1,721,070 research outputs found
Coupled experimental and computational approach to stomach biomechanics: Towards a validated characterization of gastric tissues mechanical properties
No full textGastric diseases are one of the most relevant healthcare problems worldwide. Interventions and therapies definition/design mainly derive from biomedical and clinical expertise. Computational biomechanics, with particular regard to the finite element method, provides hard-to-measure quantities during in-vivo tests, such as strain and stress distribution, leading to a more comprehensive and promising approach to improve the effectiveness of many different clinical activities. However, reliable finite element models of biological organs require appropriate constitutive formulations of building tissues, whose parameters identification needs an experimental campaign consisting in different tests on human tissues and organs. The aim of the reported here research activities was the identification of mechanical properties of human gastric tissues. Human gastric specimens were tested at tissue, sub-structural and structural levels, by tensile, membrane indentation and inflation tests, respectively. On the other hand, animal experimentations on tissue layers from literature pointed out the mechanical response at sub-tissue level during tensile loading conditions. In detail, the analysis of experimental results at sub-tissue and tissue levels led to a fibre-reinforced visco-hyperelastic constitutive formulation and to the identification of gastric layers mechanical behaviour. Results from experimentations on human samples were coupled with data derived from animal models. Data from sub-structural and structural experimentations were exploited to upgrade and validate the constitutive formulations and parameters. The developed investigations led to a reliable constitutive framework of human gastric tissues that both describe stomach mechanical functionality and allow computational investigations. Indeed, the comparisons among average computational data and experimental medians provided the following RMSEs (Root Mean Square Errors): 0.89 N, 0.15 N for corpus and fundus during membrane indentation test, respectively, and 0.44 kPa during inflation test. Accounting for the magnitude of experimental and computational data, the RMSEs can be considered low and acceptable because they concerned biological samples. In fact, biological tissues and structures are affected by a high inherent intersamples' variability, which is detectable in both the geometrical configuration and the mechanical behaviour. The specific values of the here reported RMSEs ensured the reliability of the achieved parameters and the quality of the overall developed procedure. Reliable computational models of the gastric district could become efficient clinical tools to find out the main crucial aspects of bariatric procedures, such as the mechanical stimulation of gastric mechano-receptors. Moreover, the methods of computational biomechanics will permit to run the preliminary tests of new and innovative bariatric procedures, on one hand, predicting the successful rate and the effectiveness, and, on other hand, reducing the use of animal testing
Ovarian Leiomyosarcoma as Incidentaloma during Postbariatric Abdominoplasty Surgical Procedure
Full text linkThis case report addresses the discovery, surgical management, histology, and postoperative outcomes of an incidentaloma during the preoperative evaluation of a 58-year-old woman planning to undergo abdominoplasty and hernia correction after bariatric surgery. The patients computed tomography scan revealed a large pelvic mass in addition to an enlarged uterus and an umbilical hernia. Subsequent surgical intervention included umbilical hernia repair, subtotal omental excision, and en-bloc removal of the uterine and ovarian structures. Histological analysis confirmed the mass as a high-grade utero-ovarian leiomyosarcoma. The patient received adjuvant chemotherapy and demonstrated a positive response in follow-up imaging at 6 months, with reduced mass size and no significant lymphadenopathy. Both aesthetic and morpho-functional outcomes were satisfactory. The report highlights the challenges of diagnosing and treating incidentalomas, emphasizing the need for individualized management. It discusses the rarity of primary ovarian leiomyosarcoma and the surgical approach used. The case ultimately emphasizes the importance of multidisciplinary clinical evaluations in ensuring comprehensive care for patients with unexpected radiological findings, such as utero-ovarian leiomyosarcoma
Laparoscopic surgery in a morbidly obese, high-risk cardiac patient: the benefits of deep neuromuscular block and sugammadex
No full textRespiratory function after sugammadex and neostigmine administration for reversal of moderate rocuronium-induced neuromuscular blockade in morbidly obese patients
No full textGeneral Anesthesia via Laryngeal Mask Airway in Laparoscopic Adjustable Gastric Banding (LAGB)
No full textBackground: The use of ProSeal(TM)LMA (PLMA) has been reported in obese patients undergoing abdominal
surgery procedures but not yet in super obese undergoing LAGB.
Methods: Since Sept. 2007, 10 super-obese patients (mean BMI 61,7 kg/m2, range 58.3-68,5) underwent LAGB
under general anesthesia with the PLMA and intravenous propofol. The conventional orogastric calibration tube was
replaced by a 14-G Salem gastric tube passed through the drainage tube of the PLMA. Outcome measures were O.R.
times, surgeon evaluation of the adequacy of the anesthetic technique, and patient evaluation of postanesthesia
satisfaction.
Results: Mean total times in the operating room was 42 +/-12 mins. Immediate or intraoperative problems were
encountered in 1 (10%) out of 10 patients (poor relaxation that made pneumoperitoneum more difficult). Surgeons
rated analgesia as good or excellent in all 10 patients and muscle relaxation as good or excellent in 9 out of 10
patients. Surgeons rated overall satisfaction for the anesthetic technique as good or excellent in all 10 patients.
Patient satisfaction with anesthetic technique was high and all 10 patients agreed or strongly agreed that they were
satisfied. The awakening phase was prompt after surgery (< 5 minutes), post-op nausea and vomiting was absent in
all the patients, who were able to stand and walk within one our after completion of surgery.
Conclusion: General anesthesia via PLMA with intravenous propofol is safe and effective for LAGB and yields to a
high degree of satisfaction for patients and surgeons
A presacral epidermoid cyst presenting with a perineal fistula: report of a case.
No full textPresacral epidermoid cysts are rare lesions that became clinically evident only when complicated by pain or infection. Usually they are asymptomatic and diagnosis is unexpected at the time of gynecological or ano-rectal examination or as an incidental finding report on a radiological examination such as a pelvic CT scan or MRI perfoemed fo other reasons. We report the case of a young male presenting with a perineal fistula. Clinical examination, pelvic MRI and CT scan demonstrated an infected pre-sacral cyst with an anal fistolous tract. Difficulty in localising the cyst, proximity to sacral promontory, the need to preserve the integrity of both the rectal wall and the hypogastric nerves from surgical injury led to adoption of a combined laparoscopic and perineal procedure for its complete excision
TNFalpha-based isolated perfusion for limb-threatening soft tissue sarcomas:state of the art and future trends
No full textThe management of limb-threatening soft tissue sarcomas has not yet been standardized. Although local disease control does not affect overall survival, amputation or highly mutilating surgery may be required, which impairs the patient's quality of life. Various neoadjuvant approaches have been proposed to allow limb-sparing surgery for these locally advanced tumors. With TNFalpha-based hyperthermic isolated limb perfusion, the majority of patients can be spared amputation, with acceptable rates of locoregional and systemic complications. As yet, no other available treatment seems to give comparable results when applied to limb-threatening soft tissue sarcomas. Nevertheless, several issues remain to be addressed, such as the type and dose of drugs, repeatability of the procedure, association with radiotherapy, further indications, and evaluation of response. The authors describe the principles underlying TNFalpha-based hyperthermic isolated limb perfusion, review the worldwide experience so far published, and discuss the above issues. The potential future developments of this locoregional therapeutic approach will also be reported
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