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Zen Buddhism — members — last activity Apr 25, The technical steps consisted of a mm incision made at the center of the oral vestibule followed by subplatysmal hydrodissection.
The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field.
The instrument was inserted creating a space below the platysma to the anterior neck and the strap muscles.
Three trocars were inserted in the vestibular area. The dissection begins by cutting the linea alba cervicalis. The isthmus was dissected and transected.
Anatomical structures as the superior thyroid artery, parathyroid glands, and the recurrent laryngeal nerve could be safely identified with magnified vision.
Optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases.
Unilateral thyroidectomy was performed in a mean of 54 minutes with excellent aesthetic results. The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model.
Further studies in clinical series are needed to evaluate the broad application of the device. Nowadays, minimally invasive thyroid and parathyroid gland resections for both benign and malignant tumors are rarely performed.
Recently, promising new endoscopic transoral approaches to the anterior neck have been described with good results and few complications.
This study describes the first clinical series in Germany using transoral endoscopic thyroidectomy-vestibular approach TOETVA and identifies technical issues and solutions.
The technique is indicated for hemithyroidectomy in patients without pre-existing neck operations.
The technical steps consist of a 10 mm incision at the center of the oral vestibule, followed by subplatysmal hydrodissection.
A blunt dissector stick is inserted creating a space below the platysma to the anterior neck and the infrahyoid muscles then three trocars are inserted in the vestibular area.
After separation of the infrahyoid muscles, the thyroid isthmus is transected. Anatomical structures, such as the superior thyroid artery, parathyroid glands and the recurrent laryngeal nerve can be easily identified with magnification.
Intraoperative neuromonitoring is used routinely, adding safety in avoiding nerve damage. An optimal operative field due to subplatysmal dissection enables exposure of the thyroid and parathyroid glands.
Several critical steps and suitable solutions were identified in the study. Lateral and upper positioning of lateral trocars avoiding mental nerve injury.
Initial hydrodissection of the subplatysmal space. Use of one dissector progressively creating the operative space in the anterior cervical region.
Using internal-external sutures to retract the infrahyoid muscles. Intraoperative neuromonitoring used routinely through the trocars or percutaneously through a 1 mm incision.
Extraction of the specimen through a recovery bag. Drainages are possible, but can be avoided in small operative fields.
The new TOETVA technique for thyroid surgery is a promising option for selected patients to enable transoral thyroid and parathyroid surgery through the vestibular approach.
Further studies in clinical series, especially regarding safety are needed to evaluate the indications of the technique.
Immunosuppression following liver transplantation and the course of inflammatory bowel disease - A case control study. Aim The aim of this study was to investigate the influence of immunosuppression following orthotopic liver transplantation OLT on course of inflammatory bowel disease IBD including disease activity and complications.
All drugs including immunosuppressive and anti-inflammatory medication and complications during follow-up were recorded in 6-month intervals. Also, surgical interventions before and after OLT as well as endoscopic interventions with macroscopic and microscopic findings were collected and analyzed.
Additionally, development of malignant neoplasias was recorded. The mean follow-up was 7. Short-term therapy with calcineurin inhibitors or mycophenolate mofetil led to short-term remission, yet sustained remission could only be achieved in patients receiving mycophenolate mofetil.
Patients in the control group required nearly 2 times as many surgical interventions related to IBD than patients in the transplant group.
Conclusions Our data demonstrate an overall positive impact of immunosuppression following OLT on the course of IBD, especially with mycophenolate mofetil, but an increased rate of malignancies.
Transoral endoscopic thyroid surgery: Aug Viszeralmedizin The new era of transoral endoscopic thyroid surgery: Livers discarded after standard organ retrieval are commonly used as a cell source for hepatocyte transplantation.
Due to the scarcity of organ donors, this leads to a shortage of suitable cells for transplantation. Here, the isolation of liver cells from diseased livers removed during liver transplantation is studied and compared to the isolation of cells from liver specimens obtained during partial liver resection.
There were no differences in viability, cell integrity and metabolic activity in cell culture and survival after cold storage when comparing the hepatocytes from the Rx-group and the Ex-group.
In some cases, the latter group showed tendencies of increased resistance to isolation and storage procedures. Progenitor cell enrichment was not sufficient for clinical application.
Hepatocytes isolated from diseased explanted livers showed the essential characteristics of being adequate for cell transplantation. Increased numbers of liver progenitor cells can be isolated from diseased explanted livers.
These results support the feasibility of using diseased explanted livers as a cell source for liver cell transplantation. Proof of Concept for in vivo Tissue Engineering.
Stable long-term functioning of liver cells after transplantation in humans is still not achieved successfully.
A new approach for successful engraftment of liver cells may be the transplantation of syngeneic cells into an allogeneic liver graft.
We therefore developed a new rat model for combined liver and liver cell transplantation cLCTx under stable immunosuppression.
After inducing a mitotic block, liver grafts from female donor rats Dark Agouti were transplanted into female recipients Lewis.
In male Lewis rats, liver cell proliferation was induced with subsequent cell isolation and transplantation into female recipients after organ transplantation.
Y-chromosome detection of the transplanted male cells was performed by quantitative polymerase chain reaction qPCR and fluorescence in situ hybridization FisH with localization of transplanted cells by immunohistochemistry.
Immunohistochemistry demonstrated the engraftment of transplanted cells, as confirmed by FisH, showing repopulation of the liver graft with Engraftment of transplanted syngeneic cells after cLCTx was achieved for up to 90 days under immunosuppression.
Immunohistochemistry indicated cell proliferation, and the FisH results were partly confirmed by qPCR. This new protocol in rats appears feasible for addressing long-term functioning and eventually the induction of operational tolerance in the future.
Patients who have a liver transplant for primary sclerosing cholangitis may develop recurrent disease and biliary complications, organ loss necessitating revision liver transplant, or death.
We evaluated long-term outcomes in patients who had liver transplant for primary sclerosing cholangitis. In 71 patients who had a liver transplant for end-stage liver disease because of primary sclerosing cholangitis, a retrospective review was done to evaluate biliary complication-free survival, transplanted organ survival, and death.
Human leukocyte antigen typing and matching were reviewed. The 5- and year event-free survival reached Male sex of transplant recipients was a significant risk factor for biliary complications, revision liver transplant, or death.
Most patients had inflammatory bowel disease, primarily ulcerative colitis. The human leukocyte antigen profile or number of mismatches had no effect on complication-free survival.
Biliary complications, revision liver transplant, and death are a useful combined primary endpoint for recurrent primary sclerosing cholangitis after liver transplant.
Cellular therapies require methods for non-invasive visualization of transplanted cells. Micron-sized iron oxide particles MPIOs generate strong contrast in Magnetic Resonance Imaging MRI and are therefore ideally suited as an intracellular contrast agent to image cells under clinical conditions.
However, MPIOs were previously not applicable for clinical use. Here, we present the development and evaluation of silica-based micron-sized iron oxide particles sMPIOs with a functionalizable particle surface.
The particle surfaces were covered with COOH-groups. Monodisperse sMPIOs had an average size of 1. Particle uptake, toxicity, and imaging studies were performed using HuH7 cells and human and rat hepatocytes.
Labeling was stable and had no adverse effects on labeled cells. Silica is a biocompatible material that has been approved for clinical use.
Moreover, the particle surface provides the opportunity to create multifunctional particles for targeted delivery and diagnostics. Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instrument.
Hemostasis is a central issue in laparoscopic surgery. Ultrasonic scissors and bipolar clamps are commonly used, with known advantages with each technique.
As safety parameters, temperature profiles after single activation and after a defined cut were determined. As efficacy parameters, seal failures and the maximum burst pressure BP were measured after in vivo sealing of vessels of various types and diameters categories and mm.
Moreover, the vertical width of the tissue seal was measured on serial histological slices of selected arteries. The cutting speed was measured during division of isolated arteries and during dissection of a defined length of compound tissue 10 cm of mesentery.
Burst-pressure measurement and histological analysis were performed by investigators blinded to the used sealing device. No differences in the rate of seal failures were observed.
The cutting speed of the TB was significantly higher than that of all other devices. The maximum temperature of the HA and the TB was significantly higher.
No relevant differences were observed between the HA and the TB. The ultrasonic and bipolar technique of the TB has the potential to surpass the dissection speed of ultrasonic devices with the sealing efficacy of bipolar clamps.
However, heat production that is comparable to conventional ultrasonic scissors should be minded for clinical use. An operational concept for long-term cinemicrography of cells in mono- and co-culture under highly controlled conditions - The SlideObserver.
Cell morphology, proliferation and motility, as well as mono- and heterotypic cell-to-cell interactions, are of increasing interest for in vitro experiments.
However, tightly controlling culture conditions whilst simultaneously monitoring the same set of cells is complicated.
Moreover, video-microscopy of distinct cells or areas of cells over a prolonged period of time represents a technical challenge.
The SlideObserver was designed for cinemicrography of cells in co-and monoculture. The core elements of the system are the SlideReactors, miniaturised hollow fibre-based bioreactors operated in closed perfusion loops.
Within the SlideReactors, cells can be cultured under adaptable conditions as well as in direct- and indirect co-culture. The independent perfusion loops enable controlled variation of parameters such as medium, pH, and oxygenation.
A combined automated microscope stage and camera set-up allows for micrograph acquisition of multiple user-defined regions of interest within the bioreactor units.
The operational system enabled non-stop imaging and automated control of process parameters as well as elective manipulation of either reactor.
As opposed to non-perfused culture systems or comparable devices for cinemicrographic analysis, the SlideObserver allows simultaneous morphological monitoring of an entire culture of cells in multiple bioreactors.
Despite the great potential of MPIOs for in vivo imaging of labeled cells, little is known on the intracellular localization of these particles following uptake due to the lack of techniques with the ability to monitor the particle uptake in vivo at single-cell level.
Here, we show that coherent anti-Stokes Raman scattering CARS microscopy enables non-invasive, label-free imaging of MPIOs in living cells with sub-micron resolution in three dimensions.
CARS allows simultaneous visualization of the cell framework and the MPIOs, where the particles can be readily distinguished from other cellular components of comparable dimensions, and localized inside the cell.
Labeling of hepatocytes with micron-sized iron oxide particles MPIOs enables cell detection using clinical magnetic resonance equipment.
For clinical applications, large numbers of cells must be labeled in a simple and rapid manner and have to be applied in suspension.
However, all existing protocols are based on adhesion culture labeling with subsequent resuspension, only suitable for small experimental settings.
The aim of this study was to investigate the feasibility of preparing MPIO-labeled primary human hepatocytes in a temporary suspension culture.
Particle incorporation was investigated by light and electron microscopy. Cells were compared with adhesion culture-labeled and subsequently enzymatically resuspended cells.
Suspension cultures showed a higher outcome in cell recovery compared with the conventional labeling method. Labeling in suspension had no adverse effects on cell integrity or metabolic activity.
We conclude that labeling of human hepatocytes in suspension is feasible and simple and may serve future large-scale processing of cells. Anastomotic leaks after oesophagojejunostomy usually are treated by endoluminal stenting with self-expandable metal or plastic stents.
Here we present a patient with more than 4 years of oesophageal stenting for anastomotic leakage after gastrectomy. During the attempted removal of the stent he experienced a perforation of the jejunum.
Emergency surgery with complete resection of the stent and transhiatal oesophagojejunostomy was performed.
Generally, early removal of oesophageal stents weeks after implantation is recommended, as later attempts often fail and may lead to extensive surgery.
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