A High-Intensity Focused Ultrasound Surgery Theater Design in a Private Clinic.

Noninvasive high-intensity focused ultrasound (HIFU) surgery has become a popular surgical treatment for fibroids, adenomyosis, and various gynecological diseases in China and many countries. While traditional theater designs in hospitals are standardized and easily available for reference, an outpatient HIFU theater design is not yet available in the literature or is nonexistent. The authors presented the design and setup of an ultrasound-guided HIFU center in Hong Kong and listed the space and safety requirements and special features of their HIFU theater. Despite its limited space, the HIFU surgery center has made available a nursing station, a changing room, and an observation/recovery room. A room for learning HIFU treatment and viewing is also available without any intrusion of patient's privacy during treatment. The article concluded that because the space requirements for a HIFU theater were much reduced, the cost of the HIFU theater setup would be much cost-effective. Finally, its relaxing lighting environment was totally different and impossible to be installed in a traditional operating theater in a hospital.

Small bowel obstruction from barbed suture following laparoscopic myomectomy-A case report.

Myomectomy is commonly performed for symptomatic fibroids in women who wish to conserve fertility. Laparoscopic myomectomy provides advantages as a minimally invasive procedure. To facilitate the closure of the uterine wound after enucleation of the fibroid, barbed sutures have been introduced as they can shorten the operative time and reduce the amount of bleeding. However, the use of barbed suture is not without risk. There were a few reports on the risks of barbed sutures in the literature. We report herein a case of acute abdomen because of small bowel entrapment and obstruction following the use of barbed suture in laparoscopic myomectomy. Surgeons using barbed suture in myomectomy should be vigilant on the possibility of this bowel complication whenever adverse clinical situation arises as the outcome could be serious if the condition was left unchecked.

Chinese Acupuncture Expert System (CAES)-a useful tool to practice and learn medical acupuncture.

This paper describes the development of a Chinese Acupuncture Expert System (CAES) that will assist the learning and practice of medical acupuncture. This was the development of a Chinese Acupuncture Expert System which incorporated eight functional modules. These modules were 1) Add Patient Record subsystem; 2) Diagnosis subsystem ; 3) Acupuncture Prescription subsystem ; 4) Needle Insertion Position Animation subsystem ; 5) Acupuncture Points Usage Statistic subsystem ; 6) History Query subsystem; 7) Acupuncture Points Query subsystem and 8) Diagnosis Remarks and Diagnosis Record Save subsystem. Two databases were built-Patient Record database and Diagnosis (Acupuncture) Knowledge database. All the Traditional Chinese Medicine (TCM) knowledge and acupuncture treatment prescriptions were extracted from officially used TCM textbooks and received guidance and expert advice from two acupuncturists working in this project. A Chinese Acupuncture Expert System (CAES) was built, which after the input from users of any Chinese disease symptoms and signs, it can provide a list of related TCM syndrome diagnoses based on the patients' disease symptoms and signs, and at the same time it can offer advice of the appropriate Chinese acupuncture treatment to the users. CAES also provided text descriptions and acupuncture animations showing the acupoint locations and the direction and depth of the needle insertion technique. Therefore users can easily learn acupuncture and practice it. This new acupuncture expert system will hopefully provide an easy way for users to learn and practice Chinese Acupuncture and establish its usefulness after it was fully evaluated.

Cervical endometriosis: case series and review of literature.

Cervical endometriosis is uncommon and usually an incidental or retrospective finding on histopathology reports. It can be asymptomatic or present with a diverse range of persistent symptoms and even life-threatening hemorrhage. The condition can be managed expectantly in asymptomatic patients, however persistent symptoms may warrant surgery. We encountered four cases of histologically proven cervical endometriosis at our tertiary hospital in New South Wales, Australia. All our patients had different symptoms, presentations and indications for their surgery leading to their diagnosis. This review is to report these cases followed by discussion with a review of the literature.

A new bioimpedance research device (BIRD) for measuring the electrical impedance of acupuncture meridians.

OBJECTIVES: The aim of this article is to introduce an electrical bioimpedance device that uses an old and little-known impedance measuring technique to study the impedance of the meridian and nonmeridian tissue segments. DESIGN: Three (3) pilot experimental studies involving both a tissue phantom (a cucumber) and 3 human subjects were performed using this BIRD-I (Bioimpedance Research Device) device. This device consists of a Fluke RCL meter, a multiplexer box, a laptop computer, and a medical-grade isolation transformer. Segment and surface sheath (or local) impedances were estimated using formulae first published in the 1930s, in an approach that differs from that of the standard four-electrode technique used in most meridian studies to date. RESULTS: Our study found that, when using a quasilinear four-electrode arrangement, the reference electrodes should be positioned at least 10 cm from the test electrodes to ensure that the segment (or core) impedance estimation is not affected by the proximity of the reference electrodes. A tissue phantom was used to determine the repeatability of segment (core) impedance measurement by the device. An applied frequency of 100 kHz was found to produce the best repeatability among the various frequencies tested. In another preliminary study, with a segment of the triple energizer meridian on the lower arm selected as reference segment, core resistance-based profiles around the lower arm showed three of the other five meridians to exist as local resistance minima relative to neighboring nonmeridian segments. The profiles of the 2 subjects tested were very similar, suggesting that the results are unlikely to be spurious. CONCLUSIONS: In electrical bioimpedance studies, it is recommended that the measuring technique and device be clearly defined and standardized to provide optimal working conditions. In our study using the BIRD I device, we defined our standard experimental conditions as a test frequency of 100 kHz and the position of the reference electrodes of at least 10 cm from the test electrodes. Our device has demonstrated potential for use in quantifying the degree of electrical interconnection between any two surface-defined test meridian or nonmeridian segments. Issues arising from use of this device and the measurement Horton and van Ravenswaay technique were also presented.

A modified technique of LAVH with the Biswas uterovaginal elevator.

This was a review of 512 consecutive cases of laparoscopic-assisted vaginal hysterectomy (LAVH) for benign gynecologic conditions with the Biswas uterovaginal elevator (BUVE) from February 2003 through June 2008. A single operator, using the BUVE and a standard surgical protocol, performed all hysterectomies. Variables analysis included patient demographics, operative times, uterine weight, hospital stay, intraoperative blood loss, and intraoperative and postoperative complications. LAVH was successfully performed for all patients. The median operative time was 62 [corrected] minutes, range 35 to 250 minutes. The median uterine weight was 231 [corrected] g (range 43-1690 g). The median estimated blood loss was 100 [corrected] mL (range 5-1600 mL). The median length of hospital stay was 1 [corrected] days (range 1-6 days). [corrected] No case sustained injury to the ureter or major vessels or required conversion. LAVH with the BUVE eliminates the need for laparotomy in performing hysterectomies for benign gynecologic disorders. The BUVE can achieve a full range of uterine manipulation. It allows safe and easy dissection of the bladder and precise colpotomy through simultaneous uterine elevation and delineation of vaginal fornices. Prevention of ureteric injury is made possible by moving the surgical field away from the ureter. The technique described can be used to handle a wide variety of diseases and situations and has been shown to be safe, fast, easy to learn, and reproducible and carries few complications.