Innovative Device for Indocianyne Green Navigational Surgery

Dynamic reality has been integrated into developing surgical techniques, with the goals of providing increased intraoperative accuracy, easier detection of critical anatomical landmarks, and better general results for the patient. Enhancement of the reality in surgical theaters using single or multi sensorial augmenters (haptic, thermic and visual) has been reported with various degrees of success. This paper presents a novel device for navigational surgery and ancillary clinical applications based on the fluorescent properties of Indocyanine Green (ICG), a safe, FDA-approved dye that emits fluorescence at higher wavelengths than endogenous proteins. The latest technological developments and the aforementioned convenient quantum behavior of ICG allow for its effective identification in tissues by means of a complementary metal-oxide semiconductor (CMOS) infrared camera. Following fundamental research on the fluorophor in different biological suspensions and at various concentrations, our team has built a device that casts a beam of excitation light at 780nm and collects emission light at 810-830nm, filtering ambient light and endogenous autofluorescence. The emission light is fluorescent and infrared, unlike visible light. It can penetrate tissues up to 1.6cm in depth, providing after digitization into conventional imaging anatomical and functional data of immense intra-operative value

Cesarean scar defects and placental abnormalities – a 3 year survey study

The placenta is an essential organ for embryonic and fetal development, ensuring nutrient uptake, gas exchange (via the mother\u27s blood supply), waste elimination, thermo-regulation, immunological and hormonal factors, etc. The most common placental abnormalities are represented by placenta previa, and a morbidly adherent placenta (in the form of accreta, increta, and percreta placenta). This study was performed on a sample of 99 patients diagnosed with abnormalities of placentation who underwent cesarian delivery during a period of 3 years in Bucur Maternity Hospital. Seven patients were diagnosed with morbidly adherent placenta (5 accreta and 2 percreta subtypes), the others having placenta previa (65 with lateral disposition, 18 marginal, and 9 central insertion). All patients had been diagnosed by ultrasound (which was also used for general monitoring), being confirmed during operation and histopathologically. Complications required 4 emergency peripartum hysterectomies, with no maternal mortality but with fetal death in one case. The research literature shows that about half of women with placenta previa have several episodes of bleeding, being the leading cause of antepartum hemorrhage. For some women with placenta previa/accrete, hemorrhaging is severe and requires hysterectomy as a necessary step to control the life-threatening situation. Thus, such patients should be carefully monitored to avoid as much as possible the medical, social, and psychological implications of this critical therapeutic procedure

Indocyanine green utility in sentinel node detection for cervical cancer patients

With wide implementation of screening tests for the Human Papilloma Virus, the number of diagnosed cases of premalignant or early stages of cervical cancer has increased considerably. As a consequence, surgeons’ attention has focused on determining how best to limit the surgical procedure so the benefits of the procedure will not be surpassed by postoperative morbidity. In this respect, extended lymph node dissection, routinely associated so far with cervical cancer patients, has in the last decades been replaced with sentinel node detection and biopsy. Initially performed through radiocolloid injection, this method has undergone permanent changes in order to maximize its efficacy and safety. Although the laparoscopic approach had been widely used in the past, a new method has been proposed, i.e., the use of indocyanine green injection, which has yielded promising results for sentinel node detection in the early stages of cervical carcinoma. This paper reviews the literature of the most relevant studies conducted on this topic

Innovative Device for Indocianyne Green Navigational Surgery

Dynamic reality has been integrated into developing surgical techniques, with the goals of providing increased intraoperative accuracy, easier detection of critical anatomical landmarks, and better general results for the patient. Enhancement of the reality in surgical theaters using single or multi sensorial augmenters (haptic, thermic and visual) has been reported with various degrees of success. This paper presents a novel device for navigational surgery and ancillary clinical applications based on the fluorescent properties of Indocyanine Green (ICG), a safe, FDA-approved dye that emits fluorescence at higher wavelengths than endogenous proteins. The latest technological developments and the aforementioned convenient quantum behavior of ICG allow for its effective identification in tissues by means of a complementary metal-oxide semiconductor (CMOS) infrared camera. Following fundamental research on the fluorophor in different biological suspensions and at various concentrations, our team has built a device that casts a beam of excitation light at 780nm and collects emission light at 810-830nm, filtering ambient light and endogenous autofluorescence. The emission light is fluorescent and infrared, unlike visible light. It can penetrate tissues up to 1.6cm in depth, providing after digitization into conventional imaging anatomical and functional data of immense intra-operative value

Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study

Emergency peripartum hysterectomy (EPH) is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above. The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12), with a median age of 31,16 (ranging from 21 to 44 years old). The most important risk factor present across the lot was multiparity (11 from 12), with cicatricial uterus being the second one (4 of 12). ICU median time was 4,5 days (ranging from 3 to 15 days), with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy

Indocyanine green utility in sentinel node detection for cervical cancer patients

With wide implementation of screening tests for the Human Papilloma Virus, the number of diagnosed cases of premalignant or early stages of cervical cancer has increased considerably. As a consequence, surgeons’ attention has focused on determining how best to limit the surgical procedure so the benefits of the procedure will not be surpassed by postoperative morbidity. In this respect, extended lymph node dissection, routinely associated so far with cervical cancer patients, has in the last decades been replaced with sentinel node detection and biopsy. Initially performed through radiocolloid injection, this method has undergone permanent changes in order to maximize its efficacy and safety. Although the laparoscopic approach had been widely used in the past, a new method has been proposed, i.e., the use of indocyanine green injection, which has yielded promising results for sentinel node detection in the early stages of cervical carcinoma. This paper reviews the literature of the most relevant studies conducted on this topic

The risk of bleeding and encephalopathy in surgical patients with liver cirrhosis

Liver cirrhosis is a disease with an increasing incidence. Surgical procedures in patients with cirrhosis are also increasing, due to a longer life expectancy in these patients and also to the improvement of therapeutic and diagnostic resources. Digestive hemorrhage in the cirrhotic patient requires emergency medical intervention (intensive therapy, endoscopic or even surgical approaches), being at the same time a factor that precipitates episodes of encephalopathy, i.e. the conventional complication of cirrhosis. Hepatic encephalopathy represents one of the most severe clinical events of cirrhosis, being associated with high morbidity and mortality. The causes of hepatic encephalopathy are briefly presented in this paper. Therapeutic approaches currently available consist in the administration of non-absorbable disaccharides such as lactulose and non-absorbable antibiotics such as rifaximin. New therapeutic perspectives are under evaluation, e.g. ammonia scavengers and the modulation of gut microbiota. Clotting disorders in patients with liver cirrhosis are more severe as the disease progresses and involves complex mechanisms, as presented in this review. The correction of possible disorders of hemostasis should be promptly made as a sine qua non condition prior to surgery

The correlation between histopathological and ultrasound findings regarding Cesarean section scars – A three-year survey study

The cesarean operation represents a major surgery, with a higher risk of postoperative complications and longer postoperative recovery than vaginal delivery. Due to the increasing frequency of cesarean sections, the ultrasound imaging of the uterine scar has become a particularly useful tool in identifying its potential long-term complications. This should be done pre-conceptively and quarterly or whenever necessary during pregnancy. Currently, there are only few histopathological studies on the uterine scar, trying to assess the myometrial repair and certain factors that influence the quality of the scar. The study was performed on a batch of 123 patients with previous C-sections, with multiple ultrasound exams during pregnancy and post-operative pathologic evaluation of the uterine scar in order to assess the possibility of a new prognostic score by correlating these two factors. Our study found solid evidence related to possible correlations between histopathological and ultrasound data on the cesarean section scar, which could lead to a possible predictive algorithm with implications for both prognostic and therapeutic fields

Modern management of diabetic foot complications

Diabetes mellitus comprises a heterogeneous group of metabolic abnormalities, characterized by chronic hyperglycemia, resulting from a deficiency in insulin secretion, a deficiency in action, or from both situations. In its evolution, diabetes can lead to acute or chronic complications, which can be avoided or whose progression can be slowed by optimal glycemic control, provided by the effective treatment, diet, physical activity and glycemic monitoring. One of the most common complications of diabetes is diabetic neuropathy which, in combination or not with peripheral arterial disease, may result in leg changes (ulcers, gangrene, amputations), changes that are known under the heading of diabetic foot. The risk of developing leg ulcer is 25% in the life of a patient with type 1 or 2 diabetes, and amputations of varying degrees may sometimes be necessary. These can, however, be prevented by active screening characterized by the neurological examination for neuropathic signs, and the vascular examination to highlight the presence of peripheral arterial disease. Therefore, in order to prevent the appearance of leg ulcers and to reduce the morbidity associated with it, it is important to diagnose and manage risk factors

The Utility of Magnetic Resonance Imaging in the Multidisciplinary Treatment of Patients with Rectal Cancer

Rectal cancer is one of the most common types of cancer in both men and women. In recent years, the importance of magnetic resonance imaging (MRI) has greatly increased in the multidisciplinary treatment of patients with rectal cancer. MRI has a particularly important role in the most accurate preoperative staging of these patients, both in terms of assessing the local invasion of the tumor and in terms of assessing the status of pelvic lymph nodes. Many patients with rectal cancer, especially those in the advanced stage of the disease, in the preoperative period undergo neoadjuvant radio chemotherapy. The evaluation of the clinical response of these patients to neoadjuvant therapy is of crucial importance both in terms of personalized treatment and in terms of their prognosis. In this regard, MRI has its clearly defined role at present in evaluating the efficacy of neoadjuvant therapy, as well as in postoperative follow-up