Biomedical subjects
Publications and source records attributed to R J Lanzafame.
A case of a subhepatic inflammatory mass that developed 2 months following laparoscopic cholecystectomy is presented. All cultures and biopsy specimens were negative. The presence of infection may not be necessary for significant sequelae of stone spillage and loss to occur. Efforts to avoid stone and bile spillage are imperative.
Growth factors are a group of hormone-like polypeptides that have been shown to play a central role in different phases of wound healing. The expression of these growth factors in early wound healing has not been quantified, and the pattern and distribution of these growth factors in early wound healing has not been described completely. Furthermore the quantity and pattern of distribution of these growth factors have not been investigated in early wounds produced by various methods of surgical incision. Comparison of the rate of healing between the CO2 laser wound and the scalpel wound has produced conflicting results. The present immunohistochemical study uses polyclonal antibodies specific for epidermal growth factor (EGF), platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta), and basic fibroblast growth factor (bFGF) to observe the pattern and distribution of these growth factors in rat skin wound and elucidate whether there are differences in the expression of these growth factors which might account for the delayed healing of the CO2 laser wounds compared to the scalpel as has been observed by some authors. Our results indicate that EGF, TGF-beta, PDGF, and bFGF are expressed and distributed in same areas of the early skin wound. The area of expression of these growth factors was associated with presence of wound inflammatory cells and wound fibroblasts.(ABSTRACT TRUNCATED AT 250 WORDS)
A variety of lasers are available for the treatment of pigmented and vascular lesions. This paper presents our preliminary evaluation of the Q-switched 532 nm Con-Bio laser (Continuum Biomedical, Livermore, CA) in a murine model. Mice were anesthetized with intraperitoneal pentobarbital. Laser impacts (10 nsec, 150 mJ max.) were created on the ears at fluences of 1.5, 2, 3, 4, 5, and 6 J/cm 2. Acute study animals were sacrificed 15 min postinjury. Tissues were fixed in formalin and examined via light microscopy. Chronic study animals were allowed to heal for 3 weeks postoperatively. Parameters analyzed included the presence or absence of blistering, hemorrhage, visual assessment of thermal injury, microscopic evidence of vascular coagulation, or disruption and cosmesis. Acute vascular disruption and coagulation were present in all samples. Healing and cosmesis were good at all fluences tested. Tests of the laser in a prefocused mode produced a tissue cavitation effect with a depth of coagulation of 0.73 +/- 0.44 mm and hemorrhage of 0.68 +/- 0.41 mm. A chronic study of the vascular effect on larger vessels (1-2 mm) was conducted on a rabbit ear. Acute disruption was observed, however, all vessels were recanalized when examined grossly and histologically at 3 weeks. These preliminary results suggest that this new laser may be useful for the treatment of cutaneous vascular lesions. Further studies and clinical trials are warranted.
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Studies have shown that low-level laser irradiation increases the proliferation of fibroblasts in cell culture. The mechanism of action is unknown. Basic fibroblast growth factor (bFGF) is a multifunctional polypeptide that has been detected in most tissues and which supports cell proliferation and differentiation. The purpose of this study was to determine whether laser irradiation (660 nm) can stimulate production of bFGF from fibroblast cells in cell culture. Our study showed that fibroblasts irradiated with laser energy at 2.16 J/cm2 demonstrated increased cell proliferation and enhanced production of bFGF, whereas fibroblasts irradiated with laser energy at 3.24 J/cm2 neither demonstrated increased cell proliferation or an enhanced release of bFGF as compared to the control group. These results provide direct evidence that the proliferation of fibroblasts as a result of stimulation by low level laser irradiation may be associated with the autocrine production of bFGF from fibroblasts.
General surgery represents a speciality where, while any procedure can be performed with lasers, there are no procedures for which the laser is the sine quo non. The general surgeon may perform a variety of procedures with a multitude of laser wavelengths and technologies. Laser safety in general surgery requires a multidisciplinary approach. Effective laser safety requires the oversight of the hospital's "laser usage committee" and "laser safety officer" while providing a workable framework for daily laser use in a variety of clinical scenarios simultaneously. This framework must be user-friendly rather than oppressive. This presentation will describe laser safety at the Rochester General Hospital, a tertiary care, community-based teaching hospital. The safety program incorporates the following components: input to physician credentialing and training, education and in-servicing of nursing and technical personnel, equipment purchase and maintenance, quality assurance, and safety monitoring. The University of Rochester general surgery residency training program mandates laser training during the PGY-2 year. This program stresses the safe use of lasers and provides the basis for graded hands-on experience during the surgical residency. The greatest challenge for laser safety in general surgery centers on the burgeoning field of minimally invasive surgery. Safety assurance must be balanced so as to maintain a safe operating-room environment while ensuring patient safety and the ability to permit the surgery to proceed efficiently. Safety measures for laparoscopic procedures must be sensitive to the needs of the surgical team while not providing confusing signals for the "gallery" observers. This task is critical for the safe operation of lasers in general surgery. Effective laser safety in general surgery requires constant vigilance tempered with sensitivity to the needs of the surgeon and the patient as laser technology and its applications continue to evolve.
Polypropylene mesh (Marlex) is commonly used to reinforce the abdominal wall during hernia repair. Recently, hernia repair has been performed using laparoscopic techniques. Marlex used for reinforcement is placed directly onto the peritoneum (i.e. transperitoneal) in some repairs. This practice of placing Marlex mesh directly onto the peritoneum may, however, lead to clinically significant bowel adhesions. This study tests whether three different adhesion barriers (Gore-Tex, Interceed, and poloxamer) can reduce bowel adhesion formation when placed directly over the fixed Marlex mesh in the rat. Interceed and poloxamer significantly reduced adhesion formation to Marlex mesh. Gore-Tex had the greatest amount of adhesion formation but this was not significantly different from Marlex control. Poloxamer treatment appeared to significantly reduce tensile strength and Marlex mesh incorporation. The Interceed treatment also appeared to reduce tensile strength as compared to Marlex alone, however, this difference was not significant. The use of Marlex mesh with an Interceed barrier reduces intraabdominal adhesions while not reducing the tensile strength of the Marlex mesh incorporation.
Two patients presented with symptomatic cholelithiasis and cholecystitis and ventral herniae. In Case 1, an incarcerated supraumbilical hernia was present in a morbidity obese patient. In Case 2, an incarcerated incisional hernia was present. Both patients underwent laparoscopic cholecystectomy and simultaneous herniorrhaphy. Technical details of the operative technique are presented.
The extent of immunological adjuvancy of silicone-gel, from mammary implants, up to now, has not been determined definitively. This study compares the immune potentiation effects of silicone-gel with that of Freund's adjuvant, using bovine serum albumin (BSA) as the test antigen in rats. Sixty, 250 gr., male Sprague Dawley rats were divided into six groups: I- phosphate buffered saline (PBS) only, II- silicone oil (Dow Corning Medical Grade 360 liquid silicone), III- 50% silicone-gel (McGhan Medical Corp.- mammary implant) in silicone oil, IV- complete Freund's adjuvant (CFA), V- incomplete Freund's adjuvant (IFA), and VI- 50% silicone oil in IFA. Each adjuvant was mixed or emulsified with an equal volume of 50 micrograms of BSA in 150 microliters of PBS. Each immunization was given intramuscularly in a single injection. Cardiac puncture test bleeds were taken at 12, 22, 40 and 56 days post immunization and the serum anti-BSA-antibody was measured by ELISA. The results indicate that silicone-gel is a potent immunological adjuvant, compared to both CFA and IFA. Silicone oil alone is not as potent as adjuvant and seems to inhibit the immune response when mixed with IFA. There thus appears to be a distinct possibility that silicone-gel may also be able to mediate an auto-immune reaction.
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This study examines whether primary laser excision results in augmentation of the systemic host anti-tumor response to tumor rechallenge. Single R3230AC mammary tumor implants, (0.5 x 0.5 x 1.0 mm), were grown in 112 female Fisher 344 rats. The animals were randomized. Group S tumors were excised by scalpel. Group E was excised with a Surgistat electrocautery (Valley Labs, Boulder, CO). Group CS was excised with a Sharplan 1100 CO2 laser (Sharplan, Allendale, NJ) at 25 watts (W) continuous wave (CW) (0.2 mm spot size) and the wound was "sterilized" with a 5-mm spot size by gently heating the tissue without blanching. Group K was excised with a KTP/532 laser (Laserscope, San Jose, CA) at 17 W CW using a 400 microns fiber. Group Y was excised with a Sharplan 2100 Nd:YAG laser set at 15W CW using a 0.2 mm clear sapphire tip. A second tumor implant, (0.5 x 0.5 x 1.0 mm), was placed at a remote site 14 days postoperatively. An unoperated control group was implanted. Secondary tumor volumes were measured for 36 days and the mean tumor volumes (MTV) were statistically compared. The MTV in groups CS, K, Y, and E was less than control (P less than 0.01). The MTV in groups CS, K, Y, and E was less than group S, although this was not statistically different. Lasers and cautery appear to increase the host response against subsequent tumor challenge. This study corroborates earlier studies of other modalities. Further studies to determine whether this host sensitization is an immune response and to elucidate the mechanisms of this effect are warranted.
Lasers are instruments that may enhance the surgeon's ability to perform surgery. Many medical lasers sit unused. Lack of use is associated with "user unfriendliness." Nurses and surgeons often cite factors such as complexity, location, and types of controls, and content of displays. Other factors such as culture-ethnology and its relationship to command words and symbols, affect understandability of controls, displays, and user friendliness. Laser designers and engineers must analyze the interaction between laser users and products. Laser design and operation must coincide with specific needs and expectations of the nurses and physicians. Poor design and engineering compromises result in nonuse of expensive instrumentation, products which are ineffective for clinical use, and could potentially increase the risk of possible injury to patients and staff. This discussion of the design and operation of medical laser systems, presents the advantages and disadvantages of several laser systems. User interfaces for controls: color, function, touch activation, labels and size, sound cues, laser activation, type and amount of feedback information during operation; design of storage for accessories, and need for features such as pulsing, and milliwatts will be discussed. We will present what we consider to be an ideal laser system.
The influence of Nd:YAG laser hyperthermia (45 degrees C for 20 min) on local tumor recurrence followed by CO 2 laser or scalpel excision was studied on 150 F344 female rats that were implanted with R3230AC mammary tumor in the mammary ridge. The development of local tumor recurrence was observed for 39 days postoperatively. All groups undergoing CO 2 laser excision showed a significant reduction in local tumor recurrence (p less than 0.05) compared with the scalpel technique. Animals that underwent CO 2 laser excision and wound sterilization 48 h following laser hyperthermia demonstrated the lowest recurrence when compared with scalpel excision (p less than 0.01). These results indicate that the local thermal effect achieved by laser hyperthermia or laser sterilization plays an important role in the reduction of local tumor recurrence and augments complete local tumor resection.
The results of a questionnaire distributed to enrollees at laser training programs at the Rochester General Hospital between 1986 and 1989 were compared with the results of a previous survey and current patterns of laser utilization and acceptance among surgical house staff. Laser utilization has improved slightly. However, both house staff and attending surgeons prefer, and are most comfortable with, nonlaser technology. Continued efforts to enhance the utilization of laser technology and the availability of laser education at teaching hospitals are key for the future.
Laser-induced fluorescence (LIF) of photosensitizers is used to detect cancer. The effect of argon laser light with an average irradiance of 31 mW cm-2 and Photofrin II (Dihematoporphyrin ether, DHE) at concentrations of 1.0 and 5.0 micrograms ml-1 on C1300 murine neuroblastoma cells (MNB, NB41A3) in vitro was investigated. Growth curves and cell viability (trypan blue dye exclusion) were determined at 1, 24, 96, and 144 hr post-irradiation. Light doses of 1.8 and 9.0 J cm-2 combined with 5.0 micrograms DHE ml-1 decreased both cell numbers and viability, immediately and up to 144 hr postirradiation. Argon laser light alone at a fluence of 9.0 J cm-2 caused reversible injury to the cells. This in vitro study shows that both low energy argon laser light and low dose DHE are cytocidal to C1300 MNB cells. LIF promises to aid in the detection and destruction of neuroblastoma. Surgeons should be aware that tissue irreversible damage is likely to occur when performing LIF detection of neuroblastoma. The doses of laser light and of Photofrin II found to be toxic to neuroblastoma cells in culture may provide guidelines for photodynamic therapy ablation of neuroblastoma clinically.
Endoscopic detection of small tumors is key to the early diagnosis and treatment of malignancy. This paper describes a simple, endoscopic detection system which enables tumor localization and a permanent record based on the laser-induced fluorescence of dihematoporphyrin ether (LIFD). Spectral analysis of dihematoporphyrin ether (DHE, Photofrin II) was performed with a Perkin Elmer LS-5 scanning fluorimeter. DHE at concentrations of 50 micrograms/ml and 5 micrograms/ml in 95% ethanol were tested, demonstrating fluorescence quenching at 50 micrograms/ml DHE at 406 nm excitation. This phenomenon was not observed at 442 nm excitation. Based on this data and the availability of the helium cadmium laser, a series of endoscopic detection systems was developed and tested utilizing a LiConix 4240NB helium cadmium laser (TEMoo, 442 nm, 40 mW). A fiber with a microdiverging (MDL) lens was used. Irradiance achieved at the tip of the fiber was 31.58 mW/cm2 for MDL. A Corning 34832 (550 nm) sharp cutoff barrier filter was coupled to an Olympus OES BF2T10 bronchoscope. Successful detection of LIFD was obtained. Direct observation of LIFD is possible when wearing Laserguard argon safety goggles (OD 15 at 488 nm, OD 11 at 514 nm). Photographic recording of LIFD was performed with the following cameras and parameters: Olympus OM-2S camera (OM2) with EES135 film (ISO 1600) with a 4-second exposure (method 1) and the Olympus OES SCP-10 instant camera with Polaroid 779 (ISO 640) film and a 120-second exposure (method 2). The photographic methods demonstrate the red fluorescence of DHE on filter paper disks at concentrations of 0.5 micrograms/ml (500 ng/ml). (ABSTRACT TRUNCATED AT 250 WORDS)
New instruments to facilitate laser operations are presented. These devices are based on the Kocher bronchocoele sound and are useful as dissecting tools and optical backstops to prevent iatrogenic injury.
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