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New Developments in Oral Insulin Delivery
Published in Emmanuel Opara, Controlled Drug Delivery Systems, 2020
Alec Jost, Mmesoma Anike, Emmanuel Opara
Prior to 1920, and beginning with the seminal work of Mering and Minkowski in 1889 showing that total pancreatectomy induces severe diabetes, a hypothesis had been established that an internal secretion of the pancreas controlled glucose disposal. Subsequently, while doing routine autopsies, the American pathologist Moses Barron had observed in a rare case of the formation of a pancreatic stone (pancreatic lithiasis) that the stone had completely occluded the main pancreatic duct causing all the acinar cells to disappear through atrophy while most of the islet cells survived (Barron 1920). These findings were consistent with other observations made when pancreatic ducts were blocked by ligation, and all together laid the foundation for Frederick Banting’s quest for the pancreatic internal secretion later named as “insulin.” Also, it is known that, at the first meeting of Banting with J.J.R Macleod, the professor of physiology, in whose lab Banting and Best worked at the University of Toronto, part of their discussion was that many others had tried to prepare an extract of the pancreas which contained the internal secretion and failed. Both agreed that the problem with previous extracts was that they also contained potent digestive components of the external secretion, now known as enzymes, which may have destroyed the internal secretion (Bliss 1982).
Assessing non-technical skills in the operating room
Published in Rhona Flin, George G. Youngson, Steven Yule, Enhancing Surgical Performance, 2015
Simon Paterson-Brown, Stephen Tobin, Steven Yule
Although there is undoubtedly a relationship between experience and better outcomes,54 there will come a time when the deteriorating functions associated with age make it difficult for surgeons to maintain their performance.55 In a study examining correlations between mortality and the older surgeon, surgeons over the age of 60 years were more likely to have higher mortality rates in pancreatectomy, coronary artery bypass surgery and carotid endarterectomy.56 Furthermore, inexperienced older surgeons are often less proficient than younger surgeons, especially with laparoscopic technique57 (see Chapter 11 for a wider discussion of the impact of age on non-technical skills and surgical performance, which will be particularly relevant to surgeons who are towards the end of their careers).
Hematopoietic Stem Cell Transplantation as Treatment for Type 1 Diabetes
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Júlio C. Voltarelli, Richard K. Burt, Norma Kenyon, Dixon B. Kaufman, Elizabeth C. Squiers
Approximately 1000 pancreas transplants are performed in the USA each year and about 85% involve simultaneous pancreas kidney transplants. The current contraindications for pancreatic or islet cell transplantation in type 1 diabetes are patients who have normal renal function and do not exhibit a brittle course or hypoglycemic unawareness. Due to donor risks from partial pancreatectomy, living-related pancreas or living-related islet cell transplants are currently not feasible, and an unrelated cadaver organ and stem cell source would be required. Hematopoeitic stem cells have been successfully collected from cadaveric vertebral bodies and iliac crests at the time of organ procurement.
The effectiveness of Hemopatch™ in preventing postoperative distal pancreatectomy fistulas
Published in Expert Review of Medical Devices, 2019
Anna Pisapia, Enrico Crolla, Michele Saracco, Alessandro Saglioccolo, Pasquale Dolce, Carlo Molino
Distal pancreatectomy (DP) is the standard surgical procedure for treating chronic pancreatitis and benign and malignant lesions located in the body or tail of the pancreas. Although both short- and long-term survival rates have markedly improved, postoperative morbidity and mortality associated with pancreatic fistulas remain considerable after DP [1]. To date, surgeons lack an effective tool for preventing this complication. Hemopatch™ is a sealing hemostatic device that consists of a soft, thin, pliable, flexible pad of collagen derived from the bovine dermis and coated with pentaerythritol polyethylene glycol ether tetra-succinimidyl glutarate. Hemopatch™ is indicated for procedures in which control of bleeding or leakage of other body fluids or air by conventional surgical techniques is either ineffective or impractical [2]. Hemopatch™ is structurally different from other sealants; thanks to its coating in NHS-PEG, Hemopatch™ achieves hemostasis by a dual-method mechanism: sealing off the bleeding surface and initiating body’s own clotting mechanism.
A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery
Published in Expert Review of Medical Devices, 2021
Abel J Lungu, Wout Swinkels, Luc Claesen, Puxun Tu, Jan Egger, Xiaojun Chen
Apart from the applications discussed in the fields of neurosurgery and maxillofacial surgery, applications extend to other surgical procedures, such as open surgery, laparoscopic and endoscopic surgery. Benish F. et al. [103] subdivided the AR applications in open surgery into pancreatic [104] and hepatobiliary surgery [105]. AR for these surgical procedures has been reported mainly for recognizing lesions and safe dissection. Navigation with AR has been used to enhance the protection for surgical dissection in pancreaticoduodenectomy (PD) [106]. Onda S. et al. examined the pancreaticoduodenal artery (IPDA) with an AR navigation system [107]. Other studies include hilar cholangiocarcinoma (HCAC) [108], open urological surgery [109], and open liver surgery [110]. Researchers have also utilized hybrid surgical guidance concepts to fluorescence guidance, as illustrated by Kleinjan G. et al. for sentinel lymph nodes biopsy in penile cancer during open surgery [111]. Van Oosterom et al. have done a similar study on both penile cancers for open surgery and prostate cancer for laparoscopic surgery [112]. Weidert S. et al. have also applied video augmented fluoroscopy for distal interlocking on intramedullary nails [113]. MR ultrasound guidance systems have been proposed, as shown by Ameri.G. et al. [114]. The authors describe and critically analyze implementation recommendations in the sense of a mixed reality ultrasound guidance system through a case study. In addition, an MR system using a HMD to visualize anatomical constructs in specific visceral-surgical procedures during open surgery has been described by Sauer M. et al. [17]. During open hepatic surgery, the surgeon’s field of view was superimposed by a 3D representation of the patient’s complex liver structures and shown on an MR-HMD. Unlike open surgery, laparoscopic surgery requires a different skillset and is sometimes more complicated than open surgery. A reduced number of working hours, fewer training sessions and patient safety issues result in the acquisition of these skills outside the operating room. Hence both VR and AR modeling has been leveraged [115]. Figure 4 depicts a Laparoscopic VR training set up during the laparoscopic salpingectomy procedure [116]. Bernhardt S. et al. [117] give an overview of the applications of AR in the field of laparoscopic surgery as of 2016. Laparoscopic liver surgery has been one of the major applications of VR and AR, as shown by Lau L. et al. [118] and Prevost G. et al. [119]. VR and AR have also been applied in distal laparoscopic pancreatectomy [120] and gynecological laparoscopic surgery, as indicated by Akladios C. et al. [121], for the detection of ureters during surgery.