Navigated ultrasound in laparoscopic surgery.

Laparoscopic surgery is performed through small incisions that limit free sight and possibility to palpate organs. Although endoscopes provide an overview of organs inside the body, information beyond the surface of the organs is missing. Ultrasound can provide real-time essential information of inside organs, which is valuable for increased safety and accuracy in guidance of procedures. We have tested the use of 2D and 3D ultrasound combined with 3D CT data in a prototype navigation system. In our laboratory, micro-positioning sensors were integrated into a flexible intraoperative ultrasound probe, making it possible to measure the position and orientation of the real-time 2D ultrasound image as well as to perform freehand 3D ultrasound acquisitions. Furthermore, we also present a setup with the probe optically tracked from the shaft with the flexible part locked in one position. We evaluated the accuracy of the 3D laparoscopic ultrasound solution and obtained average values ranging from 1.6% to 3.6% volume deviation from the phantom specifications. Furthermore, we investigated the use of an electromagnetic tracking in the operating room. The results showed that the operating room setup disturbs the electromagnetic tracking signal by increasing the root mean square (RMS) distance error from 0.3 mm to 2.3 mm in the center of the measurement volume, but the surgical instruments and the ultrasound probe added no further inaccuracies. Tracked surgical tools, such as endoscopes, pointers, and probes, allowed surgeons to interactively control the display of both registered preoperative medical images, as well as intraoperatively acquired 3D ultrasound data, and have potential to increase the safety of guidance of surgical procedures.

Buccal mucosal transposition flap for reconstruction of oropharyngeal-oral cavity defects: an analysis of six cases.

BACKGROUND: Operation on tumors situated in the posterior part of the oral cavity is a challenging aspect of head and neck surgery. Both the approach and the postablative reconstruction of the remaining defect require special procedures. An arsenal of reconstructive methods are available depending on the size and complexity of the defect. The goal should be to employ the simplest surgical reconstructive method, resulting in the best functional result and allowing for later complex oncotherapy. OBJECTIVE: To study the outcomes of patients treated using buccal mucosal transposition flaps for reconstruction of posterior oral cavity and oropharyngeal border defects. STUDY DESIGN: A total of 6 patients with defects of the posterior oral cavity and mesopharynx were treated with buccal mucosal transposition flaps. The patients were followed for up to 24 months. RESULTS: Defects ranging from 12 to 27 cm 2 were reconstructed with the buccal mucosal transposition flap. One patient developed an orocutaneous fistula and 1 had some trismus requiring a Z-plasty scar reorientation. One patient suffered from nasal regurgitation. Five of the 6 patients lived past 24 months, the time of follow-up of this study. CONCLUSIONS: The buccal mucosal transposition flap, with its random pattern of circulation, used alone proved to be a safe method to reconstruct soft tissue defects or line exposed hard tissues located in the posterior oral cavity and oropharynx.

[Buccal flap reconstruction of oropharyngeal defects] / Buccalis lebeny alkalmazása oropharyngealis szövetpótlásra.

AIM: Introduction of a safe and reliable method for reconstruction of soft tissue defects after excision of T1-T2 and borderline carcinomas of the posterior part of the oral cavity and mesopharynx. METHOD: Operation of two male patients suffering from tonsillolingual carcinoma, one with recurrent tumour after irradiation, the other with untreated primary and neck metastasis. After excision of the tumour with mandibular splitting method only a random buccal transposition flap was applied for reconstruction. The flap was adapted anatomically into the defect. It is a modification of previously described methods. RESULTS: Both patients healed primarily with undisturbed blood circulation of the flap. The functional rehabilitation period was short, the flap tolerated the postoperative irradiation, a moderate trismus remained after completion of the treatment, but it was not attributable to the flap. CONCLUSION: The use of the single buccal transposition flap for reconstruction of smaller defects of the posterior part of the oral cavity seems to be a simple, reliable and safe method even after irradiation. The key of the acceptable functional results is the correct adaptation of the flap

Cytotoxicity of lymphocytes and antibodies against autologous tumor cells in patients with myeloid leukaemias and preleukaemic disorders. III. Stage-dependence of oncovirus-specific immune response.

Lymphocyte and plasma samples from the quiescent and blastic phase of chronic granulocytic leukaemia (CGL) and from the blastosis and remission of acute myeloid leukaemia (AML), were compared for cytotoxic activity. Target cells were collected from the blastic phases of diseases. 51Cr-release tests showed that the lymphocytes and plasma samples from blastic crisis of CGL had no cytotoxic activity for autologous blast cells. In contrast, cryopreserved lymphocytes and plasmas from the quiescent phase of CGL proved to be cytotoxic for the autologous tumor cells, and their effect could be blocked by native gp70 antigens of gibbon ape leukaemia virus (GaLV) and baboon endogenous virus (BaEV). A blocking effect was less frequently exerted by carbohydrate-free gp70 and p15(E) antigens. A similar relationship was found between the blastosis and remission stage of AML, however, out of the antigens of BaEV only the native gp70 showed a marked blocking effect.

Detection of main core proteins of simian C-type viruses and human retrovirus HTLV and antibodies to them in patients with lymphoid malignancies.

Peripheral leukocytes or lymph node cells and blood plasma samples from patients with lymphoid malignancies were investigated for immunological markers of BaEV, GaLV and HTLV. Antigens and antibodies were shown with radioimmunoassay. Antigen related to the p30 core protein of BaEV could be detected in each cell type of leukaemias and lymphomas. Antigen related to the GaLV p30 was found mainly in B- and O-cell forms, while that related to the p24 protein of HTLV could be detected only in two T-cell malignancies. Antibodies reactive with these antigens showed a similar distribution.

Studies on the specificity of human antibodies reacting with GP70 and P15 antigens of baboon endogenous (BaEV) and gibbon ape leukaemia (GaLV) viruses.

Antibodies reacting with gp70 and p15 antigens of baboon endogenous virus (BaEV) and gibbon ape leukaemia virus (GaLV) were detected by radioimmunoprecipitation (RIP) in blood plasma samples of patients with chronic granulocytic leukaemia, acute myeloid leukaemia and with potentially preleukaemic haematological disorders. Anti-gp70 antibodies were found more frequently than anti-p15 antibodies. Digestion of the carbohydrate part of gp70 antigens by glycosidase treatment abrogated the precipitation mediated by IgM antibodies, whereas that mediated by IgG antibodies was not markedly affected. Data suggest that antibodies detected in human plasma samples may have oncovirus specificity, but in considerable part of cases they can be of heterophil nature.

Cellular and humoral cytotoxicity in patients with leukaemia and preleukaemia. II. Oncovirus specificity of the reaction.

Cytotoxic activities of lymphocytes and antibodies against autologous tumour cells detected by 51Cr release technique were frequent in patients with chronic granulocytic leukaemia, but infrequent in patients with blastosis of acute myeloid leukaemia. Among subjects with potentially preleukaemic haematological disorders autologous cytotoxic activity was observed only in cases of cytopenia, while samples from patients with polycythaemia vera proved to be devoid of cellular and humoral cytotoxicity. In the majority of cases the cytotoxic activity of lymphocytes and antibodies could be blocked by gp70 antigens of baboon endogenous virus (BaEV) and gibbon ape leukaemia virus (GaLV). p15(E) antigens of BaEV and GaLV showed blocking activity less frequently. Digestion by glycosidase of the carbohydrate of gp70 antigens reduced their blocking activity.

Antibodies to primate retrovirus antigens in circulating immune complexes of patients with acute myeloid leukemia.

Circulating immune complexes were isolated from sera of 8 patients with acute myeloid leukemia (AML) in relapse, and 20 healthy blood donors. F(ab')2 fragments were prepared from the isolated complexes. Using a radioimmunoassay (RIA), these F(ab')2 fragments, the undigested complexes and the original sera were examined for the presence of antibodies against a panel of primate retrovirus antigens: gp70, p15 and p30 of gibbon ape leukemia virus (GaLV) and baboon endogenous virus (BaEV). F(ab')2 fragments derived from the immune complexes of all patients reacted with one or more of the antigens tested, whereas no antibody activity was found in the sera or undigested immune complexes of the same patients. By a competitive RIA, antigens related to GaLV and/or BaEV were found in the serum of 7 out of 8 patients. No markers of these retroviruses were detected in the F(ab')2 preparations, in immune complexes or in sera of any of the 20 control subjects. Our results indicate that a part of the circulating immune complexes in AML contain antigens related to primate retroviruses and specific antibodies to these antigens.

Cell surface antigens reacting with antiretrovirus sera on normal mouse spleen cells: a flow cytometric study.

The development of erythroleukemia in Balb/c mice injected with Rauscher leukemia virus has been followed by indirect immunofluorescence technique and flow cytometry, using antiserum against disrupted of virions. The progression of the disease was accompanied by a great increase in the number of large, immunofluorescence positive cells. A subpopulation of normal spleen cells was also highly positive. The expression of the antigens in normal cells was examined in relation to the cell cycle. The majority of the S-G2/M phase cells were found in the antigen positive compartment of larger cells. A two-color analysis of immunofluorescence and DNA content revealed that the distribution of antigen expression in G1 phase was broad, gradually decreasing from a low-intensity mode. The cell with double DNA content distributed evenly around a modus of five-fold higher intensity. In experiments with stimulated bone-marrow cells, superiority of S-phase cells in anti-Rauscher serum binding was found. Cell-surface gp70 antigen is suggested to be involved in this cell-cycle dependent binding of antibodies by normal cells.

Changes in cyclic AMP and cyclic GMP levels during in vitro chondrogenesis.

cAMP and cGMP levels were measured in micro high-density cultures of chick limb bud mesenchyme cells stages 22-24 after 1, 2, 4 and 6 days of culturing. In these cultures, a consistent cartilage differentiation proceeds parallel to the progressive accumulation of cells in the G0 phase. The cAMP level increased by 45% by the time of the onset of cartilage phenotype expression, and significantly decreased thereafter. The cGMP level gradually diminished by a total of 39% during the period examined. It is suggested that the decrease in cell proliferation may be the consequence of the reduction of the cGMP level, and that a short-term marked elevation of cAMP level induces cartilage differentiation in the limb mesenchymal cells which are able to select only from a limited number of differentiation programmes.

Cytotoxicity of lymphocytes and antibodies against autologous tumor cells in patients with myeloid leukemias and preleukemic disorders. I. Blocking activity of gp70 antigens of primate type C viruses.

Cytotoxicity of lymphocytes or antibodies against autologous tumor cells could be demonstrated very frequently in patients with chronic myeloid leukemia, whereas the presence of such cytotoxic activities was very rare in patients with acute myeloid leukemia. Lymphocytes and antibodies cytotoxic against autologous granulocytes were found in persons with potentially preleukemic cytopenic disorders. Control subjects with nonpreleukemic hematological disorders and healthy persons exhibited no cytotoxic activity. In the majority of cases the lymphocyte- or antibody-mediated cytotoxicity could be blocked with gp70 antigen of gibbon ape leukemia virus and baboon endogenous virus.

Studies on antibodies reactive with glycoproteins of primate type C viruses in patients with myeloid leukemias and with potential preleukemia.

Human blood plasma from patients with myeloid leukemias, potentially preleukemic disorders and healthy individuals contains antibodies which react with purified glycoproteins of the baboon endogenous virus and the gibbon ape leukemia virus. Experiments are presented which illustrate characteristic distributions of antiviral antibodies in the plasma of different investigated groups. The presence of high-titer antibodies is associated with remission of acute myeloid leukemia and longer survival of patients with preleukemia.

Detection by radioimmunoassay of antigens related to the P30 polypeptides of primate type C oncoviruses in peripheral leukocytes from patients with chronic myelogenous leukaemia.

Leukocytes from patients with chronic myelogenous leukaemia were examined for antigens related to the p30 polypeptides of baboon endogenous virus (BaEV) and gibbon ape leukaemia virus (GaLV). Samples from patients with the quiescent phase of the disease proved to be negative or contained p30 of BaEV as the only viral antigen. In cases of blastoid crisis or acceleration, an antigen related to p30 of GaLV could be detected. In 5 of 6 patients, acceleration or blastoid crisis was preceded by expression of GaLV p30.

Studies on cartilage formation. XVI. Chemical and histochemical assay of lipids in the regenerating articular cartilage.

The articular surface of the distal part of the femur was removed operatively in dogs, and the regenerating articular surface and the GTC were investigated at different stages from the 7th to the 70th postoperative days. During this period cartilage islets arose in the GTAS, while the GTC transformed to connective tissue. At 7 days the lipid content of the tissue was markedly higher than at the other stages studied. Lipids, predominantly triglycerides, were present in extracellular form as well. From the 20th to the 70th day the PL fraction became predominant and, in addition to the pre-existing lecithin, relatively large quantities of lysolecithin, sphingomyelin, phosphatidyl-ethanolamine, phosphatidyl-serine and phosphatidyl-inositol could be gradually demonstrated. Differences were noted in the time of appearance and binding of PLs between the two types of granulation tissue. As time proceeded, the proportion of saturated fatty acids decreased in favour of unsaturated ones. At 70 days, the GTAS contained fatty acids up to C18. About 50% of the fatty acids consisted of C16:1, C18:2 and C18:1. At the same stage, in the GTC C16:1, C18:1 and C20:1 were present in larger amounts. Of the free fatty acids C16:1, C16 and C18 were in predominance in the GTAS and the proportion of fatty acids having more then one double bonds increased with time. In the GTC C16 and C18:1 were in great majority. According to histochemical evidence, the tissues did not contain extracellular lipids from the 20th postoperative day. In the cells, the presence of glycerides, PLs, lipoproteins and cholesterol was demonstrated. In addition, in cartilage precursors of more advanced maturity, a considerable fatty acid positivity was noted.

Isolation and characterization of the plasma membrane from Yoshida hepatoma cells.

Plasma membranes isolated from Yoshida ascites hepatoma AH-130 by a modification of the method of T.K. Ray (Biochim. Biophys. Acta 196:1, 1970), were subfractionated into three fractions having densities (d) 1.12, 1.14 and 1.16 by discontinuous sucrose density-gradient. Membrane subfractions were characterized by electron-microscopy, by assay of marker enzymes and by lipid composition. All subfractions appeared to be essentially free from whole mitochondria, lysosomes and nuclei. Subfraction d 1.16 had the highest 5'-nucleotidase, Mg++-ATPase and (Na+ +K+)-ATPase activities; cytochrome c oxidase was undetectable in any fraction and glucose-6-phosphatase was measurable only in fraction d 1.14 and 1.16. Cyclic AMP phosphodiesterase was nearly equally distributed in the fractions. Adenylate cyclase, 5'-nucleotidase and Mg++-ATPase activities of tumor membrane were lower with respect to liver plasma membrane, while cyclic AMP phosphodiesterase and (Na" +K+)-ATPase were found to have similar activities in the two membrane preparations. With respect to liver membrane, hepatoma membrane contained a higher amount of glycolipids and a higher amount of phospholipids accounted for mainly by sphingomyelin, phosphatidylserine and phosphatidic acid. The possible significance of the decrease of adenylate activity in the hepatoma membrane is briefly discussed.