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Instead of screws and metal plates we have developed a unique adhesive implant to stabilize the various types of bone fractures defined as the Fiber Reinforced Adhesive Patch (FRAP) technology. The new implant consists of an adhesive strengthened with fibers to form a composite patch. The FRAP technology is developed as a degradable adhesive facilitating a mechanically strong triazine system based on non-toxic allylic and thiol compounds. The thiolene cross linking strategy is highly desirable in a surgical environment as it can be performed via minimally invasive optical fibers and with excellent tolerance to oxygen. The number of layers and the size of the FRAP technology is chosen by the surgeon depending on the fracture characteristics and the anticipated load on the fracture. When at place, the tailor-made FRAP technology is photo-cured by UV light to a hard composite thereby bridging and stabilizing the fracture or the skull bone after neurosurgical operations. The experimental and numerical analysis on bovine bone fractures shows that the new FRAP technology should become an excellent alternative or complement to existing metal implants.

For more than 40 years platinum alloys have been employed extensively in a range of permanent implantable electronic medical devices and components. In recent years, lesser known platinum group metals (PGMs) such as palladium and iridium have emerged as a viable complements to platinum in certain implantable electronic medical device applications. Platinum alloys have been employed extensively in modern minimally invasive treatments for coronary artery disease – such as angioplasty and stents – where inertness and visibility under X-ray are crucial. Platinum and platinum/iridium alloys continue to be the first choice for device companies seeking a proven and reliable implantable metal that is biocompatible, radiopaque and electrically conductive.

The inclusion of a determinate technique among the "minimally invasive treatments" of the symptoms due to benign prostatic hyperplasia is a long and careful process. The technique has to be more patient-friendly than conventional techniques, but also needs to be time-tested against older methods. Most of these minimally invasive treatments are based upon distinct types of thermoablation; the method discussed here, hot water balloon thermoablation, is based on the heat conductive properties of the prostatic tissue.

Data from two research studies concerned with disabled children who have complex health needs were analysed in relation to families’ experiences of accessing short breaks (respite) services. Many families experience serious problems finding suitable services which can cater for both their child’s complex health needs and their own need for significant levels of support. This paper highlights which services families were using and the difficulties of obtaining a coherent and consistent package of support. Regulatory concerns relating to the piece-meal provision of services and use of children’s hospices are raised along with recommendations for improving policy and practice.

Review of a case of paraosseous extramedullary hematopoiesis (EMH) affecting the maxillary sinuses and retro-orbital spaces imitating bilateral orbital cellulitis. Maxillofacial EMH causes diagnostic/therapeutic challenges. This case report describes a 4-year-old African American male with sickle cell disease (HbSS) who presented with bilateral orbitofacial swelling. Diagnosis was made with imaging and confirmed with tissue sampling. Partial exchange transfusion was utilized to stop the progression of maxillofacial EMH and to treat the patient's chronic anemia. Follow-up MRI showed regression of orbital and retro-orbital involvement. Early treatment with conservative modalities and close observation may prevent need for more invasive treatments.

The AV node is a fascinating region, with particular and complex anatomy and physiology. It well illustrates the evolution of the rhythm disorders and their treatments; it was the first target when invasive electrophysiology started; from His recordings to DC ablation and from selective radiofrequency “slow pathway” modification to cryoablation, we have followed a long road of learning while burning; as our knowledge broadens, we can now very precisely target this region to invasive treatments. This chapter reviews the literature and discusses an approach regarding anatomic findings and physiology and its relationship to AVNRT ablation.

Depending on the definition and the population studied, stress urinary incontinence (SUI) is estimated to affect 4–35% of the adult female population, with an apparent increase in prevalence with age. As a greater proportion of the population becomes more elderly in developed countries, the prevalence of this socially and physically debilitating condition will further increase. Numerous surgical procedures have been described and found to be effective in the treatment of SUI; however, since the mid-1990s the vogue has been to perform minimally invasive sling surgery, although the first description of a pyramidalis muscle sling in the treatment of SUI dates as far back as 1910. In 1996, Ulmsten et al described the first use of the retropubic polypropylene tension-free vaginal tape (TVT) to support the midurethra, with a reported cure rate of 84% [1]. Since then the procedure has been enthusiastically performed in >1.2 million patients worldwide and many proponents now feel that TVT is the new ‘‘gold standard.’’ Novara et al have undertaken an exhaustive meta-analysis to evaluate the efficacy of TVT in comparison to traditional surgical treatments and also the newer tension-free midurethral sling procedures that have emerged since TVT was introduced [2]. The rapid uptake of minimally invasive treatments is largely due to the greater acceptability of these procedures to patients, who understandably want to avoid major surgery wherever possible. The meta-analysis by Novara et al concludes that

Vertebroplasty and kyphoplasty are minimally invasive treatments for vertebral compression fractures. Although infrequent, both transitory and persistent adverse effects have been reported. They range from asymptomatic to severe neurological deficits that are caused directly by polymethylmethacrylate (PMMA) leakage or may be related to local or general reactions not due to PMMA leakage. Transitory hypotension after the procedure has been observed, but the characteristics and etiology of this phenomenon are not defined.To describe a case of prolonged hypotension after kyphoplasty and suggest a possible mechanism.Six months after L2 kyphoplasty, a 63-year-old woman with severe osteoporosis developed a new back pain due to compression fracture of L1 and compression deformity of the superior L3 endplate. The patient underwent bilateral kyphoplasty at the L1 and L3 levels. She developed persistent hypotension for approximately 46 hours immediately after the procedure. Common causes of hypotension were ruled out and the event resolved spontaneously.On the basis of needle placement, the temporal relationship between the procedure and blood pressure change, and the lack of other identifiable causes, thermal sympathectomy from heating of the PMMA adjacent to the paravertebral sympathetic chain is proposed as a potential mechanism.Single case report based on clinical observation.Prolonged hypotension can complicate kyphoplasty at upper lumbar levels. Two days of severe hypotension has not been described as a complication of kyphoplasty. Although the mechanism is unknown, a transient thermal sympathectomy may be the cause.

Given the widespread use of medical therapies and the introduction of a myriad of minimally invasive treatments, the patient population undergoing the most established surgical procedures for BPO has considerably changed over the last two decades. General indications for surgical intervention are well described in current guidelines. However, patients may seek surgery as primary treatment, and the decision for surgery should be always based on the patient’s risk/benefit assessment. TURP is still considered as the gold standard treatment, given its well-documented long-term efficacy. Moreover, its surgical-related morbidity has been considerably reduced with introduction of bipolar systems. Simple prostatectomy can have a role in certain instances as it also appears to be safe and effective in contemporary series, especially in settings where more recent (laser) technology is not available. TUIP can be regarded as a viable option in selected patient with a suitable gland. Other recently introduced electrosurgical options, such as TUERP and TURisV, seem promising and user-friendly, but they need to be further scrutinized.

This chapter examines nanomedicine in relation to body modification, in particular the increasingly popular form of body modification that is cosmetic surgery. It asks what possibilities nanomedicine might offer patients seeking cosmetic enhancement, and whether there are risks inherent in such procedures which patients might need to be warned about and which require strict regulation. I would argue that this is nanomedicine as opposed to the cosmetic use of nanotechnology as it necessitates the same medical procedures and invasive treatments, with their inherent risks, as non-cosmetic use of nanomedicine. The chapter goes on to examine these possibilities and risks from the perspective of theorists who have sought to safeguard health care rights, particularly those of women patients. Currently in the UK 91 % of cosmetic procedures are carried out on women, and the most requested invasive cosmetic surgery is for breast implants, with the number increasing rapidly year on year: approximately 5,646 breast enlargements were carried out in 2005 (BAAPS 2006); and 8,565 in 2009 (BAAPS 2010).

Background Post-dural-puncture headache (PDPH) can be a highly disturbing complication of elective spinal anesthesia. The incidence of PDPH when small needles are used is estimated to be 0%–14.5%. PDPH usually resolves spontaneously within a few days, but there are rare cases that persist in spite of conventional and epidural blood patch therapy. Case A 59-year-old man suffered from persistent postural headache for more than two years after an otherwise uneventful spinal anesthesia. Conventional and minimally invasive treatments were unsuccessful. Intervention/outcome A neurosurgical procedure was performed, during which a dural leak was identified and repaired. The patient was immediately pain free after surgery and has remained so for the duration of follow-up (more than one year).

The natural history of Leber’s miliary aneurysms is described. A patient with Leber’s miliary aneurysm presented with count fingers visual acuity due to significant lipid exudates, intraretinal hemorrhages, and macular edema. Over the next 3 months, the macular edema resolved spontaneously and the visual acuity improved to 20/20. The dramatic improvement in both macular edema and visual acuity highlights the importance of conservative management before pursuing more invasive treatments. [ Ophthalmic Surg Lasers Imaging Retina. 2013;44:E15–E16.]

In this chapter, a mechanical evaluation of the treatment of fracture subcondyle with a splinting, using micro-implants of patients of the Regional Hospital 1° de Octubre (ISSSTE) is reported. Typical orthodontic micro-implants were used, with the purpose of evaluating their performance in the invasive treatments for the subcondyle fractures, in particular in the maxillofacial region. The evaluation of the strength of the micro-implants under effects of axial loads was required, and the minimal number of micro-implants to get enough stability and the control of the constraints and position of the lower jaw was calculated. The experimental testings considered similar micro-implants as the patient used. The experimental results determined its mechanical behavior, taking into account that the actual state of deossification of the patient was not considered for this study.

Detecting early stage breast cancers like Ductal Carcinoma In Situ (DCIS) is important, as it supports effective and minimally invasive treatments. Although Computer Aided Detection/Diagnosis (CADe/ CADx) systems have been successfully employed for highly malignant carcinomas, their performance on DCIS is inadequate. In this context, we propose a novel approach combining symmetry, kinetics and morphology that achieves superior performance. We base our work on contrast enhanced data of 18 pure DCIS cases with hand annotated lesions and 9 purely normal cases. The overall sensitivity and specificity of the system stood at 89% each.

The authors have successfully performed laparoscopic surgery for esophageal achalasia and reflux esophagitis. Five patients with esophageal achalasia who complained of severe dysphagia have been treated with laparoscopic long esophagomyotomy and esophagofundopexy. The postoperative course was uneventful for all patients. Dysphagia had disappeared immediately after surgery, and none of the patients have had any symptoms suggestive of gastric reflux or esophagitis. Two patients with reflux esophagitis, who had been reluctant to undergo concervative therapy, have been successfully treated with laparoscopic Nissen fundoplication. The postoperative course was uneventful for both patients. The symptoms of reflux esophagitis disappeared after surgery. If indications are selected properly, the procedures described are curative and minimally invasive treatments for esophageal achalasia and reflux esophagitis.

O presente estudo objetiva realizar uma revisão critica da literatura sobre sialólitos do ponto de vista de desenvolvimento, etiologia, sintomatologia, diagnóstico e tratamento. Os sialólitos são calcificações que obstruem o interior das glândulas salivares ou o interior de seus ductos, compostos por um núcleo de substância amorfa envolto de íons provenientes da saliva. A sialolitíase é a doença mais comum das glândulas salivares, possui uma predileção por homens de meia idade. Os sialólitos são mais relatados nas glândulas submandibulares por suas características anatômicas e pelas características da saliva excretada. Sabe-se muito pouco sobre a etiologia real da doença, porém são elencados como predisponentes a anatomia da glândula e seu ducto e a composição da saliva excretada. Os métodos de diagnósticos mais utilizados são a radiografia oclusal e panorâmica, mas atualmente os exames imaginológicos como a tomografia computadorizada, ressonância magnética e ultra-som vêm ganhando espaço na odontologia. Os métodos de tratamento variam conforme os aspectos cínicos do caso variando de métodos conservadores como a ordenha e manipulação da glândula até tratamentos mais invasivos como acessos cirúrgicos intra ou extra-orais.Salivary glands stones: a critical review of the literatureAbstract: This study aims to conduct a critical review of the literature on sialolith the viewpoint of development, etiology, symptoms, diagnosis and treatment. The sialolith calcifications are obstructing the interior of the salivary glands or within their ducts, comprising a core of amorphous substance wrapped ions from saliva. The sialolithiasis is the most common disease of the salivary glands, has a predilection for middle-aged men. The sialoliths are more reported in the submandibular glands by their anatomical characteristics and the characteristics of excreted saliva. We know very little about the actual etiology of the disease, but are listed as predisposing the anatomy of the gland and its duct and the composition of the secreted saliva. The methods most commonly used diagnostics are the occlusal and panoramic x-ray, but currently the imaging tests such as computed tomography, magnetic resonance and ultrasound are gaining space in dentistry. Treatment methods vary cynics aspects case ranging from conservative methods such as the milking and handling of the gland to more invasive treatments such as intra- or extra-oral surgical approaches.

Many modern surgical techniques have been developed to provide exposure or visualization of the surgical field to perform definitive treatment. The actual therapeutic part of surgery is often a small fraction of the procedure. In obtaining exposure, however, morbidity can ensue. This has led to newer techniques that use minimally invasive treatments, thus substantially decreasing overall morbidity and patient costs. By providing physicians with visualization alternatives, MR imaging and computed tomography, when combined with a therapeutic procedure, can reduce the morbidity of surgery.

To review the current data about the success rates of fibrin sealant use in pilonidal disease.Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8).In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.

Benign Pro Static Hyperplasia (BPH) is estimated to effect 50% of men by the age of 50, and 75% by the age of 80. Predicting a clinical outcome prior to minimally invasive treatments for BPH would be very useful, but has not been reliable in spite of multiple assessment parameters such as symptom indices and flow rates. I our prior work we have shown the effect of greater impact feature selection has on prediction of the BPH clinical outcomes. In this work we take an in depth look at how changes to the Artificial Intelligence and Machine Learning methods can have an affect on how well the process does at predicting the outcome of the patients in the testing group. The affect of which classifier is used, to predict BPH surgical outcomes, is investigated to see if certain classifiers perform better with the data. The affect of which metric is selected for analyzing the performance of the classifier prediction is also observed. The affect of which features and how many are selected to train and predict the data is observed. Finally, the affect of using the original, unchanged, date versus a discretized version of the data is also observed. The objective in this paper is to determine, in this case, which of the above-mentioned factors affect the outcome of the predictive models, to allow the best factor selection in each case so that the best predictive method of NPH for this data, can be determined. In particular, the data is analyzed to determine if some of these factors have a larger effect on the outcome than others. Through experimental results we show which and how some factors are found to have no real influence on clinical outcome prediction, and show how in some other cases there are a few equally good choices. Here four machine learning algorithms, namely Decision Tree, Naive Bayse, LDA, and ADABoost are selected and used in the comparison. For prediction performance metrics comparison we use the Area Under the Curve (AUC), Accuracy (ACC), and the Matthew Correlation Coefficient (MCC). Both internal cross-validation and external validation are used to analyze the performance and results of the predictive models considered.

The efficacy of the application of botulinum toxin type A (BTX-A) and hyaluronic acid (HA) as minimally invasive treatments in facial rejuvenation has been previously demonstrated. The local side effects most frequently observed are pain, swelling, erythema, and bruising. In spite of the limited and benign nature of these events, they usually cause discomfort for the patient who is looking for aesthetic improvement.

Predicting the clinical outcome prior to minimally invasive treatments for Benign Prostatic Hperlasia (BPH) cases would be very useful. However, clinical prediction has not been reliable in spite of multiple assessment parameters, such as symptom indices and flow rates. In our prior study, Artificial Intelligence (AI) algorithms were used to train computers to predict the surgical outcome in BPH patients treated by TURP or VLAP. Our aim was to investigate whether, based on eleven clinical biomarker features, AI can reproduce the clinical outcome of known cases and assist the urologist in predicting surgical outcomes. In this paper, the objective is to perform data analysis to investigate if specific features have a greater impact on predicting whether the patients had the desired outcome after a surgical procedure is done. Finally, how the number of significant features ought to be weighted to predict the outcome after surgery, is determined to create the most accurate prediction method. Here both the Decision Tree and Naive Bayse machine learning methods are used and compared.

Accurate intraoperative diagnosis of serosal invasion is a prerequisite for proper application of invasive procedures, such as intraperitoneal chemohyperthermia, for serosa positive gastric carcinomas. We reviewed the prospectively constructed data of 1,265 gastric cancer patients who underwent surgery between 2007 and 2009. Accuracies of macroscopic diagnoses of serosal invasion were determined by comparing with pathological findings. The risk factors of over- and underestimation of serosal invasion were analyzed in the univariate and multivariate model. The accuracy of macroscopic intraoperative diagnosis of serosal invasion was 88%. Serosal invasion was underestimated in 34 of 187 serosa positive patients and overestimated in 117 of 1,078 serosa negative patients; a sensitivity and specificity of 82 and 89%, respectively. When pT1 tumors were excluded, the accuracy, sensitivity, and specificity of macroscopic diagnosis of serosal invasion were 71.5, 81.8, and 65.3%, respectively. Univariate and multivariate analysis revealed that a tumor size of >4 cm and preoperative CT finding of serosa positive were independent risk factors for macroscopic overestimation as serosal invasion in pT2 gastric cancer. Meanwhile, Borrmann type 1, preoperative CT finding of serosa negative, lesser/posterior surface location, and tumor size of

PURPOSE OF REVIEW This review offers a comprehensive summary of the recent publications on the treatment of vesicovaginal fistula. Most reports are related to obstetric fistula in the developing world but in the developed world fistula treatment remains a challenge. RECENT FINDINGS The quality of the research in this field is improving. Efforts are being made to improve the classification of fistula as a prognostic tool. Surgical innovations are few in this field. Laparoscopic approaches are reported but only on a very limited amount of patients. SUMMARY The surgical management of fistula remains a two-track item: the gigantic experience on obstetric fistula of fistula surgeons in Africa and Asia and the limited experience of some Western centres with mostly a small series of iatrogenic fistula. Advances are made in both worlds. The previously isolated fistula surgeons are now better organized and they stimulate scientific research in countries with very limited resources. The centres in the developed world explore new surgical approaches such as laparoscopy and minimally invasive treatments.

Available and improved options for the treatment of femoral-popliteal disease have increased over the last decade. Even though most patients suffering from claudication due to femoral-popliteal disease are treated with aggressive medical and noninvasive methods, patients with limb-threatening disease and severely lifestyle-limiting symptoms are treated with invasive treatments, which include endovascular treatment options. Unfortunately, the unique forces involved in this vascular segment have challenged the long-term patency and clinical effectiveness of these treatments. The purpose of this brief review is to discuss treatment strategies and options for patients with femoral-popliteal disease. Included in this discussion will be the review of data from recent published studies and late-breaking trials as it pertains to certain treatment strategies.

Duplex ultrasonography (DUS) is an essential part of the evaluation of patients with most forms of superficial venous insufficiency. DUS has also become an important tool in directing and assessing the results of a variety of minimally invasive treatments of this disease. In this article, we review the salient aspects of performing an adequate DUS evaluation and the utility of this technique in guiding treatment.

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive–behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.

Rook’s Textbook of Dermatology, 8th edition. Edited by DA Burns, SM Breathnach, NH Cox and CEM Griffiths. © 2009 Blackwell Publishing, ISBN: 978-1-4051-6169-5. Introduction Over the last century there has been a dramatic increase in the ageing population in most developed countries. For example, it is expected that one in five Americans will be aged 65 years or older by the year 2030 (source 2000 USA census), a trend similar to that in most developed countries. Increased social pressure to look younger has led to great demand for effective cosmetic treatments for skin and facial rejuvenation. In particular, there has been an increase in what have been termed non-invasive and minimallyinvasive cosmetic treatments, that is treatments that avoid surgery and involve surface skin treatment such as lasers or peels, or a variety of injections [1]. Currently, most of those seeking these treatments are women, but an increasing number of men are considering rejuvenation treatments, and it is important for the practising dermatologist to be aware of the treatment options.

X-ray fluoroscopy is a medical-imaging technique whereby low-dose high-acquisition-rate x-ray images are obtained [1, 2]. Fluoroscopy provides quantum-limited high-definition digital-television viewing of structures inside the body. It makes possible many minimally invasive treatments such as balloon angioplasty, neuroembolizations, and transjugular intrahepatic portosystemic shunts (TIPS). Despite many recent developments in MR and CT imaging, x-ray fluoroscopy remains the principal imaging method for image-guided therapy. Although the x-ray dose per acquisition is low, very long sessions of fluoroscopy are required during complex interventional procedures giving relatively large doses to patients and operators [3]. Procedures lasting 4 hours with fluoroscopy times over 100 minutes are documented [4, 5], and some interventional neuroangiography procedures last 8 to 12 hours with fluoroscopy times exceeding 75 min [6]. The FDA has documented reports of severe skin injury [7, 8]. In a public health advisory, the FDA warns of “… occasional, but sometimes severe radiation-induced skin injuries to patients resulting from prolonged, fluoroscopically-guided, invasive procedures.” The advisory points out that injury can occur after less than one hour of fluoroscopy at normal exposure rates of 2 to 5 rad/ˆ•min [9]. Such exposures are easily reached in complex procedures. Hence, on average fluoroscopy accounts for one half of the population diagnostic x-ray dose [10] and for exceptionally large doses to those patients getting the most intricate procedures.

If plastic surgeons are to provide state-of-the-art care in the techniques of skin rejuvenation and minimally invasive treatments for aging, a thorough understanding of skin, anatomy, and physiology is required. With the changing population demographics, the plastic surgeon must also be knowledgeable about ethnic variations in skin anatomy and physiology. The changes that occur with aging skin, inherent developmental disorders, and development of skin cancers are complex. This chapter provides a practical guide to the understanding of skin and its application to clinical conditions.

An unknown number of patients who undergo thoracic surgery develop post-thoracotomy neuralgia (PTN). Many seek a cure. As with other chronic, benign pain conditions, a variety of treatment modalities may be offered by different specialists. Results of therapy in terms of patient satisfaction are not known. A record of 73 patients with PTN was made. It has been used to measure the incidence, the natural and therapeutic history and the success of the management of PTN. Over 70% of the cases received three or more of the treatment modalities and regimens that have been reputed to be of value. More than 50% were referred to three different types of specialist. No patient claimed to have become free of symptoms as a result of treatment and a significant proportion, not clearly defined, implied that therapy was either more disabling than PTN or made it worse. Side effects of drugs were blamed for the former, and invasive treatments, aimed at nociceptive pathways, were incriminated in the latter. It is reasoned that about 5% of patients undergoing thoracic surgery may require resources for the management of PTN. No patient studied thought that conventional treatments had brought about a cure. Some treatments, known to be deleterious, remain extant. This information reflects and corroborates that from other studies which suggests that multidisciplinary approaches are more appropriate for chronic benign pain conditions than management by isolated physicians using specific therapies.

Fluid collections of the pancreatic area are a non-negligible complication of the pancreatitis and of the pancreatic traumas. Some of these will have clinical repercussion and will need treatment. In the last 25 years, minimally invasive treatments have slowly become the treatment of choice. Especially endoscopic ultrasonographic drainage has proven to be an effective and safe technique in these conditions. We describe the technique and comment on some critical aspects that need to be considered. The procedure may be performed in several steps or in one step, and we must choose case by case which option seems the best. We describe mainly the one-step technique because in our experience it is easier and quicker. In this chapter we wanted to set up a detailed guide that shows step by step how the technique is performed, with the hope that it may be useful for the interventional echoendoscopist.

This article reviews the use of minimally invasive surgical and endoscopic techniques in the field of surgical oncology. It reviews the indications and techniques of the use of minimally invasive surgery for several oncologic indications in general surgery. In particular, it reviews the currently published literature discussing the oncologic outcomes of these techniques.

El esfínter artificial (EA) es actualmente el tratamiento considerado como "gold standard" en el tratamiento de la incontinencia urinaria post prostatectomía radical. La incontinencia de orina post prostatectomía radical es una complicación que se presenta en un 5-25% de los pacientes sometidos a este tratamiento. Esta complicación genera en los pacientes un deterioro importante en cuanto a su calidad de vida. Tratamientos conservadores y mínimamente invasivos han sido utilizados sin éxito, como por ejemplo los ejercicios de Kegel, el uso de absorbentes, farmacoterapia y electroestimulación o cirugía menor como los inyectables. Esta revisión resume las ventajas y complicaciones del esfínter artificial y su efectividad en el manejo de la incontinencia urinaria tras una prostatectomía radical.

The increasingly common incidental diagnosis of small renal masses (SRMs)(measuring under 4 cm in size) has led to the consideration of applying minimally invasive techniques to deal with them - particularly in view of the high percentage of non-malignant conditions of this size that are radiologically indistinguishable from tumor lesions. Accordingly, laparos copic access has gained great importance in the management of these masses, in an attempt to lessen the morbidity asso ciated with lumbotomy. Laparoscopic partial nephrectomy (LPN) is an evolving technique in most centers; on one hand it competes with open partialnephrectomyasthetechniqueofchoice,andontheotheritwillcompeteinthefuturewiththenon-excisionalmana gement techniques. These latter procedures in turn have become more precise thanks to laparoscopy. Based on a standardized review of the abundant literature on the treatment of SRMs, the present study examines the technical innovations and improvements afforded by the laparoscopic approach, not only for excision purposes but also a vehicle for minimally invasive treatments. Likewise, the requirements of Services of Urology and the improvements that could be introduced in health systems for advancing the application of LPN in the management of SRMs are commented. Progressive fine-tuning of the technique, with improvement of the laparoscopic repertoire and availability of hemosta tic agents, will contribute to increase the indications for LPN in the future. The limited frequency of the disorder and the need to optimize the technique will require health care supervisors to centralize this type of pathology in centers with expe rience in laparoscopy and open partial nephrectomy.

Lasers and light-based treatments are extremely useful and now standardized techniques in the management of different stages of photoaging. To obtain the most successful results, protocols involving single or combination systems can be used, depending on skin photodamage. In the last years, the trend is to choose noninvasive or minimally invasive treatments, with the aim of reducing the risk of side effects, complications, and downtime. Selective photothermolysis obtained with lasers and with intense pulse light, which is presently considered the most suitable technique by a growing number of authors, is an extremely valid procedure, in particular in types I and II, according to the Glogau classification. Photodynamic therapy is another effective tool in photoaging treatment, especially in the presence of precancerous conditions. In mild and severe photoaging, ablative laser resurfacing is a particularly successful technique, although requiring a very skilled hand. The new systems, such as fractional photothermolysis, seem to be the very next future to face up to resurfacing procedure with high efficacy and less risks. Obviously, lasers and light-based treatments alone might not be sufficient to control all aging symptoms. For this reason, any another treatment (botulinum toxin, filling agents, chemical peels, systemic and topic antioxidants) can be used in combination to improve the final clinical outcome.

As minimally invasive treatments for liver cancers, percutaneous ablation therapies represent a valid alternative to liver resections, especially in patients with poor liver function. Recently, image-guided surgical and interventional procedures using open magnetic resonance imaging (MRI) have been introduced.We performed percutaneous ablation therapy for 51 nodules of liver cancer in 34 patients using a navigation system based on open MRI. During the ablation therapy, the ultrasonography (US) probe, needle, and tumor were displayed on the MR image. Immediately after the procedure, the therapeutic effect was evaluated by open MRI.In all cases, percutaneous puncture into the tumors was successful, even in the case of tumor undetectable by US. Mean fiducial registration error was approximately 3 mm. MR images captured after the procedure clearly demonstrated the ablated area. No mortality or major complications occurred, except for mild hemorrhage, pyrexia, and ascites.We developed a novel navigation system integrating US and MR images using open MRI for percutaneous ablation therapy of liver cancers. The presented system allows a safe and accurate approach to liver cancers, especially certain tumors that cannot be adequately visualized by US, and an evaluation of therapeutic results immediately after the procedures.

In a long, historical perspective, local procedures for reduction of a rectal prolapse have dominated. The evolution of anaesthesia and better understanding of anatomy during nineteenth and twentieth centuries have made more invasive treatments possible.

With the widespread uptake of robotic surgery in the field of adult urology, attention has recently shifted to applying this technology to conditions in the pediatric population. The requirement for minimally invasive treatments and the reconstructive nature of pediatric urologic surgery makes robotic technology very appealing in this specialty. This chapter describes the current uses and recent advances of robotics in pediatric urology.

Interventional radiology procedures often play an integral role in the diagnosis and treatment of patients with cancer. In the latter stages of cancer treatment, palliative care therapies may be sought for improvement in the quality of remaining life for oncology patients. Increased awareness among interventionalists and referring oncologists regarding minimally invasive treatments for palliation is desirable to provide additional options for patients. In particular, endovascular therapies can provide control of symptoms and complications related to incurable malignancies.

Inflammation is a recognised risk factor for the vulnerable atherosclerotic plaque. The aim of this study was to explore whether there is a difference in the degree of magnetic resonance (MR) defined inflammation using ultra small superparamagnetic iron oxide (USPIO) particles within carotid atheroma in completely asymptomatic individuals and the asymptomatic carotid stenosis contralateral to the symptomatic side.20 symptomatic patients with contralateral disease and 20 completely asymptomatic patients underwent multi-sequence MR imaging before and 36 h after USPIO infusion. Images were manually segmented into quadrants and signal change in each quadrant was calculated following USPIO administration. Mean signal change was compared across all quadrants in the two groups.The mean percentage of quadrants showing signal loss was 53% in the contralateral group compared with 31% in completely asymptomatic individuals (p = 0.025). The mean percentages showing enhancement were 44% and 65%, respectively (p = 0.024). The mean signal difference between the two groups was 8.6% (95% CI 1.6% to 15.6%; p = 0.017).Truly asymptomatic plaques seem to demonstrate inflammation but not to the extent of the contralateral asymptomatic stenosis to the symptomatic side. Inflammatory activity may be a significant risk factor in asymptomatic disease.

– This retrospective study examined some different types of treatment to primary teeth. The aim of this study was to assess the treatment of traumatized primary teeth and the importance of a long-term follow up. Brazilian children in the age group of 1–4 years from a baby clinic took part in the study. Three hundred and fifteen patients suffered some type of traumatic injury, a total of 338 affected teeth. Data were registered in specific records and submitted to statistic analysis. The most prevalent type of treatment was monitor only (85%) followed by tooth extraction and endodontic procedure. Invasive treatments were performed in case of severe traumas, usually 6 months after the injury. We verified that a careful follow up might be the preferential choice to the treatment of traumatic primary teeth even in some severe cases.

Comminuted phalanx fractures about the PIP joint are a common injury seen in sports and recreational activities. Corrective treatment frequently requires some form of open reduction with internal fixation. These types of invasive treatments are insulting of soft tissue and often create significant secondary problems. These authors have designed a splint that attempts to optimize outcomes following fracture and surgical treatment.

This article reviews the literature on body dysmorphic disorder (BDD) in persons who seek appearance enhancing medical treatments such as cosmetic surgery and dermatological treatment. We begin with a discussion of the growing popularity of cosmetic surgical and minimally invasive treatments. The literature investigating the psychological characteristics is briefly highlighted. Studies investigating the rate of BDD among persons who seek appearance enhancing treatments are detailed and, collectively, suggest that approximately 5–15% of individuals who seek these treatments suffer from BDD. Retrospective reports suggest that persons with BDD rarely experience improvement in their symptoms following these treatments, leading some to suggest that BDD is a contraindication to cosmetic surgery and other treatments. The clinical management of patients with BDD who present for these treatments is briefly described and directions for future research are provided.

It is interesting to compare how developed countries adopt new technologies. In terms of novel minimally invasive treatments, these are often within the domain of interventional radiology. The Canadian Association of Radiologists (CAR) and the Canadian Interventional Radiology Association (CIRA)

This chapter discusses the care of a patient who is being managed in a disjointed fashion. It describes a complex patient with a standard back pain problem where a failure of effective communication leads to an unhappy customer and a disgruntled and bewildered family. It draws on this experience to show how teams like the pain service can occasionally work to improve collaboration and communication. It also describes the medical treatments that pain clinics may offer.

Minimally invasive treatment alternatives, such as the CyberKnife® (Accuray Incorporated, Sunnyvale, CA), are becoming increasingly important. The benefits of minimally invasive treatments are not limited to improvements in efficacy and safety. Thorough evaluation of these treatment modalities also requires in-depth examinations of financial costs and effects on the patients’ quality of life. Appreciation of the CyberKnife’s viability as a treatment option for thoracic malignancies such as early-stage non-small cell lung cancer (NSCLC) will depend heavily on such analyses. This chapter will focus on the steps involved in undertaking the difficult challenge of assessing costs and quality of life outcomes for CyberKnife treatment of early-stage NSCLC.