experimental studies, as a cost effective, non-invasive, in vivo optical measurement technique for tumor detection, with emphasis on the screening and early detection of melanoma 10-13. In this study, we show data obtained in a patient study in which patients that possess a pigmented lesion with a clinical indication for biopsy are selected for imaging. We compared the difference in thermal responses between healthy and malignant tissue and compared our data with biopsy results. We concluded that the increased metabolic activity of the melanoma lesion can be detected by dynamic infrared imaging.

We demonstrated that malignant pigmented lesions with increased metabolic activity generate quantifiable amounts of heat and the measurement of the transient thermal response of the skin to a cooling excitation allows quantitative identification of melanoma and other skin cancers (vs. non-proliferative nevi) at an early stage of the disease.

定量可视化和皮肤癌症使用动态热成像检测

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment ...

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

结合消融房颤左心耳封堵

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Goeckerman方案用于治疗中度至重度牛皮癣

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both direct and rapid analysis of therapeutic sensitivity and resistance. However, recent evidence suggests that therapeutic response is not exclusive to the inherent molecular composition of cancer cells but rather is greatly influenced by the tumor cell microenvironment, a feature that cannot be recapitulated by traditional culturing methods. Even implementation of tumor xenografts, though providing a wealth of information on drug delivery/efficacy, cannot capture the tumor cell/microenvironment crosstalk (i.e., soluble factors) that occurs within human tumors and greatly impacts tumor response. To this extent, we have developed an ex vivo (fresh tissue sectioning) technique which allows for the direct assessment of treatment response for preclinical and clinical therapeutics development. This technique maintains tissue integrity and cellular architecture within the tumor cell/microenvironment context throughout treatment response providing a more precise means to assess drug efficacy.

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Established cancer cell lines and xenografts have been the mainstay of cancer research for the past several decades. However, recent evidence suggests that therapeutic response is greatly influenced by the tumor cell microenvironment. Therefore, we have developed an ex vivo analysis of primary tumor specimens for drug development purposes.

原发性肿瘤和/或转移相关的临床前和治疗的临床开发的离体处理响应

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

Creation of Abdominal Adhesions in Mice

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or intraabdominal infection. The precise mechanisms underlying adhesion formation are poorly understood. Many compounds and physical barriers have been tested for their ability to prevent adhesions after surgery with varying levels of success. The mouse and rat are important models for the study of abdominal adhesions. Several different techniques for the creation of adhesions in the mouse and rat exist in the literature. Here we describe a protocol utilizing abrasion of the cecum with sandpaper and sutures placed in the right abdominal sidewall. The mouse is anesthetized and the abdomen is prepped. A midline laparotomy is created and the cecum is identified. Sandpaper is used to gently abrade the surface of the cecum. Next, several figure-of-eight sutures are placed into the peritoneum of the right abdominal sidewall. The abdominal cavity is irrigated, a small amount of starch is applied, and the incision is closed. We have found that this technique produces the most consistent adhesions with the lowest mortality rate.

Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

小鼠腹腔粘连的创建

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Multicolor 3D Printing of Complex Intracranial Tumors in Neurosurgery

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. The model can be used for planning and simulating critical steps of a surgical approach. Therefore, it is important that anatomical structures such as blood vessels inside a tumor can be printed to be colored not only on their surface, but throughout their whole volume. During simulation this allows for the removal of certain parts (e.g., with a high-speed drill) and revealing internally located structures of a different color. Thus, diagnostic information from various imaging modalities (e.g., CT, MRI) can be combined in a single compact and tangible object.
However, preparation and printing of such a fully colored anatomical model remains a difficult task. Therefore, a step-by-step guide is provided, demonstrating the fusion of different cross-sectional imaging data sets, segmentation of anatomical structures, and creation of a virtual model. In a second step the virtual model is printed with volumetrically colored anatomical structures using a plaster-based color 3D binder jetting technique. This method allows highly accurate reproduction of patient-specific anatomy as shown in a series of 3D-printed petrous apex chondrosarcomas. Furthermore, the models created can be cut and drilled, revealing internal structures that allow for simulation of surgical procedures.

The protocol describes the fabrication of fully colored three-dimensional prints of patient-specific, anatomical skull models to be used for surgical simulation. The crucial steps of combining different imaging modalities, image segmentation, three-dimensional model extraction, and production of the prints are explained.

神经外科复杂颅内肿瘤的多色3D打印

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

在心房颤动治疗中，为食道冷却或加热，以减少左心房消融期间的食管损伤

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...