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Introduction The Laparoscopic Approach to Cervical Cancer (LACC) trial recently showed a significant inferiority of the minimally invasive surgery when we considered them both equivalent in the treatment of cervical cancer. The objective of this article is to describe and discuss the interest of the Schautheim procedure. Surgical technique The Schautheim is the association of a radical hysterectomy by laparoscopy/robot assisted or not as described by Wertheim after a primary vaginal closure, like the first step of Schauta’s hysterectomy. This technique is described in ten steps, with a video material. Discussion The return to open surgery could lead to a loss of benefits associated with the laparoscopic approach in terms of per and post-operative morbidity. One way to achieve similar results would be to prohibit the use of uterine manipulators and create a vaginal cuff. Conclusion Several authors suggest that early-stage cervical cancer patients could still be operated by laparoscopy without reducing overall survival or increasing risk of recurrence if certain measures are followed.

For centuries it has been humankind’s instinct to cover the mouth and nose when coughing or sneezing. Common sense would dictate this instinctively reduces the dispersion of aerosol and droplets and thus the spread of contact and airborne infections.Aerosol generating procedures (AGPs) have become a new byword for procedures that put clinicians at increased risk of contracting COVID-19. Whilst the title suggests the risk is simply in aerosols, the science is much more interesting. Droplets and aerosols are different, with the distinction between them based on size. Whilst experts disagree on the absolute size when an aerosol becomes a droplet, the general acceptance is that anything bigger than 50 microns (0.05mm) is a droplet and those smaller are aerosols.In most contagious respiratory infections, the principal transmission agents are droplets (1). This is due to the relatively high viral load in a droplet, purely due to its large size, and also the fact that large droplets have weight, and so gravity pulls them down onto surfaces that others can touch – so passing it on. This is why washing hands is so effective against droplet spread.Aerosol transmission is thought to be a much less frequent cause of transmission, mainly due to the very small viral load (given the aerosol itself is by definition very small). However, it is clearly more concerning as these very small, and therefore very light particles, can travel large distances on air currents and can be directly inhaled. That said, it is thought to only play a minor role in transmission compared to droplet spread.During the COVID-19 pandemic PHE (Public Health England) updated guidance on what it considers (AGPs) Aerosol Generating Procedures. Included within this list were examinations of the upper aerodigestive tract in ENT. Any procedure enacting air over a fluid mucosal surface therefore poses a risk of viral dispersion within both droplets and aerosol. Healthcare workers were recommended to reduce endoscopy of the nose and throat. Any essential examination had to be performed using high level PPE including an respirator (N95 or FFP3)(2).Anfinrud et al (3) graphically represented a visual reduction in aerosol production by creating light sheet from a 532-nm green LASER. Comparisons were made between a person talking with and without a cover for the mouth, in their instance, a slightly dampened wash cloth. Light flashes were recorded to evaluate the number of droplets ranging between 5-200 microns. They showed that by covering the mouth, virtually no light flashes were seen. This observation supports the well-known concept that covering the mouth does indeed reduce droplet production.On impact with smooth surfaces droplets disperse to smaller sizes and can aerosolise. Similarly impact onto soft surfaces absorbs droplets reducing their projection as well as the tendency to aerosolise (3).As the pandemic plateaus in countries across the world various strategies are to be considered to return to a new normal. This would facilitate the resumption of diagnostic services whilst maintaining the protection to healthcare workers. One suggestion is the use of facemasks to help reduce the risk of inadvertent droplet dispersion (2). Despite the ‘soft surface’ barrier masks create, in the ENT setting, facemasks obscure access to the nasal cavity thus preventing nasoendoscopy.The ‘SNAP’ (Safe Nasoendoscopic Airway Procedure) developed by endoscope-i Ltd (West Midlands, UK) is a single-use, valved endoscopic port, retrofitted to any surgical mask (Figure 1), permitting entry of a 4mm flexible and rigid endoscope to examine the naso and pharyngolarynx. The valve, a 10.9 mm cylindrical tube truncated by two opposing 45 degree inclined membranes 700 microns thick, approaches a point but terminates in a 700 micron thick and 500 micron wide plateau, creating a ‘duck bill’ formation The valves are formed using a FFF (fused filament fabrication) 3D printing technique with a Flashforge Creator Pro 3D printer. The plateau atop the valve serves to provide a reference for introducing a slit using a hardened steel razor blade that is 400 microns thin. The blade is mounted in a jig to ensure angle, penetration depth and position are controlled as it is driven through the membrane. These measures ensure that the valve opening is observably consistent and less than 50 microns. Once the SNAP is fitted to a surgical mask, any cough or sneeze generated during the procedure is caught within the mask. The valve is configured such that pressure from the patient side will serve to collapse the walls of the valve membrane thereby further sealing the slit in the valve. This seal has been in vitro tested with aerosolised fluorescein(figure 2). The 45-degree angle of the valve walls from the non-patient side similarly allows the blunt tip of the nasoendoscope to deform the valve walls with ease. The cylindrical form of the walls encourages the valve membranes to return to their original flat shape following withdrawal of the endoscope.During the COVID-19 pandemic our tertiary head and neck cancer referral centre managed 120 urgent 2ww cases. Using the Tikka et al calculator (4) 40% of referrals were redirected back to the GP. The remaining 60% either went direct for imaging or underwent endoscopy. In total 40 cases were endoscoped, 9 of which using the SNAP. All 9 cases scoped with the SNAP were completed without any adverse effect. No cough or sneeze was elicited during any of the examinations and observations between the two groups were identical. Subsequently one consultant lead FEES examination was performed under controlled conditions. Again, the procedure was completed without any complications. The patient self-remarked on the comfort of the endoscopy as a result of the stability provided by the SNAP device in the alar region the prevented inadvertent movement during the chin tuck and head turn exercises.Our observations demonstrate the SNAP device is a practical and safe tool to aid reduction in droplet dispersion whilst performing nasoendoscopy. We hope to see the inclusion of such a device in recovery guidelines by national bodies in order to facilitate the return of safe nasoendoscopy in the post COVID Pandemic era.

Chronic rhinosinusitis is one of the most common chronic conditions affecting millions of people in the United States every year. Balloon sinus dilation is a minimally invasive intervention that was introduced as a possible alternative to endoscopic sinus surgery (ESS). In select patients, balloon dilation has been advocated as a relatively safe procedure with comparable efficacy to traditional ESS. Over the past 12 months, significant intracranial and intraorbital complications have been observed on five patients who underwent balloon sinus dilation as a stand-alone procedure, as well as what could be termed a power dissector-assisted balloon dilation procedure, obviating the need for a wide sinusotomy or any significant ethmoid surgery, which are typically performed to establish anatomical landmarks before the introduction of power instruments into dependent sinus cavities. Laryngoscope, 2455-2459, 2018.

BACKGROUND: Total pancreatectomy (TP) is a complex surgical procedure with significant postoperative morbidity. Despite the narrowed range of indications for TP, the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs, especially regarding malignant disease. The introduction of robotic-assisted pancreatic surgery has provided a novel and minimally invasive approach for TP, yet the feasibility of this technique is still unknown. This study assessed the safety and efficacy of robotic-assisted total pancreatectomy (RTP) compared to conventional open total pancreatectomy (OTP). METHODS: All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study. Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database. A 1:1 propensity score matching (PSM) method was utilized to compare the RTP and OTP cohorts to minimize bias. RESULTS: A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP. The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP [300 (IQR, 250–360) vs. 360 min (IQR, 300–525), P=0.031]. Additionally, en bloc resection and spleen-preserving rates were also higher in the RTP cohort. Major 30-day morbidity (Clavien-Dindo > IIIa) and 90-day mortality were similar between the two cohorts. After a median follow-up time of 15 (IQR, 8–24) months, both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency. CONCLUSIONS: RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease. However, further prospective randomized studies are needed to assess the feasibility of this approach.

Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is gradually emerging as an option among patients with cholecystitis. A stent-bridged endoscopic intervention in the gallbladder (GB) was further introduced. The aim of this study was to assess the effectiveness and safety of the electrocautery-enhanced delivery of a lumen apposing metal stent (ECE-LAMS) and this newly designed retrievable anchor (RA) applied in the transmural cholecystolithotomy. Method We retrospectively reviewed consecutive patients undergoing EUS-guided transmural cholecystoscopic therapy. The main outcome measures for the EUS-GBD procedure were technical success and adverse events, which were also compared between the guided assisted group and the RA-assisted group. The main outcome measures for transmural cholecystoscopy after EUS-GBD were the stent indwelling time, clinical success, and adverse events. Results A total of 24 (15 female) patients with gallstones received transluminal cholecystolithotomy. The mean age of the patients was 36.08±13.69 years. The success rate of the anchor-assisted group was higher than that of the guidewire-assisted group (92.9% vs. 70%, P=0.07). On an average of 12.25±2.77 (range 8-17) days after the initial GB drainage procedure, 20 patients received per-oral cholecystoscopy via the fistula. A ruptured fistula was found in 2 patients in whom the per-oral cholecystoscopy was applied on the ninth day after EUS-GBD. During the follow-up period (mean 314.2± 213.7 days), no GB stone recurrence or other long-term complications were reported. Conclusion We demonstrated that the EUS-assisted per-oral cholecystoscopy technique with ECE-LMAS is an efficient and safe procedure. For the EUS-GBD procedure, a RA could significantly increase the success rate compared with the guidewire.

Examination of the Skin-Melanoma (SM) is an essential practice to verify and authenticate the phase of the cancer in skin fragment. If the cancer phase, such as the Benign/Malignant is recognized through the screening process, a possible treatment procedure can be implemented to cure the patient. This work employs a soft-computing assisted procedure to threshold and segment the SM to identify the phase. The thresholding is executed with the Bat Algorithm (BA) and Otsu’s thresholding and the extraction is employed with the Watershed scheme. After extracting the SM slice, a relative study is applied to find the similarity level among the ground-truth and the SM to validate the performance. Further, the ABCD rule is also applied to identify the crucial SM parameters, such as Asymmetry (A), Border abnormality (B) and Diameter (D) to classify the considered SM images into Benign/Malignant. The outcome of this work confirms that, implemented practice works well on the chosen SM images.

Background: In microscope assisted middle ear procedures surgeons can only observe the parts of the tympanic cavity, the hidden areas, such as the facial recess and sinus tympani, would not be visualised which needs to be exposed for performing tympanoplasty. The aim of the study was to compare the outcomes of microscope versus endoscope assisted myringoplasties in terms of duration of the procedure, graft take up, improvement in hearing and incidence of any complications.Methods: A prospective comparative study was conducted for a period of one year. A total of 72 patients with CSOM were randomised into two groups of 36 each. Group A patients (n=36) underwent traditional myringoplasty under a microscope and group B patients (n=36) endoscopic assisted myringoplasty was performed. Post-operatively all the patients were followed up for a period of one year. During the follow-up period patients were assessed for the graft take up, hearing improvement, incidence of complications and recurrence rate between the two groups.Results: Successful graft uptake was observed in 88.8% among patients underwent microscope assisted myringoplasty and it was 94.4% in endoscopic assisted myringoplasty. The mean duration of surgery was 123 mins in microscopic assisted group compared to 92 mins in endoscopic assisted group and the difference was found to be statistically significant. Similarly, the cosmetic results and the post-operative pain were more favorable for endoscopic assisted group than microscopic assisted group and the difference was found to be statistically significant.Conclusions: Enoscopic assisted procedure could be considered as a better alternative for microscopic assisted myringoplasty.

The assignment of tasks to workstations that results in the assembly of an item or provision of a service is a common topic of discussion in operations management (OM) courses. In this paper, we present an interactive Excel spreadsheet assisted procedure for assigning the required tasks. The procedure actively engages the student in the process and serves as a tool for learning how to effectively and efficiently assign the tasks to a series (line) of connected workstations. The Excel implementation provides more flexibility in selecting tasks than textbook or other Excel based methods that rely on certain priority rules, and is considerably easier to use than math programming models. The procedure and its spreadsheet implementation are illustrated and discussed, with an example.

The pre-transplant weight loss required of end-stage renal disease patients is often unachievable. Though robot-assisted procedures among extremely obese have shown minimal complication, long-term outcomes are understudied. Previously, we reported no difference in 6-month patient and graft survival among 28 robot-assisted transplant cases (2009-2013) and 28 open controls (2004-2010). Groups were frequency-matched on age, sex, race, donor compatibility, disease, and dialysis history. Cases had greater median pre-transplant body mass index (BMI; 42.3 (31.1-64.3) vs 36.8 (30.0-51.1)). Here, we compared patient and graft survival through 5 years post-transplant. Infection, wound complications, and significant re-hospitalizations were collected. One-, three-, and five-year graft survival were 100%, 100%, and 89.3% among cases, and 96.4%, 85.7%, and 78.6% among controls. Rejection within 1 year was greater among cases (11 vs 8). Five-year rates were similar (P = 0.54). Post-transplant BMI remained comparable. No cases and eight controls experienced surgical site infection (SSI). Two cases and one control experienced hernias. Post-transplant diabetes was documented among five cases and six controls. Three deaths occurred among cases, two among controls. This is the most extensive known follow-up of such obese recipients of robot-assisted transplant. Our procedure is a promising pathway to transplant and decreased mortality for those deemed too high risk for conventional surgery.

OBJECTIVE We retrospectively compared the clinical outcomes of Lithoclast assisted lithotripsy (L group) with those of Holmium YAG laser assisted lithotripsy (H group). PATIENTS AND METHODS We analyzed records for operation time, duration of ureteral stenting, complication and stone-free rates in the L group (388 patients) and the H group (368 patients) for the primary procedure. RESULTS The stone locations (L group/H group) were U1 in 141/181, U2 in 69/57, and U3 in 178/130. Respective median stone sizes (L group/H group) were: U1,: 10.0/10.0 mm; U2,: 7.0/10.0 mm;, and U3,: 6.0/7.0 mm. Secondary procedures were performed in 79 L group patients and 35 H group patients. The median operation times (L group/H group) were 29.5/25.0 minutes. The median durations of ureteral stenting (L group/H group) were 4.0/4.0 days. The stone-free rates (L group/H group) according to the locations of the stones were 69.3/82.0% in U1, 85.5/87.0% in U2, and 92.0/98.4% in U3. Complications (L group/H group) were ureter perforation in 8/5 cases, pyelonephritis in 7/2 cases, ureteral stricture in 2/6 cases, and stone push up in 27/13 cases. CONCLUSION The operation time for holmium YAG laser assisted lithotripsy was significantly shorter than that of the Litoclast assisted procedure, and the stone-free rate with holmium YAG laser assisted lithotripsy was better than that with Lithoclast assisted lithotripsy for U1 and U3 stones.

Background: Reconstructions of the coracoclavicular (CC) ligament in an open or arthroscopically assisted procedure are often combined with a resection of the distal clavicle to prevent or treat osteoarthritic degenerations of the acromioclavicular (AC) joint. However, increased horizontal translation leading to symptomatic instability may be associated with resection of the distal clavicle. Hypothesis: Horizontal translation increases in direct correlation to subsequent resection of the distal clavicle. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen specimens (mean age, 82.0 ± 5 years) were examined using a servohydraulic testing system. A 70-N force was applied in the anterior, posterior, and superior directions, and the translations were quantified for all directions. After native testing, sequential resection of the distal clavicle at 5 and 10 mm was performed after incision of the inferior capsule, and anterior-posterior loads were retested. Finally, the AC ligaments were incised, and repeated testing was performed. Results: Native mean (± standard deviation) anterior translation was 7.90 ± 2.62 mm. After section of the inferior AC capsule, anterior translation was 8.05 ± 2.62 mm ( P = 1.0). After clavicle resection of 5 mm, anterior translation was 10.75 ± 2.38 mm ( P = .122), and after resection of 10 mm, anterior translation was significantly increased to 11.6 ± 2.37 mm ( P = .012). Complete AC capsule sectioning led to significantly greater amounts of anterior translation (12.12 ± 3.0 mm; P = .003). Posterior translation for the native specimen was 8.88 ± 2.63 mm. Sectioning of the inferior AC capsule resulted in 9.21 ± 2.71-mm translation ( P = 1.0). After clavicle resection of 5 mm, posterior translation was 10.42 ± 2.42 mm ( P = 1.0), and after 10-mm resection, it was 11.31 ± 2.86 mm ( P = .39). Sectioning of the complete AC capsule led to significantly greater amounts of posterior translation (12.31 ± 3.12 mm; P = .043). Conclusion: Ten millimeters of resection increased anterior translation of the distal clavicle with both the superior and posterior AC capsules as well as the CC ligaments intact. Both anterior and posterior translations increased after 10-mm resection and complete AC capsule sectioning. Clinical Relevance: These results suggest that resection of the distal clavicle leads to increased horizontal translation despite an intact superior and posterior AC capsule. Only sparing resection of the distal clavicle should be performed and only if strictly indicated. Violation of the AC capsule further increases horizontal translation and should therefore be avoided, or if indicated in AC joint dislocations, a reconstruction of the AC capsule should be considered.

Objetivo: determinar la utilidad de la L-carnitina vía intramuscular de 1 gr como tratamiento para los casos de factor masculino leve a moderado.Materiales y métodos: participaron en el estudio doce sujetos a las cuales se les diagnosticó oligo–asteno-teratozospermia leve a moderada. Se les administró a un grupo L-cartinina a dosis de 1 gr IM cada 4 días por lo menos por 2 meses previo al procedimiento de reproducción asistida al que fueron sometidos junto con sus parejas. Tomamos como control los parámetros espermáticos el día en que se les realizaba el procedimiento.Resultados: en el grupo que utilizó L-carnitina se observó una mejoría significativa al momento de realizar el procedimiento de reproducción asistida en cuanto a los parámetros espermáticos de concentración y en la movilidad, logrando embarazo en un 50%.Conclusión: el uso de L-carnitina incrementa la concentración y la movilidad de los espermatozoides, mejorando la tasa de embarazo.

This article presents a computer assisted procedure for virtual fragmentation of molecules. The proposed algorithm defines fragments which usually coincide with the classical functional groups. The fragmentation criteria are the bond order's value of the chemical bonds and the type of the connected atoms (hydrogen, carbon, heteroatom).

Objective. To identify the perception of the teenager puerperas regarding the practice of episiotomy. Methodology. This is a study with qualitative nature developed with 11 teenage puerperas in the Obstetrics Unit of one hospital located in the metropolitan region of Sao Paulo, Brazil. Results. Teens knew of the existence of episiotomy, but they unaware the reasons for its realization. Pain, discomfort and burning were negative repercussions presented, but most of them believe that assisted procedure in their delivery showing confidence in the professional who carried it out. Conclusion. Adolescents have different perceptions on the practice of the episiotomy, ranging from resignation to outrage. Key words: episiotomy; pregnancy in adolescence; humanizing delivery; obstetrical nursing.

Operative procedures to correct the deformity caused by pectus excavatum are generally based on either sternal elevation or turnover. In either case, the operation is highly invasive. By considering the softness of the costal cartilages in early childhood, we have developed an endoscopically assisted procedure that applies external traction continuously in order to elevate the depressed sternum and costal cartilages. Since August 1993, we have performed this operation in 11 patients with pectus excavatum who ranged in age from 3 years 1 month to 28 years. The traction screws came loose spontaneously in two early cases. Augmentation transfer of a latissimus dorsi muscle flap and dermal fat grafting were subsequently performed in these two patients, respectively. We achieved an excellent cosmetic outcome in the other nine patients, with results similar to those achieved with the conventional operation. Our technique is a two-stage procedure and the patient is limited in performing daily activities while wearing the traction device. Despite this drawback it can achieve permanent correction of the deformity. Accordingly, this method should be considered when pectus excavatum is corrected surgically, particularly in infants and young children.

Surgical procedures have tended toward 'least-invasive' or 'keyhole ' techniques for the past three decades. Synarthrodial a r throscopy and laparoscopic cholecystectomy are but two of these procedures that have revolutionized surgical thought , reduced costs and opened the door to outpat ient approaches for what were routinely inpatient procedures. Two trends have altered spine surgery in this same time period. Ins t rumenta t ion has opened new avenues for t reatment o f spinal deformity and t rauma. The second trend is to minimize surgical procedures in the degenerative spine th rough accurate Magnet ic resonance imaging (MRI) depiction o f the nature and location o f a lumbar disc herniat ion or spinal stenosis, and then to limit the surgical approach with a microscopically assisted procedure. 14 Randomized controlled trials and comparat ive trials (Tables 1 and 2) have clearly established that the outcomes of microdiscectomy are at least equal to s tandard open discectomy. 5-13 M a n y would agree that microdiscectomy is now the 'gold s tandard ' for the lumbar disc herniat ion ( L D H ) causing sciatica that is recalcitrant to conservative care? 4 ~7 It is only natural that we try to develop other 'least invasive' spinal procedures. Percutaneous disc surgery is one o f these developments. Of the three percutaneous disc procedures: chemonucleolysis, percutaneous discectomy and microendoscopic discectomy, only chemonucleolysis has survived scrutiny through

Human stem cell transplantation is a novel treatment under active research to restore lost brain function following a stroke. In this work, we propose a multiparametric framework, based on multimodal image fusion, for stereotactic implantation of human stem cells in brain targets. Five patients underwent image-guided surgical procedure using this technique. Three dimensional T1-w eighted and T2-w eighted magnetic resonance imaging (MRI) were acquired for topographical an d geometrical characterization of lesions. Afflne registration of 3D-MRI and single-photon e mission tomography (S PECT) is used to localize areas with preserved b lood flow in the lesion boundaries, considered as the surgical target. Once it has been selected a s ingle-voxel magnetic resonance spectroscopy ( MRS) is developed to verify the tissue’s biochemical condition and for in-vivo follow up purposes. Preoperative stereotactic computed tomography (CT) was performed for surgical planning. Frame-based computer assisted procedure was foliowed for targeting the implant site. All patients underwent uncomplicated surgeries. Post operative MRI showed high consistency between image-guided planning and transplantation site. Serial evaluations during 12 months demonstrated no surgery-related adverse effects. Multimodal coregistration offers a suitable approach for se lection and stereotactic access of brain targets for human stem cell transplantation.

SummaryThe outcome of the first 50 consecutive laparoscopically assisted vaginal hysterectomies performed for benign conditions at West Wood Hospital, Beverley, between 4 February 1992 and 4 November 1993, was assessed with emphasis on intra-and postoperative complications, duration of operations, postoperative analgesic requirements and duration of postoperative hospital stay. The mean age of the women was 38.6 years and mean parity was 2.1 births. The mean duration of postoperative hospital stay was 2.7 days. All the women required less postoperative analgesia and recovered from their operations faster than those who had total abdominal hysterectomy for similar indications. Five women (10 per cent) developed postoperative complications. It was concluded that the laparoscopically assisted procedure is associated with a low complication rate and quick recovery but takes longer to perform. Ways to reduce the cost of the operation are discussed.

A laparoscopically assisted procedure for the reversal of Hartmann’s colostomy was undertaken in 6 patients. The procedure was successfully done in 3 of them. The technique started with an external re

We describe a convenient, efficient, semiautomated protocol for assaying large numbers of DNA samples for over 20 mutations causing cystic fibrosis. The protocol uses the following: (1) a programmable robotic workstation to perform rapid pipetting and dot-blotting operations, (2) an allele-specific oligonucleotide hybridization in a single water bath without correcting for G + C content of oligonucleotides, and (3) a combinatorial system that allows direct determination of the genotype for more frequent mutations. We have used this system routinely for 16 months for carrier detection and for diagnosis of cystic fibrosis. The method can be readily applied to any combination of allele-specific oligonucleotide assays whether for multiple alleles at one locus or for a few alleles at multiple loci. © 1994 Wiley-Liss, Inc.

Ultrasound (US)-assisted liver biopsy is the most widespread practice for the staging of chronic hepatitis, but there are no data about a comparison with the US-guided procedure in terms of safety and diagnostic yield. The aim of this study was a retrospective analysis about 357 biopsies performed by using both these techniques.We analysed 176 US-guided biopsies and and 181 US-assisted liver biopsies performed in the same unit in patients with chronic viral hepatitis. We recorded the number of passes, sample fragmentation and sample size, number of portal spaces and degree of fibrosis. Mortality and morbidity were also assessed. Differences between the two groups of needle biopsies were analysed statistically by the Welch test, with significance at p0.05.Specimens obtained by US-guided liver biopsy were 27 mm long (range 25-28.9 mm) versus 13 mm mean value (range 12.2-13.9 mm, p0.0001) of samples from US-assisted liver biopsies and contained 15.7 portal tracts (range 14.7-16.7) versus 11 mean value (range 10-11.9, p0.0001) of specimens obtained by echo-assisted needle biopsy. Mortality and major complication rate was zero in our series. Both groups of liver biopsies were comparable with respects to number of passes and sample fragmentation.Both methods showed overlapping security. The diagnostic yield seems to be greater if liver biopsy is performed by the echo-guided technique.

Porous pure and doped silicas with pore sizes at two length scales (meso/macroporous) have been prepared and shaped both as powders and monoliths through a one-pot surfactant assisted procedure by using a simple template agent and starting from atrane complexes as inorganic precursors.

A system has been studied with 3 purposes: digitization of the head and mathematical representation of the scalp surface, assistance for electrode placement, and digitization of the exact 3-D position of each electrode after placement. The system has been validated in several ways, mainly by comparing the electrode locations obtained using the classical manual procedure based on the international 10–20 system of electrode placement, and through the assisted procedure based on the described system. The main result is improved reproducibility of the assisted procedure which is 3 times better than in the manual procedure.

The numbers in parentheses represent the order of presentation in the published program. The Southern Section Meeting of the Triologic Society was held at the Marriott Marco Island (Fla) Resort from January 13 through 15, 1994. Edward W. Stevenson, MD , vice president for the Southern Section, introduced a new technology to avoid speaker's neck strain: a rear view mirror and video monitor at the podium to observe the screens. Chapman T. McQueen, MD , and colleagues, Chapel Hill, NC, studied cadaveric orbits from a population similar to that found in the United States. By dividing the orbits into quadrants, they documented distances to the optic nerve . (1) Endoscopic approach to the pediatric orbit , for drainage of subperiosteal abscess and biopsy of tumors, was described by James G. Burson, MD, and collaborators, Atlanta, Ga. This was shown to be a satisfactory alternative to the traditional external approach. (2) Another endoscopically assisted procedure

The Residential Area Cost Analysis Model (RACAM)–a computer model designed to calculate the construction, operation and maintenance costs of alternative residential subdivision designs–is presented. A procedure for preliminary design is described which calculates the present worth and annual cost for domestic sewer, storm sewer, and water distribution systems; gas, power and telephone systems; road, sidewalk and street lighting systems; and park and buffer systems. Results of applying the model to subdivisions proposed in Hamilton, Ontario and Regina, Saskatchewan are presented. The paper concludes that RACAM, in addition to other new modeling procedures, can provide development cost information which can assist in the assessment of proposed residential subdivisions.

A computer program for calculating patient entrance exposure and fetal dose for 11 common radiographic examinations was developed. The output intensity measured at 70 kVp and a 30-inch (76-cm) source-to-skin distance was entered into the program. The change in output intensity with changing kVp was examined for 17 single-phase and 12 three-phase x-ray units. The relationships obtained from a least squares regression analysis of the data, along with the technique factors for each examination, were used to calculate patient exposure. Fetal dose was estimated using published fetal dose in mrad (10(-5) Gy) per 1,000 mR (258 microC/kg) entrance exposure values. The computations are fully automated and individualized to each radiographic unit. The information provides a ready reference in large institutions and is particularly useful at smaller facilities that do not have available physicians who can make the calculations immediately.

Determining the genetic hazard of a chemical is generally approached by using an assortment of tests for measuring the DNA reactivity of a chemical or its resultant genotoxicity. Over 100 short-term tests employing a wide diversity of species and genetic mechanisms have been used to measure genetic hazard. To date, attempts to achieve a standard test battery for denning genetic hazard have not been successful. Consequently, testing for genetic hazard involves the use of test batteries with variable types and numbers of assays. This increases the difficulties of interpreting data sets since the data sets are often filled with inconsistent responses from diverse types of assays. Several years ago, the International Commission for Protection Against Environmental Mutagens and Carcinogens (ICPEMC) established a Committee to develop a method to compile and interpret diverse short-term test data. The Committee has produced a quantitative weight-of-evidence approach that combines test data using certain parameters such as dose, replication, and metabolic capacity into a series of scores for test type, test class, test family, and an overall score that defines the total weight-of-evidence regarding the genetic hazard of the agent. A description of the method and results from the evaluation of selected chemicals is provided.

Ultrasound high resolution B-mode imaging of human arteries allows in vivo an accurate and non-invasive determination of the thickness of the intimal-medial complex. A computer assisted procedure to measure this parameter at the level of common carotid arteries was developed. The average difference between duplicate thickness determinations was 4.6%. The thickness of the intimal medial complex of common carotid arteries was then measured in a group of hypercholesterolemic patients. This parameter was significantly greater in these patients as compared to controls (P less than 0.001). The prevalence of small plaques in the carotid arterial tree was also significantly increased in patients. Analysis of data showed that in controls, but not in patients, the thickness of the intimal medial complex increases with age (r = 0.46, P less than 0.05). Within the hypercholesterolemic group, intimal-medial complex values were greater in male patients and in smokers. It is concluded that the common carotid arteries of hypercholesterolemic patients show thickening of the intimal-medial complex. Cigarette smoking, male sex and age increase the extent of this modification. The determination of this parameter using a non-invasive technique may represent an important tool to monitor in vivo the progression and/or the regression of early atherosclerosis in man.