Left Port Research Articles

Methods for in-cylinder EGR stratification and its effects on combustion and emission characteristics in a diesel engine

The effects of in-cylinder EGR stratification on combustion and emission characteristics are investigated in a single cylinder direct injection diesel engine. To achieve in-cylinder EGR stratification, external EGR rates of two intake ports are varied by supplying EGR asymmetrically using a separated intake runner. The EGR stratification pattern is improved using a 2-step bowl piston and an offset chamfer at the tangential intake port. When high EGR gas is supplied to the left (tangential) port, a high EGR region is formed at the central upper region of the combustion chamber. Consequently, combustion is initiated in the low EGR region, and PM is reduced significantly. When high EGR gas is supplied to the right (helical) port, a high EGR region is formed at the lower periphery of the combustion chamber. Therefore, combustion is initiated in the high EGR region, and NO x is reduced without PM penalty. Stratified EGR potentially reduces NO x by maximum 45%, without penalties of performance and other emissions. A proper in-cylinder swirl with stratified EGR maximizes the effects and achieves simultaneous reduction of NO x by 7% and PM by 23%. Moreover, the robustness of stratified EGR is evaluated under various operating conditions and injection strategies.

V1028 ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY

You have accessJournal of UrologyKidney & Ureter Oncology1 Apr 2011V1028 ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY Ephrem Olweny, Sara Best, and Jeffrey Cadeddu Ephrem OlwenyEphrem Olweny Dallas, TX More articles by this author , Sara BestSara Best Dallas, TX More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1063AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) pyeloplasty is technically challenging due to instrument clashing and difficulty sewing, and usually requires use of an additional 3/5-mm port to facilitate sewing. Application of the da Vinci Si™ robotic surgical system to LESS (R-LESS) may help overcome these challenges. We herein describe our technique and initial clinical experience with R-LESS pyeloplasty. METHODS Since May 2010, we have performed R-LESS pyeloplasty in 5 patients. All patients presented with symptomatic obstruction, which was confirmed by lasix renography. Initial cystoscopy with JJ stent insertion was performed. The peritoneum was entered through a 3-cm umbilical incision, and a GelPOINT™ (Applied Medical, Rancho Santa Margarita, CA) access platform was placed. An inverted-triangle trocar configuration, consisting of a left 8-mm port, a right 5-mm port, and a 12-mm camera port, positioned at least 2-cm apart on the GelPOINT™, was used. A left 5-mm assist port was triangulated off the left sided ports. Ports were placed prior to positioning the GelPOINT™ on the abdomen, which was then insufflated. An 8-mm robotic scissors or hook cautery was placed through the left port, and a 5-mm robotic grasper through the right port, criss-crossing these instruments at the umbilicus so as to maximize separation of the robotic arms. The robotic console was programmed to control these instruments intuitively, such that the right hand controlled the instrument in the left port, and vice versa for the right port instrument. An upward-facing 30-degree robotic camera was used. For the right- side, a 3-mm liver retractor was used, placed through a separate stab incision. Dismembered pyeloplasty was then completed in standard fashion, and the anastomosis completed over the pre-placed stent, without need for an additional port. A surgical drain was then positioned through the umbilicus. RESULTS R-LESS pyeloplasty was successfully completed in all 5 patients, with a mean operative time of 228 min, and estimated blood loss of 56 ml. There were no intra- or postoperative complications. Mean hospital length of stay was 2.3 days. Short and long-term functional outcome data are pending. CONCLUSIONS Initial experience with R-LESS pyeloplasty using the da Vinci Si™ robot is promising; benefits are improved ergonomics, decreased instrument clashing, and avoidance of an extra port for the anastomosis. Development of robotic systems specific to R-LESS is underway, and is expected to further facilitate widespread clinical application. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e414 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ephrem Olweny Dallas, TX More articles by this author Sara Best Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Technical Modifications in Laparoscopic Appendectomy

The technique of laparoscopic appendectomy has been modified several times in the past 20 years. In this report, we have described our modifications regarding the position of ports placement and closure of the base of appendix. Three surgeons successfully performed laparoscopic appendectomy in 108 cases with these modifications during the 3-year period. The first 10 mm port is placed in the periumbilical region. The second 10 mm and third 5 mm ports are inserted in the left and right side of abdomen below the pubic hairline respectively. Then the telescope is transferred from the periumbilical to the left suprapubic port. This mode of access leads to optimal ergonomics and cosmesis. For securing the base of appendix, only one Hem-o-lok clip (nonabsorbable polymer clip) is applied on each side. The use of Hem-o-lok clip is simple, safe and decreases the time and cost of laparoscopic appendectomy.

Hybrid Single-incision Laparoscopic Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We report one of the initial clinical experiences from India for Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis (RPC IPAA) with this new technique. A SILSTM port was used through the curved intra-umbilical 25-mm incision. A 12-mm port was placed in the right iliac fossa at the ileostomy site. Another 5mm port was placed in the left iliac fossa at the drain site. 10mm 0 degree lens was used through the SILS port. Two 5mm port were placed from the SILS port. Right iliac fossa port was the surgeon's right hand port and left hand port was 5mm SILS port. Left iliac fossa port and 5mm SILS port were used by the assistant surgeon for retraction. The specimen was delivered through the umbilical incision by extending the incision for 1.5cm on either side. Ileal J Pouch was created extracorporeally and then anastomosed to the anal canal with the circular stapler laparoscopically. The diverting loop ileostomy was brought out through the right iliac fossa 12mm port. The pelvic drain was brought out through the left iliac fossa port. The procedure was completed without any perioperative complications. Operative time was 256 minutes. Postoperative follow-up did not reveal any umbilical wound complication. Till date we have performed 26 Laparoscopic RPC with IPAA and this was the first Single Incision Laparoscopic RPC with IPAA. For experienced laparoscopic colorectal surgeons, single incision laparoscopic colectomy (SILC) is feasible. Single-incision laparoscopic colectomy is a promising alternative method as minimally invasive abdominal surgery for the treatment of patients requiring colectomy.

Ligand Regulation of the Quaternary Organization of Cell Surface M3 Muscarinic Acetylcholine Receptors Analyzed by Fluorescence Resonance Energy Transfer (FRET) Imaging and Homogeneous Time-resolved FRET

Flp-In(TM) T-REx(TM) 293 cells expressing a wild type human M(3) muscarinic acetylcholine receptor construct constitutively and able to express a receptor activated solely by synthetic ligand (RASSL) form of this receptor on demand maintained response to the muscarinic agonist carbachol but developed response to clozapine N-oxide only upon induction of the RASSL. The two constructs co-localized at the plasma membrane and generated strong ratiometric fluorescence resonance energy transfer (FRET) signals consistent with direct physical interactions. Increasing levels of induction of the FRET donor RASSL did not alter wild type receptor FRET-acceptor levels substantially. However, ratiometric FRET was modulated in a bell-shaped fashion with maximal levels of the donor resulting in decreased FRET. Carbachol, but not the antagonist atropine, significantly reduced the FRET signal. Cell surface homogeneous time-resolved FRET, based on SNAP-tag technology and employing wild type and RASSL forms of the human M(3) receptor expressed stably in Flp-In(TM) TREx(TM) 293 cells, also identified cell surface dimeric/oligomeric complexes. Now, however, signals were enhanced by appropriate selective agonists. At the wild type receptor, large increases in FRET signal to carbachol and acetylcholine were concentration-dependent with EC(50) values consistent with the relative affinities of the two ligands. These studies confirm the capacity of the human M(3) muscarinic acetylcholine receptor to exist as dimeric/oligomeric complexes at the surface of cells and demonstrate that the organization of such complexes can be modified by ligand binding. However, conclusions as to the effect of ligands on such complexes may depend on the approach used.

Laparoscopic Total Intracorporeal Correction of Choledochal Cyst in Pediatric Population

The laparoscopic correction of the choledochal cyst is an attractive treatment option. However, even the skilled surgeons do not prefer the intracorporeal jejunojejunal anastomosis due to the technical difficulties. In this article, we present the feasibility of laparoscopic total intracorporeal correction of the choledochal cyst, including the retrocolic Roux-en-Y hepaticojejunostomy and jejunojejunostomy. A prospective review of 6 cases of consecutive laparoscopic surgery for choledochal cyst in the pediatric population from March 2007 to April 2008 was performed. All patients underwent laparoscopic excision of a choledochal cyst and total intracorporeal Roux-en-Y reconstructions. The intracoporeal jejunojejunostomy was made by introducing an endoscopic gastrointestinal anastomosis device (Endo-GIA; US Surgical, Norwalk, CT) through the umbilical port with hand-sewn reinforcement. We evaluated the patient's age at the time of operation, time taken for total operation, time taken for jejunojejunostomy, and intra- and postoperative events. All 6 cases were girls (age ranging from 4 months to 7 years). All had type I choledochal cyst. Five ports were utilized: one telescopic port at the umbilicus, one left subcostal port for liver retraction, two operating ports on the right flank and left side of the umbilicus, and one right-lower quadrant port for the assistant. The mean time for total operation was 275 + or - 58 minutes (range, 210-360). Total intracoroporeal jejunojejunostomy took 38 + or - 10 minutes (range, 25-55). All patients were symptom free during the median follow up of 3.5 months. In the pediatric population with choledochal cyst, total intracorporeal Roux-en-Y hepaticojejunostomy and jejunojejunostomy during laparoscopic surgery is feasible without the need for exteriorization of the bowel.

Laparoscopic Excision of Bilateral Functioning Noncommunicating and Rudimentary Uterine Horns in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome and Pelvic Endometriosis

A 40-year-old, nulliparous woman with a known case of Mayer-Rokitansky-Kuster-Hauser syndrome had a 3-month history of cyclic and progressively increasing lower abdominal pain. At laparoscopy, the ovarian fossa, the ovaries, and the uterosacral ligaments were covered with endometriotic lesions bilaterally. Both the ovaries were free and had endometriomas of 3 to 4 cm in size. The fallopian tubes were free and turgid with normal healthy fimbriae. There were 2 horns of the uterus, the right being 5 ! 3 ! 3 cm, and the left being 3.5 ! 2 ! 2 cm. They were not communicating with the vagina, and had evidence of a functional endometrium and adenomyosis, resulting in small hematometra bilaterally. A bilateral (Fig.1 and 2) laparoscopic resection of the rudimentary uterine horns with bilateral salpingo-oophorectomy was undertaken using a harmonic scalpel and bipolar coagulation. The uterine arteries were both identified and were coagulated and resected close to the uterine horns. Both the angles of the vaginal vault were sutured using intracorporeal sutures to the respective round ligaments. Several biopsy specimens of various lesions were taken. The specimens were delivered through the extended left port. The blood loss was 100 mL. A cystoscopy with retrograde ureteral catheterization showed patent ureters bilaterally.

Laparoscopic Rapid Totally Diverting Loop Colostomy: A New Twist on an Old Technique

A minimally invasive variation of an established technique of colostomy is described. The method was originally published in 1977. In a setting where traditional celiotomy is not required, three ports are placed with the left lateral port used for the stoma. After initial peritoneal inspection, the colon segment and its mesentery are identified. A suture is passed forming a loop through the end of a soft latex drain, which is passed into the peritoneal cavity. Using the Goldfinger instrument, the mesentery is breached and the loop end of the drain is snared and brought back through the mesenteric defect. This maneuver enables the colon to be retracted through the port site for completion of the colostomy. Inserting the finger along the loop provides proximal and distal visual confirmation. The colon is stapled but not divided. Maturation of the stoma may be done immediately or delayed depending on the clinical circumstances.

Fast and dynamic odor encoding in rat olfactory cortex during odor discrimination task

Event Abstract Back to Event Fast and dynamic odor encoding in rat olfactory cortex during odor discrimination task Active movement of sensory organs plays an important role in many sensory modalities. In olfaction, animals sniffing frequency shifts dynamically depending on animals? behavioral states or task demands. Previous behavioral studies from our group showed that rats can achieve highly accurate odor discrimination with a single sniff, suggesting that sniffing is a unit of odor encoding (Uchida and Mainen, 2003). However, very little is known about how active sniffing affects odor encoding by neurons, because most neurophysiological studies in mammalian olfaction have been performed in anesthetized animals. In this study, we wished to address how odor representations develop over sniff cycles and how these representations relate to behavioral performance. We focused on the olfactory cortex because it is closer to behavioral output than the olfactory bulb and therefore we expected that it may be easier to establish direct links between behavioral performance and neuronal activity. We recorded neural activity from individual cells in the anterior piriform cortex of rats using a multi-electrode recording technique while they performed a two-alternative odor discrimination task. The rats were trained to sample an odor at a central odor port and to go left or right to a choice port to obtain water rewards. In each session, at least six odors were used, with half of them assigned to either the left or right reward port. Simultaneously, respiration was monitored using a temperature sensor implanted in the nostril. Olfactory cortical neurons showed robust and transient odor responses with specific latencies that were tightly locked to sniff cycles. Many neurons showed odor-specific adaptation or facilitation at the second sniff. We then examined how the ensemble activity evolved across sniffs. Using principal component analysis, it could be seen that ensemble activity followed odor specific trajectories. Interestingly, the ensemble activity in the first sniff was significantly different from that in the second sniff. This contrasts with the highly similar trajectories repeated over multiple sniff cycles in previous studies in anesthetized animals. We next quantified information content within each sniff cycle by asking how well an ideal observer can discriminate six odors based on the neural activity. To do this we used several different pattern classification methods including support vector machines. This analysis showed that the discriminability of odors developed very rapidly within the first sniff and that the second sniff provided less information. Using the combined spikes during the first and second sniffs did not improve odor discriminability significantly compared to using only spike during the first sniff. In summary, an informative odor representation in the olfactory cortex of behaving rats appears to develop very rapidly within a single sniff and is not substantially augmented odor representation in the second sniff. These observations may help to explain the behavioral observation that multiple sniffs in the odor sampling port does not result in increased discrimination performance. This study suggests that olfactory processing during active sniffing favors rapid processing over prolonged temporal integration during an odor discrimination task.

Robot-Assisted Laparoscopic Radical Prostatectomy in the Renal Allograft Transplant Recipient

Since the advent of immunosuppressive therapy, patients have been able to lead longer lives as transplant recipients. We report the first case of robot-assisted laparoscopic prostatectomy in the renal allograft recipient. A 54-year-old man presented with Gleason 3+3 localized prostate cancer with a prostatespecific antigen level of 8.5 ng/mL. He had a history of end-stage renal failure secondary to fulminant acute pyelonephritis necessitating bilateral nephrectomy. Renal allograft transplant in the right iliac fossa was performed in 1981, with adequate renal function while continuing his immunosuppressant regime. The patient also had previous left inguinal herniorrhaphy. Modifications to our surgical approach include placement of a bariatric port superiolaterally to the standard port site; siting the left port inferiolaterally to provide adequate access for pelvic lymph node dissection; and developing the retropubic space largely from the contralateral side to avoid allograft injury. Extensive adhesiolysis was also needed. After negative urethral margin reported on frozen section, vesicourethral anastomosis was fashioned using our Cornell bladder neck anatomic reconstruction technique. The patient needed a postoperative transfusion of 1 unit of blood and was discharged on postoperative day 2 after recommencement of immunosuppression. The final pathology report revealed pT(2c) Gleason 7 (3+4) disease and negative surgical margins. Continence was recovered within the first week of catheter removal, and erections sufficient for penetration occurred before 6-week follow-up in the clinic. Robot-assisted radical prostatectomy is feasible in the carefully selected renal allograft recipient with favorable oncologic, continence, and potency outcomes.

Ovarian Remnant Syndrome at the Port Site

Ovarian remnant syndrome is a rare gynecologic complication, mostly induced by difficult salpingo-oophorectomy with the residual ovarian tissue on the pelvic side wall. This is a report of a rare case of ovarian remnant syndrome at a port site after laparoscopic oophorectomy and a review of the related literature. A 22-year-old virgin had a laparoscopic oophorectomy for an endometrioma 5 years earlier. Postoperatively, she visited gynecologic clinics for a frequent painful sensation at the left port site. After sonographic examination and under the impression of a recurrent endometrioma, laparotomy and cyst excision were performed. Surprisingly, ectopic ovary was diagnosed by the pathologist. Review of the literature revealed ovarian remnant implantation at a port site as a very rare type of ovarian remnant syndrome. During laparoscopic oophorectomy in a woman without sexual exposure who is not a good candidate for culdotomy, the removal of the excised ovary through the port site is sometimes difficult and residual ovarian tissue implantation may occur. There are many methods to reduce the risk of port-site seeding, which we must keep in mind and execute to prevent such a complication.

Fixation of the Access-Port is Not Required in Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is increasingly performed in patients with morbid obesity. Suturing of the access-port in LAGB can be difficult and time consuming but is felt necessary by many surgeons to prevent migration and facilitate band adjustments. Between 2003 and 2006, 226 patients underwent LAGB with the MIDband. All surgery was performed by the pars flaccida approach. The access-port was positioned in a subcutaneous pouch adjacent to the left hypochondrial port site and was not secured. Regular follow-up and band fills were offered. All band or port-related complications were duly recorded. A patient satisfaction survey was also conducted among 50 randomly selected post-banding patients. Mean age was 41.65 years (range 18-73 years) and mean BMI was 45.85 kg/m2 (range 34.0-74.93 kg/m2). The access-port was inaccessible at first attempt in 5 (2%) patients. 4 of these required radiological imaging to identify the port orientation and 1 required multiple attempts at port puncture with subsequent re-operation due to tube puncture. 91% of patients reported no significant trouble other than mild discomfort and prominence of the port. This study shows non-fixation of the access-port to be safe and effective with good patient acceptability. In addition, it avoids the need for regular X-ray localization of the port.

An almost missed leptomeningeal angioma in Sturge-Weber syndrome

Although leptomeningeal angioma is the hallmark of Sturge-Weber syndrome (SWS),1 some patients with suspected SWS show no MRI evidence of pial contrast enhancement.2 A girl with a left port wine stain developed right-sided motor seizures. MRI was performed at 18 months of age. Post-gadolinium T1-weighted images …

News briefs

Researchers have developed a ballistic deflection transistor that promises to be fast and energy efficient. The BDT has a Y-shaped electrical junction with a triangular deflector block in the middle. The BDT launches an electron into the junction. The electron passes through an electrical field that pushes it slightly to one side or the other and then bounces off one of the deflector block's sides and down one part of the junction to a left or right output port. This creates the ones and zeros of binary data

Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach

OBJECTIVE: Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. METHODS: In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. RESULTS: Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. CONCLUSIONS: We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype.

Representation of Spatial Goals in Rat Orbitofrontal Cortex

The orbitofrontal cortex (OFC) is thought to participate in making and evaluating goal-directed decisions. In rodents, spatial navigation is a major mode of goal-directed behavior, and anatomical and lesion studies implicate the OFC in spatial processing, but there is little direct evidence for coding of spatial or motor variables. Here, we recorded from ventrolateral and lateral OFC in an odor-cued two-alternative choice task requiring orientation and approach to spatial goal ports. In this context, over half of OFC neurons encoded choice direction or goal port location. A subset of neurons was jointly selective for the trial outcome and port location, information useful for the selection or evaluation of spatial goals. These observations show that the rodent OFC not only encodes information relating to general motivational significance, as shown previously, but also encodes spatiomotor variables needed to define specific behavioral goals and the locomotor actions required to attain them.

Laparoscopic resection of type 1 choledochal cysts in pediatric patients

Choledochal cyst resection and hepaticojejunostomy have historically been performed using an open technique. We describe here the largest single experience with this procedure using laparoscopic techniques in eight consecutive pediatric patients. There were six girls and two boys, of ages ranging from 3 months to 13 years. All had type I choledochal cysts. Three were asymptomatic, having been noted on prenatal ultrasonography. Five ports were utilized: one 5-mm telescope port at the umbilicus, two 3-mm operating ports on both sides of the umbilicus, one 5-mm left subcostal port for liver retraction, and one LLQ 5-mm assistant port. The median operating time was 155 min (range 110-250 min), with one conversion to an open procedure due to a high transection of the cyst leading to partial retraction of the left hepatic duct into the liver substance. Mean hospital stay was 3 days. At a mean follow-up of 18.8 months, all patients were anicteric and asymptomatic. Laparoscopic resection of choledochal cysts can be performed safely in pediatric patients with minimal morbidity and good long-term results.

Queen Hatasu Descends to Throne

Queen Hatasu Descends to Throne Sue William Silverman (bio) After death, my temple rubbles, porticos, obelisks drift windless Nile hills, gold pyramidion flecks, limestone chambers molder, lunar tug of time silencing Syene quarries, my pylons, colonnades thieved by Thothmes, as if he sailed to Punt for rosewood, ebony, teak to build Temple Dayr-el-Bahari - brother mine providing me no headrest, no glass vessels of juniper, almond, moringa to sweeten feathered transformation, no slate palette to color my face for Osiris, no Dwelling Place for Ba. Scarabaei dispersed, jasper lion head lost to Museum of Ghizeh, beloved turquoise signet ring in possession of English gentleman, Ushabti in Hague, sitting statue in Berlin, my Throne-Chair presented to British Museum after 1887 Jubilee exhibition. On restless, papyrus feet, a compassed lotus guiding me, I left Port of Thebes traveling to Pomona who fed me Roman apples, souling German, French towns, square bread with currants, wandered dark Celtic villages to Usinach warmed by Druid fires, arriving London disguised in king's kilt and sandals, crowned with Kepersh war-helmet, false beard, underground to Great Russell Street, descending steep steps to forgotten grottoes, damp cellars, wormholed rooms- pocketed onionskin letter received after numerous entreaties, [End Page 131] The piece that you refer to is within the Museum's collection although the provenance is now uncertain and consequently the object is not currently on display. C. Arnold, Visitor Services ...opening doors of dust - unframed paintings, chipped enamel bowls, tarnished metals, mildewed gowns, warped wood, until I behold Amen-Knum Hatasu, my Pharaonic Throne-Chair - Truth, Law, Justice- gold emblems, two basilisks with emerald eyes, crests erect, rosewood tails spiraling bull legs to hooves, fetlocks, crossrails banded in silver, encrusted reptile annulets, plated nails. Palm-frond cartouche Ra-ma-ka - tawny boxwood fingernails, hand hieroglyph... muscle flexing, gold cobra on my brow waking, its ribs spreading skin, uncoiling yellow, the uraeus necklacing my throat, slithering round my shoulders, oozing down torso, thighs, to the ground - undulating ancient memory of fluted vibrations, its hooded chevroned head swaying imperial pose, tongue flicking scent of Thothmes' black double shadowed in plaited seat - quick fiery akh spitting fury fanging his neck ... his moon darkens. My solar name sails toward Sahara heat... cobra sloughing skin, Wadjet swallowing tail circling my chamber of Divine Cow, Mother Nefertari, and home. Sue William Silverman Sue William Silverman’s first memoir, Because I Remember Terror, Father, I Remember You (U of Georgia P) was a winner of the AWP Award Series. Her second, Love Sick: One Woman’s Journey Through Sexual Addiction, is available from W. W. Norton. Copyright © 2004 the University of Nebraska Press

An optimal, cost-effective laparoscopic appendectomy technique for our surgical residents.

Since early 1999, we have implemented a standardized technique for laparoscopic appendectomy, which is simple, safe and easily learned and mastered by our residents. Besides superior ergonomics, it offers cosmetic advantages. It is inexpensive as only reusable instruments are used. It incorporates useful modifications, such as the use of suprapubic ports, inferior approach with repositioning of the videoscope from the umbilical port to the left suprapubic port, laparoscopic gauze swabs and instrument-assisted knotting, as well as skeletonization of the appendix. We analyze the outcome of this technique between January 2000 and December 2002. The overall conversion rate of 713 laparoscopic appendectomies was 8.7%, which is comparable with the "best" rates in international literature. Operative times (mean, 59.0 minutes) and the complication rate (6.7%) compared favorably with previous reports on resident training. In summary, our residents feel comfortable with our standardized approach, while producing acceptable results with low cost.

Texture discrimination and unit recordings in the rat whisker/barrel system

We have developed a semi-automated technique for acquiring neurophysiological data during whisker-based tactile discriminative behavior. Water-deprived, blindfolded rats are tethered by means of a harness vest that permits them to contact a rough (250 μm grooves) or smooth discriminandum with only their vibrissae. Discriminanda are mounted on a motor-driven carousel, and the rat indicates its choice (rough, smooth) by licking either a right or left water port located near the carousel. A narrow light beam detects general proximity of the animal's nose to the discriminandum, although actual whisker contact is monitored by a SuperVHS camera and measured offline using field-by-field videographic analysis. Rats can be trained within 3–6 weeks at which time they perform 100–150 trials/day at a level of 80% correct. Unit recording from the somatosensory cortex reveals that neurons increase their firing upon whisker contact of a discriminandum and that firing remains elevated during several hundred milliseconds of ongoing contact, even with the smooth surface. Nevertheless, despite the animal's ability to distinguish the rough and smooth surfaces, overall neuronal firing rates were indistinguishable for the two surfaces. In some cases, temporal firing patterns differed, although not in a consistent way across recording sites.