Background The use of intraoperative fluorescence images with indocyanine green (ICG) has recently been described as an aid in decision-making during surgical procedures in adults.We present our first experiences with different laparoscopic procedures performed in children using ICG fluorescence images. Material and Method We have used ICG fluorescence imaging technique in varicocele ligation, two nephrectomies, cholecystectomy, and one case of aortocoronary fistula closure. All procedures were performed through a minimally invasive approach. A high definition camera equipped with a visible infrared light source and gray-scale vision technology was used.After injection of ICG before or during the laparoscopic procedure, precise identification of vascular anatomy and bile duct architecture were easily identified. Fluorescence helped to assess blood flow from the spermatic vessels, define the variability of renal vascularization, and determine the precise location of the aortocoronary fistula. Biliary excretion of the ICG allowed the definition of the biliary tract. Conclusion Fluorescein-assisted images allowed a clear definition of the anatomy and safe surgical maneuvers during surgical procedures. The ICG imaging system seems to be simple and safe. Larger and more specific studies are needed to confirm its applicability, expand its indications, and address its advantages and disadvantages.
Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence.Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.
Since 2008, the Louisiana Department of Transportation and Development (LaDOTD) has allowed the use of crumb rubber modification (CRM) as per the specifications. However, the introduction of CRM has presented unique challenges during design and production. LaDOTD districts have reported early cracking for dense-graded mixtures. Adhesion and stability issues have been reported for open-graded friction course (OGFC) and stone matrix asphalt (SMA) mixtures. Currently, LaDOTD specifications allow the contractor to switch asphalt cement supplies without redesigning the mixture. This study evaluated several CRM-modified mixture designs to address design and performance concerns; it also evaluated the volumetric and mechanistic properties of dense, SMA, and OGFC mixtures designed with unmodified asphalt cement, styrene-butadiene-styrene-modified asphalt cement and five crumb rubber sources. SuperPave volumetric parameters were evaluated to ascertain the impact of CRM on the design of these mixtures. Rutting and intermediate temperature cracking susceptibility were determined using the Hamburg Loaded Wheel Tracker (LWT) and semi-circular bend test (SCB), respectively. Solvent extraction and the ignition furnace were used to determine the asphalt content of the modified mixtures. The results showed that CRM improved the laboratory rutting resistance of the mixtures. However, the laboratory cracking resistance was decreased for the CRM-modified mixtures. Based on statistical analysis, additional asphalt content, reduced CRM dosage, and the use of polymer additives may mitigate the reduced laboratory cracking performance of the CRM-modified mixtures. The volumetric parameters were also affected by CRMs. The mixtures should be re-designed if the contractor anticipates using a CRM-modified asphalt cement.
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