著者は、パスカル・レジューン氏がすべての手順で彼の技術サポートに感謝したいと思います。

提示されたプロトコルは馬の病院で提示されるマレスのために使用され、制度的な動物の心配のガイドラインに従う。
注:アネストラスの前に子宮内膜嚢胞光化を行う:したがって、7月下旬または8月に観察された熱は、したがって、最も信頼性が高いように見えます。潜在的な内性炎を治療するために利用可能なエストルの数を制限することができるので、繁殖期に遅すぎるこの手順を実行しないでください。
1. 前のエストラスの間
<ol><li>処置後に、雌が妊娠する可能性があることを確認するために、子宮内膜生検1( ここでは説明しない)を含む、雌の完全な繁殖健全性検査を行う。</li>
	<li>ケニーの分類1に従って悪い子宮内膜生検のステージングの場合、子宮内膜嚢胞の光化よりも胚移植または細胞質内精子注射(ICSI)プログラムの好みを与える。</li>
</ol>2. 前のダイストルの間
<ol><li>直腸が空になったら、7.5または5MHzの線形直腸プローブとカリパーを画面上に導いた経腸直腸超音波検査を使用して子宮内の雌の子宮内嚢胞を数え、測定し、マッピングする(図3)。</li>
	<li>250 μgのクロプロステノール筋肉内投与して、排卵後6日または3日後に2〜3日以内に発情を誘導する。</li>
	<li>日常的に、重要な子宮外浮腫、35mmのアンタル卵胞、軟化して開いた子宮頸部を含む、発情徴候を観察するために、一般的な日常的な超音波検査および子宮頸部触診を行う。</li>
</ol>3. マレが熱中のときの準備
<ol><li>手術室へのアクセスを、眼鏡をかけている人に制限します。</li>
	<li>直腸を空にした後、尾を包み、ヨウ素ポビトンを使用して外陰部を無菌できれいにします。</li>
	<li>容易な操作および気性を保障するために、21G針の頸静脈のデトミジン(10 μg/kg)およびブトルファンノール(0.1mg/kg)を静脈内に投与する。</li>
	<li>膣ごとに、子宮頸部を通して胚採取カテーテルを取り付け、40 mLの空気でバルーンを吸湿する。</li>
	<li>子宮を膨らませる1.5Lの無菌生理液(0.9%NaCl)を注入する。</li>
	<li>バルーンを収縮させ、カテーテルを取り外します。</li>
	<li>無菌の袖の中に子宮頸部を通して無菌の内視鏡を渡す。</li>
</ol>4. テクニック
<ol><li>600 μm の石英繊維を 980 nm で動作するダイオードレーザーに接続します。20\u201225 W の電源を連続モードに設定します。</li>
	<li>3\u20124 cmのフリーファイバーが画面で識別されるまで、直径10 mmのビデオ内視鏡の生検チャネルを介して柔軟な石英繊維を渡します。繊維の端から最低10 mmが見えるはずです。</li>
	<li>レーザーをアクティブにして、理想的には頂点で嚢胞を穿刺する:専用のペダルは、手を自由に保つためにデバイス上で利用可能です。場合によっては、嚢胞の完全な空隙を達成するために様々な場所で複数の穿刺が必要である。嚢胞性流体は受動的に子宮に排出される。</li>
	<li>嚢胞の内層が繊維の周りに崩壊した後、膜が縮小するまでレーザーを展開する。</li>
	<li>子宮内膜嚢胞が消失したことを確認するために、処置中に子宮の経腸超音波検査を必要な回数だけ行う。</li>
</ol>5. 術後治療
<ol><li>一般的な抗生物質治療を投与する:22,000 UI/kgペニシリンプロカイン懸濁液、筋肉内、1日2回、3日間。</li>
	<li>介入の直後に、上記のように子宮洗浄を行う(ステップ3.4-3.6を参照)。<ol>
<li>無菌カフカテーテルを介して内視鏡的処置の前に子宮に注入された液体を収集する。</li>
		<li>透明な液体が回収されるまで、1 L無菌等張液(0.9%NaCl)の連続した吸入で子宮を洗い流します。</li>
		<li>手順の最後に、20 IUのオキシトシンを静脈内投与する。</li>
		<li>翌日に、気の小膜の経腸超音波検査を行う:内膜遊離液が頻繁に観察される(ステップ2.1参照)。</li>
	</ol>
</li>
	<li>無自由な発光中流体が経直腸超音波検査によって観察され、熱の終わりまで観察される限り、上記の手順で毎日子宮洗浄を行う(ステップ3.4-3.6)。時には、血清状、リンピッドおよび黄色の染色された液体が数日間収集される。 注:マレが発情状態にある場合、4時間以下のオキシトシン(20 IU)の筋肉内注射を繰り返すと、体液の蓄積を避け、子宮内の細菌汚染のリスクを低減することができます。</li>
	<li>子宮内膜嚢胞の消失および内膜遊離液の欠如を確認するために、以下のダイスの間に経腸子宮超音波検査を行う。 注:遊離内皮液が観察される場合、プロスタグランジン注入は、最終的な後続の子宮内膜炎を診断し、それを治療するために、新しい発情を誘発することをお勧めします。</li>
</ol>

<ol>
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すべての著者は、リエージュ大学の馬クリニックによって完全に雇用されており、上記の製品の1つを取引する会社との利益相反はありません。

子宮内膜嚢胞の子宮鏡検査およびレーザー光化は、前に示唆された14のように、マレの大きな発光性嚢胞を減らすための容易な処置である。技術的には、この方法は、発情の中でマレに対して行われると改善される。無菌生理液で子宮を膨らませ、処置を行っている間の空気充填および連続吸引と比較した場合の可視性が向上した。 小さな頭頂嚢胞(<10mm)は、到達し、治療す...

マレスの子宮内膜嚢胞は、ケニー1によって70年代に組織病理学的に記述された。80年代後半には、ヒステロスコピーと超音波検査の使用は、彼らの臨床記述につながり、不妊治療2、3、4、5に彼らの結果を理解するのに役立ちました。
初期段階では、子宮内膜嚢胞は現在子宮内膜の変性に関連しており、現在では子宮内膜1、3、4、6、7、8と呼ばれ、より大きな嚢胞がリンパ性拡張に関連する場合、小さな(<1cm)嚢胞が子宮内膜腺線維症に関連することが現在受け入れられている.これらの大きな嚢胞は、6.5日目から17日目の間にウマの胚移動を妨げる可能性が最も高く、母親の認識を損なうことによって生殖能力を低下させる1、3、4、6、8である。子宮内膜嚢胞はまた、特に円形で、胚小胞3、4、6、9と同様の大きさを有する場合、妊娠初期の診断を妨げる可能性がある(図1参照)。したがって、最初の胚超音波検査と双子の妊娠評価を遅らせることによって、2つの授精間の間隔を長くする可能性があります(図2を参照)。子宮内膜嚢胞はまた、子宮内膜炎を治療したり、胚を収集するために行う子宮洗浄中に流体採取に機械的に干渉する可能性がある。その結果、子宮内膜嚢胞は観察されたマレの生殖能力に影響を及ぼすため、繁殖農場では経済的に影響を及ぼす可能性がある。
基礎となる内経経10を治療する試みに加えて、嚢胞の内視鏡的に導かれた焦点治療が提案されている。電気手術用焼灼法が説明されているが、熱暴露は嚢胞11の周囲の子宮内膜を傷つける可能性がある。嚢胞の吸引は、穿刺12の時点で分泌構造がもはや活発でない場合にのみ有効である。接触繊維を用いた980 nmダイオードレーザーによるレーザー照射は、その後の子宮内膜瘢痕6,13を小さく示すようだ。レーザー装置および手順6の改善は今私達が馬の臨床の練習のこの安全で、有効な技術を提案することを可能にする。ただし、このオプションの制限について、mareの所有者に通知する必要があります。嚢胞の光化は、いくつかのマレスで胚認識を増加させ、場合によっては妊娠診断を進め、子宮内膜炎を治療したり胚を収集するために行われた子宮内膜嚢胞の負の機械的効果を制限する可能性がある。しかし、それに伴う子宮内膜症や子宮内膜炎は治療しません。
本報告書は、マレスにおけるヒステロスコピー誘導ダイオードレーザー嚢胞切れ切れを行う効率的な手順を説明することを目的としている。臨床応用に関する準備および手順について、実用説明する。

<table border="0" cellpadding="0" cellspacing="0" style="width:664px;" width="663">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Butorphanol</td>
			<td style="width:121px;">Animedica</td>
			<td style="width:161px;">Morphasol 10 mg/mL</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Detomidine</td>
			<td style="width:121px;">Dechra</td>
			<td style="width:161px;">Domidine 10 mg/mL</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Endoscope</td>
			<td style="width:121px;">Olympus</td>
			<td style="width:161px;">Vet 170-10 SN2012729</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Endoscope Vid&#233;o Tower</td>
			<td style="width:121px;">Olympus</td>
			<td style="width:161px;">CLE-E &#38; CV-E</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:214px;">Laser device</td>
			<td style="width:121px;">Wuhan Giga Optronics</td>
			<td style="width:161px;">Velas II-60B GA19-V3186</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">NaCl 0.9%</td>
			<td style="width:121px;">Baxter</td>
			<td style="width:161px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">P&#233;nicilline-proca&#239;ne</td>
			<td style="width:121px;">Kela</td>
			<td style="width:161px;">PENI-Kel 300.00 UI/ml</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:214px;">Ultrasonography</td>
			<td style="width:121px;">Aloka</td>
			<td style="width:161px;">Aloka 500 &#38; 5mHz transrectal probe</td>
			<td></td>
		</tr>
	</tbody>
</table>

endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares

マレスでは、子宮内膜嚢胞は子宮内膜症に関連しており、母親の認識障害または妥協を引き起こし、妊娠診断を遅らせる可能性があります。歴史的治療は侵襲的であり、子宮内膜に悪影響を及ぼした。子宮体腔内誘導レーザー療法は、子宮内膜嚢胞切除に容易かつ有効であり、子宮内膜に有害な影響はない。
長さ110cm、幅1.0cmの内視鏡は、外陰部洗浄後のエストルスマレの開放性子宮頸部を通して子宮内に無菌で導入される。子宮は、生理学的溶液の1L未満をゆっくりと注入し、レーザー繊維は、内視鏡の生検運河に挿入される。嚢胞は、連続モードで20\u20122 5Wに設定された接触ファイバを備えた980 nmダイオードレーザーで焼灼されます。各嚢胞は、嚢胞の完全な空隙および線維の周りの嚢胞壁の縮小まで穿刺される。生殖不能生理食液を伴う子宮洗浄は、手術後直ちに、非炎症性液が観察されるように1〜2日間行われる。
この手順は、明らかな有害な効果を持たない、簡単かつ迅速に実行されます。嚢胞切除は超音波妊娠診断を容易にし、場合によっては6.5日目から17日目の間に子宮角の適切な胚移動を回復させる可能性がある。しかし、この治療は子宮内膜症に関連する基礎組織学的病変を改善しない。これらの考慮事項は、この手順の前にブリーダーに明確に表現する必要があります。

手術は、15mm以上の直径を有する嚢胞を有するマレスに対して行われた。しかし、他の小さな嚢胞も存在する場合、他の嚢胞の光化が試みられた。一般的に、これらの大きな嚢胞は分岐または角の基礎にあった。しかし、そのうちのいくつかは子宮の体内に存在し、同様に治療された。
私たちの経験では、内皮嚢胞は内視鏡で局地化するのが非常に簡単です。さらに、生?...

Watch this Scientific Journal Video about Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares at JoVE.com

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

本報告の目的は、内視鏡的レーザー装置を用いた、血中の子宮内膜嚢胞の光化を説明し、低い不妊の問題に対処するためのこの新しいアプローチの関心と限界について議論することである。

マレスの接触繊維を用いた980 nmレーザーを用いた子宮内膜嚢胞の導き光化による内視鏡検査

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

endoscopy-guided-photoablation-endometrial-cysts-using-980-nm-laser

Research

JoVE Journal

Medicine

4.2K ビュー.  Liège University. 本報告の目的は、内視鏡的レーザー装置を用いた、血中の子宮内膜嚢胞の光化を説明し、低い不妊の問題に対処するためのこの新しいアプローチの関心と限界について議論することである。

ビデオ: Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

MRI-guided Disruption of the Blood-brain Barrier using Transcranial Focused Ultrasound in a Rat Model

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a significant obstacle to pharmaceutical treatments of brain disorders as it limits the passage of molecules from the vasculature into the brain tissue to molecules less than approximately 500 Da in size6. FUS induced BBB disruption (BBBD) is temporary and reversible4 and has an advantage over chemical means of inducing BBBD by being highly localized. FUS induced BBBD provides a means for investigating the effects of a wide range of therapeutic agents on the brain, which would not otherwise be deliverable to the tissue in sufficient concentration. While a wide range of ultrasound parameters have proven successful at disrupting the BBB2,5,7, there are several critical steps in the experimental procedure to ensure successful disruption with accurate targeting. This protocol outlines how to achieve MRI-guided FUS induced BBBD in a rat model, with a focus on the critical animal preparation and microbubble handling steps of the experiment.

Microbubble-mediated focused ultrasound disruption of the blood-brain barrier (BBB) is a promising technique for non-invasive targeted drug delivery in the brain1-3. This protocol outlines the experimental procedure for MRI-guided transcranial BBB disruption in a rat model.

ラットモデルでの経頭蓋集束超音波を用いた血液脳関門のMRI誘導破壊

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a ...

医学

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and cardiac arrest. This elevation may result in further neurological injury, in the form of transtentorial herniation1,2,3,4, midbrain compression, neurological deficit or increased cerebral infarct2,4. Current therapies are often inadequate to control elevated ICP in the clinical setting5,6,7 . Thus there is a need for accurate methods of ICP measurement in animal models to further our understanding of the basic mechanisms and to develop new treatments for elevated ICP.
In both the clinical and experimental setting ICP cannot be estimated without direct measurement. Several methods of ICP catheter insertion currently exist. Of these the intraventricular catheter has become the clinical 'gold standard' of ICP measurement in humans8. This method involves the partial removal of skull and the instrumentation of the catheter through brain tissue. Consequently, intraventricular catheters have an infection rate of 6-11%9. For this reason, subdural and epidural cannulations have become the preferred methods in animal models of ischemic injury. 
Various ICP measurement techniques have been adapted for animal models, and of these, fluid-filled telemetry catheters10 and solid state catheters are the most frequently used11,12,13,14,15. The fluid-filled systems are prone to developing air bubbles in the line, resulting in false ICP readings. Solid state probes avoid this problem (Figure 1). An additional problem is fitting catheters under the skull or into the ventricles without causing any brain injury that might alter the experimental outcomes. Therefore, we have developed a method that places an ICP catheter contiguous with the epidural space, but avoids the need to insert it between skull and brain. 
An optic fibre pressure catheter (420LP, SAMBA Sensors, Sweden) was used to measure ICP at the epidural location because the location of the pressure sensor (at the very tip of the catheter) was found to produce a high fidelity ICP signal in this model. There are other manufacturers of similar optic fibre technologies13 that may be used with our methodology. Alternative solid state catheters, which have the pressure sensor located at the side of the catheter tip, would not be appropriate for this model as the signal would be dampened by the presence of the monitoring screw. 
Here, we present a relatively simple and accurate method to measure ICP. This method can be used across a wide range of ICP related animal models.

A novel technique to record the pressures within the skull is described. The minimally invasive method uses a fibre-optic pressure sensing system to accurately measure intracranial pressure (ICP) in anaesthetized rats without causing significant brain trauma. The technique may be used in a wide range of experimental models.

光ファイバ圧力トランスデューサを使用したラットの硬膜外頭蓋内圧測定

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and ...

Reproducable Paraplegia by Thoracic Aortic Occlusion in a Murine Model of Spinal Cord Ischemia-reperfusion

Background 
Lower extremity paralysis continues to complicate aortic interventions. The lack of understanding of the underlying pathology has hindered advancements to decrease the occurrence this injury.&#160;The current model demonstrates reproducible lower&#160;extremity paralysis following thoracic aortic occlusion.
Methods 
Adult male C57BL6 mice were anesthetized with isoflurane. Through a cervicosternal incision the aorta was exposed. The descending thoracic aorta and left subclavian arteries were identified without entrance into pleural space. Skeletonization of these arteries was followed by immediate closure (Sham) or occlusion for 4 min (moderate ischemia) or 8 min (prolonged ischemia). The sternotomy and skin were closed and the mouse was transferred to warming bed for recovery.&#160; Following recovery, functional analysis was obtained at 12 hr intervals until 48 hr.
Results 
Mice that underwent sham surgery showed no observable hind&#160;limb deficit. Mice subjected to moderate ischemia for 4 min had minimal functional deficit at 12 hr followed by progression to complete paralysis at 48 hr. Mice subjected to prolonged ischemia had an immediate paralysis with no observable hind-limb movement at any point in the postoperative period. There was no observed intraoperative or post&#160;operative mortality.
Conclusion 
Reproducible lower extremity paralysis whether immediate or delayed can be achieved in a murine model. Additionally, by using a median sternotomy and careful dissection, high survival rates, and reproducibility can be achieved.

The lack of mechanistic understanding of spinal cord ischemia-reperfusion injury has hindered further adjuncts to prevent paraplegia following high risk aortic operations. Thus, the development of animal models is imperative. This manuscript demonstrates reproducible lower extremity paralysis following thoracic aortic occlusion in a murine model.

脊髄虚血再灌流のマウスモデルにおいて胸部大動脈閉塞によって再現可能対麻痺

Background
Lower extremity paralysis continues to complicate aortic interventions. The lack of understanding of the underlying pathology has hindered ...

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The molecular mechanisms leading to cyst formation in PKD remain somewhat unclear, but many genes are thought to be involved. Wnt5a is a non-canonical glycoprotein that regulates a wide range of developmental processes. Wnt5a works through the planar cell polarity (PCP) pathway that regulates oriented cell division during renal tubular cell elongation. Defects of the PCP pathway have been found to cause kidney cyst formation. Our paper describes a method for developing a zebrafish cystic kidney disease model by knockdown of the wnt5a gene with wnt5a antisense morpholino (MO) oligonucleotides. Tg(wt1b:GFP) transgenic zebrafish were used to visualize kidney structure and kidney cysts following wnt5a knockdown. Two distinct antisense MOs (AUG - and splice-site) were used and both resulted in curly tail down phenotype and cyst formation after wnt5a knockdown. Injection of mouse Wnt5a mRNA, resistant to the MOs due to a difference in primary base pair structure, rescued the abnormal phenotype, demonstrating that the phenotype was not due to &#8220;off-target&#8221; effects of the morpholino. This work supports the validity of using a zebrafish model to study wnt5a function in the kidney.

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

We describe a method of generating a possible zebrafish model of polycystic kidney disease. We used Tg(wt1b:GFP) fish to visualize kidney structure. Knockdown of wnt5a was by morpholino injection. Pronephric cyst formation after wnt5a knockdown was observed in this GFP transgenic zebrafish.

多発性嚢胞腎疾患の可能性のあるゼブラフィッシュモデル：のノックダウン<em&gt; WNT5A</em&gt;ゼブラフィッシュ腎臓で嚢胞を引き起こす

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The ...

Semi-automated Analysis of Mouse Skeletal Muscle Morphology and Fiber-type Composition

For years, distinctions between skeletal muscle fiber types were best visualized by myosin-ATPase staining. More recently, immunohistochemical staining of myosin heavy chain (MyHC) isoforms has emerged as a finer discriminator of fiber-type. Type I, type IIA, type IIX and type IIB fibers can now be identified with precision based on their MyHC profile; however, manual analysis of these data can be slow and down-right tedious. In this regard, rapid, accurate assessment of fiber-type composition and morphology is a very desirable tool. Here, we present a protocol for state-of-the-art immunohistochemical staining of MyHCs in frozen sections obtained from mouse hindlimb muscle in concert with a novel semi-automated algorithm that accelerates analysis of fiber-type and fiber morphology. As expected, the soleus muscle displayed staining for type I and type IIA fibers, but not for type IIX or type IIB fibers. On the other hand, the tibialis anterior muscle was composed predominantly of type IIX and type IIB fibers, a small fraction of type IIA fibers and little or no type I fibers. Several image transformations were used to generate probability maps for the purpose of measuring different aspects of fiber morphology (i.e., cross-sectional area (CSA), maximal and minimal Feret diameter). The values obtained for these parameters were then compared with manually-obtained values. No significant differences were observed between either mode of analysis with regards to CSA, maximal or minimal Feret diameter (all p &#62; 0.05), indicating the accuracy of our method. Thus, our immunostaining analysis protocol may be applied to the investigation of effects on muscle composition in many models of aging and myopathy.

Immunohistochemical staining of myosin heavy chain isoforms has emerged as the state-of-the-art discriminator of skeletal muscle fiber-type (i.e., type I, type IIA, type IIX, type IIB). Here, we present a staining protocol along with a novel semi-automated algorithm that facilitates rapid assessment of fiber-type and fiber morphology.

マウス骨格筋形態と繊維の種類組成の半自動解析

For years, distinctions between skeletal muscle fiber types were best visualized by myosin-ATPase staining. More recently, immunohistochemical staining of ...

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

腰椎椎間板ヘルニアの切開腰椎内視鏡外でモバイルの技術

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

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. ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

レーザードップラー流量測定を用いたラットにおける脳血流自動調節の評価

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated with a potential reduction in the ovarian reserve due to the inadvertent removal and thermal damage of healthy ovarian tissue. New ablative techniques with reduced tissue penetration depth and less thermal spread to the surrounding parenchyma may represent a viable alternative to cystectomy. For these reasons, the aim of this manuscript is to demonstrate the ablation of the endometrioma capsule using a CO2 fiber laser technique and discuss the clinical outcomes. Once the cyst has been drained and washed, a biopsy is taken. After cyst eversion, vaporization of the inner surface of the cyst is performed using a CO2 fiber laser. The technique is simple and reproducible as even young surgeons without any surgical experience were more confident in performing laser CO2 vaporization instead of cystectomy. The positive effects of CO2 technology are reported in a randomized controlled trial, where the postoperative changes in the antral follicular count (AFC) and antimullerian hormone (AMH) levels were compared between patients who had their endometrioma excised (cystectomy) and those who had undergone endometrioma vaporization with CO2 laser. The patients treated with CO2 laser showed significantly increased AFC without a reduction in serum AMH levels as compared to the cystectomy group, in which both parameters were significantly reduced. The postoperative pregnancy rate was also assessed, and comparable pregnancy rates were found after both treatments. On the contrary, patients treated with the CO2 fiber laser technique had more favorable in-vitro fertilization (IVF) outcomes compared to cystectomy.
In conclusion, the CO2 fiber laser technique may represent a viable alternative to cystectomy in the surgical treatment of endometrioma in terms of ovarian preservation, pregnancy rates, and IVF outcomes. Moreover, it has the advantage of being independent of the surgeon's skills and personal experience.

In this protocol, CO2 fiber laser technique is demonstrated for the surgical treatment of ovarian endometriosis, which represents a viable alternative in terms of fertility preservation with the major advantage of not being dependent on the surgeon's skills and personal experience.

卵巣子宮内膜腫の二酸化炭素ファイバーレーザー気化を用いた不妊治療手順

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

PCL嚢胞切除のための関節鏡視下二重後内側アプローチ

Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

著者スポットライト:後十字靭帯嚢胞を治療するための二重後内側アプローチ

We present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach.

二重後背部アプローチを使用した後十字靭帯嚢胞の関節鏡視下切除

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament ...