Stellenwert der minimal-invasiven Chirurgie beim primären und sekundären Hyperparathyroidismus

BACKGROUND: The standard surgical approach to treat primary (pHPT) and secondary hyperparathyroidism (sHPT) used to be a cervicotomy with exploration of all four parathyroid glands. This access has been challenged recently by the introduction of minimally invasive techniques in order to achieve superior cosmesic results and to reduce theatre time. We analyzed the advantages and morbidities of these surgical aproaches. PATIENTS AND METHODS: Between 1997 and 2006 a total of 123 patients (109 with pHPT and 14 with sHPT) underwent parathyroidectomy at the ENT Department in Luzern. Ultrasonographic scanning was performed on 74 patients (68%), szintigraphy in 8 patients (7%) and both scanning methods in 27 patients (25%). 103 patients were available for follow-up. The indications for each technique were reviewed and outcome measures included serum Calcium and parathyroid hormone levels. RESULTS: Sensitivity for preoperative ultrasonographic and scintigraphic scanning was 67% and 65% for identification of the correct quadrant and 74% and 71% for identification of the correct side. A bilateral exploration was performed until June 2001 for all patients. Thereafter, a minimally invasive approach was chosen for patients with pHPT, whereas patients with sHPT still require bilateral exploration. Adequate preoperative localization was a prerequisite for a minimally invasive technique. Mean postoperative serum Kalzium levels were within the normal range, independently of the surgical technique and disease. Two patients developed hypercalcemia after an initially successful operation. CONCLUSIONS: Review of the literature confirms the shift from bilateral exploration towards minimally invasive techniques. The incidence of persistent or recurrent disease as well as the rate of complications seems comparable. Operation time for minimally invasive techniques is reduced in the hands of an experienced surgeon. However, proper preoperative localization of the diseased parathyroid gland is not always possible and the expenses of intraoperative parathyroid hormone measures do not lower the overall costs. Considerable experience and a multidisiplinary approach (endocrinologist, surgeon, pathologist) is required to adopt efficient minimally invasive techniques. As for sHPT, bilateral exploration remains the treatment of choice

Possibilities for Measurement and Compensation of Stray DC Electric Fields Acting on Drag-Free Test Masses

DC electric fields can combine with test mass charging and thermal dielectric voltage noise to create significant force noise acting on the drag-free test masses in the LISA (Laser Interferometer Space Antenna) gravitational wave mission. This paper proposes a simple technique to measure and compensate average stray DC potentials at the mV level, yielding substantial reduction in this source of force noise. We discuss the attainable resolution for both flight and ground based experiments.Comment: To be published in Advances in Space Research, COSPAR 2002 conference proceedings (6 pages, 3 figures

Measuring random force noise for LISA aboard the LISA Pathfinder mission

The LTP (LISA Testflight Package), to be flown aboard the ESA / NASA LISA Pathfinder mission, aims to demonstrate drag-free control for LISA test masses with acceleration noise below 30 fm/s^2/Hz^1/2 from 1-30 mHz. This paper describes the LTP measurement of random, position independent forces acting on the test masses. In addition to putting an overall upper limit for all source of random force noise, LTP will measure the conversion of several key disturbances into acceleration noise and thus allow a more detailed characterization of the drag-free performance to be expected for LISA.Comment: 7 pages, 3 figures. To be published in Classical and Quantum Gravity with the proceedings of the 2003 Amaldi Meetin

Measuring the LISA test mass magnetic proprieties with a torsion pendulum

Achieving the low frequency LISA sensitivity requires that the test masses acting as the interferometer end mirrors are free-falling with an unprecedented small degree of deviation. Magnetic disturbances, originating in the interaction of the test mass with the environmental magnetic field, can significantly deteriorate the LISA performance and can be parameterized through the test mass remnant dipole moment $\vec{m}_r$ and the magnetic susceptibility $\chi$. While the LISA test flight precursor LTP will investigate these effects during the preliminary phases of the mission, the very stringent requirements on the test mass magnetic cleanliness make ground-based characterization of its magnetic proprieties paramount. We propose a torsion pendulum technique to accurately measure on ground the magnetic proprieties of the LISA/LTP test masses.Comment: 6 pages, 3 figure

Proposta de planejamento estratégico para a Embrapa Trigo.

Orientadora: Denise Michael dos Santos, Coorientador: Alvaro Augusto Dossa

Characterization of disturbance sources for LISA: torsion pendulum results

A torsion pendulum allows ground-based investigation of the purity of free-fall for the LISA test masses inside their capacitive position sensor. This paper presents recent improvements in our torsion pendulum facility that have both increased the pendulum sensitivity and allowed detailed characterization of several important sources of acceleration noise for the LISA test masses. We discuss here an improved upper limit on random force noise originating in the sensor. Additionally, we present new measurement techniques and preliminary results for characterizing the forces caused by the sensor's residual electrostatic fields, dielectric losses, residual spring-like coupling, and temperature gradients.Comment: 11 pages, 8 figures, accepted for publication Classical and Quantum Gravit

Upper limits on stray force noise for LISA

We have developed a torsion pendulum facility for LISA gravitational reference sensor ground testing that allows us to put significant upper limits on residual stray forces exerted by LISA-like position sensors on a representative test mass and to characterize specific sources of disturbances for LISA. We present here the details of the facility, the experimental procedures used to maximize its sensitivity, and the techniques used to characterize the pendulum itself that allowed us to reach a torque sensitivity below 20 fNm /sqrt{Hz} from 0.3 to 10 mHz. We also discuss the implications of the obtained results for LISA.Comment: To be published in Classical and Quantum Gravity, special issue on Amaldi5 2003 conference proceedings (10 pages, 6 figures