Advancement in liver laparoscopic resection - development of a new surgical device.

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Advancement in liver laparoscopic resection - development of a new surgical device

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Recent Development of Augmented Reality in Surgery: A Review.

INTRODUCTION: The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. METHODS: We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. CONCLUSIONS: The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

Comparison between the short-term results of onlay and sublay mesh placement in the management of uncomplicated para-umbilical hernia: a prospective randomized study.

PURPOSE: The aim of this study was to compare between the short-term results of onlay and sublay mesh placement in the prosthetic repair of uncomplicated para-umbilical hernia (PUH). METHODS: Eighty patients with a defect size ranging from 4 to 10 cm were prospectively randomized to either the onlay group (40 patients) or the sublay group (40 patients). The operative time, postoperative complications and short-term recurrence were reported. RESULTS: There were no statistically significant differences between both study groups as regards the patients' demographics, associated co-morbidities and mean defect size. The median operative time was significantly shorter in the onlay group compared to that in the sublay group (52 vs. 91 min respectively, p < 0.001). No statistically significant difference was found in the daily median pain score throughout the first postoperative week. The time required to remove the suction drain was significantly shorter in the sublay group compared to that in the onlay group (3 vs. 7 days respectively, p < 0.001).Complications were encountered in 4 patients (10%) in the onlay group compared to 3 patients (7.5%) in the sublay group (p = 1.000). Superficial wound infection was encountered in 1 patient (2.5%) in the sublay group, Seroma was encountered in 2 patients (5%) in the onlay group, Deep vein thrombosis was encountered in 1 patient (2.5%) in the onlay group, Chest infection was encountered in 2 patients (5%) in the sublay group compared to 1 patient (2.5%) in the onlay group. Throughout the 22 months median follow-up duration (range 6-42 months), 2 recurrences (5%) were encountered in either study group. CONCLUSIONS: Both techniques are safe, efficient and are associated with comparable complication and recurrence rates.

Effect of three anthelmentics on disposition kinetics of florfenicol in goats.

The pharmacokinetic aspects of florfenicol (FLO) were investigated via intravenous (I.V.) and intramuscular (I.M.) injections in five goats at a dose of 20 mg kg(-1) b.wt. Animals were pre-treated with albendazole orally in a dose of 2.5 mg kg(-1) b.wt, ivermectin or rafoxanide subcutaneously in a dose 0.2 and 7.5 mg kg(-1) b.wt, respectively. Florfenicol was injected intramuscularly two hours following anthelmentic administration and blood samples were taken by jugular venapuncture at standardized intervals. The concentrations of florfenicol (FLO) in serum were determined by high performance liquid chromatography (HPLC) method. The obtained results revealed that ivermectin administration did not induce a significant difference in serum florfenicol concentration between anthelmentic-treated and non-treated goats. On the other hand, goats pre-treated with rafoxanide or albendazole showed a significant decrease in serum florfenicol level as compared to non-anthementic treated goats. The absorption half-life (t(½ab)), C(max), AUMC, AUC and systemic bioavailability (F%) are significantly decreased, whereas elimination half-life (t(½el)) and MRT are increased in goats pre-treated by the three tested anthementics.

Pharmacokinetic and tissue distribution of doxycycline in broiler chickens pretreated with either: diclazuril or halofuginone.

Following IV injection of doxycycline in a dose of 20 mg kg(-1) b.wt., its serum concentration was best fitted in two-compartment open model in chickens fed either on control or on anticoccidials-containing rations. Diclazuril and halofuginone resulted in a significant short distribution half-life (t(½α)) (7.17±0.39 and 11.88±1.05 min, respectively) and increased total body clearance (Cl(tot)) 0.37±0.024 and 0.295±0.034 L/kg/h, respectively. Following oral dosing the tested drug absorbed with t(½ab) of 41.38±1.6, 17.48±0.86 and 41.83±1.8 min, respectively and their C(max) values (3.18±0.18, 5.425±0.48 and 0.986±0.037 µg/ml) were attained at 2.07±0.097, 1.403±0.074 and 2.55±0.106 h. For doxycycline alone and in presence of diclazuril and halofuginone, respectively. Systemic bioavailability was 22.64±3.46, 86.74±9.23 and 22.38±3.09%, respectively. Following IM injection t(½ab) were 9.096±1.34 for doxycycline alone, 16.24±2.21 and 15.6±1.7 min in the presence of diclazuril and halofuginone, respectively. C(max) was 3.10±0.28, 4.63±0.57 and 0.55±0.07 µg/ml reached at 0.8±0.083, 1.13±0.126 and 1.21±0.105 h. For the antibiotic alone, and in presence of either diclazuril and halofuginone, respectively. Systemic bioavailability was 22.41±3.86, 88.97±12.9 and 12.31±0.99% in chickens fed on anticoccidial-free, diclazuril- and halofuginone-containing rations, respectively. Both the tested anticoccidials induced higher doxycycline tissue residues in all tested tissue samples.

[New treatment approach in liver metastates: hand-assisted laparoscopic radiofrequency liver resection]. / Nový prístup k lécbe jaterních metastáz: manuálne asistovaná laparoskopická radiofrekvencní resekce jater.

BACKGROUND: Hand-assisted laparoscopic liver surgery, a newly developed technique based on an innovative concept, has proved useful and safe for a variety of less invasive hepatectomies. Radiofrequency assisted hepatic resection has been reported to be safe, associated with minimal morbidity and mortality and decreased intraoperative blood loss and transfusion requirements. METHOD: We describe how we perform hand assisted laparoscopic radiofrequency assisted hepatic resection using a bipolar radiofrequency device. RESULTS: The use of the hand port has allowed the surgeon to use his hand in direct liver manipulation, mobilization, and retraction. It was also useful for tactile tumor localization. Radiofrequency assisted hepatic parenchymal transaction was performed using bipolar device (Habib 4X) with minimal blood loss (35 ml), and reduced operative and resection times (75 min, 17 min respectively). CONCLUSION: This combined procedure seems to offer a safer, more effective, and less time-consuming means of resection of hepatic tumours. This might encourage surgeons to perform more frequently a laparoscopic approach for liver resection.

Disposition kinetics of danofloxacin and ciprofloxacin in broiler chickens.

Disposition kinetics of danofloxacin and ciprofloxacin were studied in broiler chickens following intravenous, intramuscular and oral administration in a single dose of 5 and 10 mg/kg-1 body weight respectively. In addition, tissue distribution and residual pattern of both drugs were determined. The maximum serum concentration (Cmax) after intramuscular and oral administration were 1.03 and 0.55 mu/ml for danofloxacin and 2.92 and 1.24 mu/ml for ciprofloxacin attained at 0.8 and 2.43 and 0.55 and 1.27 hours for danofloxacin and ciprofloxacin respectively. The volume of distribution and systemic bioavailability were higher for danofloxacin (Vdss 2.21 L/kg and F% 96.56 and 81.4%) as compared with ciprofloxacin (Vdss 1.41 L/kg and F% 75.5 and 29.4%). Data relating to intravenous injection for both drugs were analyzed using a two compartment open model curve fit. Danofloxacin and ciprofloxacin were not detected in the serum of broilers at the 5th and 3rd day respectively following the drugs withdrawal while were detected in liver, kidneys, spleen and lungs. Danofloxacin completely disappeared from all tissues at the 13th day after stopping of the drug medication but ciprofloxacin disappeared after 5 days only.

Some pharmacokinetic data for danofloxacin in healthy goats.

The pharmacokinetics of danofloxacin was determined in five clinically normal adult female goats after intravenous (IV) or intramuscular (IM) doses of 1.25 mg/kg body weight. Blood and urine samples were collected from each animal at precise time intervals. Serum and urine concentrations were determined using microbiological assay methods and the data were subjected to kinetic analysis. After intravenous injection, the serum concentration time curves of danofloxacin were characteristic of a two-compartment open model. The drug was rapidly distributed and eliminated with half-lives of 17.71 +/- 1.38 min and 81.18 +/- 3.70 min, respectively. The drug persisted in the central, highly perfused organs with a K12/K21 ratio of 0.67 +/- 0.25. The mean volume of distribution at a steady state (Vdss was 1.42 +/- 0.15 L/kg. After intramuscular administration, the serum concentration peaked after 0.58 +/- 0.04 h at approximately 0.33 +/- 0.01 microg/ml. While danofloxacin could be detected in serum for 4 and 6 h, it was recovered in urine for up to 24 and 72 h after IV and IM administration, respectively. The systemic bioavailability after IM injection was 65.70% +/- 10.28% and the serum protein-bound fraction was 13.55 +/- 1.78%.

Disposition kinetics of florfenicol in goats by using two analytical methods.

Florfenicol, a monofluorinated analogue of thiamphenicol, has antibacterial activity against a broad spectrum of bacterial strains, including enteric bacteria that are resistant to chloramphenicol and thiamphenicol. The pharmacokinetics of florfenicol was studied following a single intravenous bolus or intramuscular injections at a dose of 20 mg/kg body weight, in five healthy goats. Serum florfenicol concentrations were determined using two analytical methods: microbiological assay and high-performance liquid chromatography (HPLC). Pharmacokinetic analysis was performed using redundant routine equations and the results derived from each method were compared. While florfenicol was detected for up to 4 and 8 h after administration by the bioassay, the drug was recovered in serum after 12 and 24 h by HPLC following intravenous and intramuscular injections, respectively. Comparison of the concentration profiles obtained by the two methods revealed substantial differences in the resultant kinetic data. Values for the initial serum concentration, elimination half-life, the area under the serum concentration-time curve, the mean residence time, and the systemic bioavailability were significantly (P < 0.01) higher when florfenicol concentrations were determined using HPLC. In conclusion, differences between analytical methodologies should be considered when interpreting the kinetic data for clinical use. However, both the hepatic biotransformations and the interchangeability of enantiomers need further investigation.

Pharmacokinetic properties of florfenicol in Egyptian goats.

The single-dose disposition kinetics of florfenicol was determined in healthy, non-lactating Egyptian goats, after its intravenous (i.v.) and intramuscular (i.m.) administration at 20 mg kg-1 b.wt. Drug concentrations in serum and urine were determined using microbiological assay method and data was subjected to a kinetic analysis. Florfenicol concentrations in serum decreased in a bi-exponential manner after intravenous administration with distribution (t1/2 alpha) and elimination (t1/2 beta) half-lives of 10.256 +/- 0.938 and 56.237 +/- 3.102 minute, respectively. The steady-state volume of distribution (Vdss) and total body clearance (Cltot) were 3.413 +/- 0.304 l kg-1 and 3.306 +/- 0.333 l kg h-1. After intramuscular administration, the peak serum concentration (Cmax) was 0.859 +/- 0.025 micrograms ml-1, achieved at (Tmax) 1.220 + 0.045 h. Florfenicol was detected in urine up to 24 and 96 hour after i.v. and i.m. administration, respectively. The extent of the protein binding and systemic bioavailability of florfenicol were 22.45 +/- 1.727% and 65.718 +/- 3.372%, respectively.

Evaluating the detection of circulating filarial antigen in diagnosis of bancroftian filariasis and filarial hydrocele.

Four groups of patients were selected: 16 patients with clinical evidence of obstructive filarial lymphangiopathy without microfilaraemia; 12 patients with clinical evidence of obstructive filarial lymphangiopathy with microfilaraemia and 9 patients with microfilaraemia. Two control groups were also included. Blood films, sera and hydrocele fluid samples were collected from all subjects. Polyclonal antibody against Dirofilaria immitis worm homogenate was prepared, fractionated and conjugated with HRP. Both polyclonal antibody and monoclonal antibody (AD12) were used in a sandwich ELISA. Using polyclonal antibody, both microfilaraemic groups (groups 2 and 3) had a significantly higher mean O.D. readings than that of control groups (P < 0.05), whereas, the mean O.D. readings of patients with symptomatic amicrofilaraemia had no significant difference than control groups. Symptomatic microfilaraemic group had the highest percentage of antigen positivity 7/12 (58.3%) among all groups while symptomatic amicrofilaraemic group had the least antigen positivity 2/16 (12.5%). Patients presented with elephantiasis only or with hydrocele had no antigen positive levels 0/12 (0%) in their serum or hydrocele fluid samples. On the other hand, 2 out of 4 cases represented with hydrocele (50%) had positive antigen levels in their hydrocele fluid samples. Using monoclonal antibody, all groups had a highly significant higher mean optical density readings than control groups. Asymptomatic microfilaraemic group had the highest percentage of antigen positivity 8/9 (88.9%), followed by symptomatic microfilaraemic 8/12 (66.7%), then symptomatic amicrofilaraemic group 4/16 (25%). The same 2 patients (amicrofilaraemia) and 7 (microfilaraemia) represented with hydrocele had positive antigen levels in their hydrocele fluid samples.

Liquid chromatographic determination of flunarizine dihydrochloride in the presence of its degradation product.

A simple, stability-indicating liquid chromatographic method has been developed for the assay of flunarizine dihydrochloride in the presence of its acid-induced degradation product. A Bondapak-C18 column was used with a mobile phase consisting of methanol-water (75:25, v/v) containing 0.5% w/v sodium chloride and 0.2% v/v triethanolamine adjusted to pH 6.6 with 30% hydrochloric acid at a flow rate 2 ml min-1. Quantitation was achieved with UV detection at 254 nm based on peak area or peak height ratios. The proposed method was successfully applied to the determination of the drug in laboratory-prepared mixtures in the presence of its degradation product and in capsules. Moreover, the method was utilized to investigate the kinetics of the degradation process at different temperatures and the apparent first-order rate constant, half-life and activation energy calculated.

Pharmacokinetic interpretation of some antibiotics in camels.

Evaluation of the pharmacokinetic properties of 4 antibiotics: penicillin-G (P), streptomycin (S), chloramphenicol (C) and oxytetracycline (O) was performed in groups of camels following a single i.m. injection of therapeutic doses, i.e. 6000 IU, 10, 4 and 3 mg/kg b.wt., respectively. The concentrations of these antibiotics in serum were determined by microbiological assay methods. The highest serum concentrations were reached after 0.42, 1.44, 4.02 and 0.94 hr for P, S, C, and O respectively with corresponding t 1/2 alpha values of 0.12, 0.28, 1.48 and 0.17 hr and t 1/2 beta values of 1.09, 8.28, 6.20 and 7.00 hr.

Sulphonamides in buffaloes: effect on certain blood constituents and serum enzymes.

1. Three groups of four clinically healthy buffaloes were injected with sulphadiazine, or sulphadimidine, or sulphathiazole in a single dose of 100 mg/kg body weight. 2. Changes in the serum enzyme activities (SGOT, SGPT and alkaline phosphatase) observed with the tested sulphonamides were insignificant, except for increases in SGOT level 6 h after sulphathiazole injection, and in GOT/GPT ratio 30 min and 24 h after sulphadimidine injection. 3. The creatinine level was not affected in sulphonamide-injected animals. All blood samples collected 15 min to 24 h after sulphathiazole injection showed marked increase in glucose and urea levels. Concerning the other two sulphonamides, no significant change was observed in these parameters except for an increased glucose level 24 h after sulphadiazine injection.

Some pharmacokinetic and biochemical aspects of sulphadiazine and sulphadimidine in ewes.

Eight experiments were carried out on eight clinically healthy non-pregnant ewes. Each animal was injected intravenously with either sulphadiazine or sulphadimidine at a dose rate of 100 mg/kg body weight. A two-compartment pharmacokinetic model was developed to describe the disposition of these drugs. The elimination half-lives were 7.15 +/- 0.58 h and 9.51 +/- 0.59 h and the distribution half-lives were 0.56 +/- 0.07 h and 0.42 +/- 0.05 h for sulphadiazine and sulphadimidine, respectively. The apparent specific volumes of distribution were less than 1 litre/kg (0.410 and 0.501 litres/kg for sulphadiazine and sulphadimidine, respectively) which indicates a relatively lower distribution of these drugs to tissues than in plasma in sheep. The degree of plasma protein binding was similar for both drugs (19.15 +/- 0.55% and 23.12 +/- 0.32%) for sulphadiazine and sulphadimidine, respectively). Serum concentrations of ketone bodies, total lipids and calcium were significantly reduced, and blood glucose concentration significantly increased following administration of both of these sulphonamides, whilst serum total protein concentration was unaltered. The serum cholesterol concentration was significantly reduced following sulphadiazine administration, but not after sulphadimidine.

Disposition kinetics of furosemide in dogs.

In 12 experiments on 6 mongrel dogs, furosemide was given both orally and i.v. in a dose of 20mg/kg. Following i.v. injection, the blood concentration curve followed an open one-compartment model. The elimination half-lives after both oral and i.v. routes were nearly similar, i.e. 1.42 +10.13 and 1.13 +0.06 hours respectively. The apparent volume of distribution corresponded well to the total body water (about 60%), i.e. 69.64 +5.61 and 52.06+4.82% b.wt. after oral and i.v. routes respectively. The body clearance of this drug after i.v. and oral administration showed close values, i.e. 5.27 +0.19 and 5.96 +0.14 mg/kg(-1) min(-1) respectively. The systemic bioavailablity of furosemide after oral administration amounted to 77.13 +5.24% with a maximum blood conc. (Cmax.) of 22.73 +2.03 microgram/ml, 30 min after administration.