ドイツ研究振興協会 (ドイツ研究協会;2240 の「(リンパ) 血管新生と眼の炎症性疾患における細胞性免疫能」にハイビスカス。彼 6743/2-1 および彼 6743/3-1 ハイビスカスに)、クルク島とハイビスカスにケルン大学の GEROK プログラムです。感謝の意は、博士 Kühner、テクニカル サポート

このプロシージャのインフォームド コンセントが必要であり、ケルン、ドイツのケルン大学眼科で手術を受けたすべての患者を受けた。すべての検査や外科的介入は国の法律と、現在のバージョンの 1975 年からヘルシンキ宣言に従って実行された。
 注: 指示がプロシージャを実行する側にだけ常に参照してください限り。滅菌装置を使用します。
 1 です患者準備 <ol><li>実行徹底した眼科的検査法 (まぶた、上限と下限の涙、涙の排水に注意) と灌漑を含むとパンドをテストする調査 10。.
	<ol><li>標準化された灌漑用上・ バンガーター プローブを挿入し、その後、下げる涙。垂直方向に、それを挿入することによって開始し、小管生理学的形成に水平位置に神殿へそれを傾けます。涙管閉塞をテストする生理食塩水を慎重に注入プローブが位置の場合 。
		注: infrasaccal パンド、・ バンガーター カニューレが簡単に達する弾む抵抗せず外側鼻の壁 (&#34; ハード ストップ &#34;)。反対の涙を通して対側逆流患者に達するすべての切削油剤を用いないになります水を引くしようとすると、&#39; s 咽頭 10.</li>
	</ol></li> <li>急性感染症、涙排水システムも、外傷性、先天性または presaccal 閉塞の腫瘍を除外します。
	<ol>見て、痛みを伴う発赤の急性感染症を除外するための <li>涙排水の腫れや膿の排出。腫瘍を除外するために、無痛性腫脹、潰瘍や色素沈着を探します。Presaccal 閉塞結果弾む抵抗・ バンガーター プローブを涙嚢に進出しようとしたとき (&#34; ソフト ストップ &#34;)。先天性と外傷性の閉塞が忍耐強い歴史 10 , 19 , 20 で排除される</li>。
	</ol></li> <li>鼻腔内リンゴ疾患、例えば重度の鼻中隔偏差を除外します。これは患者の撮影によってされるべきである &#39; 鼻腔 21 のリンゴの検査との組み合わせで s 歴史</li>。
	<li>入れて、全身麻酔下の患者など誘導のためのアトラクリウムベシル、レミフェンタニル、プロポ フォールの静脈注射して標準体重に適応した投与を使用してメンテナンスのため desfluran プラス静脈レミフェンタニルの吸入 10. 挿管を実行する必要があります、しかし、喉頭マスクの使用も可能です 。
	注: 麻酔薬としての投与量は、診療所間異なる場合があります。DCR のレーザに必要な特定の麻酔プロトコルはありません</li>。
</ol> 2。レーザー援用 DCR <ol><li>挿入胸腔内視鏡、鼻に鼻孔を慎重に進めることにより空洞。外側鼻の壁に向かって内視鏡を少し傾けることによって中鼻甲介の前縁を視覚化します</li>。
	<li>は、レーザー装置とレーザー設定を正しい値を設定します。保護眼鏡をかけます。
	<ol><li>接続レーザー ダイオード レーザー (波長 810 nm) を光ファイバー (直径 400 μ m)。ダイオード レーザーの設定を 6-8 W、パルス持続時間 200 ms、100 ms 博覧会一時停止</li>。
		<li>は収まるハンドピース操縦と鈍カニューレを通してレーザー光ファイバーです。カニューレの先端に突き出る繊維の 2 〜 3 mm ができます</li>。
		<li>実行炭化木のへらで押し、適用するレーザー光ファイバー先端のレーザー エネルギー先端が十分に黒くされるまで数秒 。
		注: これは涙嚢の組織に不要なエネルギー分布を制限します</li>。
	</ol></li> <li>外側鼻の壁にレーザーのファイバーを正しく配置します。
	<ol><li>使用、涙腺プローブ下の涙 ( 図 2 a) を拡張します。最初は垂直方向にプローブを挿入し、さらに涙嚢に向けて進む前に水平方向にします。これにより、次のステップにスムーズに挿入されるレーザー繊維します</li>。
		<li>は、低い小管 ( 図 2 b , 2 c) にレーザーのファイバーを挿入します。垂直方向に、それを挿入することによって開始し、低い小管の生理学的な形成に水平位置に寺手前に倒します</li>。
		<li>は、外側鼻の壁、すなわち内側の涙腺 saccal 壁に触れるそれまで慎重にレーザー繊維と涙嚢に進出します。中鼻甲介の前縁にある、前下方向に先端を目指して</li>。
		<li>正しい内視鏡中鼻甲介 ( 図 2 d) の前の縁の高さを目指してビームの transluminescence を監視することによって位置を確認してください</li>。
	</ol></li> <li>十分な鼻涙を鼻の壁にパルス レーザー エネルギーのアプリケーションによってバイパスを作成します。
	<ol><li>適用レーザー エネルギー (上記のパラメーター セットを使用して)、中鼻甲介の前縁を目指して、圧力なしの壁に一定した接触を維持します。レーザーは鼻涙バイパス ( 図 2 d , 2 e) を作成する、それの前に直接組織を蒸発します 。
		注: 総エネルギー必要な範囲は 0.9 - 1.8 kJ と患者間に変化する傾向がある</li>。
		<li>ファイバー先端が壁に積極的に押されていないことを確認してください。これにより、金属の加熱による熱損傷を引き起こすので金属カニューレにヒント タイム スリップを聞かせしないように注意します。また先端がオフに破ることができると、横の動きを避ける</li>
		<li>外側鼻の壁を貫通レーザーのファイバーを少し引いて、慎重に循環的に余白を気化させることで、口を拡大します。( 図 2 f) 可能な限り、大規模なバイパスを作成しようとします</li>。
		<li>口の 5 mm の径を目指す</li>。
		<li>エネルギーの適用を停止し、機器を慎重に取り消し、ハンドピースとカニューレ レーザー繊維を削除します</li>。
	</ol></li> <li>生理食塩水灌漑 1.1.1 で説明・ バンガーター プローブを使用して、口の開存を確認します。特許の口を作成した場合成功した灌漑内視鏡表示されます</li>。
	<li>・ バンガーター プローブを削除します</li>。
	<li>は、シリコン チューブ ( 図 2 g) を配置します。
	<ol><li>下涙 monocanalicular シリコン チューブを挿入、大手金属チップが骨の口を通過し、鼻腔内に突出するまで慎重に進めることです</li>。
		<li>鼻腔内からヒントをつかみ、鼻からの所定の位置 ( 図 2 h) シリコン チューブを引っ張る使用ブレークスリー鉗子</li>。
		<li>は、シリコン チューブを短くはさみのペアを使用します。最後は鼻からくっつかない</li>。
		<li>も上小管 (2.7.3 を介して次手順 2.7.1) を介してシリコン気管挿管を行う ( 図 2 h).</li>
	</ol></li> <li>鼻内視鏡を削除します</li></ol>。
 3. 手術後のケアとフォロー アップ <ol><li>手術後、ey の抗生物質による治療を開始e ドロップ (例えばオフロキサシン)、充血除去剤点眼薬 (例えば xylometazolin)、ステロイド系の点眼薬 (プレドニゾロン酢酸など)。一方ステロイド一週間後抗生物質を停止して 1 ヶ月にわたって充血除去剤点眼する必要がありますから離脱ゆっくりと</li>。
	<li>6 週間と手術後 3 カ月でフォロー アップ。症状、シリコン チューブ脱、感染症、および分泌の解決方法を探します</li>。
	<li>単に涙点の高さで T 形の端をつかみ、慎重にそれらを引き出すことによって、手術後 3ヶ月でシリコン チューブを削除します</li>。
</ol>

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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+adjunctive+mitomycin+C+in+transcanalicular+diode+laser+dacryocystorhinostomy+in+different+age+groups.">Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups.</a> Eur. J. Ophthalmol. 26 (1), 1-5 (2016).</li><li>Ozsutcu, M., Balci, O., Tanriverdi, C., Demirci, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+adjunctive+mitomycin+C+in+transcanalicular+diode+laser+dacryocystorhinostomy.">Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy.</a> Eur. Arch. Otorhinolaryngol. 274 (2), 873-877 (2016).</li></ol>

利害のない衝突。

Transcanalicular レーザー DCR 前述は皮膚切開を必要とせず効果的に絶対 infrasaccal 鼻涙管閉塞を治療するために非常に高速、低侵襲の方法従って皮膚だけでなく、内側を温存眼角の腱と生理の小管ポンプ機構。プロシージャはプライマリ買収鼻涙ダクト閉塞患者に適して、特発性狭窄症以外の病態をこの手順で資格はありません。これは、一部、19,20<sup...

Infrasaccal プライマリ買収鼻涙ダクト閉塞 (パンド) は、慢性の流涙症、眼瞼炎、定期的なまたは慢性涙嚢炎につながる中高年齢の患者で一般的な疾患です。最も一般的に、患者は、排水が不十分な涙の結果の 1 つまたは両方の鼻涙ダクト infrasaccal 閉塞を開発します。
パンドの治療、外部リノストーミー (DCR) まだ金本位制にすると見なされます、100 年以上それだったときに最初に1を実行にもかかわらず、この手順は歴史的に遡る。皮膚切開し涙嚢鼻腔壁の準備、ドリルが入り込んで、妨害のダクト、鼻腔につながる骨の口を作成する使用されます。この方法2,3の 85% 以上の機能の成功率を報告されています。これらの結果はしかし、リスク生理小管ポンプ機構4,5を含むまぶたの内側の構造を置く、患者を残すことができる比較的侵襲的な手順を実行するを犠牲に、モダンな眉間の皮膚切開は、結果を改善しているが、傷跡を歓迎されません。低侵襲を実行または内視鏡アプローチの選択によってこれらのリスクが避けられる可能性があります。
侵襲的な手術を回避するために多くの仕事は、低侵襲の涙排水再開通の分野で行われています。2 つの方法は、特に、潜在的な最初の手順として確立されている: ドリル dacryoplasty とレーザ dacryoplasty。これらの手順は、涙排水システムの transcanalicular 内視鏡検査に基づいているし、短いセグメント、鼻涙管の膜様狭窄の治療を行うことが。だけ低侵襲でクイック reconvalescence によって特徴づけられる、技術を recanalizing これらの共通の欠点は長期結果6,7,について比較的低機能の成功率8,9。
これらの最初の手順と決定的な治療法として外部の DCR の空虚さを埋めるために新しいアプローチを開発されている最近。絶対 infrasaccal パンドの治療のためのレーザー DCR は最も有望なです。ような前述のアプローチのすべての患者を推奨しますこの手順で全身麻酔下に置きます。ダイオード レーザーのファイバーか小管を介して挿入されている涙嚢にして高度な.次に、骨の口が作成される、中鼻甲介の前縁10,11の高さで鼻腔に接続するまで、レーザー エネルギーは外側鼻の壁に適用されます。一定の視覚制御を保持するすべての中, endonasal 内視鏡を用いたします。新たに形成された吻合は、涙の排水のためのバイパスとして機能します。成功した洗浄後 bicanalicular シリコン気管挿管が新たに形成された口の早期瘢痕化を防ぐために実行されます。術後は、充血除去剤、ステロイドで構成され、腫れ、炎症、感染、それぞれを防ぐために抗生物質点眼薬。
手術だけでなく、reconvalescence の期間は外部 DCR (外部 DCR で 35-75 分対レーザー DCR で 10-25 分) でより一般的に短く。合併症発生率が比較的低く、最も一般的なものは離散腫れまぶたとシリコン チューブ脱。小管感染症熱傷は、まれなイベント10.74-88% の率はずっと 1 年間機能成功報告10、11,12,13,14,15,16、 17,18、こうして外部の外科的アプローチの不利益を被ることがなく外部の DCR のそれらの後ろに密接にまで。ただし、長期的な結果は提供されるまだ残っています。さらに、レーザの DCR の障害の後もセカンダリ外部 DCR 実行できますが難なく。その結果、レーザ DCR 再開通手術と外部の DCR の前に障害が発生した実行される最適な実行可能な第 2 ステップの手順としての資格します。

<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

Infrasaccal プライマリ買収鼻涙ダクト閉塞 (パンド) の治療の今日のゴールド スタンダードは、外部リノストーミー (DCR)、recanalizing 治療の失敗後に実行できる比較的侵襲です。しかし、ダイオード レーザー技術の分野での進歩は、新しいアプローチが浮上しています。レーザーア シスト transcanalicular DCR 後続 bicanalicular シリコン気管挿管とは、実行可能な低侵襲として大きい約束を示す新しいオプションです。鼻腔からの永久的な内視鏡のビジュアル コントロール、[涙嚢にダイオード レーザーのファイバーを挿入し、涙嚢と鼻腔の間の骨の口を作成するレーザーのエネルギーを適用します。す皮膚切開が必要がないのでこの方法の利点は、皮膚と同様、内側眼瞼構造と生理学的眼瞼小管ポンプ機構の温存を構成します。手術だけでなく、reconvalescence の期間は外部 DCR でより一般的に短くです。合併症を含むシリコン チューブ逸脱では、軽度の腫れと、まれに、毛細感染や熱傷。症状と口開存性の完全な解決として定義されている、1 年間機能成功率が高い、まだ外部の DCR のそれらの後ろの範囲。しかし、レーザの DCR の失敗の後セカンダリ外部 DCR は難なく実行できます。したがって、レーザーア シスト transcanalicular DCR は再開通のプロシージャおよび外部 DCR の前に障害が発生した、2 番目の手順として考慮されるべき有効なオプションです。

最適な結果:
前述の手順は約 10-25 分を受け取りは通常非常によく容認します。調べると次の日、まぶたの腫れが症例の約 60% に存在できます。常にこの小さな腫れを最大 3 日間の内で完全に解決します。患者は、痛み、脱シリコンや怪我や感染症の兆候については不満はありません。ただし、bicanalicular シリコン挿管手順の?...

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

このプロトコルの目的は、プライマリ買収鼻涙管閉塞の治療における低侵襲アプローチとして transcanalicular レーザ リノストーミーを提示することです。

プライマリの治療のための Transcanalicular ダイオード レーザ リノストーミー取得鼻涙管閉塞

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 ビュー.  University of Cologne. このプロトコルの目的は、プライマリ買収鼻涙管閉塞の治療における低侵襲アプローチとして transcanalicular レーザ リノストーミーを提示することです。

ビデオ: 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.

腹部腫瘍の治療のための熱的アブレーション

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

医学

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.

ワルトン管を経由してマウス顎下唾液腺のカニュレーション

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.

弱視における抑制の測定と治療

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.

中等度から重度の乾癬の治療のためにGoeckermanレジメン

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

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.

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

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.

女性の小型げっ歯類における神経温存ミッド尿道閉塞（NEMO）

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.

難聴の治療のためのトランス鼓膜ドラッグデリバリー

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.

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

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).

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

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

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a lack of effective treatments in the current clinical practice. With the easy accessibility of transgenic and knockout strains and their small size, which allows minimal doses of drugs required for in vivo evaluation, a well-established experimental model in mice is preferred for AP research. Moreover, SAP induced through sodium taurocholate (TC) is currently one of the most widely used and best characterized models. This model has been investigated for novel therapies and possible molecular events during the process of AP. Here, we present the generation of an AP mouse model using sodium taurocholate and a simple homemade microsyringe. Moreover, we also provide the methodology for the subsequent histology and serological testing.

A mouse model of severe acute pancreatitis is described herein. The procedure presented here is very rapid, simple, and accessible, thereby potentially allowing the study of the molecular mechanisms and different therapeutic interventions in acute pancreatitis in a convenient way.

ビリオ膵管へのタウロコール酸ナトリウムの逆行性注入を用いたマウス重症急性膵炎モデルの確立

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

プライマリの治療のための Transcanalicular ダイオードレーザリノストーミー取得鼻涙管閉塞

要約

さらに動画を探す

この動画の章

腹部腫瘍の治療のための熱的アブレーション

ワルトン管を経由してマウス顎下唾液腺のカニュレーション

弱視における抑制の測定と治療

中等度から重度の乾癬の治療のためにGoeckermanレジメン

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

女性の小型げっ歯類における神経温存ミッド尿道閉塞（NEMO）

難聴の治療のためのトランス鼓膜ドラッグデリバリー

980 nm ダイオードレーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

ビリオ膵管へのタウロコール酸ナトリウムの逆行性注入を用いたマウス重症急性膵炎モデルの確立

プライマリの治療のための Transcanalicular ダイオード レーザ リノストーミー取得鼻涙管閉塞

要約

さらに動画を探す

この動画の章

腹部腫瘍の治療のための熱的アブレーション

ワルトン管を経由してマウス顎下唾液腺のカニュレーション

弱視における抑制の測定と治療

中等度から重度の乾癬の治療のためにGoeckermanレジメン

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

女性の小型げっ歯類における神経温存ミッド尿道閉塞（NEMO）

難聴の治療のためのトランス鼓膜ドラッグデリバリー

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

ビリオ膵管へのタウロコール酸ナトリウムの逆行性注入を用いたマウス重症急性膵炎モデルの確立

プライマリの治療のための Transcanalicular ダイオードレーザリノストーミー取得鼻涙管閉塞

980 nm ダイオードレーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術