Search results for: Gurinder Vasdev

Authors: Amrit Vasdev, Edwin Rho, Gurinder Vasdev

Abstract:

Robotic surgery has enabled a new spectrum of minimally invasive breast reconstruction by improving visualization, surgeon posturing, and improved patient outcomes.1 The DaVinci robot system can be utilized in nipple sparing mastectomies and reconstructions. The process involves the insufflation of the subglandular space and a dissection of the mammary gland with a combination of cautery and blunt dissection. This case outlines a 35-year-old woman who has a long-standing family history of breast cancer and a diagnosis of a deleterious BRCA2 genetic mutation. She has decided to proceed with bilateral nipple sparing mastectomies with implants. Her perioperative mammogram and MRI were negative for masses, however, her left internal mammary lymph node was enlarged. She has taken oral contraceptive pills for 3-5 years and denies DES exposure, radiation therapy, human replacement therapy, or prior breast surgery. She does not smoke and rarely consumes alcohol. During the procedure, the patient received a standardized anesthetic for out-patient surgery of propofol infusion, succinylcholine, sevoflurane, and fentanyl. Aprepitant was given as an antiemetic and preoperative Tylenol and gabapentin for pain management. Concerns for the patient during the procedure included CO2 insufflation into the subcutaneous space. With CO2 insufflation, there is a potential for rapid uptake leading to severe acidosis, embolism, and subcutaneous emphysema.2To mitigate this, it is important to hyperventilate the patient and reduce both the insufflation pressure and the CO2 flow rate to the minimal acceptable by the surgeon. For intraoperative monitoring during this 6-9 hour long procedure, it has been suggested to utilize an Arterial-Line for end-tidal CO2 monitoring. However, in this case, it was not necessary as the patient had excellent cardiovascular reserve, and end-tidal CO2 was within normal limits for the duration of the procedure. A BIS monitor was also utilized to reduce anesthesia burden and to facilitate a prompt discharge from the PACU. Minimal Invasive Robotic Surgery will continue to evolve, and anesthesiologists need to be prepared for the new challenges ahead. Based on our limit number of patients, robotic mastectomy appears to be a safe alternative to open surgery with the promise of clearer tissue demarcation and better cosmetic results.

Keywords: anesthesia, mastectomies, robotic, hypercarbia

Procedia PDF Downloads 111

Authors: Gurinder Singh, Kulbir Singh

Abstract:

Digital multimedia contents such as image, video, and audio can be tampered easily due to the availability of powerful editing softwares. Multimedia forensics is devoted to analyze these contents by using various digital forensic techniques in order to validate their authenticity. Digital image forensics is dedicated to investigate the reliability of digital images by analyzing the integrity of data and by reconstructing the historical information of an image related to its acquisition phase. In this paper, a survey is carried out on the forgery detection by considering the most recent and promising digital image forensic techniques.

Keywords: Computer Forensics, Multimedia Forensics, Image Ballistics, Camera Source Identification, Forgery Detection

Procedia PDF Downloads 245

Authors: Gurinder Singh Brar, Sarbjeet Singh, Harry Garg

Abstract:

Wire Electric Discharge Machining (WEDM) is thermal machining process capable of machining very hard electrically conductive material irrespective of their hardness. WEDM is being widely used to machine micro-scale parts with the high dimensional accuracy and surface finish. The objective of this paper is to optimize the process parameters of wire EDM to fabricate the microchannels and to calculate the surface finish and material removal rate of microchannels fabricated using wire EDM. The material used is aluminum 6061 alloy. The experiments were performed using CNC wire cut electric discharge machine. The effect of various parameters of WEDM like pulse on time (TON) with the levels (100, 150, 200), pulse off time (TOFF) with the levels (25, 35, 45) and current (IP) with the levels (105, 110, 115) were investigated to study the effect on output parameter i.e. Surface Roughness and Material Removal Rate (MRR). Each experiment was conducted under different conditions of a pulse on time, pulse off time and peak current. For material removal rate, TON and Ip were the most significant process parameter. MRR increases with the increase in TON and Ip and decreases with the increase in TOFF. For surface roughness, TON and Ip have the maximum effect and TOFF was found out to be less effective.

Keywords: microchannels, Wire Electric Discharge Machining (WEDM), Metal Removal Rate (MRR), surface finish

Procedia PDF Downloads 498