Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.
Cholangiopancreatography, Endoscopic Retrograde ; adverse effects ; Cholangiopancreatography, Magnetic Resonance ; Endoscopy ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; physiopathology ; Pancreatic Fistula ; diagnosis ; epidemiology ; therapy ; Pleural Diseases ; diagnosis ; epidemiology ; therapy ; Treatment Outcome

A 28-year-old female with a 1-year history of ketamine abuse developed ketamine-associated urinary symptoms that were refractory to conservative treatment after the complete cessation of ketamine use. Smooth voiding with increased bladder capacity and minimal postvoid residual urine volume were achieved by performing an augmentation enterocystoplasty. An uneventful pregnancy with the vaginal delivery of a healthy baby occurred postoperatively.
Adult ; Cystitis* ; Delivery, Obstetric ; Female ; Humans ; Ketamine* ; Pregnancy* ; Urinary Bladder

Surgical traineeship has traditionally been based on a master apprentice model where learning takes place in the operating theatre. This approach has changed over the past few years with greater emphasis on surgical training taking place within the surgical skills laboratory. We developed a high fidelity simulator, the Image-guided Robotic Assisted Surgical simulator (IRAS) with an incorporated robotic guidance feature. The robot system is developed to mimic the process of an experienced surgeon physically holding a trainee's hands to demonstrate maneuvering of the laparoscopic instruments. We aimed to assess the efficacy of incorporating robotic guidance into this high fidelity surgical simulator. Forty-two participants (13 surgical residents and 29 medical students) were recruited. Participants had one practice run for familiarisation and subsequently performed the virtual laparoscopic cholecystectomy (LC) once. Among the medical students, they were ransomised to either a control or intervention group. They were tasked to perform a second- and third-timed LC assessment. Participants were asked to rate the simulator using a 5-point Likert scale Questionnaire. IRAS rated favourably in hand-eye coordination and training bimanual dexterity (mean score: 4.1 and 4.0 among students, 3.4 and 3.4 among residents) though it faired suboptimally in realism. At baseline, residents were statistically faster compared to students (overall time: 418.9 vs 586.8 seconds,= 0.001). Participants randomised to the intervention group consistently scored better. However, their overall time were not statistically significant from the control group. The robotic guidance capability of the IRAS is a key advantage of this simulator platform over the conventional platform.

Carcinoma ; diagnostic imaging ; secondary ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Pancreatic Neoplasms ; diagnostic imaging ; secondary ; Ultrasonography

Radiofrequecy ablation is the most widely used local ablative therapy for both primary and metastatic liver tumours. However, it has limited application in the treatment of large tumours (tumours >3cm) and multicentric tumours. In recent years, many strategies have been developed to extend the application of radiofrequency ablation to large tumours. A promising approach is to take advantage of the rapid advancement in imaging and robotic technologies to construct an integrated surgical navigation and medical robotic system. This paper presents a review of existing surgical navigation methods and medical robots. We also introduce our current developed model - Transcutaneous Robot-assisted Ablation-device Insertion Navigation System (TRAINS). The clinical viability of this prototyped integrated navigation and robotic system for large and multicentric tumors is demonstrated using animal experiments.
Catheter Ablation ; instrumentation ; methods ; Humans ; Imaging, Three-Dimensional ; Liver ; Liver Neoplasms ; pathology ; surgery ; therapy ; Robotics ; Surgery, Computer-Assisted ; instrumentation ; methods ; Surgical Procedures, Operative ; methods

INTRODUCTIONThe study seeks to investigate how the duration of storage of cryopreserved human cadaveric iliac arteries impacts their mechanical, structural and microbiological properties as compared to their fresh sample.

MATERIALS AND METHODSIliac arteries were harvested from 12 human cadavers and divided into 2 groups. One group underwent mechanical stress-strain assessment immediately and another was cryopreserved for a pre-determined time-period (range, 29 to 364 days). Mechanical functionality was assessed with a customised clamping mechanism. The arteries' microbiological properties were studied pre- and post-cryopreservation. The post-thawed arteries were also assessed histologically for structural integrity.

RESULTSOf the 12 pairs, only 7 (58, 119, 150, 252, 300, 332 and 364 days) iliac arteries were included in the final analysis. The other 5 pairs (29, 90, 188, 205 and 270 days) had abundant local calcification and their stress-strain curves could not be characterised. From the curves, pre- and post-cryopreserved arteries had the most similar mechanical properties when stored for 119 days. A trend of increasing relative stiffness with increased duration of storage was noted. The post-thawed arteries demonstrated minimal fragmentation except in atherosclerotic areas. Majority of the arteries were not contaminated by bacterial or fungal infection pre- and post-cryopreservation. Also, 2 arteries (364 and 332 days) which had initial bacterial colonisation showed no bacterial growth on their post-thawed sample.

CONCLUSIONMechanically, non-atherosclerotic cryopreserved arteries can be a good substitute to their corresponding fresh arterial graft. However, the length of cryopreservation has an effect on the relative stiffness of the pre- and post-cryopreserved arteries. Histological and microbiological findings suggest that cryopreservation have little impact on an artery structural integrity and may possibly have a role in maintaining sterility and sterilising the arteries.

Aged ; Biomechanical Phenomena ; Cadaver ; Cryopreservation ; Humans ; Iliac Artery ; anatomy & histology ; microbiology ; physiology ; Middle Aged

Adult ; Diagnosis, Differential ; Genital Neoplasms, Male ; pathology ; surgery ; Hernia, Inguinal ; pathology ; Humans ; Male ; Myxoma ; pathology ; surgery ; Scrotum ; pathology

PURPOSE: The urinary bladder (UB) is innervated by both sensory and autonomic nerves. Recent studies have shown that sensory neuropeptides induced contractions in the detrusor muscle. Therefore, in a mouse model, we investigated the presence of interactions between the submucosal sensory nerves and the autonomic nerves that regulate the motor function of the detrusor muscle. METHODS: UB samples from male C57BL/6 mice were isolated, cut into strips, and mounted in an organ bath. Dose-response curves to norepinephrine and phenylephrine were studied in UB strips with and without mucosa, and the effects of preincubation with a receptor antagonist and various drugs on relaxation were also studied using tissue bath myography. RESULTS: Phenylephrine-induced relaxation of the UB strips showed concentration-related effects. This relaxation appeared in both mucosa-intact and mucosa-denuded UB strips, and was significantly inhibited by lidocaine, silodosin, and guanethidine (an adrenergic neuronal blocker). Meanwhile, phenylephrine-induced relaxation was inhibited by pretreatment with propranolol and calcitonin gene-related peptide (CGRP)–depletory capsaicin in UB strips with and without mucosa. CONCLUSIONS: The present study suggests that phenylephrine activates the α-1A adrenergic receptor (AR) of the sensory nerve, and then activates capsaicin-sensitive sensory nerves to release an unknown substance that facilitates the release of norepinephrine from adrenergic nerves. Subsequently, norepinephrine stimulates β-ARs in the detrusor muscle in mice, leading to neurogenic relaxation of the UB. Further animal and human studies are required to prove this concept and to validate its clinical usefulness.
Adrenergic Neurons ; Animals ; Autonomic Pathways ; Baths ; Calcitonin Gene-Related Peptide ; Capsaicin ; Guanethidine ; Humans ; Lidocaine ; Male ; Mice ; Mucous Membrane ; Myography ; Neuropeptides ; Norepinephrine ; Phenylephrine ; Propranolol ; Receptors, Adrenergic ; Receptors, Adrenergic, alpha-1 ; Relaxation ; Urinary Bladder*

Extensive research in this decade has led to detailed understanding of genetic changes underlying human cancers. Two major tumorigenic events are mutation and amplification of oncogenes and inactivation of tumor suppressor genes. These events then trigger a series of signal transduction cascades, activating expression of downstream genes that control various cellular activities including cell cycle progression, DNA synthesis, programmed cell death, DNA repair, and cell migration. Investigations of these molecular pathways has led to the identification of many targets for therapeutic intervention. Knowledge of the expression patterns and functions of all human genes wil l provide a frame work for future molecular, genetic medicine. During the past ten years, the human genome project has generated an enormous amount of sequencing information, and sequencing of the entire human genome may be completed by the year 2003 (1,2). One can envision that this will irreversibly transform the methodology of medical research and the practice of medicine. The search for new genes, which currently consumes the effort of many talented scientists, will become past history. Additionally, studying one gene at a time will be replaced by studying large number of genes simultaneously(3). Reductionistic approaches to human disease will be replaced by systemic approach. As a prelude to this revolution, tools used for parallel analysis of gene expression in the format of ordered gene arrays have been developed and are under continued expansion. In this technical tip, we will introduce the Atlas Human cDNA Expression Array system developed by Clontech Laboratories, Inc.(4). With this technology, a conventional laboratory can profile the expression of 588 human genes simultaneously in one simple experiment without the using of expensive equipment. We will demonstrate the profiling of 588 genes in a human glioblastoma cell line to exemplify the utility of this technique.
Aptitude ; Cell Cycle ; Cell Death ; Cell Line ; Cell Movement ; DNA ; DNA Repair ; DNA, Complementary* ; Gene Expression ; Genes, Tumor Suppressor ; Genome, Human ; Glioblastoma ; Glioma* ; Human Genome Project ; Humans* ; Oncogenes ; Signal Transduction

A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.
Chloroquine/*adverse effects/therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement/*methods ; Lupus Erythematosus, Systemic/drug therapy ; Macula Lutea/drug effects/*pathology ; Middle Aged ; Ophthalmoscopy/*methods ; Retinal Diseases/chemically induced/*diagnosis