Deutsche Forschungsgemeinschaft (associação alemã de pesquisa; PARA 2240 "Angiogênese (linfa) e imunidade celular em doenças inflamatórias do olho" de LMH; Ele 6743/2-1 e ele 6743/3-1 para LMH), programa GEROK, da Universidade de Colónia para KRK e LMH. Nossa gratidão vai para Dr. Kühner para suporte técnico.

para este procedimento, o consentimento informado é necessário e tenha sido obtido para cada paciente que foi submetido a cirurgia no departamento de Oftalmologia, Universidade de Colónia, Colónia, Alemanha. Todos os exames e intervenções cirúrgicas foram executadas em conformidade com as legislações nacionais e a declaração de Helsínquia de 1975, na sua versão actual.
 Nota: salvo indicação em contrário, as instruções sempre só remeterá para o lado em que o procedimento está sendo executado. Usar equipamento esterilizado.
 1. preparação do paciente <ol><li>realizar um minucioso exame oftalmológico (com especial atenção para as pálpebras, punctum superior e inferior e drenagem da lágrima) incluindo irrigação e sondagem para testar para PANDO 10 .
	<ol><li>Para irrigação padronizada, inserir uma sonda Bangerter superior e, subsequentemente, menor punctum. Começar por inseri-lo na vertical e, em seguida, incline-a em direção ao templo em uma posição horizontal, a seguir a formação fisiológica do canalículo. Quando a sonda está em posição, cuidadosamente injetar soro fisiológico para testar a obstrução do ducto lacrimal. 
		Nota: Em infrasaccal PANDO, a cânula Bangerter facilmente atingirá a parede lateral nasal sem uma resistência saltitante (&#34; parada dura &#34;). Tentar irrigar resultará em refluxo contralateral através o punctum oposto sem qualquer líquido atingindo o paciente &#39; s faringe 10.</li>
	</ol></li> <li>Descartar infecções agudas, tumores do sistema de drenagem, bem como traumático, congênito ou obstrução de presaccal.
	<ol><li>Para descartar infecções agudas, olha para a dolorosa vermelhidão, inchaço ou purulenta descarga de drenagem da lágrima. Para descartar tumores, procure inchaço indolentes, ulceração ou pigmentação. Presaccal obstrução resulta em uma resistência saltitante ao tentar avançar a sonda Bangerter dentro do saco lacrimal (&#34; paragem suave &#34;). Obstrução congênita e traumática pode ser descartada, tendo o histórico do paciente 10 , 19 , 20.</li>
	</ol></li> <li>Descartar patologias rhinological intranasais, desvio de septo, por exemplo, grave. Isso deve ser feito tomando o paciente &#39; história s em combinação com uma rhinological inspeção da cavidade nasal 21.</li>
	<li>Coloca o paciente sob anestesia geral, por exemplo, por inalação de remifentanil desfluran mais intravenosa para manutenção, usando o padrão peso-adaptado de dosagem e injeção intravenosa de propofol e remifentanil atracúrio por indução 10. intubação deve ser realizada, mas também é possível a utilização de uma máscara de laringe. 
	Nota: Anestésicos, bem como as doses podem variar entre clínicas. Nenhum protocolo de anestesia específica é necessário para laser-assisted DCR.</li>
</ol> 2. Laser-assisted DCR <ol><li>Inserir o endoscópio de vídeo-assistida em nasal cavidade avançando com cuidado pela narina. Visualizar a margem anterior do corneto meio inclinando ligeiramente o endoscópio em direção à parede lateral nasal.</li>
	<li>Configurar o equipamento do laser e do laser de configurações para os valores corretos. Usar óculos de proteção.
	<ol><li>Conectar-se o laser de fibra óptica (diâmetro 400 µm) para o laser de diodo (comprimento de onda 810 nm). Definir o diodo laser configurações para 6-8 W, duração de pulso de 200 ms, pausa de exposição de 100 ms.</li>
		<li>a fibra óptica do laser se encaixam a peça de mão para manobras e através de uma cânula romba. Deixe 2 a 3 mm da fibra estique a ponta da cânula.</li>
		<li>Executar carbonização da ponta do laser da fibra, segurando-o em uma espátula de madeira e aplicação de energia de laser por alguns segundos até que a ponta é suficientemente escurecida. 
		Nota: Isto irá limitar a distribuição de energia indesejada no tecido do saco lacrimal.</li>
	</ol></li> <li>Posicionar a fibra laser corretamente na parede lateral nasal.
	<ol><li>Uso um lacrimal sonda para dilatar o punctum inferior ( Figura 2a). Introduzir a sonda em uma orientação vertical no início e depois trazer para uma orientação horizontal antes de avançá-lo ainda mais para o saco lacrimal. Isto permitirá a fibra de laser ser inserido sem problemas na próxima etapa.</li>
		A fibra de laser <li>Inserir o canalículo inferior ( Fig. 2b , 2C). Começar por inseri-lo na vertical e, em seguida, incline-a em direção ao templo em uma posição horizontal para seguir a formação fisiológica do canalículo inferior.</li>
		<li>Avance cuidadosamente a fibra de laser para o saco lacrimal até que toca a parede nasal lateral, ou seja, a parede medial saccal lacrimal. Lá, aponta a ponta no sentido ântero-inferior, para que ele aponta para a margem anterior do corneto meio.</li>
		<li>Verificar o posicionamento correto através do endoscópio, monitorando a transluminescence do feixe visando à altura da margem anterior do corneto meio ( Figura 2d).</li>
	</ol></li> <li>Criar uma suficiente nasolacrimal ultrapassar por aplicação de energia de laser pulsado a parede nasal.
	<ol><li>Aplicar energia de laser (usando o conjunto de parâmetros acima), mantendo contato constante na parede sem pressão, apontando para a margem anterior do corneto no meio. O laser vai vaporizar o tecido diretamente na frente dele, criando um desvio nasolacrimal ( Figura 2d , 2e). 
		Nota: A energia total necessária varia entre 0,9 - 1,8 kJ e tende a variar entre pacientes.</li>
		<li>, Certifique-se de que a ponta de fibra não é ativamente pressionada contra a parede. Tenha cuidado para não deixar a ponta entrar volta a cânula de metal porque isso poderá provocar lesões térmicas devido ao aquecimento do metal. Também evitar movimentos laterais, como a ponta pode quebrar fora</li>
		<li>Após penetrar a parede nasal lateral, puxe um pouco a fibra de laser e ampliar o óstio vaporizando cuidadosamente as margens em uma forma circular. Tente criar um desvio tão grande quanto possível ( Figura 2f).</li>
		<li>Aponta para um diâmetro total de 5 mm para o óstio.</li>
		<li>Parar de aplicar energia e retire a fibra de laser, juntamente com a peça de mão e a cânula, retirando cuidadosamente o equipamento.</li>
	</ol></li> <li>Para verificar a patência do óstio da irrigação salina usando uma sonda Bangerter, conforme descrito em 1.1.1. Se um óstio patente foi criado, irrigação bem sucedida deve ser visível através do endoscópio.</li>
	<li>Remover a sonda Bangerter.</li>
	<li>Colocar o tubo de silicone ( Figura 2 g).
	<ol><li>Através do punctum inferior, inserir um tubo de silicone monocanalicular e avançá-lo cuidadosamente até que a ponta de metal líder passa o óstio ossudo e se projeta para a cavidade nasal.</li>
		<li>Pinça Blakesley uso para pegar a ponta de dentro da cavidade nasal e puxe o tubo de silicone, o nariz e para a posição ( Figura 2h).</li>
		<li>Usar um par de tesouras para encurtar o tubo de silicone. Final não deve estar saindo do nariz.</li>
		<li>Realizar intubação de silício através o canalículo superior também (seguinte percorre 2.7.1 2.7.3) ( Figura 2 h).</li>
	</ol></li> <li>Do endoscópio nasal.</li></ol>
 3. cuidados no pós-operatório e seguimento <ol><li>após a cirurgia, iniciar o tratamento com antibiótico eye cai (por exemplo, ofloxacina), descongestionante colírio (por exemplo, xylometazolin) e colírio de esteroides (por exemplo, acetato de prednisolona). Antibióticos podem ser interrompidos depois de uma semana, enquanto esteroides e colírio descongestionante lentamente deve ser desmamado fora ao longo de um mês.</li>
	<li>De acompanhamento em seis semanas e três meses após a cirurgia. Olha para a resolução dos sintomas, prolapso de tubo de silicone, infecção e secreção.</li>
	<li>Remover tubos de silicone em três meses após a cirurgia, simplesmente agarrar a extremidade em forma de T na altura da partitura e cuidadosamente a tirá-los.</li>
</ol>

<ol>
	<li>Toti, A., 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=Nuovo+metodo+conservatoire+di+cura+radicale+delle+suppurazioni+croniche+del+sacco+lacrimale+(dacriocistorinostomia).">Nuovo metodo conservatoire di cura radicale delle suppurazioni croniche del sacco lacrimale (dacriocistorinostomia).</a> Clin. Mod. Pisa. 1 (10), 385-387 (1904).</li><li>Alnawaiseh, M., 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=Long-Term+Outcomes+of+External+Dacryocystorhinostomy+in+the+Age+of+Transcanalicular+Microendoscopic+Techniques.">Long-Term Outcomes of External Dacryocystorhinostomy in the Age of Transcanalicular Microendoscopic Techniques.</a> J. Ophthalmol. , (2016).</li><li>Tooley, A. A., 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=Dacryocystorhinostomy+for+Acquired+Nasolacrimal+Duct+Stenosis+in+the+Elderly+(&#8805;80+Years+of+Age).">Dacryocystorhinostomy for Acquired Nasolacrimal Duct Stenosis in the Elderly (&#8805;80 Years of Age).</a> Ophthalmology. , (2016).</li><li>Detorakis, E. T., Drakonaki, E., Papadaki, E., Pallikaris, I. G., Tsilimbaris, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Watery+eye+following+patent+external+DCR:+an+MR+dacryocystography+study.">Watery eye following patent external DCR: an MR dacryocystography study.</a> Orbit. 29 (5), 239-243 (2010).</li><li>Kakizaki, H., 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=The+lacrimal+canaliculus+and+sac+bordered+by+the+Horner's+muscle+form+the+functional+lacrimal+drainage+system.">The lacrimal canaliculus and sac bordered by the Horner's muscle form the functional lacrimal drainage system.</a> Ophthalmology. 112 (4), 710-716 (2005).</li><li>Emmerich, K. H., Ungerechts, R., Meyer-R&#252;senberg, H. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mikroendoskopische+Tr&#228;nenwegschirurgie.">Mikroendoskopische Tr&#228;nenwegschirurgie.</a> Ophthalmologe. 106 (3), 196-204 (2009).</li><li>Emmerich, K. H., L&#252;chtenberg, M., Meyer-R&#252;senberg, H. W., Steinhauer, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dacryoendoskopie+und+Laserdacryoplastik:+Technik+und+Ergebnisse.">Dacryoendoskopie und Laserdacryoplastik: Technik und Ergebnisse.</a> Klin. Monatsbl. Augenheilkd. 211 (6), 375-379 (1997).</li><li>Meyer-R&#252;senberg, H. W., Emmerich, K. H., L&#252;chtenberg, M., Steinhauer, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoskopische+Laserdacryoplastik+-+Methodik+und+Ergebnisse+nach+3+Monaten.">Endoskopische Laserdacryoplastik - Methodik und Ergebnisse nach 3 Monaten.</a> Ophthalmologe. 96 (5), 332-334 (1999).</li><li>Emmerich, K. H., Ungerechts, R., Meyer-R&#252;senberg, H. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcanalicular+microendoscopic+laser+DCR:+technique+and+results.">Transcanalicular microendoscopic laser DCR: technique and results.</a> Klin Monbl Augenheilkd. 229 (1), 39-41 (2012).</li><li>Koch, K. R., Cursiefen, C., Heindl, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcanalicular+Laser+Dacryocystorhinostomy:+One-Year-Experience+in+the+Treatment+of+Acquired+Nasolacrimal+Duct+Obstructions.">Transcanalicular Laser Dacryocystorhinostomy: One-Year-Experience in the Treatment of Acquired Nasolacrimal Duct Obstructions.</a> Klin. Monbl. Augenheilkd. 233 (2), 182-186 (2016).</li><li>Koch, K. R., K&#252;hner, H., Cursiefen, C., Heindl, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Significance+of+transcanalicular+laser+assisted+dacryocystorhinostomy+in+modern+lacrimal+drainage+surgery.">Significance of transcanalicular laser assisted dacryocystorhinostomy in modern lacrimal drainage surgery.</a> Ophthalmologe. 112 (2), 122-126 (2015).</li><li>Uludag, G., Yeniad, B., Ceylan, E., Yildiz-Tas, A., Kozer-Bilgin, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+comparison+between+transcanalicular+and+external+dacryocystorhinostomy.">Outcome comparison between transcanalicular and external dacryocystorhinostomy.</a> Int. J. Ophthalmol. 8 (2), 353-357 (2015).</li><li>Ozcimen, M., Uysal, I. O., Eryilmaz, M. A., Kal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endocanalicular+diode+laser+dacryocystorhinostomy+for+nasolacrimal+duct+obstruction:+short-term+results+of+a+new+minimally+invasive+surgical+technique.">Endocanalicular diode laser dacryocystorhinostomy for nasolacrimal duct obstruction: short-term results of a new minimally invasive surgical technique.</a> J. Craniofac. Surg. 21 (6), 1932-1934 (2010).</li><li>Drnovsek-Olup, B., Beltram, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcanalicular+diode+laser-assisted+dacryocystorhinostomy.">Transcanalicular diode laser-assisted dacryocystorhinostomy.</a> Indian. J. Ophthalmol. 58 (3), 213-217 (2010).</li><li>D'Ecclesia, A., 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=Endoscopic+laser-assisted+dacryocistorhinostomy+DCR+with+the+placement+of+a+customised+silicone+and+Teflon+bicanalicular+stent+Endoscopic+laser-assisted+dacryocystorhinostomy+(DCR).">Endoscopic laser-assisted dacryocistorhinostomy DCR with the placement of a customised silicone and Teflon bicanalicular stent Endoscopic laser-assisted dacryocystorhinostomy (DCR).</a> Clin. Ter. 165 (6), e391-e394 (2014).</li><li>Ayintap, E., 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=Analysis+of+age+as+a+possible+prognostic+factor+for+transcanalicular+multidiode+laser+dacryocystorhinostomy.">Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy.</a> J. Ophthalmol. , (2014).</li><li>Dogan, R., Meric, A., Ozs&#252;tc&#252;, M., Yenigun, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diode+laser-assisted+endoscopic+dacryocystorhinostomy:+a+comparison+of+three+different+combinations+of+adjunctive+procedures.">Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures.</a> Eur. Arch. Otorhinolaryngol. 270 (8), 2255-2261 (2013).</li><li>Plaza, G., Beter&#233;, F., Nogueira, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcanalicular+dacryocystorhinostomy+with+diode+laser:+long-term+results.">Transcanalicular dacryocystorhinostomy with diode laser: long-term results.</a> Ophthal Plast Reconstr Surg. 23 (3), 179-182 (2007).</li><li>Heindl, L. M., Junemann, A., Holbach, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+clinicopathologic+study+of+nasal+mucosa+in+350+patients+with+external+dacryocystorhinostomy.">A clinicopathologic study of nasal mucosa in 350 patients with external dacryocystorhinostomy.</a> Orbit. 28 (1), 7-11 (2009).</li><li>Heindl, L. M., Treutlein, E., J&#252;nemann, A. G., Kruse, F. E., Holbach, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+lacrimal+sac+biopsy+for+external+dacryocystorhinostomy:+a+clinical+pathological+study.">Selective lacrimal sac biopsy for external dacryocystorhinostomy: a clinical pathological study.</a> Ophthalmologe. 107 (12), 1139-1144 (2010).</li><li>Aziz, T., Biron, V. L., Ansari, K., Flores-Mir, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+tools+for+the+diagnosis+of+nasal+septal+deviation:+a+systematic+review.">Measurement tools for the diagnosis of nasal septal deviation: a systematic review.</a> J Otolaryngol Head Neck Surg. 43, 11 (2014).</li><li>von Goscinski, C., Koch, K. R., Cursiefen, C., Heindl, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tumors+of+the+lacrimal+drainage+system.">Tumors of the lacrimal drainage system.</a> HNO. 64 (6), 386-393 (2016).</li><li>Heindl, L. M., J&#252;nemann, A. G., Kruse, F. E., Holbach, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tumors+of+the+lacrimal+drainage+system.">Tumors of the lacrimal drainage system.</a> Orbit. 29 (5), 298-306 (2010).</li><li>Kaynak, P., 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=Transcanalicular+diode+laser+assisted+dacryocystorhinostomy+in+primary+acquired+nasolacrimal+duct+obstruction:+2-year+follow+up.">Transcanalicular diode laser assisted dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction: 2-year follow up.</a> Ophthal Plast Reconstr Surg. 30 (1), 28-33 (2014).</li><li>Goel, R., 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=Transcanalicular+Laser-Assisted+Dacryocystorhinostomy+With+Endonasal+Augmentation+in+Primary+Nasolacrimal+Duct+Obstruction:+Our+Experience.">Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience.</a> Ophthal Plast Reconstr Surg. , (2016).</li><li>Yildirim, Y., 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=Comparison+of+Transcanalicular+Multidiode+Laser+Dacryocystorhinostomy+with+and+without+Silicon+Tube+Intubation.">Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation.</a> J Ophthalmol. , (2016).</li><li>Kar, T., Yildirim, Y., Topal, T., &#199;olako&#287;lu, K., &#220;nal, M. 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>

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Transcanalicular laser-assisted DCR conforme descrito acima é uma maneira bastante rápida, minimamente invasiva para tratar infrasaccal absoluta obstrução de ducto nasolacrimal eficazmente sem a necessidade de incisão na pele, poupando assim não só a pele, mas também a medial tendão Cantal e o mecanismo fisiológico bomba canalicular. Enquanto o procedimento é adequado para pacientes com obstrução do ducto nasolacrimal adquirida primária, patologias que não sejam estenose idiopática não se qualificam para...

Infrasaccal obstrução de ducto nasolacrimal adquirida primária (PANDO) é um distúrbio comum em pacientes de meia-idade e mais velhos, levando a epífora crônica e blefarite, bem como Dacriocistite crônica ou recorrente. Mais comumente, os pacientes desenvolvem uma obstrução infrasaccal de um ou ambos os ductos nasolacrimal, resultando em lágrima insuficiente drenagem.
No tratamento de PANDO, dacryocystorhinostomy externo (DCR) ainda é considerada o padrão-ouro, mesmo que este procedimento historicamente remonta mais de cem anos de quando foi apresentada pela primeira vez1. Após a incisão na pele e preparação da parede nasal do saco lacrimal, uma broca é usada para criar um óstio ósseo levando a cavidade nasal, ignorando assim o ducto obstruído. Taxas de sucesso funcional acima de 85% têm sido relatadas para este método2,3. Estes resultados, no entanto, vem ao custo de execução de um procedimento relativamente invasivo que coloca em risco as estruturas medial da pálpebra, incluindo o mecanismo de bomba canaliculares fisiológicas4,5 e pode deixar os pacientes com um indesejável cicatriz, embora moderno nasojugal incisões na pele melhoraram os resultados. Estes riscos são potencialmente evitáveis, realizando técnicas menos invasivas ou escolhendo uma abordagem endonasal.
A fim de contornar a cirurgia invasiva, tem sido feito muito trabalho no campo da recanalização de drenagem lacrimal minimamente invasiva. Dois métodos em particular se estabeleceram como potenciais primeiro passo procedimentos: microdrill dacryoplasty e dacryoplasty assistida por laser. Estes procedimentos são baseados na endoscopia transcanalicular do sistema de drenagem lacrimal e podem ser realizados para tratar para curto-segmento membranosas estenoses do ducto nasolacrimal. Embora apenas minimamente invasiva e caracterizada por rápida reconvalescence, um inconveniente comum destes recanalizing técnicas são as taxas de sucesso funcional relativamente baixo em relação a longo prazo os resultados6,7, 8 , 9.
Em um esforço para preencher o vazio entre esses procedimentos primeiro passo e DCR externa como um tratamento definitivo, recentemente foram desenvolvidas novas abordagens. A mais promissora do que é o DCR assistida por laser para o tratamento da infrasaccal absoluta PANDO. Como com todas as abordagens acima mencionadas, os pacientes são recomendados para ser colocado sob anestesia geral para este procedimento. Uma fibra de laser de diodo é inserida através de qualquer canalículo e então é avançada para o saco lacrimal. Em seguida, a energia do laser é aplicada na parede lateral nasal até que seja criado um óstio ósseo, conectando a cavidade nasal, na altura do margem anterior10,11 meio do corneto. Enquanto isso, o controle visual constante é mantido usando endoscopia endonasal. A anastomose recém-formado serve como um desvio para a drenagem da lágrima. Após a bem sucedida irrigação, intubação de silício bicanalicular é realizada para evitar cicatrizes no início do recém-formado óstio. Tratamento pós-operatório consiste de descongestionante, esteroide e antibiótico colírio para evitar inchaço, inflamação e infecção, respectivamente.
A duração da cirurgia, bem como reconvalescence é geralmente menor do que com o DCR externo (10-25 min em laser-assisted DCR vs 35-75 min em DCR externa). Taxas de complicação são relativamente baixas, o mais comum sendo discreto inchaço das pálpebras e prolapso de tubo de silicone. Canalicular infecção e lesões térmicas são eventos raros10. Um ano sucesso funcional taxas de 74-88% foram relatados10,11,12,13,14,15,16, 17,18, assim variando pròxima atrás dos DCR externa sem sofrer as desvantagens da abordagem cirúrgica externa. No entanto, os resultados a longo prazo permanecem ainda para ser fornecido. Além disso, mesmo depois de falha de laser-assisted DCR, DCR externa secundária ainda pode ser executada sem dificuldade. Consequentemente, assistida por laser DCR qualifica-se como um procedimento de segundo-passo viável que idealmente deve ser realizado após a falha da cirurgia de recanalização e antes DCR externa.

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

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

Padrão-ouro de hoje no tratamento de obstrução de ducto nasolacrimal adquirida primária infrasaccal (PANDO) é externo dacryocystorhinostomy (DCR), um procedimento relativamente invasivo que pode ser realizado após a falha de recanalizing tratamentos. No entanto, com o progresso no campo da tecnologia de laser de diodo, surgiram novas abordagens. Assistida por laser transcanalicular DCR com intubação de silício bicanalicular subsequente é uma nova opção mostrando grande promessa como um procedimento minimamente invasivo viável. Sob permanente controle visual endoscópico da cavidade nasal, uma fibra de laser de diodo é inserida no saco lacrimal e a energia do laser é aplicada para criar um óstio ósseo entre o saco lacrimal e a cavidade nasal. Uma vez que não há incisão de pele precisa ser feita, vantagens desse método compreendem os poupadores da pele, bem como as estruturas palpebrais medial e o mecanismo fisiológico da bomba palpebral-canalicular. A duração da cirurgia, bem como reconvalescence é geralmente menor do que com DCR externa. As complicações incluem o prolapso de tubo de silicone, inchaço leve e, raramente, infecção canalicular e lesões térmicas. Taxas de sucesso funcional de um ano, definidas como completa resolução dos sintomas e a patência do óstio, são altas, ainda assim gama atrás dos DCR externa. No entanto, DCR externa secundária após fracasso da DCR assistida por laser pode ser realizada sem dificuldade. Assim, assistida por laser transcanalicular DCR é uma opção válida e que deve ser considerada como um segundo passo após falha dos processos de recanalização e antes DCR externa.

Resultado ideal:
O procedimento conforme descrito acima leva cerca de 10-25 min e é geralmente tolerado muito bem. Ao exame no dia seguinte, um pequeno inchaço da pálpebra pode estar presente em cerca de 60% dos casos. Este pequeno inchaço sempre resolve completamente num prazo máximo de três dias. Pacientes não reclamar de dor, prolapso de silício ou sinais de lesão ou infecção. No entanto, devido a intubação de silí...

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

O objetivo do presente protocolo é apresentar transcanalicular assistida por laser dacryocystorhinostomy como uma abordagem minimamente invasiva no tratamento da obstrução do ducto nasolacrimal adquirida primária.

Transcanalicular diodo Laser-assisted Dacryocystorhinostomy para o tratamento da primária adquiriu a obstrução do ducto Nasolacrimal

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 visualizações.  University of Cologne. O objetivo do presente protocolo é apresentar transcanalicular assistida por laser dacryocystorhinostomy como uma abordagem minimamente invasiva no tratamento da obstrução do ducto nasolacrimal adquirida primária.

Vídeo: 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.

Ablação térmica para o tratamento de tumores abdominais

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

Medicina

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

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

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

Canulação da glândula submandibular do rato através do duto salivar de Wharton

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

The Measurement and Treatment of Suppression in Amblyopia

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

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

A Medição e Tratamento de Supressão de ambliopia

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.

O regime Goeckerman para o tratamento de psoríase moderada a grave

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

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

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

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

Avaliação de uma nova Laser-assistida Coronary Anastomotic Connector - Trindade Clip - em um modelo de Bypass Porcina Off-bomba

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

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

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

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

Análise de Redes de forame oval Eletrodo Recordings na epilepsia do lobo temporal Os pacientes resistentes a drogas

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.

-Nervo poupadores Mid-obstrução uretral (Nemo) em fêmeas pequenos roedores

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

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

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

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

Entrega de trans-timpânicas drogas para o tratamento da ototoxicidade

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.

Enucleação da próstata para o tratamento da hiperplasia benigna da próstata usando um laser de diodo de 980 nm

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

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

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

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

Desenvolvimento de um modelo experimental não invasivo, assistido a laser de perda de células endoteliais córneas

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