Technique

A cryopreservation procedure using an aluminium cryo-plate was successfully developed using in vitro-grown Dalmatian chrysanthemum (Tanacetum cinerariifolium) shoot tips. Shoot cultures were cold-hardened at 5 degree C on MS medium containing 0.5 M sucrose over a period of 20 to 40 days. Shoot tips with basal plate (1.0-1.5 x 1.0 mm) were dissected from shoot cultures and precultured at 5 degree C for 2 days on MS medium containing 0.5 M sucrose. Precultured shoot tips were placed on aluminium cryo-plates (7 mm x 37 mm x 0.5 mm) with 10 wells (diameter 1.5 mm, depth 0.75 mm) and embedded in alginate gel. Osmoprotection was performed by immersing the cryo-plates for 30 or 60 min in 25 ml pipetting reservoirs filled with loading solution (2 M glycerol + 1.4 M sucrose). For dehydration, the loading solution was replaced with PVS 7M vitrification solution (30 percent glycerol, 19.5 percent ethylene glycol and 0.6 M sucrose in liquid MS basal medium), which was applied for 40 min. After ...

We consider here the applications and limitations of urine testing schedules used in methadone maintenance treatment programs. We show that for patients attending clinic daily, any practical testing schedule will only reliably detect those who are using heroin or other illicit drugs very frequently (e.g., daily). For patients with take-home privileges no testing schedule can effectively detect either skipped doses or use of illicit drugs. Consequently, whether for patients attending clinic daily or for patients with take-home privileges, some programs, as measured by urine test results, may actually be less successful than they appear to be.

There is considerable argument concerning the number of sentinel node biopsy cases with axillary dissection that surgeons should perform before they are eligible on abandoning axillary dissection in negative sentinel node patients. Papers that (1) address directly or indirectly the subject of credentialing or of learning curve, (2) report on a surgeon's performance, (3) are reported as feasibility or learning curve studies, or both, (4) discuss the learning curve issue, and (5) express an expert's opinion on the learning curve. The number of procedures of the learning curve can not be fixed for all surgeons. Only surgeons in specialized breast cancer centers can succeed in meeting current recommendations with 20 to 30 cases. Surgeons from affiliated community hospitals will need more than 30 cases, whereas broad-based surgeons might need as many as 60 cases with their current caseload. Not all surgeons will be able to offer the procedure to their patients by the current reco...

lntrapulmonary percussive ventilation (IPV) is a novel form of chest physiotherapy delivered by a percussive pneumatic device (IPV, Percussionaire, Sand Point, ID). There are few published reports about the use of IPV for diseases other than cystic fibrosis. We report our experience with three pediatric patients and one adult patient with persistent pulmonary consolidation refractory to conventional therapies. Three of the four patients had neurornuscular disease; one patient had segmental atelectasis due to aspiration. Three of the four patients showed clinical and radiographic improvement within 48 hours of starting IPV. The fourth patient experienced brief episodes of third-degree atrioventricular block, hypoxemia, and bradycardia during two IPV treatments. IPV was safely restarted and he slowly improved. We conclude that while IPV requires further clinical evaluation, it appears to be a safe and effective therapy for selected patients. However, close observation is essential during and after IPV treatments, especially in patients who have difficulty mobilizing or expectorating sputum. Pediatr Pulmonol.

El triatlón es un deporte combinado y de resistencia donde se desarrollan sin solución de continuidad natación, ciclismo y carrera a pie, siempre en ese orden y sin parar el cronometro. La distancia Sprint es la más corta según el reglamento y sobre la cual se disputan mayor número pruebas (0'750 km, 20 km, 5 km). Determinar los factores de rendimiento es fundamental para optimizar el entrenamiento de una modalidad deportiva. La diversidad de distancias en este deporte, obliga a realizar diferentes análisis de la competición. El objetivo de este artículo es determinar los factores de rendimiento del triatlón distancia sprint en base a la revisión de los datos aportados por la literatura científica. El poder ir a rueda o no, en el segmento de ciclismo, diferencia completamente los factores de rendimiento. Concluimos como principales factores de rendimiento: elevar el Umbral anaeróbico al máximo porcentaje posible respecto al VO 2 máx individual, producir y eliminar elevados valores de lactato, y desarrollar una buena técnica específica de natación estilo crol. Palabras Clave: Umbral anaeróbico, técnica, carga interna, carga externa, lactato, VO 2 máx.

Formalin as a fixative has no practical substitutes, but is toxic and potentially carcinogenic, so caution of its use in hospitals and elsewhere is mandatory. In our hospital, preservation of surgical specimens into formalin to be transferred to pathology labs was replaced by under-vacuum sealing (UVS) tissues into plastic bags and preservation at 4°C until transfer. Data analysis showed UVS processing to be superior in terms of staff satisfaction and of gross anatomic preservation; no problems in terms of technical feasibility or histopathologic preservation were encountered. Formalin was confined to pathology labs while its use on hospital premises was vastly reduced.

Le sud-ouest du Grand Erg occidental du Sahara est considéré comme le berceau de la foggara, une technique ancestrale de captage des eaux souterraines. Il existe actuellement 907 foggaras en exploitation dans les oasis de Touat, Gourara et Tidikelt. Malheureusement, ce patrimoine hydraulique et culturel se dégrade d'une année à l'autre en raison de problèmes techniques et sociaux. La foggara d'El Meghier, considérée comme l'une des plus grandes foggaras d'Algérie, est celle dont l'état est le plus dégradé. Le présent article a pour objectif d'expliquer les raisons de cette dégradation et les conséquences qui en découlent.

Anterior approaches to the shoulder involve partial or complete detachment of the subscapularis muscle. We have developed a new technique that permits adequate access to the humeral attachment of the inferior glenohumeral ligament (IGHL) without any detachment of the subscapularis, and have used this to successfully repair humeral avulsions of glenohumeral ligament lesions. Preliminary diagnostic arthroscopy using air insufflation of the glenohumeral joint is used to identify and grade the lesion. A 1-inch axillary incision is used to access the subscapularis tendon through the deltopectoral approach. Thereafter, anatomic landmarks are identified to expose the lateral aspect of the inferior border of the subscapularis muscle. Blunt dissection is used to separate the musculocapsular plane, and the subscapularis is retracted in an anterosuperior direction. Adequate exposure for visualization and repair of the avulsed IGHL is possible in a majority of cases where this approach is attempted. The use of arthroscopic instruments and suture anchors facilitates suture passage through the mid and posterior regions of the IGHL. If exposure is inadequate, the approach can be easily converted to a conventional L-shaped tenotomy approach through the lower or upper region of the subscapularis.

Processing of human temporal bones is a long, expensive process and the resulting celloidin sections are difficult to use for immunohistochemistry. We tested the ability of immunohistochemical assays to work in human temporal bones that were decalcified using a microwave oven. Tissue was trimmed to an approximate cube (1.5^2 cm/side) containing only the cochlea and immersed in fresh EDTA with paraformaldehyde every 6 h. This sized block required 190^400 h to decalcify. The decalcified tissue was embedded in paraffin and sectioned. Sections were immunoassayed with anti-cytochrome c oxidase, anti-neurofilament or anti-peripherin. All three antibodies labeled the appropriate structures. This procedure may stimulate advancement in the understanding of human inner ear pathology. ß

This study reports on the evaluation of four meeting techniques for decision-making by small groups. Two face-to-face and two computer conferencing techniques were evaluated by small groups solving business cases. Particular groups varied widely in their satisfaction with different meeting techniques, but there was no significant difference in the quality of the group decisions.

Early detection of platelet activation is important for the diagnosis and follow-up of several pathological conditions that primarily or secondarily involve platelets in their pathogenesis. The golden standard assay to detect thrombocyte activation is represented by the release of serotonin, classically performed by demanding methodologies, such as high-performance liquid chromatography, 14 C-labelling and enzyme-linked immunosorbent assay (ELISA). We developed a non-radioactive method, based on individual cells, for the detection of serotonin content in activated and resting platelets by flow cytometry. The assay was standardized on cells activated by Ca 2+ ionophore or by sera from patients with heparin-induced thrombocytopenia (HIT). Cells were identified by CD41a surface staining and their serotonin content measured by specific antiserotonin intracytoplasmic staining, while their activation was independently shown by annexin V binding. Cellular degranulation was detected by flow cytometry in all the cases that were also positive by standard ELISA. Moreover, multiparametric flow cytometry analysis revealed that, although virtually all activated cells bind annexin V, serotonin was released only by the platelet subset that downmodulates surface CD41a.

Tourniquet use in foot and ankle surgery is common practice; however, the technique varies among foot and ankle surgeons and there are no standard guidelines. To analyze trends in foot and ankle tourniquet use, the authors conducted an e· mail sUlVey. One thousand six hundred sixty-five foot and ankle surgeons were sent a tourniquet-use survey via a-mail, across Canada and the United States. Nineteen percent of the recipients completed and returned the surveys. Eleven (3.4%) rarefy or never use a tourniquet and 8 (2.5%) use an Esmarch bandage toumiquet at the ankle. Most use pneumatic ankle cuffs (92% use, 27% use exclusively); many also use thigh cuffs (69%) and some a/so use calf cuffs (15 %). Most thigh-cuff users (62%) experience problems with cuff fit sometimes or often. All but 3 respondents exsanguinate the limb before tourniquet inflation. Specific devices used for exsanguination varied among surgeons. Most commonly used tourniquet pressures range from s 200 to 350 mm Hg at the ankle and s 200 to 2:.351 mm Hg for the thigh (64% use pressures between 301 and 350 mm Hg). Only 7% of respondents consider limb occlusion pressure when selecting tourniquet cuff pressure. Based on published studies of limb occlusion pressures, these ranges suggest that some of the more common pressure settings may be higher than necessary for many patients. Vascular disease or previous bypass (91 %) and deep vein thrombosis (83%) were the most commonly listed contraindications to tourniquet use. Approximately 10% of respondents have either experienced or learned of skin and nerve injuries secondary to lower extremity tourniquet use at any level. The varied responses show a lack of overall consensus on tourniquet pressure settings. Guidelines for optimizing cuff pressure and technique should be established to minimize the risk of complications.

Combining both spatial and intensity information in image, we present an MRI brain image segmentation approach based on multiresolution edge detection, region selection, and intensity threshold methods. The detection of white matter structure in brain is emphasized in this paper. First, a multi-resolution brain image representation and segmentation procedure based on a multi-scale image filtering method is presented. Given the nature of the structural connectivity and intensity homogeneity of brain tissues, region-based methods such as region growing and subtraction to segment the brain tissue structure from the multi-resolution images are utilized. From the segmented structure, the region-of-interest (ROI) image in the structure region is derived, and then a modified segmentation of the ROI based on an automatic threshold method using our threshold selection criterion is presented. Examples on both T1 and T2 weighted MRI brain image segmentation is presented, showing finer brain tissue structures. ᭧

The purpose of this study was to examine whether the wrist lagging angle in golf down swing had an impact on both driving distance and driving accuracy for NCAA Division I female golfers. Seven female golfers all freshmen from a mid-Atlantic region NCAA Division I school volunteered to participate in the research with consent from their head coach. A Full Swing Golf Simulator was used to obtain variables and Dartfish was utilized to measure the wrist lagging angles in the down swing. Multivariate General Linear Regression (MGLR) was conducted to explore the possible cause and effect relationship and to identify a correlation matrix among driving distance, accuracy and wrist angle and other variables. The results indicated that only wrist angle and club head speed were significant in predicting both driving distance and accuracy. Other variables such as club head speed, smash effect, side spin and back spin were also found significant in the MGLR model (p < .01). Future studies should focus on identifying how wrist lagging angle affect male golfers and how does it affect irons in both distance and accuracy.

Objective. Resection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. Methods. We have performed a retrospective review of a consecutive series of 157 adult patients who underwent craniotomy under local anesthesia by one surgeon (P.M.B.) at Brigham and Women's Hospital in Boston. All patients had tumors in close proximity to eloquent cortex, including speech, motor, primary sensory, or visual cortex. In most cases the lesion was considered inoperable by the referring surgeon. All resection was verified by post-operative imaging approximately one month after surgery and all cases were reviewed by an independent neurosurgeon (A.D.). Results. In 122 cases, brain mapping was performed to identify eloquent cortex and in the remainder neurological monitoring was maintained during the procedure. Radiological gross total resection was achieved in 57% of patients and greater than 80% resection was achieved in 23%. Thus 4 out of 5 of patients had major resection despite the close relationship of tumor to eloquent cortex. In 13%, less than 80% of tumor was removed because of danger of neurological deficit. In 7% of patients, only a biopsy could be done because of infiltration into eloquent cortex that could only be assessed at surgery. In 76 patients with pre-operative neurological deficits, there was complete resolution of these deficits in 33%, improvement in 32%, no change in 28%, and long-term worsening in 8%. Among 81 patients with no pre-operative neurological deficit, 1 patient suffered a major permanent neurological deficit, and 2 developed minor deficits. There was a transient post-operative deficit in one-third of cases, but this had resolved at one month in all but three patients. Monitored conscious sedation was performed without anesthetic complications using midazolam, sufentanyl and fentanyl with or without propofol. Only one case needed to be converted to general anesthesia. Patient satisfaction with the procedure has been good. Operating time and hospital stay were lower than the mean for brain tumor craniotomy at this hospital. Conclusions. Tumor surgery with conscious sedation is a safe technique that allows maximal resection of lesions in close anatomical relationship to eloquent cortex, with a low risk of new neurological deficit. Only 7% of intrinsic cortical tumors were ineligible for partial or complete resection with this technique.

In the Jebala region, NW of Morocco, the making of recipients of dung from cows or/and clay (tonna and tabtoba) was common in the past. These recipients were used for stocking cereals and their dry products, for feeding the livestock, or for transporting the céréals to the rotative mill. The élaboration of these objects, which dissapeared 20 or 30 years ago, represented a general technical knowledge which was carried out by all the women in the région, in order to satisfy their domestic needs.

Two still-life paintings were scientifically examined in order to gain insights about Dutch painter Jan van Huysum&#39;s (1682-1749) purportedly secretive paintings techniques, comparing the actual works to information obtained in the few available historical technical sources. Surface investigations included macroscopic and microscopic examination, infrared reflectography and x-radiography, while material characterization of the ground, organic and inorganic pigments and binding media was carried out with a range of non-destructive and destructive analytical techniques. The belief that the two works were an original pair of pendant paintings was disproved due to substantial technical differences in the wood support, ground layers and use of yellow pigment. It was also found that Van Huysum&#39;s use of newly developed pigments (Prussian blue, Naples yellow) had lead to changes in his painting technique, which no longer corresponded to those described in the period&#39;s manuals, an...

Fluorescence resonance energy transfer (FRET) is a widely utilized optical technique for measuring small distances of 1-10 nm in live cells. In recent years, its application has been greatly popularized by the discovery of green fluorescent protein (GFP) and many improved variants which make good donor-acceptor fluorophore pairs. GFP-based proteins are structurally stable, relatively inert, and can be reliably attached to points of interest. The combination of easy access to the GFP-based FRET technique and its obvious usefulness in many applications can lead to complacency. Potential problems such as light contaminants, e.g., bleed-through and cross-talk, and inconsistent donor and acceptor concentrations are easily overlooked and can lead to errors in FRET calculation and data interpretation. In this article, we outline possible pitfalls of GFP-based FRET and approaches that address these issues, including a "Spectra FRET" technique that can be easily applied to live cell studies.

Background: Desmoid tumors are neoplasms characterized by proliferation of fibroblasts without cytologic features of malignancy. Although desmoid tumors are not uncommon, pelvic desmoid tumors are rare and therapeutically challenging. We describe the surgical management of seven patients with histologically confirmed desmoid tumors arising in the pelvis.

A procedure for the correction of urinary stress inconti-Lence has been devised which has given results approximatag and often surpassing those which follow the commonly tsed operations. A description of this new attack upon an old ¢oblem is given as well as an account of a test devised to acilitate the selection of cases in which the outcome of treataent is likely to be successful. This procedure has been arried out on 50 patients to date. Thirty-eight cases were of he usual variety of stress incontinence in females and 25 of hese had previously had a total of 40 standard gynecological perations without relief of this distressing condition. The emaining 12 patients were treated for unsatisfactory uritory control due to a variety of causes. The basic plan of this procedure was derived from a study ~f vesical dysfunction following removal of the rectum (11). A dgh incidence of disturbance in the lower urinary tract, hiefly retention, followed excision of the rectum by either he abdominoperineal approach or the perineal route alone, 'et the incidence was low following operations omitting the ~erineal dissection. Traditionally this dysfunction has been Lscribed to damage of nerves, but in this study no specifically teurological change could be demonstrated. Furthermore, ransurethral revision of the vesical outlet in those patients laving persistent retention after perineal rectal removal pro° ~ided more satisfactory results than are usually obtained in nstances of established neurogenic bladder. On the other rand, transurethral resection after rectal excision was less ;atisfactory than in cases of simple prostatism. Accordingly, t seemed apparent that a major factor producing retention tfter perineal excisions existed which was not neurological md which was not pure prostatism. An observation that nost of the patients with thi_a complication had mobility and harked sagging of the vesicaTbase and outlet suggested that ack of elevation and fixation might be this unrecognized actor. In some cases firm upward pressure on the perineum vith a fist or harness would provide temporary elevation and ixation and these patients could thereby void satisfactorily. n fact one patient declined transurethral surgery when he bund that perineal support on voiding permitted emptying md relieved overflow incontinence. From time to time myserious cases appeared in which, after removal of the rectum, t transurethral prostatectomy relieved retention only to re-;ult in incontinence! Finally, the following case seemed to ntegrate these observations and suggestions: L. W., M.H. history No. 70735, a 54 year old male, had complete lrinary retention following abdomino-perineal removal of the recum. Neurological changes in the urinary apparatus could not be lemonstrated. Two transurethral resections resulted in total inconinence even though the external urethral sphincter had not been tamaged. Perineal pressure would provide good control. Simple su-From the Departments of Surgery (Urology) and Obstetrics and ~ynecology of Cornell University Medical College and the New York ~Iospital, and the Department of Urology of the Memorial Hospital. prapubic suspension of the vesical outlet by suturing to the pubis immediately and completely corrected his urinary control which has remained normal for a period of 46 months. By analogy, the knowledge gained from the study of these rectal cases was applied to the problem of the common stress incontinence of females. A simple operative elevation and fixation via the suprapubic route was planned; but first a prognostic test was devised, based particularly upon the observations regarding sagging of the vesical outlet and the effect of perineal pressure. This test provides simple temporary elevation and fixation of the vesical outlet as an evaluation for each case considered for operation. Its value was promptly appreciated because a successful result from the new operation was rarely obtained if the preoperative test was unfavorable. Furthermore, the cause of some failures following the suspension and standard operations for incontinence can be revealed by this trial procedure.

More successful methods of vasectomy reversal would benefit those undergoing this treatment and might also increase the popularity of vasectomy. We conducted a randomized, prospective clinical trial of vasectomy reversal methods, comparing a new absorbable stent with 2-layer reattachment.We studied 116 men seeking vasectomy reversal between November 1990 and March 1994. Data were analyzed primarily by intention to treat.Patients in the stent (64 cases) and no stent (52) randomized groups were similar in age distribution, age of spouses, years since vasectomy, proportion who had undergone prior vasectomy reversal and proportion who had previously achieved pregnancy. Operation time was more than 19 minutes shorter in the stent randomized group (p = 0.006). Fewer patients in the stent than the no stent group had patent vasovasostomies (81.0 versus 89.6%, respectively, p = 0.2) postoperatively. Fewer stent randomized patients had motile sperm (76.2 versus 81.3%, respectively, p = 0.5) and normal total motile sperm counts (49.2 versus 52.1%, respectively, p = 0.8) than did those without a stent. Conception occurred in 22 and 51% of all couples in the stent and no stent groups. The relative risk of conception among those in the stent group was 0.42 (95% confidence interval 0.24 to 0.71, p = 0.002). A Mantel-Cox log-rank test comparing pregnancies in each group according to the number of postoperative months revealed that the no stent group achieved more earlier pregnancies (p = 0.003).The 2-layer microscopic vasovasostomy results in greater pregnancy rates than vasovasostomy using the absorbable stent.

Background-The anisotropy of cardiac tissue is a key determinant of 3D electric propagation and the stability of activation wave fronts in the heart. The electric properties of ventricular myocardium are widely assumed to be axially anisotropic, with activation propagating most rapidly in the myofiber direction and at uniform velocity transverse to this. We present new experimental evidence that contradicts this view. Methods and Results-For the first time, high-density intramural electric mapping (325 electrodes at Ϸ4ϫ4ϫ1-mm spacing) from pig left ventricular tissue was used to reconstruct 3D paced activation surfaces projected directly onto 3D tissue structure imaged throughout the same left ventricular volume. These data from 5 hearts demonstrate that ventricular tissue is electrically orthotropic with 3 distinct propagation directions that coincide with local microstructural axes defined by the laminar arrangement of ventricular myocytes. The maximum conduction velocity of 0.67Ϯ0.019 ms Ϫ1 was aligned with the myofiber axis. However, transverse to this, the maximum conduction velocity was 0.30Ϯ0.010 ms Ϫ1 , parallel to the myocyte layers and 0.17Ϯ0.004 ms Ϫ1 normal to them. These orthotropic conduction velocities give rise to preferential activation pathways across the left ventricular free wall that are not captured by structurally detailed computer models, which incorporate axially anisotropic electric properties. Conclusions-Our findings suggest that current views on uniform side-to-side electric coupling in the heart need to be revised. In particular, nonuniform laminar myocardial architecture and associated electric orthotropy should be included in future models of initiation and maintenance of ventricular arrhythmia. (Circ Arrhythmia Electrophysiol. 2009;2:433-440.)

The needle biopsy technique described by Bergström is the most commonly used technique to obtain samples to assess muscle metabolism. Sampling of muscle, particularly the vastus lateralis, has become an essential tool in biomedical and clinical research. Optimal sample size is critical for availability of tissue for processing. To evaluate the effectiveness of a novel technique to obtain adequate sample size using wall suction applied to needle muscle biopsy, we collected samples from subjects in on-going clinical studies for gene expression.Muscle biopsy samples of the vastus lateralis using 6 mm Bergström needles under local anesthesia were obtained from 55 subjects who had volunteered to participate in this research project. The vastus lateralis was biopsied according to the methods described by Bergström with a 6 mm biopsy needle. Wall suction was applied to the inner bore of the biopsy needle after the needle was inserted into the muscle.The mean sample of biopsy taken using the 6 mm was 233 mg (n = 55). The wall suction (200 mm Hg) applied to the needle pulled the surrounding tissue into the central bore of the needle. The quality of the samples was adequate for all biochemical assays. The biopsy technique did not result in any complications due to infection or bleeding.Using a novel technique of connecting a 6 mm Bergström biopsy needle to wall suction, we have obtained 200 to 300 mg muscle biopsy specimens uniformly, with ease, and minimal discomfort. An increase in sample size allows for a wider variety of biochemical and histopathological analysis.

Contemporary training in obstetrics and gynecology requires a delicate balance between teaching principles of basic science and clinical care and the technical skills required either in the delivery room or in surgical suites. 1 To accomplish this paradigm requires instruction not only in the core skills, such as basic suturing techniques, but also in a distinctive and new set of abilities not required in times past, ranging from interpretation of ultrasound images to advanced endoscopic surgery. However, changes in the clinical skill set are only part of the contemporary educational needs in our specialty. Changes in social awareness and the medicolegal environment demand competency in counseling and communication. 2 These issues require increasing emphasis on the development of communication and interpersonal skills in training programs. Circumstances in which unique communication skills are essential range from routine preoperative counseling and interviewing to more acute care situations that require intervention such as domestic violence. These newer needs require increasingly sophisticated formats and teaching tools to adequately train medical students and residents in the art of communication and interviewing. Technologies such as virtual reality (VR) that immerse participants into theoretical 3-dimensional (3-D) worlds, offer the opportunity for simulation of and interaction in any circumstance. Virtual reality constitutes a 3-D interface that puts an interacting subject in active exchange with a world recreated by computer programs. In this setting, the interaction is no longer unidirectional but bidirectional: a subject becomes not merely a passive observer of pictures in a text but can actively modify a 3-D virtual world. 3 Environments may be designed to simulate any interaction, whether personal or mechanical.

Purpose: Susruta, a pioneer surgeon of antiquity, practiced around 1000 BC in India. We review his many contributions with special reference to the management of urological ailments. Materials and Methods: Information gleaned from the available English translation of 3 volumes of Susruta's treatise in surgery is analyzed with commentaries and historical perspectives chronicled by Oriental and Occidental historians. Results: Susruta belonged to the period between 600 and 1000 BC. His conceptions of anatomy, physiopathology and therapeutic strategies were of unparalleled brilliance, considering the early age in the history of mankind with no supportive knowledge base preceding his era. His discussions of many aspects of urological diseases are often reaffirmed in the principles of urology today. Conclusions: Through his rational understanding, elaborate teachings and practice of the art of surgery, and many urological ailments in particular Susruta has earned the glory of being the pioneer urologist of antiquity.

A theoretical investigation of different electroneurogram recording techniques using electrode cuffs is presented. A new screened tripole arrangement is proposed with a higher inherent signal to interference ratio than the true tripole, which also allows the nulling of the residual electromyogram signal. The reduction in interference is small because the electrode impedance is large compared to the source resistance.

The purpose of this study was the retrospective evaluation of the treatment results of CO 2 laser evaporation for 27 cases of leukoplakia of the lip. The data were derived from 23 patients who presented with leukoplakia of the lower lip during the period 1978± 96. Four patients developed a second primary leukoplakia of the lip resulting in 27 cases of leukoplakia. All lesions were treated with a CO 2 laser equipped with an operation microscope and micromanipulator. Short-term evaluation showed complete epithelialisation 4 weeks after CO 2 laser evaporation; there was minimal scar formation and no subsequent interference with normal lip function. During long-term evaluation, four recurrences (14.8%) were diagnosed which developed between 5 and 31 months after treatment; these were retreated with CO 2 laser evaporation. There was no development of squamous cell carcinoma in the CO 2 laser-treated area. Selective removal of aected epithelium with minimal damage to surrounding structures is possible using CO 2 laser evaporation, followed by excellent wound healing and good functional result. Treatment can be performed under local anaesthesia on an outpatient basis. The recurrence rate is low compared with the recurrence rate after surgical excision. Therefore, CO 2 laser evaporation is considered a reliable and eective treatment modality for leukoplakia of the lip. #

Background: This study was designed to determine the minimum number of sentinel nodes necessary to accurately stage patients with breast cancer. Methods: Between August 1997 and February 2001, 509 consecutive patients were enrolled in a prospective sentinel node database. Nodes were characterized as either blue or hot (Ͼ2 times background), or both, and ranked based on the order harvested. Predictive value of the sentinel node based on these characteristics was evaluated to determine the minimum number necessary to stage the basin. Results: In all, 990 sentinel nodes were harvested from 465 basins. Pathologic stage in 126 of 128 positive basins was predicted by the first or second node harvested. The remaining 2 patients were positive by immunohistochemistry only. The hottest node predicted the status in 114 of 128 basins.

and components of the work of breathing. Pressure support. Changes in ventilatory pattern http://chestjournal.chestpubs.org/content/100/4/1082 can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml Downloaded from 3.645±0.077 * &Jl conventions are as in Table 1. The ratio ofWOBvror/\VOB ror per minute is the same as that per liter as shown in Table 1. tDenotes p<O.Ol compared with PSL =0 values. jDenotes p<O.OOS compared with PSL=0 values. §Denotes P<.05 compared with PSL=0 values by F test with Bonferroni correction.

The aim of this study was to review the long-term experience with colectomy and the ileoanal pouch procedure (IAPP) in children from one hospital. Between 1977 and 2001, 168 children under 18 years of age underwent colectomy and IAPP. One hundred thirty-one had ulcerative colitis (UC). Twenty-six had familial colonic polyposis (FP), 9 had Hirschsprung&amp;#39;s disease (HD), and 2 had colonic inertia. Ninety-seven had a J-pouch, 62 had a lateral pouch, and 9 had a straight pull-through (SP). The mean age was 13.9 years. Complications within 2 years included pouchitis (16%), ileoanal strictures (14%), and adhesions (7%). There were no deaths. Fifty-six patients (33%) required reoperation, including 20 revisions of large pouches and 8 conversions of SP to pouches because of stool frequency. Six children (3.6%) had later pouch removal (3 had Crohn&amp;#39;s disease). Stool frequency at 6 months was 3.8 (mean). At 6 months 5% had occasional soiling. Eighty-four percent can delay defecation over 1(1/2) hours; 82% can urinate without a bowel movement. With a mean follow-up of 11.2 years, 94.6% are functioning well. Colectomy with IAPP is the preferred operation for children with UC, FP, and selected HD. The J-pouch is the preferred technique because of simplicity of construction and sparsity of complications.

The explosion of neuroimaging in the last decade has contributed to a revision of the concept of bipolar disorder, which was traditionally seen as a cyclic illness with return to normality between episodes lacking "by default" permanent brain abnormalities. A conspicuous corpus of neuroimaging and neuropathology studies indicates that brain changes occur in bipolar disorder, although their etiology and their relation to clinical features are yet to be established. This review summarizes the results from magnetic resonance imaging studies using conventional and novel techniques in patients with bipolar disorder.

Objective: To determine the best technique for measuring mesial-distal tooth widths on digital models. Methods: The individual mesial-distal tooth widths were measured (first molar to first molar, maxillary and mandibular) on 32 stone casts and corresponding digital models (emodels, GeoDigm, Chanhassen, Minn). The digital models were measured using five different techniques: occlusal aspect, occlusal aspect zooming in on each individual tooth, facial aspect rotating as needed, facial aspect from three standard positions (R buccal, facial, and L buccal), and qualitatively rotating the model in any position deemed necessary. Measurements were repeated three times at least 1 week apart. The operator time needed to complete each set of measurements was recorded. Results: Four of five digital measurement techniques (except for the facial aspect from three standard positions) showed a slight positive bias (overestimation in measured width) compared with stone cast measurements. Measuring from the occlusal aspect resulted in the greatest Pearson correlation (98.509%), the least Altman-Bland standard deviation of differences value (1.881 mm), and the second fastest measuring time (2 minutes 3 seconds). Qualitatively rotating the model had similar Pearson correlation and Altman-Bland values to the Occlusal technique but took the longest time to measure (7 minutes 1 second). Conclusions: The Occlusal measurement technique for digital models was the best combination of accuracy, repeatability, and speed of measurement. (Angle Orthod. 2010;80:254-261.)

Background: A chief morbidity of Graves eye disease is upper eyelid retraction that results in exposure keratopathy and cosmetic deformity. Objective: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. Methods: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared. Results: At a meanϮSD of 8.5Ϯ8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (PϽ.001), lagophthalmos (PϽ.001), and keratopathy (PϽ.01) were significantly improved. Mild contour abnormalities (all Յ1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative eyelid crease measurements. Complications of ptosis, wound dehiscence, and a full-thickness hole each occurred once. The meanϮSD time taken to perform the procedure was 31.5Ϯ8.9 minutes per eyelid. Conclusions: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.

Squamous cell carcinoma (SCC) is a rare but well-documented complication of chronic osteomyelitis. Between February 1991 and March 1999, 13 cases (12 men and one woman) of SCC arising in chronic osteomyelitis were diagnosed and treated in our clinic. Mean age was 56.5 (38–70) years. Twelve patients underwent amputation and one underwent limb salvage. Average follow-up was 56 (24–121) months. Among the 13 patients two died of the disease. Treatment of choice for these tumours has been amputation. Carcinome cellulaire squameux est une complication d'ostéomyélite, peu fréquente, mais bien connue. Entre le février 91–mars 99, dans notre clinique, nous ont constate 13 malades (12 hommes et 1 femme) a qui nous ont vu la maladie développe a la base d'ostéomyélite chronique. L'age moyen était 56.5. (38–70) 12 malades ont subi une amputation et dans l'autre l'extrémité a été gardée. La surveillance a duré à peu près 56 (24–121) mois. Parmi ces 13 malades seulement deux sont morts. Pour ces tumeurs on peut dire que l'amputation est la méthode la plus efficace.

Purpose: Venous reconstructions are rarely performed, and factors affecting long-term results of bypass grafts implanted in the venous system are not well defined. In this report we updated our experience. Methods: The clinical data of all patients who underwent venous reconstruction for iliofemoral or inferior vena caval (IVC) occlusion due to nonmalignant disease between January 1985 and June 1999 were retrospectively reviewed. Patients were classified, and outcomes were compared according to the guidelines of the Joint Vascular Societies. Results: Forty-two patients, 23 males and 19 females (mean age, 40 years; range, 16-81), underwent 44 venous reconstructions. Thirty-six patients had limb swelling or venous claudication, 38 had pain, and 14 had healed or active ulcers. The cause of obstruction was congenital in two and acquired in 40 (deep vein thrombosis, 25; trauma, 5; retroperitoneal fibrosis, 4; IVC occlusion devices, 4; others, 2). Eighteen patients underwent saphenous vein crossover grafts (Palma procedure), 17 had expanded polytetrafluoroethylene (ePTFE) grafts implanted (femorocaval, 8; iliocaval, 5; crossfemoral, 3; cavoatrial, 1), 6 patients had spiral vein grafts (5 iliac/femoral and 1 cavoatrial), and 1 underwent femoral vein patch angioplasty. Clinical follow-up averaged 3.5 years (median, 2.5), and graft follow-up with imaging studies averaged 2.6 years (median, 1.6). Seven patients were lost to follow-up. The secondary 3-year patency rate for all reconstructions was 62%. Palma procedures had a 4-year patency rate of 83%. The secondary patency rate of iliocaval and femorocaval ePTFE bypass grafts at 2 years was 54%. The secondary patency was lower in patients with an arteriovenous fistula (P = .023). All ePTFE grafts had a 45% patency rate at 2 years, not significantly different from saphenous vein grafts (83%, P = .16). Clinical scores improved with graft patency (median, 0.0 vs 1.5; P = .044). Conclusions: Venous reconstructions for iliofemoral or IVC obstruction offer 3-year patency rates of 62%. The Palma procedure with autologous saphenous vein had the best long-term patency, whereas long-term success with ePTFE was moderate. The use of an arteriovenous fistula to improve graft patency remains controversial