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Myxoid Cysts
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Nilton Gioia Di Chiacchio, Nilton Di Chiacchio
Transillumination is based on the transmission of light through the body to distinguish between cystic and solid masses. When used to confirm the diagnosis of a myxoid cyst, the light will pass by the cyst easily, resulting in lucent-filling defects.11
Enteral nutrition
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The Ponsky–Gauderer ‘pull-method’ is described in detail as it is the most popular technique. With the patient supine and the abdomen exposed, the stomach is fully inflated with air to displace neighbouring organs and to bring the gastric and anterior abdominal walls into apposition. Digital pressure is applied to the left upper quadrant. This is seen as an indentation of the stomach wall in the endoscopic view. By pressing sharply over this region of the abdomen the site of optimal indentation can be established (Fig. 8.6a,b). When a suitable site is obtained, the endoscope is brought close to the point of indentation, the theatre lights are dimmed, and the abdomen is inspected for a bright red transillumination (Fig. 8.6c) (the transillumination facility on modern endoscopy light-sources is useful to boost the light, especially when the patient is more obese). The position at which finger indentation is best defined and transillumination is brightest is then marked on the skin. This typically lies about one-third of the way along a line drawn between the mid-point of the left inferior costal margin and the umbilicus, but sites more medially and higher than this are perfectly acceptable. If transillumination is not seen it is unsafe to proceed. Conversely, however, good transillumination does not completely exclude the possibility of a bowel loop interposed between the stomach and abdominal wall.
Ophthalmic plaque brachytherapy: choroidal melanoma and retinoblastoma
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Paul T Finger, A Linn Murphree
The surgical technique requires a conjunctival peritomy. Tenon’s fascia is opened in at least two adjacent quadrants. Transillumination is performed to define the edges of the tumor. Typically, direct and indirect techniques are used. If the tumor shadow extends beneath a rectus muscle, the muscle is isolated, sutured, transected from its insertion, and allowed to retract, so that direct and indirect transillumination is accurate. Pigmented intraocular tumors create a trans-illumination shadow on the episclera, which is marked with a surgical pen. A caliper is then used to confirm the size of the tumor base and act as a guide to mark the 2–3 mm margin around the tumor (Fig. 46.2). Multiple (typically four) episcleral sutures are used to anchor the radioactive plaque onto the sclera. If rectus muscle disinsertion is required to allow room for the plaque, a temporary reinsertion can be made. This is repaired permanently when the plaque is removed.
Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy
Published in Journal of Obstetrics and Gynaecology, 2022
Satit Klangsin, Nantaka Ngaojaruwong, Hatern Tintara
In this study, the 30-degree laparoscope was not found to be superior to the 0-degree laparoscope in terms of both visualisation quality and confidence level of surgeons in their ability to identify the three landmarks: the inferior epigastric vessel, edge of the rectus abdominis muscle and upper border of the bladder dome. To our knowledge, no study has compared laparoscopes with different angles. A previous study has reported the benefit of the 30-degree laparoscope in shortening the operation time for prostatectomy, cholecystectomy and colorectal surgeries, as well as allowing for easier surgery (according to the 10-cm rating scores) during prostatectomy and colorectal surgeries (Perrone et al. 2005). We hypothesised that the 30-degree would be superior to the 0-degree laparoscope considering that the surgical field of the inner anterior abdominal wall is not a natural viewing. Moreover, the 30-degree laparoscope transmits less light than the standard laparoscope (Perrone et al. 2005). The transillumination test, another technique used to detect the inferior epigastric vessel and bladder dome, has been shown to be able to identify these structures at rates of 80% and 45%, respectively; however, its application is limited in the case of obese patients or light abdominal skin (Hurd et al. 2003).
In vivo analysis of endocanalicular light pipe transillumination in endoscopic dacryocystorhinostomy: Anatomic considerations and cautions for the transitioning
Published in Orbit, 2022
Nina S. Boal, Elizabeth A.Z. Cretara, Benjamin S. Bleier, Allen C. Lam, Daniel R. Lefebvre
During endo-DCR surgery for all patients, a 23-gauge Constellation vitrectomy straight endoilluminator (Alcon, Fort Worth, TX, USA) light pipe was placed through the dilated punctum and inferior canaliculus after punctal dilation. The light pipe was advanced until a hard stop was felt, signaling the light source was in the lacrimal sac and contacting bone. The transillumination of the light source could then be visualized endoscopically. Note that the light pipe was placed while the light was off, so as to minimize thermal injury to the soft tissues. Once in the lacrimal sac, the light was turned on to 33% power and was manipulated until maximum light visualization was achieved endonasally, with a bias towards maintaining the light pipe as near to horizontal as possible to translate to a mid-sac position. The maxillary line was identified and the location of the maximal point of transillumination in relation to the maxillary line was noted as either anterior to and involving the maxillary line, or posterior to the maxillary line. The light was then turned off to minimize thermal exposure to the soft tissues. The light served as general confirmation of mid-lacrimal sac position; however, surgery proceeded with osteotomy creation to ultimately have complete lacrimal sac exposure, including mucosal incision starting above the axilla of the middle turbinate and extending anterior to the maxillary line to enable thorough removal of the thick frontal process of the maxilla forming the anterior lacrimal sac fossa.15
Percutaneous endoscopic gastrostomy: a dislodgement complication due to a moving hiatal hernia
Published in Scandinavian Journal of Gastroenterology, 2021
Miia L. Lehtinen, Ilkka Ilonen, Juha Kauppi, Jari Räsänen
The EGD performed in a secondary care center revealed a large Zenker’s diverticulum (ZD) in the proximal esophagus. No passage was gained distal to ZD. A large concomitant hiatal hernia was also suspected in the chest x-ray. As the patient had malnourishment due to dysphagia, resulting in severe progressive weight loss, need for an enteral feeding route was urgent and the patient was referred to a tertiary center. Surgical treatment for ZD was discussed but to improve the nutritional status before definitive surgery, the patient was consented for PEG insertion under general anesthesia. Passage distal to ZD in the EGD was time-consuming. When finally entering the stomach, a type-III uncomplicated paraesophageal hernia was noted. After an endoscopic repositioning maneuver, passage to duodenum was gained. Cutaneous transillumination was visible in the abdominal wall and a 20-Fr MIC-PEG tube (Halyard, GA, USA) was inserted using the pull-technique. A repeat EGD was abandoned due to the complicated passage distal to the ZD. A computed tomography (CT) was performed after the insertion, confirming the suspected large hiatal hernia with 50% of the stomach detected above the diaphragm plane. The MIC-PEG location was satisfactory in the gastric body below the diaphragm (Figure 1(A and B)).