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Sample records for hand surgery rio

  1. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  2. About Hand Surgery

    Science.gov (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  3. Wide Awake Hand Surgery.

    Science.gov (United States)

    Lied, Line; Borchgrevink, Grethe E; Finsen, Vilhjalmur

    2017-09-01

    "Wide awake hand surgery", where surgery is performed in local anaesthesia with adrenaline, without sedation or a tourniquet, has become widespread in some countries. It has a number of potential advantages and we wished to evaluate it among our patients. All 122 patients treated by this method during one year were evaluated by the surgeons and the patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for a year when regional or general anaesthesia had been used. The patients' mean score for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other discomfort during surgery 0.5 (SD 1.4). Eight reported that they would want general anaesthesia if they were to be operated again. The surgeons' mean evaluation of bleeding during surgery was 1.6 (SD 1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method 1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative additional anaesthesia. The proportion was lower among trained hand surgeons and fell significantly during the study period. Non-surgical theatre time was 46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the regional/general period (p theatre.

  4. Rheumatoid arthritis and hand surgery

    DEFF Research Database (Denmark)

    Peretz, Anne Sofie Rosenborg; Madsen, Ole Rintek; Brogren, Elisabeth

    2017-01-01

    Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery...

  5. The Plastic Surgery Hand Curriculum.

    Science.gov (United States)

    Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin

    2015-12-01

    Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.

  6. Lean and Green Hand Surgery.

    Science.gov (United States)

    Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

    2018-02-01

    Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

    Science.gov (United States)

    Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

    Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  8. The Black Cloud Phenomenon in Hand Surgery.

    Science.gov (United States)

    Zhao, Emily; Tiedeken, Nathan; Wang, William; Fowler, John

    2018-04-01

    The term black cloud for a surgeon is generally used to describe someone who is unusually busy compared with his or her counterparts, and it is a superstition that tends to pervade the medical world. The purpose of this study is to investigate whether black clouds exist in hand surgery. We examined one academic year's worth of hand surgery-specific call at a level I trauma center and tabulated the number of hand-related patient transfers and add-on cases per surgeon. Each surgeon was given a black cloud rating by the fellows who were in training that year. Correlations were made between the black cloud rating and the surgeons' call volume. There were 12 surgeons who shared 365 days of hand call, and 5 of them are hand surgery fellowship trained. Those 5 surgeons tended to be busier on their call days, with more cases added on overnight and the next day, and also had worse black cloud ratings than the 7 non-hand fellowship trained surgeons. In regard to hand surgery, while true emergencies occur and require emergent intervention, how busy hand surgeons may be during call may be influenced by a variety of factors not related to their patients' problems but rather their daily schedules, their hospitals' ability to facilitate add-on cases, and their rapport with their fellow surgeons to share case loads.

  9. The future of robotics in hand surgery.

    Science.gov (United States)

    Liverneaux, P; Nectoux, E; Taleb, C

    2009-10-01

    Robotics has spread over many surgical fields over the last decade: orthopaedic, cardiovascular, urologic, gynaecologic surgery and various other types of surgery. There are five different types of robots: passive, semiactive and active robots, telemanipulators and simulators. Hand surgery is at a crossroad between orthopaedic surgery, plastic surgery and microsurgery; it has to deal with fixing all sorts of tissues from bone to soft tissues. To our knowledge, there is not any paper focusing on potential clinical applications in this realm, even though robotics could be helpful for hand surgery. One must point out the numerous works on bone tissue with regard to passive robots (such as fluoroscopic navigation as an ancillary for percutaneous screwing in the scaphoid bone). Telemanipulators, especially in microsurgery, can improve surgical motion by suppressing physiological tremor thanks to movement demultiplication (experimental vascular and nervous sutures previously published). To date, the robotic technology has not yet become simple-to-use, cheap and flawless but in the future, it will probably be of great technical help, and even allow remote-controlled surgery overseas.

  10. Candidate Quality Measures for Hand Surgery.

    Science.gov (United States)

    2017-11-01

    Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts. A consortium of 9 academic upper limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, scientific acceptability, usability, and feasibility of 44 candidate quality measures. These addressed hand problems the panelists felt were most appropriate for quality measure development. Panelists rated the measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 as equivocal or uncertain, and 7 to 9 as valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), the panelists were considered to be in agreement. If 3 or more of the panelists' ratings of a measure were within the 1 to 3 range and 3 or more ratings were in the 7 to 9 range, the panelists were considered to be in disagreement. There was agreement on 43% (19) of the measures as important, 27% (12) as scientifically sound, 48% (21) as usable, and 59% (26) as feasible to complete. Ten measures met all 4 of these criteria and were, therefore, considered valid measurements of quality. Quality measures that were developed address outcomes (patient-reported outcomes for assessment and improvement of function) and processes of care (utilization rates of imaging, antibiotics, occupational therapy, ultrasound, and operative treatment). The consortium developed 10

  11. Unique Assessment of Hand Surgery Knowledge by Specialty.

    Science.gov (United States)

    Silvestre, Jason; Lin, Ines C; Chang, Benjamin; Levin, L Scott

    2016-03-01

    Orthopedic and plastic surgery residents receive unique training yet often compete for similar hand surgery fellowships. This study compared didactic hand surgery training during orthopedic and plastic surgery residency. The Plastic Surgery In-Service Training Exam and Orthopaedic In-Training Examination were analyzed for hand content for the years 2009 to 2013. Topics were categorized with the content outline for the Surgery of the Hand Examination. Differences were elucidated by means of Fisher's exact test. Relative to the Orthopaedic In-Training Examination, the Plastic Surgery In-Service Training Exam had greater hand representation (20.3 percent versus 8.1 percent; p < 0.001) with more annual hand questions (40 ± 3 versus 24 ± 2; p < 0.001). The Plastic Surgery Exam questions had more words, were less often level I-recall type, and were less often image-based. The questions focused more on finger and hand/palm anatomy, whereas the Orthopaedic examination was more wrist-focused. The Plastic Surgery Exam emphasized wound management and muscle/tendon injuries, but underemphasized fractures/dislocations. References differed, but Journal of Hand Surgery (American Volume) and Green's Operative Hand Surgery were common on both examinations. The Plastic Surgery Exam had a greater publication lag for journal references (10.7 ± 0.5 years versus 9.0 ± 0.6; p = 0.035). Differences in didactic hand surgery training are elucidated for plastic surgery and orthopedic residents. Deficiencies in the Plastic Surgery In-Service Training Exam hand curriculum relative to the Orthopaedic In-Training Examination may underprepare plastic surgeons for the Surgery of the Hand Examination. These data may assist future modifications to hand surgery training in the United States.

  12. [Hand surgery in the German DRG System 2007].

    Science.gov (United States)

    Franz, D; Windolf, J; Kaufmann, M; Siebert, C H; Roeder, N

    2007-05-01

    Hand surgery often needs only a short length of stay in hospital. Patients' comorbidity is low. Many hand surgery procedures do not need inpatient structures. Up until 2006 special procedures of hand surgery could not be coded. The DRG structure did not separate very complex and less complex operations. Specialized hospitals needed a proper case allocation of their patients within the G-DRG system. The DRG structure concerning hand surgery increased in version 2007 of the G-DRG system. The main parameter of DRG splitting is the complexity of the operation. Furthermore additional criteria such as more than one significant OR procedure, the patients' age, or special diagnoses influence case allocation. A special OPS code for complex cases treated with hand surgery was implemented. The changes in the DRG structure and the implementation of the new OPS code for complex cases establish a strong basis for the identification of different patient costs. Different case allocation leads to different economic impacts on departments of hand surgery. Whether the new OPS code becomes a DRG splitting parameter has to be calculated by the German DRG Institute for further DRG versions.

  13. Essential hand surgery procedures for mastery by graduating plastic surgery residents: a survey of program directors.

    Science.gov (United States)

    Noland, Shelley S; Fischer, Lauren H; Lee, Gordon K; Friedrich, Jeffrey B; Hentz, Vincent R

    2013-12-01

    This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.

  14. Financial impact of hand surgery programs on academic medical centers.

    Science.gov (United States)

    Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A

    2007-02-01

    This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

  15. Hand-assisted laparoscopic surgery and its applications in gynecology

    Directory of Open Access Journals (Sweden)

    Yueqian Wu

    2016-02-01

    Full Text Available Laparoscopic surgery has been used extensively since it was first applied in the 1980s. The advantages are generally accepted and include less pain, smaller incisions, faster recovery, and shorter hospital stays. However, several limitations associated with standard laparoscopic surgery (SLS have become apparent and include the loss of tactile sensation, problems with the removal of bulky and intact specimens, and the restriction of visualization of the entire operating field. These problems with SLS helped to inspire the development of laparoscopically assisted surgery followed by hand-assisted laparoscopic surgery (HALS. In a hand-assisted laparoscopic procedure, an incision is made in the patient’s abdomen. Then, a uniquely designed appliance is introduced into the abdominal cavity through the incision to maintain pneumoperitoneum. With the inserting hand, surgeons can provide manual exposure, traction, palpation, and dissection because of the feedback of tactile sensation. HALS has gained acceptance for a wide range of abdominal procedures in general surgery and urology and is now feasible for complicated surgeries such as splenectomy, nephroureterectomy, and colectomy. It has been demonstrated in numerous specialties that HALS is a safe and efficacious technique that combines the benefits of laparoscopy with the advantages of a conventional laparotomy. Standard laparoscopic surgery also has limitations in gynecological surgery. A patient may have high risks with conventional laparoscopic surgery when she has deep invasive endometriosis, multiple or massive myoma, or dense pelvic adhesions from prior surgery. HALS overcomes many of the aforementioned limitations, has less conversion to open surgery, and broadens the indications for minimally invasive surgery, not only for benign tumors but also for pelvic malignancies.

  16. Analysis of National Institutes of Health Funding in Hand Surgery.

    Science.gov (United States)

    Silvestre, Jason; Ruan, Qing Z; Chang, Benjamin

    2018-01-01

    Federal research dollars help investigators develop biomedical therapies for human diseases. Currently, the state of funding in hand surgery is poorly understood. This study defines the portfolio of National Institutes of Health (NIH) grants awarded in hand surgery. This was a cross-sectional study of hand surgeons in the US. Faculty members of accredited hand surgery fellowships and/or members of the American Society for Surgery of the Hand were queried in the NIH RePORT database for awards obtained during 2005-2015. Of 2317 hand surgeons queried, only 18 obtained an NIH grant (0.8%). Thirty-eight unique grants were identified totaling $42 197 375. R01 awards comprised the majority of funding (78.0%) while K08 awards accounted for 1.1%. The K-to-R transition rate was zero. The National Institute of Arthritis and Musculoskeletal and Skin Disease supported the most funding (65.2%), followed by the National Institute of Neurological Disorders and Stroke (30.8%). There was no statistically significant difference in NIH funding totals with hand surgeon characteristics. Funding supported translational (46.0%), basic science (29.6%), clinical (21.0%), and education-based (3.4%) research. Peripheral nerve (33.3%) and bone and joint disease (30.1%) received the most research funding. Less than 1% of hand surgeons obtain NIH research grants. Of the 2 identified K08 awards, none led to a subsequent R award. Future research should identify barriers to grant procurement to design effective policies to increase NIH funding in hand surgery.

  17. The art and science of photography in hand surgery.

    Science.gov (United States)

    Wang, Keming; Kowalski, Evan J; Chung, Kevin C

    2014-03-01

    High-quality medical photography plays an important role in teaching and demonstrating the functional capacity of the hands as well as in medicolegal documentation. Obtaining standardized, high-quality photographs is now an essential component of many surgery practices. The importance of standardized photography in facial and cosmetic surgery has been well documented in previous studies, but no studies have thoroughly addressed the details of photography for hand surgery. In this paper, we provide a set of guidelines and basic camera concepts for different scenarios to help hand surgeons obtain appropriate and informative high-quality photographs. A camera used for medical photography should come equipped with a large sensor size and an optical zoom lens with a focal length ranging anywhere from 14 to 75 mm. In a clinic or office setting, we recommend 6 standardized views of the hand and 4 views for the wrist; additional views should be taken for tendon ruptures, nerve injuries, or other deformities of the hand. For intraoperative pictures, the camera operator should understand the procedure and pertinent anatomy in order to properly obtain high-quality photographs. When digital radiographs are not available and radiographic film must be photographed, it is recommended to reduce the exposure and change the color mode to black and white to obtain the best possible pictures. The goal of medical photography is to present the subject in an accurate and precise fashion. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Case-Cohort Studies: Design and Applicability to Hand Surgery.

    Science.gov (United States)

    Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

    2018-04-24

    Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Hand Surgery – Postoperative Recovery and Medical Tourism

    Directory of Open Access Journals (Sweden)

    Ruxandra Diana Sinescu

    2014-11-01

    Full Text Available Medical tourism is a growing industry worldwide. Romania has spa treatment facilities that can ensure the development of medical tourism. This article presents a statistical analysis of hand surgery in Romania in 2012. Using adequate quantitative methods we highlight significant differences between age groups and differences regarding procedures that have gender particularities. Recovery after such surgery can be achieved through spa treatment Romania, taking advantage of lower prices compared to other developed countries and numerous medical tourism facilities.

  20. Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

    2016-08-01

    The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

  1. surgery of the hand in infants with cerebral palsy* 655

    African Journals Online (AJOL)

    1971-06-19

    Jun 19, 1971 ... cerebral palsy is by re-education-physical, occupational, speech and drug therapy."· Orthopaedic surgery is usually considered as an adjunct to therapy'" and is indicated only for its value ... than long-continued postural training and stretching.",13 ... In each child in this series, the hand on the affected side.

  2. The hand surgery fellowship application process: expectations, logistics, and costs.

    Science.gov (United States)

    Meals, Clifton; Osterman, Meredith

    2015-04-01

    To investigate expectations, logistics, and costs relevant to the hand surgery fellowship application process. We sought to discover (1) what both applicants and program directors are seeking, (2) what both parties have to offer, (3) how both parties collect information about each other, and (4) the costs incurred in arranging each match. We conducted on-line surveys of hand surgery fellowship applicants for appointment in 2015 and of current fellowship program directors. Sixty-two applicants and 41 program directors completed the survey. Results revealed applicants' demographic characteristics, qualifications, method of ranking hand fellowship programs, costs incurred (both monetary and opportunity) during the application process, ultimate match status, and suggestions for change. Results also revealed program directors' program demographics, rationale for offering interviews and favorably ranking applicants, application-related logistical details, costs incurred (both monetary and opportunity) during the application process, and suggestions for change. Applicants for hand surgery fellowship training are primarily interested in a potential program's academic reputation, emphasis on orthopedic surgery, and location. The typical, successfully matched applicant was a 30-year-old male orthopedic resident with 3 publications to his credit. Applicants rely on peers and Web sites for information about fellowships. Fellowship directors are primarily seeking applicants recommended by other experienced surgeons and with positive personality traits. The typical fellowship director offers a single year of orthopedic-based fellowship training to 2 fellows per year and relies on a common application and in-person interviews to collect information about applicants. Applicants appear to be more concerned than directors about the current state of the match process. Applicants and directors alike incur heavy costs, in both dollars and opportunity, to arrange each match. A nuanced

  3. Physician Empathy as a Driver of Hand Surgery Patient Satisfaction.

    Science.gov (United States)

    Menendez, Mariano E; Chen, Neal C; Mudgal, Chaitanya S; Jupiter, Jesse B; Ring, David

    2015-09-01

    To examine the relationship between patient-rated physician empathy and patient satisfaction after a single new hand surgery office visit. Directly after the office visit, 112 consecutive new patients rated their overall satisfaction with the provider and completed the Consultation and Relational Empathy Measure, the Newest Vital Sign health literacy test, a sociodemographic survey, and 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Pain Interference, Upper-Extremity Function, and Depression. We also measured the waiting time in the office to see the physician, the duration of the visit, and the time from booking until appointment. Multivariable logistic and linear regression models were used to identify factors independently associated with patient satisfaction. Patient-rated physician empathy correlated strongly with the degree of overall satisfaction with the provider. After controlling for confounding effects, greater empathy was independently associated with patient satisfaction, and it alone accounted for 65% of the variation in satisfaction scores. Older patient age was also associated with satisfaction. There were no differences between satisfied and dissatisfied patients with regard to waiting time in the office, duration of the appointment, time from booking until appointment, and health literacy. Physician empathy was the strongest driver of patient satisfaction in the hand surgery office setting. As patient satisfaction plays a growing role in reimbursement, targeted educational programs to enhance empathic communication skills in hand surgeons merit consideration. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Ethical and educational considerations in coding hand surgeries.

    Science.gov (United States)

    Lifchez, Scott D; Leinberry, Charles F; Rivlin, Michael; Blazar, Philip E

    2014-07-01

    To assess treatment coding knowledge and practices among residents, fellows, and attending hand surgeons. Through the use of 6 hypothetical cases, we developed a coding survey to assess coding knowledge and practices. We e-mailed this survey to residents, fellows, and attending hand surgeons. In additionally, we asked 2 professional coders to code these cases. A total of 71 participants completed the survey out of 134 people to whom the survey was sent (response rate = 53%). We observed marked disparity in codes chosen among surgeons and among professional coders. Results of this study indicate that coding knowledge, not just its ethical application, had a major role in coding procedures accurately. Surgical coding is an essential part of a hand surgeon's practice and is not well learned during residency or fellowship. Whereas ethical issues such as deliberate unbundling and upcoding may have a role in inaccurate coding, lack of knowledge among surgeons and coders has a major role as well. Coding has a critical role in every hand surgery practice. Inconstancies among those polled in this study reveal that an increase in education on coding during training and improvement in the clarity and consistency of the Current Procedural Terminology coding rules themselves are needed. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Operating room waste reduction in plastic and hand surgery.

    Science.gov (United States)

    Albert, Mark G; Rothkopf, Douglas M

    2015-01-01

    Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.

  6. Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

    Science.gov (United States)

    Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

    2017-11-15

    MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

  7. Radiographic and surgical considerations in arthritis surgery of the hand

    International Nuclear Information System (INIS)

    Nikac, Violeta; Weissman, Barbara N.; Blazar, Philip; Earp, Brandon

    2017-01-01

    Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable. (orig.)

  8. Radiographic and surgical considerations in arthritis surgery of the hand

    Energy Technology Data Exchange (ETDEWEB)

    Nikac, Violeta; Weissman, Barbara N. [Harvard Medical School, Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Blazar, Philip; Earp, Brandon [Harvard Medical School, Brigham and Women' s Hospital, Department of Orthopedics, Boston, MA (United States)

    2017-05-15

    Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable. (orig.)

  9. Development of five-finger robotic hand using master-slave control for hand-assisted laparoscopic surgery.

    Science.gov (United States)

    Yoshida, Koki; Yamada, Hiroshi; Kato, Ryu; Seki, Tatsuya; Yokoi, Hiroshi; Mukai, Masaya

    2016-08-01

    This study aims to develop a robotic hand as a substitute for a surgeon's hand in hand-assisted laparoscopic surgery (HALS). We determined the requirements for the proposed hand from a surgeon's motions in HALS. We identified four basic behaviors: "power grasp," "precision grasp," "open hand for exclusion," and "peace sign for extending peritoneum." The proposed hand had the minimum necessary DOFs for performing these behaviors, five fingers as in a human's hand, a palm that can be folded when a surgeon inserts the hand into the abdomen, and an arm for adjusting the hand's position. We evaluated the proposed hand based on a performance test and a physician's opinions, and we confirmed that it can grasp organs.

  10. Hand-assisted laparoscopic surgery for colorectal malignancies

    International Nuclear Information System (INIS)

    Memon, M.A.; Fitzgibbons, R.J.

    2004-01-01

    Objective: To report our initial experience with hand-assisted laparoscopic surgery (HALS) for colorectal malignancies using a Specially designed laparoscopic hand cannula. Patients and Methods: Nine caucasians patients with colorectal malignancies underwent HALS which included 02 right hemicolectomies, 01 transverse colectomy, 03 sigmoid colectomies, 01 anterior resection and 02 low anterior resections. Results: There were 4 males and 5 females. The mean length of incision for placement of the cannula was 7 cms (range 7-8 cms). The mean operating time was 180 minutes. Postoperatively on an average patients were ambulatory by day 2 (range 1-4) and taking oral fluids by day 3 (range 1-4). There were no conversions to laparotomy. Furthermore there was no operative mortality and no complication directly related to the use of the device. Conclusion: HALS appears to be a useful adjuvant for laparoscopic colectomy due to advantages provided by tactile sensation. A curative resection for malignancy can be performed without compromising oncological principles. (author)

  11. The Impact of Specialty on Cases Performed During Hand Surgery Fellowship Training.

    Science.gov (United States)

    Silvestre, Jason; Upton, Joseph; Chang, Benjamin; Steinberg, David R

    2018-03-07

    Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability. In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%). Orthopaedic and plastic hand surgery

  12. Optical Head-Mounted Computer Display for Education, Research, and Documentation in Hand Surgery.

    Science.gov (United States)

    Funk, Shawn; Lee, Donald H

    2016-01-01

    Intraoperative photography and capturing videos is important for the hand surgeon. Recently, optical head-mounted computer display has been introduced as a means of capturing photographs and videos. In this article, we discuss this new technology and review its potential use in hand surgery. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. The use of polyurethane foam as an antimicrobial dressing material in hand surgery

    Directory of Open Access Journals (Sweden)

    Nebil Yesiloglu

    2015-12-01

    Full Text Available Polyurethane foam is generally used in negative pressure-assisted wound closure therapy. It provides an antimicrobial environment around the wound, while reducing the rate of skin maceration. The authors used polyurethane foam in routine hand dressings after hand surgery operations that were performed for both congenital and acquired purposes. [Hand Microsurg 2015; 4(3.000: 91-92

  14. Two-handed assisted laparoscopic surgery: Evaluation in an animal model

    Directory of Open Access Journals (Sweden)

    Eduardo Sanchez-de-Badajoz

    2014-10-01

    Full Text Available Purposes To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND that was performed in five pigs. Surgical Technique A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments. Comments The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required.

  15. Hand-arm vibration in orthopaedic surgery: a neglected risk.

    Science.gov (United States)

    Mahmood, F; Ferguson, K B; Clarke, J; Hill, K; Macdonald, E B; Macdonald, D J M

    2017-12-30

    Hand-arm vibration syndrome is an occupational disease caused by exposure to hand-arm transmitted vibration. The Health and Safety Executive has set limits for vibration exposure, including an exposure action value (EAV), where steps should be taken to reduce exposure, and an exposure limit value (ELV), beyond which vibrating equipment must not be used for the rest of the working day. To measure hand-arm transmitted vibration among orthopaedic surgeons, who routinely use hand-operated saws. We undertook a cadaveric study measuring vibration associated with a tibial cut using battery-operated saws. Three surgeons undertook three tibial cuts each on cadaveric tibiae. Measurements were taken using a frequency-weighted root mean square acceleration, with the vibration total value calculated as the root of the sums squared in each of the three axes. A mean (SD) vibration magnitude of 1 (0.2) m/s2 in the X-axis, 10.3 (1.9) m/s2 in the Y-axis and 4.2 (1.3) m/s2 in the Z-axis was observed. The weighted root mean squared magnitude of vibration was 11.3 (1.7) m/s2. These results suggest an EAV of 23 min and ELV of 1 h 33 min using this equipment. Our results demonstrate that use of a battery-operated sagittal saw can transmit levels of hand-arm vibration approaching the EAV or ELV through prolonged use. Further study is necessary to quantify this risk and establish whether surveillance is necessary for orthopaedic surgeons. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  16. Buying clothes from thrift stores: an analysis of young people consuming second-hand clothing in Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Sílvia Borges Corrêa

    2015-05-01

    Full Text Available This article presents the results of a research that analyzed the consumption of second-hand clothing among young people in the city of Rio de Janeiro. Theoretically speaking, the research was guided by the anthropological perspective of consumption. The research was conducted based on the ethnographic method with participant observation and in-depth interviews. The results show the relationships between consumers and merchandise and reveal the main motivations for buying second-hand clothing and accessories.

  17. Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia

    Directory of Open Access Journals (Sweden)

    Jafar Rafiei Kiasari

    2012-08-01

    Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.

  18. Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

    Science.gov (United States)

    Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

    2016-08-01

    This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Clinical experience of magnetic resonance angiography in hand surgery

    International Nuclear Information System (INIS)

    Kawabata, Hidehiko; Yasui, Natsuo; Kitano, Motohiro; Sai, Eikoh

    1996-01-01

    Magnetic resonance angiography was performed in fourteen patients with congenital hand abnormalities. A two-dimentional time-of-flight imaging clearly demonstrated presence or absence of the radial, ulnar, and anterior interosseous arteires at forearm. However, smaller arteries such as digital arteries were depressed sometimes. This fact makes clinical application of the method somewhat limited. At present. appropriate applications in orthopaedic fields are evaluation of run-off of the major vessels after trauma or atherosclerotic diseases, venous vascular problems such as thrombophlebitis and aneurysm, and preoperative and post operative evaluation in microsurgery. If more detailed information is required, for example, in differential diagnosis of tumors conventional angiography or digital subtraction angiography is recommended. Because magnetic resonance angiography is non-invasive and does not need anesthesia, it is suitable especially for children. No requirement of contrast medium makes it easy to apply angiography to high risk patients and allergic patients to iodine. Technical advancement in near future will rise up magnetic resonance angiography to a standard evaluation method for vascular problems in orthopaedic fields very soon. (author)

  20. On norms and bodies: findings from field research on cosmetic surgery in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Dorneles de Andrade, Daniela

    2010-05-01

    Brazil has the second highest rate of cosmetic surgery worldwide, provided in a large number of public and private clinics and hospitals, especially in the southeast. This qualitative field research in Rio de Janeiro included participant observation and in-depth interviews with 18 women cosmetic surgery patients, 10 key informants (e.g. psychologists and sociologists) and 12 plastic surgeons. Fifteen of the women were either pre- or post-operative; three had not decided whether to have surgery. When asked about their motivations and expectations of the surgery, the majority of the women said they wanted to be "normal". Most of the surgeons said they acted as empathic companions from decision-making through surgery and beyond. Many of the key informants were critical of what was happening to medical ethics in relation to cosmetic surgery. With the growth in a consumer culture, they saw ethics in medicine becoming more bendable and subject to the "law" of the market. The cult of the body has become a mass phenomenon and taken on an important social dimension in a society where norms and images are broadcast widely by the media. The trend towards body-modification by cosmetic surgery at an early age is increasing dramatically. What demands critical thinking and further investigation are the consequences of cosmetic surgery for physical and mental health. Copyright 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  1. Hand-to-hand coupling and strategies to minimize unintentional energy transfer during laparoscopic surgery.

    Science.gov (United States)

    Overbey, Douglas M; Hilton, Sarah A; Chapman, Brandon C; Townsend, Nicole T; Barnett, Carlton C; Robinson, Thomas N; Jones, Edward L

    2017-11-01

    Energy-based devices are used in nearly every laparoscopic operation. Radiofrequency energy can transfer to nearby instruments via antenna and capacitive coupling without direct contact. Previous studies have described inadvertent energy transfer through bundled cords and nonelectrically active wires. The purpose of this study was to describe a new mechanism of stray energy transfer from the monopolar instrument through the operating surgeon to the laparoscopic telescope and propose practical measures to decrease the risk of injury. Radiofrequency energy was delivered to a laparoscopic L-hook (monopolar "bovie"), an advanced bipolar device, and an ultrasonic device in a laparoscopic simulator. The tip of a 10-mm telescope was placed adjacent but not touching bovine liver in a standard four-port laparoscopic cholecystectomy setup. Temperature increase was measured as tissue temperature from baseline nearest the tip of the telescope which was never in contact with the energy-based device after a 5-s open-air activation. The monopolar L-hook increased tissue temperature adjacent to the camera/telescope tip by 47 ± 8°C from baseline (P energy devices significantly reduced temperature change in comparison to the monopolar instrument (47 ± 8°C) for both the advanced bipolar (1.2 ± 0.5°C; P energy transfers from the monopolar "bovie" instrument through the operating surgeon to standard electrically inactive laparoscopic instruments. Hand-to-hand coupling describes a new form of capacitive coupling where the surgeon's body acts as an electrical conductor to transmit energy. Strategies to reduce stray energy transfer include avoiding the same surgeon holding the active electrode and laparoscopic camera or using alternative energy devices. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The efficiency of a dedicated staff on operating room turnover time in hand surgery.

    Science.gov (United States)

    Avery, Daniel M; Matullo, Kristofer S

    2014-01-01

    To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.

    Science.gov (United States)

    Engstrand, Christina; Krevers, Barbro; Kvist, Joanna

    2015-01-01

    Prospective cohort study. The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Safety and social issues of hand function and quality of life had an evident association with functional recovery. IV. Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  4. Piezoelectric osteotomy in hand surgery: first experiences with a new technique

    Science.gov (United States)

    Hoigne, Dominik J; Stübinger, Stefan; Kaenel, Oliver Von; Shamdasani, Sonia; Hasenboehler, Paula

    2006-01-01

    Background In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery. Method While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery® Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year. Results The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances. Conclusion The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery. PMID:16611362

  5. Piezoelectric osteotomy in hand surgery: first experiences with a new technique

    Directory of Open Access Journals (Sweden)

    Kaenel Oliver Von

    2006-04-01

    Full Text Available Abstract Background In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery. Method While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery® Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year. Results The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances. Conclusion The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery.

  6. Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study.

    Science.gov (United States)

    Hendrick, Richard J; Mitchell, Christopher R; Herrell, S Duke; Webster, Robert J

    2015-11-01

    Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon's functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection.

  7. Randomized Controlled Trial of Antiseptic Hand Hygiene Methods in an Outpatient Surgery Clinic.

    Science.gov (United States)

    Therattil, Paul J; Yueh, Janet H; Kordahi, Anthony M; Cherla, Deepa V; Lee, Edward S; Granick, Mark S

    2015-12-01

    Outpatient wound care plays an integral part in any plastic surgery practice. However, compliance with hand hygiene measures has shown to be low, due to skin irritation and lack of time. The objective of this trial was to determine whether single-use, long-acting antiseptics can be as effective as standard multiple-use hand hygiene methods in an outpatient surgical setting. A prospective, randomized controlled trial was performed in the authors' outpatient plastic surgery clinic at Rutgers New Jersey Medical School, Newark, NJ to compare the efficacy of an ethyl alcohol-based sanitizer (Avagard D Instant Hand Aniseptic, 3M Health Care, St. Paul, MN), a benzalkonium chloride-based sanitizer (Soft & Shield, Bioderm Technologies, Inc, Trenton, NJ, distributed by NAPP Technologies, Hackensack, NJ ), and soap and- water handwashing. Subjects included clinic personnel, who were followed throughout the course of a 3-hour clinic session with hourly hand bacterial counts taken. During the course of the trial, 95 subjects completed the clinic session utilizing 1 of the hand hygiene methods (36 ethyl alcohol-based sanitizer, 38 benzalkonium chloride-based sanitizer, and 21 soap-and-water handwashing). There was no difference between hand bacterial counts using the different methods at 4 hourly time points (P greater than 0.05). Hand bacterial counts increased significantly over the 3-hour clinic session with the ethyl alcohol-based sanitizer (9.24 to 21.90 CFU, P less than 0.05), benzalkonium chloride-based sanitizer (6.69 to 21.59 CFU, P less than 0.05), and soap-and-water handwashing (8.43 to 22.75 CFU, P less than 0.05). There does not appear to be any difference in efficacy between single-use, long-acting sanitizer, and standard multiple-use hand hygiene methods. Hand bacterial counts increased significantly over the course of the 3-hour clinic session regardless of the hand hygiene measure used. Hand condition of subjects was improved with the ethyl alcohol

  8. 1950-nm diode laser-assisted microanastomoses (LAMA): an innovative surgical tool for hand surgery emergencies.

    Science.gov (United States)

    Leclère, Franck Marie; Schoofs, Michel; Vogt, Peter; Casoli, Vincent; Mordon, Serge

    2015-05-01

    Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size laser parameters were used: spot size 400 μm, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 ± 1.4 and 8.7 ± 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

  9. Three-Hand Endoscopic Endonasal Transsphenoidal Surgery: Experience With an Anatomy-Preserving Mononostril Approach Technique.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Pamias-Portalatin, Eva; Asensio, Javier; Garcia, Oscar; Boahene, Kofi D; Quiñones-Hinojosa, Alfredo

    2018-02-01

    Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. Prospective case series and retrospective data analysis of patients who were treated with the 3-hand transsphenoidal technique between January 2007 and May 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3 min, P = .001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P = .846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized. Copyright © 2017 by the Congress of Neurological Surgeons

  10. [Functional magnetic resonance imaging. What are the benefits expected in hand surgery?].

    Science.gov (United States)

    Moutet, F; Delon-Martin, C; Martin, O; Sirigu, A; Delaquaize, F; Benali, H; Masquelet, A-C

    2013-06-01

    Functional MRI (fMRI) allowed considerable advances upon understanding of cerebral functioning. Cortical plasticity, which allows the voluntary command of a restored function by a transferred muscle remains to be investigated in its intimacy. The authors present here the round table held at the 48th annual meeting of the French Society for Surgery of the Hand on December 22nd, 2012. It tries to review the analysis of the phenomenon observed during multiple tendinous transfers for restoration of proximal radial nerve palsy. Were successively approached: 1) Methods of acquisition and analysis of the signals (C. D-M.); 2) Movement reorganization (O.M.); 3) Motor plasticity after hand allograft (A. S.); 4) The potential interest of the fMRI in hand rehabilitation (F. D.); 5) The analysis of cerebral plasticity in general (H. B.). A rather philosophical conclusion opens other fields to f MRI (A.M.). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. A Randomized Study Comparing Outcomes of Stapled and Hand-Sutured Anastomoses in Patients Undergoing Open Gastrointestinal Surgery

    OpenAIRE

    Chandramohan, S. M.; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L.; Waggoner, Jason R.; Tatla, Daljit

    2012-01-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospectiv...

  12. Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model

    Directory of Open Access Journals (Sweden)

    Saseem Poudel

    2016-01-01

    Full Text Available Background: The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. Materials and Methods: The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. Results: All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. Conclusion: The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures.

  13. Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model.

    Science.gov (United States)

    Poudel, Saseem; Kurashima, Yo; Shichinohe, Toshiaki; Kitashiro, Shuji; Kanehira, Eiji; Hirano, Satoshi

    2016-01-01

    The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures.

  14. Virtual reality as a method for evaluation and therapy after traumatic hand surgery.

    Science.gov (United States)

    Nica, Adriana Sarah; Brailescu, Consuela Monica; Scarlet, Rodica Gabriela

    2013-01-01

    In the last decade, Virtual Reality has encountered a continuous development concerning medical purposes and there are a lot of devices based on the classic "cyberglove" concept that are used as new therapeutic method for upper limb pathology, especially neurologic problems [1;2;3]. One of the VR devices is Pablo (Tyromotion), with very sensitive sensors that can measure the hand grip strenght and the pinch force, also the ROM (range of motion) for all the joints of the upper limb (shoulder, elbow, wrist) and offering the possibility of interactive games based on Virtual Reality concept with application in occupational therapy programs. We used Pablo in our study on patients with hand surgery as an objective tool for assessment and as additional therapeutic method to the classic Rehabilitation program [4;5]. The results of the study proved that Pablo represents a modern option for evaluation of hand deficits and dysfunctions, with objective measurement replacement of classic goniometry and dynamometry, with computerized data base of patients with monitoring of parameters during the recovery program and with better muscular and neuro-cognitive feedback during the interactive therapeutic modules.

  15. A national survey of program director opinions of core competencies and structure of hand surgery fellowship training.

    Science.gov (United States)

    Sears, Erika Davis; Larson, Bradley P; Chung, Kevin C

    2012-10-01

    We assessed hand surgery program directors' opinions of essential components of hand surgery training and potential changes in the structure of hand surgery programs. We recruited all 74 program directors of Accreditation Council of Graduate Medical Education-accredited hand surgery fellowship programs to participate. We designed a web-based survey to assess program directors' support for changes in the structure of training programs and to assess opinions of components that are essential for graduates to be proficient. Respondents were asked to rate 9 general areas of practice, 97 knowledge topics, and 172 procedures. Each component was considered essential if 50% or more of respondents thought that graduates must be fully knowledgeable of the topic and be able to perform the procedure at the end of training. The response rate was 84% (n = 62). A minority of program directors (n = 15; 24%) supported creation of additional pathways for hand surgery training, and nearly three-quarters (n = 46; 74%) preferred a fellowship model to an integrated residency model. Most program directors (n = 40; 65%) thought that a 1-year fellowship was sufficient to train a competent hand surgeon. Wrist, distal radius/ulna, forearm, and peripheral nerve conditions were rated as essential areas of practice. Of the detailed components, 76 of 97 knowledge topics and 98 of 172 procedures were rated as essential. Only 48% respondents (n = 30) rated microsurgery as it relates to free tissue transfer as essential. However, small and large vessel laceration repairs were rated as essential by 92% (n = 57) and 77% (n = 48) of respondents, respectively. This study found resistance to prolonging the length of fellowship training and introduction of an integrated residency pathway. To train all hand surgeons in essential components of hand surgery, programs must individually evaluate exposure provided and find innovative ways to augment training when necessary. Studies of curriculum content in hand

  16. A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

    Science.gov (United States)

    Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

    2013-08-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

  17. Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

    Directory of Open Access Journals (Sweden)

    Mihaela Pertea

    2018-05-01

    Full Text Available Objectives. To confirm the efficiency of using local anesthesia with lidocaine and epinephrine in hand surgery. Materials and methods. 75 patients in whom we used local anesthesia with 1% lidocaine and epinephrine in solution 1: 100 000. We evaluated the amount of used anesthetic, the time to onset of anesthesia, intraoperative bleeding, the duration of intervention and hospitalization, immediate postoperative complications. Results. It has been no case of digital necrosis or other vascular complications and no intraoperative bleeding. The amount of the used anesthetic varied. In no case it was necessary to use of phentolamine as an antidote to the effects of adrenaline. Conclusions. Wide awake local anesthesia no tourniquet technique is safe, having many advantages: it is not necessary to use the tourniquet with or without intravenous sedation, the surgeon and patient comfort is maximum, there is no risk of digital necrosis, hospitalization time is short and the costs are minimal.

  18. Guidelines for ethical and professional use of social media in a hand surgery practice.

    Science.gov (United States)

    Lifchez, Scott D; McKee, Desirae M; Raven, Raymond B; Shafritz, Adam B; Tueting, Jonathan L

    2012-12-01

    In growing numbers, patients are using social media platforms as resources to obtain health information and report their experiences in the health care setting. More physicians are making use of these platforms as a means to reach prospective and existing patients, to share information with each other, and to educate the public. In this ever-expanding online dialogue, questions have arisen regarding appropriate conduct of the physician during these interactions. The purpose of this article is to review the laws that govern online communication as they pertain to physician presence in this forum and to discuss appropriate ethical and professional behavior in this setting. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. [Comparison between the Austrian and German DRG systems in hand surgery].

    Science.gov (United States)

    Lotter, O; Jaminet, P; Schwarzach, S; Schaller, H E

    2013-02-01

    Diagnosis-Related Groups (DRG) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis, we compared the Austrian and the German DRG systems. The 15 most common hand surgical diagnoses and their corresponding operative treatment were transferred into the Austrian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The mean values and the median values of the upper and lower thresholds of length of stay as well as the average length of stay were all lower in Austria compared to Germany. Reimbursement in Germany was higher in 13 of 19 cases. Total proceeds amounted to 1.67 million in the German and 1.70 million in the Austrian health care system. Considering the purchasing power applying consumer prize parities, the difference of reimbursement between the countries rose to 130,000 which equals a difference of almost 8%. Reimbursement of the top 15 diagnoses in hand surgery in Austria is 8% higher than in Germany. Except for one case, mean values as well as upper and lower thresholds of length of stay are considerably shorter in Austria. Comparison of international data to refine a national compensation system is advocated.

  20. [Time to bury the adrenaline-myth!--Safe use of adrenaline anesthesia in hand surgery and orthopedics].

    Science.gov (United States)

    Hagert, Elisabet; Lalonde, Donald

    2015-02-03

    The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.

  1. Current rates of publication for podium and poster presentations at the american society for surgery of the hand annual meetings.

    Science.gov (United States)

    Abzug, Joshua M; Osterman, Meredith; Rivlin, Michael; Paryavi, Ebrahim; Osterman, A Lee

    2014-09-01

    Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH). It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations. All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher's exact test was conducted to compare current trends with previous trends. Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations) were in Journal of Hand Surgery, and 11% (59 presentations) were in Journal of Bone and Joint Surgery. Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004). Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-reviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery.

  2. Preoperative Hand Decontamination in Ophthalmic Surgery: A Comparison of the Removal of Bacteria from Surgeons' Hands by Routine Antimicrobial Scrub versus an Alcoholic Hand Rub.

    Science.gov (United States)

    Forer, Yaara; Block, Colin; Frenkel, Shahar

    2017-09-01

    The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods. Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands. Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log 10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.

  3. Current Rates of Publication for Podium and Poster Presentations at the American Society for Surgery of the Hand Annual Meetings

    Directory of Open Access Journals (Sweden)

    Joshua M. Abzug

    2014-09-01

     Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery

  4. The medical Doppler in hand surgery: its scientific basis, applications, and the history of its namesake, Christian Johann Doppler.

    Science.gov (United States)

    Ghori, Ahmer K; Chung, Kevin C

    2007-12-01

    The word Doppler is used synonymously in hand surgery for evaluating patency of vascular structures; however, the science and history behind the Doppler effect are not as well-known. We will present the theories behind the Doppler effect and the history of the person who made this discovery.

  5. Making Sense of Metal Allergy and Hypersensitivity to Metallic Implants in Relation to Hand Surgery.

    Science.gov (United States)

    Christensen, Thomas J; Samant, Shefali A; Shin, Alexander Y

    2017-09-01

    All metals implanted into a biological system undergo some degree of corrosion depending upon its composition. The electrochemical process of corrosion produces free metal ions, which may activate the host's immune system through a variety of mechanisms. Whereas dermal metal hypersensitivity is common, affecting 10% to 15% of the population, the immune reaction from implanted metals is much less common (allergy and hypersensitivity producing a multitude of patient symptoms. Superficial symptoms may be mild to severe forms of dermatitis, urticaria, pruritus, and vasculitis, whereas deep sequelae include metallosis-related pseudotumor, implant loosening, and joint stiffness. Currently, there are clinical tests to evaluate patients for metal hypersensitivity, but there is little agreement regarding the ideal timing and clinical situation prompting the work-up of a patient for a metal allergy or hypersensitivity. An understanding of the epidemiology, etiology, basic science, diagnostic testing, and treatment of patients with suspected metal allergy, as it pertains to the current literature, will aid orthopedic and plastic surgeons of all subspecialties in the management of patients requiring metallic implants. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Stiff Hands

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Stiff Hands Email to a friend * required fields ...

  7. Hand Infections

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Infections Email to a friend * required fields ...

  8. [Comparison of hand surgery in the German and Italian DRG systems].

    Science.gov (United States)

    Lotter, O; Dolderer, J; Stahl, S; Atzei, A; Haerle, M; Schaller, H E

    2011-12-01

    Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their corresponding operative treatment in our clinic in 2009 were processed using a DRG grouper. The underlying data were transferred to the Italian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The latter was adjusted and corrected by the purchasing power of each country. The mean of the upper threshold of length of stay was 10 days in the German as well as the Italian system whereas the median was 2 times higher in Italy (6 vs. 12 days). Fifteen out of 19 cases showed higher reimbursement in Germany. The case mix index (CMI) of 0.917 in Germany represents a mean payment of 2,676 € per case. In Italy the hypothetical CMI of 0.635 resulted in a mean reimbursement of 1,853 € per case. The biggest difference in remuneration could be found for replantation of multiple fingers. For this service the German health-care system pays 12,320 € more than the Italian. Total proceeds of the top 15 diagnoses applying the number of cases treated in our clinic revealed 1.7 million € in the German and 1.2 million € in the Italian DRG system. Considering the purchasing power utilizing consumer prize parities, the difference of reimbursement between the countries decreased to 300,000 €. There is no mean length of stay per DRG in Italy, only the upper threshold of length of stay is determined. In most cases the latter is higher in Italy compared to Germany. The consumption of resources for finger replantation is not adequately represented in the Italian DRG system compared to finger amputation. Reimbursement of inpatient care is influenced by multiple factors not being subject

  9. Current Rates of Publication for Podium and Poster Presentations at the American Society for Surgery of the Hand Annual Meetings

    Directory of Open Access Journals (Sweden)

    Joshua M. Abzug

    2014-09-01

    Full Text Available Background:  Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH. It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations.   Methods:  All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher’s exact test was conducted to compare current trends with previous trends. Results:  Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations were in Journal of Hand Surgery , and 11% (59 entations were in Journal of Bone and Joint Surgery . Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004.  Conclusions:  Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .

  10. Video Recording With a GoPro in Hand and Upper Extremity Surgery.

    Science.gov (United States)

    Vara, Alexander D; Wu, John; Shin, Alexander Y; Sobol, Gregory; Wiater, Brett

    2016-10-01

    Video recordings of surgical procedures are an excellent tool for presentations, analyzing self-performance, illustrating publications, and educating surgeons and patients. Recording the surgeon's perspective with high-resolution video in the operating room or clinic has become readily available and advances in software improve the ease of editing these videos. A GoPro HERO 4 Silver or Black was mounted on a head strap and worn over the surgical scrub cap, above the loupes of the operating surgeon. Five live surgical cases were recorded with the camera. The videos were uploaded to a computer and subsequently edited with iMovie or the GoPro software. The optimal settings for both the Silver and Black editions, when operating room lights are used, were determined to be a narrow view, 1080p, 60 frames per second (fps), spot meter on, protune on with auto white balance, exposure compensation at -0.5, and without a polarizing lens. When the operating room lights were not used, it was determined that the standard settings for a GoPro camera were ideal for positioning and editing (4K, 15 frames per second, spot meter and protune off). The GoPro HERO 4 provides high-quality, the surgeon perspective, and a cost-effective video recording of upper extremity surgical procedures. Challenges include finding the optimal settings for each surgical procedure and the length of recording due to battery life limitations. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Magnetoencephalographic study of hand and foot sensorimotor organization in 325 consecutive patients evaluated for tumor or epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Ronald B. Willemse

    2016-01-01

    Conclusions: MEG localization of sensorimotor cortex activation was more successful for the hand compared to the foot. In patients with neural lesions, there were signs of brain reorganization as measured by more frequent ipsilateral motor cortical activation of the foot in addition to the traditional sensory and motor activation patterns in the contralateral hemisphere. The presence of ipsilateral neural reorganization, especially around the foot motor area, suggests that careful mapping of the hand and foot in both contralateral and ipsilateral hemispheres prior to surgery might minimize postoperative deficits.

  12. Hand Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... DESCRIPTION The bones of the hand serve as a framework. This framework supports the muscles that make the wrist and fingers move. When ...

  13. Progression of Authorship of Scientific Articles in The Journal of Hand Surgery, 1985-2015.

    Science.gov (United States)

    Gu, Alex; Almeida, Neil; Cohen, Jordan S; Peck, Kathryn M; Merrell, Gregory A

    2017-04-01

    For scientists, authorship is academic currency. Authorship characteristics have been studied in a subset of the surgical and medical literature, but trends in the specialty of hand surgery have not yet been investigated. Specifically, a longitudinal analysis of number, educational training, sex, and geographical origin of authors has not been conducted. We explored the progression of authorship of scientific articles in a leading hand surgery journal. We recorded number of authors, number of references, degrees, and sex of the first and senior authors as well as geographical origin of the corresponding author in The Journal of Hand Surgery in 1985, 1995, 2005, and 2015. All original work was analyzed. A total of 892 articles were reviewed. The mean number of authors per article increased significantly from 2.6 in 1985 to 3.9 in 2015 and the number of references increased significantly from 13.7 in 1985 to 22.6 in 2015. There was a significant increase in the proportion of first authors with an MD/PhD, PhD, master's or bachelor's degree since 1985. During that same time period, a decrease in the proportion of first authors who held solely an MD was seen. There was a significant increase in proportion of the number of last authors with an MD/PhD, PhD or Master's degree in that same time period. There has been significant growth in publications originating from the "Far East" and "Other" regions, with 4.2% and 5.0% of publications, respectively, in 1985 having increased to 10.3% and 7.4% of publications, respectively, in 2015. Female first authorship significantly increased over the study period from 7.9% in 1985 to 22.1% of publications in 2015. There has been a significant increase in number of authors per article in The Journal of Hand Surgery. Similar to other studies, we noted shifts in the degrees most commonly held by authors, an increase in references per article, and a greater representation of international authors in the hand surgery. In addition, the

  14. Unplanned Readmission in Outpatient Hand Surgery: An Analysis of 23,613 Patients in the NSQIP Data Set.

    Science.gov (United States)

    Donato, Daniel P; Kwok, Alvin C; Bishop, Michael O; Presson, Angela P; Agarwal, Jayant P

    2017-01-01

    Objective: In an era of controlling cost and improving care, 30-day readmission rates have become an important quality measure. The purpose of this study was to identify the rates of 30-day unplanned readmission and the associated risk factors in patients undergoing outpatient hand surgery. Methods: The 2011-2014 National Surgical Quality Improvement Project data were queried for patients who met 368 hand-specific Current Procedural Terminology codes. Univariable and multivariable analyses were performed to identify patient- and surgery-specific risk factors associated with unplanned readmission within 30 days. Results: Of the 368 Current Procedural Terminology codes queried, 208 were represented in the data, for a total of 23,613 patients. The overall unplanned readmission rate was 0.88% (207/23,613). On both univariable and multivariable analyses, operative year (2012), increasing age, obesity, smoking status, chronic obstructive pulmonary disease, preoperative steroid use, preoperative anemia, increasing American Society of Anesthesiologists classification, increasing operative time, and a procedure performed by a surgeon other than a plastic or orthopedic surgeon were associated with increased readmission rates. Diabetes, hypertension, low albumin levels, elevated international normalized ratio, and dirty/infected wound classification were only significant in univariable analysis. Current Procedural Terminology codes associated with the highest readmission rates were related to amputations. The most common readmission diagnoses were wound complications, followed by uncontrolled postoperative pain. Conclusions: The incidence of unplanned readmission is low in patients undergoing outpatient hand surgery. Specific patient comorbidities are associated with increased unplanned readmission rates. This information may be useful in identifying patients at higher risk for unplanned readmission and in counseling of high-risk patients preparing for surgery.

  15. The use of an iPad to collect patient-reported functional outcome measures in hand surgery.

    Science.gov (United States)

    Yaffe, Mark; Goyal, Nitin; Kokmeyer, Daniel; Merrell, Gregory A

    2015-09-01

    The purpose of this study was to evaluate (1) patient preferences regarding iPad and paper-based questionnaires, (2) the efficacy of iPad and paper questionnaires in a hand surgery practice, (3) the influence of questionnaire length on patient preferences and data collection, and (4) patient characteristics associated with a preference for iPad-based questionnaires. Two hundred total patients in a single hand surgery practice were randomly assigned to one of four groups. Each group completed either the Michigan Hand Questionnaire (MHQ) or QuickDASH (QD) using either an iPad or pen and paper. Patient preferences, questionnaire completion and timing, and demographic data were analyzed. The use of an iPad was associated with a statistically stronger preference for the same delivery format in the future compared to paper for the MHQ (93.9 vs 52.1 %, p iPad group found the survey "physically easy" more often compared to the MHQ paper group, while no difference was found among QD groups. Questionnaire timing between iPad and paper groups was similar for the MHQ but statistically longer with the iPad for QD. A significantly higher proportion of patients who preferred the iPad were under the age of 50 compared to those who preferred paper. The addition of an iPad is an efficient and preferable questionnaire format for functional outcome assessment in a hand and upper extremity surgery practice setting. The iPad is particularly preferable for longer outcome questionnaires and for patients under the age of 50.

  16. A new method of surgical navigation for orthognathic surgery: optical tracking guided free-hand repositioning of the maxillomandibular complex.

    Science.gov (United States)

    Li, Biao; Zhang, Lei; Sun, Hao; Shen, Steve G F; Wang, Xudong

    2014-03-01

    In bimaxillary orthognathic surgery, the positioning of the maxilla and the mandible is typically accomplished via 2-splint technique, which may be the sources of several types of inaccuracy. To overcome the limitations of the 2-splint technique, we developed a new navigation method, which guided the surgeon to free-hand reposition the maxillomandibular complex as a whole intraoperatively, without the intermediate splint. In this preliminary study, the feasibility was demonstrated. Five patients with dental maxillofacial deformities were enrolled. Before the surgery, 3-dimensional planning was conducted and imported into a navigation system. During the operation, a tracker was connected to the osteotomized maxillomandibular complex via a splint. The navigation system tracked the movement of the complex and displayed it on the screen in real time to guide the surgeon to reposition the complex. The postoperative result was compared with the plan by analyzing the measured distances between the maxillary landmarks and reference planes, as determined from computed tomography data. The mean absolute errors of the maxillary position were clinically acceptable (<1.0 mm). Preoperative preparation time was reduced to 100 minutes on average. All patients were satisfied with the aesthetic results. This navigation method without intraoperative image registration provided a feasible means of transferring virtual planning to the real orthognathic surgery. The real-time position of the maxillomandibular complex was displayed on a monitor to visually guide the surgeon to reposition the complex. In this method, the traditional model surgery and the intermediate splint were discarded, and the preoperative preparation was simplified.

  17. Intraoperative extracorporeal autogenous irradiated tendon grafts for functional limb salvage surgery of soft tissue sarcomas of the wrist and hand.

    Science.gov (United States)

    Omori, Shinsuke; Hamada, Kenichiro; Outani, Hidetatsu; Oshima, Kazuya; Joyama, Susumu; Tomita, Yasuhiko; Naka, Norifumi; Araki, Nobuhito; Yoshikawa, Hideki

    2015-05-12

    In patients with soft tissue sarcoma of the wrist and hand, limb salvage operation is extremely challenging for surgeons in attempting a complete tumor resection with negative surgical margins. In this study, we report four patients with soft tissue sarcoma of the wrist and hand treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts. The patients were all male, and the mean age at the time of surgery was 45 years. Histological diagnoses included clear cell sarcoma in two patients, synovial sarcoma in one, and angiosarcoma in one. All four patients had high grade tumors, wherein three had American Joint Committee on Cancer (AJCC) stage III disease and one with AJCC stage IV disease. The tumors were resected en bloc with involved tendons. The tendons were isolated from the resected tissues, irradiated ex vivo, and re-implanted into the host tendons. In one patient, the bone was resected additionally because of tumor invasion to the bone. Hand function was evaluated using Musculoskeletal Tumor Society (MSTS) rating system. Of the four patients, three died of distant metastatic disease. The remaining patient lives and remains disease-free. The mean follow-up period was 33 months. One patient had local recurrence outside the irradiated graft at 20 months after surgery. The functional rating was 22. Lower scores were seen in patients with reconstruction of flexor tendons than extensor tendons. Limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts is an acceptable method in selected patients with soft tissue sarcoma of the wrist and hand.

  18. The Effectiveness of Hand Massage on Pain in Critically Ill Patients After Cardiac Surgery: A Randomized Controlled Trial Protocol.

    Science.gov (United States)

    Boitor, Madalina; Martorella, Géraldine; Laizner, Andréa Maria; Maheu, Christine; Gélinas, Céline

    2016-11-07

    Postoperative pain is common in the intensive care unit despite the administration of analgesia. Some trials suggest that massage can be effective at reducing postoperative pain in acute care units; however, its effects on pain relief in the intensive care unit and when pain severity is highest remain unknown. The objective is to evaluate the effectiveness of hand massage on the pain intensity (primary outcome), unpleasantness and interference, muscle tension, anxiety, and vital signs of critically ill patients after cardiac surgery. A 3-arm randomized controlled trial will be conducted. A total of 79 patients who are 18 years or older, able to speak French or English and self-report symptoms, have undergone elective cardiac surgery, and do not have a high risk of postoperative complications and contraindications to hand massage will be recruited. They will be randomly allocated (1:1:1) to standard care plus either 3 20-minute hand massages (experimental), 3 20-minute hand holdings (active control), or 3 20-minute rest periods (passive control). Pain intensity, unpleasantness, anxiety, muscle tension, and vital signs will be evaluated before, immediately after, and 30 minutes later for each intervention administered within 24 hours postoperatively. Peer-reviewed competitive funding was received from the Quebec Nursing Intervention Research Network and McGill University in December 2015, and research ethics approval was obtained February 2016. Recruitment started in April 2016, and data collection is expected to be complete by January 2017. To date, 24 patients were randomized and had data collection done. This study will be one of the first randomized controlled trials to examine the effect of hand massage on the pain levels of critically ill patients after cardiac surgery and to provide empirical evidence for the use of massage among this population. ClinicalTrials.gov NCT02679534; https://clinicaltrials.gov/ct2/show/NCT02679534 (Archived by WebCite at http

  19. Hand Anatomy

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy Bones Joints Muscles Nerves Vessels Tendons Anatomy The upper extremity is ...

  20. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Louise Crovesy-de-Oliveira

    2014-04-01

    Full Text Available Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent Roux-en-Y gastric and carried evaluation anthropometric and dietetic. The dietary evaluate was compared with the daily consumption requirement and food pyramid for these patients.Results: forty women with 43.1 ± 9.96 years, obesity and very high risk for metabolic complications associate with obesity, and with acceptation of supplementation (95% participated this study. The majority of women consumed group’s foods “high-calorie foods, fats and sweets are energy-dense foods” and showed high intake of foods groups “grains and cereals” and “high-fiber, low-calorie foods”. Dietary intake was low-calorie (1342.50 ± 474.06 Kcal, adequate in protein (22.10 ± 6.94%, carbohydrate (50.74 ± 10.96%, lipid (26.14 ± 7.17%, saturated fatty acids (8.69 ± 2.74% and polyunsaturated fatty acids (8.93 ± 3.51% and low-monounsaturated fatty acids (4.13 ± 1.78% and fibers (17.02 ± 10.64 g.Conclusions: nutritional habits of women showed inadequacy, these results reinforce the importance of nutritional accompanying in the late postoperative bariatric surgery.

  1. Sentinel node biopsy as an adjunct to limb salvage surgery for epithelioid sarcoma of the hand

    Directory of Open Access Journals (Sweden)

    Hammond Alex

    2005-06-01

    Full Text Available Abstract Background Epithelioid sarcomas of the hand are rare, high-grade tumors with a propensity for regional lymphatic spread approaching 40%. Case presentation A 54-year-old male with an epithelioid sarcoma of the palm was treated with neoadjuvant radiation, wide excision, and two-stage reconstruction. Sentinel lymph node biopsy was used to stage the patient's axilla. Sentinel node biopsy results were negative. The patient has remained free of local, regional and distant disease for the follow-up time of 16 months. Conclusion The rarity of this tumor makes definitive conclusions difficult but SLN biopsy appears to be a useful adjunct in the treatment of these sarcomas.

  2. Fundamentals of endoscopic surgery: creation and validation of the hands-on test.

    Science.gov (United States)

    Vassiliou, Melina C; Dunkin, Brian J; Fried, Gerald M; Mellinger, John D; Trus, Thadeus; Kaneva, Pepa; Lyons, Calvin; Korndorffer, James R; Ujiki, Michael; Velanovich, Vic; Kochman, Michael L; Tsuda, Shawn; Martinez, Jose; Scott, Daniel J; Korus, Gary; Park, Adrian; Marks, Jeffrey M

    2014-03-01

    The Fundamentals of Endoscopic Surgery™ (FES) program consists of online materials and didactic and skills-based tests. All components were designed to measure the skills and knowledge required to perform safe flexible endoscopy. The purpose of this multicenter study was to evaluate the reliability and validity of the hands-on component of the FES examination, and to establish the pass score. Expert endoscopists identified the critical skill set required for flexible endoscopy. They were then modeled in a virtual reality simulator (GI Mentor™ II, Simbionix™ Ltd., Airport City, Israel) to create five tasks and metrics. Scores were designed to measure both speed and precision. Validity evidence was assessed by correlating performance with self-reported endoscopic experience (surgeons and gastroenterologists [GIs]). Internal consistency of each test task was assessed using Cronbach's alpha. Test-retest reliability was determined by having the same participant perform the test a second time and comparing their scores. Passing scores were determined by a contrasting groups methodology and use of receiver operating characteristic curves. A total of 160 participants (17 % GIs) performed the simulator test. Scores on the five tasks showed good internal consistency reliability and all had significant correlations with endoscopic experience. Total FES scores correlated 0.73, with participants' level of endoscopic experience providing evidence of their validity, and their internal consistency reliability (Cronbach's alpha) was 0.82. Test-retest reliability was assessed in 11 participants, and the intraclass correlation was 0.85. The passing score was determined and is estimated to have a sensitivity (true positive rate) of 0.81 and a 1-specificity (false positive rate) of 0.21. The FES hands-on skills test examines the basic procedural components required to perform safe flexible endoscopy. It meets rigorous standards of reliability and validity required for high

  3. When do we think it is Safe to Drive after Hand Surgery? – Current Practice and Legal Perspective

    LENUS (Irish Health Repository)

    Murphy, SF

    2016-11-01

    Patients recovering from hand surgery frequently ask when it is safe to drive and it is unclear where the responsibility lies; the surgeon, the patient or the insurance company. An eight-question survey looking at various aspects of clinical practice was circulated to consultant and trainee plastic and orthopaedic surgeons in Ireland and the UK. Of the 89 surgeons who replied, (53%) felt the decision when to drive was the patient’s compared with the insurance company (40%) and the surgeon (7%). 80% advised patients to contact their insurance company. 87% were unaware of current regulations or guidelines. National guidelines were vague and left the decision with the treating doctor. Similarly, major insurers advise patients to contact their doctor for advice. From a legal standpoint, the patient has a duty of care to other road users to be in full control of his vehicle prior to driving, regardless of any advice received.

  4. Adaptive Hands-On Control for Reaching and Targeting Tasks in Surgery

    Directory of Open Access Journals (Sweden)

    Elisa Beretta

    2015-05-01

    Full Text Available Cooperatively controlled robotic assistants can be used in surgery for the repetitive execution of targeting/reaching tasks, which require smooth motions and accurate placement of a tool inside a working area. A variable damping controller, based on a priori knowledge of the location of the surgical site, is proposed to enhance the physical human-robot interaction experience. The performance of this and of typical constant damping controllers is comparatively assessed using a redundant light-weight robot. Results show that it combines the positive features of both null (acceleration capabilities > 0.8m/s2 and optimal (mean pointing error < 1.5mm constant damping controllers, coupled with smooth and intuitive convergence to the target (direction changes reduced by 30%, which ensures that assisted tool trajectories feel natural to the user. An application scenario is proposed for brain cortex stimulation procedures, where the surgeon's intentions of motion are explicitly defined intra-operatively through an image-guided navigational system.

  5. An improved hand-held four-detector gamma-probe for radioassisted oncological surgery

    CERN Document Server

    Dusi, W; Bollini, D; Moroni, C; Ricard, M

    2000-01-01

    The performance of an improved intraoperative gamma-probe for radioassisted oncological surgery is presented and discussed. The probe is based on a square array of four 5x5 mm sup 2 coplanar CdTe room temperature semiconductor detectors and each detector has an independent read out electronic chain, allowing an original handling of the signal. Therefore, the search for gamma-emission hot points may be carried out in two different, independent ways: (1) Finding out the position of the probe corresponding to the maximum value of the total counting rate, on the basis of a trial and error procedure (typical for the conventional probe; (2) Finding out the position of the probe where both the differences between the counting rate performed by orthogonal, adjacent halves of the array vanish (differential method). This makes the new probe sensitive to the bidimensional gradient of the gamma-ray flux, measured on the scanned plane. Furthermore, the algebraic sign of the difference indicates in which direction the prob...

  6. Relation between the Disability of the Arm, Shoulder and Hand Score and Muscle Strength in Post-Cardiac Surgery Patients.

    Science.gov (United States)

    Izawa, Kazuhiro P; Kasahara, Yusuke; Hiraki, Koji; Hirano, Yasuyuki; Watanabe, Satoshi

    2017-11-27

    Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m²; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength ( r = -0.38, p = 0.01) and with knee extensor muscle strength ( r = -0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.

  7. Relation between the Disability of the Arm, Shoulder and Hand Score and Muscle Strength in Post-Cardiac Surgery Patients

    Directory of Open Access Journals (Sweden)

    Kazuhiro P. Izawa

    2017-11-01

    Full Text Available Background: The Disabilities of the Arm, Shoulder, and Hand (DASH questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m2; left ventricular ejection fraction: 53.5 ± 13.7%. Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = −0.38, p = 0.01 and with knee extensor muscle strength (r = −0.32, p = 0.04. Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.

  8. The Effect of Two Different Hand Exercises on Grip Strength, Forearm Circumference, and Vascular Maturation in Patients Who Underwent Arteriovenous Fistula Surgery

    Science.gov (United States)

    Kong, Sangwon; Lee, Kyung Soo; Kim, Junho

    2014-01-01

    Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. Results All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. Conclusion The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball. PMID:25379494

  9. Report of the 10(th) Asia-Pacific Federation of Societies for Surgery of the Hand Congress (Organising Chair and Scientific Chair).

    Science.gov (United States)

    A, Roohi Sharifah; Abdullah, Shalimar

    2016-10-01

    A report on the 10(th) Asia-Pacific Federation of Societies for the Surgery of the Hand and 6(th) Asia-Pacific Federation of Societies for Hand Therapists is submitted detailing the numbers of attendees participating, papers presented and support received as well the some of the challenges faced and how best to overcome them from the local conference chair and scientific chair point of view.

  10. A hand-held imaging probe for radio-guided surgery: physical performance and preliminary clinical experience

    International Nuclear Information System (INIS)

    Pitre, S.; Menard, L.; Charon, Y.; Solal, M.; Garbay, J.R.

    2003-01-01

    Improvements in the specificity of radiopharmaceutical compounds have been paralleled by an upsurge of interest in developing small detectors to assist surgeons in localizing tumour tissue during surgery. This study reports the main technical features and physical characteristics of a new hand-held gamma camera dedicated to accurate and real-time intra-operative imaging. First clinical experience is also reported. The POCI (Per-operative Compact Imager) camera consists of a head module composed of a high-resolution interchangeable lead collimator and a CsI(Na) crystal plate optically coupled to an intensified position-sensitive diode. The current prototype has a 40-mm diameter field of view, an outer diameter of 9.5 cm, a length of 9 cm and a weight of 1.2 kg. Overall detector imaging characteristics were evaluated by technetium-99m phantom measurements. Three patients with breast cancer previously scheduled to undergo sentinel lymph node detection were selected for the preliminary clinical experience. Preoperative images of the lymphatic basin obtained using the POCI camera were compared with conventional transcutaneous explorations using a non-imaging gamma probe. The full-width at half-maximum (FWHM) spatial resolution was investigated in both air and scattering medium; when the phantom was placed in contact with the collimator, the POCI camera exhibited a 3.2 mm FWHM. The corresponding sensitivity was 290 cps/MBq. The preliminary clinical results showed that POCI was able to predict the number and location of all SLNs. In one case, two deep radioactive nodes missed by the gamma probe were detected on the intra-operative images. This very initial experience demonstrates that the physical performance of the POCI camera is adequate for radio-guided surgery. These results are sufficiently encouraging to prompt further evaluation studies designed to determine the specific and optimal clinical role of intra-operative imaging devices

  11. Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer.

    Science.gov (United States)

    Koh, Frederick H X; Tan, Ker-Kan; Lieske, Bettina; Tsang, Marianne L; Tsang, Charles B; Koh, Dean C

    2014-10-01

    Laparoscopic total mesorectal excision (TME) remains a technically challenging procedure. This study aims to compare the surgical outcomes of the robotic-assisted laparoscopic (RAL) versus hand-assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers. A retrospective review of all patients who underwent RAL TME for rectal cancers was performed. These cases were matched for age, sex, and stage of malignancy with patients who underwent HAL TME. Data collected included age, sex, American Society of Anesthesiologists scores, comorbid conditions, types of surgical resections and operative times, perioperative complications, length of hospital stays, and histopathologic outcomes were analyzed. From August 2008 to August 2011, 19 patients, with a median age of 62 (range, 47 to 92) years underwent RAL TME. Eight (42.1%) patients received neoadjuvant chemoradiotherapy. The median docking and operative times were 10 (range, 3 to 34) and 390 (range, 289 to 771) minutes, respectively. There was 1 (5.3%) conversion to open surgery. The grade of mesorectal excision was histopathologically reported as complete in all 19 cases. Positive circumferential margin was reported in 1 (5.3%) patient.Comparing the 2 groups, more patients in the RAL group received neoadjuvant chemoradiotherapy (8 vs. 3; P=0.048). The operative times were longer in the RAL group (390 vs. 225 min; P<0.001). A higher proportion of patients in the HAL group required conversion to open surgery (5 vs. 1; P=0.180) and developed perioperative morbidities (3 vs. 7; P=0.269). The median length of hospitalization was comparable between both groups (RAL: 7 vs. HAL: 6 d; P=0.476).The procedural cost was significantly higher in the RAL group (US$12,460 vs. US$8560; P<0.001), whereas the nonprocedural cost remained comparable between the 2 groups (RAL: US$4470 vs. HAL: US$4500; P=0.729). RAL TME is associated with lower conversion and morbidity rates compared with HAL TME. The longer

  12. In Small Animal Surgery Are Alcoholic Hand Rubs Superior to Scrubbing Brushes and Antimicrobial Soap at Reducing Bacterial Counts?

    Directory of Open Access Journals (Sweden)

    Alison Claire Mann

    2016-10-01

    Full Text Available Clinical bottom lineThe current literature suggests that the use of alcohol hand rubs provide similar, if not better, reductions in bacteria colony forming units, both immediately after hand antisepsis and in the immediate postoperative period.

  13. Hand-Assisted Robotic Surgery for Staging of Ovarian Cancer and Uterine Cancers With High Risk of Peritoneal Spread: A Retrospective Cohort Study.

    Science.gov (United States)

    Fornalik, Hubert; Brooks, Hannah; Moore, Elizabeth S; Flanders, Nicole L; Callahan, Michael J; Sutton, Gregory P

    2015-10-01

    This study aimed to determine surgical outcomes related to hand-assisted robotic surgery (HARS) for staging of ovarian cancer and uterine cancers with high risk of peritoneal spread and compare them to laparotomy and standard robotic-assisted surgery. A retrospective cohort study of women undergoing staging for uterine and ovarian cancer between January 2011 and July 2013 at a major metropolitan teaching hospital was reviewed. Patients undergoing HARS were matched with patients undergoing staging laparotomy [exploratory laparotomy (XLAP)] for the same indications and with patients undergoing traditional robotic surgery (RS) for staging of endometrioid endometrial cancer. In HARS, a longer incision is used to allow palpation of the peritoneal surfaces, to exteriorize the small bowel, to examine the mesentery, and to perform omentectomy. One hundred five patients were analyzed (15 HARS, 45 RS, 45 XLAP). Compared with XLAP, HARS was associated with decreased blood loss (200 vs 400 mL, P = 0.011) and shorter hospital stay (1 vs 4 days, P < 0.001). Patients who had undergone HARS had fewer major complications, but those results did not reach statistical significance (0% vs 27%, P = 0.063). Hand-assisted robotic surgery was associated with higher blood loss and length of stay as compared to robotic staging of endometrioid endometrial cancer (RS). Minor wound complications were also more common (27% vs 2%, P = 0.012). Hand-assisted robotic surgery allows for thorough visual and tactile assessment of peritoneal surfaces. It represents a safe alternative to laparotomy for staging of ovarian and uterine cancers with high risk of peritoneal spread. Long-term follow-up study is needed to determine oncologic adequacy of HARS.

  14. Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery

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    Abdulkadir Yektaş

    2016-01-01

    Full Text Available Intravenous regional anesthesia (IVRA is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA I-II patients (n=60 who underwent hand surgery were included. For this purpose, only lidocaine (LDC, lidocaine+adjunct tramadol (LDC+TRA group, or lidocaine+systemic tramadol (LDC+SysTRA group was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority.

  15. Uso do 5-fluorouracil no intra-operatório da cirurgia do pterígio Intra-operative use of 5-fluorouracil in pterygium surgery

    Directory of Open Access Journals (Sweden)

    Silvana A. Schellini

    2000-04-01

    Full Text Available Objetivo: Avaliar a efetividade e as complicações com a aplicação do 5- fluorouracil (5-FLU no intra-operatório da cirurgia do pterígio. Método: Foram avaliados 28 olhos de 26 indivíduos quanto ao tipo e tamanho do pterígio, cirurgias prévias e a resposta ao tratamento cirúrgico (no 7º , 21º , 60º e 90º dia de pós-operatório. Logo após a exerese do pterígio, aplicou-se 5-FLU (25 mg/ml no leito cirúrgico, durante cinco minutos; a seguir, realizou-se a técnica de deslizamento de retalho conjuntival. Resultados: A maioria dos pacientes tinha mais de 50 anos de idade e apresentava pterígio primário (70,0%, grau II (60,7%, do tipo involutivo (60,7%. No pós-operatório observaram-se: isquemia (10,7%, deiscência da conjuntiva (7,1%, ceratite (3,5%, conjuntivite (3,5% e recidiva da lesão em 1 olho (3,5%.Conclusão: O 5-FLU se mostrou droga segura e efetiva na prevenção das recidivas, podendo ser usado como coadjuvante no tratamento do pterígio para prevenir recidivas.Purpose: To evaluate the effectiveness and the complications on intraoperative application of 5-fluorouracil (5FLU in pterygium surgery. Method: We studied 28 eyes of 26 patients with pterygium, evaluating the type and size of the pterygium, previous surgeries and the response to surgical treatment (on the 7th, 21st, 60th, 90th postoperative day. The application of 5-FLU (25 mg/ml was done soon after resection, for five minutes, followed by the sliding flap technique.Results: Most of the patients were more than 50 years old, presented with primary (70.0%, degree II (60.7%, involu-tionary type (60.7% pterygium. After surgery ischemic area (10.7%, conjunctival deiscence (7.1%, keratitis (3.5%, conjunctivitis (3.5% and lesion relapse (3.5% were observed.Conclusion: 5-FLU is a safe and effective drug and could be of help in the treatment of pterygium to prevent relapse.

  16. The Effect of Ketamine and Dexamethasone in Combination with Lidocaine on the Onset and Duration of Axillary Block in Hand and Forearm Soft Tissue Surgery.

    Science.gov (United States)

    Zaman, Behrooz; Hojjati Ashrafi, Siavash; Seyed Siamdoust, Seyedalireza; Hassani, Valiollah; Mohamad Taheri, Siavash; Noorizad, Samad

    2017-10-01

    Using peripheral nerve block compared to general anesthesia has gained more popularity due to reduced postoperative pain, less need for post-surgery analgesic drugs, reduced incidence of nausea, shortness of PACU time, and increased patient satisfaction. The aim of this study was to compare the effect of ketamine and dexamethasone as additives to lidocaine on duration and onset of axillary block action. In this clinical trial, all patients who referred to Hazrat-e-Fatemeh hospital for forearm and hand soft tissue surgery with informed consent were randomly divided into three groups in order to examine the onset and duration of axillary block: lidocaine + ketamine, lidocaine + dexamethasone in axillary block, and lidocaine alone (control). Then, the onset and duration of sensory and motor blocks were measured and recorded every three minutes and after the surgery. Quantitative and qualitative variables were analyzed using ANOVA or Kruskal-Wallis test and Chi-square or Fisher exact test in SPSS v.22. Duration of sensory and motor block axillary was significantly higher in lidocaine + dexamethasone group than in lidocaine + ketamine group (P block axillary between the three groups (P > 0.05). According to the results of our study, we can conclude that adding dexamethasone or ketamine to lidocaine could improve duration of sensory and motor axillary block in patients undergoing forearm and hand soft tissue surgery. However, dexamethasone had the highest effect on duration of block axillary. We proved that dexamethasone or ketamine added to lidocaine had no effect on the onset of block axillary.

  17. A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery

    Directory of Open Access Journals (Sweden)

    Nicholas C. K. Lam

    2014-01-01

    Full Text Available Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR] strength loss in the distal group was 21.4% (14.3, 47.8%, while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.

  18. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.

    Science.gov (United States)

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M

    2011-02-01

    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P hand-assisted (P robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

  19. Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio Ventilatory profile of patients undergoing CABG surgery

    Directory of Open Access Journals (Sweden)

    Katiane Tremarin Morsch

    2009-06-01

    Full Text Available OBJETIVO: Avaliar o perfil ventilatório, radiológico e clínico dos pacientes submetidos a cirurgia eletiva de revascularização do miocárdio em hospital de referência em cardiologia no sul do Brasil. MÉTODOS: A amostra foi composta por 108 indivíduos submetidos a cirurgia eletiva de revascularização do miocárdio no Instituto de Cardiologia do Rio Grande do Sul (IC-FUC, no período de abril de 2006 a fevereiro de 2007. A abordagem cirúrgica realizada foi a da esternotomia mediana e os enxertos foram com ponte de safena e/ou artéria mamária interna. Os volumes e capacidades pulmonares, bem como a presença de distúrbios ventilatórios, foram avaliados por meio da espirometria e a força muscular ventilatória da manovacuometria. As avaliações foram realizadas no período pré-operatório e no sexto dia de pós-operatório. RESULTADOS: Observou-se redução significativa do VEF1 e da CVF quando comparados os valores pré-operatórios com os do sexto dia de pós-operatório (POBJECTIVE: To assess the ventilatory, radiological and clinical profile of patients undergoing elective CABG in a cardiology reference hospital in South Brazil. METHODS: This study included 108 patients undergoing elective CABG surgery, in the period between April 2006 and February 2007 at the Cardiology Institute of Rio Grande do Sul (IC-FUC. The surgical procedure involved median sternotomy, and the saphenous vein and/or internal mammary artery were used for grafting. Lung volume and capacity, as well as the possible existence of ventilatory changes, were assessed by spirometry, and the ventilatory muscle strength was assessed using a vaccum manometer. All evaluations were performed on the preoperative period and on the sixth postoperative day. RESULTS: Preoperative levels of FEV1 and FVC were significantly reduced on the 6th postoperative day (P<0.001 when compared to the preoperative levels. A significant decrease of ventilatory muscle strength, expressed

  20. Cirurgia redutora de volume pulmonar: critérios de seleção de pacientes no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ Lung volume reduction surgery (LVRS: criteria for selecting patient in Antonio Pedro Hospital, Federal Fluminense University, Niterói city, Rio de Janeiro, Brazil

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    Rodolfo Fred Behrsin

    2003-09-01

    mais de um fator mórbido a contra-indicar o seu procedimento. A maioria dos pacientes com critérios para CRVP, a recusa, com receio do procedimento ou após programas de reabilitação pulmonar. O critério mais significativo que indicou CRVP em um paciente operado foi a presença de enfisema heterogênio bilateral nos lobos superiores.BACKGROUND: Chronic Obstructive Pulmonary Disease (CPOD is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS is an alternative of surgical treatment of emphysema (aside from lung transplantation. OBJECTIVES: The aim of this study was to analyse patient selection criteria for LVRS. METHODS: This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions. RESULTS: Contraindications to surgery included chronic bronchitis (29% or nine patients, forced expiratory volume in one second (FEV 1 more than 80 percent predicted (13% or four patients, negative consent for surgery (10% or three patients, fibrosis pattern, severe depression and bronchiectasis (two patients each one, solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history

  1. Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial

    Science.gov (United States)

    Rawal, Narinder; Macquaire, Valery; Catalá, Elena; Berti, Marco; Costa, Rui; Wietlisbach, Markus

    2011-01-01

    This randomized, double-blind, double-dummy, multicenter trial compared efficacy and safety of tramadol HCL 37.5 mg/paracetamol 325 mg combination tablet with tramadol HCL 50 mg capsule in the treatment of postoperative pain following ambulatory hand surgery with iv regional anesthesia. Patients received trial medication at admission, immediately after surgery, and every 6 hours after discharge until midnight of the first postoperative day. Analgesic efficacy was assessed by patients (n = 128 in each group, full analysis set) and recorded in a diary on the evening of surgery day and of the first postoperative day. They also documented the occurrence of adverse events. By the end of the first postoperative day, the proportion of treatment responders based on treatment satisfaction (primary efficacy variable) was comparable between the groups (78.1% combination, 71.9% tramadol; P = 0.24) and mean pain intensity (rated on a numerical scale from 0 = no pain to 10 = worst imaginable pain) had been reduced to 1.7 ± 2.0 for both groups. Under both treatments, twice as many patients experienced no pain (score = 0) on the first postoperative day compared to the day of surgery (35.9% vs 16.4% for tramadol/paracetamol and 36.7% vs 18% for tramadol treatment). Rescue medication leading to withdrawal (diclofenac 50 mg) was required by 17.2% patients with tramadol/paracetamol and 13.3% with tramadol. Adverse events (mainly nausea, dizziness, somnolence, vomiting, and increased sweating) occurred less frequently in patients under combination treatment (P = 0.004). Tramadol/paracetamol combination tablets provided comparable analgesic efficacy with a better safety profile to tramadol capsules in patients experiencing postoperative pain following ambulatory hand surgery. PMID:21559356

  2. A hands-free region-of-interest selection interface for solo surgery with a wide-angle endoscope: preclinical proof of concept.

    Science.gov (United States)

    Jung, Kyunghwa; Choi, Hyunseok; Hong, Hanpyo; Adikrishna, Arnold; Jeon, In-Ho; Hong, Jaesung

    2017-02-01

    A hands-free region-of-interest (ROI) selection interface is proposed for solo surgery using a wide-angle endoscope. A wide-angle endoscope provides images with a larger field of view than a conventional endoscope. With an appropriate selection interface for a ROI, surgeons can also obtain a detailed local view as if they moved a conventional endoscope in a specific position and direction. To manipulate the endoscope without releasing the surgical instrument in hand, a mini-camera is attached to the instrument, and the images taken by the attached camera are analyzed. When a surgeon moves the instrument, the instrument orientation is calculated by an image processing. Surgeons can select the ROI with this instrument movement after switching from 'task mode' to 'selection mode.' The accelerated KAZE algorithm is used to track the features of the camera images once the instrument is moved. Both the wide-angle and detailed local views are displayed simultaneously, and a surgeon can move the local view area by moving the mini-camera attached to the surgical instrument. Local view selection for a solo surgery was performed without releasing the instrument. The accuracy of camera pose estimation was not significantly different between camera resolutions, but it was significantly different between background camera images with different numbers of features (P solo surgeries without a camera assistant.

  3. Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial

    Directory of Open Access Journals (Sweden)

    Rawal N

    2011-04-01

    Full Text Available Narinder Rawal1, Valery Macquaire2, Elena Catalá3, Marco Berti4, Rui Costa5, Markus Wietlisbach61Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; 2Clinique du Parc Leopold, Brussels, Belgium; 3Pain Clinic, Department Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 4Department of Anesthesiology and Reanimation, Parma Hospital, Parma, Italy; 5Garcia de Orta Hospital, Almada, Portugal; 6Department of Anesthesiology, Sursee Hospital, Sursee, SwitzerlandAbstract: This randomized, double-blind, double-dummy, multicenter trial compared efficacy and safety of tramadol HCL 37.5 mg/paracetamol 325 mg combination tablet with tramadol HCL 50 mg capsule in the treatment of postoperative pain following ambulatory hand surgery with iv regional anesthesia. Patients received trial medication at admission, immediately after surgery, and every 6 hours after discharge until midnight of the first postoperative day. Analgesic efficacy was assessed by patients (n = 128 in each group, full analysis set and recorded in a diary on the evening of surgery day and of the first postoperative day. They also documented the occurrence of adverse events. By the end of the first postoperative day, the proportion of treatment responders based on treatment satisfaction (primary efficacy variable was comparable between the groups (78.1% combination, 71.9% tramadol; P = 0.24 and mean pain intensity (rated on a numerical scale from 0 = no pain to 10 = worst imaginable pain had been reduced to 1.7 ± 2.0 for both groups. Under both treatments, twice as many patients experienced no pain (score = 0 on the first postoperative day compared to the day of surgery (35.9% vs 16.4% for tramadol/paracetamol and 36.7% vs 18% for tramadol treatment. Rescue medication leading to withdrawal (diclofenac 50 mg was required by 17.2% patients with tramadol/paracetamol and 13.3% with tramadol. Adverse events (mainly nausea, dizziness

  4. Osteoarthritis of the Hand

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Osteoarthritis Email to a friend * required fields From * ...

  5. Hands in Systemic Disease

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... hands, being composed of many types of tissue, including blood vessels, nerves, skin and skin-related tissues, bones, and muscles/tendons/ligaments, may show changes that reflect a ...

  6. The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery.

    Science.gov (United States)

    Jung, Kyung Uk; Yun, Seong Hyeon; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

    2018-04-01

    Continuous efforts to reduce the numbers and size of incisions led to the emergence of a new technique, single-incision laparoscopic surgery (SILS). It has been rapidly accepted as the preferred surgical approach in the colorectal area. In the age of SILS, what is the role of hand-assisted laparoscopic surgery (HALS)? We introduce the way to take advantage of it, as an effective alternative to avoid open conversion. This is a retrospective review of prospectively collected data of SILS colectomies performed by a single surgeon in Samsung Medical Center between August 2009 and December 2012. Out of 631 cases of SILS colectomy, 47 cases needed some changes from the initial approach. Among these, five cases were converted to HALS. Four of them were completed successfully without the need for open conversion. One patient with rectosigmoid colon cancer invading bladder was finally opened to avoid vesical trigone injury. The mean operation time of the 4 patients was 265.0 minutes. The mean estimated blood loss was 587.5 mL. The postoperative complication rate associated with the operation was 25%. Conversion from SILS to HALS in colorectal surgery was feasible and effective. It seemed to add minimal morbidity while preserving advantages of minimally invasive surgery. It could be considered an alternative to open conversion in cases of SILS, especially when the conversion to conventional laparoscopy does not seem to be helpful.

  7. The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

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    Hosein Kimiaei Asadi

    2013-01-01

    Full Text Available PURPOSE: To evaluate the effect of nitroglycerine (NTG on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID for intravenous regional anesthesia in elective forearm and hand surgery. METHODS: A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. RESULTS: There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. CONCLUSION: The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery.

  8. Cuidados imediatos no pós-operatório de cirurgia cardíaca Immediate post-operative care following cardiac surgery

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    Paulo Ramos David João

    2003-11-01

    Full Text Available OBJETIVO: Apresentar uma rotina de atendimento para crianças submetidas à cirurgia cardíaca. FONTES DOS DADOS: Realizada revisão bibliográfica através de bancos de dados (Medline, Mdconsult, PubMed, analisando as condutas sugeridas por diversos serviços fora do Brasil e comparando com a rotina de atendimento no Hospital Infantil Pequeno Príncipe, de Curitiba, onde foram realizadas cerca de 8.000 cirurgias cardíacas desde 1977 até abril de 2003. SÍNTESE DOS DADOS: O serviço citado é referência em cardiologia e cirurgia cardíaca no estado do Paraná e estados vizinhos. A evolução das condições de diagnóstico, preparo da equipe clínica e cirúrgica, unidade de terapia intensiva (UTI melhor equipada com monitorização mais avançada, equipe da UTI com pessoal treinado em todas as áreas para fazer pós-operatório de cirurgia cardíaca, estrutura hospitalar adequada, oferecendo atendimento avançado em todas as especialidades pediátricas e paramédicas, fazem com que o resultado das intervenções cirúrgicas realizadas em crianças com cardiopatias congênitas ou adquiridas, principalmente nos recém-nascidos e lactentes jovens com cardiopatias complexas, apresente sensível melhora quando comparado com anos anteriores. CONCLUSÃO: As crianças com cardiopatias, principalmente as complexas, devem ser encaminhadas para um local que seja centro de referência, onde haja condições para um atendimento global no pré, per e pós-operatório.OBJECTIVE: To present a care routine for children submitted to heart surgery. SOURCE OF DATA: Literature review of Medscape, MD Consult and PubMed. Analysis of the suggested conducts adopted by various services from different countries and comparison with the care routine at the Pequeno Príncipe Children's Hospital (Curitiba, state of Paraná, where approximately 8,000 heart surgeries were performed in children from 1977 to April 2003. SUMMARY OF THE FINDINGS: Our hospital is a reference

  9. Estudo comparativo entre as tenólises convencionais e com despertar intraoperatório realizadas na região do túnel osteofibroso flexor das mãos (zona 2 Comparative study between traditional tenolyses and with intraoperative awakening performed on the flexor osteofibrous tunnel region of the hands (zone 2

    Directory of Open Access Journals (Sweden)

    Tiago Guedes da Motta Mattar

    2009-01-01

    Full Text Available OBJETIVO: As tenólises dos tendões flexores na zona 2 são procedimentos difíceis e um verdadeiro desafio na cirurgia da mão. Com o objetivo de comparar os resultados obtidos entre as tenólises com despertar intraoperatório, realizadas sob anestesia locorregional (grupo 1, daqueles obtidos com as tenólises convencionais, realizadas sob anestesia geral ou bloqueio total do plexo braquial (grupo 2, os autores realizam um estudo prospectivo e controlado. MÉTODOS: Foram avaliados 22 pacientes com 39 dedos portadores de lesão de tendão flexor na zona 2 que evoluíram para aderências. Todos os pacientes foram operados após três meses e antes de um ano da sutura tendinosa primária. Todos apresentavam limitação da movimentação ativa sem melhora com a reabilitação. Os grupos 1 e 2 mostraram-se homogêneos em relação à idade dos pacientes, sexo, comprometimento pré-operatório e ausência de lesões ou patologias associadas. Todos os pacientes foram avaliados de acordo com a movimentação ativa (TAMs no período pré-operatório e com seis meses de pós-operatório. RESULTADOS: A análise estatística dos dados obtidos nos grupos 1 e 2 demonstra que as tenólises realizadas pelas duas técnicas proporcionam bons resultados. Ao comparar os resultados da movimentação ativa total após seis meses da tenólise, observa-se que os pacientes do grupo 1, tratados pela técnica do despertar intraoperatório, apresentavam melhores resultados. CONCLUSÕES: As tenólises dos flexores na zona 2 proporcionam bons resultados em termos de ganho de amplitude articular. A técnica de despertar intraoperatório com anestesia locorregional proporciona resultados mais satisfatórios que a técnica convencional.OBJECTIVE: Flexor tendon tenolysis on zone 2 is a difficult and really challenging for hand surgery. With the objective of comparing the results obtained between tenolyses with intraoperative awakening, performed with locoregional anesthesia

  10. Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

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    Luciano Foroni

    Full Text Available ABSTRACT Objective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN as the donor. Methods: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.

  11. Treatment of hand ischemia following angioaccess surgery using the distal revascularization interval-ligation technique with preservation of vascular access: description of an 18-case series.

    Science.gov (United States)

    Sessa, Carmine; Riehl, Gregory; Porcu, Paolo; Pichot, Olivier; Palacin, Pedro; Maghlaoua, Mohamed; Magne, Jean-Luc

    2004-11-01

    Hand ischemia is a rare complication of angioaccess surgery for hemodialysis. Management usually requires ligation of the arteriovenous fistula (AVF). The purpose of this report is to describe our experience with the use of the distal revascularization interval-ligation (DRIL) technique for treatment of ischemia without ligation of the AVF. From January 1999 to September 2002, the DRIL technique was used to treat 18 patients (10 men, 8 women, 10 diabetic patients) with severe paresthesia of the hand (n = 9) and finger necrosis (n = 10). The AVF was located at the elbow in 16 patients and at the wrist in 2 patients. Mean flow distal to the AVF was less than 10 mL in 5 patients, less than 5 mL in 10, and unmeasurable in 3. The conduit used for all DRIL arterial bypasses, including 15 brachiobrachial bypasses, 1 axillobrachial bypass, 1 brachioradial bypass, and 1 radioradial bypass, was the great saphenous vein graft. Trophic manifestations required finger amputation in five patients, pulpar necrosis resection in four, and transmetacarpal amputation of the index finger in one patient. Symptoms disappeared in 13 patients (73%) and improved in 5 (27%). The time required for healing of finger amputations and trophic manifestations ranged from 15 days to 2 months. Mean arterial flow through the DRIL bypass was 50 mL/min (range, 20-90 mL/min). With a mean follow-up interval of 16 months (range, 5-48 months), primary patency of the DRIL artery bypass and AVF was 94% and the limb salvage rate was 100%. The DRIL technique is the most effective procedure for treatment of angioaccess-induced hand ischemia. This technique can be used to achieve persistent relief of symptoms with continued access patency. The DRIL artery bypass improves vacularization of the hand, and ligature of the artery stops the vascular steal without affecting hemodialysis access. The DRIL technique should be proposed as first-line treatment for hand ischemia due to AVF for hemodialysis.

  12. Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial.

    Science.gov (United States)

    Tikuišis, R; Miliauskas, P; Samalavičius, N E; Žurauskas, A; Samalavičius, R; Zabulis, V

    2014-04-01

    Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery. Sixty four patients with colon cancer scheduled for elective colon resection were involved in this study. Patients were randomized to receive either lidocaine infusion [lidocaine group (LG)] or normal 0.9 % saline infusion [placebo group (PG)] for a period of 24 h. Anaesthetic and surgical techniques were standardized. Twenty-four-hour post-operative analgesia in the recovery area was maintained by continuous infusion of 0.1 μg/kg/h fentanyl. The primary outcome of the study was post-operative pain control. Pain was assessed using visual analogue scale (VAS) scores at 2, 4, 8, 12, and 24 h after surgery. Patients with a VAS score >3 were treated with ketorolac 30 mg as needed. Secondary outcomes included time to resumption of bowel function and length of hospital stay. Data in the two groups were compared using the two-tailed Student's t test. All statistical tests were two-tailed at a significance level of 0.05. Demographic characteristics and clinical features of both groups were similar. Intensity of pain at rest in LG compared with PG was significantly lower during the first 24 h post-operatively. LG patients reported significantly less pain during movements at 2-, 12-, and 24-h post-surgery than PG patients. The study showed that ketorolac consumption was significantly higher in PG: mean ketorolac consumption in LG was 43.77 ± 13.86 mg and in PG 51.67 ± 13.16 mg (p = 0.047). Compared with placebo, lidocaine infusion produced a 32 % reduction in time to the first drink (Cohen's d = 3.85), 16 % reduction in time to the first full diet

  13. Arthritis of the hand - Rheumatoid

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Rheumatoid Arthritis Email to a friend * required fields ...

  14. The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery.

    Science.gov (United States)

    Prasetyono, Theddeus O H; Lestari, Puri A

    2016-05-01

    One-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA). A randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test. The OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (Pmil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

  15. Comparação de critérios diagnósticos de insuficiência renal aguda em cirurgia cardíaca Comparison of diagnostic criteria for acute kidney injury in cardiac surgery

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    Márcio Campos Sampaio

    2013-01-01

    Full Text Available FUNDAMENTO: Há grande controvérsia quanto ao diagnóstico de Insuficiência Renal Aguda (IRA, existindo mais de 30 diferentes definições. OBJETIVO: Avaliar a incidência e os fatores de risco para desenvolvimento de IRA no pós-operatório de cirurgia cardíaca de acordo com os critérios RIFLE, AKIN e KDIGO, e comparar o poder prognóstico desses critérios. MÉTODOS: Estudo de corte transversal que incluiu 321 pacientes (62 [53 - 71] anos, 140 homens consecutivamente submetidos a cirurgia cardíaca entre junho de 2011 e janeiro de 2012. Os pacientes foram acompanhados por 30 dias, com vistas ao desenvolvimento de um desfecho composto (mortalidade, necessidade de diálise e internação prolongada. RESULTADOS: A incidência de IRA variou de 15% - 51%, conforme o critério diagnóstico adotado. Enquanto a idade se associou ao risco de IRA nos três critérios, houve variação nos demais determinantes. Durante o acompanhamento, 89 pacientes apresentaram o desfecho e todos os critérios se associaram ao risco aumentado na análise Cox univariada e após o ajuste para idade, sexo, diabetes e tipo de cirurgia. Contudo, após novo ajuste para tempo de circulação extracorpórea e presença de baixo débito cardíaco, apenas o diagnóstico de IRA pelo critério KDIGO manteve esta associação significativa (HR= 1,89 [95% IC: 1,18 - 3,06]. CONCLUSÕES: A incidência e os fatores de risco para IRA pós-cirurgia cardíaca têm grande variação de acordo com os critérios diagnósticos utilizados. Em nossa análise, o critério KDIGO se mostrou superior ao AKIN e ao RIFLE quanto ao seu poder prognóstico.BACKGROUND: There is considerable controversy regarding the diagnosis of Acute Kidney Injury (AKI, and there are over 30 different definitions. OBJECTIVE: To evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the prognostic power of these criteria

  16. Ocorrência de dermatófitos em amostras de unhas, pés e mãos coletadas de estudantes universitários Occurrence of dermatophyte, in nails, feet and hands of universitary students

    Directory of Open Access Journals (Sweden)

    Emersom Roberto Siqueira

    2006-06-01

    Full Text Available Este trabalho teve como objetivo, avaliar a presença de dermatófitos, especificamente em unhas, pés e mãos de estudantes universitários com e sem lesões sugestivas de dermatofitose. Foram coletadas 280 amostras dessas regiões, das quais 31 (11,1% apresentaram positividade apenas pelo exame direto, e 20 (7,1% tiveram, além do exame direto positivo, crescimento de dermatófito, mediante cultivo da amostra biológica. T. rubrum foi o dermatófito isolado com maior freqüência (80%, seguido por T. mentagrophytes (20%. Considerando os sítios analisados neste trabalho, a ocorrência de dermatófitos foi observada em 10,4% nas unhas dos pés, 5% nas escamas de pés, 2,5% nas unhas das mãos e apenas 0,4% nas escamas das mãos.The objective of this paper was to evaluate the occurrence of dermatophytes, specifically in the nails, feet and hands of university students with and without lesions. Two hundred and eighty samples were collected; 31 (11.1% were positive by direct examination, while only 20 (7.1% showed dermatophyte growth in culture, as well as direct positive examination. Trichophyton rubrum was the most frequently isolated (80% dermatophyte followed by T. mentagrophytes (20%. Considering the sites analyzed, dermatophyte occurrence was: 10.4% in toenails, 5% in foot skin, 2.5% in fingernails and 0.4% in hand skin.

  17. The effect of feedback regarding coping strategies and illness behavior on hand surgery patient satisfaction and communication: a randomized controlled trial.

    Science.gov (United States)

    Mellema, Jos J; O'Connor, Casey M; Overbeek, Celeste L; Hageman, Michiel G; Ring, David

    2015-09-01

    Patients and surgeons can feel uncomfortable discussing coping strategies, psychological distress, and stressful circumstances. It has been suggested that patient-reported outcome measures (PROMs) facilitate the discussion of factors associated with increased symptoms and disability. This study assessed the effect of providing feedback to patients regarding their coping strategy and illness behavior on patient satisfaction and patient-physician communication in orthopedic surgery. In a prospective study, 136 orthopedic patients were randomly assigned to either receive feedback about the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer-adaptive test (CAT) prior to the visit with the hand surgeon or not. The primary outcome was patient satisfaction with the consultation and secondary outcomes involved patient-physician communication. Bivariate and multivariable analyses were performed to determine the influence of the feedback on patient satisfaction and communication. There was no significant difference in patient satisfaction between patients who received feedback and patients who did not (P = 0.70). Feedback was associated with more frequent discussion of coping strategies (P = 0.045) in bivariate analysis but was not independently associated: in multivariable analysis, only PROMIS Pain Interference CAT and age were identified as independent predictors (odds ratio (OR) 1.1; 95 % confidence interval (CI) 1.0-1.1, P = 0.013, and OR 0.97, 95 % CI 0.94-0.99, P = 0.032, respectively). No factors were associated with discussion of stressors. Discussion of circumstances was independently associated with increased PROMIS Pain Interference CAT, marital status, and work status. We found that feedback regarding coping strategies and illness behavior using the PROMIS Pain Interference CAT did not affect patient satisfaction. Although feedback was associated with increased discussion of illness behavior in bivariate

  18. Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: biomechanical analysis and considerations for hand surgery.

    Science.gov (United States)

    Buschmann, Johanna; Müller, Angela; Feldman, Kirill; Tervoort, Theo A; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Calcagni, Maurizio

    2011-07-01

    For the prevention of re-rupture during early healing phase, the primary repair strength of repaired lacerated tendons in hand surgery should be maximal and the reconstructed diameter minimal. Two new repair methods (small hook thread and internal splint) were assessed for strength and reconstructed diameter characteristics. Achilles tendons of 43 female New Zealand White rabbits were sectioned 2 cm above the calcaneus. Specimens were divided into 7 groups and repaired as follows: Kirchmayr method 2-strand with 4.0 polypropylene thread; Becker method 4-strand; 6-strand; internal splint; Kirchmayr method small hook 2-strand; Becker method small hook 4-strand, non-modified tendon. Load until failure, load until gap formation, gap length, cross-sectional area and failure stress were determined. The small hook 2-strand suture had 1.3 fold higher loads until failure compared to a conventional 2-strand suture, P<0.05. The internal splint had a similar load until failure (22 N (SD 6)) as the conventional 2-strand suture (23 N (SD 4)); around half the load until failure of the conventional 4-strand suture (38 N (SD 9)). Load until gap formation correlated positively with load until failure (y=0.65+3.6; r(2)=0.72). The running suture increased the cross-sectional area at the repair site by a factor of 1.3. Using a small hook thread instead of a 4.0 polypropylene thread significantly increases the primary repair strength with the same number of strands. Internal splints may be an alternative to conventional 2-strand sutures for bridging large gaps. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. A intervenção fonoaudiológica no pós-operatório da hipertrofia benigna do músculo masseter The miofunctional oral intervention in the surgery treatment for the masseter muscle hipertrophy

    Directory of Open Access Journals (Sweden)

    Laura Davison Mangilli

    2006-04-01

    Full Text Available OBJETIVO: descrever a abordagem fonoaudiológica no pós-operatório de pacientes que realizaram correção cirúrgica da hipertrofia do músculo masseter. METODOLOGIA: foram coletados dados referentes à avaliação e ao tratamento fonoaudiológico de 4 prontuários de sujeitos de ambos os gêneros, com faixa etária entre 16 e 24 anos, com hipertrofia benigna do músculo masseter, tratados cirurgicamente. RESULTADOS: as principais queixas pós-cirúrgicas estiveram relacionadas à limitação da abertura da boca, à dor na região da cirurgia, à rigidez muscular e a estalo em região da ATM. A terapia fonoaudiológica baseou-se em orientação quanto à retirada de hábitos deletérios; termoterapia na região do músculo masseter; manipulação da musculatura envolvida extra e intrabucais; alongamento da musculatura facial e cervical; alavanca de abertura forçada de boca e exercícios de órgãos fonoarticulatórios. CONCLUSÕES: a terapia fonoaudiológica apresenta-se como uma possibilidade de complementação ao tratamento cirúrgico, na adequação da amplitude dos movimentos mandibulares, assim como na eliminação dos sintomas presentes no pós-cirúrgico e na conscientização dos hábitos deletérios, que são apontados pela literatura como possíveis fatores desencadeantes.AIM: the aim of this study was to describe miofunctional oral intervention in patients with Masseter muscle hipertrophy treated by surgery. METHODS: the sample consisted of 4 patients, male and female, with ages between 16 and 24 years, with Masseter muscle hipertrophy treated by surgery. RESULTS: the main complains on the postoperative were related to trismus, muscle rigidity, and clicking in the temporomandibular joint. The myofunctional oral therapy was based on orientation in the abnormal habits (bruxism, clenching elimination, hyperthermia induced in the masseter muscle, oral muscles massage, facial and cervical muscles stretching, miofunctional exercises and

  20. A simplified prevention bundle with dual hand hygiene audit reduces early-onset ventilator-associated pneumonia in cardiovascular surgery units: An interrupted time-series analysis.

    Directory of Open Access Journals (Sweden)

    Kang-Cheng Su

    Full Text Available To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH audit on the incidence of early-onset ventilation-associated pneumonia (VAP.This 3-year, quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH performed by non-unit-based observers was a routine task before and after bundle implementation. Based on the realistic ICU settings, we implemented a 3-component bundle, which included: a compulsory education program, a knowing internal HH audit (iHH performed by unit-based observers, and a standardized oral care (OC protocol with 0.1% chlorhexidine gluconate. The study periods comprised 4 phases: 12-month pre-implementation phase 1 (eHH+/education-/iHH-/OC-, 3-month run-in phase 2 (eHH+/education+/iHH+/OC+, 15-month implementation phase 3 (eHH+/education+/iHH+/OC+, and 6-month post-implementation phase 4 (eHH+/education-/iHH+/OC-.A total of 2553 ventilator-days were observed. VAP incidences (events/1000 ventilator days in phase 1-4 were 39.1, 40.5, 15.9, and 20.4, respectively. VAP was significantly reduced by 59% in phase 3 (vs. phase 1, incidence rate ratio [IRR] 0.41, P = 0.002, but rebounded in phase 4. Moreover, VAP incidence was inversely correlated to compliance of OC (r2 = 0.531, P = 0.001 and eHH (r2 = 0.878, P < 0.001, but not applied for iHH, despite iHH compliance was higher than eHH compliance during phase 2 to 4. Compared to eHH, iHH provided more efficient and faster improvements for standard HH practice. The minimal compliances required for significant VAP reduction were 85% and 75% for OC and eHH (both P < 0.05, IRR 0.28 and 0.42, respectively.This simplified prevention bundle effectively reduces early-onset VAP incidence. An unaware HH compliance correlates with VAP incidence. A knowing HH audit provides better improvement in HH practice. Accordingly, we suggest

  1. Cirurgia de estrabismo ajustável no peroperatório com anestesia tópica em pacientes com orbitopatia de Graves Intraoperative adjustable strabismus surgery under drop anesthesia in patients with Graves' orbitopathy

    Directory of Open Access Journals (Sweden)

    Patrícia Grativol Costa

    2008-06-01

    Full Text Available OBJETIVO: Descrever as características clínicas pré-operatórias dos pacientes com estrabismo secundário à orbitopatia de Graves e os resultados da cirurgia com anestesia tópica e sutura ajustável. MÉTODOS: Estudo retrospectivo realizado no Hospital das Clínicas da Universidade de São Paulo. Foram pesquisados os prontuários de todos os pacientes atendidos no ambulatório de estrabismo no período de março de 1994 a maio de 2004. Destes, foram separados aqueles com estrabismo associado à orbitopatia de Graves submetidos à cirurgia ajustável com anestesia tópica. As características clínicas pré-operatórias e os resultados cirúrgicos foram levantados a partir desta análise. RESULTADOS: Foram incluídos 13 pacientes. O tipo de desvio mais freqüentemente encontrado foi esotropia com hipotropia. Em 9 pacientes modificou-se o retrocesso programado no pré-operatório. Três casos necessitaram de uma segunda cirurgia. Após 6 meses de seguimento, 8 dos 13 pacientes estavam ortotrópicos ou com foria pequena e com algum grau de estereopsia. CONCLUSÃO: Neste estudo observou-se que 62% (8/13 dos pacientes apresentavam hipotropia com esotropia, provavelmente por causa do comprometimento associado do reto inferior e reto medial. Nove dos 13 pacientes necessitaram de ajuste no peroperatório e apenas 3 foram reoperados, indicando a importância da técnica ajustável para melhor alinhamento ocular no pós-operatório, possibilitando obter resultados mais satisfatórios.PURPOSE: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia. METHODS: The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied. RESULTS

  2. Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery

    Directory of Open Access Journals (Sweden)

    Maria Elaine Trevisan

    2010-12-01

    Full Text Available A cirurgia abdominal alta está associada a um risco elevado de complicações pulmonares que podem ser reduzidas pelo uso criterioso de manobras terapêuticas visando a expansão pulmonar. O objetivo foi comparar duas técnicas de incentivo respiratório na recuperação da dinâmica toracoabdominal em pacientes submetidos à cirurgia abdominal alta. O grupo de estudo experimental foi constituído por 16 pacientes internados na Clínica Cirúrgica do Hospital Universitário de Santa Maria distribuídos aleatoriamente em dois grupos: o grupo 1 foi constituído por dez pacientes que usaram o dispositivo Voldyne e o grupo 2, por seis pacientes submetidos ao padrão ventilatório com inspiração fracionada em três tempos. A expansibilidade toracoabdominal foi avaliada por cirtometria antes da cirurgia e no 1º, 3º¸ e 5º dias do pós-operatório (PO. Observou-se redução significativa dos valores de cirtometria no 1º PO que, gradualmente, foram sendo recuperados, não mais havendo diferença significativa no 5o PO em relação aos valores pré-operatórios em ambos os grupos. O grupo 1 obteve significativamente melhores índices de recuperação da mobilidade toracoabdominal do que o grupo 2. Também o tempo de recuperação do grupo 1 atingiu médias mais elevadas durante todo o período de PO investigado. Embora ambas as técnicas utilizadas fossem efetivas, o incentivo inspiratório por meio do Voldyne mostrou melhores resultados na recuperação da expansibilidade pulmonar após cirurgia abdominal alta.Upper abdominal surgery is associated to increased risk of pulmonary complications, which may be lessened by judicious use of therapeutic maneuvers aimed at lung expansion. The purpose here was to compare two respiratory incentive techniques on recovery of thoracic-abdominal dynamics in patients having undergone upper abdominal surgery. Sixteen patients in such condition were randomly divided into group 1 (n=10, who did respiratory training

  3. The Avocado Hand

    LENUS (Irish Health Repository)

    Rahmani, G

    2017-11-01

    Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut\\/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the “avocado hand”. We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.

  4. Perfil socioeconômico e epidemiológico dos pacientes submetidos à cirurgia de catarata em um hospital universitário Socioeconomic and epidemiologic profile of patients submitted to cataract surgery at a university hospital

    Directory of Open Access Journals (Sweden)

    Beatriz de Abreu Fiuza Gomes

    2008-10-01

    Full Text Available OBJETIVO: Determinar as características sócioeconômicas dos pacientes operados de catarata em hospital universitário, avaliar o acesso à unidade terciária e determinar o tempo de espera até o tratamento cirúrgico. MÉTODOS: Estudo transversal, realizado através da revisão de prontuários de 148 pacientes operados de catarata escolhidos aleatoriamente durante o primeiro semestre de 2007. RESULTADOS: Os pacientes apresentaram idade mediana de 70,5 anos, com maior prevalência de mulheres (60,1%, da raça branca (48,0%, com baixo grau de instrução (ensino fundamental incompleto, 50,7%, acuidade visual igual ou pior a 20/200 (57,4% e diagnóstico realizado em consulta regular no hospital universitário (47,8%. Apenas 9,4% dos pacientes operados foram diagnosticados na campanha de catarata. O tempo médio entre o diagnóstico e a cirurgia foi 3,5 meses e relacionou-se principalmente à realização dos exames oftalmológicos e clínicos pré-operatórios. CONCLUSÃO: Os pacientes com baixa renda familiar são os principais usuários do Sistema Único de Saúde (SUS e o acesso ao tratamento cirúrgico é demorado, resultando em visão subnormal incapacitante. Ressalta-se a importância da campanha de catarata no ingresso de pacientes carentes ao hospital de alta complexidade.PURPOSE: To determine the socio-economic characteristics of the patients who were submitted to cataract surgery in a university hospital, to evaluate the accessibility to the tertiary health service and to determine the waiting time for cataract surgery. METHODS: A cross-sectional study of medical charts from 148 random patients who underwent cataract surgery during the first semester of 2007. RESULTS: The patients in this study had median of age of 70.5 years, and the major prevalence was of female (60.1%, caucasian (48.0%, with low educational level (incomplete fundamental study, 50.7%, best corrected visual acuity 20/200 or worst; the diagnosis of cataract was done

  5. Rio+20

    Directory of Open Access Journals (Sweden)

    Robert Horn

    2012-10-01

    Full Text Available This reflection on Rio+20 examines many of the major social institutions and how they fulfilled their functions during the United Nations Conference on Sustainable Development at Rio. The institutions are: 1. Nation-states as a collective. 2. Individual nation-states. 3. Vanguard institutions (some NGOs. 4. Action and convening NGOs. 5. Global media. 6. Governments of nation-states acting domestically 7. Individual governments in bilateral and multilateral situations. 8. Similar institutions in different countries acting together. 9. Businesses. 10. Global science. Each is considered within the assumptions of what the society expects them to deliver (in general, what is possible for them to deliver, and what they did deliver at Rio. In approaching Rio+20, our account differs considerably from much of the reportage by the mainstream media.

  6. Hand Therapy

    Science.gov (United States)

    ... from conditions such as carpal tunnel syndrome and tennis elbow , as well as from chronic problems such as ... Tools Advice from a Certified Hand Therapist on Tennis Elbow Advice from a Certified Hand Therapist: Living with( ...

  7. Pediatrics Department of the Russian Medical Academy of Continuous Professional Education and Moscow Research Clinical Institute of Pediatry and Children Surgery – half century hand in hand

    Directory of Open Access Journals (Sweden)

    I. N. Zakharova

    2018-01-01

    Full Text Available The long-term cooperation of the two scientific institutions contributing to the professional development of pediatricians is based on the long-term scientific relations of the Department of Pediatrics of the Russian Medical Academy of Continuing Professional Education and the Moscow Research Institute of Pediatrics and Pediatric Surgery (now the Research Institute of Pediatrics named after Academician Yu.E.Veltischev. The role of remarkable pediatric scientists – G.N. Speransky, Yu.E. Veltstschev, M.S. Ignatova, N.A. Korovina in the development of these links and pediatric science in Russia. 

  8. Fisioterapia respiratória no pré e pós-operatório de cirurgia de revascularização do miocárdio Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Simone Cavenaghi

    2011-09-01

    respiratória é parte integrante na gestão dos cuidados do paciente cardiopata, tanto no pré quanto no pós-operatório, pois contribui significativamente para um melhor prognóstico desses pacientes por meio de técnicas específicas.The cardiovascular diseases are among the main death causes in the developed world. They have been increasing epidemically in the developing countries. In spite of several alternatives for the treatment of the coronary artery disease; the surgery of the myocardial revascularization is an option with proper indications of medium and long-term with good results. It provides the remission of the angina symptoms contributing to the increase of the expectation and improvement of the life quality. Most of patients undergoing myocardial revascularization surgery develop postoperative lung dysfunction with important reduction of the lung volumes, damages in the respiratory mechanism, decrease in the lung indulgence and increase of the respiratory work. The reduction of volumes and lung capacities can contribute to alterations in the gas exchanges, resulting in hypoxemia and decrease in the diffusion capacity. Taking this into account, the Physiotherapy has been requested more and more to perform in the pre as well as in the postoperative period of this surgery. This study aimed at updating the knowledge regarding the respiratory physiotherapy performance in the pre and postoperative period of the myocardial revascularization surgery enhancing the prevention of lung complications. The Physiotherapy uses several techniques in the preoperative period; such as: the incentive spirometry, exercises of deep breathing, cough, inspiratory muscle training, earlier ambulation and physiotherapeutic orientations. While in the postoperative period, the objective is the treatment after lung complications took place, performed by means of physiotherapeutic maneuvers and noninvasive respiratory devices, aiming at improving the respiratory mechanism, the lung

  9. Estudo comparativo da eficácia de colírios antiinflamatórios não esteróides na manutenção da dilatação pupilar durante a cirurgia de catarata Comparative efficacy of nonsteroidal antiinflammatory eye drops in maintenance of pupillary dilation during cataract surgery

    Directory of Open Access Journals (Sweden)

    Rafael Naves Tomás

    2003-12-01

    Full Text Available OBJETIVO: Antiinflamatórios não hormonais, com efeitos antiprostaglandínicos, têm sido usados no pré-operatório de cirurgia de catarata para manutenção da midríase per-operatória. Infelizmente, ainda não existe um antiprostaglandínico ideal. Este é um estudo de corte transversal, randomizado, grupo-placebo e duplo-mascarado, comparando a eficácia do cetorolac de trometamina, flurbiprofeno sódico, diclofenaco sódico e um placebo, hipromelose, quanto à manutenção peroperatória da midríase. MÉTODOS: Cento e dezesseis pacientes, submetidos à extração extracapsular da catarata com implantação de lente intra-ocular, foram separados aleatoriamente em quatro grupos, que receberam a mesma rotina de dilatação e de instilação dos antiprostaglandínicos. O grupo I recebeu cetorolac de trometamina; grupo II, flurbiprofeno sódico; grupo III, diclofenaco sódico e grupo IV, hipromelose, o placebo. Os dados referentes à pupila foram obtidos por meio de questionário objetivo proposto aos cirurgiões no início e ao final da cirurgia. RESULTADOS: Os resultados mostraram diferença significativa entre o grupo I e o placebo quanto à manutenção da dilatação peroperatória. Também foi significativa a diferença entre o grupo I e os demais grupos em relação à suficiência da midríase para o início do ato cirúrgico e para a ocorrência de miose intra-operatória. Não se registrou diferença significante entre o uso de flurbiprofeno e de diclofenaco quando comparados ao placebo para os mesmos parâmetros (pBACKGROUND AND PURPOSE: Nonsteroidal antiinflammatory drugs, with antiprostaglandin effect, have been used in the preoperative period of cataract surgery for maintenance of mydriasis during the surgery. Unfortunately, the ideal antiprostaglandin has yet to be introduced. This study is a transversal cut, randomized, placebo-group and double-masked clinical trial comparing the efficacy of ketorolac tromethamine

  10. [Hand osteoarthritis].

    Science.gov (United States)

    Šenolt, Ladislav

    Hand osteoarthritis (OA) is a common chronic disorder causing pain and limitation of mobility of affected joints. The prevalence of hand OA increases with age and more often affects females. Clinical signs obviously do not correlate with radiographic findings - symptomatic hand OA affects approximately 26 % of adult subjects, but radiographic changes can be found in up to two thirds of females and half of males older than 55 years.Disease course differ among individual patients. Hand OA is a heterogeneous disease. Nodal hand OA is the most common subtype affecting interphalangeal joints, thumb base OA affects first carpometacarpal joint. Erosive OA represents a specific subtype of hand OA, which is associated with joint inflammation, more pain, functional limitation and erosive findings on radiographs.Treatment of OA is limited. Analgesics and nonsteroidal anti-inflammatory drugs are the only agents reducing symptoms. New insights into the pathogenesis of disease should contribute to the development of novel effective treatment of hand OA.

  11. The role of the medical physic on radiologic, hemodynamic and surgery unit at Hospital das Clinicas de Porto Alegre, Rio Grande do Sul State, Brazil

    International Nuclear Information System (INIS)

    Bacelar, A.; Furtado, A.P.A.; Krebs, E.M.; Oliveira, S.S.; Lima, A.A.; Jacques, L.C.; Silveira, C.S.

    1996-01-01

    The activities executed by the medical physic in the radiologic, hemodynamic and surgery unit are presented. Topics such as organization of a radiologic protection project and a quality assurance program, monthly information of the individual doses, sanitary inspection and training of the professionals involved are emphasized. The methodology and results are briefly presented

  12. Bartonella and Coxiella infective endocarditis in Brazil: molecular evidence from excised valves from a cardiac surgery referral center in Rio de Janeiro, Brazil, 1998 to 2009.

    Science.gov (United States)

    Lamas, Cristiane da Cruz; Ramos, Rosana Grandelle; Lopes, Gabriel Quintino; Santos, Marisa Silva; Golebiovski, Wilma Felix; Weksler, Clara; Ferraiuoli, Giovanna Ianini D'Almeida; Fournier, Pierre-Edouard; Lepidi, Hubert; Raoult, Didier

    2013-01-01

    PCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998-2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  13. Rio de Janeiro: Instrumentation school

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    Students from Latin America were able to get hands-on experience in state-of-the-art physics instrumentation in this year's School on Instrumentation for High Energy Physics organized by the active Instrumentation Panel of ICFA (the International Committee for Future Accelerators) at the Centro Brasileiro de Pesquicas Fisicas (CBPF), Rio de Janeiro, in July

  14. Variability in Resident Operative Hand Experience by Specialty.

    Science.gov (United States)

    Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

    2018-01-01

    Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

  15. Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards.

    Science.gov (United States)

    Davis, C R

    2010-05-01

    Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P porters (21% - 67%, P 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ. This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.

  16. Robotic Hand

    Science.gov (United States)

    1993-01-01

    The Omni-Hand was developed by Ross-Hime Designs, Inc. for Marshall Space Flight Center (MSFC) under a Small Business Innovation Research (SBIR) contract. The multiple digit hand has an opposable thumb and a flexible wrist. Electric muscles called Minnacs power wrist joints and the interchangeable digits. Two hands have been delivered to NASA for evaluation for potential use on space missions and the unit is commercially available for applications like hazardous materials handling and manufacturing automation. Previous SBIR contracts resulted in the Omni-Wrist and Omni-Wrist II robotic systems, which are commercially available for spray painting, sealing, ultrasonic testing, as well as other uses.

  17. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  18. Complicações pulmonares em crianças submetidas à cirurgia cardíaca em um hospital universitário Pulmonary complications in pediatric cardiac surgery at a university hospital

    Directory of Open Access Journals (Sweden)

    Daniel Lago Borges

    2010-06-01

    Full Text Available OBJETIVO: Identificar a prevalência de complicações pulmonares em crianças submetidas à cirurgia cardíaca, assim como características demográficas e clínicas da população estudada. MÉTODOS: A amostra foi composta por 37 crianças, de ambos os sexos, submetidas à cirurgia cardíaca no Hospital Universitário Presidente Dutra, São Luís (MA, durante o ano de 2007. Não foram incluídos pacientes que apresentaram doença pulmonar pré-cirúrgica, portadores de distúrbios neurológicos, óbito intra-operatório, além de falta de dados no prontuário. Os dados foram obtidos pela coleta nas evoluções médicas e de enfermagem dos respectivos prontuários. RESULTADOS: Quanto às características populacionais, houve predomínio de crianças do sexo feminino, provenientes do interior do estado e na faixa etária escolar. Patologias consideradas de baixo risco foram a maioria, destacando-se a persistência do canal arterial, comunicação interventricular e comunicação interatrial. Observou-se que a maior parcela das crianças fez uso de circulação extracorpórea por mais de 30 minutos, sendo a mediana igual a 80 minutos, sofreu esternotomia mediana, utilizou apenas dreno mediastinal e fez uso de ventilação mecânica pós-operatória, sendo a mediana aproximadamente de 6,6 horas. Somente três (8,1% pacientes apresentaram complicações pulmonares, sendo que destes, dois foram a óbito. CONCLUSÃO: A maioria das crianças da amostra era do sexo feminino, na faixa etária escolar e proveniente do interior do estado. Os baixos tempos de circulação extracorpórea e ventilação mecânica, além de cardiopatias congênitas consideradas de baixo risco, podem ter sido fatores contribuintes para o pequeno índice de complicações pulmonares no pós-operatório.OBJECTIVE: To identify the prevalence of pulmonary complications in children undergone cardiac surgery, as well as demographic and clinical characteristics of this population

  19. Fisioterapia no pós-operatório de cirurgia cardíaca: a percepção do paciente Physical therapy in postoperative cardiac surgery: patient's perception

    Directory of Open Access Journals (Sweden)

    Paula Monique Barbosa Lima

    2011-06-01

    Full Text Available INTRODUÇÃO: Muitas estratégias para melhorar os serviços prestados pela fisioterapia estão baseadas na satisfação dos pacientes. Ouvir e observar o comportamento dos pacientes dentro de um hospital é fundamental para a compreensão e melhoria do serviço e ambiente hospitalar. OBJETIVO: O presente estudo teve como objetivo identificar a percepção dos pacientes submetidos à cirurgia cardíaca acerca do serviço de fisioterapia prestado nas enfermarias dos hospitais de referência em cirurgia cardíaca na cidade de Maceió, AL, Brasil e, a partir dessas informações, detectar quais ações são percebidas como prioritárias para que sejam traçados planos de melhorias da qualidade do atendimento. MÉTODOS: Trata-se de um estudo descritivo transversal e quantitativo, realizado nos hospitais de referência em cirurgia cardíaca na cidade de Maceió, AL, Brasil, no período de setembro a novembro de 2008. Foram incluídos no estudo 30 pacientes usuários do Sistema Único de Saúde, sendo 12 (40% do gênero feminino e 18 (60% do gênero masculino. A idade média desta amostra foi de 49,2 ± 11,9 anos e a maioria pertencia à classe socioeconômica D (36,7%. RESULTADOS: Observou-se que só 16,7% tiveram contato com o fisioterapeuta antes da cirurgia. Em relação a orientações educativas acerca do pós-operatório, apenas 2,9% dos pacientes relataram tê-las recebido. No entanto, 56,8% classificaram o atendimento como bom e 100% dos pacientes referiram acreditar que o tratamento fisioterapêutico poderia melhorar o seu estado de saúde. CONCLUSÃO: Sugerimos a implementação de protocolos fisioterapêuticos pré-operatórios com medidas preventivas e educacionais, bem como novos trabalhos que possam caracterizar a população de usuários de planos de saúde/particulares.INTRODUCTION: Many strategies to improve services provided by for physiotherapy are based on patients satisfaction. Listen and observe the behavior of patients in a

  20. Tendon Transfer Surgery

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... DESCRIPTION The tendon is the strong cord at either end of a muscle that is attached to bone. Tendons , combined with ...

  1. Adultos com cardiopatia congênita submetidos à primeira cirurgia: prevalência e resultados em um hospital terciário Adults with congenital heart disease undergoing first surgery: prevalence and outcomes at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Gustavo Alves de Mello

    2012-12-01

    Full Text Available INTRODUÇÃO: O tratamento cirúrgico da cardiopatia congênita em adultos apresentou importante crescimento nos últimos anos. Contudo, ainda assim, o número de pacientes que atingem a idade adulta sem tratamento cirúrgico adequado permanece elevado. OBJETIVO: Avaliar os resultados hospitalares e diagnósticos dos pacientes adultos com cardiopatia congênita submetidos à primeira operação. MÉTODOS: Estudo retrospectivo, que analisou prontuários de pacientes operados para correção de cardiopatia congênita com idade maior ou igual a 18 anos. O critério de exclusão foi cirurgia para reoperação. Foi analisado o período entre dezembro de 2007 e dezembro de 2010, com inclusão de 79 pacientes. RESULTADOS: Os defeitos do septo atrial foram os mais prevalentes (53,1%, seguidos de comunicação interventricular (15,2%, coarctação da aorta (6,3% e canal atrioventricular parcial (6,3%. Treze (16,4% pacientes apresentavam doença associada adquirida e 14 pacientes (17,7%, congênita. Trinta e três (41,8% pacientes apresentavam hipertensão pulmonar. O tempo médio de internamento em UTI e hospitalar foi de 3,9 e 14,5 dias, respectivamente. Complicações ocorreram em 18 (22,8% pacientes, sendo as infecciosas as mais comuns. A mortalidade hospitalar foi de dois (2,5% pacientes. CONCLUSÃO: O tratamento da cardiopatia congênita em adultos como primeira cirurgia apresentou resultado bastante favorável. Contudo, em nossa série, houve maior tempo de internamento em UTI e hospitalar.INTRODUCTION: Surgical treatment of congenital heart disease in adults showed a significant growth in recent years. But even so, the number of patients who reach adulthood without adequate surgical treatment remains high. OBJECTIVE: To demonstrate the results and hospital diagnoses of adult patients with congenital heart disease underwent the first surgery. METHODS: A retrospective analysis of records of patients operated for correction of congenital heart

  2. Hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Flyvholm, M.-A.

    2012-01-01

    Background. Healthcare workers are at increased risk of developing hand eczema. Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients/materials......Background. Healthcare workers are at increased risk of developing hand eczema. Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients...... dermatitis, younger age, male sex (male doctors), and working hours. Eighty nine per cent of subjects reported mild/moderate lesions. Atopic dermatitis was the only factor significantly related to severity. Sick leave was reported by 8% of subjects, and notification to the authorities by 12%. Conclusions...... or severity, but cultural differences between professions with respect to coping with the eczema were significant. Atopic dermatitis was related to increased prevalence and severity, and preventive efforts should be made for healthcare workers with atopic dermatitis....

  3. Hand Osteoblastoma

    Directory of Open Access Journals (Sweden)

    M. Farzan

    2006-06-01

    Full Text Available Background and Aim: Osteoblastoma is one of the rarest primary bone tumors. Although, small bones of the hands and feet are the third most common location for this tumor, the hand involvement is very rare and few case observations were published in the English-language literature. Materials and Methods: In this study, we report five cases of benign osteoblastoma of the hand, 3 in metacarpals and two in phalanxes. The clinical feature is not specific. The severe nocturnal, salicylate-responsive pain is not present in patients with osteoblastoma. The pain is dull, persistent and less localized. The clinical course is usually long and there is often symptoms for months before medical attention are sought. Swelling is a more persistent finding in osteoblastoma of the hand that we found in all of our patients. The radiologic findings are indistinctive, so preoperative diagnosis based on X-ray appearance is difficult. In all of our 5 cases, we fail to consider osteoblastoma as primary diagnosis. Pathologically, osteoblastoma consisting of a well-vascularized connective tissue stroma in which there is active production of osteoid and primitive woven bone. Treatment depends on the stage and localization of the tumor. Curettage and bone grafting is sufficient in stage 1 or stage 2, but in stage 3 wide resection is necessary for prevention of recurrence. Osteosarcoma is the most important differential diagnosis that may lead to inappropriate operation.

  4. Efeitos adversos no pós-operatório de cirurgias ginecológicas e mamárias Adverse postoperative effects in minor gynaecological and breast surgeries

    Directory of Open Access Journals (Sweden)

    Adriana Cássia Paiva Santos

    2006-08-01

    Full Text Available OBJETIVOS: Analisar a ocorrência de efeitos adversos no período de 24 horas da evolução pós-anestésica e pós-cirúrgica em mulheres submetidas a intervenções cirúrgicas ginecológicas e mamárias de pequeno porte e identificar os principais fatores associados. MÉTODOS: Trata-se de estudo tipo corte transversal que incluiu 159 mulheres submetidas a intervenções cirúrgicas ginecológicas e mamárias consideradas de pequeno porte. As mulheres foram internadas no dia anterior à intervenção cirúrgica e permaneceram no hospital por pelo menos 24 horas após o término do procedimento. As técnicas anestésicas realizadas foram bloqueio intercostal, bloqueio espinhal e anestesia geral. RESULTADOS: Os eventos adversos mais freqüentes foram vômitos, náuseas e dor, e ocorreram em 40,3% das mulheres. Destes, 60% foram observados nas primeiras quatro horas e 80% em até seis horas, após a intervenção cirúrgica. As mulheres submetidas ao bloqueio intercostal apresentaram alta mais precoce da recuperação anestésica; o bloqueio espinhal esteve associado mais freqüentemente à dor no período pós-operatório, porém houve menor incidência de náuseas e vômitos em relação à anestesia geral e bloqueio intercostal. Antecedente de tabagismo contribuiu para ocorrência de dor. CONCLUSÃO: O período de seis horas de observação mostrou-se adequado para a avaliação da maioria das complicações e efeitos adversos que ocorrem após intervenções cirúrgicas, ginecológicas e mamárias, de pequeno porte.OBJECTIVES: To analyze the occurrence of adverse effects in the first 24-hour postoperative/postanesthetic period in women undergoing minor gynecologic or minor breast surgeries and to identify main associated factors. METHODS: A cross-sectional study was conducted with 159 women who underwent minor gynecologic or breast surgeries. The women were admitted to the hospital one day before surgery and remained hospitalized for at least

  5. Uso de bomba centrífuga no pós-operatório de cirurgia cardíaca Assisted circulation in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Paulo M Pêgo-Fernandes

    1992-12-01

    Full Text Available Nos casos de choque cardiogênico após cirurgia cardíaca com auxílio da circulação extracorpórea retratarlos às drogas e ao balão intra-aórtico, as bombas centrífugas têm sido a primeira opção em vários Serviços. Esse fato deve-se à facilidade de manuseio, de instalação, custo razoável, grande disponibilidade, e alto grau de eficiência. O objetivo deste trabalho é o relato da experiência do Instituto do Coração com 8 pacientes submetidos a essa terapêutica, no período de maio de 1990 a dezembro de 1991. Nesses 8 doentes foi utilizado previamente balão intra-aórtico e feito uso maciço de drogas vasoativas. A idade variou de 54 a 66 anos. Três foram submetidos a revascularização do miocárdio, 2 a correção de aneurisma de ventrículo esquerdo, 2 a troca de valva mitral e 1 a transplante cardíaco. Em 7 a assistência foi de ventrículo esquerdo e em 1 de direito. A duração da assistência variou de 18 a 126 horas. Ocorreram três óbitos em assistência, sendo que dois eram pacientes em "ponte" para transplante que não obtiveram doador, e um morreu por complicações de sangramento e insuficiência renal aguda. Dos 5 (62,5% pacientes retirados da assistência, 2 faleceram tardiamente sendo 1 com pulmão de choque e 1 com complicação neurológica e insuficiência renal. Quando comparamos a evolução clínica com o pico de CKMB, verificamos que os 3 pacientes com pico maior que 80 faleceram, 2 em assistência e 1 tardiamente. Dos 5 doentes com pico de CKMB menor que 80, 4 foram retirados de assistência, com 3 sobreviventes tardios, e o único que morreu em assistência foi por problemas de sangramento. Os 3 (35% pacientes sobreviventes estão no 5º, 9º e 19º meses de seguimento, 2 em classe funcional II e 1 em classe I. A utilização precoce, antes de complicações irreversíveis, da assistência circulatória, deverá permitir resultados progressivamente melhores, nesse grupo de pacientes de alto risco

  6. Incidência de cirurgia cardíaca em octogenários: estudo retrospectivo Incidencia de cirugía cardíaca en octogenarios: estudio retrospectivo Incidence of cardiac surgery in octogenarian patients: retrospective study

    Directory of Open Access Journals (Sweden)

    Luciano Brandão Machado

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O aumento da expectativa de vida faz com que pacientes cada vez mais idosos tenham indicação de tratamento cirúrgico de cardiopatias. Este estudo tem como objetivo avaliar a incidência de pacientes com mais de 80 anos submetidos à cirurgia cardíaca no Instituto do Coração do Hospital das Clínicas da FMUSP, nos últimos 16 anos. MÉTODO: Foram analisados, no período de 1986 a 2001, o número de cirurgias de revascularização do miocárdio (RM e cirurgia valvar (CV e, em cada grupo, o número de cirurgias em pacientes com mais de 80 anos. Os dados foram analisados descritivamente. RESULTADOS: Os dados revelam aumento progressivo do número de octogenários submetidos à cirurgia cardíaca. As cirurgias de revascularização do miocárdio tiveram aumento de 0,13% em 1986 para 3,5% em 2001. As cirurgias valvares aumentaram de 0% em 1986 para 1,44% em 2001, registrando o maior valor de 3,02% em 1999. CONCLUSÕES: Os conhecimentos da fisiopatologia, da senilidade e os avanços no manuseio do trauma cirúrgico estão permitindo estender os recursos da cirurgia cardíaca no grupo de paciente mais idoso. A escolhas da técnica anestésica deve ser criteriosa, bem como a hidratação, a assistência ventilatória e a analgesia pós-operatória, permitindo redução da morbimortalidade neste grupo de maior risco cirúrgico.JUSTIFICATIVA Y OBJETIVOS: El aumento de la expectativa de vida hace con que pacientes cada vez mas edosos tengan indicación de tratamiento quirúrgico de cardiopatias. Este estudio tiene como objetivo evaluar la incidencia de pacientes con más de 80 años sometidos a cirugía cardíaca en el Instituto del Corazón del Hospital de Clínicas de la FMUSP, en los últimos 16 años. MÉTODO: Fueron analizados, en el período de 1986 a 2001, el número de cirugías de revascularización del miocardio (RM y cirugía valvar (CV y, en cada grupo, el número de cirugías en pacientes con más de 80 a

  7. Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca The therapeutic effects of music in children following cardiac surgery

    Directory of Open Access Journals (Sweden)

    Thamine P. Hatem

    2006-06-01

    Full Text Available OBJETIVO: Verificar de forma objetiva e subjetiva o efeito da música em crianças no pós-operatório de cirurgia cardíaca em uma unidade de terapia intensiva cardiopediátrica, em conjunto com ações da prática convencional. MÉTODOS: Ensaio clínico aleatorizado por placebo, no qual foram avaliadas 84 crianças, com faixa etária de 1 dia a 16 anos, nas primeiras 24 horas de pós-operatório, submetidas a sessão de 30 minutos de musicoterapia, utilizando música clássica e observadas no início e fim das sessões quanto às seguintes variáveis: freqüência cardíaca, pressão arterial, pressão arterial média, freqüência respiratória, temperatura, saturação de oxigênio, além de uma escala facial de dor. Foi considerado o nível de significância estatística de 5%. RESULTADOS: Dos 84 pacientes iniciais, cinco (5,9% recusaram participar do estudo. O grupo de cardiopatias mais comum foi o de congênitas acianogênicas com shunt E-D (41% intervenção: 44,4% controle. Quanto à avaliação subjetiva através da escala facial de dor e objetiva das freqüências cardíaca e respiratória, observou-se diferença estatisticamente significante entre os dois grupos após a intervenção (p OBJECTIVE: To investigate, both objectively and subjectively, the effect of music on children in a pediatric cardiac intensive care unit following heart surgery, in conjunction with standard care. METHODS: Randomized clinical trial with placebo, assessing 84 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period, given a 30 minute music therapy session with classical music and observed at the start and end of the session, recording heart rate, blood pressure, mean blood pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score. Statistical significance was set at 5%. RESULTS: Five of the initial 84 patients (5.9% refused to participate. The most common type of heart disease was acyanotic

  8. Sepse no pós-operatório de cirurgia cardíaca: descrição do problema Sepsis in the postoperative period of cardiac surgery: problem description

    Directory of Open Access Journals (Sweden)

    Dinaldo Cavalcanti de Oliveira

    2010-03-01

    Full Text Available FUNDAMENTOS: A despeito do avanço no diagnóstico e na terapêutica da sepse nos últimos anos, a morbidade e mortalidade são elevadas. OBJETIVO: Avaliar a prevalência, a evolução hospitalar e o prognóstico de pacientes que apresentaram sepse no pós- operatório de cirurgia cardíaca. MÉTODOS: Trata-se de um registro prospectivo que incluiu pacientes (n = 7.332 submetidos à cirurgia cardíaca (valvar ou coronariana entre janeiro de 1995 e dezembro de 2007. Utilizamos os critérios clássicos de diagnóstico de sepse para identificar os pacientes que evoluíram com tal enfermidade e avaliamos as comorbidades pré-operatórias, a evolução hospitalar e o prognóstico. RESULTADOS: A sepse ocorreu em 29 pacientes (prevalência = 0,39%. O sexo masculino predominou sobre o feminino (79% vs. 21%. A idade média foi de 69 ± 6,5 anos. As principais comorbidades pré-operatórias eram: hipertensão arterial sistêmica (79%, dislipidemia (48% e antecedente familiar de doença arterial coronariana (38%. O índice Apache médio foi de 18 ± 7, enquanto o Sofa indicou 14,2 ± 3,8. O foco infeccioso primário foi pulmonar em 19 pacientes (55%. Houve 19 culturas positivas, e a média de hidratação endovenosa nas primeiras 24 horas foi de 1.016 ± 803 ml. As principais complicações foram: insuficiência renal aguda (65%, síndrome de baixo débito cardíaco (55% e arritmia ventricular maligna (55%. A mortalidade foi de 79% (23 pacientes. CONCLUSÃO: A sepse após cirurgia cardíaca foi um evento raro, porém com desfechos clínicos catastróficos. O índice elevado de morbidade e mortalidade revelou a necessidade de um aprimoramento no tratamento, visando melhorar a evolução clínica dos pacientes.BACKGROUND: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high. OBJECTIVE: To assess the prevalence, in-hospital evolution and prognosis of patients that presented sepsis in the

  9. Rio report

    Energy Technology Data Exchange (ETDEWEB)

    Saxe, D

    1992-08-01

    At the world-wide Earth Summit held in Rio de Janeiro in 1992, two new legally binding documents were signed by over 140 countries: the Convention on Climate Change and the Convention on Biological Diversity. These conventions will come into force when ratified by 50 and 30 countries respectively. The objectives of these conventions, the steps to be taken toward their compliance, and their implications for Canada are discussed. Since climatic change could bring about adverse effects such as water shortages and loss of permafrost, Canada has committed itself to a quick start toward compliance with preparation of a detailed national inventory of greenhouse gas emissions. The biodiversity convention could make it harder to develop hydropower in Canada at the same time that the climate change convention makes hydropower more attractive. Other documents from the Earth Summit included declarations on forestry management, sustainable development, and future conventions on desertification and fishing. Notable features of the summit included a refocusing of the environmental agenda to the priorities of the poorer countries, a recognition that environmental issues are linked to poverty and economic development, and an attack on the consumption patterns of the richer countries.

  10. Rio report

    International Nuclear Information System (INIS)

    Saxe, D.

    1992-01-01

    At the world-wide Earth Summit held in Rio de Janeiro in 1992, two new legally binding documents were signed by over 140 countries: the Convention on Climate Change and the Convention on Biological Diversity. These conventions will come into force when ratified by 50 and 30 countries respectively. The objectives of these conventions, the steps to be taken toward their compliance, and their implications for Canada are discussed. Since climatic change could bring about adverse effects such as water shortages and loss of permafrost, Canada has committed itself to a quick start toward compliance with preparation of a detailed national inventory of greenhouse gas emissions. The biodiversity convention could make it harder to develop hydropower in Canada at the same time that the climate change convention makes hydropower more attractive. Other documents from the Earth Summit included declarations on forestry management, sustainable development, and future conventions on desertification and fishing. Notable features of the summit included a refocusing of the environmental agenda to the priorities of the poorer countries, a recognition that environmental issues are linked to poverty and economic development, and an attack on the consumption patterns of the richer countries

  11. Fatores de risco para recidiva de peso no pós-operatório tardio de cirurgia bariátrica = Risk factors for weight regain in the late postoperative of bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bardal, Adriane Granato

    2016-01-01

    Conclusões: Nessa amostra, a baixa assiduidade às consultas nutricionais no pré-operatório, bem como a renda familiar elevada foram fatores de risco para recidiva de peso no pós-operatório tardio de cirurgia bariátrica

  12. Addressing Medical Errors in Hand Surgery

    OpenAIRE

    Johnson, Shepard P.; Adkinson, Joshua M.; Chung, Kevin C.

    2014-01-01

    Influential think-tank such as the Institute of Medicine has raised awareness about the implications of medical errors. In response, organizations, medical societies, and institutions have initiated programs to decrease the incidence and effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is...

  13. American Society for Surgery of the Hand

    Science.gov (United States)

    ... Contact Us Mailing List Purchase Permission Requests Our Social Media Channels Policies ASSH Policies Code of Ethics Membership Protocols ASSH Bylaws Exhibitors and Partners Annual Meeting Opportunities Course Opportunities Partnership, Grants and Special Programs Year-Round Opportunities Electives ...

  14. Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Jandir Ferreira Gomes Júnior

    2008-09-01

    Full Text Available OBJETIVO: Avaliar os resultados do tratamento cirúrgico da fibrilação atrial por ablação da parede posterior atrial esquerda utilizando o eletrocautério, em cirurgia valvar mitral. MÉTODOS: De maio de 2004 a dezembro de 2006, 23 pacientes foram submetidos a correção cirúrgica de valvopatia mitral e ao tratamento da fibrilação atrial utilizando o eletrocautério convencional para a realização de linhas de ablação no endocárdio atrial esquerdo. A idade média dos pacientes era de 59 anos, sendo 60,8% do sexo feminino. A média do diâmetro atrial esquerdo era de 50,3 ± 5,09 mm e a fração de ejeção do ventrículo esquerdo de 53,6 ± 11,03%. RESULTADOS: O tempo médio de circulação extracorpórea foi de 52,5 ± 13,3 min; pinçamento aórtico, 35,6 ± 12,9 min; ablação do endocárdio atrial, 3,05 ± 0,16 min. Todos os pacientes estavam livres de fibrilação atrial após o procedimento; na alta hospitalar, 69,5%; no 6º mês, 91,3%; no 12º mês, 76,4%; no 18º e 24º meses, 68,4%. No 12º mês, a média do diâmetro atrial esquerdo era de 42,1 ± 3,5 mm; a fração de ejeção do ventrículo esquerdo era de 59,2 ± 3,48%; e a contração atrial esquerda estava presente em 68,8% de todos os pacientes. CONCLUSÃO: O tratamento cirúrgico da fibrilação atrial com eletrocautério, em cirurgia valvar mitral, foi capaz de determinar a reversão dessa arritmia a um número significativo de pacientes durante um seguimento clínico de curto e médio prazo, sem mortalidade e com baixa morbidade.OBJECTIVE: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior left atrial wall using electrocautery in mitral valve surgery. METHODS: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean

  15. Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica Predictors of infection in post-coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Priscila Ledur

    2011-06-01

    Full Text Available INTRODUÇÃO: Embora a cirurgia de revascularização miocárdica (CRM seja uma boa alternativa terapêutica na doença arterial grave, pode evoluir com complicações, especialmente infecções. OBJETIVOS: Determinar a incidência de infecção no pós-operatório de CRM e seus preditores clínicos em um centro de referência cardiológico brasileiro. MÉTODOS: Estudo de coorte. Foram coletados dados de todos os pacientes submetidos à CRM entre janeiro/2004 e fevereiro/2006, excluindo-se cirurgias de urgência, sem glicemia pré-operatória e com infecção prévia à cirurgia. Análise estatística: teste t-Student, qui quadrado e regressão logística. RESULTADOS: Foram avaliados 717 pacientes, 61,9 ± 11 anos, 67,1% homens, 29,6% com diabetes, dos quais 137 (19,1% desenvolveram infecção (62% respiratória, 25% superficial de ferida operatória, 9,5% urinária, 3,6% profunda de ferida operatória. Diabetes foi mais prevalente naqueles que desenvolveram infecção, assim como maior tempo de permanência do cateter venoso central (79,3 ± 40,5 vs. 61,0 ± 19,3 h, PBACKGROUND: Although coronary artery bypass grafting (CABG is a good alternative therapy in severe arterial disease, it may evolve with complications, especially infections. OBJECTIVES: To determine the incidence of infection in post-CABG and its clinical predictors in a cardiology reference center in Brazil. METHODS: Cohort study. Data were collected from all patients undergoing CABG between January/2004 and February/2006, excluding emergency surgery, absent record of glucose blood levels preoperatively and infection prior to surgery. Statistical analysis: Student's t test, chi square, logistic regression. RESULTS: We evaluated 717 patients, 61.9 ± 11 years old, 67.1% were men, 29.6% with diabetes, of whom 137 (19.1% developed infection (62% respiratory, 25% superficial wound, 9.5% urinary, 3.6% deep wound. Diabetes was more prevalent in those who developed infection, as well as

  16. Deforestation near Rio Branco, Brazil

    Science.gov (United States)

    2001-01-01

    Settlement and deforestation surrounding the Brazilian town of Rio Branco are seen here in the striking 'herring bone' deforestation patterns that cut through the rainforest. Rio Brancois the capital of the Brazilian state of Acre and is situated near the border with northeastern Bolivia. The town is a center for the distribution of goods, including rubber, metals, medicinal plants, Brazil nuts and timber. Colonization projects in the region are supported by farming, logging activities, and extensive cattle ranching. Much of the surrounding terrain is of a poorly-draining clay hardpan soil, and heavy rainfall periodically converts parts of the forested region to swamp.The large overview image was acquired by the Multi-angle Imaging SpectroRadiometer's vertical-viewing (nadir) camera on July 28, 2000, and covers an area of 336 kilometers x 333 kilometers. A plume of smoke is visible north of the Rio Branco road, which roughly parallels the slender, twisting Rio Abuna. Most of the major rivers in the image provide reference points for state or international (Bolivia-Brazil) boundaries, and flow northeast to the Rio Madeira (east of the smoke plume). The border between Acre and the Bolivian department of Pando is marked by the Rio Abuna. Pando's southern boundary with the department of Beni is marked by the Rio Madre de Dios, the large river in the lower half of the image.The two higher-resolution inset images highlight a settled area north of the town of Rio Branco. These nadir views cover an area of 60 kilometers x 67 kilometers, and were acquired eleven months apart during Terra orbits 3251 and 8144. In the later image, more haze is present, possibly due to smoke from fires on that day. Comparing the two images provides a method of measuring the changes and expansion in the area of cleared land. One newly cleared patch is apparent near the middle of the later image, slightly off to the right. This polygon represents an area of about 16 square kilometers, or 4000

  17. Middle Rio Grande Basin Research Report 2008

    Science.gov (United States)

    Deborah M. Finch; Catherine Dold

    2008-01-01

    An ecosystem is rarely static. A natural system composed of plants, animals, and microorganisms interacting with an area's physical factors, an ecosystem is always fluctuating and evolving. But sometimes, often at the hands of humans, ecosystems change too much. Such is the case with many of the ecosystems of the Middle Rio Grande Basin of New Mexico.

  18. Avaliação da preceptoria na residência médica em cirurgia geral, no centro cirúrgico, comparação entre um hospital universitário e um hospital não universitário Assessment of preceptorship in general surgery residency in the operating room, comparison between a teaching hospital and a non teaching hospital

    Directory of Open Access Journals (Sweden)

    Elizabeth Gomes Santos

    2012-12-01

    Full Text Available OBJETIVO: Avaliar e comparar a preceptoria no programa de residência médica em Cirurgia Geral, no centro cirúrgico, em um hospital universitário e em um hospital não universitário, a partir da ótica dos residentes que ingressaram em 2010 e 2011. MÉTODOS: Questionário aplicado aos residentes, modificado de Sarker SK, Vincent C, e Darzi AW e usando-se a escala de Likert para qualificar o ítem pesquisado sobre as atitudes dos preceptores. A comparação da distribuição das respostas entre os dois hospitais foi analisada pelo teste de c² para tendências. RESULTADOS: No hospital universitário foram avaliados 12 preceptores por sete residentes. No hospital não universitário foram 11 preceptores avaliados por 13 residentes. O hospital não universitário apresentou a tendência de resposta discordante e indiferente (DC, D e I maior que o hospital universitário. Só o resultado de uma pergunta apresentou significância estatística. Não houve diferença significativa na comparação das respostas nas demais perguntas entre os dois hospitais. CONCLUSÃO: Os hospitais apresentaram preceptoria semelhante.BACKGROUND: Medical residency is well known as the best training method after graduation. It is a moment when, in addition to receiving technical guidance, residents should also develop attitudes, ethics, and professionalism. In order for that to occur, preceptors should be prepared for their task. OBJECTIVE: To evaluate and compare the preceptorship in the Medical Residency in General Surgery program, in the operating room of a Teaching Hospital (TH and a Non-teaching Hospital (NTH, from the viewpoint of the residents who entered in 2010 and 2011. METHODS: A questionnaire was applied to the residents, adapted from Sarker, Vincent and Darzi, and the Likert scale was used to qualify the survey items on the preceptors' attitudes. RESULTS: At the TH, 12 preceptors were evaluated by 7 residents. One of the residents did not answer the

  19. Clean Hands Count

    Medline Plus

    Full Text Available ... has been rented. This feature is not available right now. Please try again later. Published on May ... 34 How The Clean Hands - Safe Hands System Works - Duration: 3:38. Clean Hands-Safe Hands 5, ...

  20. Correlação entre gasometria atrial direita e índice cardíaco no pós-operatório de cirurgia cardíaca Correlation between right atrial venous blood gasometry and cardiac index in cardiac surgery postoperative period

    Directory of Open Access Journals (Sweden)

    João Jackson Duarte

    2010-06-01

    Full Text Available OBJETIVO: Determinar a confiabilidade em se correlacionar o índice cardíaco com os dados fornecidos pela gasometria do sangue venoso atrial direito em pacientes submetidos à cirurgia cardíaca, durante o período pós-operatório. MÉTODOS: A partir das amostras de sangue arterial e venoso do átrio direito, colhidas no pós-operatório de cirurgia cardíaca, foram determinados os parâmetros de oxigênio do sangue venoso do átrio direito. Estes parâmetros foram então comparados com o índice cardíaco determinado pela termodiluição. RESULTADOS: Houve boa correlação entre a saturação de oxigênio do sangue venoso do átrio direito (SvO2, diferença artério-venosa do conteúdo de oxigênio do sangue colhido no átrio direito e o índice cardíaco aferido pela termodiluição, com boa sensibilidade e especificidade e alto valor preditivo positivo e negativo. A pressão do sangue do átrio direito (PvO2 apresentou baixa sensibilidade na estimativa de baixo débito cardíaco. CONCLUSÃO: No pós-operatório de cirurgia cardíaca, a SvO2e a diferença artério-venosa do conteúdo de oxigênio (C(avO2 apresentaram-se como parâmetros confiáveis correlacionados a baixo débito cardíaco. A PvO2 foi pouco sensível no diagnóstico de baixo débito no pós-operatório de cirurgia cardíaca.OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2 and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2, add to the calculation of artery-venous difference of the oxygen content - radial artery / right atrium (C

  1. The BDS iGMAS RIOS station at Observatório Nacional, Rio de Janeiro

    Science.gov (United States)

    Humberto Andrei, Alexandre; Song, Shuli; Junqueira, Selma; Beauvalet, Laurene

    2016-07-01

    position of the satellites by analyzing the pseudo-ranges obtained by C1W code for GPS, and C7I code for BDS. Using the Allan variation a crucial result is obtained. It is shown that the BDS system can perform at the level of the GPS system, provided equal satellite coverage. On the other hand at the Observatório Nacional it is detected a near constant bias of about 35m between the ranges simultaneously derived from the RIOS (iGMAS) and RJEP (GNSS) stations, no matter the observed satellite, or constellation. Both results are presented and discussed. We also present the current status of the installation of a second BDS iGMAS station, in a northern, equatorial location in Brazil. The operational and scientific perspectives are disclosed.

  2. Alterações metabólicas e digestivas no pós-operatório de cirurgia bariátrica Digestive and metabolic changes in postoperative bariatric surgery

    Directory of Open Access Journals (Sweden)

    Luiz Jóia-Neto

    2010-12-01

    Full Text Available RACIONAL: As alterações na digestão e perdas de nutrientes são aspectos relevantes na redução do peso e na manutenção do estado nutricional do paciente submetido à gastroplastia, mas poucos estudos estão disponíveis na literatura. OBJETIVO: Estudar as alterações sistêmicas decorrentes da redução de peso ao longo do tempo, após o tratamento cirúrgico. MÉTODO: Estudo tipo coorte prospectivo com amostra de 44 indivíduos, obesos mórbidos, operados com derivação gástrica em Y-de-Roux e com anel de silicone. Análises clínicas foram realizados em tempos distintos: período pré-operatório, seis meses após a operação e durante os anos de 2006 e 2007. Os exames efetuados foram: glicemia de jejum; albumina sérica; colesterol total; hemoglobina; gordura fecal; substância redutora nas fezes; sangue oculto nas fezes. Endoscopia digestiva alta também foi realizada para medir o anel em centímetros. Ainda foram estudados o genero, idade, altura, peso, IMC, diabetes, e o tempo após a operação. RESULTADOS: A mediana do peso foi de 141 kg (91 - 216 e o IMC, teve mediana de 49,28 kg/m² (36,3 - 80,31. A anemia se manifestou em oito (18,2% pacientes e 13 (29,5% apresentaram albumina com valores reduzidos. No final do estudo, a média dos meses de seguimento foi de 52,56 + 8,84 meses. O peso médio foi de 86,96 + 15,44 kg e a média do IMC foi de 32,41 + 4,82 kg/m². A pesquisa de gordura fecal foi positiva em 16 pacientes (36,4%, substância redutora positiva nas fezes em um (2,3% paciente e presença de sangue oculto nas fezes foi positiva em 13(29,5% pacientes. O diâmetro interno do anel de silicone apresentou uma média de 0,75 cm + 0,23 cm. CONCLUSÃO: Após a operação ocorreu perda significativa de peso, porém, o IMC ainda se mantinha acima de 35 kg/m² na maioria dos pacientes acompanhados por longo tempo. Houve melhora substancial dos níveis de colesterol e glicemia. O diâmetro do anel não demonstrou associa

  3. Lifelong Learning for the Hand Surgeon.

    Science.gov (United States)

    Adkinson, Joshua M; Chung, Kevin C

    2015-09-01

    Hand surgeons are faced with the impossible task of mastering a rapidly expanding pool of knowledge and surgical techniques. Dedication to lifelong learning is, therefore, an essential component of delivering the best, most up-to-date care for patients. Board certification, participation in continuing medical education and maintenance of certification activities, and attendance at national meetings are essential mechanisms by which hand surgeons may foster the acquisition of essential knowledge and clinical skills, This article highlights the history, current status, and emerging needs in continuing medical education for the hand surgeon. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Coupler for surgery on small animals

    Science.gov (United States)

    Johnson, J. E., Jr.; Swartz, P. F.

    1979-01-01

    Minicoupler simplifies exchange of fluids with organs of laboratory animals enabling one person to perform surgery on experimental animals such as rats and mice. Innovation eliminates obstructing hands and instruments from areas of surgery.

  5. Hand infections: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Tolga Türker

    2014-09-01

    Full Text Available Purpose. Hand infections are common, usually resulting from an untreated injury. In this retrospective study, we report on hand infection cases needing surgical drainage in order to assess patient demographics, causation of infection, clinical course, and clinical management.Methods. Medical records of patients presenting with hand infections, excluding post-surgical infections, treated with incision and debridement over a one-year period were reviewed. Patient demographics; past medical history; infection site(s and causation; intervals between onset of infection, hospital admission, surgical intervention and days of hospitalization; gram stains and cultures; choice of antibiotics; complications; and outcomes were reviewed.Results. Most infections were caused by laceration and the most common site of infection was the palm or dorsum of the hand. Mean length of hospitalization was 6 days. Methicillin-resistant Staphylococcus aureus, beta-hemolytic Streptococcus and methicillin-susceptible Staphylococcus aureus were the most commonly cultured microorganisms. Cephalosporins, clindamycin, amoxicillin/clavulanate, penicillin, vancomycin, and trimethoprim/sulfamethoxazole were major antibiotic choices. Amputations and contracture were the primary complications.Conclusions. Surgery along with medical management were key to treatment and most soft tissue infections resolved without further complications. With prompt and appropriate care, most hand infection patients can achieve full resolution of their infection.

  6. DEVELOPMENT OF PLASTIC SURGERY.

    Science.gov (United States)

    Pećanac, Marija Đ

    2015-01-01

    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  7. Emprego de altas doses de amiodarona via oral na reversão da fibrilação atrial no pós-operatório de cirurgia cardíaca High dose amiodarone for the reversion of atrial fibrillation during the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    João Carlos Vieira da Costa Guaragna

    1997-12-01

    Full Text Available OBJETIVO: Relatar a experiência no emprego de altas doses de amiodarona via oral (1800mg/d na reversão da fibrilação atrial (FA em pacientes submetidos à cirurgia cardíaca. MÉTODOS: Analisados, retrospectivamente, 80 pacientes que apresentaram FA no pós operatório de cirurgia cardíaca, constituindo 2 grupos: grupo A com 28 pacientes em uso de amiodarona e grupo B recebendo digital, sendo que este grupo foi subdividido no grupo C com 21 pacientes onde foi associada amiodarona, quando não houvesse reversão da arritmia em 48h. As diferenças foram consideradas significativas para um valor de PPURPOSE: To report our experience using high dose oral amiodarone (1,800mg/day for the reversion of atrial fibrillation to sinus rhythm in patients submitted to cardiac surgery. METHODS: We retrospectively analyzed the records of 80 patients who had atrial fibrillation during the postoperative period after cardiac surgery, initially divided in two groups: group A, 28 patients that used amiodarone, and group B composed of patients receiving digoxin. The latter group was divided further in a third group (C, with 21 patients in which amiodarone was associated with digoxin if there was no reversion of the arrhythmia after 48 hours of treatment. The observed differences were considered significant at P<0.05. RESULTS: Atrial fibrillation occurred in 19.4% of the patients submitted to surgery, predominating in males, 60 to 69 years-old. In group A there was reversion to sinus rhythm in 78.6% of the cases. In group B digoxin succeeded in 60%, and in group C 90% of the patients reverted to sinus rhythm. CONCLUSION: High dose oral amiodarone, alone or combined to digoxin, can be safe and effective for the treatment of atrial fibrillation after cardiac surgery.

  8. Avaliação das compensações linfáticas no pós-operatório de câncer de mama com dissecção axilar através da linfocintilografia Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection

    Directory of Open Access Journals (Sweden)

    Laura Ferreira de Rezende

    2008-12-01

    Full Text Available O sistema linfático é um componente do corpo humano intimamente relacionado ao sistema venoso. Entretanto, o conhecimento científico a seu respeito é limitado. A etiologia e os fatores de risco para o desenvolvimento do linfedema no pós-operatório de câncer de mama são multifatoriais e ainda não foram completamente esclarecidos. O objetivo desta revisão da literatura foi descrever o padrão linfocintilográfico e avaliar as compensações linfáticas do membro superior no pós-operatório de câncer de mama com dissecção axilar.The lymphatic system is a component of the human body that is closely related to the venous system. However, scientific knowledge of this system is limited. The etiology and risk factors for the development of postoperative lymphedema in patients with breast cancer seem to be multifactorial and have not been fully understood yet. The objective of this review of the literature was to describe lymphoscintigraphic pattern and to evaluate upper limb lymphatic compensation following breast cancer surgery with axillary dissection.

  9. Denmark: HAND in HAND Policy Questionnaire

    DEFF Research Database (Denmark)

    Laursen, Hilmar Dyrborg; Nielsen, Birgitte Lund

    2018-01-01

    Som del af det internationale EU finansierede projekt Hand in Hand, der fokuserer på de såkaldte SEI-kompetencer (Social, Emotional, Intercultural), er dansk policy i relation til elevernes sociale, emotionelle og interkulturelle læring kortlagt i denne rapport. Der refereres bl.a. til "elevernes...

  10. Diagnostic imaging of the hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Hospital for Cardiovascular Diseases, Bad Neustadt an der Saale (Germany). Dept. of Radiology; Lanz, Ulrich [Perlach Hospital, Munich (Germany). Dept. of Hand Surgery

    2008-07-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  11. Diagnostic imaging of the hand

    International Nuclear Information System (INIS)

    Schmitt, Rainer; Lanz, Ulrich

    2008-01-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  12. Management of post burn hand deformities

    Directory of Open Access Journals (Sweden)

    Sabapathy S

    2010-10-01

    Full Text Available The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns. Reconstructive procedures can greatly improve the function of the hands. Appropriate choice of procedures and timing of surgery followed by supervised physiotherapy can be a boon for a burns survivor.

  13. Cancelamento de cirurgias programadas em um hospital-escola: um estudo exploratório La cancelación de cirugías programadas en un hospital-escuela: un estudio exploratorio Cancellation of scheduled surgeries in a university hospital: an exploratory study

    Directory of Open Access Journals (Sweden)

    Jacqueline Borges Cavalcante

    2000-08-01

    Full Text Available Apesar da vasta literatura disponível sobre o preparo do cliente cirúrgico e sobre a realização do ato cirúrgico, o enfoque dado à suspensão deste ato tem sido bastante restrito. Objetiva-se neste estudo identificar o quantitativo de cirurgias programadas e suspensas e os serviços mais afetados por esse acontecimento. O estudo foi realizado nos serviços de cirurgia de um hospital público de ensino, de grande porte, localizado na região metropolitana de Fortaleza, Ceará. Os dados foram levantados através dos livros de registro cirúrgico, mapas diários de programa cirúrgico e dos prontuários de clientes selecionados para serem submetidos à cirurgia no período de setembro a dezembro de 1996. Os dados levantados foram analisados quantitativamente e apresentados em tabelas. Os resultados demonstram que das 1.145 cirurgias programadas no período selecionado, 379 (33% foram suspensas. Os serviços mais prejudicados foram o de Cirurgia Geral, Oftalmologia, Cirurgia de Cabeça e Pescoço, Traumatologia e Ortopedia, Otorrinolaringologia, Nefrologia e Transplante Renal, e o de Proctologia. Faz-se necessário maiores investigações nessa área a fim de se conhecer as causas e/ou motivos que determinaram o cancelamento dessas cirurgias, bem como a participação da enfermagem no estudo dessa problemática.A pesar de la literatura disponible traer un inmenso abordaje en relación con la preparación del cliente para el acto quirúrgico, el enfoque dado a la suspensión de este acto se ha restringido.. Se busca identificar la cantidad de cirugía fijadas y suspendidas y los servicios más afectados por ese evento. El estudio se realizó en los servicios de cirugía de un hospital público de enseñanza, de grande porte, localizados en el área metropolitana de Fortaleza, Ceará. Los datos fueron recogidos a través de los libros de registro quirúrgico, mapas diarios de programa quirúrgico y de las historias clínicas de los clientes

  14. Robotic hand project

    OpenAIRE

    Karaçizmeli, Cengiz; Çakır, Gökçe; Tükel, Dilek

    2014-01-01

    In this work, the mechatronic based robotic hand is controlled by the position data taken from the glove which has flex sensors mounted to capture finger bending of the human hand. The angular movement of human hand’s fingers are perceived and processed by a microcontroller, and the robotic hand is controlled by actuating servo motors. It has seen that robotic hand can simulate the movement of the human hand that put on the glove, during tests have done. This robotic hand can be used not only...

  15. Diagnósticos de enfermagem no perioperatório de cirurgia cardíaca Diagnósticos de enfermería en el perioperatorio de cirugía cardiaca Nursing diagnosis in the perioperative of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Luzia Elaine Galdeano

    2006-03-01

    Full Text Available Foram identificados os diagnósticos de enfermagem de pacientes no período perioperatório de cirurgia cardíaca e verificada a concordância ou não entre a primeira autora e outros enfermeiros na identificação desses diagnósticos. Dezessete pacientes admitidos para cirurgia cardíaca foram avaliados utilizando-se instrumentos para o período perioperatório. No pré-operatório, das nove categorias diagnósticas identificadas pela primeira autora, três apresentaram concordância com os enfermeiros (exemplo: Intolerância à atividade. No trans-operatório, sete categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para infecção. No pós-operatório imediato, 11 categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para disfunção neurovascular periférica.Fueron identificados los diagnósticos de enfermería de pacientes en el periodo peri-operatorio de cirugía cardiaca y verificada la existencia o no de concordancia entre la primera investigadora y otros enfermeros en la identificación de esos diagnósticos. Diecisiete pacientes admitidos para cirugía cardiaca fueron sometidos a evaluación, utilizando un instrumento para cada momento del periodo peri operatorio. En el peri-operatorio, de los diagnósticos identificados por la primera investigadora, tres coincidieron con los enfermeros (ejemplo Intolerancia a la actividad. En el trans-operatorio, siete categorías coincidieron entre los enfermeros y la primera investigadora (ejemplo: Riesgo de infección. En el post-operatorio inmediato, 11 categorías coincidieron entre los enfermeros y la primera investigadora (ejemplo: Riesgo para disfunción neuro-vascular periférica.This study identified the nursing diagnoses of patients in the perioperative period of cardiac surgeries and verified the existence or not of agreement between the first author and other nurses in the identification of these diagnoses

  16. Clean Hands Count

    Medline Plus

    Full Text Available ... to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  17. Clean Hands Count

    Medline Plus

    Full Text Available ... intended to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... also aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  18. Clean Hands Count

    Science.gov (United States)

    ... intended to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... also aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  19. Wash Your Hands

    Science.gov (United States)

    ... hand sanitizers might not remove harmful chemicals like pesticides and heavy metals from hands. Be cautious when ... Health Promotion Materials Fact Sheets Podcasts Posters Stickers Videos Web Features Training & Education Our Partners Publications, Data & ...

  20. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  1. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  2. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  3. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  4. Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

    Directory of Open Access Journals (Sweden)

    Sandra Frankfurt

    2009-07-01

    Full Text Available OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH basal (U/L, entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC foi calculado conforme a fórmula de Quetelet [peso (kg/estatura (cm²]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3, o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed

  5. Hand hygiene strategies

    OpenAIRE

    Yazaji, Eskandar Alex

    2011-01-01

    Hand hygiene is one of the major players in preventing healthcare associated infections. However, healthcare workers compliance with hand hygiene continues to be a challenge. This article will address strategies to help improving hand hygiene compliance. Keywords: hand hygiene; healthcare associated infections; multidisciplinary program; system change; accountability; education; feedback(Published: 18 July 2011)Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1: 72...

  6. Guideline Implementation: Hand Hygiene.

    Science.gov (United States)

    Goldberg, Judith L

    2017-02-01

    Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Robotic hand and fingers

    Science.gov (United States)

    Salisbury, Curt Michael; Dullea, Kevin J.

    2017-06-06

    Technologies pertaining to a robotic hand are described herein. The robotic hand includes one or more fingers releasably attached to a robotic hand frame. The fingers can abduct and adduct as well as flex and tense. The fingers are releasably attached to the frame by magnets that allow for the fingers to detach from the frame when excess force is applied to the fingers.

  8. Proposta de escore de risco pré-operatório para pacientes candidatos à cirurgia cardíaca valvar Propuesta de escore de riesgo preoperatorio para pacientes candidatos a cirugía cardiaca valvular Proposed preoperative risk score for patients candidate to cardiac valve surgery

    Directory of Open Access Journals (Sweden)

    João Carlos Vieira da Costa Guaragna

    2010-04-01

    para mortalidad hospitalaria para los pacientes candidatos a cirugía en el Hospital São Lucas de la Pontificia Universidad Católica del Rio Grande do Sul (HSL-PUCRS. MÉTODOS: La muestra del estudio incluyó 1.086 pacientes adultos a los que se realizó cirugía cardiaca valvular entre enero de 1996 y diciembre de 2007 en el HSL-PUCRS. Para identificar factores de riesgo y mortalidad hospitalaria se utilizó regresión logística. El modelo fue desarrollado en 699 pacientes y se probó su desempeño en los datos restantes (n = 387. El modelo final fue creado con el análisis de la muestra total (n = 1.086. RESULTADOS: La mortalidad global fue del 11,8%: un 8,8% de casos electivos y un 63,8% de cirugía de emergencia. En el análisis multivariado, 9 variables permanecieron como predictores independientes para el desenlace: edad avanzada, prioridad quirúrgica, sexo femenino, fracción de eyección 2,5 mg/dl o diálisis. El área bajo la curva ROC fue 0,83 (IC: 95%,0,78-0,86. El modelo de riesgo mostró buena habilidad para mortalidad observada/prevista: el test Hosmer-Lemeshow fue x² = 5,61; p = 0,691 y r = 0,98 (coeficiente de Pearson. CONCLUSIÓN: Las variables predictoras de mortalidad hospitalaria permitieron construir un escore de riesgo simplificado para la práctica diaria, que clasifica al paciente en bajo, medio, elevado, muy elevado y extremadamente elevado riesgo preoperatorio.BACKGROUND: To establish a risk score for heart surgery allows the assessment of preoperative risk, informing the patient and defining care during the intervention. OBJECTIVE: To assess preoperative risk factors for death in cardiac valve surgery and construct a simple risk model (score for in-hospital mortality of patients candidate to surgery at Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS. METHODS: The study sample included 1,086 adult patients that underwent cardiac valve surgery between January 1996 and December 2007 at HSL

  9. Comparative study of presurgical hand hygiene with hydroalcoholic solution versus traditional presurgical hand hygiene.

    Science.gov (United States)

    López Martín, M Beatriz; Erice Calvo-Sotelo, Alejo

    To compare presurgical hand hygiene with hydroalcoholic solution following the WHO protocol with traditional presurgical hand hygiene. Cultures of the hands of surgeons and surgical nurses were performed before and after presurgical hand hygiene and after removing gloves at the end of surgery. Cultures were done in 2different days: the first day after traditional presurgical hand hygiene, and the second day after presurgical hand hygiene with hydroalcoholic solution following the WHO protocol. The duration of the traditional hand hygiene was measured and compared with the duration (3min) of the WHO protocol. The cost of the products used in the traditional technique was compared with the cost of the hydroalcoholic solution used. The variability of the traditional technique was determined by observation. Following presurgical hand hygiene with hydroalcoholic solution, colony-forming units (CFU) were detected in 5 (7.3%) subjects, whereas after traditional presurgical hand hygiene CFU were detected in 14 subjects (20.5%) (p < 0.05). After glove removal, the numbers of CFU were similar. The time employed in hand hygiene with hydroalcoholic solution (3min) was inferior to the time employed in the traditional technique (p < 0.05), its cost was less than half, and there was no variability. Compared with other techniques, presurgical hand hygiene with hydroalcoholic solution significantly decreases CFU, has similar latency time, a lower cost, and saves time. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  10. Hand dominance in orthopaedic surgeons.

    LENUS (Irish Health Repository)

    Lui, Darren F

    2012-08-01

    Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

  11. Avoiding unfavorable results in postburn contracture hand

    Science.gov (United States)

    Bhattacharya, Sameek

    2013-01-01

    Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation. PMID:24501479

  12. Avaliação da função renal em pacientes no pós-operatório de cirurgia cardíaca: a classificação AKIN prediz disfunção renal aguda? Evaluation of the renal function in patients in the postoperative period of cardiac surgery: does AKIN classification predict acute kidney dysfunction?

    Directory of Open Access Journals (Sweden)

    Marcia Cristina da Silva Magro

    2009-03-01

    Full Text Available OBJETIVOS: Identificar a freqüência de lesão renal aguda e comparar a aplicação da classificação AKIN com o uso isolado da creatinina sérica no pós-operatório de cirurgia cardíaca. MÉTODOS: Este estudo foi desenvolvido prospectivamente em um hospital de ensino e pesquisa especializado em cardiologia da rede pública do estado de São Paulo. Foram acompanhados 44 pacientes submetidos à cirurgia cardíaca eletiva, desde o pós-operatório imediato até o 2º pós-operatório. RESULTADOS: Constatou-se que dos 44 pacientes, 75% eram hipertensos, 27% diabéticos e eram majoritariamente do sexo masculino (64%, com média de idade de 55±16 anos. Observou-se que a idade avançada e o índice de massa corpórea elevado apresentaram correlação significativa para disfunção renal (pOBJECTIVES: To identify the frequency of the Acute Kidney Injury and to compare the application of the AKIN classification with the separate use of the serum creatinine in the postoperative period of cardiac surgery. METHODS: This study was prospectively developed in a teaching and specialized research hospital in cardiology of the public health system of the state of São Paulo. Forty-four patients submitted to the elective cardiac surgery since the immediate post-surgical period up to the 2nd post-surgical period were followed. RESULTS: It was possible to verify that from the forty-four patients, 75% were hypertensive, 27% were diabetic and mostly were male (64%, with an average age of 55+16 years old. It was observed that advanced age and the elevated body mass index shows a significant correlation to renal dysfunction (p<0, 05. According to the AKIN classification, the urinary flow criterion identified more renal dysfunction than creatinine criterion. It was verified that the renal dysfunction occurred more frequently in the postsurgery period and the majority (82% from the 63,6% of the patients which were submitted to the revascularization of the myocardium

  13. Diagnósticos de enfermagem de pacientes no período pré-operatório de cirurgia cardíaca Diagnósticos de enfermería de pacientes en el periodo pre operatorio de cirurgía cardiaca Nursing diagnosis of patients in the preoperatory period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Luzia Elaine Galdeano

    2004-09-01

    Full Text Available O objetivo deste estudo foi identificar os diagnósticos de enfermagem de pacientes no período pré-operatório de cirurgia cardíaca. Para a coleta de dados foi elaborado e validado um instrumento de baseado no Modelo Conceitual de Horta. Foram avaliados 17 pacientes adultos no período pré-operatório de cirurgia cardíaca, sendo nove homens e oito mulheres, com idade média de 58 anos. Os diagnósticos de enfermagem identificados, segundo a Taxonomia I da NANDA, com freqüência superior a 50,0% foram: Intolerância à atividade (88,2%, Risco para infecção (76,5%, Risco para disfunção neurovascular periférica (76,5%, Déficit de conhecimento (76,5%, Perfusão tissular cardiopulmonar alterada (70,6%, Padrão respiratório ineficaz (70,6%, Dor (70,6%, Padrões de sexualidade alterados (58,8% e Distúrbio no padrão de sono (52,9%. Observou-se uma predominância dos diagnósticos relacionados às necessidades psicobiológicas.El objetivo de este estudio fué identificar los diagnósticos de enfermería en pacientes de cirugía cardiaca en el periodo pre operatorio. Para la colecta de datos fué elaborado y validado un instrumento basado en el modelo conceptual de Horta (1979. Fueron evaluados 17 pacientes adultos de cirugía cardiaca en el periodo pre operatorio, de los cuales nueve hombres y ocho mujeres, con una edad media de 58 años. Los diagnósticos de enfermería, identificados según Taxonomia I de la NANDA con frecuencia superior a 50,0% fueron: Intolerancia a la actividad (88,2%, Riesgo a infección (76,5%, Riesgo a disfunción neurovascular periférica (76,5%, Déficit de conocimiento (76,5%, Perfusión tisular cardiopulmonar alterada (70,6%, Padrón respiratorio ineficaz (70,6%, Dolor (70,6%, Patrones de sexualidad alterados (58,8% y Disturbio en el patrón del sueño (52,9%. Observamos predominio de los diagnósticos relacionados con las necesidades psicobiológicas.The purpose of this study was to identify nursing diagnosis

  14. Hand1 overexpression inhibits medulloblastoma metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Asuthkar, Swapna; Guda, Maheedhara R. [Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Martin, Sarah E. [Department of Pathology, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Antony, Reuben; Fernandez, Karen [Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Lin, Julian [Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Tsung, Andrew J. [Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Illinois Neurological Institute, Peoria, IL 61656 (United States); Velpula, Kiran K., E-mail: velpula@uic.edu [Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States); Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61656 (United States)

    2016-08-19

    Medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current treatment includes surgery, radiation and chemotherapy. However, ongoing treatment in patients is further classified according to the presence or absence of metastasis. Since metastatic medulloblastoma are refractory to current treatments, there is need to identify novel biomarkers that could be used to reduce metastatic potential, and more importantly be targeted therapeutically. Previously, we showed that ionizing radiation-induced uPAR overexpression is associated with increased accumulation of β-catenin in the nucleus. We further demonstrated that uPAR protein act as cytoplasmic sequestration factor for a novel basic helix-loop-helix transcription factor, Hand1. Among the histological subtypes classical and desmoplastic subtypes account for the majority while large cell/anaplastic variant is most commonly associated with metastatic disease. In this present study using immunohistochemical approach and patient data mining for the first time, we demonstrated that Hand1 expression is observed to be downregulated in all the subtypes of medulloblastoma. Previously we showed that Hand1 overexpression regulated medulloblastoma angiogenesis and here we investigated the role of Hand1 in the context of Epithelial-Mesenchymal Transition (EMT). Moreover, UW228 and D283 cells overexpressing Hand1 demonstrated decreased-expression of mesenchymal markers (N-cadherin, β-catenin and SOX2); metastatic marker (SMA); and increased expression of epithelial marker (E-cadherin). Strikingly, human pluripotent stem cell antibody array showed that Hand1 overexpression resulted in substantial decrease in pluripotency markers (Nanog, Oct3/4, Otx2, Flk1) suggesting that Hand1 expression may be essential to attenuate the EMT and our findings underscore a novel role for Hand1 in medulloblastoma metastasis. - Highlights: • Hand1 expression is downregulated in Medulloblastoma. • Hand1 over expression reduce

  15. Hand1 overexpression inhibits medulloblastoma metastasis

    International Nuclear Information System (INIS)

    Asuthkar, Swapna; Guda, Maheedhara R.; Martin, Sarah E.; Antony, Reuben; Fernandez, Karen; Lin, Julian; Tsung, Andrew J.; Velpula, Kiran K.

    2016-01-01

    Medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current treatment includes surgery, radiation and chemotherapy. However, ongoing treatment in patients is further classified according to the presence or absence of metastasis. Since metastatic medulloblastoma are refractory to current treatments, there is need to identify novel biomarkers that could be used to reduce metastatic potential, and more importantly be targeted therapeutically. Previously, we showed that ionizing radiation-induced uPAR overexpression is associated with increased accumulation of β-catenin in the nucleus. We further demonstrated that uPAR protein act as cytoplasmic sequestration factor for a novel basic helix-loop-helix transcription factor, Hand1. Among the histological subtypes classical and desmoplastic subtypes account for the majority while large cell/anaplastic variant is most commonly associated with metastatic disease. In this present study using immunohistochemical approach and patient data mining for the first time, we demonstrated that Hand1 expression is observed to be downregulated in all the subtypes of medulloblastoma. Previously we showed that Hand1 overexpression regulated medulloblastoma angiogenesis and here we investigated the role of Hand1 in the context of Epithelial-Mesenchymal Transition (EMT). Moreover, UW228 and D283 cells overexpressing Hand1 demonstrated decreased-expression of mesenchymal markers (N-cadherin, β-catenin and SOX2); metastatic marker (SMA); and increased expression of epithelial marker (E-cadherin). Strikingly, human pluripotent stem cell antibody array showed that Hand1 overexpression resulted in substantial decrease in pluripotency markers (Nanog, Oct3/4, Otx2, Flk1) suggesting that Hand1 expression may be essential to attenuate the EMT and our findings underscore a novel role for Hand1 in medulloblastoma metastasis. - Highlights: • Hand1 expression is downregulated in Medulloblastoma. • Hand1 over expression reduce

  16. Bloqueio atrioventricular no pós-operatório de cirurgia cardíaca valvar: incidência, fatores de risco e evolução hospitalar Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution

    Directory of Open Access Journals (Sweden)

    Andres Di Leoni Ferrari

    2011-09-01

    Full Text Available INTRODUÇÃO: Distúrbios do sistema de condução cardíaco são complicações potenciais e conhecidas dos procedimentos de cirurgia cardíaca valvar. OBJETIVOS: Investigar a associação entre fatores peri-operatórios com bloqueio atrioventricular (BAV e a necessidade de estimulação cardíaca artificial temporária (ECAT e, se necessário, implante de marcapasso definitivo no pós-operatório de cirurgia cardíaca (POCC valvar. MÉTODOS: Coorte histórica de pacientes submetidos a cirurgia cardíaca valvar, sendo realizada análise de banco de dados por regressão logística. RESULTADOS: No período de janeiro de 1996 a dezembro de 2008, foram realizadas 1102 cirurgias cardíacas valvares: 718 (65,2% na valva aórtica e 407 (36,9% na valva mitral; destas, 190 (17,2% cirurgias de revascularização miocárdica associadas à cirurgia valvar e 23 (2,1% cirurgias valvares combinadas (aórtica+mitral. Cento e oitenta e sete (17% pacientes apresentaram quadro clínico e eletrocardiográfico de BAV durante o POCC valvar, necessitando de ECAT. Quatorze (7,5% pacientes evoluíram para implante de marcapasso definitivo (1,27% do total da amostra. A análise multivariada evidenciou associação significativa de BAV com cirurgia de valva mitral (OR=1,76; IC 95% 1,08-2,37; P=0,002, implante de prótese biológica (OR=1,59; IC 95% 1,02-3,91; P= 0,039, idade maior que 60 anos (OR = 1,99; IC 95% 1,35-2,85; PINTRODUCTION: Disturbances of the cardiac conduction system are potential complications after cardiac valve surgery. OBJECTIVES: This study was designed to investigate the association between perioperative factors and atrio-ventricular block, the need for temporary cardiac artificial pacing and, if necessary, permanent pacemaker implantation after cardiac valve surgery. METHODS: Retrospective analysis of the Cardiac Surgery Database - Hospital São Lucas/PUCRS. The data are collected prospectively and analyzed retrospectively. RESULTS: Between January

  17. Hand eczema classification

    DEFF Research Database (Denmark)

    Diepgen, T L; Andersen, Klaus Ejner; Brandao, F M

    2008-01-01

    of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system...... A classification system for hand eczema is proposed. Conclusions It is suggested that this classification be used in clinical work and in clinical trials....

  18. Coordination of hand shape.

    Science.gov (United States)

    Pesyna, Colin; Pundi, Krishna; Flanders, Martha

    2011-03-09

    The neural control of hand movement involves coordination of the sensory, motor, and memory systems. Recent studies have documented the motor coordinates for hand shape, but less is known about the corresponding patterns of somatosensory activity. To initiate this line of investigation, the present study characterized the sense of hand shape by evaluating the influence of differences in the amount of grasping or twisting force, and differences in forearm orientation. Human subjects were asked to use the left hand to report the perceived shape of the right hand. In the first experiment, six commonly grasped items were arranged on the table in front of the subject: bottle, doorknob, egg, notebook, carton, and pan. With eyes closed, subjects used the right hand to lightly touch, forcefully support, or imagine holding each object, while 15 joint angles were measured in each hand with a pair of wired gloves. The forces introduced by supporting or twisting did not influence the perceptual report of hand shape, but for most objects, the report was distorted in a consistent manner by differences in forearm orientation. Subjects appeared to adjust the intrinsic joint angles of the left hand, as well as the left wrist posture, so as to maintain the imagined object in its proper spatial orientation. In a second experiment, this result was largely replicated with unfamiliar objects. Thus, somatosensory and motor information appear to be coordinated in an object-based, spatial-coordinate system, sensitive to orientation relative to gravitational forces, but invariant to grasp forcefulness.

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  20. RIO Country Report 2015

    DEFF Research Database (Denmark)

    Grimpe, Christoph; Mitchell, Jessica

    The 2015 series of RIO Country Reports analyse and assess the policy and the national research and innovation system developments in relation to national policy priorities and the EU policy agenda with special focus on ERA and Innovation Union. The executive summaries of these reports put forward...

  1. TREATMENT OF FRACTURES TO THE HAND

    Directory of Open Access Journals (Sweden)

    Valentina Colombo

    2012-03-01

    Full Text Available The aim of this article is to discuss the treatment of fractures to the hand given the importance of this organ in terms of functional anatomy. After classifying the various types of fractures, surgery and rehabilitation options for all types are discussed. Particular emphasis is placed on therapy for the most frequently seen lesions such as fractures to the scaphoid, the fifth metacarpal and the base of the first metacarpal. The importance of the use of prophylaxis against stiffness and treatment for oedema, which are commonly seen in fractures to the hand, is also highlighted.

  2. Clean Hands Count

    Medline Plus

    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ... 089,212 views 4:50 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,032 views ...

  3. Mind the hand

    DEFF Research Database (Denmark)

    Davidsen, Jacob; Christiansen, Ellen Tove

    2014-01-01

    Apart from touching the screen, what is the role of the hands for children collaborating around touchscreens? Based on embodied and multimodal interaction analysis of 8- and 9-year old pairs collaborating around touchscreens, we conclude that children use their hands to constrain and control acce...

  4. Clean Hands Count

    Medline Plus

    Full Text Available ... 024 views 2:58 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 2,805 views 3:13 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,574 views ...

  5. HAND INJURIES IN VOLLEYBALL

    NARCIS (Netherlands)

    BHAIRO, NH; NIJSTEN, MWN; VANDALEN, KC; TENDUIS, HJ

    We studied the long-term sequelae of hand injuries as a result of playing volleyball. In a retrospective study, 226 patients with injuries of the hand who were seen over a 5-year period at our Trauma Department, were investigated. Females accounted for 66 % of all injuries. The mean age was 26

  6. Clean Hands Count

    Medline Plus

    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,760 ... 536,963 views 1:46 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,574 views ...

  7. Clean Hands Count

    Medline Plus

    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 74,478 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,292 views 5:46 Hand Washing Technique - ...

  8. Clean Hands Count

    Medline Plus

    Full Text Available ... 029 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 081,511 views 4:50 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,194 views ...

  9. Clean Hands Count

    Medline Plus

    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 75,362 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 views 5:46 Hand Washing Technique - ...

  10. Clean Hands Count

    Medline Plus

    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ... 086,746 views 4:50 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,802 views ...

  11. Clean Hands Count

    Medline Plus

    Full Text Available ... 453 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 ... 28,656 views 3:40 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,480 views ...

  12. Clean Hands Count

    Medline Plus

    Full Text Available ... 362 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 219,427 views 1:27 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,194 views ...

  13. Clean Hands Count

    Medline Plus

    Full Text Available ... 03. R Mayer 371,490 views 4:03 The psychological trick behind getting people to say yes - Duration: 8:06. PBS NewsHour 606,671 views 8:06 Should You Really Wash Your Hands? - Duration: 4:51. Gross Science 57,828 views 4:51 Healthcare Worker Hand ...

  14. Clean Hands Count

    Medline Plus

    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ... 28,656 views 3:40 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,032 views ...

  15. Clean Hands Count

    Medline Plus

    Full Text Available ... 5 Moments of Hand Hygiene - Duration: 1:53. Salem Health 13,972 views 1:53 Hand Hygiene ... Mode: Off History Help Loading... Loading... Loading... About Press Copyright Creators Advertise Developers +YouTube Terms Privacy Policy & ...

  16. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-01-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  17. "Puffy hand syndrome".

    Science.gov (United States)

    Chouk, Mickaël; Vidon, Claire; Deveza, Elise; Verhoeven, Frank; Pelletier, Fabien; Prati, Clément; Wendling, Daniel

    2017-01-01

    Intravenous drug addiction is responsible for many complications, especially cutaneous and infectious. There is a syndrome, rarely observed in rheumatology, resulting in "puffy hands": the puffy hand syndrome. We report two cases of this condition from our rheumatologic consultation. Our two patients had intravenous drug addiction. They presented with an edema of the hands, bilateral, painless, no pitting, occurring in one of our patient during heroin intoxication, and in the other 2 years after stopping injections. In our two patients, additional investigations (biological, radiological, ultrasound) were unremarkable, which helped us, in the context, to put the diagnosis of puffy hand syndrome. The pathophysiology, still unclear, is based in part on a lymphatic toxicity of drugs and their excipients. There is no etiological treatment but elastic compression by night has improved edema of the hands in one of our patients. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  18. Hipotermia no período intra-operatório em pacientes submetidos a cirurgias eletivas La hipotermia en el período intraoperatorio en pacientes sometidos a cirugías electivas Intraoperative hypothermia in patients undergoing elective surgery

    Directory of Open Access Journals (Sweden)

    Vanessa de Brito Poveda

    2009-01-01

    Full Text Available OBJETIVO: Analisar a temperatura corporal do paciente submetido a cirurgia eletiva no período intra-operatório. MÉTODOS: Para a coleta de dados elaborou-se um instrumento que foi submetido à validação aparente e de conteúdo e a amostra foi constituída de 70 pacientes. As variáveis mensuradas foram: temperatura e umidade da sala de cirurgia e temperatura corporal do paciente em diferentes momentos do período intra-operatório. RESULTADOS: Em relação à temperatura corporal dos pacientes observou-se que no final do procedimento anestésico-cirúrgico a média foi de 33,6º C. A temperatura média da sala na chegada dos pacientes foi de 24,6º C e na quarta hora de procedimento anestésico-cirúrgico foi de 22,4ºC. Houve correlação estatisticamente significante e positiva entre as variáveis mensuradas. CONCLUSÃO: Os resultados apontaram a necessidade de implementação de intervenções efetivas para a prevenção da hipotermia e, neste cenário, a atuação do enfermeiro é crucial para a melhoria da assistência prestada ao paciente cirúrgico.OBJETIVO: Analizar la temperatura corporal del paciente sometido a cirugía electiva en el período intra-operatorio. MÉTODOS: Para la recolección de datos se elaboró un instrumento que fue sometido a la validación aparente y de contenido. La muestra estuvo constituida por 70 pacientes. Las variables mensuradas fueron: temperatura y humedad de la sala de cirugía y temperatura corporal del paciente en diferentes momentos del período intra-operatorio. RESULTADOS: En relación a la temperatura corporal de los pacientes se observó que al final del procedimiento anestésico-quirúrgico el promedio fue de 33,6º C. La temperatura promedio de la sala a la llegada de los pacientes fue de 24,6º C y en la cuarta hora de procedimiento anestésico-quirúrgico fue de 22,4ºC. Hubo correlación estadísticamente significativa positiva entre las variables mensuradas. CONCLUSIÓN: Los resultados

  19. Preditores de falha da extubação em crianças no pós-operatório de cirurgia cardíaca submetidas à ventilação pulmonar mecânica Post cardiac surgery In children: extubation failure predictor's

    Directory of Open Access Journals (Sweden)

    Cíntia Johnston

    2008-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: É importante conhecer os fatores de risco para falha da extubação em crianças no pós-operatório cardíaco (POC, para evitar os efeitos indesejados inerentes ao procedimento de re-intubação (lesão da via aérea, necessidade de medicações, alterações cardiocirculatórias e ao tempo prolongado de suporte ventilatório (risco de pneumonias, perda da força muscular ventilatória. O objetivo deste estudo foi avaliar os parâmetros da ventilação pulmonar mecânica (VPM, a mecânica ventilatória [índice de respiração rápida superficial (IRS, força dos músculos ventilatórios (PiMáx e PeMáx, relação carga/força (RCF] e os gases sanguíneos antes e após a extubação de crianças no POC. MÉTODO: Estudo observacional, do tipo transversal prospectivo, realizado no período de março 2004 a março 2006, incluindo crianças no POC aptas para a extubação traqueal, em hospital universitário. Com o tubo traqueal in situ e em ventilação espontânea foram mensurados o volume-minuto expiratório (V E, a PiMáx e PeMáx. Foram calculados os índices ventilatórios IRS [(FR/VC/Peso] e RCF = [15x[(3xMAP/PiMáx]+0,03 x IRS -5], a pressão média das vias aéreas [MAP={(PIP-PEEPx[Ti/(Te+Ti]}+PEEP] e o índice de oxigenação [IO=(FiO2 x MAP/PaO2x100]. Os gases sanguíneos foram coletados 1h antes da extubação. O sucesso da extubação foi considerado quando após 48h não houve re-intubação. RESULTADOS: Participaram do estudo 59 crianças. Houve falha na extubação em 19% (11/59, mediana (IC25% e 75%: idade 36 (12-82 meses, peso 12 (8-20 kg, MAP 8 (6-9 e IO 2(2-5, tempo de VPM no POC 1(1-3 dias. A falha versus sucesso da extubação em mediana (IC 25% e 75%: IO [5(3-8 versus 2(2-4; p = 0,005], RCF [8(6-11 versus 5(4-6; p = 0,002] e tempo de VPM [3(2-5 versus 1(1-2 dias; p = 0,026]; média ± desvio-padrão: V E [1,7 ± 0,82 versus 3 ± 2,7 mL/kg/min; p = 0,003], PaO2 [64 ± 34 versus 111 ± 50 mmHg; p

  20. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  1. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  2. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  3. O cuidado de enfermagem no pós-operatório de cirurgia cardíaca: um estudo de caso El cuidado de enfermería en el postoperatorio de cirugía cardiaca: un estudio de caso. The nursing care after cardiac surgery: a case study

    Directory of Open Access Journals (Sweden)

    Sabrina da Costa Machado Duarte

    2012-12-01

    información sobre la atención que envuelve los pacientes, familiares y el personal de enfermería.The aim of this study was to describe the needs of patients after cardiac surgery identified by the nurses and discuss nursing care based on these findings. A descriptive, exploratory qualitative approach was developed at the cardiac intensive care unit of the Hospital Federal dos Servidores do Estado do Rio de Janeiro. Data collection occurred in 2008, using interview and participant observation techniques and data analysis followed content analysis procedure. Findings show a nursing care compromised with technical care and procedures but devoid the interaction with the patient itself and their family. As conclusion we suggest the adoption of the nursing process as methodology of work to improve quality and contributing to enrich information about patient's care, their family and the nursing team.

  4. Perfil dos microrganismos isolados no trato urinário após sondagem vesical em cirurgia ginecológica Profile of microorganisms found in urocultures after urinary catheterization in patients undergoing elective gynecological surgery

    Directory of Open Access Journals (Sweden)

    Sônia Cristina Hinrichsen

    2009-03-01

    Full Text Available OBJETIVOS: determinar os microrganismosfreqüentemente encontrados nas uroculturas apóssondagem vesical e o perfil de sensibilidade aos antibióticos em mulheres submetidas a cirurgia ginecológica eletiva. MÉTODOS: estudo de corte transversal em mulheres submetidas a cirurgia ginecológica com sondagem vesical, no Instituto de Medicina Integral Professor Fernando Figueira (IMIP, em Recife, Pernambuco, Brasil, de janeiro a maio de 2007. As uroculturas foram coletadas em dois períodos: até 24h da retirada do cateter e após sete/10 dias. RESULTADOS: amostras de urina foram colhidas em 249 mulheres. Encontrouse 23,6% (n=46 de uroculturas positivas com até 24h da retirada da sonda e 11,1% (n=25 com sete/10 dias após sondagem vesical. Não foi observada diferença significativa em relação aos microrganismos, quando se compararamas duas uroculturas. A Klebsiella spp. foi o principal microrganismo em ambas uroculturas (até 24h=47,8% vs sete/10 dias=44,0%; p=0,76, seguido de Escherichia coli e outros Gram-negativos. Os antibióticos amicacina, cefepima, ciprofloxacina, meropenem e ticarcilina-clavulanato foram os que apresentaram sensibilidade igual ou superior a 75%para os principais microrganismos isolados. CONCLUSÕES: Klebsiella spp. foi o microrganismo mais encontrado nas uroculturas após sondagem vesical em cirurgias ginecológicas e o antibiótico com sensibilidade igual ou maior a 95% com via de administração oral foi a ciprofloxacina.OBJECTIVES: to determine the microorganisms mostfrequently found in urocultures after urinary catheterization and their antibiotic sensitivities in women undergoing elective gynecological surgery. METHODS: the study was carried out at theInstituto de Medicina Integral Professor FernandoFigueira, IMIP, in Recife, Pernambuco, Brazil, between January and May 2007. Urine cultures wereobtained from these patients on two occasions subsequent to the removal of the catheter: within the first 24h and 710 days

  5. Peculiaridades no pós-operatório de cirurgia cardíaca no paciente idoso Peculiaridades en el post operatorio de cirugía cardíaca en el paciente de edad avanzada Peculiarities of post-cardiac surgery care in elderly patients

    Directory of Open Access Journals (Sweden)

    Paulo de Oliveira Vasconcelos Filho

    2004-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O paciente idoso tem características fisiológicas próprias e, muitas vezes, pode apresentar deficiências orgânicas ou afecções graves, que por si, já tornam o pós-operatório complicado. O objetivo deste artigo é apresentar uma revisão das condutas pós-operatórias de cirurgia cardíaca no idoso, apresentando as alterações mais freqüentes nesse tipo de paciente. CONTEÚDO: As condutas no período intra-operatório do paciente idoso devem ser tomadas tendo em vista a diminuição da morbidade pós-operatória. Na chegada do paciente idoso à UTI, devem ser cumpridos os mesmos critérios utilizados na internação de outros pacientes adultos de cirurgia cardíaca, para o serviço ter sempre um padrão, que não leve a uma alteração na rotina e que não provoque equívocos. Estabelecer um plano de cuidados intensivos para o pós-operatório de cirurgia cardíaca irá resultar em uma ótima utilização de recursos da unidade, em efetividade de atenção e em diminuição do tempo nos cuidados em relação ao paciente idoso. Os exames auxiliares solicitados também devem seguir um padrão, estabelecido pelo serviço, a não ser que alterações sejam identificadas. Complicações neurológicas, pulmonares, circulatórias, insuficiência renal, infecção e hipotireoidismo são freqüentes, com particularidades no idoso. Elas estão delineadas neste artigo e devem ser bem compreendidas pelo intensivista que cuida desse tipo de paciente. CONCLUSÕES: As complicações apresentadas neste artigo são as que trazem maior preocupação ao intensivista, quando há um paciente idoso em pós-operatório de cirurgia cardíaca na UTI. Este paciente necessita de cuidados especiais, mesmo quando a cirurgia transcorre em perfeita normalidade, pois o estresse cirúrgico é muito grande e o idoso tem reserva funcional diminuída.JUSTIFICATIVA Y OBJETIVOS: El paciente de edad avanzada tiene características fisiol

  6. (In)Visible Hand(s)

    OpenAIRE

    Predrag Zima

    2007-01-01

    In this paper, the author discusses the regulatory role of the state and legal norms, in market economy, especially in so-called transition countries. Legal policy, and other questions of the state and free market economy are here closely connected, because the state must ensure with legal norms that economic processes are not interrupted: only the state can establish the legal basis for a market economy. The free market’s invisible hand is acting in questions such as: what is to be produced,...

  7. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  8. Prevention of hand eczema

    DEFF Research Database (Denmark)

    Fisker, Maja H; Ebbehøj, Niels E; Vejlstrup, Søren Grove

    2018-01-01

    Objective Occupational hand eczema has adverse health and socioeconomic impacts for the afflicted individuals and society. Prevention and treatment strategies are needed. This study aimed to assess the effectiveness of an educational intervention on sickness absence, quality of life and severity...... of hand eczema. Methods PREVEX (PreVention of EXema) is an individually randomized, parallel-group superiority trial investigating the pros and cons of one-time, 2-hour, group-based education in skin-protective behavior versus treatment as usual among patients with newly notified occupational hand eczema...

  9. Diagnósticos de enfermagem em pacientes no período pós-operatório de cirurgias cardíacas Diagnósticos de enfermería en pacientes en el período postoperatorio de cirugías cardíacas Nursing diagnoses in patients in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Flávia Lamberti Pivoto

    2010-10-01

    Full Text Available OBJETIVO: Identificar, em conjunto com enfermeiras de uma Unidade de Tratamento Intensivo Pós-Operatória Cardiológica, diagnósticos de enfermagem presentes em pacientes no período pós-operatório de cirurgias cardíacas, com vistas à futura implementação do processo de enfermagem nessa unidade. MÉTODOS: Trata-se de um estudo qualitativo, ancorado na pesquisa convergente-assistencial. Os dados foram obtidos, nos registros de enfermagem de 20 pacientes submetidos à cirurgia cardíaca, no mês de abril de 2008, acrescidos da experiência profissional de seis enfermeiras participantes do grupo de convergência reunido durante cinco encontros. RESULTADOS: Foram estabelecidos 15 diagnósticos, segundo a Taxonomia II da North American Nursing Diagnosis Association, corroborados por outros autores. CONCLUSÃO: Identificar diagnósticos de enfermagem comuns em pacientes no pós-operatório de cirurgias cardíacas permite um direcionamento da assistência de enfermagem e subsidia o estabelecimento de intervenções fundamentadas e adequadas às necessidades individuais apresentadas por esses pacientes.OBJETIVO: Identificar en conjunto con las enfermeras, de una Unidad de Tratamiento Intensivo Postoperatorio Cardiológico, los diagnósticos de enfermería realizados en pacientes en el período postoperatorio de cirugías cardíacas, con la finalidad de, futuramente, implementar el proceso de enfermería en esa unidad. MÉTODOS: Se trata de un estudio cualitativo, basado en la investigación convergente-asistencial. Los datos fueron obtenidos de los registros de enfermería de 20 pacientes sometidos a cirugía cardíaca, en el mes de abril de 2008, acrecidos de la experiencia profesional de seis enfermeras participantes del grupo de convergencia que se reunió durante cinco encuentros. RESULTADOS: Fueron establecidos 15 diagnósticos, según la Taxonomía II de la North American Nursing Diagnosis Association, corroborados por otros autores

  10. Robotic aortic surgery.

    Science.gov (United States)

    Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean

    2011-01-01

    Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease.

  11. Clean Hands Count

    Medline Plus

    Full Text Available ... myths and misperceptions about hand hygiene and empower patients to play a role in their care by ... Copyright Creators Advertise Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign ...

  12. Clean Hands Count

    Medline Plus

    Full Text Available ... Clean Hands Count Centers for Disease Control and Prevention (CDC) Loading... Unsubscribe from Centers for Disease Control and Prevention (CDC)? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 65K ...

  13. Clean Hands Count

    Medline Plus

    Full Text Available ... Clean Hands Count Centers for Disease Control and Prevention (CDC) Loading... Unsubscribe from Centers for Disease Control and Prevention (CDC)? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 66K ...

  14. Tropical Diabetic Hand Syndrome

    African Journals Online (AJOL)

    2015 Annals of Medical and Health Sciences Research | Published by Wolters Kluwer - Medknow. 473. Introduction ... diabetes.[2,3] Tropical diabetic hand syndrome is a terminology .... the importance of seeking medical attention immediately.

  15. Clean Hands Count

    Medline Plus

    Full Text Available ... now. Please try again later. Published on May 5, 2017 This video for healthcare providers is intended ... 36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 views 5:46 ...

  16. Clean Hands Count

    Medline Plus

    Full Text Available ... reminding healthcare providers to clean their hands. See: https://www.cdc.gov/handhygiene/campa... . Comments on this ... are allowed in accordance with our comment policy: http://www.cdc.gov/SocialMedia/Tools/... This video can ...

  17. Clean Hands Count

    Medline Plus

    Full Text Available ... empower patients to play a role in their care by asking or reminding healthcare providers to clean ... It's in your hands - prevent sepsis in health care' A 5 May 2018 advocacy message from WHO - ...

  18. Clean Hands Count

    Medline Plus

    Full Text Available ... why Close Clean Hands Count Centers for Disease Control and Prevention (CDC) Loading... Unsubscribe from Centers for Disease Control and Prevention (CDC)? Cancel Unsubscribe Working... Subscribe Subscribed ...

  19. Clean Hands Count

    Medline Plus

    Full Text Available ... has been rented. This feature is not available right now. Please try again later. Published on May ... Wash your Hands - it just makes sense. - Duration: 1:36. Seema Marwaha 404,414 views 1:36 ...

  20. Clean Hands Count

    Medline Plus

    Full Text Available ... Washing Video from CDC called "Put Your Hands Together" - Duration: 3:40. Patrick Boshell 27,834 views ... Policy & Safety Send feedback Test new features Loading... Working... Sign in to add this to Watch Later ...

  1. Clean Hands Count

    Medline Plus

    Full Text Available ... Published on May 5, 2017 This video for healthcare providers is intended to promote or encourage adherence ... role in their care by asking or reminding healthcare providers to clean their hands. See: https://www. ...

  2. Confirmação de presença de usuário à cirurgia eletiva por telefone como estratégia para reduzir absenteísmo Confirmación de presencia del paciente a cirugías electivas por teléfono como estrategia reductora del ausentismo Telephone confirmation of a patient's intent to be present for elective surgery as a strategy to reduce absenteeism

    Directory of Open Access Journals (Sweden)

    Marla Andréia Garcia de Avila

    2013-02-01

    Full Text Available O presente trabalho trata-se de pesquisa quase experimental para avaliar o impacto na redução do absenteísmo de usuários agendados para cirurgia eletiva, quando submetidos à confirmação de presença por telefone. O estudo foi conduzido no Centro Cirúrgico do Hospital das Clínicas da Faculdade de Medicina de Botucatu, durante trinta dias, perfazendo 89 usuários. Os resultados indicaram a efetividade da intervenção, que reduziu o absenteísmo em 30%. Recomenda-se sua implementação na antevéspera da cirurgia, possibilitando novas tentativas para encontrar o usuário no domicílio e convocação de outro. A criação de um núcleo de atendimento poderia constituir um canal de comunicação entre instituição e usuário, permitindo a confirmação da presença da pessoa e a oportunidade de sanar dúvidas sobre o tratamento e comunicar eventuais impedimentos à cirurgia. O núcleo demandaria um profissional com habilidade e conhecimento do serviço, uma vez que os usuários requerem orientações sobre o tratamento durante o contato telefônico.Investigación cuasi experimental evaluando el impacto en la reducción del ausentismo de pacientes agendados para cirugía electiva, confirmando su presentación por vía telefónica. Estudio realizado en el Centro Quirúrgico del Hospital de Clínicas de la Facultad de Medicina de Botucatu, durante 30 días, involucrando a 89 pacientes. Los resultados indican la efectividad de la acción, que redujo el ausentismo en 30%. Se recomienda implementarla en la antevíspera de la cirugía, con tiempo para nuevos intentos de encontrar al paciente en domicilio o de convocar a otro. La creación de un centro de atención podría constituirse en un canal de comunicación institución-paciente, permitiendo la confirmación de la presencia, la oportunidad de subsanar dudas acerca del tratamiento y comunicar eventuales impedimentos para la cirugía. El centro demandaría de un profesional con habilidad y

  3. Hands of early primates.

    Science.gov (United States)

    Boyer, Doug M; Yapuncich, Gabriel S; Chester, Stephen G B; Bloch, Jonathan I; Godinot, Marc

    2013-12-01

    Questions surrounding the origin and early evolution of primates continue to be the subject of debate. Though anatomy of the skull and inferred dietary shifts are often the focus, detailed studies of postcrania and inferred locomotor capabilities can also provide crucial data that advance understanding of transitions in early primate evolution. In particular, the hand skeleton includes characteristics thought to reflect foraging, locomotion, and posture. Here we review what is known about the early evolution of primate hands from a comparative perspective that incorporates data from the fossil record. Additionally, we provide new comparative data and documentation of skeletal morphology for Paleogene plesiadapiforms, notharctines, cercamoniines, adapines, and omomyiforms. Finally, we discuss implications of these data for understanding locomotor transitions during the origin and early evolutionary history of primates. Known plesiadapiform species cannot be differentiated from extant primates based on either intrinsic hand proportions or hand-to-body size proportions. Nonetheless, the presence of claws and a different metacarpophalangeal [corrected] joint form in plesiadapiforms indicate different grasping mechanics. Notharctines and cercamoniines have intrinsic hand proportions with extremely elongated proximal phalanges and digit rays relative to metacarpals, resembling tarsiers and galagos. But their hand-to-body size proportions are typical of many extant primates (unlike those of tarsiers, and possibly Teilhardina, which have extremely large hands). Non-adapine adapiforms and omomyids exhibit additional carpal features suggesting more limited dorsiflexion, greater ulnar deviation, and a more habitually divergent pollex than observed plesiadapiforms. Together, features differentiating adapiforms and omomyiforms from plesiadapiforms indicate increased reliance on vertical prehensile-clinging and grasp-leaping, possibly in combination with predatory behaviors in

  4. Diagnosis-Related Groups in Hand Surgery – a comparison of six European countries [Fallpauschalen in der Handchirurgie – ein Vergleich von sechs europäischen Ländern

    Directory of Open Access Journals (Sweden)

    Stahl, Stephane

    2012-04-01

    Full Text Available [english]
    Diagnosis-Related Group (DRG is a classification system, which groups patients according to their diagnosis and resource consumption. Common hand surgical diagnoses and procedures were processed using national DRG-groupers of six European countries. The upper thresholds of length of stay (LoS are indicated for every country with the exception of Spain. The mean value in the series was 9.9 days for Germany, 4.5 days for Austria, 10.7 days for Italy, 9.7 days for Sweden and 9.4 days for the United Kingdom (UK. Germany and Austria also have lower thresholds of LoS and the average LoS.Multiple finger replantation presented the highest single case reimbursement in Germany, Austria and the UK (13,825 €, 10,576 € and Scaphoid non-union had the highest single case reimbursement in Italy (2,676 €, flap coverage of wounds in Spain (5,506 € and trapeziometacarpal arthritis in Sweden (5,350 €. The mean values for single case reimbursement were as follows: Germany 3,211 €, Austria 2,821 €, Italy 1,947 €, Spain 3,594 €, Sweden 2,403 € and the UK 3,253 €. Ten out of 19 cases showed the highest reimbursement in Spain, followed by the UK (5 cases, Sweden (2 cases, Germany and Austria (1 case each. Applying the case numbers of our clinic to the reimbursement system of each country, total proceeds would be 2.25 million € in Spain, in Germany as well as the UK, 1.75 million € in Austria, in Sweden and 1.22 million € in Italy. The consequences of international differences in efficiency and reimbursement are hard to assess as they are influenced by multiple factors that are seldom purely market-driven. However, the consideration of international data for benchmarking and refinement of national compensation systems should be a useful instrument. [german]
    Diagnosis-Related Groups (DRG bezeichnet ein Klassifikationssystem, welches Patienten anhand ihrer Diagnosen und des Ressourcenverbrauchs einteilt. H

  5. Avaliação do escore CABDEAL como preditor de disfunção neurológica no pós-operatório de revascularização miocárdica com circulação extracorpórea Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    Vinícius José da Silva Nina

    2012-09-01

    Full Text Available INTRODUÇÃO: As complicações neurológicas são temidas no pós-operatório das cirurgias cardíacas, sendo importante causa de óbito e de gastos hospitalares. Sua predição ainda é incerta. OBJETIVO: Avaliar a aplicabilidade de um escore pré-operatório como preditor de disfunção neurológica no pós-operatório de revascularização miocárdica (RM com circulação extracorpórea (CEC. MÉTODOS: Estudo prospectivo que avaliou 77 pacientes submetidos à RM no período de fevereiro a outubro de 2011. Utilizando-se o escore CABDEAL (creatinine, age, body mass index, diabetes, emergency surgery, abnormality on ECG, lung disease, os pacientes foram agrupados em alto (CABDEAL > 4 e baixo risco (CABDEALINTRODUCTION: Neurological dysfunction is a feared postoperative morbidity of cardiac surgery, an important cause of death and increased spending in hospitals. Its prediction, however, is still uncertain. OBJECTIVE: To assess the applicability of a preoperative score as a predictor of neurological dysfunction after coronary artery bypass grafting (CABG under cardiopulmonary bypass (CPB. METHODS: Prospective study that evaluated 77 patients who underwent CABG from February to October 2011. Using the score CABDEAL (creatinine, age, body mass index, diabetes, emergency surgery, abnormality on ECG, lung disease, patients were grouped into high (CABDEAL > 4 and low risk (CABDEAL<4. The predictive value of the score was compared with intraoperative and postoperative variables (aortic clamping time, CPB and ventilation time as predictors of encephalopathy and stroke. Data were analyzed with descriptive statistics and compared with the Fisher exact test. ROC curve analysis was performed to evaluate the accuracy of the model for the neurological outcomes. It was considered the significant value P<0.05. RESULTS: The mortality rate was 2.6% (n=2. There were 2 episodes of stroke (2.6% and 12 (15.5% of encephalopathy. High risk CABDEAL (P=0

  6. Hand eczema: An update

    Directory of Open Access Journals (Sweden)

    Chembolli Lakshmi

    2012-01-01

    Full Text Available Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD. In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis, wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment.

  7. Hand Hygiene: When and How

    Science.gov (United States)

    Hand Hygiene When and How August 2009 How to handrub? How to handwash? RUB HANDS FOR HAND HYGIENE! WASH HANDS WHEN VISIBLY SOILED Duration of the ... its use. When? YOUR 5 MOMENTS FOR HAND HYGIENE 1 BEFORETOUCHINGA PATIENT 2 B P ECFLOER R ...

  8. Use of acupuncture after arthroscopic knee surgery and its relationship to pain, physical activity and need of walking aid Acupuntura em relação a dor, atividade física e a necessidade de apoio para a marcha, no pós-operatório das cirurgias artroscópicas no joelho

    Directory of Open Access Journals (Sweden)

    Rassen Saidah

    2003-01-01

    Full Text Available The purpose of this study was to evaluate the efficacy of Acupuncture in the postoperative arthroscopic knee surgery, using "The Opposite Side" technique from the Traditional Chinese Medicine. The 36 pain in the knee were grouped according to the disorders found during the arthroscopic surgery: 50% with isolated lesion of the medial meniscus, 19.44% with lesion of the medial meniscus associated to knee arthrosis ,11.11% with lesion of lateral meniscus associated to knee arthrosis, 8.33% with isolated lesion of lateral meniscus of the knee, 2.77% lesion of both isolated meniscus, 2.77%with lesion of both isolated meniscus, 2.77% with chrondomalacia patella, and 2.77% were free body carrier. Group I, 18 patients (Acupuncture were submitted to 20 acupuncture session. Contralateral points of acupuncture were performed in the injured knee. Group II, 18 patients (Physiotherapy were submitted to 20 physiotherapy sessions under the administration of nonsteroidal anti-inflammatory agents. The non-parametrical analysis of the results showed that either the subjective data (pain intensity, difficulty in walking, in crouching, on going upstairs/downstairs, on running, on using some support walking presented good results in the majority of the studied parameters. Although, the results of the treatment were similar, the acupuncture showed better results since it presented earlier improvement than the physiotherapy.O presente estudo teve a finalidade de avaliar a eficácia da Acupuntura no pós-operatório das cirurgias artroscópicas no joelho utilizando-se a técnica "ao oposto" da Medicina Tradicional Chinesa. Os 36 pacientes portadores de gonalgias foram distribuídos conforme a patologia encontrada nas artroscopias cirúrgicas: 50,0% tinham lesão do menisco medial isolada, 19,44% lesão meniscal medial associada à artrose de joelho, 11,11% lesão meniscal lateral associada à artrose de joelho, 8,33% lesão meniscal lateral isolada de joelho, 2

  9. Importance of the evaluation of serum albumin concentration in postoperative period of patients submitted to major surgeries Importância da avaliação da concentração da albumina sérica no pós-operatório de operações de grande porte

    Directory of Open Access Journals (Sweden)

    Luiz Ronaldo Alberti

    2010-06-01

    Full Text Available BACKGROUND: The prevalence of protein-energy malnutrition in surgical patients is high, ranging from 10% to 54%. The correct assessment of the nutritional status of such patients is crucial since malnourishment is a risk factor for morbidity and mortality. AIM: To assess the effect of surgical trauma in serum albumin concentration during the immediate postoperative period of major surgeries. METHODS: The study was conducted on 100 randomly chosen adult patients submitted to elective major surgeries, classified according to sex, age and skin color. Blood samples for the determination of serum albumin concentrations were obtained on the days before and after the surgical procedure. RESULTS: There was a reduction in serum albumin from 3.72 ± 0.47 to 2.83 ± 0.71 g/dL (PRACIONAL: A prevalência de desnutrição energético-protéica em pacientes cirúrgicos é alta, variando entre 10% a 54%. A correta avaliação do estado nutricional desses pacientes é crucial uma vez que a desnutrição é um fator de risco para a morbidade e mortalidade. OBJETIVO: Avaliar o efeito do trauma cirúrgico na concentração sérica de albumina, durante o período pós-operatório imediato de operações de grande porte. MÉTODOS: O estudo foi conduzido em 100 pacientes escolhidos aleatoriamente adultos submetidos a procedimentos cirúrgicos eletivos de grande porte, classificados de acordo com sexo, idade e cor da pele. As amostras de sangue para a determinação da concentração sérica de albumina foram obtidas nos dias antes e após o procedimento cirúrgico. RESULTADOS: Houve diminuição da albumina sérica de 3,72 ± 0,47-2,83 ± 0,71 g / dL (P <0,0001, sem diferença de sexo ou cor da pele para operações de grande porte. Com relação à faixa etária, a maior queda da albumina foi observada entre os pacientes com idade superior a 65 anos, seguidos pelos pacientes mais jovens (<45 anos e, finalmente, pacientes com idade entre 45-65 anos. CONCLUSÃO: As

  10. Pharmacological analgesia in neonates undergoing cardiac surgery Uso de fármacos analgésicos en postoperatorio de cirugía cardiaca neonatal Uso de fármacos analgésicos em pós-operatório de cirurgia cardíaca neonatal

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2008-08-01

    Full Text Available The objectives of this study were to verify the frequency of pharmacological analgesia and the occurrence of postoperative pain in neonates undergoing cardiac surgery. METHODS: This is a cross-sectional study and data were collected from 30 medical charts of neonates who underwent cardiac surgery in a private hospital in the city of São Paulo. RESULTS: The majority (96.6% of neonates received analgesia: 18 (60.0% received continuous analgesics, five (16.7% received intermittent drugs, and six (20.0% received a combination of continuous and intermittent analgesics. Fentanyl citrate was continuously administered to 24 (80.0% neonates. Intermittent dipyrone and morphine was administered to ten (33.3% and one (3.3% neonates, respectively. Pain registers were observed in 17 (56.7% medical charts and the occurrence of pain among neonates who received analgesics was 53.4%. CONCLUSION: There was no efficacy in pharmacological postoperative pain control in the neonates included in this study.Los objetivos de este estudio fueron verificar la frecuencia de cobertura analgésica farmacológica y la aparición de dolor postoperatorio en neonatos sometidos a la cirugía cardiaca. MÉTODO: Se Trata de un estudio transversal con recolección de datos de Historias Clínicas de 30 neonatos sometidos a cirugía cardiaca en un hospital privado de la ciudad de San Pablo. RESULTADOS: La frecuencia de cobertura analgésica fue de 96,6%, 18(60,0% recibieron analgesia continua, cinco (16,7% intermitente y seis (20,0% intermitente y continua. El citrato de fentanil fue administrado continuamente a 24 (80,0% neonatos. Dipirona y morfina fueron administradas en dosis intermitentes a diez (33,3% y a un (3,3% neonatos, respectivamente. Fueron identificados registros de ocurrencia de dolor en 17 (56,7% Historias Clínicas. La ocurrencia de dolor postoperatorio en recién nacidos con cobertura analgésica fue 53,4 %. CONCLUSIÓN: los datos apuntan que el abordaje analg

  11. O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Marcelo Kern

    2006-02-01

    Full Text Available OBJETIVO: Avaliar a efetividade do Balão Intra-Aórtico (BIAo profilático em cirurgia de revascularização miocárdica (CRM eletiva, para prevenir o infarto trans ou pós-operatório e para reduzir a mortalidade intra-hospitalar nos pacientes com baixa fração de ejeção ventricular esquerda. MÉTODOS: Em modelo de estudo de coorte, foram analisados 239 pacientes com fração de ejeção do ventrículo esquerdo inferior ou igual a 40%, submetidos à CRM eletiva com circulação extracorpórea (CEC, no período compreendido entre março de 1995 a fevereiro de 2001. RESULTADOS: Destes, 58 pacientes receberam BIAo pré-operatório e os demais foram operados sem assistência circulatória (grupo controle. Os dois grupos de pacientes tinham características semelhantes quanto a fatores associados aos desfechos em questão. Ocorreram 5 (8,6% óbitos no grupo com BIAo e 21 (11,6%, no grupo controle (diferença não-signifícativa. Ocorreram 2 (3,4% infartos no grupo com BIAo e 28 (15,5%, no grupo controle BIAo (p OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB in elective myocardial revascularization surgery (MRS, to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction <40%, submitted to elective MRS with extracorporeal circulation (ECC were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group. The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6% in the group with IAB and 21 (11.6% in the control group (non-significant difference. There were 2 (3.4% infarctions in the IAB group and 28 (15.5% in the control group (p< 0

  12. The passage from Rio.

    Science.gov (United States)

    Strong, M F

    1992-01-01

    The Secretary-General of the UN Conference on Environment and Development notes that after the Earth Summit in Rio de Janeiro discussions about the environment and development will differ from those prior to the Summit. These discussions must now incorporate problems of developing countries, poverty, inequalities, flow of resources to developing countries, and terms of trade. The Rio Declaration on Environment and Development consists of important tenets, but it must evolve into an Earth Charter to be endorsed on the 50th anniversary of the UN in 1965. The Summit's Plan of Action, Agenda 21, must also continue to evolve and, despite its shortcomings, is the most extensive and, if implemented, most effective international action ever approved by the international community. Financing the Agenda 21 initiatives remains to be decided. New possible sources of funding must be based n the polluter pays principle and may include new taxes, user charges, emission permits, and citizen funding. Even though the most serious problem in the 1990s is stabilization of atmospheric gases, the Rio agreement does not include targets or timetables. Governments must take united action immediately to reduce carbon dioxide emissions by at least 60%. 1 nation has not yet approved the convention on biological diversity. Governments also need to move forward on conventions on decertification and deforestation. They need to incorporate the global objectives of Agenda 21 into their own national policies and practices. This must also be done at the global, regional, organizational, local, and individual levels. The global community must also begin technology capacity building. The participatory process should also include nongovernmental organizations. Population growth must also slow dramatically to achieve sustainable development. The various participatory levels must consider elimination of poverty.

  13. Microbiota bacteriana da conjuntiva no pré-operatório de injeção intravítrea de antiangiogênico por degeneração macular relacionada à idade comparada com a de cirurgia de catarata Preoperative conjunctival bacterial microbiota of antiangiogenic intravitreous injection for age-related macular degeneration compared to cataract surgery preoperative microbiota

    Directory of Open Access Journals (Sweden)

    José Ricardo Diniz

    2010-06-01

    pacientes no pré-operatório de cirurgia de catarata.Purpose: To evaluate the conjunctival bacterial microbiota and antibiogram profile in the preoperative of antiangiogenic intravitreous injection for age-related macular degeneration, and compare to the preoperative microbiota of patients submitted to cataract surgery. Methods: Cross-sectional, observational, case series study. Two groups were organized: group I (macular degeneration with 26 eyes from 26 patients (12 men/14 women with mean age of 69.2 ± 11.5 years; group II (cataract with 27 eyes from 27 patients (9 men/18 women with mean age of 67.6 ± 7.9 years. The groups were similar regarding age (p=0.538 and gender (p=0.787. The lower conjunctival sac was swabbed and the obtained material was immediately put in a tube filled with liquid culture media BHI ("brain heart infusion". Samples were processed according to standard laboratory techniques and antibiogram was determined for each bacterial colony. Results: Twenty-six bacterial colonies growth in group I, with 2 eyes showing no growth and 30 colonies growth in group II. Gram positive bacteria were more prevalent in both groups: 23/26 colonies (88.4% in group I and 29/30 colonies (96.7% in group II, with a Staphylococcus aureus predominance in both groups, with 16 samples (61.5% and 17 (56.7%, respectively. Coagulase negative Staphylococcus was the second most common identified bacteria, with 19.2% in group I and 20.0% in group II. No differences between the groups reached statistical significance. No statistically significant difference was noted on the antibiotic sensibility between both groups. Conclusions: There was no difference in the distribution of bacteria and antibiogram profile of the conjunctival microbiota in the preoperative of intravitreous injection of antiangiogenic for macular degeneration compared to the preoperative of cataract surgery.

  14. Hepatobiliary Hands of Hopkins.

    Science.gov (United States)

    Pitt, Henry A

    2018-02-01

    This historical perspective documents the role that John L. Cameron played in advancing hepatobiliary research, education, and surgery at Johns Hopkins in the 1970s, 1980s, and 1990s. Dating back to William S. Halsted in the 19th century, leaders of the Department of Surgery at Johns Hopkins have been interested in hepatobiliary disease and surgery. John L. Cameron had broad hepato-pancreato-biliary (HPB) interests when he completed his surgical training. Over the next 3 decades, he focused on the pancreas. As a result, many faculty and trainee hepatobiliary careers were launched. This perspective is based on 18 years of service as a surgical resident and faculty member at Johns Hopkins. An extensive literature search on the hepatobiliary publications of Halsted, Trimble, Blalock, Longmire, Zuidema, and Cameron was undertaken for this manuscript. Numerous hepatobiliary publications from Johns Hopkins from the 1970s, 1980s, 1990s, and early 2000s were also reviewed. John L. Cameron's early biliary interests included stones, infections, malignancies, and strictures. He was innovative with respect to portal hypertension and Budd-Chiari surgery and supportive when liver transplantation emerged in the 1980s. Volume-outcome studies in the 1990s included hepatic and complex biliary surgery. He supported and encouraged studies of biliary lithotripsy, laparoscopic cholecystectomy, clinical pathways, hepatobiliary cysts, and gallstone pathogenesis. Lessons learned by many who worked with John L. Cameron included the importance of mentorship, innovation, friendship, and collaboration. He taught leadership and change management by example. He fostered a multidisciplinary approach and encouraged randomized controlled trials.

  15. Rio responses in the Netherlands

    International Nuclear Information System (INIS)

    Bruggink, J.J.C.

    1994-01-01

    Three of the five agreements reached in Rio - the Rio Declaration, Agenda 21 and the Framework Convention on Climate Change - are briefly summarised from and energy perspective. The state of the art in the two national policy areas that are crucial for sustainable development, environmental policy and development cooperation, are then described. Some conclusions are drawn regarding the major bottlenecks and challenges for Dutch policies in the wake of Rio. 2 figs

  16. Hand Fractures: Indications, the Tried and True and New Innovations.

    Science.gov (United States)

    Cheah, Andre Eu-Jin; Yao, Jeffrey

    2016-06-01

    Hand fractures are the second most common fracture of the upper extremity, and management of patients with these injuries is common for most hand surgery practices. In this article, we outline the principles of management of these injuries with a special focus on those that are common or complex. We also highlight recent innovations in the context of these injuries. From this cross-section of contemporary evidence on phalangeal and metacarpal fracture treatment, we have noted a trend toward minimally invasive surgery with immediate postoperative mobilization, the use of wide-awake anesthesia, as well as sustained investigation and innovation in the biomechanics and treatment of proximal interphalangeal joint fracture dislocations. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

    Science.gov (United States)

    Engstrand, Christina; Krevers, Barbro; Nylander, Göran; Kvist, Joanna

    2014-07-01

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Dexmedetomidina como droga adjuvante no despertar transitório no intra-operatório de correção cirúrgica de escoliose: relato de caso Dexmedetomidina como droga adyuvante en el despertar transitorio en el intra-operatorio de corrección quirúrgica de escoliosis: relato de caso Dexmedetomidine as adjuvant drug for wake-up test during scoliosis correction surgery: case report

    Directory of Open Access Journals (Sweden)

    Airton Bagatini

    2004-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A escoliose é um defeito da coluna vertebral que necessita muitas vezes de correção cirúrgica. Uma peculiaridade desta correção é a necessidade do paciente despertar no intra-operatório e movimentar os membros inferiores com intuito de afastar lesões do sistema nervoso central (SNC, após a correção do defeito ortopédico. Neste relato, foi associada dexmedetomidina à anestesia venosa total com propofol e remifentanil com o objetivo de obter as ações sedativa, analgésica e de estabilidade ventilatória desta droga, durante o despertar transitório em paciente submetida à correção cirúrgica de escoliose. RELATO DO CASO: Paciente do sexo feminino, 16 anos, branca, estado físico ASA I, com escoliose torácica e lombar em 12 níveis, foi submetida à cirurgia sob anestesia geral. Como medicação pré-anestésica foi utilizado lorazepam na dose de 2 mg, por via oral, na véspera e 90 minutos antes do procedimento. Após monitorização, foi realizada venóclise e punção da artéria radial no membro superior esquerdo; a veia subclávia direita foi puncionada com cateter de duplo lúmen, para infusão de drogas e medidas hemodinâmicas. A indução anestésica foi feita com 1 µg.kg-1 de remifentanil e propofol, em infusão alvo-controlada, para concentração plasmática de 3 µg.ml-1. Como bloqueador neuromuscular, foi utilizado atracúrio na dose de 0,5 mg.kg-1. A manutenção da anestesia foi realizada com infusão contínua de dexmedetomidina (0,4 µg.kg-1.h-1, remifentanil (0,3 µg.kg-1.min-1 e propofol (3 µg.ml-1 em infusão alvo-controlada. No momento do teste para movimentação dos membros inferiores, foram interrompidas as infusões de propofol e remifentanil, mantendo a dexmedetomidina. Com a superficialização do plano anestésico, o paciente assumiu ventilação espontânea e após 14 minutos da interrupção das drogas, sob comando verbal, movimentou os membros inferiores. Durante este

  19. Avaliação clínica e funcional no pré-operatório de doenças degenerativas da coluna vertebral Evaluación clínica y funcional en el preoperatorio de patologías degenerativas de columna Clinical and functional evaluation in preoperative period of degenerative disease spine surgery

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2009-09-01

    Full Text Available OBJETIVO: a utilização de instrumentos de avaliação clínica e funcional nos pacientes com doenças da coluna vertebral pode determinar a evolução e predizer o desfecho pós-operatório. O objetivo deste estudo foi descrever a metodologia de avaliação de doenças degenerativas espinhais e verificar os resultados. MÉTODOS: após a indicação de tratamento cirúrgico nos pacientes com doenças das colunas lombar e cervical, os mesmos foram informados dos objetivos do estudo e convidados a participar. Os questionários foram respondidos no consultório médico, onde possíveis dúvidas surgidas durante o preenchimento eram esclarecidas por uma pessoa treinada não envolvida com a cirurgia. Todos os instrumentos de avaliação usados eram autoaplicativos. Foram utilizados a escala numérica de dor, o Questionário de Qualidade de Vida SF-36, o Questionário de Evitação por Medos e Crenças (FABq, o Inventário de Depressão de Beck (BDI, a Escala de Depressão e Ansiedade Hospitalar (HAD, o Índice de Incapacidade Oswestry (ODI e o Índice de Disfunção Relacionado ao Pescoço (NDI. RESULTADOS: foram avaliados 220 pacientes com doenças da coluna lombar e 32 da cervical. A prevalência de depressão segundo o BDI foi de 28,0% e de 31,2% em pacientes com doença cirúrgica lombar e cervical, e a prevalência de ansiedade pelo HAD-A de 40,1% e 46,9%, respectivamente. A média do ODI foi de 46,5, e a do NDI, de 25,4. Quanto ao preenchimento dos questionários, a maioria dos pacientes, uma vez instruídos, não apresentou dificuldades em finalizá-los. O tempo médio de preenchimento de todos os instrumentos foi de 25 a 35 minutos. CONCLUSÕES: a utilização de instrumentos validados para avaliação dos pacientes com doenças degenerativas vertebrais é exequível e deve ser estimulada entre os cirurgiões que atuam no âmbito da coluna vertebral.OBJETIVO: la utilización de instrumentos de evaluación clínica y funcional de patolog

  20. Congenital hand anomalies in Upper Egypt

    Directory of Open Access Journals (Sweden)

    Tarek Abulezz

    2016-01-01

    Full Text Available Background: Congenital hand anomalies are numerous and markedly variant. Their significance is attributed to the frequent occurrence and their serious social, psychological and functional impacts on patient's life. Patients and Methods: This is a follow-up study of 64 patients with hand anomalies of variable severity. All patients were presented to Plastic Surgery Department of Sohag University Hospital in a period of 24 months. Results: This study revealed that failure of differentiation and duplication deformities were the most frequent, with polydactyly was the most common anomaly encountered. The mean age of presentation was 6 years and female to male ratio was 1.46:1. Hand anomalies were either isolated, associated with other anomalies or part of a syndrome. Conclusion: Incidence of congenital hand anomalies in Upper Egypt is difficult to be estimated due to social and cultural concepts, lack of education, poor registration and deficient medical survey. Management of hand anomalies should be individualised, carefully planned and started as early as possible to achieve the best outcome.

  1. Clean Hands Count

    Medline Plus

    Full Text Available ... CDC) 97,825 views 5:12 CDC Flu Education Video - Duration: 10:26. Nicole Shelton 213 views ... Infection Control Video - Duration: 20:55. Paramedical Services Education Page 4,735 views 20:55 Hand Washing ...

  2. Hand Eczema: Treatment options

    DEFF Research Database (Denmark)

    Lund, Tamara Theresia; Agner, Tove

    2017-01-01

    Hand eczema is a common disease, it affects young people, is often work-related, and the burden of the disease is significant for the individual as well as for society. Factors to be considered when choosing a treatment strategy are, among others, whether the eczema is acute or chronic, the sever...

  3. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 824 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 409,492 ...

  4. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 786 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 ...

  5. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 414 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  6. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 869 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  7. Wash Your Hands

    Centers for Disease Control (CDC) Podcasts

    2010-03-08

    This video shows kids how to properly wash their hands, one of the most important steps we can take to avoid getting sick and spreading germs to others.  Created: 3/8/2010 by Centers for Disease Control and Prevention (CDC).   Date Released: 3/8/2010.

  8. Clean Hands Count

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    Full Text Available ... no cure tomorrow - Duration: 3:10. World Health Organization 75,585 views 3:10 Wash 'Em - Hand ... soap and water - Duration: 1:27. World Health Organization 224,180 views 1:27 The five moments ...

  9. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 460 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  10. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 75,362 views 3:10 Wash ' ... handwash? With soap and water - Duration: 1:27. World Health Organization 219,427 views 1:27 Hand ...

  11. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 74,478 views 3:10 Wash your Hands - ... handwash? With soap and water - Duration: 1:27. World Health Organization 215,487 views 1:27 Infection Control Video - ...

  12. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 741 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  13. Matching hand radiographs

    NARCIS (Netherlands)

    Kauffman, J.A.; Slump, Cornelis H.; Bernelot Moens, H.J.

    2005-01-01

    Biometric verification and identification methods of medical images can be used to find possible inconsistencies in patient records. Such methods may also be useful for forensic research. In this work we present a method for identifying patients by their hand radiographs. We use active appearance

  14. Clean Hands Count

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    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 72,885 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 views 5:46 'It's in your ...

  15. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 029 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,974 ...

  16. Clean Hands Count

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    Full Text Available ... no cure tomorrow - Duration: 3:10. World Health Organization 78,256 views 3:10 Wash 'Em - Hand ... message from WHO - Duration: 10:07. World Health Organization 9,045 views 10:07 A very serious ...

  17. Hands-On Calculus

    Science.gov (United States)

    Sutherland, Melissa

    2006-01-01

    In this paper we discuss manipulatives and hands-on investigations for Calculus involving volume, arc length, and surface area to motivate and develop formulae which can then be verified using techniques of integration. Pre-service teachers in calculus courses using these activities experience a classroom in which active learning is encouraged and…

  18. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 78,256 views 3:10 Wash ... handwash? With soap and water - Duration: 1:27. World Health Organization 230,361 views 1:27 Hand ...

  19. Hands-on Humidity.

    Science.gov (United States)

    Pankiewicz, Philip R.

    1992-01-01

    Presents five hands-on activities that allow students to detect, measure, reduce, and eliminate moisture. Students make a humidity detector and a hygrometer, examine the effects of moisture on different substances, calculate the percent of water in a given food, and examine the absorption potential of different desiccants. (MDH)

  20. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 396 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  1. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 094 views 1:19 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,974 ...

  2. Clean Hands Count

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    Full Text Available ... starting stop Loading... Watch Queue Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with ... ads? Get YouTube Red. Working... Not now Try it free Find out why Close Clean Hands Count ...

  3. Clean Hands Count

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    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 69,414 views 3:10 Hand Washing ... Video - Duration: 5:46. Thomas Jefferson University & Jefferson Health 408,436 views 5:46 83 videos Play ...

  4. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 319 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  5. Clean Hands Count

    Medline Plus

    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ...

  6. Clean Hands Count

    Medline Plus

    Full Text Available ... 14. Lake Health 14,415 views 3:14 Safety Demo: The Importance of Hand Washing - Duration: 2: ... Copyright Creators Advertise Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign ...

  7. Clean Hands Count

    Medline Plus

    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 72,319 views 3:10 Wash 'Em - Hand ... handwash? With soap and water - Duration: 1:27. World Health Organization 205,878 views 1:27 Germ Smart - Wash ...

  8. Hands On Earth Science.

    Science.gov (United States)

    Weisgarber, Sherry L.; Van Doren, Lisa; Hackathorn, Merrianne; Hannibal, Joseph T.; Hansgen, Richard

    This publication is a collection of 13 hands-on activities that focus on earth science-related activities and involve students in learning about growing crystals, tectonics, fossils, rock and minerals, modeling Ohio geology, geologic time, determining true north, and constructing scale-models of the Earth-moon system. Each activity contains…

  9. Clean Hands Count

    Medline Plus

    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 384 views 1:19 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  10. Clean Hands Count

    Medline Plus

    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 285 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  11. Clean Hands Count

    Medline Plus

    Full Text Available ... Gorin 243,451 views 2:57 Hand Hygiene Dance - Duration: 3:15. mohd hafiz 34,146 views ... Language: English Location: United States Restricted Mode: Off History Help Loading... Loading... Loading... About Press Copyright Creators ...

  12. Clean Hands Count

    Medline Plus

    Full Text Available ... YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. Working... Not now Try ... Wash your Hands - it just makes sense. - Duration: 1:36. Seema Marwaha 400,493 views 1:36 ...

  13. Clean Hands Count

    Medline Plus

    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 033 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  14. Clean Hands Count

    Medline Plus

    Full Text Available ... Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson Health 408,436 views 5: ... Prevention (CDC) 97,277 views 5:12 Loading more suggestions... Show more Language: English Location: United States ...

  15. Hands-On Hydrology

    Science.gov (United States)

    Mathews, Catherine E.; Monroe, Louise Nelson

    2004-01-01

    A professional school and university collaboration enables elementary students and their teachers to explore hydrology concepts and realize the beneficial functions of wetlands. Hands-on experiences involve young students in determining water quality at field sites after laying the groundwork with activities related to the hydrologic cycle,…

  16. Clean Hands Count

    Medline Plus

    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 043 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,292 ...

  17. Clean Hands Count

    Medline Plus

    Full Text Available ... News 581,131 views 18:49 Just Good Music 24/7 ● Classic Live Radio classics. 1,406 ... 611,013 views 1:46 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,798 views ...

  18. Clean Hands Count

    Medline Plus

    Full Text Available ... 52 Hand Sanitizers and Soaps Put to the Test - Duration: 2:26. ABC News 42,006 views ... Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign in to add ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  20. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia

    NARCIS (Netherlands)

    Sinnott, K. Anne; Dunn, Jennifer A.; Wangdell, Johanna; Johanson, M. Elise; Hall, Andrew S.; Post, Marcel W.

    Reconstructive arm/hand surgery for tetraplegia is performed to improve arm/hand function and therefore personal well-being for individuals who accept such elective surgeries. However, changes at an impairment level do not always translate into functional or quality of life changes. Therefore,

  1. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  2. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  3. Evaluation of content and accessibility of hand fellowship websites.

    Science.gov (United States)

    Silvestre, Jason; Guzman, Javier Z; Abbatematteo, Joseph M; Chang, Benjamin; Levin, L Scott

    2015-09-01

    Graduates of general, orthopedic, and plastic surgery residencies utilize web-based resources when applying for hand fellowship training. The purpose of this study was to evaluate the accessibility and content of hand fellowship websites (HFWs). Websites of accredited hand surgery fellowships were eligible for study inclusion. HFWs were evaluated for comprehensiveness in the domains of education and recruitment. Website content was correlated with program characteristics via Fisher exact tests. Fifteen plastic, 65 orthopedic, and 1 general surgery hand fellowships were analyzed. Seventy-four hand fellowships maintained an HFW (91 %). HFWs were not found for 3 plastic and 4 orthopedic hand programs (20 versus 6 %, p = 0.118). HFWs provided only half of all analyzed content (54 %-education and 49 %-recruitment). Orthopedic programs had more education content than plastic surgery programs (55 versus 44 %, p = 0.030). Programs in the South had more education content than programs in the Northeast (63 versus 47 %, p = 0.001), but not more than programs in the West (54 %) or Midwest (55 %). Larger programs with more fellows had greater education content than those with only one fellow (57 versus 49 %, p = 0.042). Programs affiliated with top-ranked medical schools had less education content than lower-ranked schools (48 versus 56 %, p = 0.045). No differences existed in recruitment content between programs. Most hand surgery fellowships lack readily accessible and comprehensive websites. The paucity of online content suggests HFWs are underutilized as educational resources and future opportunity may exist to optimize these tools.

  4. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  5. Morbimortalidade em octogenários submetidos à cirurgia de revascularização miocárdica Morbimortalidad en octogenarios sometidos a cirugía de revascularización miocárdica Morbimortality in octogenarian patients submitted to coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Fernando Pivatto Júnior

    2010-07-01

    Full Text Available FUNDAMENTO: O progressivo aumento da longevidade da população tem levado cada vez mais pacientes octogenários a necessitarem de cirurgia de revascularização miocárdica (CRM, sendo necessário conhecer os riscos e benefícios desse procedimento nessa faixa etária. OBJETIVO: Descrever a morbimortalidade hospitalar de pacientes com idade igual ou superior a 80 anos submetidos à CRM e identificar variáveis que se constituem em seus preditores. MÉTODOS: Foram estudados 140 casos consecutivos entre janeiro de 2002 e dezembro de 2007. Os pacientes possuíam em média 82,5 ± 2,2 anos (80-89, e 55,7% eram do sexo masculino. Na amostra, 72,9% tinham hipertensão arterial, 26,4% diabete, 65,7% lesão grave em três ou mais vasos e 28,6% em tronco da coronária esquerda. Cirurgia associada esteve presente em 35,7% dos pacientes, sendo a valvar aórtica em 26,4% e a mitral em 5,6%. RESULTADOS: A mortalidade foi de 14,3% (CRM isolada 10,0% x 22,0% associada; p = 0,091 e a morbidade de 37,9% (CRM isolada 34,4% x 44,0% associada; p = 0,35. Complicações mais frequentes: baixo débito cardíaco (27,9%, disfunção renal (10,0% e suporte ventilatório prolongado (9,6%. Na análise bivariada, os maiores preditores de mortalidade foram sepse (RR 10,2 IC 95%: 6,10-17,7, CRM prévia (RR 8,06 IC 95%: 5,16-12,6, baixo débito cardíaco pós-operatório (RR 7,77 IC 95%: 3,03-19,9 e disfunção renal pós-operatória (RR 7,36 IC 95%: 3,71-14,6. Quanto à morbidade, foram preditores tempo de circulação extracorpórea >120 min. (RR: 2,34 IC 95%: 1,62-3,38 e de isquemia > 90 min. (RR: 2,29 IC 95%: 1,56-3,37. CONCLUSÃO: A CRM em octogenários está relacionada a uma morbimortalidade maior do que nos pacientes mais jovens, o que, entretanto, não impede a intervenção se houver indicação pela condição clínica.FUNDAMENTO: El progresivo aumento de la longevidad de la población ha llevado cada vez más pacientes octogenarios a necesitar cirugía de

  6. [Blast injuries of the hands in precarious health situation].

    Science.gov (United States)

    Allah, K C; Kossoko, H; Assi Djè Bi Djè, V; Yéo, S; Bonny, R; Richard Kadio, M

    2014-06-01

    The hands of "blast" resulting from the handling of unstable explosives. Their repercussion is functional and vital in trauma patients. The authors report their experience of care from the hands of blast in precarious health situation. Between 2001 and 2012, 33 hand blasts were supported in 30 injured civilians and military, received emergency, during and after armed conflict. Two women (6.7%) and 28 men (93.3%) were received, including four teenagers (13.3%) and 26 adults (86.7%). During the war, 15 officers weapon (50%) and three civilians (10%) underwent surgery, or 60% of hand injuries. In peacetime, civilians were mostly operated in 33.3% of cases, against 6.7% of cases of agents' weapon. Nineteen hands blast (57.6%) were observed during the war and 14 in peacetime, or 42.4% of cases. The average age was 25.2 years, with extremes of 12 and 50 years. Thirteen left hands (39.4%) and 20 right hands (60.6%) were operated. The lesion concerned all the anatomical structures of the hand. It was unilateral in 27 cases (81.9%) and bilateral in three cases (9.1%). Three types of hand trauma were observed and were as follows: trauma patients with injuries of the hand (18.2%), trauma of severe and isolated proximal hand or finger amputations (75.7%), and trauma of the hand without apparent seriousness (6.1%). The associated lesion was eye (one case), chest (one case), abdominal (five cases). Debridement was performed immediate emergency (93.9%) and delayed (6.1%). The treatment was surgical hemostasis, made mainly of amputations (69.7%) and regularization of digital stumps (12.1%). The repair was performed in 18.2% of cases. One death has been reported in a polytrauma patient with chest blast. Blast injuries of the hand are common in times of war in armed agents. The young people, manual workers and children are paying a heavy price in peacetime. As land mines which affect feet, instable hand grenades are left exposed in nature. In precarious health situation, instead of

  7. SURGERY AND CARDIOVASCULAR SURGERY JOURNALS ANALYSIS.

    Science.gov (United States)

    Schanaider, Alberto

    2015-01-01

    To analyze critically the effectiveness and value of bibliometric indicators in journals of Surgery or Cardiovacular Surgery in the context of the postgraduate programs of CAPES Medicine III. A sampling with 16 academic programs and one professional master of Medicine III, encompassing the General and Digestive System Surgery, Cardiovascular Surgery and Multidisciplinary courses with such contents, was evaluated. Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), and also Scielo databases were used. Only in seven programs, the teachers had an average of Qualis A1 articles greater than the others strata. Eleven journals in the surgical area are in stratum A1 (5%) and it reaches 25% in Cardiovascular Surgery. Among the six journals with the largest number of publications Qualis A1 in area Medicine III, five are from non-specific areas. The Acta Cirúrgica Brasileira represented 58% of the publications in the stratum A2. There are some obstacles in the Qualis classification with little uniformity among the Medicine areas I, II and III. A permanent committee should be set to update the Qualis, composed by the three medical areas. It should be considered using other index databases and the unification of the Qualis criteria for journals in medicine. Rating criteria of multi and transdisciplinary journals need to be reviewed. It is essential an institutional financial support for national journals chosen by peers aiming to provide a full computerization process and a professional reviewer of the English language, in order to increase the impact factor. Analisar criticamente a eficácia e valor de indicadores bibliométricos dos periódicos da Cirurgia e Cirurgia Cardiovascular no contexto dos Programas de Pós-Graduação da área Medicina III da CAPES. Foi avaliada uma amostragem com 16 programas acadêmicos e um mestrado profissional da área de Medicina III, compreendendo a Cirurgia Geral e do Aparelho Digestivo, a Cirurgia Cardiovascular e Cursos Multidisciplinares

  8. Surgery for trigger finger.

    Science.gov (United States)

    Fiorini, Haroldo Junior; Tamaoki, Marcel Jun; Lenza, Mário; Gomes Dos Santos, Joao Baptista; Faloppa, Flávio; Belloti, Joao Carlos

    2018-02-20

    Trigger finger is a common clinical disorder, characterised by pain and catching as the patient flexes and extends digits because of disproportion between the diameter of flexor tendons and the A1 pulley. The treatment approach may include non-surgical or surgical treatments. Currently there is no consensus about the best surgical treatment approach (open, percutaneous or endoscopic approaches). To evaluate the effectiveness and safety of different methods of surgical treatment for trigger finger (open, percutaneous or endoscopic approaches) in adults at any stage of the disease. We searched CENTRAL, MEDLINE, Embase and LILACS up to August 2017. We included randomised or quasi-randomised controlled trials that assessed adults with trigger finger and compared any type of surgical treatment with each other or with any other non-surgical intervention. The major outcomes were the resolution of trigger finger, pain, hand function, participant-reported treatment success or satisfaction, recurrence of triggering, adverse events and neurovascular injury. Two review authors independently selected the trial reports, extracted the data and assessed the risk of bias. Measures of treatment effect for dichotomous outcomes calculated risk ratios (RRs), and mean differences (MDs) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). When possible, the data were pooled into meta-analysis using the random-effects model. GRADE was used to assess the quality of evidence for each outcome. Fourteen trials were included, totalling 1260 participants, with 1361 trigger fingers. The age of participants included in the studies ranged from 16 to 88 years; and the majority of participants were women (approximately 70%). The average duration of symptoms ranged from three to 15 months, and the follow-up after the procedure ranged from eight weeks to 23 months.The studies reported nine types of comparisons: open surgery versus steroid injections (two

  9. Movimento do ombro após cirurgia por carcinoma invasor da mama: estudo randomizado prospectivo controlado de exercícios livres versus limitados a 90º no pós-operatório Shoulder movement after surgery for invasive breast carcinoma: randomized controlled study of postoperative exercises

    Directory of Open Access Journals (Sweden)

    Marcela Ponzio Pinto e Silva

    2004-03-01

    Full Text Available OBJETIVO: avaliar a eficácia de um protocolo de exercícios físicos na recuperação do movimento do ombro em mulheres submetidas a esvaziamento linfonodal axilar por câncer de mama, comparando exercícios com amplitude livre e restrita do movimento. MÉTODOS: 59 mulheres submetidas a linfadenectomia axilar associada a mastectomia modificada (46 ou quadrantectomia (13 foram incluídas neste estudo clínico, prospectivo e randomizado. No primeiro dia após a cirurgia, 30 mulheres foram randomizadas para realizar os exercícios do ombro com amplitude livre do movimento e 29 mulheres tiveram a amplitude restrita a 90º nos primeiros 15 dias de pós-operatório. Eram realizados 19 exercícios, com três sessões semanais, por seis semanas. Foram comparadas as médias com desvio-padrão (DP de déficit de flexão e abdução do ombro, assim como as taxas de incidência bruta e ajustadas de seroma e deiscência. RESULTADOS: após 42 dias as médias de flexão e abdução do ombro foram semelhantes nos dois grupos. Houve déficit de flexão de 17,2º e 21,6º, e de abdução de 19,7º e 26,6º, nos grupos com exercício livre e limitado a 90º, respectivamente. As incidência de seroma e deiscência não estiveram relacionadas com o exercício nem com o tipo de cirurgia, tempo de permanência do dreno, número de linfonodos dissecados ou comprometidos, idade ou obesidade. CONCLUSÃO: a fisioterapia precoce com movimentação livre do ombro da mulher não esteve associada com o aumento ou diminuição da capacidade funcional e nem com maiores complicações cirúrgicas.PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46 or quadrantectomy (13 were

  10. Cirurgias colorretais no Hospital Universitário da Universidade Federal de Sergipe: três anos da criação do Serviço de Coloproctologia (série histórica Colorrectal surgery at the Federal University Hospital of Sergipe: an overview of three years after the creation of the Colorretal Group

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2008-03-01

    Full Text Available Estudamos cirurgias colorretais do SC-HU/UFS (Serviço de Coloproctologia do Hospital Universitário da Universidade Federal de Sergipe realizadas de janeiro de 2004 a julho de 2006, série histórica da criação da residência médica em coloproctologia. De setenta pacientes, 53(75,7% eram do gênero masculino, 17(24,3% feminino; idade variou de 19 a 85 anos com média de 52 anos. Os setenta pacientes foram submetidos a 102 procedimentos, com média de 1,4 cirurgias/paciente, 29(28,4% reoperações. Dezenove(18,6% foram reconstituições de trânsito intestinal, 15(14,8% retossigmoidectomias, 11(10,8% colectomias totais, 9(8,8% colectomias direitas, 6(5,8% amputações abdomino-perineais, 3(2,9% proctocolectomias, 2(1,9% colectomias esquerdas. Dezoito(17,6% cirurgias indicadas por neoplasias de cólon, 8(7,8% do reto e 1(0,9% do canal anal; 10(9,9% foram megacólon; 10(9,9% colostomias prévias, 5(5,9% Doença de Crohn, 5(4,9% DDC, 3(2,9% RCUI. Quarenta e oito(47,1% cirurgias tiveram complicações cirúrgica: 32(31,4% complicações da ferida operatória, 13(12,7% abscessos abdominais, 11(10,8% fístulas, 7(6,9% deiscências, etc. Índice de infecção de ferida foi 26,5%. Cinqüenta e cinco pacientes(53,9% foram submetidos à anastomose, 32(58,2% manuais e 23(41,8% mecânicas. Deiscência de anastomose em 7(12,7% cirurgias: 1(3,1% deiscência em anastomose manual e 6(26,1%, em mecânica. Óbito em 11(15,7% pacientes. Avaliamos principais dados do trabalho objetivando definir metas, elaborar e melhorar protocolos vigentes objetivando otimizar o programa de residência médica.We studied colorectal surgeries carried through by the SC-HU/UFS from January 2004 to July 2006, historical series, referring to the creation of the colorectal medical residence. Registres by seventy patients that 53(75.7% were masculine sort and 17(24.3% feminine; medium age is 52 years. They had been submitted to the 102 procedures, 1,4 surgeries/patients, 29

  11. surgery of the hand in infants with cerebral palsy* 655

    African Journals Online (AJOL)

    1971-06-19

    Jun 19, 1971 ... walking, etc., become possible without conscious afferent information. If corrective limb ... This 'brain's body image' is compiled from the informa- tion which reaches the ... cal self-confidence which improve with practice (or the.

  12. Compact Dexterous Robotic Hand

    Science.gov (United States)

    Lovchik, Christopher Scott (Inventor); Diftler, Myron A. (Inventor)

    2001-01-01

    A compact robotic hand includes a palm housing, a wrist section, and a forearm section. The palm housing supports a plurality of fingers and one or more movable palm members that cooperate with the fingers to grasp and/or release an object. Each flexible finger comprises a plurality of hingedly connected segments, including a proximal segment pivotally connected to the palm housing. The proximal finger segment includes at least one groove defining first and second cam surfaces for engagement with a cable. A plurality of lead screw assemblies each carried by the palm housing are supplied with power from a flexible shaft rotated by an actuator and output linear motion to a cable move a finger. The cable is secured within a respective groove and enables each finger to move between an opened and closed position. A decoupling assembly pivotally connected to a proximal finger segment enables a cable connected thereto to control movement of an intermediate and distal finger segment independent of movement of the proximal finger segment. The dexterous robotic hand closely resembles the function of a human hand yet is light weight and capable of grasping both heavy and light objects with a high degree of precision.

  13. Surgery for adrenal tumors

    International Nuclear Information System (INIS)

    Salamah, S.M.

    2002-01-01

    Objective: To analyze the presentation, localization, pathology, surgical management and outcome of surgery for adrenal gland tumors. Design: Prospective clinico epidemiological study. Place and Duration of Study: The study was conducted at the Department of General Surgery, University Unit, Riyadh medical Complex Kingdom of Saudi Rabia from June, 1991 to may, 2001. Subjects and Methods: A total of 21 cases with adrenal tumors were studied for demographic data, clinical presentation, diagnostic workup, localization, surgical management, pathology and outcome. The outcome of these patients was followed prospectively. Results: The study included 12 female and 9 male patients. The mean age at surgery was 36.7 years. Hypertension (69.%) was the commonest presentation in hypersecretory functional tumors. The localization accuracy for ultrasonography, computerized tomography, MRI and MIBG scan was 95.2%, 98.3% 87.8% and 83.6% respectively. Pheochromocytoma was the most common adrenal pathology observed in 14 (66.6%) cases. The overall morbidity was 19% with no hospital mortality. Complete follow-up of available 19 patients (90.5 %) revealed no tumor recurrence and persistent hypertension in 14.3% cases. Conclusion: surgery on adrenal glands is safe in experienced hands and is recommended in institutes with all backup facilities. (author)

  14. Importância da troponina I no diagnóstico do infarto do miocárdio no pós-operatório de cirurgia de revascularização The importance of troponin I in the diagnosis of myocardial infarction in the postoperative of coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Marcos Aurélio Barboza de Oliveira

    2009-03-01

    Full Text Available OBJETIVO: Estabelecer um valor de corte para a troponina I, correlacionando-a com a ocorrência de infarto do miocárdio pós-cirúrgico (IAMPC. MÉTODOS: Foram incluídos 180 pacientes consecutivos portadores de coronariopatia obstrutiva com indicação cirúrgica. A idade média dos pacientes foi de 60,6 ± 9,3 anos, sendo 119 (66,1% do sexo masculino e 61 (33,9%, do feminino. Os pacientes foram divididos em dois grupos: grupo sem infarto (A - 170 pacientes - e infartado (B - 10 pacientes. Foram coletados de cada um troponina I, ao momento da indução anestésica e ao segundo dia do pósoperatório, e correlacionada com a presença ou não de IAMPC. A análise estatística foi feita com a ajuda do programa StatsDirect 1.6.0 para Windows. RESULTADOS: A troponina I pré-operatória apresentou uma média de 1,0 ± 6 ng/ml. A regressão logística univariada mostrou correlação da troponina I do segundo dia de pós-operatório com IAMPC com P=0,0005. A curva ROC determinou um valor de corte de 6,1 ng/ml, sensibilidade = 90,0% e especificidade = 82,1%, OR = 49,8 (IC 95% 6,1-410,4 com POBJECTIVE: The aim of this study is to establish a cut-off value for troponin I by correlating it to occurrence of postoperative myocardial infarction. METHODS: 180 consecutive patients with coronary disease referred for surgery were included. The mean age of the patients were 60.6 (±9.3 years, with 119 (66.1% males and 61 (33.9% females. The patients were divided into two groups: group without myocardial infarction (A - 170 patients - and with myocardial infarction (B - 10 patients.The troponin I was collected from each patient at the beginning of anesthesia and on the second postoperative day by correlating it to presence or not of postoperative myocardial infarction. StatsDirect 1.6.0 for Windows was used for statistical analysis. RESULTS: Preoperative troponin I was 1.0 (±6 ng/ml as mean. Univariate logistic regression showed correlation of troponin I of the

  15. MRI of the wrist and hand

    International Nuclear Information System (INIS)

    Reicher, M.A.; Kellerhouse, L.E.

    1990-01-01

    Magnetic resonance imaging (MRI) is becoming the preferred technique for evaluating a wide range of wrist and hand disorders and has a crucial role in planning arthroscopic and nonarthroscopic wrist surgery. This book details the capabilities of MRI for detecting wrist, hand, and finger pathology; provides a complete understanding of examination techniques, imaging protocols, and anatomy; and contains nearly 400 clear, sharp scans and numerous line drawings showing examination techniques, anatomic structures, and pathologic findings. After an introductory review of MR physics, the book describes state- of-the-art MRI techniques and explains the rationale for selecting imaging protocols. A complete MRI examination of a normal wrist is presented, along with a multiplanar atlas of cross-sectional wrist anatomy

  16. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  17. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  18. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  19. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  20. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  1. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  2. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  3. Sinus Surgery

    Science.gov (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  4. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  5. Contemporary indications for transsphenoidal pituitary surgery.

    Science.gov (United States)

    Miller, Brandon A; Ioachimescu, Adriana G; Oyesiku, Nelson M

    2014-12-01

    To analyze current indications for transsphenoidal pituitary surgery. The current literature regarding transsphenoidal surgery for all subtypes of pituitary adenomas and other sellar lesions was examined. Alternate approaches for pituitary surgery were also reviewed. Transsphenoidal surgery continues to be the mainstay of surgical treatment for pituitary tumors, and has good outcomes in experienced hands. Pre- and postoperative management of pituitary tumors remains an important part of the treatment of patients with pituitary tumors. Even as medical and surgical treatment for pituitary tumors evolves, transsphenoidal surgery remains a mainstay of treatment. Outcomes after transshenoidal surgery have improved over time. Neurosurgeons must be aware of the indications, risks and alternatives to transsphenoidal pituitary surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Performance Comparison Between FEDERICA Hand and LARM Hand

    OpenAIRE

    Carbone, Giuseppe; Rossi, Cesare; Savino, Sergio

    2015-01-01

    This paper describes two robotic hands that have been\\ud developed at University Federico II of Naples and at the\\ud University of Cassino. FEDERICA Hand and LARM Hand\\ud are described in terms of design and operational features.\\ud In particular, careful attention is paid to the differences\\ud between the above-mentioned hands in terms of transmission\\ud systems. FEDERICA Hand uses tendons and pulleys\\ud to drive phalanxes, while LARM Hand uses cross four-bar\\ud linkages. Results of experime...

  7. Second-hand signals

    DEFF Research Database (Denmark)

    Bergenholtz, Carsten

    2014-01-01

    Studies of signaling theory have traditionally focused on the dyadic link between the sender and receiver of the signal. Within a science‐based perspective this framing has led scholars to investigate how patents and publications of firms function as signals. I explore another important type...... used by various agents in their search for and assessment of products and firms. I conclude by arguing how this second‐hand nature of signals goes beyond a simple dyadic focus on senders and receivers of signals, and thus elucidates the more complex interrelations of the various types of agents...

  8. Hand grip strength

    DEFF Research Database (Denmark)

    Frederiksen, Henrik; Gaist, David; Petersen, Hans Christian

    2002-01-01

    in life is a major problem in terms of prevalence, morbidity, functional limitations, and quality of life. It is therefore of interest to find a phenotype reflecting physical functioning which has a relatively high heritability and which can be measured in large samples. Hand grip strength is known......-55%). A powerful design to detect genes associated with a phenotype is obtained using the extreme discordant and concordant sib pairs, of whom 28 and 77 dizygotic twin pairs, respectively, were found in this study. Hence grip strength is a suitable phenotype for identifying genetic variants of importance to mid...

  9. The hand and wrist

    International Nuclear Information System (INIS)

    Wood, M.B.; Berquist, T.H.

    1985-01-01

    Trauma is the most common etiologic factor leading to disability in the hand and wrist. Judicious radiographic evaluation is required for accurate assessment in practically all but the most minor of such injuries. Frequently serial radiographic evaluation is essential for directing the course of treatment and for following the healing process. A meaningful radiographic evaluation requires a comprehensive knowledge of the normal radiographic anatomy, an overview of the spectrum of pathology, and an awareness of the usual mechanisms of injury, appropriate treatment options, and relevant array of complications

  10. Correction of severe postburn claw hand.

    Science.gov (United States)

    Davami, Babak; Pourkhameneh, Golnar

    2011-12-01

    Burn scar contractures are perhaps the most frequent and most frustrating sequelae of thermal injuries to the hand. Unfortunately, stiffness occurs in the burned hand quickly. A week of neglect in the burned hand can lead to digital malpositioning and distortion that may be difficult to correct. The dorsal contracture is the most common of all the complications of the burned hand. It is the result of damage to the thin dorsal skin and scant subcutaneous tissue, which offers little protection to the deeper structures. Consequently, these injuries are deep resulting in a spectrum of deformities that has remained the bane of reconstructive surgery. Flap coverage will be required in the event of exposure of joints and tendons with absent paratenons. Multiple different flap types are available to treat complex severe postburn hand contractures. In our center, which is the largest regional burn center in northwest Iran, we have considerable experience in the treatment of thermal hand injuries. Between 2005 and 2010, we treated 53 consecutive patients with 65 severe postburn hand deformities. There were 35 men and 18 women with a mean age of 35±3 years. Flame injury was the inciting traumatic event in each patient. The severity of original injury and inadequate early treatment resulted in all of the fingers developing a severe extension contracture with scarred and adherent extensor tendons and subluxed metacarpophalangeal joints. In 36 cases, the injury was in the patients' dominant hand. We first incised the dorsal aspect of the contracted hands where there was maximum tension, then tenolysed the extensor tendons and released the volar capsules, collateral ligaments, and volar plate in all cases. In 30 cases, we also tenolysed the flexor tendons. We reduced the subluxed metacarpophalangeal joints and fixed them with Kirschner wires in 70 to 90 degrees flexion. Then, we planned and performed axial groin flaps to reconstruct the defects in all of them. In all of these

  11. Applications of piezoelectric surgery in endodontic surgery: a literature review.

    Science.gov (United States)

    Abella, Francesc; de Ribot, Joan; Doria, Guillermo; Duran-Sindreu, Fernando; Roig, Miguel

    2014-03-01

    Piezosurgery (piezoelectric bone surgery) devices were developed to cut bone atraumatically using ultrasonic vibrations and to provide an alternative to the mechanical and electrical instruments used in conventional oral surgery. Indications for piezosurgery are increasing in oral and maxillofacial surgery, as in other disciplines, such as endodontic surgery. Key features of piezosurgery instruments include their ability to selectively cut bone without damaging adjacent soft tissue, to provide a clear operative field, and to cut without generating heat. Although piezosurgery instruments can be used at most stages of endodontic surgery (osteotomy, root-end resection, and root-end preparation), no published data are available on the effect of piezosurgery on the outcomes of endodontic surgery. To our knowledge, no study has evaluated the effect of piezosurgery on root-end resection, and only 1 has investigated root-end morphology after retrograde cavity preparation using piezosurgery. We conducted a search of the PubMed and Cochrane databases using appropriate terms and keywords related to the use and applications of piezoelectric surgery in endodontic surgery. A hand search also was conducted of issues published in the preceding 2 years of several journals. Two independent reviewers obtained and analyzed the full texts of the selected articles. A total of 121 articles published between January 2000 and December 2013 were identified. This review summarizes the operating principles of piezoelectric devices and outlines the applications of piezosurgery in endodontic surgery using clinical examples. Piezosurgery is a promising technical modality with applications in several aspects of endodontic surgery, but further studies are necessary to determine the influence of piezosurgery on root-end resection and root-end preparation. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. Perfuração de Luvas durante Cirurgias Ginecológicas Glove Perforation during Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Eddie Fernando Candido Murta

    2000-05-01

    Full Text Available Objetivo: analisar a incidência de perfuração de luvas cirúrgicas durante atos operatórios ginecológicos. Métodos: estudo prospectivo de 454 luvas usadas em 65 procedimentos utilizando-se o método de pressão de água. Resultados: do total de 454 luvas examinadas, foram verificadas perfurações em 54 (11,9%, sendo estatisticamente significativo o maior número de perfurações em comparação ao grupo controle, uma (1,7% em 60 analisadas (pPurpose: to analyze the frequency of glove perforation during gynecologic surgeries. Methods: a prospective study of 454 gloves used in 65 surgeries by the water pressure method. Results: of a total of 454 gloves, 54 (11.9% had perforations. Comparison with the control group showed p<0.05 (chi² test, 1 (1.7% perforation in 60 gloves tested. Of the total of gloves used in 65 surgeries, 29 (44.6% had perforations, 44 (81% had one perforation and 10 (19% had more than one perforation. The two most common sites of perforations were the index finger, 20 (29.5% and the thumb, 14 (25.9%. Perforation was predominant in the left hand (72.1%. The surgeons were the members of the team with the greatest number of glove perforations. Total hysterectomy was the most frequent surgery in which glove perforations occurred (50% of the cases. Conclusion: the glove perforations occurred with relatively high frequency during gynecologic surgeries. The index finger of the left hand proved to be the most affected region. Among the members of the team, the highest percentage of glove perforations occurred in those of the surgeons. Total hysterectomy had the highest perforation rate.

  13. Back to basics: hand hygiene and surgical hand antisepsis.

    Science.gov (United States)

    Spruce, Lisa

    2013-11-01

    Health care-associated infections (HAIs) are a significant issue in the United States and throughout the world, but following proper hand hygiene practices is the most effective and least expensive way to prevent HAIs. Hand hygiene is inexpensive and protects patients and health care personnel alike. The four general types of hand hygiene that should be performed in the perioperative environment are washing hands that are visibly soiled, hand hygiene using alcohol-based products, surgical hand scrubs, and surgical hand scrubs using an alcohol-based surgical hand rub product. Barriers to proper hand hygiene may include not thinking about it, forgetting, skin irritation, a lack of role models, or a lack of a safety culture. One strategy for improving hand hygiene practices is monitoring hand hygiene as part of a quality improvement project, but the most important aspect for perioperative team members is to set an example for other team members by following proper hand hygiene practices and reminding each other to perform hand hygiene. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  14. Rock in Rio: forever young

    Directory of Open Access Journals (Sweden)

    Ricardo Ferreira Freitas

    2014-12-01

    Full Text Available The purpose of this article is to discuss the role of Rock in Rio: The Musical, as herald of megafestival Rock in Rio. Driven by the success that musicals have reached in Brazil, we believe that the design of this spectacle of music, dance and staging renews the brand of the rock festival, once it adds the force of young and healthy bodies to its concept. Moreover, the musical provides Rock in Rio with some distance from the controversal trilogy of sex, drugs and rock and roll, a strong mark of past festivals around the world. Thus, the musical expands the possibilities of growth for the brand.

  15. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  17. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  18. Moving mountains in Rio

    International Nuclear Information System (INIS)

    Runnalls, D.

    1992-01-01

    The June 1992 United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro has been planned more as a discussion of environment and development, rather than sustainable development as suggested by the 1987 World Commission on Environment and Development (the Brundtland Commission). The Canadian agenda for UNCED is like that of most of the developed countries, and focuses mainly on climatic change, deforestation, loss of biodiversity in the tropics, and health of the oceans. The agenda of the developing countries is based on the knowledge that most of these global problems have been caused or aggravated by the industrialized countries. The developing countries fear that actions imposed to solve environmental problems will threaten their economic development. A key demand from the developing countries is a commitment by developed countries to reduce their greenhouse gas emissions, leaving space for the developing countries to increase their emissions as they develop. There is little or no pressure on governments in the developed world to come to such a comprehensive deal. For Canada, much remains to be done in setting national priorities, and many of the issues to be discussed at UNCED are under provincial jurisdiction

  19. Surgical treatment of synovial-collagen disorders of the hand

    Directory of Open Access Journals (Sweden)

    H Kirk Watson

    2015-04-01

    Full Text Available Critical relationships between collagen and synovium exist and affect the function of the hand. Understanding these relationships enhances the ability to perform surgery including procedures addressing soft tissue and joint pathology. We present a series of surgical procedures based on this principle.

  20. Hand Matters: Left-Hand Gestures Enhance Metaphor Explanation

    Science.gov (United States)

    Argyriou, Paraskevi; Mohr, Christine; Kita, Sotaro

    2017-01-01

    Research suggests that speech-accompanying gestures influence cognitive processes, but it is not clear whether the gestural benefit is specific to the gesturing hand. Two experiments tested the "(right/left) hand-specificity" hypothesis for self-oriented functions of gestures: gestures with a particular hand enhance cognitive processes…

  1. Antimicrobial efficacy of alcohol-based hand gels.

    Science.gov (United States)

    Guilhermetti, M; Marques Wiirzler, L A; Castanheira Facio, B; da Silva Furlan, M; Campo Meschial, W; Bronharo Tognim, M C; Botelho Garcia, L; Luiz Cardoso, C

    2010-03-01

    In recent years, several commercial alcohol-based hand gels have appeared on the market to improve the hand-cleansing compliance of healthcare workers. Although the antimicrobial efficacy of these products has been reported in different countries, few studies have investigated this subject in Brazil. In this study, we assessed the antimicrobial efficacy of 12 alcohol-based hand gels produced in Brazil, containing 70% w/w or v/v ethyl alcohol as the active ingredient, according to the European Standard EN 1500 (EN 1500). The following alcohol gels were tested: Hand Gel, Voga Gel, Solumax Solugel, Doctor Clean, Rio Gel, Clear Gel, Sevengel, Hand CHC, Gel Bac, WBL-50 Gel, Sanigel and Soft Care Gel. In addition, 70% w/w ethyl alcohol and three alcohol-based hand rubs (Sterillium, Sterillium Gel, and Spitaderm), commonly used in Europe and effective according to EN 1500, were also tested. All the products tested, except for two, were approved by the EN 1500 test protocol with a 60s application. The results confirmed the antimicrobial efficacy of the majority of the alcohol gels produced in Brazil for hand hygiene of healthcare workers. Copyright 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Rio Chama Floodplain Management Study

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The Village of Chama requested the Soil Conservation Service, through the Upper Chama Soil and Water Conservation District, to conduct a study of the Rio Chama and...

  3. A técnica de Lichtenstein nas hérnias inguinais primárias e recidivadas - cirurgia ambulatorial em hospital universitário Lichtenstein hernia repair in primary and recurrent inguinal hernias - ambulatory surgery in a university hospital

    Directory of Open Access Journals (Sweden)

    Marco Antonio de Oliveira Peres

    2007-12-01

    üente nos ambulatórios.BACKGROUND: Lichtenstein hernia repair is gold standard in inguinal hernia surgeries, allowing a tension-free polypropylene mesh, low recurrence, wide applicability, easy teaching to young surgeons, early discharge and lower costs. AIM: A retrospective analysis was made using the results in the ambulatory surgery of primary inguinal hernias and recurrences, performing the Lichtenstein technique in a University Hospital. METHODS: From August of 1994 to December of 2001, 343 inguinal hemioplasties were performed in 326 patients with primary and recurrent inguinal hernias. Three hundred and four (88.6% were male, with ages ranging between 19 to 85 years. Concomitant diseases were observed in 196 cases (60.1%, were hypertension, smoking and cardiopathy were predominant. Regarding the side of the hernias, 232 were on the right and 94 on the left side; seventeen male patients (7.3% showed bilateral presentation. Among the 38 (11.1% recurrent hernias, 27 were on the right side. The classic Lichtenstein technique was indicated in all, using polypropylene mesh, of 15 x 7.5 cm. RESULTS: Local anesthesia was the first choice in 55.9% of cases. Anesthetist intervention and the conversion of the local anesthesia for general was necessary in only one case (0.3%. Four patients needed single day hospital admissions. Early local complications were of seroma: 15 cases; superficial infection of operative wound: 11 (3.3%; hematoma: 5 cases and venous thrombosis of the spermatic cord : 2 cases. After a five year follow-up, hernia recurrences were observed in three cases (0.87%. CONCLUSION: The technique revealed to be of easy application, could be performed under local anesthesia and as an outpatient, with low rates of complications and recurrences. It also allowed students and residents to learn the technique, as well as to attend to such demanding and frequent disease in daily clinics.

  4. Classification of hand eczema

    DEFF Research Database (Denmark)

    Agner, T; Aalto-Korte, K; Andersen, K E

    2015-01-01

    BACKGROUND: Classification of hand eczema (HE) is mandatory in epidemiological and clinical studies, and also important in clinical work. OBJECTIVES: The aim was to test a recently proposed classification system of HE in clinical practice in a prospective multicentre study. METHODS: Patients were...... recruited from nine different tertiary referral centres. All patients underwent examination by specialists in dermatology and were checked using relevant allergy testing. Patients were classified into one of the six diagnostic subgroups of HE: allergic contact dermatitis, irritant contact dermatitis, atopic...... system investigated in the present study was useful, being able to give an appropriate main diagnosis for 89% of HE patients, and for another 7% when using two main diagnoses. The fact that more than half of the patients had one or more additional diagnoses illustrates that HE is a multifactorial disease....

  5. Left hand polydactyly: a case report.

    Science.gov (United States)

    Mumoli, Nicola; Gandini, Daniele; Wamala, Edris Kalanzi; Cei, Marco

    2008-11-24

    Polydactyly is a congenital anomaly with a wide range of manifestations that occurs in many forms, ranging from varying degrees of mere splitting to completely duplicated thumb. When duplication occurs alone, it is usually unilateral and sporadic. In this case report we describe an otherwise healthy 19-year-old woman of Tibetan heritage with isolated left hand preaxial polydactyly. She experienced working related difficulties in her daily yak's milking. She subsequently underwent surgical correction, and the over number thumb was removed with associated meticulous skeletal and soft tissue reconstruction. Polydactyly is the most common congenital digital anomaly of the hand and foot. It can occur in isolation or as part of a syndrome. Surgery is necessary to create a single, functioning thumb and is indicated to improve cosmesis. Skin, nail, bone, ligament, and musculoskeletal elements must be combined to reconstruct an optimal digit. In this case (Tibetan society is almost exclusively a sheep-breeding one) surgery was necessary to leave a single, functioning thumb for her work as yak milkmaid.

  6. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  7. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Management of Atopic Hand Dermatitis

    DEFF Research Database (Denmark)

    Halling-Overgaard, Anne-Sofie; Zachariae, Claus; Thyssen, Jacob P

    2017-01-01

    This article provides an overview of clinical aspects of hand eczema in patients with atopic dermatitis. Hand eczema can be a part of atopic dermatitis itself or a comorbidity, for example, as irritant or allergic contact dermatitis. When managing hand eczema, it is important to first categorize...

  9. Hand Washing: Do's and Dont's

    Science.gov (United States)

    ... hands frequently can help limit the transfer of bacteria, viruses and other microbes. Always wash your hands before: Preparing food or eating Treating wounds or caring for a sick person Inserting or removing contact lenses Always wash your hands after: Preparing food Using ...

  10. Hand aperture patterns in prehension.

    Science.gov (United States)

    Bongers, Raoul M; Zaal, Frank T J M; Jeannerod, Marc

    2012-06-01

    Although variations in the standard prehensile pattern can be found in the literature, these alternative patterns have never been studied systematically. This was the goal of the current paper. Ten participants picked up objects with a pincer grip. Objects (3, 5, or 7cm in diameter) were placed at 30, 60, 90, or 120cm from the hands' starting location. Usually the hand was opened gradually to a maximum immediately followed by hand closing, called the standard hand opening pattern. In the alternative opening patterns the hand opening was bumpy, or the hand aperture stayed at a plateau before closing started. Two participants in particular delayed the start of grasping with respect to start of reaching, with the delay time increasing with object distance. For larger object distances and smaller object sizes, the bumpy and plateau hand opening patterns were used more often. We tentatively concluded that the alternative hand opening patterns extended the hand opening phase, to arrive at the appropriate hand aperture at the appropriate time to close the hand for grasping the object. Variations in hand opening patterns deserve attention because this might lead to new insights into the coordination of reaching and grasping. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Robotic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Jean eBouquet De Jolinière

    2016-05-01

    Full Text Available Abstract Minimally invasive surgery (MIS can be considered as the greatest surgical innovation over the past thirty years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D monitor reduction in-depth perception, camera instability, limited range of motion and steep learning curves. The surgeon has a low force feedback which allows simple gestures, respect for tissues and more effective treatment of complications.Since 1980s several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon's skills, achieve accuracy and high precision during complex surgery and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three- dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

  12. Robotic assisted andrological surgery

    Science.gov (United States)

    Parekattil, Sijo J; Gudeloglu, Ahmet

    2013-01-01

    The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE). PMID:23241637

  13. Unimanual SNARC Effect: Hand Matters.

    Science.gov (United States)

    Riello, Marianna; Rusconi, Elena

    2011-01-01

    A structural representation of the hand embedding information about the identity and relative position of fingers is necessary to counting routines. It may also support associations between numbers and allocentric spatial codes that predictably interact with other known numerical spatial representations, such as the mental number line (MNL). In this study, 48 Western participants whose typical counting routine proceeded from thumb-to-little on both hands performed magnitude and parity binary judgments. Response keys were pressed either with the right index and middle fingers or with the left index and middle fingers in separate blocks. 24 participants responded with either hands in prone posture (i.e., palm down) and 24 participants responded with either hands in supine (i.e., palm up) posture. When hands were in prone posture, the counting direction of the left hand conflicted with the direction of the left-right MNL, whereas the counting direction of the right hand was consistent with it. When hands were in supine posture, the opposite was true. If systematic associations existed between relative number magnitude and an allocentric spatial representation of the finger series within each hand, as predicted on the basis of counting habits, interactions would be expected between hand posture and a unimanual version of the spatial-numerical association of response codes (SNARC) effect. Data revealed that with hands in prone posture a unimanual SNARC effect was present for the right hand, and with hands in supine posture a unimanual SNARC effect was present for the left hand. We propose that a posture-invariant body structural representation of the finger series provides a relevant frame of reference, a within-hand directional vector, that is associated to simple number processing. Such frame of reference can significantly interact with stimulus-response correspondence effects, like the SNARC, that have been typically attributed to the mapping of numbers on a left

  14. Unimanual SNARC Effect: Hand Matters

    Directory of Open Access Journals (Sweden)

    Marianna eRiello

    2011-12-01

    Full Text Available A structural representation of the hand embedding information about the identity and relative position of fingers is necessary to counting routines. It may also support associations between numbers and allocentric spatial codes that predictably interact with other known numerical spatial representations, such as the mental number line. In this study, 48 Western participants whose typical counting routine proceeded from thumb-to-little on both hands performed magnitude and parity binary judgments. Response keys were pressed either with the right index and middle fingers or with the left index and middle fingers in separate blocks. 24 participants responded with either hands in prone posture (i.e. palm down and 24 participants responded with either hands in supine (i.e. palm up posture. When hands were in prone posture, the counting direction of the left hand conflicted with the direction of the left-right mental number line, whereas the counting direction of the right hand was consistent with it. When hands were in supine posture, the opposite was true. If systematic associations existed between relative number magnitude and an allocentric spatial representation of the finger series within each hand, as predicted on the basis of counting habits, interactions would be expected between hand posture and a unimanual version of the Spatial-Numerical Association of Response Codes (SNARC effect. Data revealed that with hands in prone posture a unimanual SNARC effect was present for the right hand, and with hands in supine posture a unimanual SNARC effect was present for the left hand. We propose that a posture-invariant body structural representation of the finger series provides a relevant frame of reference, a within-hand directional vector, that is associated to simple number processing. Such frame of reference can significantly interact with stimulus-response correspondence effects that have been attributed to the mapping of numbers on a mental

  15. Efeitos da estimulação temporária atrial direita na prevenção da fibrilação atrial no pós-operatório de revascularização do miocárdio com circulação extracorpórea Effect of temporary right atrial pacing in prevention of atrial fibrillation after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Vicente Avila Neto

    2007-09-01

    Full Text Available OBJETIVO: Avaliar os efeitos da estimulação atrial direita temporária na prevenção da fibrilação atrial no pósoperatório de revascularização do miocárdio com circulação extracorpórea e identificar os fatores de risco para o aparecimento dessa arritmia. MÉTODO: Estudamos 160 pacientes que, ao término da cirurgia de revascularização miocárdica, submeteram-se ao implante de eletrodos epicárdicos na parede lateral do átrio direito e foram randomizados em grupos não-estimulado (NE e grupo com estímulo atrial direito (AD. O ritmo cardíaco foi monitorizado durante as 72 horas seguintes ao término da operação e as variáveis estudadas foram: a incidência de fibrilação atrial, os fatores de risco pré, intra e pós-operatórios para o seu aparecimento e eventos pósoperatórios. Resultados: Foram detectados 21 (13,1% episódios de fibrilação atrial, sendo 20 no grupo NE e um no grupo submetido à estimulação do átrio direito (AD. O risco relativo para o desenvolvimento de fibrilação atrial foi de 0,18 (IC 95%= 0,05-0,60 para o grupo AD quando comparado ao grupo NE. A regressão logística identificou que as variáveis idade mais jovem, uso de beta-bloqueador no pré-operatório e presença da estimulação atrial direita estiveram associadas a uma menor razão de chances (odds ratio para o surgimento de fibrilação atrial no pós-operatório. CONCLUSÕES: A estimulação atrial direita temporária reduziu a incidência de fibrilação atrial pós-operatória. A idade avançada e a não estimulação atrial foram fatores preditivos independentes para a ocorrência dessa arritmia.OBJECTIVE: To evaluated the effects of temporary atrial pacing to prevent the atrial fibrillation after coronary artery bypass graft surgery and the risk factors to the occurrence of this arrhytmia. METHODS: We have studied 160 patients who, at the end of coronary artery bypass graft surgery, were submitted to epicardial electrode

  16. GENERAL SURGERY

    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...

  17. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  18. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  19. Rodding Surgery

    Science.gov (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  20. A diabetic patient presenting with stiff hand following fasciectomy for Dupuytren's contracture: A case report.

    Science.gov (United States)

    Fournier, Katia; Papanas, Nikolaos; Compson, Jonathan P; Maltezos, Efstratios

    2008-10-27

    Reported is the case of a 68-year-old male presenting with severe wrist and hand stiffness following surgery for a Dupuytren's contracture. Complications of surgery or rehabilitation and complex regional pain syndrome were excluded as factors explaining this stiffness. Given the patient's diabetes mellitus and the striking similarity with the typical diabetic stiff hand, it is suggested that diabetes may have contributed to the development of the complication.

  1. Hand dominance in upper extremity musculoskeletal disorders.

    Science.gov (United States)

    Shiri, Rahman; Varonen, Helena; Heliövaara, Markku; Viikari-Juntura, Eira

    2007-05-01

    To investigate the role of hand dominance in common upper extremity musculoskeletal disorders (UEMSD) in a population study. The target population consisted of a representative sample of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in the study. The prevalence of UEMSD was as follows: rotator cuff tendinitis 3.8%, bicipital tendinitis 0.5%, lateral epicondylitis 1.1%, medial epicondylitis 0.3%, carpal tunnel syndrome (CTS) 3.8%, and surgery due to CTS 1.3%. CTS was 2.5 times as prevalent in women as men, whereas the other UEMSD were as common in both sexes. Rotator cuff and bicipital tendinitis and medial epicondylitis were more prevalent in the dominant arm only in women, whereas lateral epicondylitis was more prevalent in the dominant elbow in both sexes. The higher prevalence of rotator cuff and bicipital tendinitis in the dominant side persisted beyond working age. The prevalence of CTS did not differ by hand dominance. Dominant hand had been operated more frequently for CTS in women. Our findings show that UEMSD are more prevalent in the dominant than nondominant arm mainly in women. For shoulder tendinitis, the difference persists throughout adult age. Physical load factors may have long-lasting effects on the shoulder and they may play a greater role in women than men.

  2. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  3. Robotically enhanced rubber hand illusion.

    Science.gov (United States)

    Arata, Jumpei; Hattori, Masashi; Ichikawa, Shohei; Sakaguchi, Masamichi

    2014-01-01

    The rubber hand illusion is a well-known multisensory illusion. In brief, watching a rubber hand being stroked by a paintbrush while one's own unseen hand is synchronously stroked causes the rubber hand to be attributed to one's own body and to "feel like it's my hand." The rubber hand illusion is thought to be triggered by the synchronized tactile stimulation of both the subject's hand and the fake hand. To extend the conventional rubber hand illusion, we introduce robotic technology in the form of a master-slave telemanipulator. The developed one degree-of-freedom master-slave system consists of an exoskeleton master equipped with an optical encoder that is worn on the subject's index finger and a motor-actuated index finger on the rubber hand, which allows the subject to perform unilateral telemanipulation. The moving rubber hand illusion has been studied by several researchers in the past with mechanically connected rigs between the subject's body and the fake limb. The robotic instruments let us investigate the moving rubber hand illusion with less constraints, thus behaving closer to the classic rubber hand illusion. In addition, the temporal delay between the body and the fake limb can be precisely manipulated. The experimental results revealed that the robotic instruments significantly enhance the rubber hand illusion. The time delay is significantly correlated with the effect of the multisensory illusion, and the effect significantly decreased at time delays over 100 ms. These findings can potentially contribute to the investigations of neural mechanisms in the field of neuroscience and of master-slave systems in the field of robotics.

  4. Rastreamento e diagnóstico das neoplasias de ovário: papel dos marcadores tumorais

    Directory of Open Access Journals (Sweden)

    Francisco José Candido dos Reis

    2005-04-01

    Full Text Available O câncer de ovário é a neoplasia ginecológica mais letal e a sobrevida global é inferior a 40% em cinco anos. Isto ocorre principalmente porque a maioria das pacientes apresenta estadios avançados no momento do diagnóstico. Nestes casos as opções terapêuticas - citorredução e quimioterapia - são apenas parcialmente efetivas. Quando diagnosticado precocemente, por outro lado, a sobrevida em cinco anos é superior a 90% e a cirurgia geralmente é o único tratamento necessário. No entanto, em função da baixa prevalência do câncer de ovário na população, mesmo testes muito específicos produzem altas taxas de resultados falso-positivos e aumento de intervenções cirúrgicas para abordar massas anexiais assintomáticas. Com base nestes fatos, é essencial a busca de métodos e estratégias para se detectar estes tumores em estádios iniciais e ao mesmo tempo evitar intervenções desnecessárias. Neste artigo são revisadas as bases e as possíveis conseqüências de estratégias para a detecção precoce dos tumores ovarianos. São discutidos os principais métodos disponíveis e os resultados de alguns estudos com este objetivo.Ovarian cancer is the most letal gynecologic tumor, the 5-year survival is less than 40%. The main reason is the advanced stage at the moment of the diagnosis. In these cases the therapeutic options, citorreductive surgery and chemotherapy, are not completely effective. On the other hand, 5-year survival for early stage ovarian cancer is higher than 90%, and most of the times the surgery is the only treatment needed. However, because of the low prevalence of ovarian cancer in the general population, even tests with high specificity present many false positive results and eventually an increase in surgical procedures to investigate asymptomatic adnexal masses. Based on these facts the search for methods and strategies to diagnose early stage ovarian cancer and at the same time to avoid unnecessary

  5. Hand-related physical function in rheumatic hand conditions

    DEFF Research Database (Denmark)

    Klokker, Louise; Terwee, Caroline; Wæhrens, Eva Elisabet Ejlersen

    2016-01-01

    INTRODUCTION: There is no consensus about what constitutes the most appropriate patient-reported outcome measurement (PROM) instrument for measuring physical function in patients with rheumatic hand conditions. Existing instruments lack psychometric testing and vary in feasibility...... and their psychometric qualities. We aim to develop a PROM instrument to assess hand-related physical function in rheumatic hand conditions. METHODS AND ANALYSIS: We will perform a systematic search to identify existing PROMs to rheumatic hand conditions, and select items relevant for hand-related physical function...... as well as those items from the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) item bank that are relevant to patients with rheumatic hand conditions. Selection will be based on consensus among reviewers. Content validity of selected items will be established...

  6. Hand-related physical function in rheumatic hand conditions

    DEFF Research Database (Denmark)

    Klokker, Louise; Terwee, Caroline B; Wæhrens, Eva Ejlersen

    2016-01-01

    as well as those items from the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) item bank that are relevant to patients with rheumatic hand conditions. Selection will be based on consensus among reviewers. Content validity of selected items will be established......INTRODUCTION: There is no consensus about what constitutes the most appropriate patient-reported outcome measurement (PROM) instrument for measuring physical function in patients with rheumatic hand conditions. Existing instruments lack psychometric testing and vary in feasibility...... and their psychometric qualities. We aim to develop a PROM instrument to assess hand-related physical function in rheumatic hand conditions. METHODS AND ANALYSIS: We will perform a systematic search to identify existing PROMs to rheumatic hand conditions, and select items relevant for hand-related physical function...

  7. HENRY'S "HAND OF GOD"

    Directory of Open Access Journals (Sweden)

    Željko Kaluđerović

    2014-04-01

    Full Text Available In this paper the author discusses the views and statements of the French football player Thierry Henry he gave after his illegal play during the playoff match between France and the Republic of Ireland to claim one of the final spots in the World Cup 2010 in South Africa. First, by controlling the ball with his hand before passing it on for the goal Henry has shown disregard for the constitutive rules of football. Then, by stating that he is "not a referee" he demonstrated that for some players rules are not inherent to football and that they can be relativized, given that for them winning is the goal of the highest ontological status. Furthermore, he has rejected the rules of sportsmanship, thus expressing his opinion that the opponents are just obstacles which have to be removed in order to achieve your goals. Henry's action has disrupted major moral values, such as justice, honesty, responsibility and beneficence. The rules of fair play have totally been ignored both in Henry's action and in the Football Association of France's unwillingness to comment on whether a replay should take place. They have ignored one of the basic principles stated in the "Declaration of the International Fair Play Committee", according to which, fair play is much more than playing to the rules of the game; it's about the attitude of the sportsperson. It's about respecting your opponent and preserving his or her physical and psychological integrity. Finally, the author believes that the rules, moral values and fair play in football are required for this game to become actually possible to play

  8. HENRY'S "HAND OF GOD"

    Directory of Open Access Journals (Sweden)

    Željko Kaluđerović

    2014-04-01

    Full Text Available In this paper the author discusses the views and statements of the French football player Thierry Henry he gave after his illegal play during the playoff match between France and the Republic of Ireland to claim one of the final spots in the World Cup 2010 in South Africa. First, by controlling the ball with his hand before passing it on for the goal Henry has shown disregard for the constitutive rules of football. Then, by stating that he is "not a referee" he demonstrated that for some players rules are not inherent to football and that they can be relativized, given that for them winning is the goal of the highest ontological status. Furthermore, he has rejected the rules of sportsmanship, thus expressing his opinion that the opponents are just obstacles which have to be removed in order to achieve your goals. Henry's action has disrupted major moral values, such as justice, honesty, responsibility and beneficence. The rules of fair play have totally been ignored both in Henry's action and in the Football Association of France's unwillingness to comment on whether a replay should take place. They have ignored one of the basic principles stated in the "Declaration of the International Fair Play Committee", according to which, fair play is much more than playing to the rules of the game; it's about the attitude of the sportsperson. It's about respecting your opponent and preserving his or her physical and psychological integrity. Finally, the author believes that the rules, moral values and fair play in football are required for this game to become actually possible to play.

  9. Prevalência de artralgia em indivíduos obesos no pré e pós-operatório tardio de cirurgia bariátrica = Prevalence of arthralgia in obese individuals in the pre and postoperative of bariatric surgery

    OpenAIRE

    Soccol, Franciella Baggio

    2009-01-01

    Objetivos: analisar a prevalência de artralgia no pré e no pós-operatório tardio de cirurgia bariátrica, comparar o índice de massa corporal (IMC) dos indivíduos obesos nos períodos pré e pós-operatório, verificar a associação entre teste de caminhada de seis minutos e artralgia e avaliar a correlação entre teste de caminhada de seis minutos e IMC. Métodos: estudo de coorte retrospectivo, composto por 43 indivíduos obesos que realizaram avaliação no período pré e pós-operatório tardio de ciru...

  10. Prevalência de artralgia em indivíduos obesos no pré e pós-operatório tardio de cirurgia bariátrica = Prevalence of arthralgia in obese individuals in the pre and postoperative of bariatric surgery

    OpenAIRE

    Soccol, Franciella Baggio

    2009-01-01

    Objetivos: analisar a prevalência de artralgia no pré e no pós-operatório tardio de cirurgia bariátrica, comparar o índice de massa corporal (IMC) dos indivíduos obesos nos períodos pré e pós-operatório, verificar a associação entre teste de caminhada de seis minutos e artralgia e avaliar a correlação entre teste de caminhada de seis minutos e IMC Métodos: estudo de coorte retrospectivo, composto por 43 indivíduos obesos que realizaram avaliação no período pré e pós-operatório tardio de ci...

  11. Somatotrophic and corticotrophic function outcome after transesphenoidal surgery in patients with sellar tumors and pre-operative endocrine deficits Evolução das funções somatotrófica e corticotrófica após cirurgia transesfenoidal em pacientes com tumores selares e deficits endócrinos pré-operatórios

    Directory of Open Access Journals (Sweden)

    Fernando R. Pimentel-Filho

    1997-09-01

    Full Text Available Sixteen patients with sellar tumors that were treated surgically and who had pre-operative somatotrophic and corticotrophic function deficits were submitted to pre- and early post-operative insulin tolerance tests (ITTs. Seven patients had non-functioning adenomas, 5 had prolactinomas, 3 had craniopharyngioma and 1 had cordoma of the clivus. All patients had macro-tumors and none received radiotherapy within the studied period. Seven patients had GH, 4 had Cortisol and 5 had both GH/cortisol function pre-operative deficit. Five patients with isolated GH, 4 with isolated Cortisol and 3 with both GH/cortisol deficiencies showed a postoperative functional recovery. New Cortisol secretion deficits were observed in 2 patients postoperatively and both required long-term steroid replacement. These data suggest that preoperative endocrine deficits may be reversible after surgical decompression of the sellar region and that new endocrine deficits are rarely seen after surgery. All such patients should be tested postoperatively from an endocrinological point of view to reevaluate the need for replacement therapies.Dezesseis pacientes com tumores da região selar que foram tratados cirurgicamente e que possuíam deficits funcionais dos eixos somatotrófico ou corticotrófico foram submetidos a teste de tolerância à insulina pré- e pós-operatoriamente. Sete pacientes possuíam adenomas não-funcionantes, 5 possuíam prolactinomas, 3 craniofaringiomas e 1 possuía cordoma de clivus. Todos os pacientes possuíam macrotumores e nenhum deles foi submetido a radioterapia durante o período do estudo. Sete pacientes possuíam deficiência isolada do setor somatotrófico, 4 isolada do setor corticotrófico e 5 possuíam deficiência de ambos os setores. Cinco pacientes com deficiência isolada do setor somatotrófico, 4 com deficit isolado do setor corticotrófico e 3 com deficiência nos dois setores obtiveram melhora funcional pós-operatoriamente. Novos

  12. Patient feelings during the preoperative period for cardiac surgery Sentimientos de los pacientes en el preoperatorio de cirugía cardíaca Sentimentos de pacientes no pré-operatório de cirurgia cardíaca

    Directory of Open Access Journals (Sweden)

    Tatiana Victorelli Pires Vargas

    2006-06-01

    Full Text Available This qualitative study aimed to identify the feelings patients presented when confronted with the news about the need to undergo cardiac surgery and, later, during the preoperative period. Twenty male patients were interviewed. The case study methodology was adopted and the analysis process resulted in two theme categories: Feelings of apprehension (fear, worry, anxiety, suspicion and jittery and Positive and hopeful feelings. We observed that, although both categories were present at the two moments, over time, during the preoperative period, the need for surgical intervention was accepted better and the Feelings of apprehension started to be mentioned less, while the Positive and hopeful feelings were most frequently mentioned by the patients.Fueron entrevistados a 20 pacientes del género masculino con objeto de identificar los sentimientos demostrados tras la noticia a cerca de la necesidad de realizar una cirugía cardíaca y, posteriormente, en el período de internación preoperatoria. La metodología utilizada fue la del estudio de caso y el proceso de análisis resultó en dos categorías temáticas: Sentimientos de aprensión (miedo, preocupación, ansiedad, recelo, desconfianza y nerviosismo y Sentimientos positivos y de esperanza. Constatamos que, aunque esas dos categorías estuvieron presentes en los dos momentos, a lo largo del tiempo, en el período de internación preoperatoria, los pacientes aceptaron mejor la necesidad de la intervención quirúrgica y los Sentimientos de aprensión pasaron a ser menos citados, mientras los Sentimientos positivos y de esperanza eran los más relatados por los pacientes.Com o objetivo de identificar os sentimentos apresentados frente à notícia da necessidade de realização de uma cirurgia cardíaca e, posteriormente, no período de internação que a antecede (pré-operatório, foram entrevistados 20 pacientes do sexo masculino. A metodologia foi a de estudo de caso, e o processo de an

  13. Comparação do índice de respiração rápida e superficial (IRRS calculado de forma direta e indireta no pós-operatório de cirurgia cardíaca Comparison of the rapid shallow breathing index (RSBI calculated under direct and indirect form on the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Fernando A. M. Lessa

    2010-12-01

    Full Text Available OBJETIVOS: Comparar e analisar a correlação entre o índice de respiração rápida e superficial (IRRS determinado com os valores fornecidos pelo software do ventilador mecânico Raphael® e pelo ventilômetro digital. MÉTODOS: Participaram do estudo 22 indivíduos adultos (17 homens e 5 mulheres, intubados, no pós-operatório de cirurgia cardíaca. Antes da coleta de dados, cada indivíduo foi avaliado, recebeu atendimento fisioterapêutico a fim de promover higiene brônquica e reexpansão pulmonar e foi posicionado em decúbito dorsal elevado em 45º, e depois foram registrados os valores de volume minuto (VM e frequência respiratória (FR obtidos pelo ventilador e pelo ventilômetro. O IRRS foi calculado pela relação FR/volume corrente (VC. Aplicou-se o teste t-pareado para comparação das variáveis relacionadas. Utilizou-se o coeficiente de correlação intraclasse (CCI para mensuração da replicabilidade dos escores. RESULTADOS: Observou-se diferença significativa entre o IRRS obtido pelo ventilador mecânico e o obtido pelo ventilômetro (p-valor=0,011 e concordância moderada para VM (CCI=0,74, alta concordância para FR (CCI=0,80, VC (CCI=0,79 e IRRS (CCI=0,86. Para todas as variáveis, o p-valor foi menor que 0,05. CONCLUSÕES: Houve concordância estatisticamente significativa entre o IRRS calculado pelos valores registrados no ventilador mecânico e pela ventilometria Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR sob o número ACTRN12610000756022.OBJECTIVES: To compare and to analyze whether the values of rapid shallow breathing index (RSBI determined by a ventilator display and a digital ventilometer were correlated. METHODS: Twenty-two adult patients (17 males and 5 females in the postoperative period of cardiac surgery and in mechanical ventilation were studied. Prior to the data collection, each patient was evaluated, received physical therapy, in order to promote bronchial hygiene and

  14. Efeitos de um programa de reabilitação da musculatura inspiratória no pós-operatório de cirurgia cardíaca Efectos de un programa de rehabilitación de la musculatura inspiratoria en el postoperatorio de cirugía cardiaca Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Paulo Eduardo Gomes Ferreira

    2009-04-01

    Full Text Available FUNDAMENTO: Os músculos respiratórios são afetados pós operações cardíacas. OBJETIVO: Verificar se o condicionamento pré-operatório dos músculos inspiratórios poderia ajudar a diminuir a disfunção respiratória pós-operatória. MÉTODOS: Trinta voluntários de ambos os sexos com idade mínima de 50 anos, aguardando cirurgia de revascularização do miocárdio e/ou cirurgia de válvula cardíaca foram alocados de forma randômica em dois grupos. Quinze pacientes foram incluídos em um programa domiciliar de pelo menos 2 semanas de treinamento pré-operatório dos músculos inspiratórios usando um dispositivo com uma carga correspondente a 40% da pressão inspiratória máxima. Os outros 15 receberam orientações gerais e não treinaram os músculos inspiratórios. A espirometria, antes e depois do programa de treinamento, bem como a evolução dos gases sanguíneos arteriais e das pressões inspiratória e expiratória máximas, foram avaliados em ambos os grupos antes e depois da cirurgia. Os desfechos clínicos dos dois grupos também foram comparados. RESULTADOS: Observamos que o treinamento dos músculos inspiratórios aumentou a capacidade vital forçada, a ventilação voluntária máxima e a relação entre o volume expirado forçado no primeiro segundo e a capacidade vital forçada. A evolução dos gases sanguíneos e das pressões expiratória e inspiratória máximas antes e depois da cirurgia foi similar em ambos os grupos, com desfechos também similares. CONCLUSÃO: Concluímos que nosso programa domiciliar de treinamento dos músculos inspiratórios foi seguro e melhorou a capacidade vital forçada e a ventilação voluntária máxima, embora os benefícios clínicos desse programa não tenham sido claramente demonstrados no presente estudo.FUNDAMENTO: Los músculos respiratorios se ven afectados tras operaciones cardíacas. OBJETIVO: Verificar si el condicionamiento preoperatorio de los músculos inspiratorios podr

  15. Efeito da fisioterapia contra-resistida com relação à massa corporal magra em pacientes no pós-operatório de cirurgia bariátrica Effect of counter resisted physiotherapy in relationship to the lean body mass after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Denise Serpa Bopp Nassif

    2011-09-01

    Full Text Available RACIONAL: Cálculos metabólicos e de atividade física são realizados a partir do tecido ativo presente no corpo, conhecido como massa corporal magra, que resulta da soma da massa magra isenta de gordura com a gordura essencial. A cinesioterapia é a musculação terapêutica que auxilia na força e flexibilidade. OBJETIVOS: No paciente submetido a tratamento cirúrgico para obesidade mórbida: 1 avaliar o efeito da fisioterapia contra-resistida na massa magra; 2 avaliar os fatores associados às variações de massa corporal magra com tratamento fisioterapêutico; 3 comparar o grupo de pacientes que perdeu com o que ganhou massa magra com o tratamento fisioterapêutico, analisando as co-morbidades que interferiram para esses resultados. MÉTODO: Foram incluídos 100 pacientes operados pela técnica de Fobi-Capella, ou derivação em Y-de-Roux, sem anel e divididos em grupo A composto por pacientes que perderam massa corporal magra nos dois períodos avaliados (entre 30 dias e três meses e entre três meses e seis meses e o grupo B pelos demais pacientes que apresentaram ganho de massa corporal magra em pelo menos um dos períodos avaliados. A coleta de dados foi realizada através do Protocolo Eletrônico Multiprofissional em Cirurgia Bariátrica e Metabólica com Ênfase em Fisioterapia, identificado pela siga SINPE© (Sistema Integrado de Protocolos Eletrônicos. Os pacientes realizaram avaliação fisioterapêutica pré-operatória e foram acompanhados no período pós-operatório em quatro fases: na internação hospitalar, submetidos à musculação terapêutica em 30 dias após a operação, aos três meses e aos seis meses do pós-operatório. RESULTADOS: Houve diferença significativa entre as três avaliações (pBACKGROUND: Calculations of metabolic and physical activity are carried out from the active tissue in the body, known as lean body mass, which is the sum of fat-free lean mass to essential fat. Kinesiotherapy helps in

  16. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  17. Preparing for Surgery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  19. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  1. Facial Cosmetic Surgery

    Science.gov (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  2. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  3. Inalação de solução salina hipertônica como coadjuvante da fisioterapia respiratória para reversão de atelectasia no pós-operatório de cirurgia cardíaca pediátrica Inhalation of hypertonic saline solution as coadjuvant in respiratory physiotherapy to reverse atelectasis in the postoperative of pediatric heart surgery

    Directory of Open Access Journals (Sweden)

    Naila Luisa Saiki da Silva

    2006-12-01

    Full Text Available Criança de 11 meses, sexo feminino, submetida à operação de fechamento de comunicação interventricular, comunicação interatrial e ligadura de canal arterial. Evoluiu no pós-operatório com atelectasia persistente em base pulmonar à direita, não respondendo às manobras fisioterapêuticas convencionais, efetuadas seis vezes ao dia. Após associação, como coadjuvante, da inalação de solução salina hipertônica com NaCl a 6%, imediatamente antes e após o atendimento fisioterápico, observou-se crises de tosse produtiva, com maior indução do escarro e resolução completa da atelectasia, com três dias de tratamento.The case of an eleven-month-old female child is presented diagnosed as having congenital heart disease with pulmonary hyperflow, who was submitted to a surgery to close an interventricular communication, interatrial communication and arterial canal ligature. The infant evolved with persistent atelectasis at the right lung base in the postoperative period which did not respond to conventional physiotherapeutic measures. Inhalation of hypertonic saline solution with 6% NaCl was associated as a coadjuvant therapy, giving a total cure of the atelectasis after three days of treatment.

  4. Regulating public space on the beachfronts of Rio de Janeiro.

    Science.gov (United States)

    Godfrey, Brian J; Arguinzoni, Olivia M

    2012-01-01

    Despite the fortification of buildings, streets, and public squares, Rio de Janeiro's beaches remain widely regarded as democratic spaces of social diversity and accessibility. Our study revisits the question of Rio's “democratic” beachfronts, based on local interviews, field observations, official reports, and newspaper accounts. We focus on historical and contemporary perceptions of planning, privatization, and public-order programs on the city's southern seaside. Institutional discourses have justified increasing regulation to combat threats of disorder and insecurity. While residents value the relative openness of beachfronts, they also acknowledge issues of safety, social segmentation, and subtle forms of bias. The public generally applauds recent “Shock of Order” policing and commercial revitalization, although critics lament the loss of traditional freedoms for informal beach vendors and casual sports. These paradoxes highlight enduring tensions between social order and hierarchy on one hand, and democratic rights and equality on the other.

  5. Laparoscopic surgery: A pioneer's point of view.

    Science.gov (United States)

    Périssat, J

    1999-08-01

    For a surgeon who performed some of the first laparoscopic cholecystectomies, laparoscopic surgery is undoubtedly the main revolution in the last decade of this century. It is impossible not to be fascinated by the extraordinary changes introduced in our profession in less than 10 years. However, looking back in history, one realizes that laparoscopy is but one of those leaps forward that have always punctuated the evolution of our profession. Since the last century we have witnessed the advent of painless surgery, infectionless surgery, reconstructive surgery, microsurgery, surgery under extracorporeal circulation, organ replacement, and so on. We are in the time of scarless surgery, with no lengthy postoperative handicap. Maybe tomorrow will see surgery performed by remote-controlled robots and surgery at the molecule level. The laparoscopic revolution is particularly important because for the first time surgery no longer involves any physical contact between the surgeon's hand and the patient. Let us hope that this will not lead to total absence of a human relationship in the surgical operation. To avoid this possibility we must remain resolutely involved in the development of laparoscopic surgery; we must keep our minds open to the future advances of science and technology and integrate them in our operative procedures.

  6. GASTOS TRIBUTÁRIOS E RECURSOS ORÇAMENTÁRIOS NAS POLÍTICAS CULTURAIS

    Directory of Open Access Journals (Sweden)

    Eduardo Gomor dos Santos

    2014-01-01

    Full Text Available This paper analyses the availability of public resources for Brazilian cultural policies. The study comes from an intrinsic relation between culture and politics, between ways of seeing, living and thinking the world and its political consequences, identifying the umbilical link between culture and hegemony in classes societies. Analyses laws based on tax waiver, specifically patronage, which presented annual values similar to the Ministry of Culture budget itself; and Living Culture Program, which represented a significant change in State intervention in cultural themes. It concludes that incentive laws mean losses in democratic control and also reproduce regional inequalities, with higher resources concentration in São Paulo and Rio de Janeiro, acting as marketing tool for large corporations. Living Culture Program, on the other hand, presents a more equality public resources distribution, but is still contemplated with a derisive budget compared to incentive laws.

  7. Multi-fingered robotic hand

    Science.gov (United States)

    Ruoff, Carl F. (Inventor); Salisbury, Kenneth, Jr. (Inventor)

    1990-01-01

    A robotic hand is presented having a plurality of fingers, each having a plurality of joints pivotally connected one to the other. Actuators are connected at one end to an actuating and control mechanism mounted remotely from the hand and at the other end to the joints of the fingers for manipulating the fingers and passing externally of the robot manipulating arm in between the hand and the actuating and control mechanism. The fingers include pulleys to route the actuators within the fingers. Cable tension sensing structure mounted on a portion of the hand are disclosed, as is covering of the tip of each finger with a resilient and pliable friction enhancing surface.

  8. The human hand as an inspiration for robot hand development

    CERN Document Server

    Santos, Veronica

    2014-01-01

    “The Human Hand as an Inspiration for Robot Hand Development” presents an edited collection of authoritative contributions in the area of robot hands. The results described in the volume are expected to lead to more robust, dependable, and inexpensive distributed systems such as those endowed with complex and advanced sensing, actuation, computation, and communication capabilities. The twenty-four chapters discuss the field of robotic grasping and manipulation viewed in light of the human hand’s capabilities and push the state-of-the-art in robot hand design and control. Topics discussed include human hand biomechanics, neural control, sensory feedback and perception, and robotic grasp and manipulation. This book will be useful for researchers from diverse areas such as robotics, biomechanics, neuroscience, and anthropologists.

  9. ESD and the Rio Conventions

    Science.gov (United States)

    Sarabhai, Kartikeya V.; Ravindranath, Shailaja; Schwarz, Rixa; Vyas, Purvi

    2012-01-01

    Chapter 36 of Agenda 21, a key document of the 1992 Earth Summit, emphasised reorienting education towards sustainable development. While two of the Rio conventions, the Convention on Biological Diversity (CBD) and the United Nations Framework Convention on Climate Change (UNFCCC), developed communication, education and public awareness (CEPA)…

  10. Giant lipomas of the hand

    Directory of Open Access Journals (Sweden)

    Gokce Yildiran

    2015-04-01

    Conclusion: Giant lipomas of the hand are very rare and may cause compressions and other complications. Thus, they require a careful preoperative evaluation in order to make a proper differential diagnosis. [Hand Microsurg 2015; 4(1.000: 8-11

  11. Canadian hand dermatitis management guidelines

    DEFF Research Database (Denmark)

    Lynde, Charles; Guenther, Lyn; Diepgen, Thomas L

    2010-01-01

    Hand dermatitis (HD) is one of the most common skin conditions; however, it is not a homogeneous disease entity. The severity of HD may range from very mild cases to severe chronic forms, which may result in prolonged disability and, occasionally, refractory HD. Chronic hand dermatitis (CHD...

  12. Hand, Foot, and Mouth Disease

    Centers for Disease Control (CDC) Podcasts

    Hand, foot, and mouth disease is a contagious illness that mainly affects children under five. In this podcast, Dr. Eileen Schneider talks about the symptoms of hand, foot, and mouth disease, how it spreads, and ways to help protect yourself and your children from getting infected with the virus.

  13. Computed tomography-controlled stereotactic surgery

    International Nuclear Information System (INIS)

    Matsumoto, Keizo; Shichijo, Fumio; Gyoten, Tetsuya; Tomida, Keisuke; Miyake, Hajime

    1986-01-01

    A single use of coordinate system of computed tomography (CT) scanner is utilized for CT-controlled stereotactic surgery. Depth, direction and readjustment of target trajectory were defined by known values of cursor number in CT images and numbers of the sliding table indicator. We loaded calculation formulas into hand held computer to obtain immediate answers. Stereotactic apparatus consisted two main parts: the patient's head fixation and probe holder. Surgery was performed in cases of hypertensive intracerebral hemorrhage for evacuation of the hematomas successfully. Target accuracy was satisfactory. With further advance of this surgery, automatic stereotactic control with a special robot machine seeing possible. (author)

  14. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  15. Effect of hand sanitizer location on hand hygiene compliance.

    Science.gov (United States)

    Cure, Laila; Van Enk, Richard

    2015-09-01

    Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Degloving injuries of the hand

    Directory of Open Access Journals (Sweden)

    R Krishnamoorthy

    2011-01-01

    Full Text Available Avulsion of skin from the hand or fingers is an injury that has a dramatic presentation. The entire musculo-skeletal unit of the finger is intact, and the patient can often move the parts of his naked hand quite normally. The challenge for the reconstructive surgeon lies in resurfacing the hand or finger with a good quality pliable sensate skin cover while preserving the movements and function of the hand. Traditionally, skin grafting has been the standard method of reconstruction in such injuries. However, skin grafting does have many disadvantages, too. This article deals with the features of such injuries, management protocols and other reconstructive options available in the armamentarium of the hand surgeon.

  17. 3D Printed Robotic Hand

    Science.gov (United States)

    Pizarro, Yaritzmar Rosario; Schuler, Jason M.; Lippitt, Thomas C.

    2013-01-01

    Dexterous robotic hands are changing the way robots and humans interact and use common tools. Unfortunately, the complexity of the joints and actuations drive up the manufacturing cost. Some cutting edge and commercially available rapid prototyping machines now have the ability to print multiple materials and even combine these materials in the same job. A 3D model of a robotic hand was designed using Creo Parametric 2.0. Combining "hard" and "soft" materials, the model was printed on the Object Connex350 3D printer with the purpose of resembling as much as possible the human appearance and mobility of a real hand while needing no assembly. After printing the prototype, strings where installed as actuators to test mobility. Based on printing materials, the manufacturing cost of the hand was $167, significantly lower than other robotic hands without the actuators since they have more complex assembly processes.

  18. The hand of Homo naledi

    Science.gov (United States)

    Kivell, Tracy L.; Deane, Andrew S.; Tocheri, Matthew W.; Orr, Caley M.; Schmid, Peter; Hawks, John; Berger, Lee R.; Churchill, Steven E.

    2015-01-01

    A nearly complete right hand of an adult hominin was recovered from the Rising Star cave system, South Africa. Based on associated hominin material, the bones of this hand are attributed to Homo naledi. This hand reveals a long, robust thumb and derived wrist morphology that is shared with Neandertals and modern humans, and considered adaptive for intensified manual manipulation. However, the finger bones are longer and more curved than in most australopiths, indicating frequent use of the hand during life for strong grasping during locomotor climbing and suspension. These markedly curved digits in combination with an otherwise human-like wrist and palm indicate a significant degree of climbing, despite the derived nature of many aspects of the hand and other regions of the postcranial skeleton in H. naledi. PMID:26441219

  19. Em foco: sustentabilidade Rio 2016, Agosto 2015

    OpenAIRE

    2015-01-01

    Neste endereço, é possível encontrar o primeiro relatório de sustentabilidade do Rio 2016, "Abraçando Mudanças", bem como o Plano de Gestão de Sustentabilidade, o Relatório de Gestão de Pegada de Carbono e o Relatório de Impacto dos Jogos.

  20. Estratégias ventilatórias frente à hipoxemia em cirurgia cardíaca: validação de questionário para anestesiologistas no Brasil Estrategias ventilatorias frente a la hipoxemia en cirugía cardíaca: validación de cuestionario para anestesiólogos en Brasil Ventilatory strategies for hypoxemia during cardiac surgery: survey validation for anesthesiologists in Brazil

    Directory of Open Access Journals (Sweden)

    Celso Augusto Martins Parra

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A hipoxemia perioperatória ocorre frequentemente em cirurgia cardíaca e a atelectasia é sua principal causa. Além disso, podemos citar como causas circulação extracorpórea (CEC, dissecção de artérias torácicas internas, status clínico prévio do paciente, entre outras. O presente estudo elaborou um questionário anônimo para observar as estratégias ventilatórias frente à hipoxemia em cirurgia cardía ca adotadas por cinco mil anestesiologistas distribuídos no país. MÉTODO: Foram enviados questionários por e-mail a cinco mil anestesiologistas do Brasil. RESULTADOS: Dos questionários enviados, foram recebidas 81 respostas válidas. Dentre as respostas, 65 (80% anestesiologistas fazem uso da ventilação controlada a volume (VCV frente a 16 (20% que preferem ventilação controlada à pressão (PCV. O volume (Vt corrente utilizado é inferior a 10 mL.kg-1 para 46 (61% contra 29 (39% que adotam um Vt maior que 10 mL.kg-1. Quarenta e sete (58% usam PEEP e 17 (21% utilizam FiO2 acima de 60%. No caso de hipoxemia intraoperatória, 20,9% aumentam ou introduzem PEEP, 70,3% aumentam a FiO2, 19,7% realizam manobra de recrutamento alveolar, 13,5% aumentam o volume-corrente e 20,9% realizam checagem de falhas no aparelho de anestesia. As respostas foram enviadas de 15 estados. CONCLUSÕES: As condutas descritas nos questionários respondidos são compatíveis com a literatura internacional. Com ajuste no formato do questionário e na abordagem aos anestesiologistas, novos estudos poderão ser realizados.JUSTIFICATIVA Y OBJETIVOS: La hipoxemia perioperatoria ocurre frecuentemente en la cirugía cardíaca, y la atelectasia es su principal causa. Además, podemos citar como causas la circulación extracorpórea (CEC, disección de arterias torácicas internas, status clínico previo del paciente, entre otras. El presente estudio elaboró un cuestionario anónimo para observar las estrategias ventilatorias frente a

  1. Reevaluation of needlescopic surgery.

    Science.gov (United States)

    Tagaya, Nobumi; Kubota, Keiichi

    2012-01-01

    Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.

  2. Antifibrinolytics in liver surgery

    Directory of Open Access Journals (Sweden)

    Jalpa Makwana

    2010-01-01

    Full Text Available Hyperfibrinolysis, a known complication of liver surgery and orthotopic liver transplantation (OLT, plays a significant role in blood loss. This fact justifies the use of antifibrinolytic drugs during these procedures. Two groups of drug namely lysine analogues [epsilon aminocaproic acid (EACA and tranexamic acid (TA] and serine-protease-inhibitors (aprotinin are frequently used for this purpose. But uniform data or guidelines on the type of antifibrinolytic drugs to be used, their indications and correct dose, is still insufficient. Antifibrinolytics behave like a double-edged sword. On one hand, there are benefits of less transfusion requirements but on the other hand there is potential complication like thromboembolism, which has been reported in several studies. We performed a systematic search in PubMed and Cochrane Library, and we included studies wherein antifibrinolytic drugs (EACA, TA, or aprotinin were compared with each other or with controls/placebo. We analysed factors like intraoperative red blood cell and fresh frozen plasma requirements, the perioperative incidence of hepatic artery thrombosis, venous thromboembolic events and mortality. Among the three drugs, EACA is least studied. Use of extensively studied drug like aprotinin has been restricted because of its side effects. Haemostatic effect of aprotinin and tranexamic acid has been comparable. However, proper patient selection and individualized treatment for each of them is required. Purpose of this review is to study various clinical trials on antifibrinolytic drugs and address the related issues like benefits claimed and associated potential complications.

  3. Hand function with touch screen technology in children with normal hand formation, congenital differences, and neuromuscular disease.

    Science.gov (United States)

    Shin, David H; Bohn, Deborah K; Agel, Julie; Lindstrom, Katy A; Cronquist, Sara M; Van Heest, Ann E

    2015-05-01

    To measure and compare hand function for children with normal hand development, congenital hand differences (CHD), and neuromuscular disease (NMD) using a function test with touch screen technology designed as an iPhone application. We measured touch screen hand function in 201 children including 113 with normal hand formation, 43 with CHD, and 45 with NMD. The touch screen test was developed on the iOS platform using an Apple iPhone 4. We measured 4 tasks: touching dots on a 3 × 4 grid, dragging shapes, use of the touch screen camera, and typing a line of text. The test takes 60 to 120 seconds and includes a pretest to familiarize the subject with the format. Each task is timed independently and the overall time is recorded. Children with normal hand development took less time to complete all 4 subtests with increasing age. When comparing children with normal hand development with those with CHD or NMD, in children aged less than 5 years we saw minimal differences; those aged 5 to 6 years with CHD took significantly longer total time; those aged 7 to 8 years with NMD took significantly longer total time; those aged 9 to 11 years with CHD took significantly longer total time; and those aged 12 years and older with NMD took significantly longer total time. Touch screen technology has becoming increasingly relevant to hand function in modern society. This study provides standardized age norms and shows that our test discriminates between normal hand development and that in children with CHD or NMD. Diagnostic III. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Carcinoma inflamatório mamário canino.

    OpenAIRE

    Gomes, Cristiano; Voll, Juliana; Ferreira, Kelly; Ferreira, Rafael Rodrigues; Oliveira, Luciana Oliveira de; Contesini, Emerson Antônio; Oliveira, Rosemari Teresinha de

    2006-01-01

    O carcinoma inflamatório mamário é um carcinoma anaplásico com características clínicas e histopatológicas como crescimento rápido, envolvimento difuso, eritema, calor e dor nas mamas, edema nos membros posteriores, extensa infiltração de células inflamatórias, células epiteliais malignas nos linfonodos regionais apresentando um péssimo prognóstico. O cão é a única espécie animal em que esta neoplasia ocorre espontaneamente, entretanto apresenta uma incidência bastante rara tanto em humanos q...

  5. Hand in Hand - SEI Programmes for School Staff

    DEFF Research Database (Denmark)

    Nielsen, Birgitte Lund; Réol, Lise Andersen; Laursen, Hilmar Dyrborg

    2017-01-01

    This catalogue of research in the field of SEI programmes for the school staff’s and teachers’ SEI competencies is based on a review performed by the main researchers Birgitte Lund Nielsen, Lise Andersen Réol and Hilmar Dyrborg Laursen, VIA University College, Denmark, but discussed by the entire...... team of Hand in Hand partner countries and researchers. The aim was to identify the central aspects and elements concerning successful implementation, and school staff’s development of professional competencies in the specific field of supporting students’ social, emotional and intercultural (SEI......) competencies. Abstract: Framed by the EU-project Hand in Hand focusing on Social, Emotional and Intercultural (SEI) competencies among students and school staff, the paper discusses implementation and professional competencies based on a research review. The following five topics were identified: 1...

  6. Sonography of pathological changes in the hand

    Directory of Open Access Journals (Sweden)

    Anna Dębek

    2014-03-01

    Full Text Available Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain’s and Wartenberg’s disease, intersection syndrome or degenerative lesions of carpometacarpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys. In the case of carpal tunnel syndrome one can not only visualize the median nerve but also other structures of the tunnel that may cause compression. Similarly ulnar nerve compression within the Guyon’s canal can be well evaluated. In cases of nerve trauma one can precisely define the level, and in cases of nerve discontinuity, the distance between stumps can be measured which is important in surgery planning. Often nerve trauma is a sequelae of tendon reconstruction. In such cases scars and nerve entrapment can be depicted. Tumors within a hand are usually benign, of which the most common are ganglia. On ultrasound examination a connection between a ganglion and its source (usually a joint or sheath can frequently be defined. The relationship of tumors to nerves, tendon sheaths or vessels may suggest their nature. Ultrasound with dynamic tissue assessment is a very valuable adjunct to clinical examination.

  7. The Marble-Hand Illusion.

    Science.gov (United States)

    Senna, Irene; Maravita, Angelo; Bolognini, Nadia; Parise, Cesare V

    2014-01-01

    Our body is made of flesh and bones. We know it, and in our daily lives all the senses constantly provide converging information about this simple, factual truth. But is this always the case? Here we report a surprising bodily illusion demonstrating that humans rapidly update their assumptions about the material qualities of their body, based on their recent multisensory perceptual experience. To induce a misperception of the material properties of the hand, we repeatedly gently hit participants' hand with a small hammer, while progressively replacing the natural sound of the hammer against the skin with the sound of a hammer hitting a piece of marble. After five minutes, the hand started feeling stiffer, heavier, harder, less sensitive, unnatural, and showed enhanced Galvanic skin response (GSR) to threatening stimuli. Notably, such a change in skin conductivity positively correlated with changes in perceived hand stiffness. Conversely, when hammer hits and impact sounds were temporally uncorrelated, participants did not spontaneously report any changes in the perceived properties of the hand, nor did they show any modulation in GSR. In two further experiments, we ruled out that mere audio-tactile synchrony is the causal factor triggering the illusion, further demonstrating the key role of material information conveyed by impact sounds in modulating the perceived material properties of the hand. This novel bodily illusion, the 'Marble-Hand Illusion', demonstrates that the perceived material of our body, surely the most stable attribute of our bodily self, can be quickly updated through multisensory integration.

  8. Abiquiu Dam and Reservoir, Rio Grande Basin, Rio Chama, New Mexico. Embankment Criteria and Performance Report.

    Science.gov (United States)

    1987-04-01

    EMBANKMENT CRITERIA AND PERFORMANCE REPORT PERTINENT DATA 1. General Data. LOCATION: Rio Arriba County, New Mexico, on the Rio Chama at river mile 33. PURPOSE...is located across the Rio Chama, approximately 30 miles upstream from its confluence with the Rio Grande, in Rio Arriba County, New Mexico. The dam is...6600- 4 i ’. 6600 65060- -60 6600- a + v6500s-go FA**v~w -6500 6300- 60 - ~ ~ ~ wo Ala filll------------------ EMBNKEN SECTION62 *LDN WOR SAFEL VAIE

  9. Sphincter Saving Surgery in Low Rectal Carcinoma in a Resource ...

    African Journals Online (AJOL)

    Background: Surgery is the principal modality of treatment of rectal carcinoma in order to achieve cure. Sphincter saving surgery improves the quality of life of patients with low rectal carcinoma. Aim: To report a case of sphincter saving low anterior resection for low rectal cancer with hand sown colorectal anastomosis

  10. Barotrauma pulmonar no intra-operatório de procedimento cirúrgico oftalmológico: relato de caso Barotrauma pulmonar en el intraoperatorio de procedimiento quirúrgico oftalmológico: relato de caso Intraoperative pulmonary barotrauma during ophthalmologic surgery: case report

    Directory of Open Access Journals (Sweden)

    Affonso Henrique Zugliani

    2008-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Acidentes anestésicos graves por mau funcionamento de ventiladores mecânicos tornaram-se raros nos tempos atuais. Porém, detalhes técnicos, mesmo em aparelhos de fabricação recente, podem resultar em armadilhas para o anestesiologista e ameaçar a segurança do paciente. O objetivo deste relato de caso foi enfatizar a necessidade de análise criteriosa do material em uso, assim como de detectar e tratar o pneumotórax hipertensivo intra-operatório. RELATO DO CASO: Paciente do sexo feminino, 16 anos, estado físico ASA I, submetida a recobrimento conjuntival de córnea sob anestesia geral. A manutenção foi feita com isoflurano e ventilação controlada mecânica. A anestesia transcorreu sem anormalidades. Na fase final do procedimento cirúrgico, após mobilização do aparelho de anestesia para o início do procedimento de despertar, observou-se quadro de hipóxia, hipotensão arterial e dificuldade ventilatória. Retirados os campos cirúrgicos, evidenciou-se importante enfisema subcutâneo, envolvendo a face, o pescoço e o membro superior. Procedeu-se à troca da cânula traqueal, observando-se a presença de sangue em seu interior. A radiografia de tórax confirmou o diagnóstico de pneumotórax, que foi prontamente drenado. A inspeção no equipamento revelou acotovelamento da mangueira que liga a região inferior do canister ao corpo do aparelho, em função da mobilização do braço articulado, bloqueando o fluxo normal de gases e levando a barotrauma pulmonar. CONCLUSÕES: O pneumotórax hipertensivo durante anestesia geral com ventilação com pressão positiva deve ser sempre um acidente a ser considerado. Múltiplos fatores podem precipitá-lo, o que exige alto grau de suspeição sempre que estiverem envolvidos no ato anestésico-cirúrgico. O equipamento de anestesia deve ser cuidadosamente examinado para que sejam detectadas potenciais causas de acidentes anestésicos.JUSTIFICATIVA Y OBJETIVOS

  11. A paisagem de rios urbanos

    OpenAIRE

    Porath, Soraia Loechelt

    2004-01-01

    Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Arquitetura e Urbanismo Os rios têm sido uma presença constante na formação e crescimento das cidades. Desde os primórdios das civilizações, por uma questão de sobrevivência e utilidade, servem como fonte de recursos e meio de circulação. Porém, os rios urbanos são mal compreendidos. São entendidos como um limite ao crescimento das cidades, um obstáculo a ser transposto, e dest...

  12. Hand-assisted laparoscopic splenectomy

    NARCIS (Netherlands)

    Bemelman, W. A.; de Wit, L. T.; Busch, O. R.; Gouma, D. J.

    2000-01-01

    Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers. Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure through enhanced vascular control, easier

  13. Animal Bites of the Hand

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Animal Bites Email to a friend * required fields From * ... key to prevent problems from a bite. CAUSES Animal Bites Millions of animal bites occur in the ...

  14. Hand and foot contamination monitor

    International Nuclear Information System (INIS)

    Jakati, R.K.; Kaptral, R.S.; Ananthkrishnan, T.S.; Pansare, M.G.

    1989-01-01

    In order to make quick measurements of beta and gamma contaminations on hands and feet of personnel working in radioactive environments, hand and foot contamination monitors are widely used. This paper describes such a monitor system designed with Intel 8085 based microcomputer. The monitoring and warning system is designed to perform measurement of activity spread over surface of hands and soles of shoes or feet. Even though the system has many features to aid testing and maintainance operation, it is easy to use for unskilled persons. In order to check the contamination, the person stands on platform and inserts both his hands into detector assemblies thereby actuating the sensing switches. After a preset interval, annunciation of clean or contaminated status is declared by the system. (author)

  15. Hand, Foot, and Mouth Disease

    Centers for Disease Control (CDC) Podcasts

    2013-08-08

    Hand, foot, and mouth disease is a contagious illness that mainly affects children under five. In this podcast, Dr. Eileen Schneider talks about the symptoms of hand, foot, and mouth disease, how it spreads, and ways to help protect yourself and your children from getting infected with the virus.  Created: 8/8/2013 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 8/8/2013.

  16. Hand Grasping Synergies As Biometrics.

    Science.gov (United States)

    Patel, Vrajeshri; Thukral, Poojita; Burns, Martin K; Florescu, Ionut; Chandramouli, Rajarathnam; Vinjamuri, Ramana

    2017-01-01

    Recently, the need for more secure identity verification systems has driven researchers to explore other sources of biometrics. This includes iris patterns, palm print, hand geometry, facial recognition, and movement patterns (hand motion, gait, and eye movements). Identity verification systems may benefit from the complexity of human movement that integrates multiple levels of control (neural, muscular, and kinematic). Using principal component analysis, we extracted spatiotemporal hand synergies (movement synergies) from an object grasping dataset to explore their use as a potential biometric. These movement synergies are in the form of joint angular velocity profiles of 10 joints. We explored the effect of joint type, digit, number of objects, and grasp type. In its best configuration, movement synergies achieved an equal error rate of 8.19%. While movement synergies can be integrated into an identity verification system with motion capture ability, we also explored a camera-ready version of hand synergies-postural synergies. In this proof of concept system, postural synergies performed well, but only when specific postures were chosen. Based on these results, hand synergies show promise as a potential biometric that can be combined with other hand-based biometrics for improved security.

  17. Hand Grasping Synergies As Biometrics

    Directory of Open Access Journals (Sweden)

    Ramana Vinjamuri

    2017-05-01

    Full Text Available Recently, the need for more secure identity verification systems has driven researchers to explore other sources of biometrics. This includes iris patterns, palm print, hand geometry, facial recognition, and movement patterns (hand motion, gait, and eye movements. Identity verification systems may benefit from the complexity of human movement that integrates multiple levels of control (neural, muscular, and kinematic. Using principal component analysis, we extracted spatiotemporal hand synergies (movement synergies from an object grasping dataset to explore their use as a potential biometric. These movement synergies are in the form of joint angular velocity profiles of 10 joints. We explored the effect of joint type, digit, number of objects, and grasp type. In its best configuration, movement synergies achieved an equal error rate of 8.19%. While movement synergies can be integrated into an identity verification system with motion capture ability, we also explored a camera-ready version of hand synergies—postural synergies. In this proof of concept system, postural synergies performed well, but only when specific postures were chosen. Based on these results, hand synergies show promise as a potential biometric that can be combined with other hand-based biometrics for improved security.

  18. Effects of hand grip exercise on shoulder joint internal rotation and external rotation peak torque.

    Science.gov (United States)

    Lee, Dong-Rour; Jong-Soon Kim, Laurentius

    2016-08-10

    The goal of this study is to analyze the effects of hand grip training on shoulder joint internal rotation (IR)/external rotation (ER) peak torque for healthy people. The research was conducted on 23 healthy adults in their 20 s-30 s who volunteered to participate in the experiment. Hand grip power test was performed on both hands of the research subjects before/after the test to study changes in hand grip power. Isokinetic machine was used to measure the concentric IRPT (internal rotation peak torque) and concentric ERPT (external rotation peak torque) at the velocity of 60°/sec, 90°/sec, and 180°/sec before/after the test. Hand grip training was performed daily on the subject's right hand only for four weeks according to exercise program. Finally, hand grip power of both hands and the maximum torque values of shoulder joint IR/ER were measured before/after the test and analyzed. There was a statistically significant difference in the hand grip power of the right hand, which was subject to hand grip training, after the experiment. Also, statistically significant difference for shoulder ERPT was found at 60°/sec. Hand grip training has a positive effect on shoulder joint IRPT/ERPT and therefore can help strengthen muscles around the shoulder without using weight on the shoulder. Consequently, hand grip training would help maintain strengthen the muscles around the shoulder in the early phase of rehabilitation process after shoulder surgery.

  19. Hand Injuries by the Killer Kite Manja and Their Management.

    Science.gov (United States)

    Mir, Mohd Altaf; Ali, Adil Mahmud; Yaseen, Mohd; Khan, Arshad Hafeez

    2017-05-01

    Although hand injuries due to kite strings seem to be trivial, these injuries could be serious enough to lose the function of hand. This case series in the division of Plastic and Reconstructive Surgery of our institution from August 2014 to January 2016 evaluated the clinic-etiological profile, severity and management of hand injuries due to kite strings assessed clinically and radiologically. Eleven patients reported kite related injuries during two years, and 5 presented during 17 months. Of 11 patients, 8 were male and 3 were female with a M:F ratio of 2.66:1. The majority of patients presented with the mean age of 19.9±4.27 years. Eight patients presented acutely to the emergency while 3 believed the injury to be trivial and had delayed presentation. Injuries in the right hand were 8 and 3 in the left hand. Seven patients had injuries in zone II of the hand while 4 presented with zone III injuries. Total number of injured digits was 14 (1.4±1.11), total number of injured tendons was 26 (2.36±2.18), only one patient had nerve injury (mean=0.09), and no patient had any major vessel injury. So strict attention to safety measures and parental/guardian supervision while flying kites can avoid many preventable injuries to life and limb and also let the sport be an enjoyable and safe.

  20. The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

    Science.gov (United States)

    Badalato, Gina M; Shapiro, Edan; Rothberg, Michael B; Bergman, Ari; RoyChoudhury, Arindam; Korets, Ruslan; Patel, Trushar; Badani, Ketan K

    2014-01-01

    Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference. Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance. Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (Probot tasks, respectively (Probotic and open approaches for raw time scores (Phand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts. The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

  1. Tennis elbow surgery - discharge

    Science.gov (United States)

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  2. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  3. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  4. Hip Replacement Surgery

    Science.gov (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  5. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  8. Radiological imaging of congenital hand anomalies - a 6-year single-centre experience and what the hand surgeons want to know

    International Nuclear Information System (INIS)

    Gerety, E.L.; Hopper, M.A.; Grant, I.

    2015-01-01

    Congenital hand anomalies present a rare but important physical and emotional challenge for children and parents. Radiological imaging is important for accurate diagnosis, to aid decision making and to monitor changes in the growing hand. The goal of any treatment is to help the child achieve his/her maximum potential, to provide a useful hand with attention to cosmesis. We investigated the range of congenital hand anomalies imaged in a tertiary referral centre. We examined the timing of imaging and the key clinical questions. The radiology imaging system was searched retrospectively for radiographs of congenital hand anomalies over a 6-year period. The images were reviewed and patient demographics, diagnosis and other imaging recorded. Over 6 years, 85 patients had imaging. Twenty-three patients had bilateral problems and 11 had recognised syndromes. The most common abnormalities imaged were duplicated thumbs (28 %), followed by syndactyly (18 %). Children were first imaged as early as 1 day old, with the median age of initial imaging 12 months. Thumb duplication and syndactyly are the most common conditions for which radiographs are requested at our hospital, although overall syndactyly is considered the most common congenital hand anomaly. For a variety of reasons, children are often imaged very early, before review by the Specialist in Children's Hand Surgery (despite surgery being unlikely before 1 year of age.) We discuss the classification systems and specific issues that hand surgeons want to know from the radiologists. (orig.)

  9. Radiological imaging of congenital hand anomalies - a 6-year single-centre experience and what the hand surgeons want to know

    Energy Technology Data Exchange (ETDEWEB)

    Gerety, E.L.; Hopper, M.A. [Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Grant, I. [Cambridge University Hospitals NHS Foundation Trust, Department of Plastic Surgery, Cambridge (United Kingdom)

    2014-12-19

    Congenital hand anomalies present a rare but important physical and emotional challenge for children and parents. Radiological imaging is important for accurate diagnosis, to aid decision making and to monitor changes in the growing hand. The goal of any treatment is to help the child achieve his/her maximum potential, to provide a useful hand with attention to cosmesis. We investigated the range of congenital hand anomalies imaged in a tertiary referral centre. We examined the timing of imaging and the key clinical questions. The radiology imaging system was searched retrospectively for radiographs of congenital hand anomalies over a 6-year period. The images were reviewed and patient demographics, diagnosis and other imaging recorded. Over 6 years, 85 patients had imaging. Twenty-three patients had bilateral problems and 11 had recognised syndromes. The most common abnormalities imaged were duplicated thumbs (28 %), followed by syndactyly (18 %). Children were first imaged as early as 1 day old, with the median age of initial imaging 12 months. Thumb duplication and syndactyly are the most common conditions for which radiographs are requested at our hospital, although overall syndactyly is considered the most common congenital hand anomaly. For a variety of reasons, children are often imaged very early, before review by the Specialist in Children's Hand Surgery (despite surgery being unlikely before 1 year of age.) We discuss the classification systems and specific issues that hand surgeons want to know from the radiologists. (orig.)

  10. Nudging to improve hand hygiene.

    Science.gov (United States)

    Caris, M G; Labuschagne, H A; Dekker, M; Kramer, M H H; van Agtmael, M A; Vandenbroucke-Grauls, C M J E

    2018-04-01

    Hand hygiene is paramount to prevent healthcare-associated infections, but improving compliance is challenging. When healthcare workers seldom encounter healthcare-associated infections, they will consider the odds of causing infections through poor hand hygiene negligible. Cognitive biases such as these may induce non-compliance. Nudging, 'a friendly push to encourage desired behaviour', could provide an easily implemented, inexpensive measure to address cognitive biases and thus support hand hygiene interventions. To investigate whether behavioural nudges, displayed as posters, can increase the use of alcohol-based hand rub. We developed nudges based on a systematic review of previously described cognitive biases, and tested these through a cross-sectional survey among the target audience. We then conducted a controlled before-after trial on two hospital wards, to assess the effect of these nudges on the use of alcohol-based hand rub, measured with electronic dispensers. Poisson regression analyses adjusted for workload showed that nudges displayed next to dispensers increased their overall use on one ward [poster 1: relative risk: 1.6 (95% confidence interval: 1.2-2.2); poster 2: 1.7 (1.2-2.5)] and during doctor's rounds on both wards [poster 1: ward A: 1.7 (1.1-2.6); ward B: 2.2 (1.3-3.8)]. Use of dispensers without adjacent nudges did not increase. Nudges based on cognitive biases that play a role in hand hygiene, and displayed as posters, could provide an easy, inexpensive measure to increase use of alcohol-based hand rub. When applying nudges to change behaviour, it is important to identify the right nudge for the right audience. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  11. Breast Reduction Surgery

    Science.gov (United States)

    ... considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as ...

  12. Myelopathy hand in cervical radiculopathy

    International Nuclear Information System (INIS)

    Hosono, Noboru; Mukai, Yoshihiro; Takenaka, Shota; Fuji, Takeshi; Sakaura, Hironobu; Miwa, Toshitada; Makino, Takahiro

    2010-01-01

    The so-called 'myelopathy hand', or characteristic finger paralysis, often recognized in cervical compression myelopathy, has been considered a unique manifestation of cervical myelopathy. We used our original grip and release test, a 15-second test in which finger motion is captured with a digital camera, to investigate whether cervical radiculopathy has the same characteristics as myelopathy hand. Thirty patients with pure radiculopathy, id est (i.e.), who had radiating arm pain and evidence of corresponding nerve root impingement on X-ray images or MRI scans, but did not have spinal cord compression, served as the subjects. In contrast to other radiculopathies, C7 radiculopathy was manifested by a significant reduction in the number of finger motion cycles on the affected side in comparison with the unaffected side, the same as in myelopathy hand. Uncoordinated finger motion was significantly more frequent on the affected side in C6 radiculopathy than on the unaffected side. These findings contradict the conventional notion that myelopathy hand is a unique manifestation of cervical myelopathy, but some radiculopathies manifested the same kinds of finger paralysis observed in myelopathy hand. (author)

  13. O RIO CAPITAL IMAGINADO PELA CRÍTICA CINEMATOGRÁFICA: os casos de Rio Fantasia e Rio, 40 graus

    Directory of Open Access Journals (Sweden)

    Eliska Altmann

    Full Text Available No artigo, busca-se verificar como o Rio de Janeiro, “cidade-capital”, foi imaginado por críticos cinematográficos brasileiros. Por meio de críticas aos filmes Rio fantasia (1957, de Watson Macedo, e Rio, 40 graus (1955, de Nelson Pereira dos Santos, pretende-se entender como a então Capital Federal foi descrita e legitimada por agentes que formam julgamentos, quiçá, para a posteridade.

  14. Hand-Based Biometric Analysis

    Science.gov (United States)

    Bebis, George (Inventor); Amayeh, Gholamreza (Inventor)

    2015-01-01

    Hand-based biometric analysis systems and techniques are described which provide robust hand-based identification and verification. An image of a hand is obtained, which is then segmented into a palm region and separate finger regions. Acquisition of the image is performed without requiring particular orientation or placement restrictions. Segmentation is performed without the use of reference points on the images. Each segment is analyzed by calculating a set of Zernike moment descriptors for the segment. The feature parameters thus obtained are then fused and compared to stored sets of descriptors in enrollment templates to arrive at an identity decision. By using Zernike moments, and through additional manipulation, the biometric analysis is invariant to rotation, scale, or translation or an in put image. Additionally, the analysis utilizes re-use of commonly-seen terms in Zernike calculations to achieve additional efficiencies over traditional Zernike moment calculation.

  15. Natural control capabilities of robotic hands by hand amputated subjects.

    Science.gov (United States)

    Atzori, Manfredo; Gijsberts, Arjan; Caputo, Barbara; Muller, Henning

    2014-01-01

    People with transradial hand amputations who own a myoelectric prosthesis currently have some control capabilities via sEMG. However, the control systems are still limited and not natural. The Ninapro project is aiming at helping the scientific community to overcome these limits through the creation of publicly available electromyography data sources to develop and test machine learning algorithms. In this paper we describe the movement classification results gained from three subjects with an homogeneous level of amputation, and we compare them with the results of 40 intact subjects. The number of considered subjects can seem small at first sight, but it is not considering the literature of the field (which has to face the difficulty of recruiting trans-radial hand amputated subjects). The classification is performed with four different classifiers and the obtained balanced classification rates are up to 58.6% on 50 movements, which is an excellent result compared to the current literature. Successively, for each subject we find a subset of up to 9 highly independent movements, (defined as movements that can be distinguished with more than 90% accuracy), which is a deeply innovative step in literature. The natural control of a robotic hand in so many movements could lead to an immediate progress in robotic hand prosthetics and it could deeply change the quality of life of amputated subjects.

  16. Urunana Audiences at Home and Away: Together 'Hand in Hand'?

    NARCIS (Netherlands)

    H.M. Hintjens (Helen); F. Bayisenge

    2011-01-01

    textabstractUrunana (‘Hand in Hand’) is Rwanda’s first radio soap opera. The production emerged during the late 1990s from a three-way transnational production partnership between: The Great Lakes section of the BBC World Service; the Well Woman Media Project of the London-based NGO, Health

  17. Efeito analgésico intra-operatório da cetamina, clonidina ou dexmedetomidina, administradas por via peridural, em cirurgia de abdômen superior Efecto analgésico intra-operatorio de la cetamina, clonidina o dexmedetomidina, administradas por vía peridural, en cirugía de abdomen superior Intraoperative analgesic effect of epidural ketamine, clonidine or dexmedetomidine for upper abdominal surgery

    Directory of Open Access Journals (Sweden)

    Taylor Brandão Schnaider

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cetamina reduz a nocicepção, bloqueando os canais dos receptores NMDA, em doses sub-anestésicas. A ativação dos receptores alfa2-adrenérgicos induz intensa resposta analgésica. O objetivo desta pesquisa foi avaliar os efeitos da cetamina, clonidina e dexmedetomidina, por via peridural, em pacientes submetidos à cirurgia do abdômen superior. MÉTODO: Participaram deste estudo aleatório e duplamente encoberto, 70 pacientes, de ambos os gêneros, com idade entre 18 e 50 anos, estado físico ASA I e II, submetidos a colecistectomia por via subcostal, sob anestesia geral associada à peridural lombar. Na anestesia peridural foram administrados, aleatoriamente, 20 mL de ropivacaína a 0,75% e 1 mL de cloreto de sódio a 0,9% no grupo Controle (n = 10; 20 mL de ropivacaína a 0,75% e 0,5 mg.kg-1 de cetamina no grupo Cetamina (n = 20; 20 mL de ropivacaína a 0,75% e 1 mL de clonidina (150 µg no grupo Clonidina (n = 20 ou 20 mL de ropivacaína a 0,75% e 2 µg.kg-1 de dexmedetomidina no grupo Dexmedetomidina (n = 20. A indução anestésica foi realizada com etomidato, alfentanil e rocurônio, sendo a manutenção obtida pela administração de isoflurano e alfentanil. A analgesia foi observada por meio dos sinais clínicos e a concentração inspirada do agente inalatório por meio do analisador de gases ins e expirados, durante o ato operatório. RESULTADOS: Nos pacientes em que foi administrada cetamina, clonidina ou dexmedetomidina, ocorreu diminuição da freqüência cardíaca e da pressão arterial sistêmica, e não houve necessidade de complementação analgésica peri-operatória. Com relação à concentração inspirada do isoflurano, as necessidades variaram entre 0,5vol% e 1vol%, não se observando sinais clínicos ou respostas que sugerissem níveis inadequados de anestesia. CONCLUSÕES: A administração de cetamina, clonidina ou dexmedetomidina, por via peridural, reduz o consumo de alfentanil e a

  18. EthoHand: A dexterous robotic hand with ball-joint thumb enables complex in-hand object manipulation

    OpenAIRE

    Konnaris, C; Gavriel, C; Thomik, AAC; Aldo Faisal, A

    2016-01-01

    Our dexterous hand is a fundmanetal human feature that distinguishes us from other animals by enabling us to go beyond grasping to support sophisticated in-hand object manipulation. Our aim was the design of a dexterous anthropomorphic robotic hand that matches the human hand's 24 degrees of freedom, under-actuated by seven motors. With the ability to replicate human hand movements in a naturalistic manner including in-hand object manipulation. Therefore, we focused on the development of a no...

  19. Intrinsic contractures of the hand.

    Science.gov (United States)

    Paksima, Nader; Besh, Basil R

    2012-02-01

    Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of intrinsic and extrinsic muscles, which allows the hand to be so versatile and functional. The loss of muscle function primarily affects the interphalangeal joints but also may affect etacarpophalangeal joints. The resulting clinical picture is often termed, intrinsic contracture or intrinsic-plus hand. Disruption of the balance between intrinsic and extrinsic muscles has many causes and may be secondary to changes within the intrinsic musculature or the tendon unit. This article reviews diagnosis, etiology, and treatment algorithms in the management of intrinsic contractures of the fingers. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Lionfish envenomation of the hand.

    Science.gov (United States)

    Patel, M R; Wells, S

    1993-05-01

    Lionfish (Pterois volitans) envenomation of the hand causes excruciating pain and occurs in three grades: (1) erythematous reaction, (2) blister formation, and (3) dermal necrosis. The initial treatment in all cases is to soak the hand in nonscalding water (45 degrees C) until the pain subsides by denaturing the thermolabile venom proteins. The blisters should be immediately excised to prevent dermal necrosis, inasmuch as the blister fluid contains residual active venom. To prevent a hypersensitivity reaction, any further contact with the fish should be avoided.

  1. Hand-it-on”

    DEFF Research Database (Denmark)

    Dieckmann, Gerhard Peter; Graae Zeltner, Louise; Helsø, Anne-Mette

    2016-01-01

    Non-technical skills (NTS) are an integral part of the abilities healthcare professionals need to optimally care for patients. Integrating NTS into the already complex tasks of healthcare can be a challenge for clinicians. Integrating NTS into simulation-based training increases the demands...... and where they can apply them in their work. It complements existing approaches to teaching NTS by limiting the complexity of the game and by removing medical content, allowing learners to concentrate on NTS. Hand-it-on is relevant for groups and teams working across the range of different healthcare...... and the replication of Hand-it-on by many simulation teams support its value....

  2. Discovering Hands - México

    OpenAIRE

    Salamanca Cárdenas, Daniela; Castelblanco Domínguez, Junio Andrés; Aguilar Ardila, Laura Andrea

    2016-01-01

    El modelo de Discovering Hands ha sido reconocido internacionalmente como un proyecto innovador que se ha expandido por diferentes países del mundo, como Austria, y se ha empezado a estudiar la propuesta en países como República Checa, India y Colombia. (Discovering Hands, 2016). Esto se debe a que no solo mejora el tratamiento de cáncer de mama, sino que también reduce los costos totales de tratamiento de la enfermedad y aumenta la fuerza laborar de los países donde esté presente. Al represe...

  3. [The history of pediatric plastic surgery].

    Science.gov (United States)

    Glicenstein, J

    2016-10-01

    The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Laparoscopic Surgery for Recurrent Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Antonino Spinelli

    2012-01-01

    Full Text Available In spite of the recent improvements in drug therapy, surgery still represents the most frequent treatment for Crohn's disease (CD complications. Laparoscopy has been widely applied over the last twenty years in colorectal surgery and was associated with lower postoperative pain, shorter hospitalization, faster return to daily activities, and better cosmetic results. Laparoscopy experienced a slower diffusion in inflammatory bowel disease surgery than in oncologic colorectal surgery, but proved to be safe and effective, and is currently considered the gold standard for the treatment of primary uncomplicated ileocolic CD. Indications for laparoscopy in CD have recently been widened to embrace more complicated or recurrent CD. This paper reviews the available data on the subset of recurrent CD patients. The reported results indicate that laparoscopy may be safely applied even in selected recurrent CD cases in hands of IBD surgeons with broad laparoscopic experience.

  5. Modeling and evaluation of hand-eye coordination of surgical robotic system on task performance.

    Science.gov (United States)

    Gao, Yuanqian; Wang, Shuxin; Li, Jianmin; Li, Aimin; Liu, Hongbin; Xing, Yuan

    2017-12-01

    Robotic-assisted minimally invasive surgery changes the direct hand and eye coordination in traditional surgery to indirect instrument and camera coordination, which affects the ergonomics, operation performance, and safety. A camera, two instruments, and a target, as the descriptors, are used to construct the workspace correspondence and geometrical relationships in a surgical operation. A parametric model with a set of parameters is proposed to describe the hand-eye coordination of the surgical robot. From the results, optimal values and acceptable ranges of these parameters are identified from two tasks. A 90° viewing angle had the longest completion time; 60° instrument elevation angle and 0° deflection angle had better performance; there is no significant difference among manipulation angles and observing distances on task performance. This hand-eye coordination model provides evidence for robotic design, surgeon training, and robotic initialization to achieve dexterous and safe manipulation in surgery. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Cirurgia ambulatorial: identificação dos diagnósticos de enfermagem no período perioperatório Cirugía ambulatoria: identificación de los diagnósticos de enfermería en el período peri-operatorio Surgery in out patient units: identification of nursing diagnoses in the perioperative period

    Directory of Open Access Journals (Sweden)

    Maria Cristina Simões Flório

    2003-10-01

    Full Text Available O objetivo da presente investigação foi a identificação dos diagnósticos de enfermagem no período perioperatório do paciente cirúrgico ambulatorial. Como referencial teórico, selecionamos a teoria de Levine, na qual são propostos quatro princípios de conservação, a saber: conservação de energia, conservação da integridade estrutural, conservação da integridade pessoal e conservação da integridade social. Os dados foram coletados pela pesquisadora, no serviço de cirurgia ambulatorial de um hospital privado da cidade de Ribeirão Preto (São Paulo, nos meses de janeiro e fevereiro de 2001, utilizando um instrumento previamente validado. A amostra consistiu de trinta pacientes adultos submetidos a cirurgia de diferentes especialidades médicas, com anestesia regional ou geral. Após a coleta dos dados, procedemos a identificação dos diagnósticos de enfermagem, utilizando o processo de raciocínio diagnóstico descrito por Risner, e a construção das categorias diagnósticas teve como referência a taxonomia da NANDA e o estudo de Carpenito. No período perioperatório, foram identificados quinze diagnósticos e, neste estudo, analisamos aqueles que obtiveram uma freqüência igual ou maior que 50%, a saber: ansiedade, risco para infecção, risco para lesão por posicionamento perioperatório e dor.El objetivo de la presente investigación fue la identificación de los diagnósticos de enfermería en el período peri-operatorio del paciente ambulatorio quirúrgico. Como referencial teórico seleccionamos la teoría de Levine, en la cual son propuestos cuatro principios de conservación de energía, conservación de la integridad cultural, conservación de la integridad personal y conservación de la integridad social. Los datos fueron recolectados por la investigadora en el servicio de cirugía ambulatoria de un hospital privado de la ciudad de Ribeirão Preto (São Paulo en los meses de enero y febrero de 2001 utilizando

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  8. Characterizing hand-piled fuels

    Science.gov (United States)

    Clinton S. Wright; Paige C. Eagle; Cameron S. Balog

    2010-01-01

    Land managers throughout the West pile and burn surface fuels to mitigate fire hazard in dry forests. Whereas piling was historically conducted with heavy machinery following commercial harvesting operations, land managers are increasingly prescribing the use of hand piling and burning to treat surface fuels created by thinning and brush cutting. An estimate of the...

  9. Right-handed fossil humans.

    Science.gov (United States)

    Lozano, Marina; Estalrrich, Almudena; Bondioli, Luca; Fiore, Ivana; Bermúdez de Castro, José-Maria; Arsuaga, Juan Luis; Carbonell, Eudald; Rosas, Antonio; Frayer, David W

    2017-11-01

    Fossil hominids often processed material held between their upper and lower teeth. Pulling with one hand and cutting with the other, they occasionally left impact cut marks on the lip (labial) surface of their incisors and canines. From these actions, it possible to determine the dominant hand used. The frequency of these oblique striations in an array of fossil hominins documents the typically modern pattern of 9 right- to 1 left-hander. This ratio among living Homo sapiens differs from that among chimpanzees and bonobos and more distant primate relatives. Together, all studies of living people affirm that dominant right-handedness is a uniquely modern human trait. The same pattern extends deep into our past. Thus far, the majority of inferred right-handed fossils come from Europe, but a single maxilla from a Homo habilis, OH-65, shows a predominance of right oblique scratches, thus extending right-handedness into the early Pleistocene of Africa. Other studies show right-handedness in more recent African, Chinese, and Levantine fossils, but the sample compiled for non-European fossil specimens remains small. Fossil specimens from Sima del los Huesos and a variety of European Neandertal sites are predominately right-handed. We argue the 9:1 handedness ratio in Neandertals and the earlier inhabitants of Europe constitutes evidence for a modern pattern of handedness well before the appearance of modern Homo sapiens. © 2017 Wiley Periodicals, Inc.

  10. Exposures related to hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Agner, T.

    2012-01-01

    Background. Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed. Objectives. The aims of the study were to investigate the relationship bet...

  11. Unusual case of cleft hand

    Directory of Open Access Journals (Sweden)

    Sahasrabudhe Parag

    2007-01-01

    Full Text Available We present a case of a six-year-old male child with cleft hand deformity involving the dominant right hand. It was a rare case of atypical cleft hand with no missing tissue but cleft extending to metacarpal level and associated hypoplasia of thumb and index finger. As per Manske′s classification of cleft hand our patient belongs to the Class III variety. There was associated malposition of the index finger with absence of first web space and syndactly of thumb and index finger at the metacarpal level. A modified Snow-Littler procedure was planned. The surgical plan involved closure of cleft, release of thumb and index finger syndactly and reconstruction of the first web space. The functional outcome was good considering hypoplasia of the index finger and thumb. Depending upon the function of the thumb tendon transfers can be planned to augment thumb function at a later date along with correction of rotational deformities of the index and middle finger.

  12. A natural human hand model

    NARCIS (Netherlands)

    Van Nierop, O.A.; Van der Helm, A.; Overbeeke, K.J.; Djajadiningrat, T.J.P.

    2007-01-01

    We present a skeletal linked model of the human hand that has natural motion. We show how this can be achieved by introducing a new biology-based joint axis that simulates natural joint motion and a set of constraints that reduce an estimated 150 possible motions to twelve. The model is based on

  13. Hand-held medical robots.

    Science.gov (United States)

    Payne, Christopher J; Yang, Guang-Zhong

    2014-08-01

    Medical robots have evolved from autonomous systems to tele-operated platforms and mechanically-grounded, cooperatively-controlled robots. Whilst these approaches have seen both commercial and clinical success, uptake of these robots remains moderate because of their high cost, large physical footprint and long setup times. More recently, researchers have moved toward developing hand-held robots that are completely ungrounded and manipulated by surgeons in free space, in a similar manner to how conventional instruments are handled. These devices provide specific functions that assist the surgeon in accomplishing tasks that are otherwise challenging with manual manipulation. Hand-held robots have the advantages of being compact and easily integrated into the normal surgical workflow since there is typically little or no setup time. Hand-held devices can also have a significantly reduced cost to healthcare providers as they do not necessitate the complex, multi degree-of-freedom linkages that grounded robots require. However, the development of such devices is faced with many technical challenges, including miniaturization, cost and sterility, control stability, inertial and gravity compensation and robust instrument tracking. This review presents the emerging technical trends in hand-held medical robots and future development opportunities for promoting their wider clinical uptake.

  14. Hands-On Nuclear Physics

    Science.gov (United States)

    Whittaker, Jeff

    2013-01-01

    Nuclear science is an important topic in terms of its application to power generation, medical diagnostics and treatment, and national defense. Unfortunately, the subatomic domain is far removed from daily experience, and few learning aids are available to teachers. What follows describes a low-tech, hands-on method to teach important concepts in…

  15. Hands as markers of fragmentation

    Directory of Open Access Journals (Sweden)

    A. Barnard

    2005-07-01

    Full Text Available Margaret Atwood is an internationally read, translated, and critiqued writer whose novels have established her as one of the most esteemed authors in English (McCombs & Palmer, 1991:1. Critical studies of her work deal mainly with notions of identity from psychoanalytical perspectives. This study has identified a gap in current critical studies on Atwood’s works, namely the challenging of textual unity which is paralleled in the challenging of the traditional (single narrative voice. The challenging of textual unity and the single narrative voice brings about the fragmentation of both. This article will focus on the role that hands play as markers of fragmentation in “The Blind Assassin” (2000. In the novel, the writing hand destabilises the narrative voice, since it is not connected to the voice of a single author. If the author of the text – the final signified – is eliminated, the text becomes fragmentary and open, inviting the reader to contribute to the creation of meaning. Hands play a signficant role in foregrounding the narrator’s fragmented identity, and consequently, the fragmentation of the text. We will investigate this concept in the light of Roland Barthes’ notion of the scriptor, whose hand is metaphorically severed from his or her “voice”. Instead of the text being a unified entity, it becomes unstable and it displays the absence of hierarchical textual levels. Based mainly on Barthes’ writings, this article concludes that hands foreground the narrator’s fragmented identity, which is paralleled in the fragmented text.

  16. [Robotic general surgery: where do we stand in 2013?].

    Science.gov (United States)

    Buchs, Nicolas C; Pugin, François; Ris, Frédéric; Jung, Minoa; Hagen, Monika E; Volonté, Francesco; Azagury, Dan; Morel, Philippe

    2013-06-19

    While the number of publications concerning robotic surgery is increasing, the level of evidence remains to be improved. The safety of robotic approach has been largely demonstrated, even for complex procedures. Yet, the objective advantages of this technology are still lacking in several fields, notably in comparison to laparoscopy. On the other hand, the development of robotic surgery is on its way, as the enthusiasm of the public and the surgical community can testify. Still, clear clinical indications remain to be determined in the field of general surgery. The study aim is to review the current literature on robotic general surgery and to give the reader an overview in 2013.

  17. Dental Student Hand Hygiene Decreased With Increased Clinical Experience.

    Science.gov (United States)

    Yaembut, Nanmanas; Ampornaramveth, Ruchanee S; Pisarnturakit, Pagaporn P; Subbalekha, Keskanya

    2016-01-01

    To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience. This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants. This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology. The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively). More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups. HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. 76 FR 80430 - Rio Tinto plc and Rio Tinto Limited; Notice of Application

    Science.gov (United States)

    2011-12-23

    ... plc and Rio Tinto Limited; Notice of Application December 19, 2011. AGENCY: Securities and Exchange Commission (``Commission''). ACTION: Notice of application under section 3(b)(2) and 45(a) of the Investment Company Act of 1940 (the ``Act''). SUMMARY: Summary of Application: Rio Tinto plc (``RTP'') and Rio Tinto...

  19. A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

    Science.gov (United States)

    Kim, Won-Gon

    2016-08-01

    A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book.

  20. Inspirômetro de incentivo no pós-operatório de cirurgia torácica: uma revisão sistemática = Incentive spirometer in the postoperative period of thoracic surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Baranow, Karen von

    2016-01-01

    Full Text Available Introdução: Complicações pulmonares pós-operatórias podem ocorrer após cirurgias pulmonares afetando desfavoravelmente o curso clínico e aumentando o risco de morbidades e mortalidade. A Fisioterapia respiratória atua prevenindo, amenizando ou revertendo essas possíveis complicações, sendo a inspirometria de incentivo uma das técnicas utilizadas. Objetivo: Avaliar o efeito do uso da inspirometria de incentivo no período pós-operatório de cirurgia torácica sobre a função pulmonar, força da musculatura ventilatória, complicações pulmonares e o tempo de internação hospitalar. Materiais e Métodos: A busca incluiu as bases Medline/Pubmed, Embase e Scielo, além de busca manual, de setembro a outubro de 2015. Foram incluídos estudos randomizados que avaliaram o uso da inspirometria de incentivo em comparação com outros métodos de tratamento fisioterapêutico em pacientes no pós-operatório de cirurgia torácica (pulmonar. Resultados: Dos 480 artigos encontrados, três foram incluídos. Todos os estudos selecionados avaliaram a função pulmonar, sendo a sua melhora evidenciada em apenas um estudo. Apenas um avaliou e apresentou melhora na força da musculatura ventilatória. As complicações pulmonares, assim como o tempo de internação hospitalar, não foram reduzidas ou evitadas após o uso da inspirometria de incentivo. Conclusão: Não existem evidências suficientes que justifiquem a recomendação da inspirometria de incentivo no pós-operatório de cirurgias pulmonares sobre a função pulmonar, o tempo de internação hospitalar, força da musculatura ventilatória e as complicações pulmonares

  1. Die Sprache der Hande zu den Handen sprechen (Talking the Language of the Hands to the Hands). DB-LINK.

    Science.gov (United States)

    Miles, Barbara

    This paper examines the importance of hands for the person who is deafblind, reviews hand development, and identifies specific teaching skills that facilitate hand development and expressiveness in persons who are deafblind. It notes that the hands of a deafblind individual serve not only as tools but also as sense organs (to compensate for their…

  2. Invasive macrodystrophia lipomatosa of the hand.

    Science.gov (United States)

    Colonna, M R; Guarneri, C; do Stagno d'Alcontres, F; Risitano, G; Cavallari, V; Ribuffo, D

    2014-01-01

    The Authors point out the interest of differential diagnosis and conservative surgical treatment of a rare case of digital and ulnar side of the hand gigantism, with massive fatty infiltration of soft tissues and a neurovascular bundle, to be included into Macrodystrophia Lipomatosa with fibrolipomatous hamartomata. Excision of the mass included 4th ray disarticulation (the fifth had been amputated several years ago) as well as microsurgical external and internal neurolysis of the ulnar nerve, the ulnar neurovascular bundle being exposed and covered with dermal substitute INTEGRATM, with a good result both from a cosmetic and functional point of view at three year follow up. This is the first report of INTEGRATM covering of a neurovascular bundle. Samples taken from the dermal substitute matrix interface at day 6 and day 25 were examined with transmission Electron Microscopy: a newly formed tissue, rich in precursor cells, was detected. Conservative surgery, requiring particular microsurgical skills and use of dermal templates, plays an outstanding role in treatment of these rare but aggressive soft tissues masses of the upper limb.

  3. Traumatic injuries during the postoperative period after orthognathic surgery in patient with complete bilateral cleft lip and palate = Injúria traumática durante o período pós-operatório após cirurgia ortognática em paciente com fissura transforame incisivo bilateral

    Directory of Open Access Journals (Sweden)

    Menezes, Luciane Macedo de

    2011-01-01

    Conclusão: Pacientes que realizaram cirurgia ortognática estão sujeitos a complicações pós-operatórias; infecção, acidentes com veículo motor, armas de fogo, violência doméstica estão entre as causas mais comuns citadas de complicações no pós-operatório tardio. O conhecimento dessas intercorrências possibilita que medidas preventivas sejam adotadas para evitarem-se complicações graves principalmente em pacientes com fissuras que necessitam da abordagem de uma equipe interdisciplinar composta por profissionais de saúde

  4. New ways of visualization in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Bartłomiej Grobelski

    2010-09-01

    Full Text Available Scientific achievements enabled tremendous progress of surgical minimally invasive methods in the 20th century.Laparoscopy and endoscopy became everyday diagnostic and therapeutic tools of modern medicine. Despite itsirrefutable opportunities and advantages, classical minimally invasive surgery still has substantial limitations. Theseinclude: two-dimensional visualization without depth, a small field of view, and the necessity of precise hand-eyecoordination. That is why pressure is placed on manufacturers of endoscopic devices to surmount these technicalobstacles. To write this paper we searched databases for articles on new means of visualization in laparoscopicsurgery. We discuss augmented reality, three-dimensional vision and image-guided surgery.

  5. Comparação entre exercícios de respiração profunda e espirometria de incentivo no pós-operatório de cirurgia de revascularização do miocárdio Comparison between deep breathing exercises and incentive spirometry after CABG surgery

    Directory of Open Access Journals (Sweden)

    Julia Alencar Renault

    2009-06-01

    Full Text Available OBJETIVO: Comparar os efeitos dos exercícios de respiração profunda (ERP e espirômetro de incentivo a fluxo (EI em pacientes submetidos a cirurgia de revascularização do miocárdio (CRVM por meio das seguintes variáveis: capacidade vital forçada - CVF, volume expiratório forçado de primeiro segundo - VEF1, pressões respiratórias máximas e saturação de oxigênio. MÉTODOS: Trinta e seis pacientes foram submetidos a aplicação de ventilação não-invasiva por dois períodos de 30 minutos durante as primeiras 24 horas pós-extubação e distribuídos randomicamente em dois grupos, a saber: ERP (n=18 e EI (n=18, sendo as variáveis espirométricas avaliadas no pré-operatório e sétimo dia pós-operatório (DPO e a força da musculatura respiratória e saturação de oxigênio no pré-operatório, primeiro, segundo e sétimo DPO. RESULTADOS: Os grupos foram considerados homogêneos em relação às variáveis demográficas e cirúrgicas. Observouse queda dos valores referentes à CVF e VEF1 entre o préoperatório e o sétimo DPO, porém sem diferença estatística entre os grupos. Houve queda das pressões respiratórias máximas no primeiro DPO, mas com restabelecimento gradual e parcial até o sétimo DPO, também sem diferença estatística entre os grupos. A saturação de oxigênio foi a única variável restabelecida no sétimo DPO, mas também sem diferença estatística entre os grupos. CONCLUSÃO: Não foram observadas diferenças significativas nas pressões respiratórias máximas, variáveis espirométricas e saturação de oxigênio entre pacientes submetidos a exercícios de respiração profunda e espirometria de incentivo no pós-operatório de cirurgia de revascularização miocárdica.OBJECTIVE: To compare the effects of deep breathing exercises (DBE and the flow-oriented incentive spirometry (IS in patients undergone coronary artery bypass grafting (CABG through the following variables: forced vital capacity

  6. Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

    Directory of Open Access Journals (Sweden)

    Teona Sebe Ioana

    2015-11-01

    Full Text Available Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis, Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP and proximal interphalangeal joint (PIP of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy

  7. Basal Cell Carcinoma of the Dorsal Hand: An Update and Comprehensive Review of the Literature.

    Science.gov (United States)

    Loh, Tiffany Y; Rubin, Ashley G; Brian Jiang, Shang I

    2016-04-01

    Excessive ultraviolet radiation (UVR) exposure is the primary predisposing factor for basal cell carcinoma (BCC). However, surprisingly, BCCs occur very rarely on the dorsal hand, which is subject to intense sun exposure, and their infrequent presentation in this location suggests that other factors besides UVR may play a role in BCC pathogenesis. Because dorsal hand BCCs are uncommon, knowledge of their characteristics is limited, and more data are needed to describe their clinical presentation and treatment. To perform an updated review of the literature on the management of dorsal hand BCCs. The authors conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal hand," "basal cell carcinoma hand," and "basal cell carcinoma finger," and "basal cell carcinoma thumb." The authors identified 176 cases of dorsal hand BCCs in the literature, 120 of which had sufficient data for analysis. Only 4 cases were treated with Mohs micrographic surgery (MMS). The authors present 14 additional cases of dorsal hand BCCs treated with MMS. Basal cell carcinomas on the dorsal hand occur infrequently, and potential risk factors include being a male of white descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment method.

  8. Branqueamento dentário

    OpenAIRE

    Silva, Liliana Raquel Rêgo

    2016-01-01

    A estética dentária tem recebido bastante enfoque nos últimos anos, particularmente devido à importância a que a população atribui à aparência estética do sorriso. É, assim, desejado um sorriso o mais branco possível e que de preferência seja fácil de obter, eficaz, rápido, económico e que seja o menos invasivo possível. No entanto, muitos pacientes apresentam frequentemente dentes com cor alterada, comprometendo desta forma a estética do sorriso. O branqueamento dentário é uma técnica não in...

  9. Rio sambas to research drum

    International Nuclear Information System (INIS)

    Flatern, R. von

    2002-01-01

    Perhaps the most published graphic in the oil industry is one that traces the price of oil through time. It is used as an overlay to correlate everything from the history of rig activity levels to predicting coming oil shortages and gluts. In Rio de Janeiro this month during the 17th World Petroleum Congress, Dr Don Paul of ChevronTexaco and Saudi Aramco's Abdulaziz Al-Kaabi used it to illustrate the role research and technology development must play within the oil industry. The author discusses the way the oil industry is spending money on research and development, he explains that in the past 20 years the biggest innovation in the industry has been 3D seismic. The critical strategy for oil business was the adaptation of 3D seismic from another industry which was then moulded for its own needs. The article goes on to describe the importance of the development of a portfolio of research and development

  10. Tools used for hand deburring

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, L.K.

    1981-03-01

    This guide is designed to help in quick identification of those tools most commonly used to deburr hand size or smaller parts. Photographs and textual descriptions are used to provide rapid yet detailed information. The data presented include the Bendix Kansas City Division coded tool number, tool description, tool crib in which the tool can be found, the maximum and minimum inventory requirements, the cost of each tool, and the number of the illustration that shows the tool.

  11. Non-invasive volumetric analysis of asymptomatic hands using a 3-D scanner.

    Directory of Open Access Journals (Sweden)

    Hiroki Shinkai

    Full Text Available Hand swelling is one of the symptoms often seen in practice, but none of the available morphometric methods can quickly and efficiently quantify hand volume in an objective manner, and the current gold-standard volume measurement requires immersion in water, which can be difficult to use. Therefore, we aimed to analyze the accuracy of using 3-dimensional (3-D scanning to measure hand volume. First, we compared the hand volume calculated using the 3-D scanner to that calculated from the conventional method among 109 volunteers to determine the reliability of 3-D measurements. We defined the beginning of the hand as the distal wrist crease, and 3-D forms of the hands were captured by the 3-D scanning system. Second, 238 volunteers (87 men, 151 women with no disease or history of hand surgery underwent 3-D scanning. Data collected included age, height, weight, and shoe size. The wrist circumference (WC and the distance between distal wrist crease and tip of middle finger (DDT were measured. Statistical analyses were performed using linear regression to investigate the relationship between the hand volume and these parameters. In the first study, a significantly strong positive correlation was observed [R = 0.98] between the hand volume calculated via 3-D scanning and that calculated via the conventional method. In the second study, no significant differences between the volumes, WC or DDT of right and left hands were found. The correlations of hand volume with weight, WC, and DDT were strong. We created a formula to predict the hand volume using these parameters; these variables explained approximately 80% of the predicted volume. We confirmed that the new 3-D scanning method, which is performed without touching the hand and can record the form of the hand, yields an accurate volumetric analysis of an asymptomatic hand.

  12. Hand osteoarthritis: diagnosis, pathogenesis, treatment

    Directory of Open Access Journals (Sweden)

    R. M. Balabanova

    2018-01-01

    Full Text Available Due to the development of synovitis, early-stage hand osteoarthritis (HOA mimics hand joint injury in rheumatoid arthritis (RA. However, the topography of synovitis is diverse in these diseases:  distal interphalangeal and thumb joints are involved in the process in HOA. In the latter, tests are negative for immunological markers  (anti-cyclic citrullinated peptide antibodies, which is typical of RA.  The differences between HOA and RA are prominent, as evidenced  by hand X-rays and magnetic resonance imaging. Investigations  suggest that cytokine profile imbalance is implicated in the  pathogenesis of osteoarthritis, which brings it closer to RA. However, therapy for HOA has not been practically developed; there are only a few works on the use of disease-modifying antirheumatic drugs and  biological agents in these patients. It is necessary to work out Russian guidelines for the treatment of HOA.

  13. The hands of the projectionist.

    Science.gov (United States)

    Cartwright, Lisa

    2011-09-01

    This essay considers the work of projection and the hand of the projectionist as important components of the social space of the cinema as it comes into being in the nineteenth century and the early decades of the twentieth. I bring the concept ofMaurice Merleau-Ponty on the place of the body as an entity that applies itself to the world "like a hand to an instrument" into a discussion of the pre-cinematic projector as an instrument that we can interpret as evidence of the experience of the work of the projectionist in the spirit of film theory and media archaeology, moving work on instrumentation in a different direction from the analysis of the work of the black box in laboratory studies. Projection is described as a psychological as well as a mechanical process. It is suggested that we interpret the projector not simply in its activity as it projects films, but in its movement from site to site and in the workings of the hand of its operator behind the scenes. This account suggests a different perspective on the cinematic turn of the nineteenth century, a concept typically approached through the study of the image, the look, the camera, and the screen.

  14. [Alternative approaches in thyroid surgery].

    Science.gov (United States)

    Maurer, E; Wächter, S; Bartsch, D K

    2017-08-01

    In thyroid surgery multiple different cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed in the last 20 years. The aim of all these alternative approaches to the thyroid gland is optimization of the cosmetic result. The indications for the use of alternative and conventional approaches are principally the same. Important requirements for the use of alternative methods are nevertheless a broad experience in conventional thyroid operations of the thyroid and adequate patient selection under consideration of the size of the thyroid and the underlying pathology. Contraindications for the use of alternative approaches are a large size of the thyroid gland including local symptoms, advanced carcinomas, reoperations and previous radiations of the anterior neck. The current article gives an overview of the clinically implemented alternative approaches for thyroid surgery. Of those the majority must still be considered as experimental. The alternative approaches to the thyroid gland can be divided in cervical minimally invasive, extracervical endosopic (robot-assisted) and transoral operations (natural orifice transluminal endoscopic surgery, NOTES). Since conventional thyroid operations are standardized procedures with low complication rates, alternative approaches to the thyroid gland are considered critically in Germany. The request for a perfect cosmetic result should not overweigh patients' safety. Only a few alternative approaches (e. g. MIVAT, RAT) can yet be considered as a safe addition in experienced hands in highly selected patients.

  15. Robot-assisted general surgery.

    Science.gov (United States)

    Hazey, Jeffrey W; Melvin, W Scott

    2004-06-01

    With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

  16. [from Hygiene To The Building Of A City: The State And Sanitation In Rio De Janeiro].

    OpenAIRE

    Marques, E C

    2015-01-01

    The paper offers a historical analysis of the creation of the sector responsible for inaugurating and managing Rio de Janeiro's basic sanitary services, examining the period from the mid-nineteenth century, when sanitary issues were first posed, through the 1920s. The analysis centers on the relation between the service structure established by the state, on the one hand, and urban space, on the other, taking a particular look at the special interests involved in creation of this structure. E...

  17. O ser-enfermeiro em face do cuidado à criança no pós-operatório imediato de cirurgia cardíaca El ser-enfermero frente a la atención al niño en el posoperativo inmediato de cirugía cardíaca The nurse-being dealing with the care to the child in the immediate post-operative cardiac surgery

    Directory of Open Access Journals (Sweden)

    Herwellyn Camilo de Melo

    2012-09-01

    Full Text Available Objetivou-se compreender o cuidado à criança durante o pós-operatório imediato de cirurgia cardíaca a partir da percepção do ser-enfermeiro. Utilizou-se a entrevista fenomenológica com seis enfermeiras lotadas na Unidade de Recuperação de Cirurgia Torácica do Pronto-Socorro Cardiológico de Pernambuco, de março a maio de 2011. A pesquisa é de natureza qualitativa com abordagem ancorada na fenomenologia existencial de Martin Heidegger. Os dados foram produzidos e analisados de acordo com os quatro momentos propostos por Martins e Bicudo. A análise permitiu delinear o cuidado do enfermeiro como sistemático, complexo e minucioso, que requer ao mesmo tempo aptidões técnico-científicas, exigindo do ser que cuida habilidade para lidar com seus sentimentos diante das eventualidades do dia a dia. Conclui-se que o cuidado à criança é construído em meio a uma dinâmica constitutiva entre tecnologias duras e subjetividade, onde haverá momentos em que uma será valorizada em detrimento da outra.Esta investigación objetivó analizar la atención al niño durante el posoperativo inmediato de cirugía cardíaca desde la percepción del ser-enfermero. La entrevista fenomenológica se llevó a cabo con seis enfermeras que trabajan en la Unidad de Recuperación de Cirugía Torácica del Pronto-Socorro Cardiológico de Pernambuco, de marzo a mayo de 2011. La investigación tiene naturaleza cualitativa con abordaje anclado en la fenomenología existencial de Martin Heidegger. Los datos fueron producidos y analizados según los cuatro momentos sugeridos por Martins y Bicudo. El análisis permitió delinear la atención del enfermero como sistemática, complexa y minuciosa, que requiere al mismo tiempo aptitudes técnicas y científicas, exigiendo del ser que cuida habilidad para lidiar con sus sentimientos en las eventualidades del día a día. Se concluye que la atención al niño es construida en medio a una dinámica constitutiva entre

  18. Ansiedade no período pré-operatório de cirurgias de mama: estudo comparativo entre pacientes com suspeita de câncer e a serem submetidas a procedimentos cirúrgicos estéticos Ansiedad en el período preoperatorio de cirugías de mama: estudio comparativo entre pacientes con sospecha de cáncer a ser sometidas a procedimientos quirúrgicos estéticos Preoperative anxiety in surgeries of the breast: a comparative study between patients with suspected breast cancer and that undergoing cosmetic surgery

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    Maria Luiza Melo Alves

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A avaliação da ansiedade não faz parte da rotina da avaliação pré-anestésica (APA, o que faz com que situações especiais em que o estado emocional dos pacientes possa estar alterado, passem despercebidas pelo anestesiologista. Este estudo visou comparar, no momento da APA ambulatorial, fatores de risco, intensidade e prevalência de ansiedade em pacientes com suspeita de câncer de mama e a serem submetidas a procedimentos cirúrgicos estéticos de mama. MÉTODO: Após aprovação pelo Comitê de Ética, foram estudadas, no ambulatório de APA, 114 pacientes, ASA I ou II, idade > 14 anos, divididas nos grupos: GMAMA - pacientes com suspeita de câncer de mama; GPLAST - pacientes a serem submetidas à cirurgia plástica estética. Após consentimento esclarecido, as pacientes responderam o teste de avaliação de ansiedade (IDATE - Inventário de Ansiedade Traço-Estado antes da avaliação pré-anestésica. Foram analisados: dados sociodemográficos; experiência com procedimentos cirúrgicos anteriores; número e percentual de pacientes com ansiedade baixa, moderada e alta (IDATE I e II; mediana das pontuações das escalas IDATE I e II. RESULTADOS: Os grupos foram homogêneos em relação aos dados sociodemográficos e experiência com procedimentos cirúrgicos anteriores. Observou-se diferença significativa dos níveis e prevalência de ansiedade-estado (IDATE I. Não foram identificados fatores de risco para ansiedade-estado e ansiedade-traço. CONCLUSÕES: As pacientes com suspeita de câncer de mama a serem submetidas à retirada de nódulo ou tecido mamário para diagnóstico apresentaram níveis e prevalência de ansiedade-estado alta maiores do que as pacientes a serem submetidas a mamoplastias; os níveis e a prevalência de ansiedade-traço foram similares nos dois grupos e não foram identificados fatores de risco para ansiedade-estado e ansiedade-traço.JUSTIFICATIVA Y OBJETIVOS: La evaluaci

  19. Development of a Three-Dimensional Hand Model Using Three-Dimensional Stereophotogrammetry: Assessment of Image Reproducibility.

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    Inge A Hoevenaren

    Full Text Available Using three-dimensional (3D stereophotogrammetry precise images and reconstructions of the human body can be produced. Over the last few years, this technique is mainly being developed in the field of maxillofacial reconstructive surgery, creating fusion images with computed tomography (CT data for precise planning and prediction of treatment outcome. Though, in hand surgery 3D stereophotogrammetry is not yet being used in clinical settings.A total of 34 three-dimensional hand photographs were analyzed to investigate the reproducibility. For every individual, 3D photographs were captured at two different time points (baseline T0 and one week later T1. Using two different registration methods, the reproducibility of the methods was analyzed. Furthermore, the differences between 3D photos of men and women were compared in a distance map as a first clinical pilot testing our registration method.The absolute mean registration error for the complete hand was 1.46 mm. This reduced to an error of 0.56 mm isolating the region to the palm of the hand. When comparing hands of both sexes, it was seen that the male hand was larger (broader base and longer fingers than the female hand.This study shows that 3D stereophotogrammetry can produce reproducible images of the hand without harmful side effects for the patient, so proving to be a reliable method for soft tissue analysis. Its potential use in everyday practice of hand surgery needs to be further explored.

  20. Acute hand and wrist injuries in athletes: evaluation and management.

    Science.gov (United States)

    Morgan, W J; Slowman, L S

    2001-01-01

    Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.

  1. Doença hepática gordurosa não alcoólica e sua relação com a síndrome metabólica no pré-operatório de pacientes submetidos à cirurgia bariátrica Nonalcoholic fatty liver disease and its association with metabolic syndrome in the preoperative period in patients undergoing bariatric surgery

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    Bruna Z. Schild

    2013-04-01

    Full Text Available OBJETIVO: Verificar a relação entre a doença hepática gordurosa não alcoólica (DHGNA e síndrome metabólica (SM no período pré-operatório de pacientes submetidos à cirurgia bariátrica. MÉTODOS: Foram revisados 68 prontuários de pacientes de um centro de tratamento avançado da obesidade da cidade de Caxias do Sul - RS. As variáveis estudadas foram gênero, idade, parâmetros bioquímicos (nível de glicose em jejum, colesterol HDL e triglicerídeos, ultrassonografia abdominal, pressão arterial e antropometria (peso, estatura, circunferência abdominal e Índice de Massa Corporal. O diagnóstico da DHGNA foi obtido pela ultrassonografia abdominal e o da SM através do protocolo descrito pelo National Cholesterol Education Program's Adult Treatment Panel III, atualizado pela American Heart Association; e a National Heart, Lung, and Blood Institute. RESULTADOS: 72,1% (n = 49 da amostra foi composta pelo gênero feminino e a média de idade encontrada na população foi de 37,57 ± 10,29 anos. A média de peso entre eles foi de 123,14 ± 25,40 kg, a altura de 1,67 ± 0,09 m e o valor médio de IMC de 56,24 ± 9,30 kg/m². Apresentaram diagnóstico de DHGNA 60% (n = 27 dos pacientes portadores de SM (p = 0,008, 63,4% (n = 26 dos pacientes portadores de hipertensão arterial (p = 0,013 e 66,7% (n = 18 dos pacientes que apresentaram níveis glicêmicos alterados (p = 0,028. CONCLUSÃO: Os resultados do presente estudo mostraram que o diagnóstico de SM, bem como a presença das desordens associadas a esta (obesidade, hipertensão arterial e elevação nos níveis glicêmicos estão fortemente relacionadas à presença da DHGNA.OBJECTIVE: To investigate the association between nonalcoholic fatty liver disease (NAFLD and metabolic syndrome (MS in the preoperative period in patients undergoing bariatric surgery. METHODS: A total of 68 medical records of patients from a center for advanced treatment of obesity in the city of Caxias do Sul

  2. Estudo demográfico de pacientes portadores de deformidades de coluna vertebral que aguardam cirurgia em hospital terciário de alta complexidade Estudio demográfico de pacientes con deformidades de la columna en espera de cirugía en hospital de tercer nivel de alta complejidad Demographic study of patients with spinal deformities who are awaiting surgery in a tertiary hospital of high complexity

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    Nicola Jorge Carneiro Neto

    2012-09-01

    Full Text Available OBJETIVO: Definir as características demográficas dos pacientes portadores de deformidades secundárias da coluna vertebral que aguardam em fila de espera para tratamento cirúrgico em hospital terciário de alta complexidade. MÉTODOS: As informações foram obtidas através dos prontuários dos pacientes no período previamente definido. Os dados foram selecionados conforme os critérios já apresentados e manipulados estatisticamente. RESULTADOS: O estudo incluiu um total de 170 pacientes, dos quais 94 eram do sexo feminino com idades entre 1 e 58 anos, e 76 do sexo masculino com idade entre 1 e 26 anos. Entre as deformidades encontradas foram identificadas: escolioses congênitas por segmentação (6 ou 3,5%, formação (39 ou 22,9%, mistas (34 ou 20,0% e complexas (14 ou 8,2%, escolioses neuromusculares por paralisia cerebral (PC (54 ou 31,8%, miopatia (11 ou 6,5%, artrogripose (2 ou 1,2% e escolioses por neurofibromatose (10 ou 5,9%. CONCLUSÃO: Existe uma considerável lista de pacientes portadores de deformidades de coluna vertebral que aguardam em fila de espera para tratamento cirúrgico por um período muitas vezes bastante prolongado. Este fato acarreta um problema social de difícil manuseio e quando somadas, escoliose neuromuscular e escoliose congênita são responsáveis pela grande maioria dos casos que aguardam cirurgia.OBJETIVO: Definir las características demográficas de los pacientes con deformidades secundarias de la columna vertebral en la lista de espera para el tratamiento quirúrgico en un hospital de tercer nivel de complejidad alta. MÉTODOS: Las informaciones fueron obtenidas de los archivos de pacientes en período predefinido. Los datos fueron seleccionados de acuerdo con los criterios ya presentados y manipulados estadísticamente. RESULTADOS: En el estudio participaron un total de 170 pacientes, de los cuales 94 eran mujeres de edades comprendidas entre 1 y 58, y 76 varones de edades comprendidas entre 1 y 26

  3. Prolonged disengagement from distractors near the hands

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    Daniel B Vatterott

    2013-08-01

    Full Text Available Because items near our hands are often more important than items far from our hands, the brain processes visual items near our hands differently than items far from our hands. Multiple experiments have attributed this processing difference to spatial attention, but the exact mechanism behind how spatial attention near our hands changes is still under investigation. The current experiments sought to differentiate between two of the proposed mechanisms: a prioritization of the space near the hands and a prolonged disengagement of spatial attention near the hands. To differentiate between these two accounts, we used the additional singleton paradigm in which observers searched for a shape singleton among homogenously shaped distractors. On half the trials, one of the distractors was a different color. Both the prioritization and disengagement accounts predict differently colored distractors near the hands will slow target responses more than differently colored distractors far from the hands, but the prioritization account also predicts faster responses to targets near the hands than far from the hands. The disengagement account does not make this prediction, because attention does not need to be disengaged when the target appears near the hand. We found support for the disengagement account: Salient distractors near the hands slowed responses more than those far from the hands, yet observers did not respond faster to targets near the hands.

  4. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  5. Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

    Science.gov (United States)

    Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M

    2016-01-01

    To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

  6. Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

    Science.gov (United States)

    Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

    2016-03-01

    Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

  7. Blog literário: alguns comentários

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    Alamir Aquino Corrêa

    2015-07-01

    Full Text Available http://dx.doi.org/10.5007/1807-9288.2015v11n1p420 Se o conceito de literatura é marcado por discussões e reformulações ao longo da história, parece-nos importante partir da ideia que “as escritas de si” presentes na pós-modernidade apontam para a revisão de algumas noções a respeito do ficcional e da literariedade presentes em textos que são veiculados na internet, especificamente o blog. A escrita de autoria feminina, tradicional espaço de expressão subjetiva recolhida muitas vezes apenas em diários íntimos, encontrou na internet um meio para fazer ecoar vozes antes silenciadas devido à condição da mulher na sociedade e, portanto, também terá destaque dentre os assuntos aqui discutidos, ao lado de reflexões sobre a canonicidade de textos e da configuração do blog como espaço de autorreferencialidade e de publicidade da escrita literária.

  8. [Optimising care structures for severe hand trauma and replantation and chances of launching a national network].

    Science.gov (United States)

    Haas, E M; Volkmer, E; Holzbach, T; Wallmichrath, J; Engelhardt, T O; Giunta, R E

    2013-12-01

    Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand

  9. Multiple intramedullary nailing of proximal phalangeal fractures of hand

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    Patankar Hemant

    2008-01-01

    Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.

  10. Nutrition Following Pancreatic Surgery

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    ... BACK Contact Us DONATE NOW GENERAL DONATION PURPLESTRIDE Nutrition Following Pancreatic Surgery Home Facing Pancreatic Cancer Living with Pancreatic Cancer Diet and Nutrition Nutrition Following Pancreatic Surgery Ver esta página en ...

  11. Blood donation before surgery

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    ... page: //medlineplus.gov/ency/patientinstructions/000367.htm Blood donation before surgery To use the sharing features on ... team. Related MedlinePlus Health Topics Blood Transfusion and Donation Surgery Browse the Encyclopedia A.D.A.M., ...

  12. Cosmetic ear surgery

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    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  13. Open heart surgery

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    ... this page: //medlineplus.gov/ency/article/002950.htm Open heart surgery To use the sharing features on this ... large arteries connected to the heart. The term "open heart surgery" means that you are connected to a ...

  14. Pediatric heart surgery - discharge

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    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may ... indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or ...

  16. Refractive corneal surgery - discharge

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    ... surgery. Avoid contact sports (such as boxing and football) for the first 4 weeks after surgery. DO ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  19. Surgery for pancreatic cancer

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    ... laparoscopically (using a tiny video camera) or using robotic surgery depends on: The extent of the surgery ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

  20. Anti-reflux surgery

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    ... surgery. You may need another surgery in the future if you develop new reflux symptoms or swallowing ... Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...