Biomedical subjects

A J Welch

Publications and source records attributed to A J Welch.

At least 37 records · Page 2Linked to original sources

PubMed2001

Surgical adhesives for laser-assisted wound closure.

Solid protein solder-doped polymer membranes were developed for laser-assisted tissue repair. Biodegradable polymer membranes of controlled porosity were fabricated with poly(L-lactic-co-glycolic acid) (PLGA), poly(ethylene glycol) (PEG), and salt particles, using a solvent-casting and particulate-leaching technique. The membranes provided a porous scaffold that readily absorbed the traditional protein solder composed of serum albumin, indocyanine green dye, and de-ionized water. In vitro investigations were conducted to assess the influence of various processing parameters on the strength of tissue repairs formed using the new membranes. These parameters included PLGA copolymer and PLGA/PEG blend ratios, membrane pore size, initial albumin weight fraction, and laser irradiance used to denature the solder. Altering the PLGA copolymer ratio had little effect on repair strength, however such variations are known to influence the degradation rate of the membranes. The repair strength increased with increased membrane pore size and bovine serum albumin concentration. The addition of PEG during the membrane casting stage increased the flexibility of the membranes but not necessarily the repair strength. Typically, the repair strength increased with increasing irradiance from 12 to 18 W/cm(2). The new solder-doped polymer membranes provided all of the benefits associated with solid protein solders including high repair strength and improved edge coaptation. In addition, the flexible, moldable nature of the new membranes offers the capability of tailoring the membranes to a wide range of clinically relevant geometries.

Animals↗

PubMed2001

An international human becoming hermeneutic study of Tom Hegg's A cup of Christmas Tea.

This article seeks to contribute to human becoming theory and to nursing by providing an international human becoming hermeneutic study of Thomas Hegg's A Cup of Christmas Tea. The human becoming hermeneutic method was used in this study to discover emergent meanings about human experiences. Guided by the method, the authors discovered three emergent meanings: honoring the cherished; communing with the was, is, and will be; and triumphing with new vision. These meanings were synthesized by the authors. A Cup of Christmas Tea is the story of the way triumphing with new vision arises with honoring the cherished in communing with the was, is, and will be. The conclusion for families and nurses is that by remaining open to all possibilities that exist in each now, moments of serendipitous togetherness can transform human trepidation and negative views of later life.

Humans↗

PubMed2001

Erbium: YAG versus holmium:YAG lithotripsy.

PURPOSE: We test the hypothesis that erbium:YAG (Er:YAG) lithotripsy is more efficient than holmium:YAG (Ho:YAG) lithotripsy. MATERIALS AND METHODS: Human calculi composed of greater than 97% calcium oxalate monohydrate and cystine were studied. Calculi were irradiated in water using Er:YAG or Ho:YAG lasers. Er:YAG lithotripsy was done with a 425 microm sapphire optical fiber at a pulse energy of 50 mJ at 10 Hz. Ho:YAG lithotripsy was performed with a 365 microm low hydroxy optical fiber at a pulse energy of 500 mJ at 10 Hz or a 425 microm sapphire optical fiber at a pulse energy of 50 mJ at 10 Hz. Fragmentation was defined as the initial stone mass minus the final dominant fragment mass and normalized for incident laser fluence (energy per unit area of fiber tip). RESULTS: Mean fragmentation plus or minus standard deviation for calcium oxalate monohydrate was 38 +/- 27 mg for Er:YAG and 22 +/- 6 for Ho:YAG (low hydroxy silica fiber) versus 5 +/- 1 for Ho:YAG (sapphire fiber, p = 0.001). When fragmentation was normalized for incident laser fluence given different optical fiber sizes, mean fragmentation efficiency was 53.6 +/- 38.7 g-microm2/J for Er:YAG lithotripsy compared with 22.6 +/- 6.4 for Ho:YAG (low hydroxy silica fiber) lithotripsy (p = 0.04). Mean cystine fragmentation was 15 +/- 3 mg for Er:YAG versus 9 +/- 1 for Ho:YAG (sapphire fiber, p = 0.0005). CONCLUSIONS: Er:YAG lithotripsy is more efficient than Ho:YAG lithotripsy.

Humans↗

PubMed2001

New range of light-activated surgical adhesives for tissue repair.

A new range of light-activated surgical adhesives has been developed for laser-assisted tissue repair. The surgical adhesive is composed of a polymer scaffold doped with the traditional protein solder mix of serum albumin and a chromophoric dye. Problems associated with inflexibility in conforming to various tissue geometries, instability in a hydrated environment due to non-uniform tissue adhesive denaturation, and solubility in physiological fluids prior to denaturation are overcome using the adhesives. The new adhesives offer a viable alternative to conventional fasteners, including sutures, staples and clips, currently used for tissue repair. In addition, it could be possible to use patches prepared from the adhesive in the field as a simple and effective method to stop bleeding and repair tissue quickly in an emergency situation. First, studies were conducted to improve the flexibility of traditional protein solders to enable them to be tailored to a wide range of clinically relevant geometry's including tubes, crescents and tape. Second, the creation of a chromophore concentration gradient across the thickness of the adhesive was investigated as a means to allow control of the heat source gradient through the adhesive. Increased deposition of the laser energy near the vital solder/tissue interface was thus achieved. Finally, predenaturation of the adhesive was investigated as a means for enhancing its stability in a hydrated environment thus improving the handling characteristics of the adhesive for clinical application. The application of the new surgical adhesives to augment laser tissue repairs is shown to enhance edge co-optation, improve repair strength and to reduce thermal tissue injury. The moldable, absorption controllable and flexible nature of the new adhesives greatly improves the clinical applicability of laser-solder tissue repair.

Animals↗

PubMed2000

Bioheat transfer analysis of cryogen spray cooling during laser treatment of port wine stains.

BACKGROUND AND OBJECTIVE: The thermal response of port wine stain (PWS) skin to a combined treatment of pulsed laser irradiation and cryogen spray cooling (CSC) was analyzed through a series of simulations performed with a novel optical-thermal model that incorporates realistic tissue morphology. STUDY DESIGN/MATERIALS AND METHODS: The model consisted of (1) a three-dimensional reconstruction of a PWS biopsy, (2) a Monte Carlo optical model, (3) a finite difference heat transfer model, and (4) an Arrhenius thermal damage calculation. Simulations were performed for laser pulses of 0.5, 2, and 10 ms and a wavelength of 585 nm. Simulated cryogen precooling spurts had durations of 0, 20, or 60 ms and terminated at laser onset. Continuous spray cooling, which commenced 60 ms before laser onset and continued through the heating and relaxation phases, was also investigated. RESULTS: The predicted response to CSC included maximal pre-irradiation temperature reductions of 27 degrees C at the superficial surface and 12 degrees C at the dermoepidermal junction. For shorter laser pulses (0.5, 2 ms), precooling significantly reduced temperatures in superficial regions, yet did not effect superficial vessel coagulation. Continuous cooling was required to reduce significantly thermal effects for the 10-ms laser pulse. CONCLUSIONS: For the PWS morphology and treatment parameters studied, optimal damage distributions were obtained for a 2-ms laser pulse with a 60-ms precooling spurt. Epidermal and vascular morphology as well as laser pulse duration should be taken into account when planning CSC/laser treatment of PWS. Our novel, realistic-morphology modeling technique has significant potential as a tool for optimizing PWS treatment parameters.

Biopsy↗

PubMed2000

Optimal parameters for laser tissue soldering: II. Premixed versus separate dye-solder techniques.

BACKGROUND AND OBJECTIVE: Laser tissue soldering by using an indocyanine green (ICG)-doped protein solder applied topically to the tissue surface and denatured with a diode laser was investigated in Part I of this study. The depth of light absorption was predominantly determined by the concentration of the ICG dye added to the solder. This study builds on that work with an in vitro investigation of the effects of limiting the zone of heat generation to the solder-tissue interface to determine whether more stable solder-tissue fusion can be achieved. STUDY DESIGN/MATERIALS AND METHODS: An alternative laser tissue soldering technique was investigated, which increased light absorption at the vital solder-tissue interface. A thin layer of ICG dye was smeared over the surface to be treated, the protein solder was then placed directly on top of the dye, and the solder was denatured with an 808-nm diode laser. Because laser light at approximately 800 nm is absorbed primarily by the ICG dye, this thin layer of ICG solution restricted the heat source to the space between the solder and the tissue surfaces. A tensile strength analysis was conducted to compare the separate dye-solder technique with conventional techniques of laser tissue soldering for which a premixed dye-solder is applied directly to the tissue surface. The effect of hydration on bond stability of repairs formed by using both techniques was also investigated using tensile strength and scanning electron microscopy analysis. RESULTS: Equivalent results in terms of tensile strength were obtained for the premixed dye-solder technique using protein solders containing 0.25 mg/ml ICG (liquid solder, 220 +/- 35 N/cm(2); solid solder, 602 +/- 32 N/cm(2)) and for the separate dye-solder technique (liquid solder, 228 +/- 41 N/cm(2); solid solder, 578 +/- 29 N/cm(2)). The tensile strength of native bovine thoracic aorta was 596 +/- 31 N/cm(2). Repairs created by using the separate dye-solder technique were more stable during hydration than their premixed dye-solder counterparts. The conventional premixed dye-solder was simpler and approximately twice as fast to apply. The separate dye-solder technique, however, increased the shelf-life of the solder, because the dye was mixed at the time of the experiment, thus conserving its spectral absorbency properties. CONCLUSION: Two laser-assisted tissue soldering techniques have been evaluated for repairing aorta incisions in vitro. The advantages and disadvantages of each of these techniques are discussed.

Absorption↗

PubMed2000

Biodegradable polymer film reinforcement of an indocyanine green-doped liquid albumin solder for laser-assisted incision closure.

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine whether solid material reinforcement of a liquid albumin solder coagulum could improve the cohesive strength of the solder and, thus, the ultimate breaking strength of the incision repair in vitro. STUDY DESIGN/MATERIALS AND METHODS: A 50%(w/v) bovine serum albumin solder with 0.5 or 2.5 mg/ml indocyanine green (ICG) dye was used to repair an incision in bovine aorta. The solder was coagulated with an 806-nm continuous wave diode laser. A 50-micrometer-thick poly(DL-lactic-co-glycolic acid) film was used to reinforce the solder (the controls had solder but no reinforcement). Acute breaking strengths were measured, and the data were analyzed by Student's t-test. RESULTS: Observations of the failure modes indicate cohesive strength reinforcement of the test specimens vs. the controls. The 2.5 mg/ml ICG reinforced solder was stronger than the controls without reinforcement (P < 0.05) for all laser powers tested. There was no difference between the test specimens and the controls with 0.5 mg/ml ICG solder for low laser powers, but at higher laser powers, the reinforced solder was stronger than the controls (P < 0.05). CONCLUSION: Reinforcement of liquid albumin solders in laser-assisted incision repair seems to have advantages in terms of acute breaking strength over conventional methods that do not reinforce the cohesive strength of the solder.

Animals↗

PubMed2000

Novel solid protein solder designs for laser-assisted tissue repair.

BACKGROUND AND OBJECTIVES: Previous studies have shown that the application of chromophore-enhanced albumin protein solders to augment laser tissue repairs significantly improves repair strength, enhances edge co-optation, and reduces thermal tissue injury. These investigations are furthered with this in vitro study conducted to assess a new range of specially designed chromophore-enhanced solid protein solders manufactured and tested for application during laser-assisted tissue repair. STUDY DESIGN/MATERIALS AND METHODS: The experimental study was divided into three parts. In the first part of the study, the creation of a chromophore concentration gradient across the thickness of the solid protein solder was investigated as a means to improve control of the heat source gradient through the solder during laser irradiation. In the second part of the study, predenaturation of the solid protein solder was investigated as a means for enhancing the stability of the solder in physiological fluids before irradiation. Finally, in the third part of the study, the feasibility of using synthetic polymers as a scaffold for traditional albumin protein solder mixes was investigated as a means of improving the flexibility of the solder. RESULTS: Uniform denaturation across the thickness of the solder was achieved by controlling the chromophore concentration gradient, thus ensuring stable solder-tissue fusion when the specimen was submerged in a hydrated environment. Predenaturation of the solid protein solder significantly reduced the solubility of the solder, and consequently, improved the handling characteristics of the solder. The solder-doped polymer membranes were flexible enough to be wrapped around tissue, whereas their solid nature avoided problems associated with "runaway" of the less viscous liquid solders currently used by researchers. In addition, the solder-doped polymer membranes could be easily tailored to a wide range of geometries suitable to many clinical applications. CONCLUSION: The novel solid protein solder designs presented here add a new dimension to tissue repair as their flexible, moldable, and absorption controllable nature, greatly improves the clinical applicability of laser-assisted tissue repair.

Animals↗

PubMed2000

Modelling infrared temperature measurements: implications for laser irradiation and cryogen cooling studies.

The use of thermographic techniques has increased as infrared detector technology has evolved and improved. For laser-tissue interactions, thermal cameras have been used to monitor the thermal response of tissue to pulsed and continuous wave irradiation. It is important to note that the temperature indicated by the thermal camera may not be equal to the actual surface temperature. It is crucial to understand the limitations of using thermal cameras to measure temperature during laser irradiation of tissue. The goal of this study was to demonstrate the potential difference between measured and actual surface temperatures in a quantitative fashion using a ID finite difference model. Three ablation models and one cryogen spray cooling simulation were adapted from the literature, and predictions of radiometric temperature measurements were calculated. In general, (a) steep superficial temperature gradients, with a surface peak, resulted in an underestimation of the actual surface temperature, (b) steep superficial temperature gradients, with a subsurface peak, resulted in an overestimation, and (c) small gradients led to a relatively accurate temperature estimate.

Body Temperature↗

PubMed2000

Dynamics of pulsed holmium:YAG laser photocoagulation of albumen.

The pulsed holmium:YAG laser (lambda = 2.12 microm, tau(p) = 250 micros) has been investigated as a method for inducing localized coagulation for medical procedures, yet the dynamics of this process are not well understood. In this study, photocoagulation of albumen (egg white) was analysed experimentally and results compared with optical-thermal simulations to investigate a rate process approach to thermal damage and the role of heat conduction and dynamic changes in absorption. The coagulation threshold was determined using probit analysis, and coagulum dynamics were documented with fast flash photography. The nonlinear computational model, which included a Beer's law optical component, a finite difference heat transfer component and an Arrhenius equation-based damage calculation, was verified against data from the literature. Moderate discrepancies between simulation results and our experimental data probably resulted from the use of a laser beam with an irregular spatial profile. This profile produced a lower than expected coagulation threshold and an irregular damage distribution within a millisecond after laser onset. After 1 ms, heat conduction led to smoothing of the coagulum. Simulations indicated that dynamic changes in absorption led to a reduction in surface temperatures. The Arrhenius equation was shown to be effective for simulating transient albumen coagulation during pulsed holmium:YAG laser irradiation. Greater understanding of pulsed laser-tissue interactions may lead to improved treatment outcome and optimization of laser parameters for a variety of medical procedures.

Albumins↗

PubMed2000

Free electron laser lithotripsy: threshold radiant exposures.

PURPOSE: To determine the threshold radiant exposures (J/cm2) needed for ablation or fragmentation as a function of infrared wavelengths on various urinary calculi and to determine if there is a relation between these thresholds and lithotripsy efficiencies with respect to optical absorption coefficients. MATERIALS AND METHODS: Human calculi composed of uric acid, calcium oxalate monohydrate (COM), cystine, or magnesium ammonium phosphate hexahydrate (MAPH) were used. The calculi were irradiated in air with the free electron laser (FEL) at six wavelengths: 2.12, 2.5, 2.94, 3.13, 5, and 6.45 microm. RESULTS: Threshold radiant exposures increased as optical absorption decreased. At the near-infrared wave-lengths with low optical absorption, the thresholds were >1.5 J/cm2. The thresholds decreased below 0.5 J/cm2 for regions of high absorption for all the calculus types. Thresholds within the high-absorption regions were statistically different from those in the low-absorption regions, with P values much less than 0.05. CONCLUSIONS: Optical absorption coefficients or threshold radiant exposures can be used to predict lithotripsy efficiencies. For low ablation thresholds, smaller radiant exposures were required to achieve breakdown temperatures or to exceed the dynamic tensile strength of the material. Therefore, more energy is available for fragmentation, resulting in higher lithotripsy efficiencies.

Differential Threshold↗

PubMed2000

7,8-Diphenyl-9-dimethylsulfido-10,11-mu-hydro-7, 8-dicarba-nido-undecaborane(9).

In the title compound, C(16)H(25)B(9)S, there are two crystallographically independent molecules, and the conformations of the phenyl and SMe(2) substituents indicate some intramolecular steric crowding. The bridging H atom is asymmetrically disposed. The title compound is a precursor to a crowded vertex-labelled nido carborane ligand important in establishing the mechanism of isomerization of icosahedral heteroboranes.

Journal Article↗

PubMed2000

Pulsed laser-induced thermal damage in whole blood.

An investigation of the effects of laser irradiation with a wavelength of 532 nm and pulse duration of 10 ms on whole blood was performed in vitro. Threshold radiant exposures for coagulation were quantified and transient radiometric temperatures were measured. The progression of effects with increasing radiant exposure--from evaporation to coagulation-induced light scattering to aggregated coagulum formation to ablation--is described. Results indicate that coagulation and ablation occur at temperatures significantly in excess of those assumed in previous theoretical studies. An Arrhenius rate process analysis based on hemoglobin data indicates good agreement with experimental results.

Biomedical Engineering↗

PubMed2000

Initial in vivo results of a hybrid retinal photocoagulation system.

We describe initial in vivo experimental results of a new hybrid digital and analog design for retinal tracking and laser beam control. An overview of the design is given. The results show in vivo tracking rates which exceed the equivalent of 38 degrees/s in the eye. A robotically assisted lesion pattern is created for laser surgery to treat conditions such as diabetic retinopathy and retinal breaks.

Animals↗

PubMed1999

Use of an agent to reduce scattering in skin.

BACKGROUND AND OBJECTIVE: A method to increase light transport deeply into target areas of tissue would enhance both therapeutic and diagnostic laser applications. The effects of a hyperosmotic agent on the scattering properties of rat and hamster skin were investigated. STUDY DESIGN/MATERIALS AND METHODS: A hyperosmotic agent, glycerol, was applied in vitro and in vivo to rat and hamster skin to assess the changes in tissue optical properties. Changes in the reduced scattering coefficient after application of the agent in vitro to rat skin and after the skin has been rehydrated were assessed to evaluate the effect of the agent on tissue. RESULTS: Experimental results showed a transient change in the optical properties of in vitro rat skin. A 50% increase in transmittance and decrease in diffuse reflectance occurred within 5-10 min after the introduction of anhydrous glycerol. In addition, reduction of light scattering with this technique increased depth of visibility with optical coherence tomography. Injection of glycerol under the skin allowed in vivo visualization of blood vessels. CONCLUSIONS: The application of the agent reduces the amount of refractive mismatch found in the tissue and markedly reduces random scattering, thereby making the skin less turbid for visible wavelengths for a controlled period of time.

Administration, Topical↗

PubMed1999

Modeling laser treatment of port wine stains with a computer-reconstructed biopsy.

BACKGROUND AND OBJECTIVE: The efficacy of laser treatment of port wine stains (PWS) has been shown to be highly dependent on patient-specific vasculature. The effect of tissue structure on optical and thermal mechanisms was investigated for different pulse durations by using a novel theoretical model that incorporates tissue morphology reconstructed tomographically from a PWS biopsy. STUDY DESIGN/MATERIALS AND METHODS: An optical-thermal numerical model capable of simulating arbitrarily complex, three-dimensional tissue geometries was developed. The model is comprised of (1) a voxel-based Monte Carlo optical model, (2) a finite difference thermal model, and (3) an Arrhenius rate process calculation to predict the distribution of thermal damage. Simulations based on previous computer-based reconstruction of a series of 6 microm sections from a PWS biopsy were performed for laser pulse durations (taup) of 0.5, 5.0, and 10.0 ms at a wavelength of 585 nm. RESULTS: Energy deposition rate in the blood vessels was primarily a function of vessel depth in skin, although shading effects were evident. Thermal confinement and selectivity of damage were seen to be inversely proportional to pulse duration. The model predicted blood-specific damage for taup = 0.5 ms, vascular and perivascular damage for taup = 5 ms, and widespread damage in superficial regions for taup = 10 ms. The effect of energy deposition in the epidermis was most pronounced for longer pulse durations, resulting in increased temperature and extent of damage. CONCLUSION: Pulse durations between 0.5 and 5 ms are likely optimal for the PWS analyzed. The incorporation of a tomographically reconstructed PWS biopsy into an optical-thermal model represents a significant advance in numerical modeling of laser-tissue interaction.

Adult↗

PubMed1999

Simultaneous irradiation and imaging of blood vessels during pulsed laser delivery.

BACKGROUND AND OBJECTIVE: Simultaneous irradiation and viewing of 10-120 microm cutaneous blood vessels were performed to investigate the effects of 2-micros 577-nm dye laser pulses. STUDY DESIGN/MATERIALS AND METHODS: A modified scanning laser confocal microscope recorded vessel response to different radiant exposures (J/cm2). Probit analysis determined the 50% probability ("threshold") radiant exposure necessary to cause embolized or partly occluding coagula, coagula causing complete blood flow stoppage, and hemorrhage. RESULTS: A statistically significant difference in the threshold radiant exposure existed for each damage category for blood vessels 10-30 microm in diameter, but not for larger vessels. For vessels over 60 microm, complete flow stoppage was unattainable; increasing laser pulse energy produced hemorrhage. In larger vessels, coagula often were attached to the superficial vessel wall while blood flowed underneath. Monte Carlo optical and finite difference thermal modeling confirmed experimental results. CONCLUSION: These results provide insight into the role of pulse duration and vessel diameter in the outcome of pulsed dye laser irradiation.

Angiography↗

PubMed1999

Optimal parameters for laser tissue soldering. Part I: tensile strength and scanning electron microscopy analysis.

BACKGROUND AND OBJECTIVES: The use of liquid and solid albumin protein solders to enhance laser tissue repairs has been shown to significantly improve postoperative results. The published results of laser-solder tissue repair studies have, however, indicated inconsistent success rates. This can be attributed to variations in laser irradiance, exposure time, solder composition, chromophore type, and concentration. An in vitro study was performed using indocyanine green-doped albumin protein solders in conjunction with an 808 nm diode laser to determine optimal laser and solder parameters for tissue repair in terms of tensile strength and stability during hydration. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five different combinations of laser irradiance (6.4, 12.7, 19.1, 25.5, 31.8 W/cm2) and exposure time (20, 30, 40, 50, 100 or 40, 60, 80, 100, 200 seconds) were used. The effect of changing bovine serum albumin (BSA) concentration (25% and 60%) and indocyanine green (ICG) dye concentration (2.5 mg/ml and 0.25 mg/ml) of the protein solder on the tensile strength of the resulting bonds was investigated. The effect of hydration on bond stability was also investigated using both tensile strength and scanning electron microscopy analysis. RESULTS: Tensile strength was observed to decrease significantly with increasing irradiance. An optimum exposure time was found to exist where further irradiation did not improve the tensile strength of the bond. Tensile strength was found to be greatly improved by increasing the BSA concentration. Finally, the lower ICG dye concentration increased the penetration depth of the laser light in the protein solder leading to higher tensile strengths. The strongest repairs were formed by using 6.4 W/cm2 irradiation for 50 seconds with a protein solder composed of 60% BSA and 0.25mg/ml ICG. In addition, the solid protein solder provided more stable adhesion to the tissue than did the liquid protein solder when the tissue was submerged in a hydrated environment. CONCLUSIONS: This study greatly enhances the current understanding of the various factors affecting the soldering process. It provides a strong basis for optimization of the laser light delivery parameters and the solder constituents to achieve strong and reliable laser tissue repairs.

Animals↗