A step towards stereotactic navigation during pelvic surgery: 3D nerve topography

Background: Long-term morbidity after multimodal treatment for rectal cancer is suggested to be mainly made up by nerve-injury-related dysfunctions. Stereotactic navigation for rectal surgery was shown to be feasible and will be facilitated by highlighting structures at risk of iatrogenic damage. The aim of this study was to investigate the ability to make a 3D map of the pelvic nerves with magnetic resonance imaging (MRI). Methods: A systematic review was performed to identify a main positional reference for each pelvic nerve and plexus. The nerves were manually delineated in 20 volunteers who were scanned with a 3-T MRI. The nerve identifiability rate and the likelihood of nerve identification correctness were determined. Results: The analysis included 61 studies on pelvic nerve anatomy. A main positional reference was defined for each nerve. On MRI, the sacral nerves, the lumbosacral plexus, and the obturator nerve could be identified bilaterally in all volunteers. The sympathetic trunk could be identified in 19 of 20 volunteers bilaterally (95%). The superior hypogastric plexus, the hypogastric nerve, and the inferior hypogastric plexus could be identified bilaterally in 14 (70%), 16 (80%), and 14 (70%) of the 20 volunteers, respectively. The pudendal nerve could be identified in 17 (85%) volunteers on the right side and in 13 (65%) volunteers on the left side. The levator ani nerve could be identified in only a few volunteers. Except for the levator ani nerve, the radiologist and the anatomist agreed that the delineated nerve depicted the correct nerve in 100% of the cases. Conclusion: Pelvic nerves at risk of injury are usually visible on high-resolution MRI w

Supporting information : Biginelli Reaction Synthesis of Novel Multitarget- Directed Ligands with Ca2+ Channel Blocking Ability, Cholinesterase Inhibition, Antioxidant Capacity, and Nrf2 Activation

Peer reviewe

The Extended Learning Curve for Laparoscopic Fundoplication: A Cohort Analysis Of 400 Consecutive Cases

Many studies have looked at the learning curve associated with laparoscopic Nissen fundoplication (LNF) in a given institution. This study looks at the learning curve of a single surgeon with a large cohort of patients over a 10-year period. Prospective data were collected on 400 patients undergoing laparoscopic fundoplication for over 10 years. The patients were grouped consecutively into cohorts of 50 patients. The operating time, the length of postoperative hospital stay, the conversion rate to open operation, the postoperative dilatation rate, and the reoperation rate were analyzed. Results showed that the mean length of operative time decreased from 143 min in the first 50 patients to 86 min in the last 50 patients. The mean postoperative length of hospital stay decreased from 3.7 days initially to 1.2 days latterly. There was a 14% conversion to open operation rate in the first cohort compared with a 2% rate in the last cohort. Fourteen percent of patients required reoperation in the first cohort and 6% in the last cohort. Sixteen percent required postoperative dilatation in the first cohort. None of the last 150 patients required dilatation. In conclusion, laparoscopic fundoplication is a safe and effective operation for patients with gastroesophageal reflux disease. New techniques and better instrumentation were introduced in the early era of LNF. The learning curve, however, continues well beyond the first 20 patients

Minimally invasive surgery and cancer: controversies part 1

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the pro–con debate format

Equine onchocerciasis in Queensland and the Northern Territory of Australia

Investigations were conducted on the taxonomy, distribution in the carcase, pathology and transmission of Onchocerca spp. in equids from Queensland and the Northern Territory. Examination of small groups of horses and ponies revealed high infection rates with O. cervicalis, while lesser numbers were infected with O. gutturosa. O. reticulata was not found. Neither of the Australian species is likely to be of economic importance to the horsemeat industry. The findings support the belief that O. cervicalis is a pre‐disposing factor in the aetiology of equine nuchal disease, most commonly seen clinically as fistulous withers. O. gutturosa is virtually non‐pathogenic. Forcipomyia (Lasiohelea) townsvillensis, Austrosimulium pestilens and Culicoides victoriae are suggested as potential vectors, and it is unlikely that C. brevitarsis is involved. Copyrigh

The effects of two calcium antagonists (nifedipine and verapamil) n renal function in sheep

The effects of the calcium antagonists, nifedipine and verapamil, were measured in five conscious Merino ewes at a dose rate of 0.5 microgram min-1 kg-1 for 60 min. Nifedipine caused a significant fall in mean arterial blood pressure (MABP) and central venous pressure (CVP) and an increase in heart rate (HR). There was no significant effect on renal vascular resistance (RVR) but, with the fall in MABP, renal plasma flow (RPF) decreased. There was a significant rise in glomerular filtration rate (GFR) and a small rise in filtration fraction (FF). Solute excretion, urine osmolality and solute-free water reabsorption (Tc, H2O) increased and urine flow (V) decreased. Plasma potassium (PK) and osmolality (Posm) decreased. Verapamil produced a similar fall in MABP and also had similar effects on the other parameters, except that in this case RVR was significantly reduced and there were significant increases in RPF and GFR. The rise in GFR which occurred regardless of the change in RPF, can account for the increase in solute excretion, although an effect of the calcium antagonists on tubular function cannot be excluded