An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.

Novel spatula and dissector for safer deep anterior lamellar keratoplasty / Uso de espátula e dissector para otimização da ceratoplastia lamelar anterior profunda (DALK)

Objective: We describe a novel spatula and dissector to facilitate the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Methods: A 29-year-old man who was diagnosed with bilateral keratoconus underwent deep anterior lamellar keratoplasty (DALK). After 350μm partial thickness incision of the recipient cornea, the Bonfadini dissector was inserted at the deepest point in the peripheral incision and could be advanced to the center of the cornea safely because of its "semi-sharp" tip. After achieving the big-bubble (BB) separation of Descemet membrane (DM) from the overlying stroma, the anterior stromal disc was removed. Viscoelastic material was placed on the stromal bed to prevent uncontrolled collapse and perforation of DM during the paracentesis blade incision into the BB. We could detect the safe opening of the BB using the Bonfadini dissector by the leakage of air bubbles into the viscoelastic material. After injecting viscoelastic material into the BB space, we inserted the Bonfadini spatula into the bigbubble safely because of its curved profile and blunt edges. The groove along the length of the Bonfadini spatula enables safe and efficient incision or the residual stromal tissue using the pointed end of a sharp blade while protecting the underlying DM. After removal of posterior stroma, the donor button was sutured with 16 interrupted 10-0 nylon sutures. Results: This technique and the use of the Bonfadini spatula and dissector facilitate exposure of Descemet membrane. Conclusion: The smooth Bonfadini DALK spatula and dissector facilitate safe and efficient completion of DALK surgery. .

Objetivo: Descrevemos o uso de novos instrumentais cirúrgicos para facilitar a técnica de "big-bubble" na ceratoplastia lamelar anterior profunda (DALK). Métodos: Paciente masculino, 29 anos, foi diagnosticado com ceratocone bilateral e submetido à ceratoplastia lamelar anterior profunda (DALK). Após incisão da córnea receptora numa profundidade de 350μm de espessura parcial, o dissector Bonfadini foi inserido no ponto mais profundo da incisão periférica e pode avançar para o centro da córnea com segurança devido à sua ponta semiafiada. Depois de realizar a "big-bubble" (BB) e atingir a separação da Membrana de Descemet (MD) do estroma sobrejacente, o disco corneano de estroma anterior foi removido. Um viscoelástico foi colocado sobre o leito do estroma remanescente para impedir o colapso não-controlado e perfuração da MD durante a incisão na BB com lâmina de paracentese. Verificamos segurança no rompimento do estroma remanescente com o auxílio do dissector Bonfadini, para liberação da bolha de ar da BB através do viscoelástico. Depois de injetar o viscoelástico no espaço da BB, inserimos a espátula Bonfadini neste espaço, o que demonstrou-se seguro devido ao formato curvo e das bordas arredondadas do instrumental. A chanfradura ao longo do comprimento da espátula Bonfadini permite a incisão pela ponta de uma lâmina afiada, protegendo assim a MD subjacente. Após a remoção do estroma posterior, o botão doador foi suturado com 16 pontos interrompidos de fio nylon 10.0. Resultados: Esta técnica e o uso da espátula Bonfadini e dissector facilitam a exposição de membrana de Descemet. Conclusão: A superfície lisa da espátula Bonfadini e dissector, facilitam a realização segura e eficiente da ceratoplastia lamelar anterior profunda (DALK). .

Um objeto reluzente - passos iniciais da clínica psicanalítica com bebês de D. W. Winnicott / A shiny object - initial steps of psychoanalytic clinic for babies with D. W. Winnicott / Un objeto brillante - pasos iniciales del tratamiento psicoanalitico de los bebés con D. W. Winnicott

Com base em interrogações concernentes à especificidade da clínica psicanalítica com bebês, retomamos o método winnicottiano denominado "Observação de bebês em uma situação estabelecida" (Winnicott, 1941/1978a) para recuperar seu alcance teórico-clínico. Com esse instrumento, Winnicott avalia a condição psíquica do bebê em um setting específico que inclui o clínico, a mãe, o bebê e uma espátula reluzente. O instrumento winnicottiano, mesmo tendo sido descrito em um artigo da década de 1940, é atual e eficaz para reconhecer os sinais precoces de sofrimento do bebê...

Departing from interrogations concerning the specificity of the psychoanalytical practice with infants, we resume the Winnicottian method known as "The observation of infants in a set situation" (Winnicott, 1941/1978a) in order to recover the theoretical and clinical range of this instrument. Through this instrument, Winnicott evaluates the psychic condition of the infant and locates his/hers behavioral pattern in a specific setting, which includes the doctor, the mother, the infant, and an object (a shiny spatula). We believe that the Winnicottian´s instrument, even though described in an article written in the 40's, is current and efficient in recognizing early signs of baby distress...

De las cuestiones relativas a la especificidad del método psicoanalítico con niños reanudó Winnicott llama "La observación de bebés en una situación establecida" (Winnicott, 1941/1978a). Con este instrumento, Winnicott evaluar el estado mental del bebé en un entorno específico que incluye al médico, la madre, el bebé y un cuchillo reluciente. Creemos que el instrumento de Winnicott, a pesar de que fue descrito en un artículo publicado en los años 40, es la manera actual y eficaz para reconocer los primeros signos de sufrimiento bebé...

Can the use of ayer’s spatula and cytobrush in combination, improve the adequacy of cervical smears.

Background: The most common cancer affecting women in developing countries is cervical cancer. The most effective tools of cancer detection is cervical smears. The present study is done to see whether the combination two devices can increase the adequacy of smears, The Ayer’s spatula is good sampling device but for sampling endocervical cells it is not that useful, therefore Cytobrush is used in combination to improve the adequacy as it is most efficient in sampling the endocevical cells. Material and methods: The collection of cervical smears was done by combination of Ayer’s spatula and Cytobrush. They were fixed in 95% ethanol and stained by Papanicolaou’s stain. Results: In this study 387 (96.75%) smears were satisfactory and 13(3.25%) were unsatisfactory smears. Conclusion: The combination is better than the devices used alone. The cost is limiting factor in developing countries, but it can be brought down by others ways.

Evaluación de la calidad citológica a través de tres espátulas para la toma del PAP / Evaluation of cytological quality in three different spatulas for PAP testing

Objetivo: identificar la espátula que presente el menor porcentaje de PAP “menos que óptimos”. Metodología: estudio transversal, cuya muestra fue de carácter intencional y estratificada proporcionalmente, constituida por 761 mujeres entre 25 años y 64 años de los consultorios del Servicio de Salud Metropolitano Norte (SSMN). A cada mujer se le tomó PAP por parte de las matronas del servicio utilizando una de tres espátulas: Ayre; espátula plástica y la combinación Citobrush – Ayre (C+A). Los PAP se clasificaron en “satisfactorios” o “menos que óptimos” según el Sistema Bethesda.Resultados: el mayor porcentaje de “menos que óptimas” (17,4 por ciento), se ubicó entre los 25 a 34 años de edad, y el mínimo -0,8 por ciento - entre los 55 a 64 años, siendo este resultado estadísticamente significativo (pvalue<0,000 Prueba Chi2). Al comparar la “calidad citológica” con cada una de las espátulas utilizadas se encontraron diferencias significativas (pvalue < 0,014). La combinación (C+A) y la espátula plástica tuvieron los menores porcentajes de “menos que óptimas” (9,8 por ciento y 10 por ciento, respectivamente) comparado con la espátula de Ayre (17,3 por ciento). Conclusión: La combinación (C+A) presentó el menor porcentaje de “menos que óptimos” y la mejor “calidad citológica”. La combinación (C+A) se comportó como un factor favorecedor de la “calidad citológica”. La mejor “calidad citológica” está asociada a las mayores edades con todas las espátulas utilizadas en este estudio.

Objective: Identify the spatula that achieves the lowest percentage of “less tan optimal” PAP smears.Methodology: Cross-sectional study, with an intentional and proportionally stratified simple, consistingof 761 women between 25 and 64 years of age, in the public health centers of the Northern Metropolitan Health Service. Midwives took the PAP sample from each women using one of the three spatulas: Ayre, a plastic spatula and the combination Citobrush-Ayre (C+A). (Fig 1, 2, 3). The PAP samples were classified as “satisfactory” or “less tan optimal” according to the Bethesda System. Results: The highest percentage of “less tan optimal” samples, (17.4%), was found in women between 25 and 34 years of age, and the minimum (0.8 per cent) in women from 55 to 64 years. This result was statistically significant (p value <0.000 Chi2). Comparing the “cytological quality” of each spatula, significant differences were also found (p value < 0.014). The combination (C+A) and the plastic spatula had lower percentages of “less than optimal” samples (9.8 per cent and 10 per cent, respectively) compared with the Ayre spatula (17.3 per cent). Conclusion: The combination (C+A) achieved the lowest percentage of “less than optimal” samples, and the best “cytological quality.” The combination (C+A) was a factor favoring “cytological quality.” The best “cytological quality” is associated with older age groups with all spatulas used in this study.

Cervical Cytology: A Randomized Comparison of False-Negative Rate in Three Sampling Methods / 대한산부인과학회잡지

No abstract available.