Disinfection of upper gastrointestinal fibreoptic endoscopy equipment: an evaluation of a cetrimide chlorhexidine solution and glutaraldehyde.
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There is little information available on the bacteriological contamination of upper gastrointestinal fibreoptic endoscopes during routine use and the effects of 'disinfecting solutions'. A bacteriological evaluation was therefore made of cleaning an endoscope and its ancillary equipment with (1) water, (2) an aqueous solution of 1% cetrimide with 0.1% chlorhexidine, and (3) activated aqueous 2% glutaraldehyde. All equipment, but particularly the endoscope itself, was found to be heavily contaminated after use with a wide variety of organisms of which 53% were Gram positive. Cleaning the endoscope and ancillary equipment with water and the cetrimide/chlorhexidine solution alone or in combination was inadequate to produce disinfection but immersion in glutaraldehyde for two minutes consistently produced sterile cultures with our sampling technique. A rapid and simple method for disinfection of endoscopic equipment is therefore recommended and we think this is especially suitable for busy endoscopy units. (+info)
An ambulant porcine model of acid reflux used to evaluate endoscopic gastroplasty.
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BACKGROUND: There is a lack of suitable models for testing of therapeutic procedures for gastro-oesophageal reflux disease. Endoscopic sewing methods might allow the development of a new less invasive surgical approach to treatment of gastrointestinal disorders. AIMS: To develop an animal model of gastro-oesophageal reflux for testing the efficacy of a new antireflux procedure, endoscopic gastroplasty, performed at flexible endoscopy without laparotomy or laparoscopy. METHODS: At endoscopy a pH sensitive radiotelemetry capsule was sewn to the oesophageal wall, 5 cm above the lower oesophageal sphincter, in six large white pigs. Ambulant pH recordings (48-96 hours; total 447 hours) were obtained. The median distal oesophageal pH was 6.8 (range 6.4-7.3); pH was less than 4 for 9.3% of the time. After one week, endoscopic gastroplasty was performed by placing sutures below the gastro-oesophageal junction, forming a neo-oesophagus of 1-2 cm in length. Postoperative manometry and pH recordings (24-96 hours; total 344 hours) were carried out. RESULTS: Following gastroplasty, the median sphincter pressure increased significantly from 3 to 6 mm Hg and in length from 3 to 3.75 cm. The median time pH was less than 4 decreased significantly from 9.3% to 0.2%. CONCLUSIONS: These are the first long term measurements of oesophageal pH in ambulant pigs. The finding of spontaneous reflux suggested a model for studying treatments of reflux. Endoscopic gastroplasty increased sphincter pressure and length and decreased acid reflux. (+info)
Endoscopic laser recanalisation of presaccal canalicular obstruction.
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AIM: To document the results of erbium (Er)-YAG laser treatment in presaccal canalicular obstruction in combination with the use of a flexible endoscope. METHODS: For the first time an Er-YAG laser (Schwind, Sklerostom) was attached to a flexible endoscope (Schwind, Endognost) and used to recanalise a stenosis of the upper, lower, or common canaliculus. In 17 patients (mean age 41.5 (SD 11.9) years), 19 treatments (two bilateral) were performed. In all cases the scar was observed using the endoscope and was excised by laser ablation. A silicone intubation was performed in all cases. In addition to the endoscopy an irrigation was performed to prove the intactness of the lacrimal pathway system after laser treatment. RESULTS: Membranous obstructions with a maximum length of 2.0 mm (14 procedures) in the canaliculus were opened easily using the laser, and the silicone intubation was subsequently performed without difficulty. Scars thicker than 2.0 mm could not be opened safely without canaliculus penetration (five procedures). Irrigation was positive in all cases up to the end of a 6 month period, providing the tubes remained in place. The maximum follow up is now 17 months (minimum 8 months) and in 16 cases (84.2%) the canaliculi are still intact. CONCLUSION: Endoscopic laser treatment combined with silicone intubation enables us to recanalise presaccal stenoses of canaliculi under local anaesthesia up to a scar thickness of 2.0 mm. Best results can be achieved in cases where much tissue can be saved. Under such conditions this procedure can substitute for more invasive surgical techniques, especially a conjunctivo-dacryocystorhinostomy (CDCR). (+info)
A decrease in circulating levels of immunoreactive insulin-like growth factor binding protein-1 (IGFBP-1) after endometrial ablation using a gynecologic resectoscope.
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To determine how endometrium alone would contribute to maintaining the circulating levels of Insulin-like growth factor binding protein-1 in vivo, serum immunoreactive IGFBP-1 levels were measured in 19 patients undergoing endometrial ablation using gynecologic resectoscopy. After endometrial ablation there was a significant decrease in the mean levels of circulating IGFBP-1, which was not correlated with the menstrual cycle. This result indicates that the endometrium is one of the sources of the circulating IGFBP-1. (+info)
Newly developing endoscopic devices--shadow optics and micromachine.
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Based on the newly-developed engineering technologies, many kinds of useful equipment have been available for minimally invasive surgery. Recently the time to connect clinical needs and advanced technologies has become faster. In this article, we have summarized the recent technologies for endoscopic surgeries. Shadow optic technologies for better geometric perception using dual illumination in a conventional 2-D monitor and "Overview optics" for a panoramic view with an additional visual system are introduced. Micromachine technology is very close to practical implementation for minimally invasive surgeries. Virtual Biopsy is the one of the hottest topics for the next generation of endoscopy. Stereoscopic and volumetric vision systems are still on the way, which should overcome the irritating goggles and stereo display devices. As well as operational theater that integrates all the required equipment with a computer-based system, including voice recognition, still requires the standard protocols to connect many kinds of devices from different manufacturers. (+info)
Laboratory evaluation of a microangioscope for potential percutaneous cerebrovascular applications.
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A laboratory-based study of the physical and performance characteristics of a new 0.25-mm-thin microangioscope was performed. The microangioscope tested was compatible with currently available microcatheters, but its tip was considerably stiff and of limited radiopacity. Poor image quality and difficult image interpretation were further drawbacks. Intensive efforts are directed at addressing current limitations and testing further innovations that could pave the way for future performance in neurovascular endoscopy. (+info)
Transnasal access for sampling a skull base lesion.
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SUMMARY: Transnasal needle access for sampling was used in two patients with posterior nasopharyngeal lesions. The procedure was performed under CT guidance. This new technique is simple and appears suitable for selected cases. The two cases and the details of the procedure are described. (+info)
Evrim Bougie: a new instrument in the management of urethral strictures.
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BACKGROUND: In this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments. METHODS: Three patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation. CONCLUSION: Internal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery. (+info)