Evaluation of collimated polarized light imaging for real-time intraoperative selective nerve identification in the human hand.

Intraoperative peripheral nerve lesions are common complications due to misidentification and limitations of surgical nerve identification. This study validates a real-time non-invasive intraoperative method of nerve identification. Long working distance collimated polarized light imaging (CPLi) was used to identify peripheral radial nerve branches in a human cadaver hand by their nerve specific anisotropic optical reflection. Seven ex situ and six in situ samples were examined for nerves, resulting after histological validation, in a 100% positive correct score (CPLi) versus 77% (surgeon). Nerves were visible during a clinical in vivo observation using CPLi. Therefore CPLi is a promising technique for intraoperative nerve identification.

Inside Front Cover: Polarized-Light-Emitting Quantum-Rod Diodes (Adv. Mater. 11/2005).

Polarized-light-emitting quantum-rod diodes have been successfully produced using thin layers of quantum rods oriented by a rubbing technique, as shown on the inside cover. Hikmet and co-workers report on p. 1436 that diode emission at 620 nm with a luminance efficiency of 0.65 cd A-1 and an external quantum efficiency of 0.49 % is obtained. Light emitted polarized parallel to the long axis of the rods is 1.5 times more intense than that polarized perpendicular to the rods.

Polarized-Light-Emitting Quantum-Rod Diodes.

For the first time, polarized-light-emitting quantum-rod diodes have been successfully produced, using thin layers of quantum rods oriented by a rubbing technique. Diode emission at 620 nm with a luminance efficiency of 0.65 Cd A-1 and an external quantum efficiency of 0.49 % is obtained.

Inferior vena caval resection with autogenous peritoneo-fascial patch graft caval repair: a new technique.

BACKGROUND: In the course of oncological surgery, resection of the inferior vena cava (IVC) may be required to obtain an adequate resection margin and to offer the best opportunity of cure. The remaining defect in the IVC may be managed by: (i) primary repair which may lead to subsequent narrowing of the lumen, possibly leading to turbulent flow and thrombus formation; (ii) patch grafting of the defect, which may prevent narrowing. Several synthetic and biosynthetic materials are available as patch grafts and autologous pericardium has also been used. METHODS: The harvesting and use of the autogenous peritoneo-fascial (APF) graft as an alternative caval patch graft material in the management of defects in the caval wall is proposed. Autogenous peritoneo-fascial caval patch graft repair in six patients was undertaken. RESULTS: One patient with leiomyosarcoma secondaries in the liver eventually succumbed to the disease. The other five patients are clinically well with no evidence of IVC obstruction or venous aneurysms. CONCLUSION: Preliminary results show that this new technique of utilizing an APF patch graft for caval repair is clinically a suitable alternative to current biosynthetic and synthetic materials and may in fact be superior in many aspects.

"Gallstone hip" and other sequelae of retained gallstones.

The fate of gallstones spilled during laparoscopic cholecystostomy has been thought to be relatively benign. Recent experience and a review of the recent literature shows that this is not always the case. We report three cases of complications of retained stones and analyse the literature with regard to types of complications, time to presentation, and recommendations for managing spilled gallstones. Retained gallstones have been shown to cause adhesions in the rat and inflammatory reactions in dogs with no evidence of absorption. The average time to presentation of complications arising from retained gallstones is 27.3 weeks. Complications include: Intraabdominal abscess formation with or without abdominal wall sinus tract formation, persisting abdominal wall sinus tracts from port site abscess, subhepatic inflammatory masses, cholelithoptysis, microabscesses and granuloma formation, liver abscess and "dumbell" shaped abscess with one side of the "dumbell" forming a subcutaneous abscess. We recommend the judicious use of retrieval devices during the extraction phase of the laparoscopic cholecystectomy, diligent removal of any spilled stones and awareness of delayed postoperative pain and tenderness as a harbinger of symptomatic retained gallstones. Documentation of intraoperative gallstone spillage, volume, type of gallstones, and effort to retrieve is recommended.