1. Présentation de cas <ol><li> Le patient est mis en place pour une visite à la clinique gynécologique, souvent en raison de l&#39;apparition de troubles de la coagulation. Un examen physique est effectué. <ol><li> S&#39;il le juge nécessaire, le patient doit subir une hystérectomie. La paperasse est prête, et le patient reçoit la prémédication pour le jour de la chirurgie. </li><li> Les patients de 60 ans et plus doivent d&#39;abord soumettre des échantillons de sang et surveillés par électrocardiogramme (ECG ou) avant la procédure. </li></ol></li><li> Le jour de la chirurgie, le patient n&#39;est pas autorisé à consommer quoi que ce soit par voie orale pendant six heures avant d&#39;être admis. <ol><li> Une exception est faite pour les boissons sucrées clairs sans pulpe, qui sont autorisées jusqu&#39;à deux heures avant d&#39;être admis. </li><li> Le patient prend la prémédication (t.Paracetemol 1 g + t.Etodolac 300 mg + t.Dexamethason 8 mg) avec le dernier verre. </li></ol></li><li> Le patient est admis app. une heure avantl&#39;heure prévue de la chirurgie. <ol><li> L&#39;infirmière de paroisse prépare d&#39;abord le patient pour une chirurgie. </li><li> L&#39;anesthésiste examine le patient et prépare les documents pour l&#39;anesthésie. </li></ol></li><li> Lorsque la chambre de manoeuvre est disposé et l&#39;équipe est prête, le gynécologue transporte le patient en salle d&#39;opération. <ol><li> Le patient est allongé sur la table d&#39;opération et est recouvert d&#39;une couverture chirurgicale. </li><li> Une voie IV est placée dans la main gauche et de 1000 ml de solution saline est démarré. L&#39;équipement de surveillance est fixée. </li><li> L&#39;anesthésie est induite avec du propofol et du rémifentanil jusqu&#39;à la perte de conscience (LOC) se produit, et maintenu en utilisant TOF. </li><li> Pour faciliter l&#39;intubation, une petite dose de rocuronium (15 mg) est administré. </li><li> Laryngoscopie directe est effectuée. S&#39;il est difficile de visualiser la corde vocale, la McGrath videolaryngoscop est utilisé. L&#39;intubation est ensuite effectuée. </li></ol></li><li> Insufflationde l&#39;abdomen est démarré à 12 mm de Hg CO 2. <ol><li> Les ports sont placés. </li><li> La procédure est lancée. </li><li> Les chirurgiens sont dit quand train de quatre taux (TOF) est&gt; 90%, correspondant au blocage neuromusculaire est sevré. </li><li> Au niveau du col de la préhension de la distance entre le promontoire à la surface de la peau au niveau de l&#39;ombilic est marqué. </li><li> La pince est placée sur la table d&#39;opération. Avec une bande de mesure, la distance entre l&#39;extrémité de l&#39;élément de préhension et le col de l&#39;élément de préhension (au doigt du chirurgien) est marqué, et ensuite la distance calculée est mesuré en centimètres. </li></ol></li><li> La pression d&#39;insufflation de CO 2 est abaissée à 8 mm de mercure. <ol><li> Au niveau du col de la préhension de la distance entre le promontoire à la surface de la peau au niveau de l&#39;ombilic est marqué. </li><li> La pince est placée sur la table. Avec ruban à mesurer la distance marquée est interprétée centimètres. </li></ol></li><li&gt; CO 2 pression d&#39;insufflation est réglé à 12 mm Hg. <ol><li> Blocage neuromusculaire profond est appliqué à un message Tetanic Count (PTC) &lt;2. </li><li> Au niveau du col de la préhension de la distance entre le promontoire à la surface de la peau au niveau de l&#39;ombilic est marqué. </li><li> La pince est placée sur la table. Avec ruban à mesurer la distance marquée est mesurée en centimètres. </li></ol></li><li> CO 2 la pression d&#39;insufflation est abaissée à 8 mm de mercure. <ol><li> Au niveau du col de la préhension de la distance entre le promontoire à la surface de la peau au niveau de l&#39;ombilic est marqué. </li><li> Au niveau du col de la préhension de la distance entre le promontoire à la surface de la peau au niveau de l&#39;ombilic est marqué. </li></ol></li><li> La procédure est terminée. <ol><li> Perfusions de propofol et du rémifentanil sont terminées. </li><li> Le patient est réveillé et a déménagé à son lit. </li><li> Le patient est transféré à la salle de réveil. </li></ol&gt; </li></ol>

<ol>
	<li>Jones, R. K., Caldwell, J. E., Sorin, C. B., Brull, J., Soto, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reversal+of+Profound+Rocuronium-induced+Blockade+with+Sugammadex.">Reversal of Profound Rocuronium-induced Blockade with Sugammadex.</a> Anesthesiology. 109, 816-824 (2008).</li><li>Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Enfbaek, J., Skovgaard, L. T., Krintel, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+neuromuscular+block+is+a+risk+factor+for+post-operative+pulmonary+complications:+A+prospective,+randomized,+and+blinded+study+of+postoperative+pulmonary+complications+after+atracurium,+vecuronium+and+pancuronium.">Residual neuromuscular block is a risk factor for post-operative pulmonary complications: A prospective, randomized, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium.</a> Acta Anaesthesiol. Scand. 41, 1095-1103 (1997).</li><li>Abrishami, A., Ho, J., Wong, J., Yin, L., Chung, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sugammadex,+a+selective+reversal+medication+for+preventing+postoperative+residual+neuromuscular+blockade.">Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.</a> The Cochrane Collaborations. , (2009).</li><li>Plaud, B., Debaene, B., Donati, F., Marty, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+Paralysis+after+Emergence+from+Anesthesia.">Residual Paralysis after Emergence from Anesthesia.</a> Anesthesiology. 112, 1013-1022 (2010).</li><li>Lee, D. W., Kim, M. J., Lee, Y. K., Lee, H. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+Intraabdominal+Pressure+Affect+Development+of+Subcutaneous+Emphysema+at+Gynecologic+Laparoscopy?.">Does Intraabdominal Pressure Affect Development of Subcutaneous Emphysema at Gynecologic Laparoscopy?.</a> Minimally Invasive Gynecology. , 761-765 (2011).</li><li>Sandhu, T., Yamada, S., Ariyakachon, V., Chakrabandhu, T., Chongruksut, W., Ko-iam, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-pressure+pneumoperitoneum+versus+standard+pneumoperitoneum+in+laparoscopic+cholecystectomy,+a+prospective+randomized+clinical+trial.">Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial.</a> Surg. 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P., Dillemans, B. R. S., Crombach, M., Missant, C., Sels, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+the+abdominal+pressure+volume+relationship.">On the abdominal pressure volume relationship.</a> The internet Journal of Anesthesiology. 21, (2009).</li><li>Srvastava, A., Niranjan, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Secrets+of+safe+laparoscopic+surgery:+Anaesthetic+and+surgical+considerations.">Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations.</a> J. Minim. Access. Surg. 6, 91-94 (2010).</li><li>Grosse-Sundrup, M., Henneman, J. P., Sandberg, W. S., Bateman, B. T., Uribe, J. V., Nguyen, N. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intermediate+acting+non-depolarizing+neuromuscular+blocking+agents+and+risk+of+postoperative+respiratory+complications:+prospective+propensity+score+matched+cohort+study.">Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study.</a> BMJ. 345, e6329 (2012).</li><li>Kaneko, G., Miyajima, A., Yazawa, S., Yuge, K., Kikuchi, E., Asanuma, H., Nakagawa, K., Oya, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+predictor+of+prolonged+operative+time+during+laparoscopic+radical+prostatectomy?.">What is the predictor of prolonged operative time during laparoscopic radical prostatectomy?.</a> Int. J. Urol. 20 (3), 330-336 (2012).</li><li>Drahonovsky, J., Haakova, L., Otcenasek, M., Krofta, L., Kucera, E., Feyereisl, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+comparison+of+vaginal+hysterectomy,+laparoscopically+assisted+vaginal+hysterectomy,+and+total+laparoscopic+hysterectomy+in+women+with+benign+uterine+disease.">A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease.</a> Eur. J. Obstet. Gynecol. Reprod. Biol. 148 (2), 172-176 (2010).</li></ol>

Aucun conflit d&#39;intérêt déclaré.

<html> Calculer directement le volume de travail disponible pour la chirurgie laparoscopique est difficile, mais la relation entre l&#39;insufflation de CO 2 pression et le volume abdominal est plus facile à mesurer 9. Ici, nous présentons une méthode pour utiliser la pince chirurgicale pour estimer l&#39;espace dans l&#39;abdomen pendant l&#39;insufflation, comme une alternative à la méthode de comptabilisation du volume d&#39;insufflation de CO 2. Ces mesures ont...

Les agents bloquants neuromusculaires sont couramment utilisés pour faciliter l&#39;intubation trachéale, et, pendant l&#39;anesthésie, afin de faciliter une intervention chirurgicale. L&#39;utilisation d&#39;agents pharmacologiques pour atteindre une relaxation profonde tout au long de la procédure laparoscopique permet aux chirurgiens de procéder soit au même niveau de CO 2 insufflation tout en bénéficiant de meilleures conditions chirurgicales, ou l&#39;abaissement de la pression d&#39;insufflation à réduire le risque de complications chirurgicales. Plusieurs études ont montré l&#39;effet positif de l&#39;abaissement de la pression de travail 5,6,7. Un symptôme qui est souvent observé après une hystérectomie laparoscopique est une douleur à l&#39;épaule, ce qui est souvent affirmé comme un problème majeur et le problème le plus important lorsque l&#39;on parle au patient lors du suivi. 8 Myomectomie laparoscopique ou hystérectomie est habituellement recommandé lorsque les méthodes les plus conservateurs n&#39;arrivent pas à contrôler les symptômes causés par des fibromes utérins. Dans notre institution, ces procédures sonteffectuée dans un CO 2 insufflant pression de 12 mm Hg. Il ya deux gynécologues expérimentés de la scène tous les cas gynécologiques. Tous nos cas sont anesthésiés avec du propofol et du rémifentanil, et l&#39;intubation est souvent facilitée par une faible dose de rocuronium (15 mg). De notre travail clinique quotidien, nous avons identifié douleur à l&#39;épaule comme l&#39;un des effets secondaires les plus inquiétants après une hystérectomie laparoscopique, qui est soutenu par la littérature 8. Des études ont montré que la réduction de la pression intra-abdominale peut aussi réduire la douleur de l&#39;épaule. Dans un effort pour réduire la pression d&#39;insufflation de CO 2, une de nos préoccupations antérieures a été si le champ opératoire et la visibilité pendant la procédure serait compromise. Essayer de déterminer l&#39;aperçu au cours de la procédure, nous avons mis en place une méthode pour comparer l&#39;espace de travail intra-abdominale. Toutefois, il peut être très difficile de contrôler le volume intra-abdominale exact chez un patient au cours surGery. Dans une étude belge, la relation entre le volume pression a été décrite, mais les auteurs de l&#39;étude ont conclu qu&#39;il existe de grandes variations interindividuelles 9. Afin d&#39;obtenir une déclaration plus fiable de l&#39;espace intra-abdominale, nous utilisons la distance entre le promontoire de la peau que la métrique.

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

Douleur à l&#39;épaule est un symptôme fréquemment rapportés suite à des interventions laparoscopiques telles que la myomectomie ou une hystérectomie, et des études récentes ont montré que l&#39;abaissement de la pression d&#39;insufflation pendant la chirurgie peut réduire le risque de douleur post-opératoire. Dans cette étude pilote, on présente une méthode pour mesurer l&#39;espace intra-abdominale à la disposition du chirurgien pendant laproscopy, afin d&#39;examiner si la relaxation produite par le blocage neuromusculaire profond peut augmenter l&#39;espace chirurgical travailler suffisamment pour permettre une réduction du CO 2 pression d&#39;insufflation. Utilisation de la pince laparoscopique, la distance entre le promontoire de la peau est mesurée à deux pressions d&#39;insufflation différents: de 8 mm de Hg et 12 mm de mercure. Après les mesures initiales, un agent de blocage neuromusculaire (rocuronium) est administré au patient et le volume intra-abdominale est mesurée à nouveau. Des données préliminaires recueillies auprès de 15 patients montre que l&#39;espace intra-abdominale à 8 mm Hg avec blockade est comparable à l&#39;espace intra-abdominale mesurée à 12 mm Hg sans blocus. L&#39;impact du blocage neuromusculaire n&#39;est pas corrélée avec la hauteur patient, son poids, l&#39;IMC et l&#39;âge. Ainsi, en utilisant le blocage neuromusculaire à maintenir un volume constant tout en réduisant la pression d&#39;insufflation peut produire de meilleurs résultats pour les patients.

Cette étude pilote de 15 patients a été effectuée pour évaluer l&#39;impact du blocage neuromusculaire profond pendant la chirurgie laparoscopique. La méthode illustrée ici a été utilisé pour obtenir des mesures de l&#39;espace intra-abdominale chez les patients qui subissent une hystérectomie laparoscopique (Figure 1). Chez chaque patient, les mesures de l&#39;espace intra-abdominale ont été prises dans les conditions suivantes: 12 mm Hg sans blocage neuromuscu...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Cet article présente une méthode pour mesurer le volume abdominal de travail au cours de la myomectomie laparoscopique utilisant la pince chirurgicale, et applique cette technique pour obtenir des données de pilotes si le blocage neuromusculaire profond (NMB) peut permettre l&#39;utilisation d&#39;abaisser la pression d&#39;insufflation. Pression d&#39;insufflation réduite pendant la chirurgie laparoscopique a été montré pour réduire la douleur post-opératoire, et donc l&#39;utilisation de NMB pendant la chirurgie peut permettre de meilleurs résultats pour les patients.

Le blocage neuromusculaire profonde mène à un volume intra-abdominale Agrandir pendant la laparoscopie

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

deep-neuromuscular-blockade-leads-to-larger-intraabdominal-volume

Research

JoVE Journal

Medicine

13.0K vues.  Aleris-Hamlet Hospitals, Soeborg, Denmark. Cet article présente une méthode pour mesurer le volume abdominal de travail au cours de la myomectomie laparoscopique utilisant la pince chirurgicale, et applique cette technique pour obtenir des données de pilotes si le blocage neuromusculaire profond (NMB) peut permettre l'utilisation d'abaisser la pression d'insufflation. Pression d'insufflation réduite pendant la chirurgie laparoscopique a été montré pour réduire la douleur post-opératoire, e...

Vidéo: Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

Peropératoire tâches comportementales chez les humains subissent de profondes Awake Chirurgie stimulation cérébrale

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

Recherche

Médecine

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

Pilotage de la colonne dorsale avec fils en parallèle double à partir de sources d&#39;alimentation dédié: un modèle de calcul

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

Utilisant la stimulation magnétique transcrânienne à l&#39;étude du système neuromusculaire de l&#39;homme

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

Construction des chambres de vapeur utilisée pour exposer des souris à l&#39;alcool pendant l&#39;équivalent de toutes trois trimestres de développement humain

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Évaluation clinique de la démarche spatio-temporelles des paramètres chez les patients âgés et les adultes

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

Utilisation de Saccadometry avec la stimulation cérébrale profonde pour l&#39;étude normale et pathologique fonction cérébrale

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure.
We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment.
Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment.
The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

To assess the pulmonary diffusion and vasculature responses to exercise, we describe the multiple-inspired oxygen diffusion capacity technique to determine capillary blood volume and membrane diffusing capacity, as well as agitated saline contrast echocardiography to assess the recruitment of intrapulmonary arteriovenous anastomoses.

Évaluation du volume pulmonaire de sang capillaire, Membrane Diffusing Capacité et intrapulmonaire artério Anastomoses Pendant l&#39;exercice

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts to spare normal ovarian cortex. Optimization of tubal anatomy is another frequent consideration. Fertility-sparing laparoscopic techniques at the time of cystectomy for ovarian endometrioma seek to limit iatrogenic surgical damage to the ovarian cortex and strategically assess and respond to genital tract patency. Surgical candidates frequently desire relief from endometriosis-associated pain while also seeking to optimize spontaneous or assisted conception rates. Operative benefits include potential for surgical and histopathologic diagnosis of endometriosis, evaluation of genital tract patency, and treatment of visualized lesions. Resection of ovarian endometrioma nonetheless poses significant risks, including surgical injury, blood loss, post-surgical decline in ovarian reserve and post-operative inflammation with adhesion formation, both of which may impair folliculogenesis.
We present the case of a 32-year-old woman with known endometriosis and continued pain refractory to medical management who opted for surgical management of her disease tailored toward optimizing her chances at future conception. Using this case as an example, we describe techniques and considerations for diagnostic laparoscopy, adhesiolysis, ovarian cystectomy, chromopertubation, and salpingectomy with a focus on maintaining a fertility-preserving approach.

This protocol presents techniques to laparoscopically excise ovarian endometrioma, to perform adhesiolysis with sparing electrosurgical application, and to employ intraoperative chromopertubation to assess for genital tract patency. This systematic approach will facilitate optimal endometriosis management, guide concomitant adnexal surgeries, and enhance post-surgical fertility outcomes.

Techniques chirurgicales pour optimiser la réserve ovarienne pendant la cystectomie laparoscopique pour l’endométriome ovarien

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

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.

Laparoscopie-endoscopie Chirurgie coopérative pour le traitement des tumeurs stromales gastro-intestinales gastriques

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

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

Évaluation fonctionnelle du cœur du donneur pendant la perfusion ex situ : aperçu des boucles pression-volume et de l’échocardiographie de surface

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...