Deutsche Forschungsgemeinschaft (Asociación alemana de la investigación; PARA 2240 "Angiogénesis (linfa) e inmunidad celular en las enfermedades inflamatorias del ojo" a LMH; ÉL 6743/2-1 y él 6743/3-1 a LMH), programa GEROK de la Universidad de Colonia a KRK y LMH. Nuestro agradecimiento al Dr. Kühner para soporte técnico.

para este procedimiento, el consentimiento informado es necesario y se ha obtenido para cada paciente que ha experimentado la cirugía en el Departamento de Oftalmología, Universidad de Colonia, Colonia, Alemania. Todos los exámenes y las intervenciones quirúrgicas fueron ejecutadas conforme a las leyes nacionales y la declaración de Helsinki de 1975 en su versión actual.
 Nota: a menos que se indique lo contrario, será siempre sólo instrucciones de al lado en el que se está llevando a cabo el procedimiento. Use equipo esterilizado.
 1. preparación del paciente <ol><li>realizar una exhaustiva examinación oftálmica (con especial atención a los párpados, punctum superior e inferior y drenaje de la lágrima) incluyendo riego y sondeo para PANDO 10 .
	<ol><li>Para riego estandarizado, inserte una sonda de Bangerter en la parte superior y, posteriormente, bajar punctum. Comienza introduciendo verticalmente, luego inclinar hacia el templo a una posición horizontal para seguir la formación fisiológica de la pequeño. Cuando la sonda está en posición, cuidadosamente inyectar solución salina para poner a prueba por obstrucción del conducto lacrimal. 
		Nota: En infrasaccal PANDO, la cánula de Bangerter podrán llegar fácilmente a la pared nasal lateral sin una resistencia hinchable (&#34; duro parada &#34;). Tratando de regar se traducirá en reflujo contralateral a través del punctum enfrente sin ningún líquido que alcanza el paciente &#39; s faringe 10.</li>
	</ol></li> <li>Descartar infecciones agudas, tumores del sistema de drenaje lagrimal así como traumático, congénito o presaccal la obstrucción.
	<ol><li>Para descartar infecciones agudas, busque para enrojecimiento doloroso, hinchazón o purulenta la descarga del drenaje lagrimal. Para descartar tumores, buscar indolente inflamación, ulceración o pigmentación. Presaccal obstrucción resulta en una resistencia animosa al intentar avanzar la sonda de Bangerter en el saco lacrimal (&#34; paro suave &#34;). Se debe descartar obstrucción congénita y traumática tomando historia paciente 10 , 19 , 20.</li>
	</ol></li> <li>Descartar patologías rhinological intranasales, desviación del tabique por ejemplo severo. Esto debe hacerse tomando la paciente &#39; historia en combinación con una inspección rhinological de la cavidad nasal 21.</li>
	<li>Poner al paciente bajo anestesia general, por ejemplo, por inyección intravenosa de propofol, remifentanilo y atracurio para la inducción y la inhalación de remifentanilo desfluran plus intravenosos de mantenimiento, adaptados al peso de dosificación estándar 10. la intubación debe ser realizada, pero también es posible el uso de una mascarilla laringe. 
	Nota: Los anestésicos, así como las dosis pueden variar entre clínicas. Ningún protocolo específico de la anestesia se requiere para asistida por láser DCR.</li>
</ol> 2. Laser-asistida DCR <ol><li>Insertar el endoscopio video-asistida en la nasal cavidad cuidadosamente la avanzando a través de la fosa nasal. Visualizar el margen anterior del cornete medio inclinando ligeramente el endoscopio hacia la pared nasal lateral.</li>
	<li>Configurar los equipos de láser y láser ajustes a los valores correctos. Colóquese gafas de protección.
	<ol><li>Conecte el láser óptico de fibra (diámetro 400 μm) para el laser del diodo (longitud de onda 810 nm). Configuración de diodo láser para 6-8 W, duración de pulso de 200 ms, 100 ms exposición pausa.</li>
		<li>Introducir la fibra óptica de láser en la pieza de mano para maniobrar y a través de una cánula Roma. Dejar 2-3 mm de la fibra sobresalga en la punta de la cánula.</li>
		<li>Realizar carbonización de la punta de la fibra de láser manteniendo sobre una espátula de madera y aplicar energía de laser durante unos segundos hasta que la punta es lo suficientemente ennegrecida. 
		Nota: Esto limitará la distribución de la energía no deseada en el tejido del saco lacrimal.</li>
	</ol></li> <li>Posicionamiento correcto de la fibra láser en la pared nasal lateral.
	<ol><li>Uso un lacrimal sonda para dilatar el punctum inferior ( Figura 2a). Inserte la sonda en posición vertical al principio y luego poner en una orientación horizontal antes de avanzar más lejos lo hacia el saco lagrimal. Esto permitirá que para que la fibra de láser que se insertará suavemente en el paso siguiente.</li>
		<li>Introducir la fibra láser en el pequeño canal inferior ( figura 2b , 2C). Comienza introduciendo verticalmente, luego inclinar hacia el templo a una posición horizontal para seguir la formación fisiológica de la inferior pequeño.</li>
		<li>Avanzar cuidadosamente la fibra láser en el saco lagrimal hasta que toque la pared nasal lateral, es decir, la pared medial saccal lacrimal. Objetivo, la punta en sentido antero-inferior para que apunte al margen anterior del cornete medio.</li>
		<li>Verificar la colocación correcta endoscópicamente mediante el control de transluminescence de apuntar la viga a la altura del margen anterior del cornete medio ( Figura 2d).</li>
	</ol></li> <li>Crear una suficiente nasolacrimal de derivación mediante la aplicación de la energía de láser pulsado para la pared nasal.
	<ol><li>Aplicar energía láser (mediante el conjunto de parámetros arriba), manteniendo un constante contacto a la pared sin presión, con el objetivo del margen anterior del cornete medio. El láser que vaporiza el tejido directamente delante de él, creando un bypass nasolagrimal ( Figura 2d , 2e). 
		Nota: La energía total requerida oscila entre 0.9 - 1.8 kJ y suele variar entre los pacientes.</li>
		<li>Asegúrese de que la punta de la fibra no se presiona activamente contra la pared. Tenga cuidado de no dejar la hoja de la punta en la cánula de metal ya que esto causará lesiones térmicas debido al calentamiento del metal. También evitar movimientos hacia los lados, la punta puede romperse apagado</li>
		<li>Al interior de la pared nasal lateral, tire de la fibra láser un poco y ampliar el ostium por vaporización cuidadosamente los márgenes de forma circular. Tratar de crear tan grande un puente como sea posible ( figura 2f).</li>
		<li>Busca un diámetro total de 5 mm para el ostium.</li>
		<li>Pare aplicar energía y quite la fibra láser junto con la pieza de mano y la cánula retraiga cuidadosamente el equipo.</li>
	</ol></li> <li>Verificar la permeabilidad de lo ostium de una irrigación salina utilizando una sonda de Bangerter como se describe en 1.1.1. Si se creó un ostium patentes, irrigación exitosa debe ser visible endoscópicamente.</li>
	<li>Extraiga la sonda de Bangerter.</li>
	<li>Colocar el tubo de silicona ( figura 2 g).
	<ol><li>El punctum inferior, inserte un tubo de silicio de monocanalicular y avanzar con cuidado hasta que la punta metálica principal pasa la abertura ósea y sobresale en la cavidad nasal.</li>
		<li>Pinzas de Blakesley uso para tomar la punta desde dentro de la cavidad nasal y el tubo de silicona de la nariz y en la posición ( figura 2 h).</li>
		<li>Utilizar un par de tijeras para acortar el tubo de silicona. Al final no debe ser pegado de la nariz.</li>
		<li>Realizar intubación de silicio mediante el pequeño superior así (siguientes pasos 2.7.1 a 2.7.3) ( figura 2 h).</li>
	</ol></li> <li>Retire el endoscopio nasal.</li></ol>
 3. cuidado postoperatorio y seguimiento <ol><li>después de la cirugía, iniciar un tratamiento con antibiótico eye gotas (por ejemplo, ofloxacina), colirio descongestivo (e.g. xylometazolin) y colirio de esteroides (p. ej. prednisolona acetato). Antibióticos pueden suspenderse después de una semana, mientras que esteroides y gotas descongestivas lentamente deben ser destetadas apagado en el transcurso de un mes.</li>
	<li>Seguimiento a las seis semanas y tres meses después de la cirugía. Mira para la resolución de los síntomas, prolapso del tubo de silicona, infección y secreción de.</li>
	<li>Quitar los tubos de silicona a los tres meses después de la cirugía simplemente agarrando el extremo en forma de T a la altura de la puncta y con cuidado tirando de los mismos.</li>
</ol>

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No hay conflicto de intereses.

Dacriocistorinostomía DCR láser-asistida como se describe anteriormente es una manera bastante rápida y mínimamente invasiva para tratar la infrasaccal absoluta obstrucción nasolacrimal del conducto con eficacia sin necesidad de incisión en la piel, ahorrando así no sólo la piel sino también el intermedio tendón Cantal y el mecanismo de la bomba con canalículos fisiológica. Mientras que el procedimiento es muy adecuado para los pacientes con obstrucción del conducto nasolagrimal adquirida primaria, patologí...

Infrasaccal obstrucción del conducto nasolacrimal adquirida primaria (PANDO) es un trastorno común en pacientes de mediana edad y mayores a epífora crónica y blefaritis y Dacriocistitis recurrente o crónica. Comúnmente, los pacientes desarrollan una obstrucción infrasaccal de uno o ambos conductos nasolagrimal, dando por resultado la lágrima insuficiente drenaje.
En el tratamiento de PANDO, dacriocistorrinostomía externa (DCR) es todavía considerado como el estándar de oro, aunque este procedimiento históricamente se remonta más de 100 años de cuando fue por primera vez1. Después de la incisión de la piel y la preparación de la pared nasal del saco lacrimal de un taladro se utiliza para crear un ostium óseo hacia la cavidad nasal, obviando el conducto obstruido. Se han reportado tasas de éxito funcional por encima del 85% para este método2,3. Estos resultados, sin embargo, llegan a costa de realizar un procedimiento relativamente invasivo que pone en riesgo las estructuras mediales del párpado incluyendo el mecanismo fisiológico con canalículos bomba4,5 y puede dejar a los pacientes con un no deseados la cicatriz, aunque moderna nasojugal incisiones de la piel han mejorado resultados. Estos riesgos son potencialmente evitables al realizar técnicas menos invasivas o elegir un enfoque endonasal.
Con el fin de evitar la cirugía invasiva, se ha realizado mucho trabajo en el campo de la recanalización de drenaje lagrimal mínimamente invasiva. Dos métodos en particular se han establecido como posibles procedimientos de primer paso: microdrill dacryoplasty y dacryoplasty asistida por láser. Estos procedimientos se basan en la Dacriocistorinostomía endoscopia del sistema de drenaje lagrimal y pueden realizarse para tratar la estenosis membranosas corto segmento del conducto nasolagrimal. Aunque sólo mínimamente invasiva y caracterizada por rápida convalecencia, un inconveniente común de estas técnicas de recanalizing son las tasas de éxito funcional relativamente baja con respecto a los resultados a largo plazo6,7, 8 , 9.
En un esfuerzo por llenar el vacío entre estos procedimientos de primer paso y DCR externa como tratamiento definitivo, recientemente se han desarrollado nuevos enfoques. El más prometedor de los cuales es DCR láser-asistida para el tratamiento de absoluta infrasaccal PANDO. Como con todos los enfoques mencionados, pacientes se recomiendan para ser sometido a anestesia general para este procedimiento. Una fibra de láser de diodo se inserta vía sea pequeño y luego se avanza en el saco lagrimal. A continuación, energía láser se aplica a la pared nasal lateral hasta que se crea una abertura ósea, conecta a la cavidad nasal a la altura de margen anterior10,11 el de cornete medio. Al mismo tiempo, se mantiene constante control visual mediante endoscopia endonasal. La anastomosis recién formada es un bypass para el drenaje de la lágrima. Después de la irrigación exitosa, intubación de silicio bicanalicular se realiza para prevenir la cicatrización temprana de la abertura recién formada. El tratamiento postoperatorio consiste en descongestionante, esteroide y colirio antibiótico para prevenir la hinchazón, inflamación e infección, respectivamente.
La duración de la cirugía y convalecencia es generalmente más corta que con la DCR externa (10-25 min en DCR láser-asistida vs 35-75 min en DCR externa). Las tasas de complicaciones son relativamente bajas, las más comunes siendo discreta hinchazón de los párpados y el prolapso del tubo de silicona. Infección con canalículos y lesiones térmicas son eventos raros10. Un año éxito funcional tipos de 74-88% han sido registrados10,11,12,13,14,15,16, 17,18, así que van muy detrás de los de DCR externa sin sufrir las desventajas de la vía de abordaje externo. Sin embargo, resultados a largo plazo siguen siendo aún ser proporcionado. Además, incluso después de fracaso de DCR láser-asistida, DCR externa secundaria puede todavía realizarse sin dificultad. En consecuencia, asistida por láser DCR califica como un procedimiento viable de segundo paso que debe realizarse óptimamente después de fracaso de la cirugía de recanalización y antes DCR externa.

<table border="0" cellpadding="0" cellspacing="0" width="812">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">C1.multi</td>
			<td style="width:281px;">LUT</td>
			<td style="width:119px;">05.0082h.1</td>
			<td style="width:196px;">Endoscope camera</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">HL 250</td>
			<td style="width:281px;">LUT</td>
			<td style="width:119px;">95.2048n</td>
			<td>Endoscope light source</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">MD-19E</td>
			<td style="width:281px;">ACL GmbH</td>
			<td style="width:119px;">1119</td>
			<td>Endoscope screen</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">FOX (laser)</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">n/a</td>
			<td>Diode laser</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Laser fiber</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">LL13001s</td>
			<td>Laser fiber</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Laser handpiece</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">n/a</td>
			<td>Handpiece</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Wide Collarette Monoka</td>
			<td style="width:281px;">Fa. FCL, Paris, France</td>
			<td style="width:119px;">S1.1630</td>
			<td>monocanalicular silicon tube</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Suction elevatorium</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">474015</td>
			<td>For intranasal use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Forceps (Gr&#252;nwald)</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">426620</td>
			<td>For intranasal use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Forceps (Blakesley-Wilde)</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">456502</td>
			<td>To grab the silicon tube</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Lacrimal canula</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">81071</td>
			<td>Blunt cannula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Bangerter probe cannula</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">81055</td>
			<td>Bangerter probe cannula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Wooden spatula</td>
			<td style="width:281px;">any</td>
			<td style="width:119px;">n/a</td>
			<td>Wooden spatula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Xylometazolin 0.05% eye drops</td>
			<td>GlaxoSmithKline Consumer Healthcare</td>
			<td style="width:119px;">n/a</td>
			<td>Decongestant eye drops</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Dexapos comod eye drops</td>
			<td style="width:281px;">Ursapharm</td>
			<td style="width:119px;">n/a</td>
			<td>steroid eye drops</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Floxal eye drops</td>
			<td style="width:281px;">Dr. Gerhard Mann</td>
			<td style="width:119px;">n/a</td>
			<td>antibiotic eye drops</td>
		</tr>
	</tbody>
</table>

transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction

Estándar de oro de hoy en el tratamiento de la obstrucción del conducto nasolacrimal adquirida primaria infrasaccal (PANDO) es la dacriocistorrinostomía externa (DCR), un procedimiento relativamente invasivo que puede realizarse después de la falta de tratamientos de recanalizing. Sin embargo, con el progreso en el campo de la tecnología de láser de diodo, han surgido nuevos enfoques. Asistida por láser Dacriocistorinostomía DCR con bicanalicular subsecuente intubación de silicio es una nueva opción que muestra gran promesa como un procedimiento mínimamente invasivo viable. Bajo permanente control visual endoscópica de la cavidad nasal, una fibra de láser de diodo se inserta en el saco lacrimal y se aplica energía láser para crear una abertura ósea entre el saco lagrimal y la cavidad nasal. Puesto que no hay incisión cutánea debe realizarse, ventajas de este método incluyen la preservación de la piel, así como las estructuras palpebrales mediales y el mecanismo fisiológico bomba palpebral con canalículos. La duración de la cirugía y convalecencia es generalmente más corta que con la DCR externa. Las complicaciones incluyen prolapso de tubo de silicon, hinchazón leve y, raramente, infección canalicular y lesiones térmicas. Tasas de un año de éxito funcional, definidas como la resolución completa de los síntomas y la permeabilidad del ostium, son altas, aún así la gama detrás de la DCR externa. Sin embargo, DCR externa secundaria tras fracaso de DCR asistida por láser puede realizarse sin dificultad. Así, asistida por láser Dacriocistorinostomía DCR es una opción válida que debe considerarse como un segundo paso después de la falta de procedimientos de recanalización y antes DCR externa.

Resultado óptimo:
El procedimiento como se describe anteriormente tarda aproximadamente 10-25 minutos y generalmente se tolera muy bien. En el examen al día siguiente, una pequeña hinchazón de los párpados puede estar presente en aproximadamente el 60% de los casos. Esta hinchazón poco siempre resuelve totalmente en un plazo máximo de tres días. Pacientes no se quejan de dolor, prolapso de silicio o signos de lesión o infe...

Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

El objetivo de este protocolo es presentar Dacriocistorinostomía transcanalicular asistida por láser como un enfoque mínimamente invasivo en el tratamiento de la obstrucción del conducto nasolagrimal adquirida primaria.

Dacriocistorinostomía diodo dacriocistorrinostomía láser-asistida para el tratamiento de primaria adquirió la obstrucción del conducto nasolagrimal

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

transcanalicular-diode-laser-assisted-dacryocystorhinostomy-for

Research

JoVE Journal

Medicine

10.9K vistas.  University of Cologne. El objetivo de este protocolo es presentar Dacriocistorinostomía transcanalicular asistida por láser como un enfoque mínimamente invasivo en el tratamiento de la obstrucción del conducto nasolagrimal adquirida primaria.

Video: Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

La ablación térmica para el tratamiento de los tumores abdominales

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

Investigación

Medicina

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their head and neck regions for cancer treatment. Both groups of patients experience symptoms such as xerostomia (dry mouth), dysphagia 
(impaired chewing and swallowing), severe dental caries, altered taste, oro-pharyngeal infections (candidiasis), mucositis, pain and discomfort.
One innovative approach of regenerative medicine for the treatment of salivary gland hypo-function is speculated in RS Redman, E Mezey 
et al. 2009: stem cells can be directly deposited by cannulation into the gland as a potent method in reviving the functions of the impaired organ. Presumably, 
the migrated foreign stem cells will differentiate into glandular cells to function as part of the host salivary gland. Also, this cannulation technique is an 
expedient and effective delivery method for clinical gene transfer application.
Here we illustrate the steps involved in performing the cannulation procedure on the mouse submandibular salivary gland via the Wharton's duct 
(Fig 1). C3H mice (Charles River, Montreal, QC, Canada) are used for this experiment, which have been kept under clean conventional conditions at 
the McGill University animal resource center. All experiments have been approved by the University Animal Care Committee and were in accordance with the 
guidelines of the Canadian Council on Animal Care.
For this experiment, a trypan blue solution is infused into the gland through the opening of the Wharton's duct using a 
insulin syringe with a 29-gauge needle encased inside a polyethylene tube. Subsequently, the mouse is dissected to show that the infusions migrated 
into the gland successfully.

A protocol for the cannulation of the mouse submandibular salivary gland via the Wharton's duct is described. For this experiment, the trypan blue solution is used as a dyer to demonstrate how this technique effectively delivers infusions into the targeted gland, and to suggest the reliability of this new approach as a potential clinical drug/cell therapy for the regeneration of salivary glands.

Canulación de la glándula salival submaxilar del ratón a través del conducto de Wharton

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their ...

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

La medición y tratamiento de la represión en la ambliopía

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

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.

El Régimen Goeckerman para el tratamiento de psoriasis moderada a grave

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

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

This paper describes a novel nonocclusive coronary anastomotic connector in a porcine off-pump coronary artery bypass (OPCAB) model. This easy-to-use coronary connector has intrinsic potential to facilitate minimally invasive OPCAB surgery.

Evaluación de una anastomosis coronaria Conector asistida por láser Novela - el videoclip Trinidad - en un modelo porcino de bypass sin circulación extracorpórea

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the ...

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.

Análisis de la red de foramen oval de electrodos Grabaciones en epilepsia del lóbulo temporal pacientes resistentes a los medicamentos

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

Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal model to investigate bladder remodeling in pBOO are female rodents undergoing partial obstruction at the proximal urethra. Variability in the degree of obstruction and animal mortality are major concerns with proximal obstruction. Furthermore, dissecting around the proximal urethra and bladder neck jeopardizes bladder innervation.
We developed a nerve-sparing mid-urethral obstruction (NeMO) model for pBOO avoiding the disadvantages of the traditional model. We approached the urethra just inferior to the pubic symphysis, which obviated the need for laparotomy as well as for dissection in this area; also, the striated urethral sphincter remained untouched. We performed NeMO in female Sprague-Dawley rats (12 obstructions, 6 sham animals) as well as in female C57/bl6 mice (20 obstructions, 18 sham animals). After two weeks, we evaluated bladder function, bladder mass, and body mass.
We had no mortalities among obstructed- or sham-operated female rats; as described for the traditional proximal pBOO-method, we tied the suture around the proximal urethra and a temporarily placed 0.9 mm metal rod. NeMO induced an 85% increase in bladder mass after two weeks, average residual urine volume was 0.4 mL in partially obstructed rats while only 0.03 mL in sham animals. In mice, we tested 3 sizes of cannulas that we placed along the urethra when tying the suture. We found that using a 27-gauge cannula resulted in over 50% animal mortality; placing the 25-gauge cannula did not yield the desired response in increasing bladder mass; utilizing a 26-gauge cannula yielded favorable results with minimal animal mortality (1/8) yet a significant 2-fold increase in bladder mass.

Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents

Traditional modeling of partial bladder outlet obstruction in rodents is fraught with animal mortality. A denervation injury from dissection around the proximal urethra and bladder neck is also of major concern. We developed and evaluated a safe and reliable mid-urethral obstruction model, avoiding the shortcomings of the traditional model.

Preservación de los nervios de mitad de obstrucción uretral (NEMO) en femenino pequeños roedores

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal ...

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could interfere with the chemotherapeutic efficacy of the primary drugs. This is especially true for the drug cisplatin, whose anticancer actions are attenuated by antioxidants which provide adequate protection against hearing loss. Other current or potential otoprotective agents could pose a similar problem, if administered systemically. The application of various biologicals or protective agents directly to the cochlea would allow for high levels of these agents locally with limited systemic side effects. In this report, we demonstrate a trans-tympanic method of delivery of various drugs or biological reagents to the cochlea, which should enhance basic science research on the cochlea and provide a simple way of directing the use of otoprotective agents in the clinics. This report details a method of trans-tympanic drug delivery and provides examples of how this technique has been used successfully in experimental animals to treat cisplatin ototoxicity.

We present a technique for localized administration of drugs through the trans-tympanic route into the cochlea. Drug delivery through this route would not interfere with the anti-cancer efficacy of the chemotherapeutic drugs such as cisplatin.

Trans-timpánica fármaco para el tratamiento de la ototoxicidad

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could ...

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

Enucleación de la próstata para el tratamiento de la hiperplasia prostática benigna mediante un láser de diodo de 980 nm

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Development of a Noninvasive, Laser-Assisted Experimental Model of Corneal Endothelial Cell Loss

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the optical breakdown at the laser focus. Acoustic shock waves and cavitation bubbles are generated, causing tissue rupture. Bubble sizes and pressure amplitudes vary with pulse energy and position of the focal point. In this study, enucleated porcine eyes were positioned in front of a commercially available Nd:YAG laser. Variable pulse energies as well as different positions of the focal spots posterior to the cornea were tested. Resulting lesions were evaluated by two-photon microscopy and histology to determine the best parameters for an exclusive detachment of corneal endothelial cells (CEC) with minimum collateral damage. The advantages of this method are the precise ablation of CEC, reduced collateral damage, and above all, the non-contact treatment.

Here, we present a protocol to detach corneal endothelial cells (CEC) from Descemet&#8217;s membrane (DM) using a neodymium:YAG (Nd:YAG) laser as an ex vivo disease model for bullous keratopathy (BK).

Desarrollo de un Modelo Experimental No Invasivo, Asistido por Láser de Pérdida Celular Endotelial Corneal

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the ...