1,721,006 research outputs found
Training in bariatric and metabolic endoscopy
Full text linkThe limited penetration of bariatric surgery and the scarce outcome of pharmacological therapies created a favorable space for primary bariatric endoscopic techniques. Furthermore, bariatric endoscopy is largely used to diagnose and treat surgical complications and weight regain after bariatric surgery. The increasingly essential role of endoscopy in the management of obese patients results in the need for trained professionals. Training methods are evolving, and the apprenticeship method is giving way to the simulation-based method. Existing simulation platforms include mechanical simulators, ex vivo and in vivo models, and virtual reality simulators. This review analyzes current training methods for bariatric endoscopy and available training programs with dedicated bariatric core curricula, giving a glimpse of future perspectives
Optimal workup for a hiatal hernia
Full text linkHiatal hernias are common and generally correlated with obesity and increasing age. However, many individuals have no symptoms and are never diagnosed, thus it’s hard to establish the real prevalence of hiatal hernias. To pursue a diagnosis of hiatal hernia is not necessary in asymptomatic patients, but symptomatic ones need evaluation and should be considered for surgical repair. The clinical workup is based on the patient's symptomatology and clinical presentation. For elective HH repair we advocate the use of few standard pre-operative tests as first line. More specific functional and morphological studies scan should be used case by case depending on the hernia size, patients’ symptoms and setting
Multimedia Article. The Fear of Transgastric Cholecystectomy: Misinterpretation of the Biliary Anatomy
No full textIntroduction: Prevention of injury during cholecystectomy relies on accurate dissection of the cystic duct and artery and avoidance of major biliary and vascular structures. The advent of natural orifice translumenal surgery (NOTES) has led to a new look into the biliary anatomy, especially Calot's triangle. Here we show the clinical case of a NOTES transgastric cholecystectomy for uncomplicated cholelithiasis, in which misinterpretation of the biliary anatomy occurred.
Methods and procedure: A 5-mm port was introduced at the umbilicus to ascertain the feasibility of transgastric cholecystectomy and to ensure safe gastrotomy creation and closure. Transgastric access was obtained using a percutaneous endoscopic gastrostomy (PEG)-like technique on the anterior mid body of the stomach to pass a 12-mm gastroscope (Karl Storz, Tuttlingen, Germany). The laparoscope was switched to a grasper for gallbladder retraction. Dissection was started close to the gallbladder using the endoscope at the junction between the infundibulum and what was thought to be the cystic duct. During dissection, the size and the orientation of the cystic duct appeared to be unclear. The decision was made to switch to a laparoscopic view to reorient the dissection plane and clarify the anatomy. At laparoscopy, dissection of the triangle of Calot, although started close to the gallbladder, appeared far too low. The common bile duct had been mistaken for the cystic duct. Once the biliary anatomy was clarified, the vision was switched back to the endoscope, but an additional 2-mm grasper was introduced to improve exposure while cholecystectomy was performed in a standard fashion.
Conclusions: Specific anatomic distortions due to NOTES technique together with the lack of exposure provided by current methods of retraction tend to distort Calot's triangle by flattening it rather than opening it out. At this stage, whenever the anatomy of the biliary tract is unclear, a temporary "conversion" to a laparoscopic view, more familiar to the surgeon's eye, is recommended
Fully Endoscopic Removal of Migrated Mesh After Laparoscopic Fundoplication Eroded Into the Gastroesophageal Junction: A Case Report (With Video)
No full textTransoral Endoscopic Esophageal Myotomy Based on Esophageal Function Testing in a Survival Porcine Model
No full textBackground: The most effective treatment of achalasia is Heller myotomy.
Objective: To explore a submucosal endoscopic myotomy technique tailored on esophageal physiology testing and to compare it with the open technique.
Design: Prospective acute and survival comparative study in pigs (n = 12; 35 kg).
Setting: University animal research center.
Intervention: Eight acute-4 open and 4 endoscopic-myotomies followed by 4 survival endoscopic procedures.
Main outcome measurements: Preoperative and postoperative manometry; esophagogastric junction (EGJ) distensibility before and after selective division of muscular fibers at the EGJ and after the myotomy was prolonged to a standard length by using the EndoFLIP Functional Lumen Imaging Probe (Crospon, Galway, Ireland).
Results: All procedures were successful, with no intraoperative and postoperative complications. In the survival group, the animals recovered promptly from surgery. Postoperative manometry demonstrated a 50% drop in mean lower esophageal sphincter pressure (LESp) in the endoscopic group (mean preoperative LESp, 22.2 ± 3.3 mm Hg; mean postoperative LESp, 11.34 ± 2.7 mm Hg; P < .005) and a 69% loss in the open procedure group (mean preoperative LESp, 24.2 ± 3.2 mm Hg; mean postoperative LESp, 7.4 ± 4 mm Hg; P < .005). The EndoFLIP monitoring did not show any distensibility difference between the 2 techniques, with the main improvement occurring when the clasp circular fibers were taken.
Limitations: Healthy animal model; small sample.
Conclusion: Endoscopic submucosal esophageal myotomy is feasible and safe. The lack of a significant difference in EGJ distensibility between the open and endoscopic procedure is very appealing. Were it to be perfected in a human population, this endoscopic approach could suggest a new strategy in the treatment of selected achalasia patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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