Abstract:

Tumor development, growth and progression depends on an adequate vascular supply, which derives from the host vasculature. This process involves complex interactions between tumor cells and nonneoplastic vasculature, the immune system, and the connective tissues. Tumor angiogenesis refers to the development of new vessels within the tumor. An imbalance between angiogenic growth factors and inhibitors released by the tumor cells and/or endothelial and inflammatory cells is necessary to produce tumor neovascularization. In the last two decades, several studies have clarified the main aspects of this phenomenon, although further analysis will be necessary to understand if tumoral neoangiogenesis can play a pivotal role as a potential target for innovative anticancer therapies. Here, I review and update the basic aspects of tumor angiogenesis, as well as the role of the quantitative analysis of tumor vasculature as an independent prognostic indicator in human cancers.

Authors:

Gabriella Fontanini, M.D. University of Pisa, Pisa, Italy

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Abstract:

Laser tissue welding is a relatively new technique, which was initially described only about 30 years ago. Over the past 10 years, the implementation of protein solders has redefined the field. Alternative methods of wound closure and of tissue approximation have been quickly accepted in clinical medicine. The techniques and theory involved in performing laser tissue welding may soon be essential knowledge for all surgeons. Just as laparoscopy has become a mainstay for general surgeons and urologists, novel mechanisms of tissue approximation will continue to replace older, less efficacious techniques.

Authors:

Dix P. Poppas, M.D. G. Bino Rucker, M.D. Douglas S. Scherr, M.D. New York Presbyterian Hospital, Cornell University, New York, NY

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Abstract:

Hand-assisted laparoscopic surgery (HALS) has been sporadically described in the past to assist the surgeon during operations of complexity or when operations require specimen removal. The hand will offer the surgeon an advantage in terms of tactile feedback, exposure, retraction, or orientation so that it will enable him or her to operate with greater safety and efficiency. The fundamental pre-requisite for successful HALS is a reliable hand-assist device. We perform HALS for complex advanced laparoscopic surgery where it may save time, increase accuracy and improve safety. Additionally, this approach is considered for any operation that requires specimen removal, since an enlarged incision may be required. Early introduction of the hand may facilitate dissection and specimen removal.

Authors:

Demetrius E. Litwin, M.D. Yuki Novitsky, M.D. Kent W. Kercher, M.D. Andras Sandor, M.D. Steven M. Yood, M.D. M.P.H. John J. Kelly, M.D. William C. Meyers, M.D. Karen A Gallagher, RN., B.S. University of Massachusetts Medical School and University of Massachusetts Memorial Healthcare, Worcester, MA

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Abstract:

After the meteoric entry of minimally invasive surgery onto the general surgery scene 9 years ago, it currently stands at a crossroads with regard to the 21st century. Many challenges hamper safe and costeffective deployment of minimally invasive techniques. There must be a stabilization and reduction of complication rates associated with laparoscopic cholecystectomy. Common bile duct injuries are in fact two to three times higher for laparoscopic cholecystectomy than for the open procedure. This matter has been discussed only at local morbidity and mortality conferences or at national meetings. Patients are being injured. The surgical community has failed to police itself and the public knows it. This led in 1992 to New York State health officials setting standards of training and surgeon preparedness for performing laparoscopic cholecystectomy. If surgeons don't handle the problem, the politicians and the lawyers soon will.

Authors:

James C. Rosser, Jr., M.D., F.A.C.S. Michinori Murayama, M.D., Ph.D. Yale University School of Medicine, New Haven, CT

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Abstract:

UP to 30% of those who undergo surgery potentially develop a surgical site infection depending on the procedure performed. Infection increases the risk of further complications, lengthens hospital stays and increases management costs. A significant proportion of surgical site infections are caused by Staphyloccoccus spp. and prior nasal carriage is a risk factor for post surgical infection.

Authors:

Steven T. Bailey, BA Joseph J. Cullen, M.D., F.A.C.S. University of Iowa College of Medicine, Iowa City, IA

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Abstract:

Since 1990 new developments have found their way into almost every area of minimally invasive surgery (MIS), and nowadays, 90% of all gynecological operations and 80% of all abdominal operations can be performed by this approach. In contrast to surgical development, operating room (OR) design has not progressed much over the past half century. While a number of surgical suites have been designed for specific specialties, more commonplace is the flexible OR concept.

Authors:

Omid Abri, M.D., Klinik Für Minimal Invasive Chirurgie, Berlin, Germany Zoltan Szabo, Ph. D., F.I.C.S. MOET Institute, San Francisco, CA; Istvan Gal, M.D., Ph.D., Bugat Pal County Hospital, Gyöngyös,

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Abstract:

Over the last decade, the laparoscopic approach has become the preferred method of intervention for many procedures, including cholecystectomy, appendectomy, inguinal hernia repair, lung biopsy, hysterectomy, and numerous orthopaedic procedures. Laparoscopic surgery is not an intuitive skill and must be developed through long hours of training, practice, and clinical experience. While surgeons may become proficient in the use of current laparoscopic instruments, many of them feel the advancement of laparoscopic surgery is hampered by the limited functionality of their instruments.

Authors:

Charles Klieman, M.D., F.A.C.S., F.A.C.C, F.A.C.P.,St. Francis Medical Center, Lynwood/Hoag Memorial Hospital Presbyterian, Newport Beach, CA, John Stiggelbout, M.S.M.E., M.B.A ,Whittier, CA

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Abstract:

Venous ulcers are a common cause of pain and suffering in the elderly US population. Up to 1 million individuals suffer from this disease, and the true costs in terms of medical care and quality of life are only beginning to be appreciated. Bioengineered skin constructs are being used increasingly to treat venous ulcers with some success and can be used if traditional first-line treatment methods fail.

Authors:

John T. Shen, B.A, Vincent Falanga, M.D., F.A.C.P., Boston University School of Medicine, Boston, MA

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Abstract:

The diagnostic information in scintigraphic images is generally not contained in specific morphological image attributes, but in the regional distribution of count rate densities across the organ volumes. In a subclass of scintigraphic images, the evaluation is actually based on a dual comparison.

Authors:

Michael L. Goris, M.D., Ph.D., William M. Pace, M.D., Margaret Maclean, M.D., Archie Yee, M.D., Arden Kwan, M.D., Kaiser Permanente Medical Center, Walnut Creek, CA

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