A middle-ear simulator for practicing prosthesis placement for otosclerosis surgery using ward-based materials

Owa, Anthony; Gbejuade, Herbert; Giddings, C.E.B.

doi:10.1258/002221503321892361

Cited by 30 publications

(25 citation statements)

References 22 publications

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“…The first human simulator, Resusci Anne, was produced by Laerdal (Stavanger, Norway) in the 1960s. Today, surgical simulators are available in many specialties,17–19 including skull base and sinus,20 tonsil,21 and middle ear22, 23 surgery. Within the field of laryngology, a number of simulators have been described 3–7.…”

Section: Discussionmentioning

confidence: 99%

Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis†

Charatcharoenwitthaya

et al. 2008

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There is limited information on test performance for detecting cholangiocarcinoma in primary sclerosing cholangitis (PSC), particularly when used sequentially. This study aimed to characterize diagnostic performance of serum carbohydrate antigen 19-9 (CA 19-9), ultrasonography, computed tomography, magnetic resonance imaging, cholangiography, and biliary cytologic techniques for detecting cholangiocarcinoma in PSC. All consecutive patients with PSC were screened and followed for development of cholangiocarcinoma from 2000 through 2006. Of 230 patients, 23 developed cytopathologically confirmed cholangiocarcinoma with an annual incidence of 1.2%. The optimal cutoff value for serum CA 19-9 was 20 U/mL, which yielded a sensitivity of 78%, specificity of 67%, positive predictive value (PPV) of 23%, and negative predictive value (NPV) of 96%. Serum CA 19-9 combined with either ultrasonography, computed tomography, or magnetic resonance imaging provided a sensitivity of 91%, 100%, and 96%, specificity of 62%, 38%, and 37%, PPV of 23%, 22%, and 24%, and NPV of 98%, 100%, and 98%, respectively, if at least one method was positive. Subsequent cholangiographic examinations in these patients increased specificity to 69% and PPV to 42% while maintaining sensitivity of 91% and NPV of 96%. Following this group, conventional cytology, aneuploidy detection by digital imaging analysis, and aneusomy detection by fluorescence in situ hybridization in brushing samples of biliary strictures had a sensitivity of 50%, 57%, and 86%, specificity of 97%, 94%, and 83%, PPV of 86%, 89%, and 80%, and NPV of 83%, 74%, and 88%, respectively, for detecting cholangiocarcinoma. Conclusion: Tumor serology combined with cross-sectional liver imaging may be useful as a screening strategy and cholangiography with cytologic examination is helpful for the diagnosis of cholangiocarcinoma in patients with PSC. C holangiocarcinoma occurs with increased frequency in patients with primary sclerosing cholangitis (PSC) and is currently a leading cause of death in these patients. [1][2][3][4] The development of cholangiocarcinoma is unpredictable on the basis of the duration, symptoms, and severity of PSC. 2,4 The cholangiographic appearance of benign strictures of PSC makes the diagnosis of cholangiocarcinoma difficult in this setting. Most patients are diagnosed with advanced unresectable disease, which imparts a dismal prognosis and is a contraindication of liver transplantation. 3 However, innovative approaches using a combination of neoadjuvant chemoradiotherapy and liver transplantation provide excellent outcomes with 5-year survival of 82% in Abbreviations: AUC, area under the curve; CT, computed tomography; DIA, digital From the

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Section: Discussionmentioning

confidence: 99%

Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis†

Charatcharoenwitthaya

et al. 2008

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“…Although temporal bone preparation is essential for residents before performing middle ear surgery in the operating room, additional and explicit training in ossicular chain and tympanic membrane is desirable. Two other simplified and inexpensive models for stapesplasty training (13,14) provide an economical method for acquiring microsurgical skills but are limited to the sole placement of a stapes piston, which additionally is not the first middle ear operation performed by surgical novices.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Skills Training With a New Tympanoplasty Model

Neudert

Kluge

Beleites

et al. 2012

Otology &Amp; Neurotology

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“…This implies resident microsurgical skills can be improved after such an intensive course. Reports have been written of incus and stapes footplate stimulators constructed using wardbased materials [12,13], but reports of objective performance from their use have not been published. In a temporal bone model of stapedotomy [14], experienced and novice surgeons were compared by their performance during fenestration, the degree of force applied to the footplate, prosthesis crimp quality and prosthesis mobility during crimping.…”

Section: Trainingmentioning

confidence: 99%