Artifact reduction of coaxial needles in magnetic resonance imaging-guided abdominal interventions at 1.5 T: a phantom study

Needle artifacts pose a major limitation for MRI-guided interventions, as they impact the visually perceived needle size and needle-to-target-distance. The objective of this agar liver phantom study was to establish an experimental basis to understand and reduce needle artifact formation during MRI-guided abdominal interventions. Using a vendor-specific prototype fluoroscopic T1-weighted gradient echo sequence with real-time multiplanar acquisition at 1.5 T, the influence of 6 parameters (flip angle, bandwidth, matrix, slice thickness, read-out direction, intervention angle relative to B0) on artifact formation of 4 different coaxial MR-compatible coaxial needles (Nitinol, 16G–22G) was investigated. As one parameter was modified, the others remained constant. For each individual parameter variation, 2 independent and blinded readers rated artifact diameters at 2 predefined positions (15 mm distance from the perceived needle tip and at 50% of the needle length). Differences between the experimental subgroups were assessed by Bonferroni-corrected non-parametric tests. Correlations between continuous variables were expressed by the Bravais–Pearson coefficient and interrater reliability was quantified using the intraclass classification coefficient. Needle artifact size increased gradually with increasing flip angles (p = 0.002) as well as increasing intervention angles (p < 0.001). Artifact diameters differed significantly between the chosen matrix sizes (p = 0.002) while modifying bandwidth, readout direction, and slice thickness showed no significant differences. Interrater reliability was high (intraclass correlation coefficient 0.776–0.910). To minimize needle artifacts in MRI-guided abdominal interventions while maintaining optimal visibility of the coaxial needle, we suggest medium-range flip angles and low intervention angles relative to B0.

What do we know about N.V. Sklifosovsky?

Nikolay Sklifosovsky was called the acting surgeon of all wars of the 19th century. At the age of 30, he first got into the Austro-Prussian War, which allowed him to gain invaluable experience, after which he volunteered for the front during all the Russian-Turkish campaigns.Participation in military actions allowed him to rise to the rank of general and made Sklifosovsky the founder of modern military field surgery. It was he who first in the world began to use local anesthesia, using cocaine during palatal surgery; he proposed to disinfect instruments and introduced the rules of asepsis and antiseptics. However, his innovative ideas not only contributed to the rescue of hundreds of wounded, but also caused ridicule from colleagues, who used to say things like, you, Sklifosovsky, are so big, but you are afraid of some small bacteria that cannot be clearly discerned. Scientific and practical interests of N.V. Sklifosovsky were not limited to abdominal interventions alone; he successfully performed operations on female genital organs, joints and was very interested in maxillofacial surgery. On Sklifosovsky’s initiative, dentistry was included in the program of university disciplines as an independent science. Despite his undeniable achievements, in life outside the walls of medical institutions, he remained a very simple and courteous person; he never refused to provide medical care to the poor, and sometimes he himself purchased medicine for such patients. Wanting to calm and cheer up the patient before the operation, he never spared his time talking with patients.

Dilemmas Regarding Abdominal Re-Exploration for War Casualties Following On-Site Abdominal Trauma Surgery and Subsequently Delayed Arrival to Medical Care Abroad – An Unusual Scenario

Background: During the Syrian civil war, casualties were treated on-site and only later transferred to foreign medical centers. Significant number needed abdominal re-operation. Our aim is to present our approach to abdominal trauma casualties who survived the on-site surgery and needed abdominal reoperation abroad.Methods: Medical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the casualty population involving abdominal trauma into 4 sub-groups according to the location of abdominal surgical intervention, focusing on missed injuries and post-operative complications in the re-laparotomy sub-group. Results: By July 2018, 236 casualties suffering abdominal trauma (among 1331 trauma casualties) had been admitted to our hospital. Life-saving abdominal interventions had been done in 138 subjects in Syria before arrival to our medical center. Seventy-nine underwent abdominal surgery in Israel, of whom, 46 (33.3%) needed abdominal re-laparotomy. Indications for re-exploration included severe peritoneal inflammation, neglected abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy. Conclusions: Clinical presentation of the Syrian casualties following emergency medical care outside our borders, and the fact that re-operation was not done by the same team responsible for the initial abdominal intervention posed major diagnostic challenges and necessitated increased suspicion and changes in our medical approach.

Upper Gastrointestinal Endoscopy: Basic Upper Endoscopy

Since the beginning of the 1970s, flexible endoscopy of the gastrointestinal tract has been the dominant modality for the diagnosis of gastrointestinal disease. Over the same period, developments in technology and methodology have made possible the use of endos-copy to treat a host of conditions that once were considered to be manageable only by means of surgical intervention. The concept of performing endoscopic surgery has become a reality with the advancement of endoscopic therapies to control hemorrhage and perform mucosal ablations, resections, and tissue approximation. In addition, investigation into intra-abdominal interventions has begun with the progression of natural orifice transluminal endoscopic surgery (NOTES). The tools created for both intraluminal and transluminal procedures will allow the endoscopist to continue to supplant surgical therapies for numerous gastrointestinal diseases. The integration of flexible endoscopic techniques into the armamentarium of the gastrointestinal surgeon permits a more multidi-mensional approach to the treatment of digestive system disorders. The modern surgeon must continue to stay abreast of these en-doscopic advances to provide appropriate patient care. This review contains 12 figures, 2 tables, and 21 references. Key words: optical biopsy, chromoendoscopy, over the scope clips, endoscopic suturing techniques

Infusion Therapy Optimization in Selective Abdominal Surgery

Purpose. Evaluation of the influence of intra-operative targeted infusion therapy managed by the monitoring of stroke volume variability on post-operative results of major surgeries of gastrointestinal organs.Materials and Methods. The prospective study included 80 patients subjected to selective operative interventions of abdominal organs involving entero-enteroanastomosis. In the experimental group (n=39), the infusion therapy was conducted according to the developed targeted therapy protocol, of which the key parameter was stroke volume variability. In the control group (n=41), infusion therapy was conducted based on routine hemodynamic monitoring (average arterial pressure, heart rate, blood loss level with regard to intra-operative situation). In both groups, operative intervention was carried out in identical conditions (combined anesthesia, identical drugs to induce and maintain anesthesia); the only differences included infusion therapy.Results. In the experimental group versus the control group the intra-operative infusion volume was smaller, the number of patients with complications and the total number of complications were reliably lower, and the gastrointestinal tract functional recovery occurred earlier. Conclusion. A targeted infusion therapy based on a stroke volume variability monitoring as the key parameter allows optimizing the infusion load and facilitates reduction of the number of patients with complications and earlier recovery of gastrointestinal tract functions after major operative abdominal interventions.

Use of Synthetic Protetic Materials in Surgical Abdominal Defects. Analysis of the Advantages and Lack of the Liechtenstein Method

Liechtenstein procedure represents the most frequent technique used for surgical abdominal interventions. Although, it is a modern and inovative procedure, it still has a relative risk for complications. A number of 93 subjects were included in our research. We develop our study in General Surgery Department of County Emergency Hospital of Craiova, Romania between 1st July 2017-31th March 2018. From the total of 93 patients, 88% were men. Most of subjects had ages between 70 and 79 years old, were operated by Liechtenstein technique and they were coming from quite equal percent from rural and urban areas.The incidence for complications(seroma, hematoma, infection, abscess) was generally lower for the patients diagnosticated with Liechtenstein procedure comparing with the subjects operated by other technique. Liechtenstein procedureis recommended especially for its simplicity and efficiency, reproducibility and safety. It is very important to choose the perfect synthetic prosthetic material to have a good evolution of the disorder and a small recurrence rate.