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Sample records for surgical approach utilizing

  1. Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach.

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    Rodriguez, Joseph F; Packiam, Vignesh T; Boysen, William R; Johnson, Scott C; Smith, Zachary L; Smith, Norm D; Shalhav, Arieh L; Steinberg, Gary D

    2017-07-01

    To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data. Using the National Cancer Database, we identified patients who underwent nephroureterectomy for localized upper tract urothelial carcinoma between 2010 and 2013. Demographic and clinicopathologic characteristics were compared among the three operative approaches. Multivariate regression analyses were used to determine the impact of approach on performance of lymphadenectomy (LND), positive surgical margins (PSM), and overall survival (OS). In total, there were 9401 cases identified for analysis, including 3199 ONU (34%), 2098 RNU (22%), and 4104 LNU (44%). From 2010 to 2013, utilization of RNU increased from 14% to 30%. On multivariate analysis, LND was more likely in RNU (odds ratio [OR] 1.52; p ONU. RNU was associated with decreased PSM compared with ONU (OR = 0.73; p = 0.04). After adjusting for other factors, OS was not significantly associated with surgical approach. RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

  2. Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.

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    Tejwani, Rohit; Young, Brian J; Wang, Hsin-Hsiao S; Wolf, Steven; Purves, J Todd; Wiener, John S; Routh, Jonathan C

    2017-06-01

    relationships between different diagnosis codes. Despite these limitations, we note that the NIS database is rigorously monitored and audited for coding accuracy and, therefore, represents a reasonably reliable panorama of the characteristics of an inpatient surgical cohort. However, it is important to note that the choice of operative modality is, undoubtedly, multifactorial and patient/setting-specific. There is increasing use of MIS for pediatric urology procedures, although utilization rates vary among procedures. MIS was associated with a lower postoperative complication rate than for open procedures. Higher-volume MIS centers have a lower complication rate than lower-volume centers. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  3. [Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries].

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    Rejas Ugena, E; Trinidad Ruiz, G; Alvarez Domínguez, J; Carrasco Claver, F; Pino Rivero, V; Blasco Huelva, A

    2006-05-01

    To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.

  4. Metatarsal Reconstruction with a Fibular Osteocutaneous Flap: A Novel Approach Utilizing Virtual Surgical Planning

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    Hugo St. Hilaire, MD, DDS

    2014-11-01

    Full Text Available Summary: Craniofacial reconstruction remains the main application for virtual surgical planning (VSP. We present a case in which this technology was applied to reconstruct a bony defect of the first metatarsal bone from a gunshot injury. VSP was used to facilitate a 1-stage reconstruction with a fibular osteocutaneous flap. A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone. Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators. Successful reconstruction of the metatarsal bone was achieved with excellent functional outcomes. We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

  5. Vitiligo- A surgical approach

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    Deepti Ghia

    2012-01-01

    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  6. [Surgical adrenal approaches: learned experiences].

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    Bravo-Lázaro, Santos; Hernandis-Villalba, Juan; Meroño-Carbajosa, Emilio; Navío-Perales, Juan; Marzal-Felici, Vicente

    2014-01-01

    Laparoscopic surgery is the standard approach for surgical adrenal gland pathology. However, the open procedure still has its role. Our intention is to report our results and experience using different techniques. A retrospective study of 40 patients was carried out. Demographic and surgical data were analyzed. Thirty two patients had benign pathology and eight had malignant tumors. Laparotomy was performed in 18 patients: seven patients with malignant tumors and 11 with benign pathology. Young's approach was indicated in four patients. Laparoscopic aproach was indicated in 25 patients with seven patients requiring conversion to laparotomy. The conversion rate was 28% In most cases, the laparoscopic approach is the standard technique. Appropriate case selection is of primary importance. Other surgical techniques should be considered if necessary.

  7. Right Diaphragm Spontaneous Rupture: A Surgical Approach

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    Duilio Divisi

    2011-01-01

    Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.

  8. Spinal intramedullary ependymoma: surgical approaches and outcome.

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    Borges, Lawrence F

    2017-07-26

    Intramedullary Ependymomas are uncommon tumors that can occur within the medullary substance of the spinal cord. Despite this difficult location, they are typically benign tumors that can most often be removed completely with an acceptable surgical risk. Therefore, the recommended management approach is usually surgical excision. This review will consider the historical context in which surgeons began treating these tumors and then review the more recent literature that guides their current management.

  9. [Pancoast tumors ; modified surgical approaches and techniques].

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    Tsunezuka, Yoshio; Yachi, T; Waseda, R; Yamamoto, D

    2010-01-01

    The surgical treatment of Pancoast tumors is associated with difficulties related to its anatomical locations. Different surgical approaches have been reported but every approaches have some advantages and disadvantages. We report 2 Pancoast tumors cases with unique surgical approaches and our techniques. Case 1 : A 38-year-old man complained of face edema. The chest computed tomography (CT) revealed an right anterior apical tumor with direct invasion of the 1st and 2nd rib. Preoperative chemotherapy with 2 courses of carboplatin [area under the blood concentration-time curve (AUC) 6, day 1] and paclitaxel (80 mg/m2, day1, 8, 15) and concurrent extracorporeal radiation (70 Gy) was used to treat the adenocarcinoma. The skin incision was performed according to Masaoka's anterior approach, and a proximal median sternotomy communicated with an incision in the 4th intercostal space. The clavicula was freed by the L-shaped incision on the manubrium and the 1st cartilage section according to Grunenwald method to retract the section. Case 2 : A 65-year-old man complained back pain. The chest CT revealed an right superior sulcus tumor, displaced bronchus (B1+B3 tracheal bronchus, B2) and pulmonary arteries anomalies. Combined Shaw-Paulson incision and 4 intercostal lateral thoracotomy was performed to right upper lobectomy and systematic lymph nodes dissection.

  10. Surgical approaches for tongue base schwannoma.

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    Ying, Binbin; Zhu, Songsong; Qiao, Yang; Ye, Weimin; Maimaiti, Abdikerimjian; Hu, Jingzhou; Zhang, Yong

    2013-01-01

    Schwannomas (neurilemmomas) are benign nerve sheath tumor originating from Schwann cells. They are well circumscribed and rarely infiltrate and metastasize. Schwannomas of the head and neck commonly occur in the tongue followed by the palate, floor of mouth, buccal mucosa, and mandible. Tongue base schwannomas could extend to the pharyngeal cavity or the floor of the mouse, and it is difficult to differentiate between tumors of the lingual, hypoglossal, and glossopharyngeal nerves.Surgical treatment of tongue base schwannomas is difficult because of limited operative exposure. Although mandibulotomy with lip splitting could obtain good exposure, surgeons might strike a balance between exposure obtaining and morbidity following because there are intricate neurovascular anatomical relationships in this region, and mandibulotomy with lip splitting would cause significant morbidity. Surgical approach options are important for tongue base schwannoma removal. From March 2008 to March 2010, 8 patients were clinically and pathologically diagnosed with tongue base schwannomas in our department, and all underwent surgical treatment. In our experience, transoral approach was used for tongue base schwannomas extending to the floor of the mouse and suprahyroid pharyngotomy approach for those extending to the pharyngeal cavity. Follow-up was made until now. One patient who experienced transoral excision still experienced numbness in the region of the lateral tongue tip, and the other 7 patients had no postoperative long-term complications.

  11. Novel Surgical Approaches to the Orbit.

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    Campbell, Ashley A; Grob, Seanna R; Yoon, Michael K

    2015-01-01

    Determining safe surgical access to the orbit can be difficult given the complex anatomy and delicacy of the orbital structures. When considering biopsy or removal of an orbital tumor or repair of orbital fractures, careful planning is required to determine the ideal approach. Traditionally, this has at times necessitated invasive procedures with large incisions and extensive bone removal. The purpose of this review was to present newly techniques and devices in orbital surgery that have been reported over the past decade, with aims to provide better exposure and/or minimally invasive approaches and to improve morbidity and/or mortality.

  12. Surgical technique: Retroperitoneoscopic approach for adrenal masses in children.

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    Yankovic, F; Undre, S; Mushtaq, I

    2014-04-01

    Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of adrenal masses. The transperitoneal laparoscopic and retroperitoneoscopic approaches are described. Both are safe and as effective as open adrenalectomy, with the added benefit of the minimally invasive approach. It can be utilized for patients requiring surgery for a phaeochromocytoma, adrenal adenoma, adrenal adenocarcinoma, Cushing's syndrome, neuroblastoma, and an incidentaloma. Relative contraindications include previous surgery of the liver or kidney, large tumours (>8-10 cm in diameter) or coagulation disorders. Although the transperitoneal route is used more widely, the retroperitoneal approach provides direct access to the adrenal gland and easy visualization of the adrenal vein. It avoids also colonic mobilization, minimizes the risk of injury to hollow viscera, and the potential risk of adhesion formation. However, the reversed orientation of the kidney and hilum, combined with a significantly smaller working space, may make this approach difficult to master.

  13. Crown lengthening: a surgical flap approach.

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    Lundergan, W; Hughes, W R

    1996-09-01

    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  14. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

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    Nuño-Guzmán, Carlos M.; García-Carrasco, Daniel; Haro, Miguel; Arróniz-Jáuregui, José; Corona, Jorge L.; Salcido, Macario

    2014-01-01

    Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2–6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up. PMID:25759630

  15. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

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    Carlos M. Nuño-Guzmán

    2014-11-01

    Full Text Available Zenker's diverticulum (ZD, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

  16. VATS Lobectomy: Surgical Evolution from Conventional VATS to Uniportal Approach

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    Diego Gonzalez-Rivas

    2012-01-01

    Full Text Available There is no standardized technique for the VATS lobectomy, though most centres use 2 ports and add a utility incision. However, the procedure can be performed by eliminating the two small ports and using only the utility incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resection, the technique has been spreading worldwide. The single-port technique provides a direct view to the target tissue. The conventional triple port triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. The parallel instrumentation achieved during single-port approach mimics inside the maneuvers performed during open surgery. Furthermore, it represents the less invasive approach possible, and avoiding the use of trocar, we minimize the compression of the intercostal nerve. Further development of new technologies like sealing devices for all vessels and fissure, robotic arms that open inside the thorax, and wireless cameras will facilitate the uniportal approach to become the standard surgical procedure for pulmonary resection in most thoracic departments.

  17. Dermato-Surgical Approach In Vitiliogo

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    Malakar Subrata

    1995-01-01

    Full Text Available Vitiligo is a hypomelanotic disorder often difficult to treat. Different medicinal treatments such as PUNA, steroids and adjunct theraples give partial or complete repigmentation in about 60-90% cases. Moreover, vitiligo patches which are refractory to most medical therapies are acrofacial, mucosal and segmental. At the backdrop of these medicinal shortcomings, various surgical procedures and their modifications have gradually evolved. To decide why, where and when surgical interference is required, is of utmost importance. In this review different surgical modes, including some of the latest, and their future prospects are discussed.

  18. Surgical approach to hysterectomy for benign gynaecological disease

    NARCIS (Netherlands)

    Aarts, J.W.M.; Nieboer, T.E.; Johnson, N.; Tavender, E.; Garry, R.; Mol, B.W.; Kluivers, K.B.

    2015-01-01

    BACKGROUND: The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES: To assess the effectiveness and safety of different surgical approaches to hysterectomy

  19. Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

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    Houdenhoven, van Mark; Oostrum, van Jeroen M.; Wullink, Gerhard; Hans, Erwin; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert

    2008-01-01

    Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes ope

  20. Laparoscopic approach for inflammatory bowel disease surgical managment.

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    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

  1. Total ankle replacement through a lateral approach: surgical tips

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    Usuelli Federico Giuseppe

    2016-01-01

    Full Text Available Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS ankle and hindfoot scores, visual analogue scale (VAS pain score, and the Short Form Health Survey (SF-12 questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001. The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001. The Physical and Mental Health Composite Scale scores (PCS and MCS of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001 and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001, respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants.

  2. Total ankle replacement through a lateral approach: surgical tips

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    Usuelli, Federico Giuseppe; Indino, Cristian; Maccario, Camilla; Manzi, Luigi; Salini, Vincenzo

    2016-01-01

    Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants. PMID:27855774

  3. Approach to Pediatric Patients during Surgical Interventions

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    Seher Ünver

    2013-12-01

    Full Text Available A child’s surgical period usually contains unpleasant and difficult experiences, for the child and the parents. The child in this period experiences greater anxiety and distress. On the other hand, pediatric patients have complex states that directly effects their perioperative care during. Because their perioperative care includes not only the knowledge of general surgical procedure and care of a patient in the operating room. It also includes the specific understanding of a child’s airway, anatomy and physiology, the understanding of child development and care of the child and family. This review is prepared to present these differences of the pediatric surgical patients and the care during their perioperative period. (Jo­ur­nal of Cur­rent Pe­di­at­rics 2013; 11: 128-33

  4. Carotid body tumors: radioguided surgical approach

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    Gossetti Bruno

    2009-12-01

    Full Text Available Abstract Background Carotid body tumours (CBTs are very rare lesions which should be treated as soon as possible even when benign since small tumour size permits easier removal and lower incidence of perioperative complications and recurrence. Malignant forms are rare and they can be identified by lymph node invasion and metastases in distant locations. The need of reliable and effective diagnostic modalities for both primary CBTs and its metastases or recurrence is evident. The present study reviews our experience and attempt to define the role of colour coded ultrasound (CCU and Somatostatin receptor scintigraphy (SRS with Indium-111-DTPA-pentetretide (Octreoscan® using both planar and single photon emission tomography (SPECT technique in the diagnosis and follow-up of these uncommon lesions within a multidisciplinary approach. Methods From 1997 to 2008, 12 patients suffering from 16 CBTs (4 bilateral were investigated by CCU and SRS-SPECT before and after surgery. All tumours were grouped according to Shamblin's classification in order to assess the technical difficulties and morbidity of surgical resection on the ground of their size and relationship with the carotid arteries. Intraoperative radiocaptation by Octreoscan® was also carried out in all cases to evaluate the radicality of surgery. All perioperative scans were evaluated by the same nuclear medicine physician. Results Preoperatively CCU showed CBTs (four were not palpable with a sensitivity of 100%. Radioisotope imaging identified the CBTs as chemodectomas in 15 cases while no radioisotopic uptake was detected in 1 vagus nerve neurinoma. No evidence of metastasis or multicentricity were seen by total body radioisotopic scans. Combined data from CCU and SRS-SPECT allowed to determine tumour size in order to select 7 larger tumours which were submitted to selective preoperative embolization. Intraoperatively Octreoscan demonstrated microscopic tumour leftovers promptly removed in 1

  5. Comprehensive Surgical Approaches to Management of Various Facial Nevi

    Institute of Scientific and Technical Information of China (English)

    Xiao-gen Hu; Hai-huan Ma; Yan-yong Zhao; Qing-hua Yang

    2009-01-01

    To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.Methods From August 2002 to January 2008, 16 cases with facial nevi had been treated in our wards with the selected approaches. Surgical approaches including serial excision or one-time radical excision, free skin graft, and expanded flap were adopted in accordance with the individual size and location of the facial nevi. Results All cases experienced complete excision and had satisfactory cosmetic appearance in the end.Conclusion The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.

  6. Managerial implications and suitability of a master surgical scheduling approach

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    J.M. van Oostrum (Jeroen); E. Bredenhoff (Eelco); E.W. Hans (Erwin)

    2008-01-01

    textabstractMaster surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is schedule

  7. Managerial implications and suitability of a master surgical scheduling approach

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    J.M. van Oostrum (Jeroen); E. Bredenhoff (Eelco); E.W. Hans (Erwin)

    2008-01-01

    textabstractMaster surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is

  8. Standardized surgical approaches to ear surgery in rats

    Institute of Scientific and Technical Information of China (English)

    Peng Li; Dalian Ding; Kelei Gao; Richard Salvi

    2015-01-01

    Objective:To describe several approaches of ear surgeries for experimental studies in rats. Methods:Anesthetized rats were prepared for demonstration of various ear surgery approaches designed to optimize experimental outcomes in studies with specific goals and exposure requirements. The surgical approaches included the posterior tympanum, superior tympanum, inferior tympanum and occipital approaches. Results: The middle ear cavity and inner ear were successfully exposed from different angles via the mentioned surgical approaches. For example, electrode placement for recording of cochlear bioelectric responses was easily achieved through the posterior tympanum or inferior tympanum approach. Alternatively, drug delivery or gene transfection via round window membrane was most easily accomplished using the posterior tympanum approach. Cochlear perfusion of protective or ototoxic drugs was best performed using the inferior tympanum approach. Ossicular chain interruption to induce a prolonged conductive hearing loss was readily achieved using a superior tympanum approach. Lastly, surgical destruction of the endolymphatic sac to induce experimental endolymphatic hydrops was readily performed via an occipital surgical approach. Conclusion: These standardized surgical approaches can be applied in scientific studies of the ear with different purposes covering electro-physiology, conductive hearing loss, intra-cochlear drug perfusion and experimental studies relevant to Meniere's disease.

  9. A Design Approach for an Innovative LED Surgical Light

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    Hadrath, Stefan; Morgenbrod, Nico

    2014-12-01

    We will present a design approach for a surgical light consisting of a central high-power LED module and a metal-free TIR reflector. The reflector's surface is designed as a grooved surface providing two TIR reflections.

  10. Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?

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    Friedman, James M; Hagander, Lars; Hughes, Christopher D; Nash, Katherine A; Linden, Allison F; Blossom, Jeff; Meara, John G

    2013-01-01

    An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. The highest annual surgical utilization rate was 184 operations/100,000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Unicystic ameloblastoma with mural proliferation: conservative or surgical approach?

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    Samuel, Soumi; Mistry, Freddy K; Chopra, Shilpa; Pillai, Ajay

    2014-01-01

    Ameloblastoma occurs in a wide variety of forms. Various forms of ameloblastomas have various treatment modalities ranging from a conservative approach to surgical resection with reconstruction. We report a case of unicystic ameloblastoma with mural proliferation in a 17-year-old girl, who presented with a swelling in the lower left jaw associated with dull aching pain and was managed initially by a conservative approach followed by surgical enucleation on recurrence. PMID:25103487

  12. Innovative surgical approaches for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Riccardo; Memeo; Nicola; de’Angelis; Vito; de; Blasi; Zineb; Cherkaoui; Oronzo; Brunetti; Vito; Longo; Tullio; Piardi; Daniele; Sommacale; Jacques; Marescaux; Didier; Mutter; Patrick; Pessaux

    2016-01-01

    Hepatocellular carcinoma(HCC)is the sixth most common cancer worldwide,with an increasing diffusion in Europe and the United States.The management of such a cancer is continuously progressing and the objective of this paper is to evaluate innovation in the surgical treatment of HCC.In this review,we will analyze the modern concept of preoperative management,the role of laparoscopic and robotic surgery,the intraoperative use of three dimensional models and augmented reality,as well as the potential application of fluorescence.

  13. Treatment of aging vocal folds: surgical approaches.

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    Seino, Yutomo; Allen, Jacqui E

    2014-12-01

    Aging may affect the voice through either physiological or pathological changes. Globally society is aging and the working lifetime is extending. Increasing numbers of elderly will present with voice issues. This review examines current thinking regarding surgical treatment of the aging voice. The mainstay of surgical treatment remains injection laryngoplasty and medialization thyroplasty. In-office injection laryngoplasty is increasingly common. Data suggest that patients with vocal fold atrophy do not achieve as much benefit from augmentation treatments as other causes of glottal incompetence. In addition the timing of injection laryngoplasty may influence the rate of subsequent medialization thyroplasty. Disease-specific treatments can provide some benefit to voice, such as deep brain stimulation in Parkinson's disease. Novel treatments including growth factor therapy are entering clinical practice and will provide new options for the clinician in future. Voice disorders affect approximately 20% of the elderly population. Causes include neurologic, malignant, iatrogenic and benign vocal fold disorders. These should be ruled out before accepting dysphonia is age-related in nature. Treatment should be specific to recognized vocal disorders but may also address physiologic changes in the glottis. Injection laryngoplasty and thyroplasty remain effective options for treating glottal incompetence but novel therapies are showing promising results.

  14. Expected Utility Optimization - Calculus of Variations Approach

    CERN Document Server

    Tran, Khoa

    2007-01-01

    In this paper, I'll derive the Hamilton-Jacobi (HJ) equation for Merton's problem in Utility Optimization Theory using a Calculus of Variations (CoV) Approach. For stochastic control problems, Dynamic Programming (DP) has been used as a standard method. To the best of my knowledge, no one has used CoV for this problem. In addition, while the DP approach cannot guarantee that the optimum satisfies the HJ equation, the CoV approach does. Be aware that this is the first draft of this paper and many flaws might be introduced.

  15. A bayesian approach to laboratory utilization management

    Directory of Open Access Journals (Sweden)

    Ronald G Hauser

    2015-01-01

    Full Text Available Background: Laboratory utilization management describes a process designed to increase healthcare value by altering requests for laboratory services. A typical approach to monitor and prioritize interventions involves audits of laboratory orders against specific criteria, defined as rule-based laboratory utilization management. This approach has inherent limitations. First, rules are inflexible. They adapt poorly to the ambiguity of medical decision-making. Second, rules judge the context of a decision instead of the patient outcome allowing an order to simultaneously save a life and break a rule. Third, rules can threaten physician autonomy when used in a performance evaluation. Methods: We developed an alternative to rule-based laboratory utilization. The core idea comes from a formula used in epidemiology to estimate disease prevalence. The equation relates four terms: the prevalence of disease, the proportion of positive tests, test sensitivity and test specificity. When applied to a laboratory utilization audit, the formula estimates the prevalence of disease (pretest probability [PTP] in the patients tested. The comparison of PTPs among different providers, provider groups, or patient cohorts produces an objective evaluation of laboratory requests. We demonstrate the model in a review of tests for enterovirus (EV meningitis. Results: The model identified subpopulations within the cohort with a low prevalence of disease. These low prevalence groups shared demographic and seasonal factors known to protect against EV meningitis. This suggests too many orders occurred from patients at low risk for EV. Conclusion: We introduce a new method for laboratory utilization management programs to audit laboratory services.

  16. Current Approaches for the Prevention of Surgical Site Infections

    Directory of Open Access Journals (Sweden)

    Sander Florman

    2007-01-01

    Full Text Available Surgical site infections (SSIs are the most common type of nosocomial infection among surgical patients and are commonly caused by the patients’ own microbial flora. The prevalence of SSI is a major concern because of the associated increase in the incidence of morbidity and mortality, length of hospitalization and cost of care for postoperative patients. Key factors that determine whether patients are at risk for developing SSI include the inherent potential contamination of the surgical site, the duration of the operation and the individual patient susceptibility. Preventive preoperative measures that can reduce the risk of SSIs include administration of antimicrobial prophylaxis, proper utilization of skin antiseptic agents for both the patient and the surgical team, proper patient preoperative hair removal and the policy of canceling elective procedures when remote skin, urinary or pulmonary infections occur. This paper will review the efficacy and safety of available antiseptic agents, as well as discuss patient-specific prevention strategies.

  17. [Management of orbital cavernous hemangioma - evaluation of surgical approaches: report of 43 cases].

    Science.gov (United States)

    Aymard, P-A; Langlois, B; Putterman, M; Jacomet, P-V; Morax, S; Galatoire, O

    2013-12-01

    Cavernous hemangioma is the most frequent benign orbital tumor in adults. The purpose of this study was to examine its clinical features, to define surgical indications, and to determine the roles of the various surgical approaches praticed in ophthalmology: transconjunctival (increasingly utilized), anterior transcutaneous, and lateral orbitotomy. The records of all patients treated for orbital cavernous hemangioma (OCH) since 2004 at the Fondation Rothschild (Paris, France) were retrospectively reviewed. Forty-three patients were treated for orbital cavernous hemangioma. Fifty-eight percent were women, mean age 50.2; 79 % of the tumors were intraconal. Among those patients, 36 underwent surgical removal, 5 were followed periodically, and 2 were lost to follow-up. The main surgical indications were: optic nerve compression (26 patients), proptosis (24 patients) and diplopia (3 patients). Transconjunctival, anterior transcutaneous and Kronlein approaches were used in 16, 12 and 4 patients respectively. Four patients had intrapalpebral hemangiomas easily reached transcutaneously. Two patients demonstrated transient partial 3rd nerve palsy (one with the lateral orbitotomy approach and one with the transconjunctival approach), one patient with the lateral orbitotomy approach developed a palsy of the superior branch of the 3rd nerve, and one patient with the transcutaneous anterior approach developed mydriasis. Surgical excision of OCH's is required in the presence of clinical complications. The transconjunctival approach is a safe technique which can lead to complete resection of the tumor in most cases.

  18. Policy Analysis of Surgical Utilization at Blanchfield Army Community Hospital

    Science.gov (United States)

    2009-04-09

    Utilization 12 anterior /posterior cruciate ligament (ACL/PCL) reconstruction surgery may take 2-3 hours and a cataract surgery may only take 10-20 minutes...equipment, or secondary services like an ICU or physical therapy . Larger, more in depth cases could be performed at Gateway, thus allowing for an...Fort Campbell’s Post Office is on the Kentucky side which, ultimately, provides the post with a Kentucky mailing address. The physical facility of BACH

  19. Market oriented approach by public utilities

    Energy Technology Data Exchange (ETDEWEB)

    Mantel, J.J.; Verkuil, J.M.

    1989-08-01

    Public utilities, especially the larger ones, have an image of being inefficient, technocratic and bureaucratic institutions, unresponsive to modern lifestyles, growing consumerism, differentiated customer needs and changing social values. Improving this image and increasing customer satisfaction requires the adoption of a systematic market oriented approach, based on an appropriate segmentation of the client and general public. This article gives the broad outline of such an approach followed by some generally applicable practical recommendations. Finally it stresses the importance of human aspects of organizational behaviour and, consequently, the crucial part of corporate culture. 2 figs., 1 tab.

  20. "Bat Wing Surgical Approach for the Temporomandibular Joint".

    Science.gov (United States)

    Garcia Y Sanchez, J M; Davila Torres, J; Pacheco Rubio, G; Gómez Rodríguez, C L

    2015-09-01

    The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure. When the first description on TMJ surgery by Orlow in 1913 was published it gave an account describing the basic retroauricular, preauricular, endoaural and submandibular approaches, on treatment of articular pathologies as used today. The proposed study of the 'Bat Wing' approach, first described in 1993 by Garcia y Sanchez J.M. as a surgical alternative, offers great advantages is that it avoids the section of the ear canal and provides a wide surgical field. The management of the proposed technique has wide application with multiple joints addressed, achieving major objectives such as avoiding facial nerve damage, as well as avoiding the section of the external auditory canal with an optimum visibility of the operative field. The Department of Maxillofacial Surgery National Medical Center XXI Century records over a period of approximately 18 months have completed twenty TMJ surgeries using the 'Bat Wing', approach. The bat wing approach is a surgical alternative that offers broad exposure of the surgical field in TMJ, it is effective and meets the goal of exposing the area to intervene safely, good visibility and access to the site to intervene. It perfectly fulfills the above described.

  1. A review of the surgical approaches to glaucoma treatment

    Directory of Open Access Journals (Sweden)

    Spratt Alexander

    2013-07-01

    Full Text Available The conventional approach of initially treating glaucoma medically and holding surgical intervention as a reserve option was endorsed by the findings of the Collaborative Initial Glaucoma Treatment Study (CIGTS study.1 This study reported that patients had similar visual field outcomes at five years from either medical treatment or immediate filtration surgery and supported the status quo of glaucoma management. The market for medical treatments has since increased and polypharmacy is now an accepted norm for glaucoma treatment. Surgical remedies for glaucoma have existed in a less pressured environment such that trabeculectomy, after four decades of slow evolution and complications, remains the most commonly performed type of glaucoma surgery worldwide. This ecosystem has begun to change in recent years. New surgical alternatives have arrived, reached a sizeable number and gained considerable traction as viable competitors to conventional glaucoma medical and surgical treatments. This raises important questions as to how these advances in glaucoma surgical options may affect the future landscape of glaucoma treatment. Has trabeculectomy already yielded some of its high ground? Why has trabeculectomy not been able to evolve more rapidly in response to new competitive pressures? If trabeculectomy has reached its evolutionary zenith are the newer alternatives any better? And, is it time to re-examine the conventional ‘medical before surgical’ approach to glaucoma? This article reviews the evidence for current surgical techniques available to patients with glaucoma.

  2. The UCLA surgical approach to sphincteric incontinence in women.

    Science.gov (United States)

    Rovner, E S; Ginsberg, D A; Raz, S

    1997-01-01

    Stress urinary incontinence (SUI) in the female may be treated by a variety of non-surgical and surgical therapies. However, once the patient has chosen to undergo operative repair the ideal procedure is based on three considerations: the degree of anterior vaginal wall prolapse, the degree of incontinence and associated anatomic abnormalities requiring surgical repair. In the vast majority of cases vaginal wall sling is our procedure of choice for the surgical treatment of SUI in the female. Vaginal wall sling is based on sound anatomic principles, may be performed as an outpatient procedure and is equally efficacious for the treatment of SUI due to anatomic incontinence (urethral hypermobility) and intrinsic sphincter deficiency. Since vaginal wall sling is performed through a transvaginal approach, other associated manifestations of pelvic floor prolapse such as rectocele can be addressed and repaired simultaneously. When necessary the vaginal wall sling can be easily modified to repair large grade cystoceles.

  3. Surgical approach for recurrent inguinal hernias

    DEFF Research Database (Denmark)

    Öberg, S; Andresen, K; Rosenberg, J

    2016-01-01

    Purpose: Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior–posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates...... between repairs performed according to the guidelines with the ones performed against it. Methods: This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein–Lichtenstein vs......-reoperation for Lichtenstein–Lichtenstein was only seen if the primary hernia was medial. Conclusions: A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein...

  4. Minimally invasive surgical approach to pancreatic malignancies

    Institute of Scientific and Technical Information of China (English)

    Lapo; Bencini; Mario; Annecchiarico; Marco; Farsi; Ilenia; Bartolini; Vita; Mirasolo; Francesco; Guerra; Andrea; Coratti

    2015-01-01

    Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci?? robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), with

  5. [Foramen magnum tumor--the diagnosis and surgical approach].

    Science.gov (United States)

    Tokuda, K; Abe, H; Iwasaki, Y; Chono, Y

    1986-03-01

    The seven cases of the foramen magnum tumors were presented with the clinical manifestations and surgical consideration. Early clinical symptoms of the cases with extramedullary lesions were suboccipital neck pain followed by dysesthesia, clumsiness of hand and weakness. On the other hand, early symptoms of the cases with intramedullary lesions were dysesthesia, often followed by swallowing difficulty or hoarsness, which may have some difference from the clinical course of the extramedullary tumor cases. CT scan was remarkably useful in the diagnosis of the foramen magnum tumor. Surgical treatment was done to 6 cases: Five of these cases were operated by suboccipital craniectomy, and one case with an anteriorly located meningioma in the foramen magnum region was operated by transoral approach. Total removal could be performed in the case without damage to the medulla or spinal cord. The surgical treatment was reviewed, and the approach appropriate to tumor location around the foramen magnum should be selected.

  6. Utilization of the NASA Robonaut as a Surgical Avatar in Telemedicine

    Science.gov (United States)

    Dean, Marc; Diftler, Myron

    2015-01-01

    The concept of teleoperated robotic surgery is not new; however, most of the work to date has utilized specialized robots designed for specific set of surgeries. This activity explores the use of a humanoid robot to perform surgical procedures using the same hand held instruments that a human surgeon employs. For this effort, the tele-operated Robonaut (R2) was selected due to its dexterity, its ability to perform a wide range of tasks, and its adaptability to changing environments. To evaluate this concept, a series of challenges was designed with the goal of assessing the feasibility of utilizing Robonaut as a telemedicine based surgical avatar.

  7. Gradual approach to refinement of the nasal tip: surgical results

    Directory of Open Access Journals (Sweden)

    Thiago Bittencourt Ottoni de Carvalho

    2015-02-01

    Full Text Available Introduction: The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty. Objective: To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure. Methods: Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1 no surgery on nasal tip; (2 interdomal breakup; (3 cephalic trim; (4 domal suture; (5 shield-shaped graft; (6 vertical dome division; (7 replacement of lower lateral cartilages. Results: Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occurred in 4% of cases. Conclusion: The protocol used allowed the implementation of a gradual surgical approach to nasal tip definition with the nasal anatomical characteristics, high rate of patient satisfaction with the surgical outcome, and low rate of revision.

  8. Utility of an intraoperabive gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

    NARCIS (Netherlands)

    Jorna, Francisca H.; Jager, Pieter L.; Lemstra, Clara; Wiggers, Theo; Stegeman, Coen A.; Plukker, John T. M.

    2008-01-01

    BACKGROUND: In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism. METHODS: The value of the probe in guiding resection o

  9. Survey on Robot-Assisted Surgical Techniques Utilization in US Pediatric Surgery Fellowships.

    Science.gov (United States)

    Maizlin, Ilan I; Shroyer, Michelle C; Yu, David C; Martin, Colin A; Chen, Mike K; Russell, Robert T

    2017-02-01

    Robotic technology has transformed both practice and education in many adult surgical specialties; no standardized training guidelines in pediatric surgery currently exist. The purpose of our study was to assess the prevalence of robotic procedures and extent of robotic surgery education in US pediatric surgery fellowships. A deidentified survey measured utilization of the robot, perception on the utility of the robot, and its incorporation in training among the program directors of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellowships in the United States. Forty-one of the 47 fellowship programs (87%) responded to the survey. While 67% of respondents indicated the presence of a robot in their facility, only 26% reported its utilizing in their surgical practice. Among programs not utilizing the robot, most common reasons provided were lack of clear supportive evidence, increased intraoperative time, and incompatibility of instrument size to pediatric patients. While 58% of program directors believe that there is a future role for robotic surgery in children, only 18% indicated that robotic training should play a part in pediatric surgery education. Consequently, while over 66% of survey respondents received training in robot-assisted surgical technique, only 29% of fellows receive robot-assisted training during their fellowship. A majority of fellowships have access to a robot, but few utilize the technology in their current practice or as part of training. Further investigation is required into both the technology's potential benefits in the pediatric population and its role in pediatric surgery training.

  10. Surgical correction of the webbed neck: an alternative lateral approach

    Directory of Open Access Journals (Sweden)

    Mehri Turki, Imen

    2017-03-01

    Full Text Available Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli.Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars.Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

  11. Surgical correction of the webbed neck: an alternative lateral approach

    Science.gov (United States)

    Mehri Turki, Imen

    2017-01-01

    Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli. Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars. Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

  12. Surgical Approaches to Breast Augmentation: The Transaxillary Approach.

    Science.gov (United States)

    Strock, Louis L

    2015-10-01

    The transaxillary approach to breast augmentation has the advantage of allowing breast implants to be placed with no incisions on the breasts. There has been a general perception of a lack of technical control compared with the inframammary approach. This article presents the transaxillary approach from the perspective of the technical control gained with the aid of an endoscope, which allows precise creation of the tissue pocket with optimal visualization. The aspects of technique that allow optimal technical control are discussed, in addition to postoperative processes that aid in stabilizing the device position and allow consistent and predictable outcomes.

  13. Time Trade-off Utility Analysis for Surgical Intervention in Comitant Strabismus, Glaucoma, and Cataract

    Directory of Open Access Journals (Sweden)

    Kishimoto,Fumiko

    2012-06-01

    Full Text Available The utility value was compared among 3 surgical interventions, and the validity of the time trade-off (TTO method was evaluated by analyzing the correlations of the utility value with the results of the Visual Function Questionnaire-14 (VF-14 and other variables. The subjects were 127 patients aged 40-85 years who were surgically treated between January 2008 and March 2010, including 26 patients with glaucoma, 50 with cataracts, and 51 with comitant strabismus. The scores on VF-14 and utility values determined using TTO were calculated retrospectively. The mean value (SD of the utility gain was 0.096 (0.105 for glaucoma, 0.101 (0.105 for comitant strabismus, and 0.167 (0.237 for unilateral and 0.245 (0.167 for bilateral cataracts, indicating significant postoperative improvements in the utility value. A significant correlation was observed between the utility value and the postoperative VF-14 scores of the bilateral cataracts, and the postoperative visual acuity of the better eye of the unilateral cataract. The mean value of the quality-adjusted life years was 2.181 for bilateral and 1.424 for unilateral cataracts, 1.132 for strabismus, and 0.870 for glaucoma with an annual discount rate of 3%. The gain of utility value was highest in bilateral cataracts, and lowest in glaucoma, and thus the TTO analysis was considered to be highly valid for cataract surgery.

  14. A low morbidity surgical approach to the sheep femoral trochlea

    Directory of Open Access Journals (Sweden)

    Orth Patrick

    2013-01-01

    Full Text Available Abstract Background The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation. Methods Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections. Results The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches. Conclusions The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.

  15. Esthesioneuroblastoma with intracranial extension: A non-surgical approach.

    Science.gov (United States)

    Thomas, Sarah Boby; Balasubramaniam, Deepak; Hiran, K R; Dinesh, M; Pavithran, K

    2016-01-01

    Esthesioneuroblastoma is a rare tumor arising from the olfactory mucosa of upper respiratory tract. The primary modality of treatment has been surgery with craniofacial resection followed by post-operative radiotherapy. There are only a few reported cases of non-surgical approaches. We report a case of esthesioneuroblastoma with intracranial extension treated with Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide, Etoposide protocol followed by radiation with 5 years of follow-up. This is the first reported case using this chemotherapy schedule.

  16. Aortic Root Rupture during Transcatheter Aortic Valve Implantation in a Patient with Idiopathic Thrombocytopenic Purpura: Utility of Transesophageal Echocardiography in Early Detection and Description of a Semiconservative Surgical Management Approach.

    Science.gov (United States)

    Chandrasekhar, Jaya; Ruel, Marc; Nicholson, Donna; Labinaz, Marino

    2016-12-01

    An 87-year-old man with idiopathic thrombocytopenic purpura and platelet count of 56 × 10(9)/L underwent transesophageal echocardiography (TEE)-guided transcatheter aortic valve implantation using a femoral approach. Post valve deployment, a new pericardial effusion was noted which was successfully drained. Despite this, the patient became hypotensive needing vasopressor support with reaccumulation of pericardial fluid. Emergent sternotomy was performed and a perforation of the right ventricular apex was noted which was sealed with a pledgeted suture. Continued bleeding prompted further exploration; the aorta was seen to be mottled in conjunction with clear aortic root hematoma on TEE and a diagnosis of root rupture was made. This was semiconservatively managed without conversion to a full aortic root repair or replacement procedure. Multiple sutures were applied to the periaortic space and the bleeding sealed with use of BioGlue (Cryolife Inc., Kennesaw, GA) and Surgicel (Ethicon Inc., Somerville, NJ). The postoperative course was stable and the patient remained well at 3-month follow-up.

  17. Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment

    Institute of Scientific and Technical Information of China (English)

    Ender Gunes Yegin; Erkan Oymaci; Emrah Karatay; Ahmet Coker

    2016-01-01

    BACKGROUND: Hepatocellular carcinoma (HCC) is a com-plex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple con-founding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortal-ity globally with a rising trend of incidence in some of the de-veloped countries, which indicates the need for better surgical and nonsurgical management strategies. DATA SOURCES: PubMed database was searched for relevant articles in English on the issue of HCC management. RESULTS: Surgical resection represents a potentially cura-tive option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and micro-wave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The signiifcant survival beneift with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treat-ment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential beneift is sug-gested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immuno-therapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications

  18. Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment

    Institute of Scientific and Technical Information of China (English)

    Ender Gunes Yegin; Erkan Oymaci; Emrah Karatay; Ahmet Coker

    2015-01-01

    BACKGROUND: Hepatocellular carcinoma (HCC) is a com-plex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple con-founding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortal-ity globally with a rising trend of incidence in some of the de-veloped countries, which indicates the need for better surgical and nonsurgical management strategies. DATA SOURCES: PubMed database was searched for relevant articles in English on the issue of HCC management. RESULTS: Surgical resection represents a potentially cura-tive option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and micro-wave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The signiifcant survival beneift with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treat-ment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential beneift is sug-gested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immuno-therapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications

  19. Pediatric pituitary resection: characterizing surgical approaches and complications.

    Science.gov (United States)

    Hanba, Curtis; Svider, Peter F; Shkoukani, Mahdi A; Sheyn, Anthony; Jacob, Jeffrey T; Eloy, Jean Anderson; Folbe, Adam J

    2017-01-01

    Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children

  20. Tongue base schwannoma: report, review, and unique surgical approach.

    Science.gov (United States)

    Sawhney, Raja; Carron, Michael A; Mathog, Robert H

    2008-01-01

    Base of tongue schwannomas are exceedingly rare and therefore often are not immediately included in the differential diagnosis and treatment of oropharyngeal tumors. After a thorough review of the English literature, we found only 6 previously reported cases of tongue base schwannomas. We are contributing a report of a 37-year-old woman with progressive dysphagia, dysarthria, and large tongue base schwannoma. Diagnosis was confirmed by imaging studies and biopsy followed by surgical excision designed to preserve nerve function. A number of surgical approaches have been described for tongue base schwannomas. Each has its own degree of postoperative morbidity. The use of a unilateral transcervical incision with blunt dissection was simple and quickly accomplished with protection of nearby nerves. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

  1. Surgical removal of large central neurocytomas with small incision approach

    Directory of Open Access Journals (Sweden)

    Shu-mao LU

    2014-01-01

    Full Text Available Objective To investigate the strategy and technique of small incision surgery through interhemispheric transcallosal approach for removal of large central neurocytomas in supratentorial ventricule. Methods Clinical data and therapy of 6 cases with central neurocytomas were retrospectively studied. All tumors were removed through small incision interhemispheric transcallosal approach, and the clinical data were analyzed. Results Total resection was achieved in all cases. Three cases experienced transient mutism and one case experienced hemiparalysis. All of them received nerve-nurturing treatment and recovered within 2 weeks. Five cases were followed-up from 6 months to 2 years and there was no recurrence. Conclusions The advantages of interhemispheric transcallosal approach include provision of sufficient surgical visual field and space, protection of normal brain tissue by natural cavity and shortest surgical pathway. Small incision surgery may not only reduce invalid brain exposure and hemorrhage during operation, but also decrease operation time. The small incision surgery through interhemispheric transcallosal approach is an effective choice for removal of central neurocytomas involved in supratentorial ventricule.

  2. Surgical approach to impacted mandibular third molars--operative classification.

    Science.gov (United States)

    Abu-El Naaj, Imad; Braun, Refael; Leiser, Yoav; Peled, Micha

    2010-03-01

    The aim of the present study is to suggest a convenient way to classify the position of the impacted third mandibular molar relative to the mandibular canal and to suggest indications for the use of each surgical approach for mandibular third molar extraction. The presented new typing system, Third Molar Classification (TMC), is a simple and easy-to-apply method for the surgical management of mandibular third molars and can be extended for any ectopic or impacted mandibular tooth. There are 3 major types of third molar positions. The second type is subdivided further into 2 subtypes. In the present study, 9 patients with high-risk mandibular third molars were treated according to the present classification and are presented and discussed. Patients typed as TMC IIb were treated with a sagittal split osteotomy approach and patients typed as TMC III were treated with an extraoral approach. The operative classification was successfully implemented in very rare cases of deeply impacted mandibular third molars. In 3 of 9 cases (33%) minor complications included some degree of hypoesthesia using the extraoral approach; these complications resolved spontaneously without the need for any intervention. The present study describes the use of a new surgical classification system for treatment planning in all types of mandibular third molar extractions. We believe that the present classification could help the oral and maxillofacial surgeon in decision-making and limit the possible risks that are present when attempting to extract impacted mandibular third molars. Copyright (c) 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Treatment of Children's Fears: A Strategic Utilization Approach.

    Science.gov (United States)

    Protinsky, Howard

    1985-01-01

    Describes briefly Milton Erickson's strategic utilization approach to therapy. Discusses the usefulness of this approach in treating children's fears. Presents two case histories in which the approach successfully eliminated the fear of the child. (BH)

  4. Treatment of Children's Fears: A Strategic Utilization Approach.

    Science.gov (United States)

    Protinsky, Howard

    1985-01-01

    Describes briefly Milton Erickson's strategic utilization approach to therapy. Discusses the usefulness of this approach in treating children's fears. Presents two case histories in which the approach successfully eliminated the fear of the child. (BH)

  5. Surgical approaches for minimally invasive plate osteosynthesis in dogs.

    Science.gov (United States)

    Pozzi, A; Lewis, D

    2009-01-01

    Fracture stabilisation techniques continue to evolve and to provide approaches which minimise the iatrogenic trauma associated with surgery. Minimally invasive plate osteosynthesis (MIPO) is a recently described method of biological internal fixation performed by introducing a bone plate via small insertional incisions that are made remote to the fracture site. The plate is slid adjacent to the bone in an epiperiosteal tunnel connecting the two insertional incisions. Screws are placed in the plate through the insertional incisions or via additional stab incisions made over the holes in the plate. In this paper we describe the surgical approaches used to perform MIPO in humeral, radial, femoral and tibial fractures in dogs. We found that these approaches allowed safe insertion of the plate without grossly damaging neuro-vascular structures. Further studies are needed to evaluate the clinical outcome of MIPO in dogs.

  6. [Surgical approaches in surgery for cicatrical tracheal stenosis].

    Science.gov (United States)

    Parshin, V D; Rusakov, M A; Parshin, V V; Mirzoian, O S; Khoruzhenko, A I

    2015-01-01

    At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.

  7. Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect based approach.

    Science.gov (United States)

    Magdy, Emad A

    2008-01-01

    Surgical repair of postlaryngectomy pharyngocutaneous fistula (PCF) can be challenging. Although several studies describe separate reconstruction methods, only few address the variability in defect characteristics and hence flap selection. The current clinical study presents a retrospective review of 19 patients who underwent surgical repair of persistent PCFs, over a 4-year period in a tertiary referral institute by a single primary surgeon. All but one patient were men with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. Previous neck irradiation was the most common comorbid condition encountered (52.6%), followed by low hemoglobin level (47.4%), hepatic disease (36.8%) and diabetes mellitus (31.6%). According to defect characteristics, six patients received a local cervical skin procedure, ten patients had reconstructions using the pectoralis major musculocutaneous flap and three patients required a radial forearm free flap repair. All PCFs were eventually successfully closed with no major complications. Patients were followed-up for an average of 19.7 months (range, 5-38 months). Acceptable oral swallowing results were achieved in all but one patient. In conclusion, successful results are achievable in difficult persistent PCF cases with a defect based reconstruction approach kept in mind.

  8. Haglund Deformity – Surgical Resection by the Lateral Approach

    Directory of Open Access Journals (Sweden)

    S Natarajan

    2015-03-01

    Full Text Available The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund deformity by a lateral approach provides good to excellent results. During the period from 2009 to 2012, 40 patients with 46 feet had undergone resection of Haglund deformity using lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale. The mean AOFAS score at the follow up was 86/100, with the majority of patients reporting alleviation of pain at one year follow up. The lateral approach to calcaneal ostectomy can be an effective treatment for those suffering from refractory Haglund deformity. However, the patient must be made aware of the duration of recovery being long.

  9. Surgical Treatment of Hepatic Hydrothorax: A "Four-Step Approach".

    Science.gov (United States)

    Jung, Yochun

    2016-03-01

    Recently, various video-assisted thoracoscopic surgical techniques have been reported with occasional success in treating hepatic hydrothorax (HH). In 2 patients with refractory HH, we applied a combination of four therapeutic modalities as a single procedure named as a "four-step approach": (1) pneumoperitoneum for localization of diaphragmatic defects, (2) thoracoscopic pleurodesis, (3) postoperative continuous positive airway pressure, and (4) drainage of ascites for abdominal decompression. The treatment was successful in both patients, without recurrence during the follow-up period of 24 and 3 months, respectively.

  10. Surgical approach to retrosternal goitre: do we still need sternotomy?

    Science.gov (United States)

    Rugiu, M G; Piemonte, M

    2009-12-01

    Retrosternal goitre is defined as a goitre with a portion of its mass > or = 50% located in the mediastinum. Surgical removal is the treatment of choice and, in most cases, the goitre can be removed via a cervical approach. Aim of this retrospective study was to analyse personal experience in the surgical management of retrosternal goitres, defining, in particular, the features requiring sternotomy. Over a 5-year period (2004-2008), 986 patients underwent thyroidectomy in the ENT Department of the University Hospital of Udine, Italy; in 53 patients, 37 females, 16 males (mean age: 64 years, range: 35-85), thyroidectomy was performed for a retrosternal goitre, which extended, at computed tomography at least 3 cm below the cervico-thoracic isthmus. Retrosternal goitres were removed via a cervical approach in 49 patients; a sternotomy was necessary in 4 patients (7.5%), due to an ectopic intra-thoracic thyroid in one patient, and a very large thyroid reaching the main bronchial bifurcation in the other 3 (mean weight of goitres: 883 g, range: 520-1600). Histo-pathological studies revealed a benign lesion in 50 patients and a carcinoma in 2 (3.7%). The incidence of transient and permanent hypoparathyroidism was 13% and 3.7%, respectively. Transient recurrent laryngeal nerve palsy occurred in one patient (1.8%), post-operative bleeding in 3 patients (5.6%) and respiratory complications, requiring a tracheotomy in one case, in 2 patients (3.7%). Surgical removal of a retrosternal goitre is a challenging procedure; it can be performed safely, in most cases, via a cervical approach, with a complication rate slightly higher than the average rate for cervical goitre thyroidectomy, especially concerning hypoparathyroidism and post-operative bleeding. The most significant criteria for selecting patients requiring sternotomy are computed tomography features, in particular the presence of an ectopic goitre, the thyroid gland volume and the extent of the goitre to or below the

  11. The standardized surgical approach improves outcome of gallbladder cancer

    Directory of Open Access Journals (Sweden)

    Igna Dorian

    2007-05-01

    Full Text Available Abstract Background The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014. The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.

  12. Abdominal cystic lymphangiomas in pediatrics: surgical approach and outcomes.

    Science.gov (United States)

    Méndez-Gallart, R; Bautista, A; Estévez, E; Rodríguez-Barca, P

    2011-01-01

    Abdominal Cystic lymphangiomas (ACL) are uncommon benign masses usually presented during infancy. Although extremely rare, they may cause complications; therefore, the recommended therapy is surgical excision. The purpose of this study is to report our experience with the diagnosis and surgical treatment of ACL in pediatric population. From January 1994 to December 2009, 10 patients (6 females; 4 males) with diagnostic confirmation of ACL were retrospectively included in study. Children's age ranged between 9 months and 8 years (mean age at diagnosis was 2.5 years). Clinical presentation, cyst location, imaging studies employed, surgical approach and pathologic features were analyzed. The most common symptom was abdominal pain but three cases were incidentally detected. One case had presented with acute abdomen after traumatic haemorrhage of the tumor. All patients were diagnosed with ultrasonography as first-line radiological study. MRI was used in last three cases. At surgery, concomitant bowel resection was necessary in 3 children. Location of the lesion (omentum, mesentery) did not influence the outcome but surgery was more difficult (operative time over three hours) in patients with lymphangioma affecting mesentery of the jejunum. Mean hospital stay after surgery was 6.7 days. Mean follow-up was 5.1 years. No recurrence of the cystic lymphangioma was noticed during follow-up. One case developed an intestinal occlusion due to bowel adhesions 1 year after surgery. ACL usually affect infants and young children and may present with spectrum of symptoms from an incidental finding to an acute life-threatening abdominal obstruction. Complete excision of the tumor is a safe and effective method in the management of ACL in pediatric population. Surgery is mandatory to avoid potential complications.

  13. Comparison of the different surgical approaches for lumbar interbody fusion.

    Science.gov (United States)

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-02-01

    This review will outline the history of spinal fusion. It will compare the different approaches currently in use for interbody fusion. A comparison of the techniques, including minimally invasive surgery and graft options will be included. Lumbar interbody fusion is a commonly performed surgical procedure for a variety of spinal disorders, especially degenerative disease. Currently this procedure is performed using anterior, lateral, transforaminal and posterior approaches. Minimally invasive techniques have been increasing in popularity in recent years. A posterior approach is frequently used and has good fusion rates and low complication rates but is limited by the thecal and nerve root retraction. The transforaminal interbody fusion avoids some of these complications and is therefore preferable in some situations, especially revision surgery. An anterior approach avoids the spinal cord and cauda equina all together, but has issues with visceral exposure complications. Lateral lumbar interbody fusion has a risk of lumbar plexus injury with dissection through the psoas muscle. Studies show less intraoperative blood loss for minimally invasive techniques, but there is no long-term data. Iliac crest is the gold standard for bone graft, although adjuncts such as bone morphogenetic proteins are being used more frequently, despite their controversial history. More high-level studies are needed to make generalisations regarding the outcomes of one technique compared with another.

  14. Approach to the medical management of surgically resectable gastric cancer.

    Science.gov (United States)

    Tesfaye, Anteneh; Marshall, John L; Smaglo, Brandon G

    2016-02-01

    The optimal adjuvant management of patients with resectable gastric cancer remains a therapeutic challenge. Although the benefit of adjuvant therapy for these patients is clearly established, recurrence and mortality rates remain high despite such treatment. Moreover, surgical comorbidities and treatment toxicities result in high rates of failure to complete treatment after surgery. Two divergent approaches to adjuvant treatment have emerged as standard: postoperative chemoradiotherapy and perioperative chemotherapy. Because these approaches have never been compared directly, recommendations for adjuvant treatment require multidisciplinary discussion. During this discussion, the characteristics of the symptoms, the histology, location, and stage of the tumor, and the feasibility of the patient's completing all recommended therapy may be considered. In our own practice, we favor perioperative chemotherapy for patients with asymptomatic, proximal, higher-stage disease and adjuvant chemoradiotherapy for patients with symptomatic, distal, lower-stage disease. Herein, we summarize the available data for approaches to the adjuvant treatment of gastric cancer, with special consideration of the characteristics of the patients enrolled in the various studies. We also describe how we developed our paradigm for recommending a particular approach to adjuvant treatment for each patient.

  15. Surgical approach to the superior mid-orbit.

    Science.gov (United States)

    Krohn-Hansen, Dag; Nicolaissen, Bjørn; Meling, Torstein R; Haaskjold, Erling

    2013-09-01

    Access to the superior mid-orbit is required for procedures on the levator muscle in the correction of upper eyelid ptosis and in surgery aimed at local lesions in this region. The purpose with this human cadaver study was to clarify the anatomical substrate for a surgical approach to the levator muscle and the upper mid-orbit structures, in which the orbital septum and the retroseptal fat pad is not harmed during surgery. Macro-anatomical dissections and histological examinations were performed on five human orbits from three formalin embalmed cadaver heads. It was found that the orbital septum extends posteriorly from its junction with the levator aponeurosis. This posterior continuation of the orbital septum encloses the superior orbital fat pad and separates this from the anterior surface of the levator muscle. In between the orbital septum and the levator, there is a dissection space that provides a minimal invasive access corridor to the structures in the upper mid-orbit.

  16. Utility Indifference Pricing: A Time Consistent Approach

    CERN Document Server

    Pirvu, Traian A

    2011-01-01

    This paper considers the optimal portfolio selection problem in a dynamic multi-period stochastic framework with regime switching. The risk preferences are of exponential (CARA) type with an absolute coefficient of risk aversion which changes with the regime. The market model is incomplete and there are two risky assets: one tradable and one non-tradable. In this context, the optimal investment strategies are time inconsistent. Consequently, the subgame perfect equilibrium strategies are considered. The utility indifference prices of a contingent claim written on the risky assets are computed via an indifference valuation algorithm. By running numerical experiments, we examine how these prices vary in response to changes in model parameters.

  17. Cyclodialysis ab interno as a surgical approach to intractable glaucoma.

    Science.gov (United States)

    Jordan, Jens F; Dietlein, Thomas S; Dinslage, Sven; Lüke, Christoph; Konen, Walter; Krieglstein, Günter K

    2007-08-01

    In glaucoma filtration surgery, the problem of subconjunctival scarring has still not been satisfactorily solved. Suprachoroidal drainage of aqueous humour offers a promising, alternative option for intractable glaucoma. We here present a clinical study on the surgical approach of gonioscopic cyclodialysis ab interno. Twenty-eight eyes of 20 patients with intractable glaucoma were included in this prospective, consecutive, case-control study. The eyes had had a mean of 4.4 +/- 2.4 previous antiglaucomatous interventions. Baseline intraocular pressure (IOP) was 34.3 +/- 10.5 mmHg despite maximum therapy. Under gonioscopic control, cyclodialysis ab interno was performed over two clock times to gain access to the suprachoroidal space. No additional trabecular meshwork surgery was performed. Success was defined as a lowering of IOP to below 21 mmHg without the need for further medication or intervention. Mean postoperative IOP was 14.6 +/- 12.4 mmHg. Mean follow-up (FU) for all eyes was 121.8 days. After a mean of 60 days, 21 eyes (75%) needed further surgical intervention. Qualified success was seen in four eyes (14.3%), with a mean FU of 383.6 days. Three eyes (10.7%) showed absolute success after a mean FU period of 202.7 days. In our series, we obtained the best results for phakic eyes, followed by pseudophakic and aphakic eyes. The results of this study do not provide convincing evidence of the functional efficacy of cyclodialysis ab interno. Nevertheless, the technique is easy to perform and offers safe and atraumatic access to the resorptive capability of the choroid. Conjunctival manipulation is avoided. Contrary to reports in the current literature, in our series, the best results were obtained for phakic eyes, though the small number of eyes included does not allow reliable statistics. Further studies will need to focus on the use of different space-retaining substances or a widening of the cyclodialysis cleft to improve surgical outcome.

  18. Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

    Directory of Open Access Journals (Sweden)

    Hakan Basar

    2014-01-01

    Conclusion: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

  19. Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2016-01-01

    Conclusion: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.

  20. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

    Science.gov (United States)

    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours.

  1. Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest approach

    Institute of Scientific and Technical Information of China (English)

    励峰; 李伟; 康宁; 龚宝生; 吴东进; 徐方杰; 邱兆昆; 吴卫华

    2011-01-01

    Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

  2. Surgical management of ventrally located spinal meningiomas via posterior approach.

    Science.gov (United States)

    Notani, Naoki; Miyazaki, Masashi; Kanezaki, Shozo; Ishihara, Toshinobu; Kawano, Masanori; Tsumura, Hiroshi

    2017-02-01

    Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult. Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3 years (47-88 years). The average observation period was 55.4 months (22-132 months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence. Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11 years after an operation involving a Simpson grade II resection CONCLUSION: Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.

  3. Treatment for Paget’s disease: surgical approaches

    Directory of Open Access Journals (Sweden)

    E. Yu. Fetisova

    2015-01-01

    Full Text Available Breast cancer (BC ranks first in the pattern of female malignancies (20.7 % and remains the top cancer among women. Paget’s disease (PD is a rare BC form that occurs in the orifice of the lactiferous tubes and that is characterized by involvement of the nipple, large ducts, often to form a lump in the breast; this rare abnormality is encountered in 0.5–5 % of all BC cases. PD has a number of peculiarities. According to different authors, PD is attended with invasive or noninvasive BC in most cases (90–98 %. The involvement is commonly multifocal. PD has a very high risk for a lump (100 and 96 % for palpable and nonpalpable breast tumors, respectively. Almost 50 % of these patients have palpable breast lumps. Despite the fact that the course of PD has its peculiarities because of the rarity of this abnormality, the approaches to its treatment are not different from those in other histopathological types of BC. As for the surgical treatment of PD, until the present time there have been many unsolved problems that remain a matter of debate. The surgical treatment of PD does not differ from the treatment of BC and is primarily determined by disease stage and tumor subtype. The volume of operations for PD varies: from Madden’s radical mastectomy to lumpectomy and sentinel lymph node biopsy. It should be kept in mind that besides nipple-areole complex involvement, invasive or noninvasive BC is often detected in PD. Organ-sparing surgery for PD is mainly a method of rehabilitation for patients. Whether organsparing surgery can be performed is also determined by breast size. Oncoplaplastic resections may be carried out for PD. If the patient wishes to preserve her breast, the range of both single-stage and delayed reconstructive operations is wide. The assessment of the biological features of a tumor and the more differentiated approach to therapy in this cohort of patents might improve considerable survival rates; the determination

  4. Bat Wing Surgical Approach for the Temporomandibular Joint

    National Research Council Canada - National Science Library

    Garcia y Sanchez, J M; Davila Torres, J; Pacheco Rubio, G; Gómez Rodríguez, C L

    The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure...

  5. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review.

    Science.gov (United States)

    Donaldson, L H; Gill, A J; Hibbert, M

    2016-11-01

    There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates. A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%. In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high. © 2016 Royal Australasian College of Physicians.

  6. Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma

    Directory of Open Access Journals (Sweden)

    Jonathan J Morrison

    2012-01-01

    Full Text Available Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT. Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts′ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH and those not requiring immediate surgery (non-LTTH. Statistical Analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher′s exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP, pulse pressure, shock index (SI=heart rate/SBP and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.

  7. Sustainable development through biomass utilization: A practical approach

    Science.gov (United States)

    Ravi Malhotra

    2008-01-01

    (Please note, this is an abstract only) This paper is for folks involved in community development efforts targeted towards biomass utilization. Our approach to evaluate the potential for establishing enterprises that utilize locally available forest resources is tailored specifically to the needs of the local community. We evaluate the: 1. Technical feasibility and...

  8. Consistent evaluation of an ultrasound-guided surgical navigation system by utilizing an active validation platform

    Science.gov (United States)

    Kim, Younsu; Kim, Sungmin; Boctor, Emad M.

    2017-03-01

    An ultrasound image-guided needle tracking systems have been widely used due to their cost-effectiveness and nonionizing radiation properties. Various surgical navigation systems have been developed by utilizing state-of-the-art sensor technologies. However, ultrasound transmission beam thickness causes unfair initial evaluation conditions due to inconsistent placement of the target with respect to the ultrasound probe. This inconsistency also brings high uncertainty and results in large standard deviations for each measurement when we compare accuracy with and without the guidance. To resolve this problem, we designed a complete evaluation platform by utilizing our mid-plane detection and time of flight measurement systems. The evaluating system uses a PZT element target and an ultrasound transmitting needle. In this paper, we evaluated an optical tracker-based surgical ultrasound-guided navigation system whereby the optical tracker tracks marker frames attached on the ultrasound probe and the needle. We performed ten needle trials of guidance experiment with a mid-plane adjustment algorithm and with a B-mode segmentation method. With the midplane adjustment, the result showed a mean error of 1.62+/-0.72mm. The mean error increased to 3.58+/-2.07mm without the mid-plane adjustment. Our evaluation system can reduce the effect of the beam-thickness problem, and measure ultrasound image-guided technologies consistently with a minimal standard deviation. Using our novel evaluation system, ultrasound image-guided technologies can be compared under equal initial conditions. Therefore, the error can be evaluated more accurately, and the system provides better analysis on the error sources such as ultrasound beam thickness.

  9. Minimally invasive surgical approaches for temporal lobe epilepsy

    Science.gov (United States)

    Chang, Edward F.; Englot, Dario J.; Vadera, Sumeet

    2016-01-01

    Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60–80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease. PMID:26017774

  10. Living donor liver hilar variations:surgical approaches and implications

    Institute of Scientific and Technical Information of China (English)

    Onur Yaprak; Tolga Demirbas; Cihan Duran; Murat Dayangac; Murat Akyildiz; Yaman Tokat; Yildiray Yuzer

    2011-01-01

    BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

  11. A surgical approach in the management of mucormycosis in a trauma patient.

    Science.gov (United States)

    Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D

    2016-11-01

    Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

  12. MODERN APPROACHES TO SURGICAL TREATMENT OF CHARCOT NEUROARTHROPATHY (review

    Directory of Open Access Journals (Sweden)

    S. V. Pavlyuchenko

    2016-01-01

    Full Text Available The present review addresses a pressing orthopaedic issue of surgical treatment for patients with severe foot deformities occurring as consequence to Charcot neuroarthropathy. Described pathology is a severe threatening condition causing high risk of infections and potential limb loss. The paper describes main foot reconstructive procedures employed depending on pathology stage and localization as well as identifies ways to improve surgical treatment of affected patients.

  13. Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

    Science.gov (United States)

    Parwani, Simran R; Parwani, Rajkumar N

    2014-01-01

    Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

  14. Haglund Deformity – Surgical Resection by the Lateral Approach

    OpenAIRE

    Natarajan, S; VL Narayanan

    2015-01-01

    The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund de...

  15. [New surgical approach in apicoectomy of maxillary molars' palatal root].

    Science.gov (United States)

    Hrusztics, Aminett; Bogdán, Sándor; Fellegi, Veronika; Szabó, György

    2003-06-01

    The term of apicectomy has been well-known for more than 200 years, nevertheless it is not performed frequently on molars. As a result of this a lot of molars became extracted. The aim of the authors was to present the new surgical technique which is described in detail. The radicular cyst localised on the palatal root of the first maxillary molar was operated on. Uneventful healing was obtained. This surgical technique is recommended in some special cases.

  16. Integrated Transport Planning Framework Involving Combined Utility Regret Approach

    DEFF Research Database (Denmark)

    Wang, Yang; Monzon, Andres; Di Ciommo, Floridea;

    2014-01-01

    Sustainable transport planning requires an integrated approach involving strategic planning, impact analysis, and multicriteria evaluation. This study aimed at relaxing the utility-based decision-making assumption by newly embedding anticipated-regret and combined utility regret decision mechanisms...... in a framework for integrated transport planning. The framework consisted of a two-round Delphi survey, integrated land use and transport model for Madrid, and multicriteria analysis. Results show that (a) the regret-based ranking has a similar mean but larger variance than the utility-based ranking does, (b...

  17. Technological Innovations in Surgical Approach for Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Brian Hung-Hin Lang

    2010-01-01

    Full Text Available Over the last decade, surgeons have witnessed dramatic changes in surgical practice as a result of the introduction of new technological advancement. Some of these changes include refinement of techniques in thyroid cancer surgery. The development of various endoscopic thyroidectomy techniques, the addition of the da Vinci robot, and the use of operative adjuncts in thyroid surgery, such as intraoperative neuromonitoring and quick intraoperative parathyroid hormone, have made thyroid cancer surgery not only safer and better accepted by patients with thyroid cancer but also offer them more surgical treatment options.

  18. Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer.

    Science.gov (United States)

    Muelleman, Thomas John; Peterson, Jeremy; Chowdhury, Naweed Iffat; Gorup, Jason; Camarata, Paul; Lin, James

    2016-06-01

    Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.

  19. Turning symptoms into allies: utilization approaches with posttraumatic symptoms.

    Science.gov (United States)

    Phillips, M

    1993-01-01

    Adult patients with symptoms connected to the trauma of childhood sexual abuse often present in therapy with multiple symptoms and life difficulties and offer a challenge to even the most experienced clinician. In this paper, I describe my work with three such patients who were crippled in different ways by symptoms that had proved resistant to years of various therapeutic interventions. In every case, I accepted and utilized these symptoms as positive resources for successful and rapid change. Patients were then taught self-utilization approaches which allowed them to sustain and extend initial improvements. I conclude that the indirect utilization principle introduced by Milton Erickson provides an effective method to use in approaching some of the more persistent patterns of posttraumatic symptomatology related to childhood sexual abuse.

  20. Frenulectomy: proposal of a new surgical approach and case report.

    Science.gov (United States)

    Marenzi, G; Urciuolo, V; Cimmino, P; Cirillo, A; Sammartino, G

    2011-01-01

    The frenula of the oral cavity represent the insertion of perioral muscles in jaws, consisting of a fold of the triangular fibro-connective tissue covered with mucous membrane and usually inserted at the mucogingival line. The purpose of this work, after a review of literature, was to provide the clinical signs above the median frenum removal order for the orthodontic closure of a interincisor diastema and to present a new surgical technique.

  1. Surgical Approaches for Stage IVA Thymic Epithelial Tumors.

    Science.gov (United States)

    Shapiro, Mark; Korst, Robert J

    2014-01-14

    Thymic epithelial tumors (TET) are rare mediastinal neoplasms that can metastasize to the pleural space (stage IVA). Complete surgical resection remains the backbone of therapy for patients with early stage TET, however, the role of surgery in the management of patients with stage IVA disease is not fully defined. Published reports in this regard are mainly small, retrospective, and uncontrolled, with unclear inclusion criteria. Surgical options to manage pleural disease include metastasectomy, extrapleural pneumonectomy, and metastasectomy/pleurectomy combined with heated intrapleural chemotherapy. The choice of the most appropriate surgical strategy needs to be individualized according to the quantity and location of disease, the patient's overall condition, as well as operator and institutional expertise. In the majority of cases, metastasectomy of pleural implants will be sufficient to achieve a complete resection. The available literature suggests that in selected patients with stage IVA TET, delivery of neoadjuvant chemotherapy followed by complete resection is a viable treatment option that can be associated with long-term survival.

  2. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M

    2013-12-01

    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery.

  3. Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

    Full Text Available Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.

  4. Evaluation of surgical freedom for microscopic and endoscopic transsphenoidal approaches to the sella.

    Science.gov (United States)

    Elhadi, Ali M; Hardesty, Douglas A; Zaidi, Hasan A; Kalani, M Yashar S; Nakaji, Peter; White, William L; Preul, Mark C; Little, Andrew S

    2015-03-01

    Microscopic and endoscopic transsphenoidal approaches to the sellar are well established. Surgical freedom is an important skull base principle that can be measured objectively and used to compare approaches. To compare the surgical freedom of 4 transsphenoidal approaches to the sella turcica to aid in surgical approach selection. Four transsphenoidal approaches to the sella were performed on 8 silicon-injected cadaveric heads. Surgical freedom was determined with stereotactic image guidance using previously established techniques. The results are presented as the area of surgical freedom and angular surgical freedom (angle of attack) in the axial and sagittal planes. Mean total exposed area surgical freedom for the microscopic sublabial, endoscopic binostril, endoscopic uninostril, and microscopic endonasal approaches were 102 ± 13, 89 ± 6, 81 ± 4, and 69 ± 10 cm2, respectively. The endoscopic binostril approach had the greatest surgical freedom at the pituitary gland and ipsilateral and contralateral internal carotid arteries (25.7 ± 5.4, 28.0 ± 4.0, and 23.0 ± 3.0 cm2) compared with the microscopic sublabial (21.8 ± 3.5, 21.3 ± 2.4, and 19.5 ± 6.3 cm2), microscopic endonasal (14.2 ± 2.7, 14.1 ± 3.2, and 16.3 ± 4.0 cm2), and endoscopic uninostril (19.7 ± 4.8, 22.4 ± 2.3, and 19.5 ± 2.9 cm2) approaches. Axial angle of attack was greatest for the microscopic sublabial approach to the same targets (14.7 ± 1.3°, 11.0 ± 1.5°, and 11.8 ± 1.1°). For the sagittal angle of attack, the endoscopic binostril approach was superior for all 3 targets (16.6 ± 1.7°, 17.2 ± 0.70°, and 15.5 ± 1.2°). Microscopic sublabial and endoscopic binostril approaches provided superior surgical freedom compared with the endonasal microscopic and uninostril endoscopic approaches. This work provides objective baseline values for the quantification and evaluation of future refinements in surgical technique or instrumentation.

  5. Removal of Supernumerary Teeth Utilizing a Computer-Aided Design/Computer-Aided Manufacturing Surgical Guide.

    Science.gov (United States)

    Jo, Chanwoo; Bae, Doohwan; Choi, Byungho; Kim, Jihun

    2017-05-01

    Supernumerary teeth need to be removed because they can cause various complications. Caution is needed because their removal can cause damage to permanent teeth or tooth germs in the local vicinity. Surgical guides have recently been used in maxillofacial surgery. Because surgical guides are designed through preoperative analysis by computer-aided design software and fabricated using a 3-dimensional printer applying computer-aided manufacturing technology, they increase the accuracy and predictability of surgery. This report describes 2 cases of removal of a mesiodens-1 from a child and 1 from an adolescent-using a surgical guide; these would have been difficult to remove with conventional surgical methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Stroke prevention-surgical and interventional approaches to carotid stenosis

    Directory of Open Access Journals (Sweden)

    Kumar Rajamani

    2013-01-01

    Full Text Available Extra cranial carotid artery stenosis is an important cause of stroke, which often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy (CEA has been well-established for several decades for symptomatic high and moderate grade stenosis. Carotid stenting is a less invasive alternative to CEA and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as a potential mode of therapy for high surgical risk patients with symptomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

  7. Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Yurdal Gezercan

    2014-08-01

    Full Text Available Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient's clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed. [Cukurova Med J 2014; 39(4.000: 669-678

  8. Assessing habitat utilization by neotropical primates: a new approach.

    Science.gov (United States)

    Warner, Mark D

    2002-01-01

    This study aims to ascertain habitat utilization, in relation to forest structural variation, by a multi-species group of primates in tropical lowland rainforest in Southeast Peru during dry season. A new approach to assessing habitat utilization was used. Habitat variation was described by structural and indicator variables collected in quadrats along transects through a study area within Terra Firme and Floodplain forest. Variables were grouped into 'factors' accounting for most of the variation by means of a Principal Components Analysis (PCA). Presence or absence of the primates within the quadrats, assessed by repeat transect surveys, was taken to indicate habitat preferences. Discrimination between the habitat and forest structure in areas of primate presence as opposed to absence was carried out by means of Discriminant Function Analysis (DFA). This highlighted patterns in most utilized habitat. Vertical utilization of the forest was also assessed along with presence in bamboo and general activity on encounter. Suggestions of habitat preference and utilization are made for each of the six sympatric species studied, based on significantly discriminating habitat factors, vertical stratification on encounter and relationships with bamboo. Saguinus fuscicollis and Cebus moloch appeared as habitat generalists. Cebus apella, Saimiri sciureus, and Aotus spp., exhibited varying degrees of preference for habitat factors suggesting disturbed forest, Cebus albifrons was more generalistic but with a possible association with primary, naturally disturbed forest. C. apella was encountered in Terra Firme forest significantly more than in Floodplain. For S. sciureus, C. moloch, and C. apella, upper understory was the most utilized forest layer, for C. albifrons, middle canopy and for S. sciureus and Aotus spp., lower understory. Both positive and negative relationships with bamboo were highlighted. Significant positive relationships between Aotus spp., and bamboo suggest

  9. Comparison of the surgical approaches for a Chiari pelvic osteotomy.

    Science.gov (United States)

    Ito, H; Matsuno, T; Minami, A

    2003-03-01

    We present the mid- to long-term results of the Chiari pelvic osteotomy for dysplastic hips. We followed 135 hips in 129 patients, with a mean age at the time of surgery of 24 years, for a mean of 16.2 years We used the anterior iliofemoral approach without trochanteric osteotomy in the initial 31 hips. Thereafter, we used transtrochanteric approaches in an attempt to ensure that the osteotomy was at the most appropriate level, and to advance the high-riding greater trochanter distally. The next 79 hips therefore underwent a posterolateral approach and the most recent 25 hips an Ollier lateral U approach. The clinical result was excellent or good in 103 hips (77%). The outcome in 104 hips in which we used a transtrochanteric approach was superior, the osteotomy level was more appropriate and a Trendelenburg gait less common than in 31 hips in which we used an anterior approach. We therefore recommend the use of a transtrochanteric approach in order to ensure that the osteotomy is at an appropriate level and in order to achieve effective distal advancement of the high-riding greater trochanter.

  10. [Medical resource utilization and allocation in Japan--evaluation of surgical expenditures].

    Science.gov (United States)

    Hiki, Yoshiki

    2004-05-01

    We evaluated the appropriateness of medical cost allocation in Japan from the global aspect especially the percentage of the national budget for medical cost to gross national product (GDP). Base on OECD-Health Data in 2002, Japan was ranked high in the world in terms of medical services but was ranked the second lowest in terms of the percentage of medical cost to GDP (7.6%) among G7 advanced countries. In addition, at surgical departments, allocated medical cost is mostly used for surgical supplies and instruments, and only negligibly for doctor's fee. Unless this situation is improved, the surgical department in Japan will decline. Improvement measures should be taken without delay.

  11. Surgical approach for elastic stable intramedullary nail in pediatric radius shaft fracture

    DEFF Research Database (Denmark)

    Nørgaard, Sandra L.; Schødt Riber, Sara; Danielsson, Frederik B.

    2017-01-01

    When using elastic stable intramedullary nailing in children’s distal radius shaft fractures, the surgical approach can either be lateral or dorsal. The aim of this article was to carry out a systematic review of the literature comparing the two types of approaches in terms of complications...

  12. Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

    Directory of Open Access Journals (Sweden)

    Lourdes Quintanilla-Dieck

    2016-01-01

    Full Text Available Objectives. First branchial cleft anomalies (BCAs constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.

  13. Extraoral surgical approach of ectopic mandibular third molar to the lower border of mandible.

    Science.gov (United States)

    Laino, Luigi; Menditti, Dardo; Lo Muzio, Lorenzo; Laino, Gregorio; Lauritano, Floriana; Cicciù, Marco

    2015-05-01

    The surgical removal of impacted lower third molar is an ordinary intervention. The treatment of choice in this pathology is an intraoral or, seldom, extraoral surgical approach. Various surgical procedures have been described to remove ectopic mandibular teeth. The more common technique is an intraoral approach (so named "conservative"), even when the tooth is located in an ectopic area. However, the "intraoral approach" is often related with the difficulty of view, the bleeding of the surgical site, and with the possible lesions of inferior alveolar or lingual nerve. From the other side, a nonconservative surgical approach like "extraoral pathway" may be associated with no aesthetic cutaneous postoperative scar tissue. The aim of those 2 study cases is to highlight the management of infected ectopic third molars located close to the lower border of the mandibular body, underlining the anatomical land markers of the submandibular area. The authors have applied the extraoral pathway using an incision of small size. From our analysis, the treatment of those typical can be managed by using a "mini-skin-incision" (so termed as mini-submandibular approach) respecting the cosmetic expectations of the patients.

  14. Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches.

    Science.gov (United States)

    Wells, John A; Condado, Jose F; Kamioka, Norihiko; Dong, Andy; Ritter, Andrew; Lerakis, Stamatios; Clements, Stephen; Stewart, James; Leshnower, Bradley; Guyton, Robert; Forcillo, Jessica; Patel, Ateet; Thourani, Vinod H; Block, Peter C; Babaliaros, Vasilis

    2017-03-13

    The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL). Data comparing the treatment of PVL with TI and SI are limited. A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year. Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p < 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p < 0.001), a shorter intensive care unit stay (0 vs. 3 days; p < 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups. In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002.

    Science.gov (United States)

    Babalola, Ebenezer O; Bharucha, Adil E; Melton, L Joseph; Schleck, Cathy D; Zinsmeister, Alan R; Klingele, Christopher J; Gebhart, John B

    2008-09-01

    To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

  16. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches

    Energy Technology Data Exchange (ETDEWEB)

    Agten, Christoph A.; Sutter, Reto; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Dora, Claudio [Balgrist University Hospital, Orthopedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2017-03-15

    To compare soft-tissue changes after total hip arthroplasty with posterior, direct-lateral, anterolateral, or anterior surgical approaches. MRI of 120 patients after primary total hip arthroplasty (30 per approach) were included. Each MRI was assessed by two readers regarding identification of surgical access, fatty muscle atrophy (Goutallier classification), tendon quality (0 = normal, 1 = tendinopathy, 2 = partial tear, 3 = avulsion), and fluid collections. Readers were blinded to the surgical approach. Surgical access was correctly identified in all cases. The direct lateral approach showed highest Goutallier grades and tendon damage for gluteus minimus muscle (2.07-2.67 and 2.00-2.77; p = 0.017 and p = 0.001 for readers 1 and 2, respectively) and tendon (2.30/1.67; p < 0.0005 for reader 1/2), and the lateral portion of the gluteus medius tendon (2.77/2.20; p < 0.0005 for reader 1/2). The posterior approach showed highest Goutallier grades and tendon damage for external rotator muscles (1.97-2.67 and 1.57-2.40; p < 0.0005-0.006 for reader 1/2) and tendons (1.41-2.45 and 1.93-2.76; p < 0.0005 for reader 1/2). The anterolateral and anterior approach showed less soft tissue damage. Fluid collections showed no differences between the approaches. MRI is well suited to identify surgical approaches after THA. The anterior and anterolateral approach showed less soft tissue damage compared to the posterior and direct lateral approach. (orig.)

  17. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

    Directory of Open Access Journals (Sweden)

    Suresh K Sankhla

    2015-01-01

    Full Text Available Objective: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas. Methods: Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors. Results: A gross total or near total excision was achieved in 10 (66.7% patients, subtotal resection in 4 (26.7%, and partial removal in 1 (6.7% patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20% developed postoperative CSF leaks which were managed conservatively. Three (20% patients with diabetes insipidus and 2 (13.3% with panhypopituitarism required long-term hormonal replacement therapy. Conclusions: Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks.

  18. Giant Orbitoethmoidal Osteoma: When an Open Surgical Approach Is Required

    Directory of Open Access Journals (Sweden)

    Hussam Abou Al-Shaar

    2015-01-01

    Full Text Available Giant orbitoethmoidal osteoma in children is considered to be rare. This type of pathology can be associated with significant disfiguring proptosis and limitation of eye movement. Here, we report on a child who presented with a giant orbitoethmoidal osteoma that was removed through an orbitofrontal approach. The cosmetic result was excellent and evident immediately after surgery. A review of the literature complements this report.

  19. Osteochondroma of the mandibular condyle: Report of two surgical approaches.

    Science.gov (United States)

    Lim, William; Weng, Lye Kok; Tin, Goh Bee

    2014-01-01

    Osteochondromas are common tumors of the long bones, but are rare in the craniofacial region. We detailed two different management of osteochondroma of the mandibular condyle treated utilizing three-dimensional (3D) imaging and computer-assisted planning. Simultaneous open temporomandibular joint and orthognathic surgeries were done to treat both the pathology and secondary facial asymmetry. An osteochondroma that presented as a bony mass at the lateral aspect of the left mandibular condyle of a 24-year-old Chinese female was treated with simultaneous orthognathic surgery and conservative excision. No recurrence was detected 7 months postsurgery. An osteochondroma that presented as a generalized enlargement of the right mandibular condyle of a 25-year-old Chinese male was treated with simultaneous orthognathic surgery and condylectomy. There were no significant issues 3 years postsurgery. Simultaneous orthognathic and temporomandibular joint surgeries are a viable option for the management of osteochondroma of the mandibular condyle. The availability of 3D imaging enabled better presurgical examination of the lesion, which directed treatment toward condylectomy or conservative excision.

  20. Endoscopic versus microscopic approach for surgical treatment of acromegaly.

    Science.gov (United States)

    Fathalla, Hussein; Cusimano, Michael D; Di Ieva, Antonio; Lee, John; Alsharif, Omar; Goguen, Jeannette; Zhang, Stanley; Smyth, Harley

    2015-07-01

    Transsphenoidal surgery in the setting of acromegaly is quite challenging due to increased soft tissue mass, bony overgrowth, and bleeding. There is a debate on the endoscopic versus microscopic approach for these patients. The purpose of our study is to compare the outcomes for acromegaly after transsphenoidal surgery using both techniques. Retrospective review of 65 acromegalic patients who underwent transsphenoidal surgery in our department. Clinical remission was defined as resolution of typical acromegalic symptoms. Radiological resection was defined by volumetric criteria, and biochemical remission was defined as by the 2010 consensus on the criteria for remission of acromegaly. There was no significant difference in age, preoperative endocrine status, percent of macro adenomas, suprasellar, or infrasellar extension between both groups. Patients were assigned to both groups based on our existing referral pattern. Endoscopic approach was performed in 42 patients, while the microscopic approach was performed in 23 patients. No significant difference in remission rates was found between both groups (45.2 vs. 34.7 %, p = 0.40). The endoscopic group, however, had a significantly higher rate of gross total resections (61 vs. 42 %, p = 0.05). There was also a trend towards higher rates of gross total resections when cavernous sinus was present (48 vs. 14.2 %, p = 0.09). Postoperative diabetes insipidus occurred more in microscopic patients (34.7 vs. 17 %, p = 0.05), otherwise there was no significant difference in rates of complications. The median follow-up period was 56.6 months (range 6-156, mean 66.1). There is no significant difference in the rates of biochemical remission between the endoscopic and microscopic techniques. The endoscope technique, however, seems to be superior in achieving gross total resection especially with tumors invading the cavernous sinus.

  1. Comparison of two different approaches for internal jugular vein cannulation in surgical patients.

    Directory of Open Access Journals (Sweden)

    Chudhari L

    1998-07-01

    Full Text Available We compared the anterior approaches of internal jugular venous cannulation in 200 surgical patients, vis-Ã -vis the ease of cannulation and threading, number of attempts required and the incidence of complications following each route. The technique of posterior approach used in this study was found to have a higher rate of success in cannulation and lower rate of complication such as carotid puncture. The posterior approach was also a safe alternate route in obese or short necked patients.

  2. Surgical treatment of thoracic outlet syndrome; by supraclavicular approach

    Directory of Open Access Journals (Sweden)

    Osman Abd Ellah Mohamed

    2012-01-01

    Full Text Available Background: Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the supraclavicular approach in management of neurovascular compression at the thoracic outlet. Materials and Methods: Twenty patients (15 females and 5 males with mean age of 20 years (ranging from 18 to 40 years underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression (C8 - T1. Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. Results: After 35 months of follow-up, 17 patients showed excellent results, two cases had good results and one case had fair results according to the visual analog scale, and nerve conduction velocities. Conclusions: We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow-up, and supraclavicular approach in neurogenic decompression which is relatively safe and effective.

  3. Online Instructional Design Approaches Utilizing a Tablet PC

    Directory of Open Access Journals (Sweden)

    Pam Lowry

    2009-11-01

    Full Text Available Online students can experience what instructional strategies can be utilized using a Tablet PC in online courses. This paper summarizes how inking in Word, Powerpoint, and Windows Journal can be effective in an online course both asynchronously and synchronously. Approaches concerning assignments, discussion boards, presentations, note taking are discussed and how they can be more effective for faculty members and students using a Tablet PC. Students actually experience how a Tablet PC can be utilized in an asynchronous and synchronous environment. In summary, preliminary data will be discussed from the students and professor’s point of view and next steps. As content and assignments are being designed and developed for an online graduate course, it is important to keep in mind teaching styles, student’s learning styles, and a faculty member’s approach to promoting a Tablet PC in an online course. Even though graduate students were not required to have a Tablet PC, the course enabled them to understand how effective a Tablet PC could be in an online course whether it was delivered asynchronous or synchronously. Powerpoint presentations were created to delivery asynchronously and synchronously content to students by utilizing a Tablet PC to illustrate concepts within the presentation. Assignments were created such as evaluating e-learning products, creating a Blackboard unit, evaluating online courses, group instruction sessions, and weekly discussion boards. As these assignments were graded, comments were written on their Word and Powerpoint files using Tablet PC inking. As the Tablet PC initiative is less than one year old at Lawrence Technological University, preliminary data is being collected from faculty members and students. After this class is taught summer 2008, additional research on the efforts of course design and student learning will be explored. The Tablet PC has the potential for enhancing online course delivery.

  4. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery*

    Science.gov (United States)

    Suzuki, Heliane Sanae; Serafini, Sérgio Zuñeda; Sato, Maurício Shigueru

    2014-01-01

    BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique. PMID:24626646

  5. Evaluation of PO2 and PCO2 changes during surgical removal of third molars utilizing enflurane anesthesia.

    Science.gov (United States)

    Kraut, R A; Rubal, B; Bush, B

    1985-01-01

    This study investigated the changes in partial pressure of oxygen during surgical removal of wisdom teeth utilizing a spontaneous ventilation general anesthesia technique with enflurane. Simultaneous transcutaneous and arterial blood gas determination confirmed the presence of two oxygen patterns. Normal preoperative pulmonary function tests, coupled with the stability of the Paco(2) between surgery and extubation, indicates that the 23±10 mmHg increase in transcutaneous oxygen (Ptco(2)) reported in 14 of 27 patients evaluated, was due to ventilation perfusion defects, since 13 of the 27 patients showed a 149±22 mmHg increase in Ptco(2) during the same time period.

  6. Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study.

    Science.gov (United States)

    Öberg, S; Andresen, K; Rosenberg, J

    2016-12-01

    Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior-posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates between repairs performed according to the guidelines with the ones performed against it. This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein-Lichtenstein vs. Lichtenstein-Laparoscopy, and Laparoscopy-Laparoscopy vs. Laparoscopy-Lichtenstein. The outcome was re-reoperation rates, which were compared by crude rates, cumulated rates, and hazard ratios. There was no difference in the re-reoperation rates when the primary repair was laparoscopic, regardless of the type of reoperation. However, Lichtenstein-Lichtenstein had a significantly higher re-reoperation rate compared with Lichtenstein-Laparoscopy (crude rate 8.7 vs. 3.1 %, p value hernia was medial. A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein or a laparoscopic repair according to surgeon's choice. For a primary laparoscopic operation, the method of repair of a recurrent hernia did not affect the re-reoperation rate.

  7. Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly

    Directory of Open Access Journals (Sweden)

    Horacio Armando Marenco

    2015-09-01

    Full Text Available Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM operated by the endoscopic endonasal approach (EEA. Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

  8. Utility of melatonin to treat surgical stress after major vascular surgery--a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    registered. Blood samples were collected preoperatively and at 5 min, 6 hr and 24 hr after clamp removal or after re-circulation of the first leg and the samples were analyzed for malondialdehyde (MDA), ascorbic acid (AA), dehydroascorbic acid (DHA), and interleukin-6 (IL-6). Troponin I (TpI) and C...... with melatonin intravenously up to 60 mg in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical...

  9. Surgical Correction of Rigid Equinovarus Contracture Utilizing Extensive Soft Tissue Release.

    Science.gov (United States)

    Reeves, Christopher L; Shane, Amber M; Zappasodi, Francesca; Payne, Trevor

    2016-01-01

    Although deforming contractures of the lower extremities after acute cerebrovascular events are well documented in the literature, there is limited literature regarding specific surgical considerations for the correction of these deformities, which are nonosseus in nature. The equinovarus foot, regardless of its origin, is a challenging pathologic condition for the foot and ankle surgeon. It is critical to have a firm understanding of the cause and symptoms behind an equinovarus deformity before treatment. The clinical presentation is discussed with special attention to deformities in adults with rigid equinovarus deformities after cerebrovascular-related accidents or peripheral ischemic events. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  11. Surgical treatment of Peyronie's disease: choosing the best approach to improve patient satisfaction

    Institute of Scientific and Technical Information of China (English)

    Paulo H. Egydio

    2008-01-01

    Aim: To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie's disease. Methods:Recent advances in approaches to Peyronie's disease are discussed based on the literature and personal experiences.Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction (ED), and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion: Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis (length and rigidity). Length and girth

  12. Radiofrequency Ablation for 110 Malignant Liver Tumours: Preliminary Results on Percutaneous and Surgical Approaches

    Directory of Open Access Journals (Sweden)

    J. Wong

    2009-01-01

    Conclusion: RFA is a safe and effective procedure for treating patients with malignant liver tumours. No difference in short term outcomes was observed between percutaneous and surgical approaches. A more prolonged follow-up study is required to assess longer-term outcomes.

  13. Z-APPROACH USAGE IN SURGICAL TREATMENT OF ACHILLES TENDON RUPTURES

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    A. A. Gritsyuk

    2010-01-01

    Full Text Available The authors worked out and checked out rational Z-approach to the Achilles tendon with taking into consideration anatomical, physiological and biomechanical features of this region. Entrance allowed trustworthy reduce frequency and area of postoperative wound rim necrosis, and allowed statistic trustworthy reduce number of complications after surgical treatment of Achilles tendon ruptures.

  14. Study on surgical approaches and electrode implantation of oculomotor nerve and inferior obliquus in beagle dogs.

    Science.gov (United States)

    Zhu, Ning-Xi; Meng, You-Qiang; Feng, Bao-Hui; Wang, Xu-Hui; Li, Xin-Yuan; Yang, Min; Zhu, Shu-Gan; Li, Shi-Ting

    2009-03-01

    To study the surgical anatomy and approaches of intracranial oculomotor nerve (OMN) and inferior obliquus (IO), and the methods of their electrode implantation in dogs. The research was performed on 30 adult beagle dogs at Shanghai Jiaotong University Medical College, Shanghai, China from November 2007 to August 2008. All animals were subjected to a right transfrontotemperal approach to intracranial OMN, a transconjunctival route to IO, and the neuro-stimulating and recording electrode implantation under general anaesthesia. The OMN was stimulated and the electromyography of IO recorded and analyzed with the Powerlab System. The security and reliability of the implanted electrodes were investigated. The surgical anatomy and approaches of both the OMN from its exit from midbrain to the entrance into cavernous sinus and the IO were described. Moreover, the implantation methods of OMN stimulating electrode and the electromyographic recording electrode of IO were displayed. The implanted electrodes were safe and reliable. Some electrophysiologic data of IO were obtained in the healthy dogs. Also, some perioperative precautions for intracranial and ophthalmic surgical procedures in dog were exhibited. The mortality rate of the dogs was 0%, and no operative complications were observed. With the data provided, these surgical approaches and the methods of electrode implantation offer a choice to construct an animal model for studying various aspects of OMN regeneration.

  15. Applying electrical utility least-cost approach to transportation planning

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, G.A.; Growdon, K.; Lagerberg, B.

    1994-09-01

    Members of the energy and environmental communities believe that parallels exist between electrical utility least-cost planning and transportation planning. In particular, the Washington State Energy Strategy Committee believes that an integrated and comprehensive transportation planning process should be developed to fairly evaluate the costs of both demand-side and supply-side transportation options, establish competition between different travel modes, and select the mix of options designed to meet system goals at the lowest cost to society. Comparisons between travel modes are also required under the Intermodal Surface Transportation Efficiency Act (ISTEA). ISTEA calls for the development of procedures to compare demand management against infrastructure investment solutions and requires the consideration of efficiency, socioeconomic and environmental factors in the evaluation process. Several of the techniques and approaches used in energy least-cost planning and utility peak demand management can be incorporated into a least-cost transportation planning methodology. The concepts of avoided plants, expressing avoidable costs in levelized nominal dollars to compare projects with different on-line dates and service lives, the supply curve, and the resource stack can be directly adapted from the energy sector.

  16. Public utilities and low income customers - a marketing approach

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2000-08-18

    There is increasing recognition of the importance of dealing with material hardship rather than just income poverty. This paper deals with electricity disconnection and shows how Electricite de France (EDF), the French monopoly provider of electricity, has been testing a number of new policy instruments to avoid disconnection among its low income residential customers. EDF's approach is grounded in marketing principles and techniques both in terms of its willingness to respond to French public customers surveys to analyses the satisfaction of this segment of clientele to its energy assistance programs. EDF's programmes show how utilities, both public and private, can go beyond financial assistance as represented by the LIHEAP energy voucher programme in the USA. (Author)

  17. The utilization of six sigma and statistical process control techniques in surgical quality improvement.

    Science.gov (United States)

    Sedlack, Jeffrey D

    2010-01-01

    Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.

  18. The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis

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    Ozlem Ural

    2016-01-01

    Full Text Available Aims: To evaluate the utility of margin-reflex distance (MRD as an alternative to levator function (LF in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male, levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.

  19. A benders decomposition approach to multiarea stochastic distributed utility planning

    Science.gov (United States)

    McCusker, Susan Ann

    Until recently, small, modular generation and storage options---distributed resources (DRs)---have been installed principally in areas too remote for economic power grid connection and sensitive applications requiring backup capacity. Recent regulatory changes and DR advances, however, have lead utilities to reconsider the role of DRs. To a utility facing distribution capacity bottlenecks or uncertain load growth, DRs can be particularly valuable since they can be dispersed throughout the system and constructed relatively quickly. DR value is determined by comparing its costs to avoided central generation expenses (i.e., marginal costs) and distribution investments. This requires a comprehensive central and local planning and production model, since central system marginal costs result from system interactions over space and time. This dissertation develops and applies an iterative generalized Benders decomposition approach to coordinate models for optimal DR evaluation. Three coordinated models exchange investment, net power demand, and avoided cost information to minimize overall expansion costs. Local investment and production decisions are made by a local mixed integer linear program. Central system investment decisions are made by a LP, and production costs are estimated by a stochastic multi-area production costing model with Kirchhoff's Voltage and Current Law constraints. The nested decomposition is a new and unique method for distributed utility planning that partitions the variables twice to separate local and central investment and production variables, and provides upper and lower bounds on expected expansion costs. Kirchhoff's Voltage Law imposes nonlinear, nonconvex constraints that preclude use of LP if transmission capacity is available in a looped transmission system. This dissertation develops KVL constraint approximations that permit the nested decomposition to consider new transmission resources, while maintaining linearity in the three

  20. [Surgical approaches of tumors of the posterior cone of the orbit].

    Science.gov (United States)

    Bachelet, J T; Shipkov, H; Breton, P; Berhouma, M; Jouanneau, E; Gleizal, A

    2016-04-01

    The surgical management of posterior orbital tumors is complex because it is an anatomical area located at the borders between the face and the skull base. The goal of the procedures carried-out in this area is to resect the tumor while preserving vision by using the safest possible approach. The aim of our work was to determine, in the light of our experience and of a review of the literature, the advantages and drawbacks of the numerous approaches described.

  1. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc......Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose...... in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical situations....

  2. The Surgical Approach to Differentiated Thyroid Cancer [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Iain Nixon

    2015-11-01

    Full Text Available The incidence of thyroid cancer is increasing rapidly. A large percentage of new cases identified fall into a low-risk category. As the incidence has increased, clinical experience has confirmed that the majority of patients will have excellent outcomes and that those at risk of doing badly can be reliably identified. Treatment for thyroid cancer is predominantly surgical. The decision about how aggressively this disease should be managed has remained controversial due to the excellent outcomes irrespective of the nature of surgical procedure chosen. This article reviews the developments in our understanding of the biology of thyroid cancer and the evidence that supports the approach to management.

  3. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  4. Histopathologic approach to the surgical lung biopsy in interstitial lung disease.

    Science.gov (United States)

    Jones, Kirk D; Urisman, Anatoly

    2012-03-01

    Interpretation of lung biopsy specimens is an integral part in the diagnosis of interstitial lung disease (ILD). The process of evaluating a surgical lung biopsy for disease involves answering several questions. Unlike much of surgical pathology of neoplastic lung disease, arriving at the correct diagnosis in nonneoplastic lung disease often requires correlation with clinical and radiologic findings. The topic of ILD or diffuse infiltrative lung disease covers several hundred entities. This article is meant to be a launching point in the clinician's approach to the histologic evaluation of lung disease.

  5. Abdominal and perineal approaches in the surgical treatment of rectal prolapse

    Directory of Open Access Journals (Sweden)

    Mesut Gül

    2012-03-01

    Full Text Available Introduction: Rectal prolapse is a disease, which is an important cause of social and functional problems and has a continuing debate about the ideal surgical treatment of itself. In this study, we aimed to investigate the abdominal and perineal approaches with early and late postoperative result in the patients undergoing surgery for rectal prolapse.Materials and methods: Between 2006-2011, the records of 21 patients undergoing surgery with the diagnosis of rectal prolapse were reviewed, retrospectively. The demographic and physical examination findings, surgical procedures, early and late postoperative complications, recurrence and mortality rates were recorded.Results: The median age was 43 years and female/male ratio was 1.63/1. The most common presenting complaint was gas control failure and often wetting with mucus. Stage 1 and stage 3 rectal prolapses was detected in 19% and 81% of the patients, respectively. The most common surgical procedure was Notaras (54%. Early postoperative complications were seen in 14.3% of the patients. There were no postoperative recurrence, mortality and complication requiring re-exploration. Advanced age and shorter duration of hospital stay were determined and often performed under regional anesthesia in the patients undergoing perineal approach. No statistical differences were observed in terms of early postoperative complications and recurrence.Conclusion: Results of abdominal and perineal approaches were similar, when they were applied with taking into account the risk factors for surgical treatment, findings of the patients and the surgeon’s experience.

  6. Implementation of whole slide imaging in surgical pathology: A value added approach

    Directory of Open Access Journals (Sweden)

    Mike Isaacs

    2011-01-01

    Full Text Available Background: Whole slide imaging (WSI makes it possible to capture images of an entire histological slide. WSI has established roles in surgical pathology, including support of off-site frozen section interpretation, primary diagnosis, educational activities, and laboratory quality assurance (QA activities. Analyses of the cost of WSI have traditionally been based solely on direct costs and diagnostic accuracy; however, these types of analyses largely ignore workflow and cost issues that arise as a result of redundancy, the need for additional staffing, and customized software development when WSI is integrated into routine diagnostic surgical pathology. The pre-scan, scan, and post-scan costs; quality control and QA costs; and IT process costs can be significant, and consequently, pathology groups can find it difficult to perform a realistic cost-benefit analysis of adding WSI to their practice. Materials and Methods: In this paper, we report a "value added" approach developed to guide our decisions regarding integration of WSI into surgical pathology practice. The approach focuses on specific operational measures (cost, time, and enhanced patient care and practice settings (clinical, education, and research to identify routine activities in which the addition of WSI can provide improvements. Results: When applied to our academic pathology group practice, the value added approach resulted in expanded and improved operations, as demonstrated by outcome based measures. Conclusion: A value added can be used to perform a realistic cost-benefit analysis of integrating WSI into routine surgical pathology practice.

  7. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches.

    Science.gov (United States)

    Kerwin, Leonard Y; El Tal, Abdel Kader; Stiff, Mark A; Fakhouri, Tarek M

    2014-08-01

    Cosmetic, functional, and structural sequelae of scarring are innumerable, and measures exist to optimize and ultimately minimize these sequelae. To evaluate the innumerable methods available to decrease the cosmetic, functional, and structural repercussions of scarring, pubMed search of the English literature with key words scar, scar revision, scar prevention, scar treatment, scar remodeling, cicatrix, cicatrix treatment, and cicatrix remodeling was done. Original articles and reviews were examined and included. Seventy-nine manuscripts were reviewed. Techniques, comparisons, and results were reviewed and tabulated. Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable. However, advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach. Comparison studies of the innumerable specific modalities for scar revision and prevention are impossible. Standardization of techniques is lacking. Scarring, the body's natural response to a wound, can create many adverse effects. At this point, the practice of sound, surgical fundamentals still trump the most advanced preventative methods and revision techniques. Advances in medical approaches are available, however, to assist the scarring process, which even the most advanced surgical fundamentals will ultimately lead to. Whether through newer topical therapies, light treatment, or classical surgical intervention, our treatment armamentarium of scars has expanded and will allow us to maximize scar prevention and to minimize scar morbidity.

  8. Evolving a common surgical curriculum for ASEAN nations with a public health approach.

    Science.gov (United States)

    Lum, Siew Kheong

    2013-03-01

    The Association of Southeast Asian Nations (ASEAN) Mutual Recognition Arrangement (MRA) on medical practitioners' agreement will become a reality in the year 2015. Doctors registered in one ASEAN country will be given reciprocal recognition in another country under this agreement. Rapid and excessive movement of human resources between countries in a short span of time is undesirable and can be destabilizing. The surgical fraternity in the ASEAN countries should plan for a common surgical curriculum, a common examination and an ASEAN Board of Surgery so that standards of future trainees in different countries are comparable. The curriculum should take into consideration the diversity of the countries in socio-economic development. Ideally, it should be based on a public health approach to bring affordable quality surgical care to the masses in an efficient and effective manner.

  9. Nonmagnetic rigid and flexible outer sheath with pneumatic interlocking mechanism for minimally invasive surgical approach.

    Science.gov (United States)

    Yamashita, Hiromasa; Zuo, Siyang; Masamune, Ken; Liao, Hongen; Dohi, Takeyoshi

    2009-01-01

    We developed a nonmagnetic rigid and flexible outer sheath with pneumatic interlocking mechanism using flexible toothed links and a wire-driven bending distal end. The outer sheath can be switched between rigid and flexible modes easily depending on surgical scenes, and the angle of its distal end can be controlled by three nylon wires. All components of flexible parts are made of MRI-compatible nonmagnetic plastics. We manufactured the device with 300-mm long, 16-mm outer diameter, 7-mm inner diameter and 90-mm bending distal end. Holding power of the device in rigid mode was maximum 3.6 N, which was sufficient for surgical tasks in body cavity. In vivo experiment using a swine, our device performed smooth insertion of a flexible endoscope and a biopsy forceps into reverse side of the liver, intestines and spleen with a curved path. In conclusion, our device shows availability of secure approach of surgical instruments into deep cavity.

  10. Classical surgical approach and treatment with clips of extracranial internal carotid artery berry aneurysm

    Directory of Open Access Journals (Sweden)

    Haris Vukas

    2016-06-01

    Full Text Available Introduction: We can define extracranial carotid artery aneurysm (ECAA as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA or in a case of common carotid artery (CCA greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.

  11. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    Science.gov (United States)

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  12. Endoscopic or Surgical Approach to Cure Pancreatitis and Its Complications: The History Continues

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    Raffaele Pezzilli

    2008-07-01

    Full Text Available Endoscopic and surgical treatment are the two main techniques for the treatment of pancreatitis, mainly represented by the persistent pain not responding to medical treatment and the complications associated with pain, such as pseudocysts and ductal stenosis. However, the dilemma is related to the procedures we use to treat these complications: surgical or endoscopic approach? Probably the treatment of choice is based on the expertise available in the various centers, but we also need an evidence-based approach. Thus, in 2007 [1], I commented on the paper of Cahen et al. [2] with enthusiasm for two reasons: the first was that, for the first time, a comparative study on the long term results of endoscopic vs. surgical treatment of chronic pancreatitis patients was carried out, and the second was that the follow-up period was sufficient to assess the results of the two different treatments, not only from a medical point of view but also considering the patient reported outcomes using the SF-36 questionnaire. For the same reasons, I invite you to read, with attention, the paper of Varadarajulu et al. [3] reporting the data of the clinical outcomes of EUS-guided cystgastrostomy in comparison to surgical cystgastrostomy for the management of patients with uncomplicated pancreatic pseudocysts; the authors also evaluated the cost analysis of each treatment modality. Unfortunately, this was a retrospective case-controlled study carried out in a tertiary-referral center.

  13. Towards synthetic biological approaches to resource utilization on space missions.

    Science.gov (United States)

    Menezes, Amor A; Cumbers, John; Hogan, John A; Arkin, Adam P

    2015-01-06

    This paper demonstrates the significant utility of deploying non-traditional biological techniques to harness available volatiles and waste resources on manned missions to explore the Moon and Mars. Compared with anticipated non-biological approaches, it is determined that for 916 day Martian missions: 205 days of high-quality methane and oxygen Mars bioproduction with Methanobacterium thermoautotrophicum can reduce the mass of a Martian fuel-manufacture plant by 56%; 496 days of biomass generation with Arthrospira platensis and Arthrospira maxima on Mars can decrease the shipped wet-food mixed-menu mass for a Mars stay and a one-way voyage by 38%; 202 days of Mars polyhydroxybutyrate synthesis with Cupriavidus necator can lower the shipped mass to three-dimensional print a 120 m(3) six-person habitat by 85% and a few days of acetaminophen production with engineered Synechocystis sp. PCC 6803 can completely replenish expired or irradiated stocks of the pharmaceutical, thereby providing independence from unmanned resupply spacecraft that take up to 210 days to arrive. Analogous outcomes are included for lunar missions. Because of the benign assumptions involved, the results provide a glimpse of the intriguing potential of 'space synthetic biology', and help focus related efforts for immediate, near-term impact.

  14. The choice of surgical approach in the treatment of two-column acetabular fractures

    Directory of Open Access Journals (Sweden)

    A. A. Grin’

    2014-01-01

    Full Text Available The study aimed a comparison of treatment results in patients with two-column acetabular fractures (AO, Type C when using different operative approaches: ilioinguinal (12, Y-type (16 and a combination of posterior-lateral and ilioinguinal approaches (3. Surgical treatment was carried out not later than 3 weeks after injury. The joint congruence was reached in all the cases. The operative time, blood loss, complications, long-term results of treatment were evaluated. The study showed the effectiveness of ilioinguinal approach in case of the simple two-column fractures. When treating patients with complex fractures of the anterior column, the authors found no significant difference in operative time and intraoperative blood loss between the cases of V-type and combined approaches. In patients with two-column fractures accompanied with posterior wall lesion the time of surgery was significantly lower when using the Y-shaped approach as against the two different approaches.

  15. ENDOSCOPE-ASSISTED ENDONASAL APPROACH IN THE SURGICAL TREATMENT OF ESTHESIONEUROBLASTOMA IN CHILDREN

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    O. A. Merkulov

    2012-01-01

    Full Text Available This trial was undertaken to examine 3 patients aged 7 months to 13 years with esthesioneuroblastoma were examined to evaluate the possibilities and efficiency of an endoscopic endonasal approach in its surgical treatment in pediatric practice. Additional orientation was provided by a Vector Vision Compact system (Brain Lab, USA. The trial has established that the endoscopic endonasal approach to creating an isolated transnasal and combined transnasal/transethmoidal corridor and a transcribriform approach is highly effective and reasonably safe for the treatment of children with esthesioneuroblastoma: no intra- and postoperative complications were recorded in the trial; analysis of the immediate results of surgical interventions has shown a clinical regression in all the patients. Fatal outcomes and recurrent tumor were absent in the late (1–5-year period. The additional employment of the navigation equipment allowed one to more accurately use surgical tools in the narrow anatomic spaces and to more thoroughly affect an abnormality, which was eventually shown in more conservative surgery.

  16. Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

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    Diego Ramos

    2016-01-01

    Full Text Available Introduction: Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors. Material and methods: We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay. Results: Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years. Surgical enucleation was achieved in all patients. In 8 cases (61.54% a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies, and in 5 cases (38.56% an abdominal approach was performed (3 laparotomies and 2 laparoscopies; enucleation was carried out through a minimally invasive approach in 6 patients (46.15%. There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes and median postoperative stay was 6.5 days (range 2-27 days. There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months no recurrences were reported. Conclusion: Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group

  17. Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

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    Nikolić Živorad S.

    2016-01-01

    Full Text Available Introduction. No consensus has been reached yet on the surgical approach for treatment of condylar fractures. Objective. The aim of this study was to present modified Risdon approach (without facial nerve identification in the treatment of subcondylar mandibular fractures. Method. This is a retrospective study of a period 2005-2012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (19-68 years old were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. Results. No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8% patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. Conclusion. In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result - due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure. [Projekat Ministarstva nauke Republike Srbije, br. 175075

  18. Long-term results of endosurgical and open surgical approach for Zenker diverticulum

    Institute of Scientific and Technical Information of China (English)

    Luigi Bonavina; Davide Bona; Medhanie Abraham; Greta Saino; Emmanuele Abate

    2007-01-01

    AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum.METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years.RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3cm).CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction,indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach.Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.

  19. Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management

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    Iram Khan

    2014-01-01

    Full Text Available Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

  20. Recurrent rhinosporidiosis: coblation assisted surgical resection-a novel approach in management.

    Science.gov (United States)

    Khan, Iram; Gogia, Shweta; Agarwal, Alok; Swaroop, Ajay

    2014-01-01

    Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

  1. Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management

    Science.gov (United States)

    Khan, Iram; Gogia, Shweta; Agarwal, Alok; Swaroop, Ajay

    2014-01-01

    Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning. PMID:25574413

  2. Surgical approach for ulcerated locally advanced breast cancer. A single Center experience: a retrospective study.

    Science.gov (United States)

    Laforgia, Rita; Punzo, Clelia; Panebianco, Annunziata; Volpi, Annalisa; Minafra, Marina; Sederino, Maria Grazia

    2017-01-01

    The aim of our retrospective study is to analyze surgical possibilities for the extended LABC in those cases not suitable for a neoadjuvant chemotherapy step and to consider various reconstruction techniques. Between 2009 and 2015 we enrolled 11 patients, admitted to the Emergency Department, presenting ulcerated LABC that needed palliative surgical demolitive procedures because of bleeding and anemia and in which was necessary to use natural tissues transposition or synthetic substitutes for the reconstruction of the skin flaps. The mean follow up was 12 months. Mortality rate was 82% (9 patients); in 2 cases there was local relapse after 6 months; 9 months was the longest disease free survival. Thanks to multidisciplinary strategies LABC's surgical treatment improved results with a five-year survival rate between 30-40% and better quality of survival. Despite extended demolitive approach, there is still a 50% of death because of metastases. Our results confirm that musculocutaneous flap, skin anterior thigh grafts, bilayer matrix wound dressing are excellent reconstructive strategies in locally advanced ulcerated breast cancer after aggressive extended surgery even if palliative to improve patients' further survival. Our data also showed that those patients presenting medium level of malignancy as "luminal b" subtype (7 patients) if treated earlier with a radical surgical procedure would have better prognosis. Oncoplastic techniques, Ulcerated breast cancer.

  3. Usefulness of CT-scan in the diagnosis and therapeutic approach of gallstone ileus: report of two surgically treated cases

    OpenAIRE

    Michele, Danzi; Luciano, Grimaldi; Massimiliano, Fabozzi; Stefano, Reggio; Roberta, Danzi; Ernesto, Soscia; Bruno, Amato

    2013-01-01

    Background Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way. Description In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to...

  4. Comprehensive approach in surgical reconstruction of facial nerve paralysis: a 10-year perspective.

    Science.gov (United States)

    Gur, Eyal; Stahl, Shy; Barnea, Yoav; Leshem, David; Zaretski, Arik; Amir, Aharon; Meilik, Beni; Miller, Ehud; Shapira, Eyal; Abu Jabel, Amin; Weiss, Jerry; Arad, Ehud

    2010-04-01

    Facial paralysis presents diverse functional and aesthetic abnormalities. Reconstruction may be achieved by several methods. We reviewed the management and outcome of facial paralysis patients to establish principles on which a comprehensive reconstructive approach may be based. Records were reviewed of all patients operated for facial paralysis at our institution between 1998 and 2007. Ninety-five patients were included, of which 15 patients had static reconstruction alone, and 80 patients had dynamic reconstruction. Presented is our experience in reconstruction of facial paralysis over the past decade, delineating a comprehensive approach to this condition. Various surgical techniques are described.

  5. Radiofrequency thermal ablation (RFA) of liver tumors: open surgical or percutaneous approach?

    Science.gov (United States)

    Crucitti, A; Danza, F M; Pirulli, P G V; Antinori, A; Antonacci, V; La Greca, A; Bock, E; Magistrelli, P

    2004-11-01

    RFA was used to ablate 81 liver lesions: 61 liver metastases and 20 hepatomas. An open surgical approach was adopted in 19 instances (27.5%), 12 of which were simultaneously treated for associated diseases, and percutaneous treatment was adopted in 50 instances (72.5%). The CT liver control at 6 months showed a complete necrosis in 50 lesions (66.3%). The advantages of the percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and less discomfort in repeating the procedure. In conclusion, radiofrequency liver nodule ablation could be considered, today, as one of the promising and versatile techniques for loco-regional liver cancer control.

  6. A Novel Approach to Surgical Instructions for Scrub Nurses by Using See-Through-Type Head-Mounted Display.

    Science.gov (United States)

    Yoshida, Soichiro; Sasaki, Asami; Sato, Chikage; Yamazaki, Mutsuko; Takayasu, Junya; Tanaka, Naofumi; Okabayashi, Norie; Hirano, Hiromi; Saito, Kazutaka; Fujii, Yasuhisa; Kihara, Kazunori

    2015-08-01

    In order to facilitate assists in surgical procedure, it is important for scrub nurses to understand the operation procedure and to share the operation status with attending surgeons. The potential utility of head-mounted display as a new imaging monitor has been proposed in the medical field. This study prospectively evaluated the usefulness of see-through-type head-mounted display as a novel intraoperative instructional tool for scrub nurses. From January to March 2014, scrub nurses who attended gasless laparoendoscopic single-port radical nephrectomy and radical prostatectomy wore the monocular see-through-type head-mounted display (AiRScouter; Brother Industries Ltd, Nagoya, Japan) displaying the instruction of the operation procedure through a crystal panel in front of the eye. Following the operation, the participants completed an anonymous questionnaire, which evaluated the image quality of the head-mounted display, the helpfulness of the head-mounted display to understand the operation procedure, and adverse effects caused by the head-mounted display. Fifteen nurses were eligible for the analysis. The intraoperative use of the head-mounted display could help scrub nurses to understand the surgical procedure and to hand out the instruments for the operation with no major head-mounted-display wear-related adverse event. This novel approach to support scrub nurses will help facilitate technical and nontechnical skills during surgery.

  7. Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica.

    Science.gov (United States)

    Alberti, Olaf; Wickboldt, Jürgen; Becker, Ralf

    2009-04-01

    Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach. The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 +/- 12.9 years. The mean follow-up was 3.2 +/- 3.3 years. Seven of the patients underwent bilateral surgery. Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.

  8. Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

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    Satoshi Koizumi

    2017-04-01

    Full Text Available The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

  9. Nutrition for the pediatric surgical patient: approach in the peri-operative period

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    Falcão Mário Cícero

    2002-01-01

    Full Text Available Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

  10. Posterior Approach to Kidney Dissection: An Old Surgical Approach for Integrated Medical Curricula

    Science.gov (United States)

    Daly, Frank J.; Bolender, David L.; Jain, Deepali; Uyeda, Sheryl; Hoagland, Todd M.

    2015-01-01

    Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated…

  11. Posterior Approach to Kidney Dissection: An Old Surgical Approach for Integrated Medical Curricula

    Science.gov (United States)

    Daly, Frank J.; Bolender, David L.; Jain, Deepali; Uyeda, Sheryl; Hoagland, Todd M.

    2015-01-01

    Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated…

  12. Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery?

    Directory of Open Access Journals (Sweden)

    Pranav Sharma

    2016-01-01

    Conclusions: RENAL nephrometry score was associated with surgical approach intuitively chosen by an experienced surgeon, but the presence of adherent perinephric fat did not correlate with decision-making.

  13. Muscle damage during minimally invasive surgical total knee arthroplasty traditional versus optimized subvastus approach.

    Science.gov (United States)

    Rossi, Roberto; Maiello, Alessio; Bruzzone, Matteo; Bonasia, Davide Edoardo; Blonna, Davide; Castoldi, Filippo

    2011-08-01

    Decreased muscle damage is reported as an advantage of minimally invasive surgical (MIS) approaches in total knee arthroplasty (TKA). The purpose of this study was to evaluate the anatomy of vastus medialis obliquus (VMO) tendon at its patellar insertion as well as to determine the amount and location of muscle damage comparing traditional subvastus approach and optimized subvastus approach. TKAs were performed in ten human cadavers (20 knees). In each specimen, one knee underwent the traditional subvastus approach and the contralateral knee the optimized subvastus approach. The risk of tearing and damaging the VMO muscle during the traditional subvastus approach is significantly higher (70% of the cases) compared to the optimized technique (30%). The amount of damage to the VMO muscle using the traditional subvastus approach was: 80% of the muscle's width in two cases, 60% in three cases, and 30% in two. The damage created by the optimized subvastus approach occurred along the edge of the tendon and the first fibers of the VMO muscle close to the muscle-tendon junction (less than 20% of muscle's width). Clinical studies are needed to determine the functional implications of these findings.

  14. Morphological study of surgical approach by superior temporal sulcus-temporal horn of lateral ventricle approach using volume rendering.

    Science.gov (United States)

    Sun, Wei; Jia, Linpei; Dong, Yidian; Zhao, Hang; Liu, Haoyuan; Yang, Kerong; Li, Youqiong

    2014-03-01

    In this research, we acquired the length of the superior temporal sulcus, the shortest distance from the superior temporal sulcus to the temporal horn of the lateral ventricle, and the approach angle between the median sagittal plane and the shortest segment from the superior temporal sulcus to the temporal horn of the lateral ventricle measuring 98 specimens by magnetic resonance imaging volume rendering. At the same time, we preliminarily oriented the point of the superior temporal sulcus, which is closest to the temporal horn of the lateral ventricle, aimed at finding out the best entrance point of surgical approach through the superior temporal sulcus to the temporal horn of the lateral ventricle and reducing the damage to optic radiation as well as other nerve fibers during the operation. The results indicate that the point at the front side 3/5 of the superior temporal sulcus may be the ideal surgical approach entrance point, and there is no difference between 2 cerebral hemispheres (P < 0.05).

  15. Surgical treatment of thoracic disc herniations using a modified transfacet approach

    Directory of Open Access Journals (Sweden)

    Xizhong Yang

    2014-01-01

    Full Text Available Background: Ideal surgical treatment for thoracic disc herniation (TDH is controversial due to variations in patient presentation, pathology, and possible surgical approach. Althougth discectomy may lead to improvements in neurologic function, it can be complicated by approach related morbidity. Various posterior surgical approaches have been developed to treate TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation that are not optimally treated with an anterior approach. A transfacet pedicle approach was first described in 1995, but outcomes and complications have not been well described. The aim of this work was to evaluate the clinical effect and complications in a consecutive series of patients with symptomatic thoracic disc herniations undergoing thoracic discectomy using a modified transfacet approach. Materials and Methods: 33 patients with thoracic disc herniation were included in this study. Duration of the disease was from 12 days to 36 months, with less than 1 month in 13 patients. Of these, 15 patients were diagnosed with simple thoracic disc herniation, 6 were associated with ossified posterior longitudinal ligament, and 12 with ossified or hypertrophied yellow ligament. A total of 45 discs were involved. All the herniated discs and the ossified posterior longitudinal ligaments were excised using a modified transfacet approach. Laminectomy and replantation were performed for patients with ossified or hypertrophied yellow ligament. The screw-rod system was used on both sides in 14 patients and on one side in l9 patients. Results: 29 patients were followed up for an average of 37 months (range 12-63 months and 4 patients were lost to followup. Evaluation was based on Epstein and Schwall criteria.5 15 were classified as excellent and 10 as good, accounting for 86.21% (25/29; 2 patients were classified as improved and 2 as poor. All the patients recovered neurologically after

  16. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter?

    Science.gov (United States)

    Petis, Stephen M; Howard, James L; Lanting, Brent A; Marsh, Jacquelyn D; Vasarhelyi, Edward M

    2016-01-01

    The purposes of this study were to determine the impact of surgical approach on costs of total hip arthroplasty (THA) from a hospital perspective and to provide an updated cost estimation of THA. A prospective, microcosting analysis was performed on 118 patients undergoing a THA through an anterior, lateral, or posterior approach. We determined that overall costs (intraoperative costs and hospital stay) were significantly less for the anterior ($7300.22; 95% confidence interval [CI], 7064.49-7535.95) vs lateral ($7853.10; 95% CI, 7577.29-8128.91; P = .031) and anterior vs posterior approach ($8287.46; 95% CI, 7906.42-8668.51; P costs from a hospital perspective.

  17. [Intraorbital extraocular Langerhans' cell granuloma: primary surgical approach. Why? - case report].

    Science.gov (United States)

    Valentim Neto, João Guilherme; Schaurich, Cristina Góes

    2009-01-01

    We present a case in which a patient with intraorbital Langerhans' cell granuloma, with anatomical and functional skills compromised by intraorbital hypertension, which was treated with urgency orbitotomy by cranial approach. Male, two years-old, presented conjuntival proptosis, red eye, complete ophthalmoplegy, exophthalmos, with non-fotoreactive mydriasis and blepharoptosis of the right eye. Fundoscopy presented venous enlargement with optic disc edema. A cranial approach with orbitotomy was carried out, removed the lesion with total remission of clinical presentation and anatomic appearance as well. The handling of Langerhans' cell granuloma can vary from primary surgical approach as corticotherapy to chemotherapy and radiotherapy. In this case, the surgery was the first option due to the imminent risk of loss of visual function.

  18. Technical modifications in the robotic-assisted surgical approach for gynaecologic operations.

    Science.gov (United States)

    Peeters, Frederik; Vaknin, Zvi; Lau, Susie; Deland, Claire; Brin, Sonya; Gotlieb, Walter H

    2010-12-01

    To investigate the development of new technical approaches for improving the implementation of robotics in gynaecologic surgery, we conducted a prospective evaluation of five technical modifications developed during the implementation of a robotics program that included 171 robotic endometrial staging procedures from December 2007 until May 2010. Modification of the use of a Hohl uterine manipulator by applying only the intravaginal component minimizes the theoretical risk of spillage of endometrial cancer cells, without losing the capability of delineating the vaginal fornices. Entry to the peritoneal cavity under visual control using a left upper quadrant approach and a 5-mm endoscope through a 5-mm Endopath(®) trocar is quick and decreases the risk of bowel or vessel injury. Use of 12-mm Endopath(®) trocars with blunt tips without closure of the fascia was not associated with post-operative hernias. Positioning the Da Vinci(®) Surgical System at a 30° angle at the side of the patient allows easy access to the vagina for removal of large surgical specimens and does not interfere with proper movements of the robotic arms. Use of a tissue specimen bag introduced via the vagina at completion of surgery allows removal of large uteri vaginally to avoid (mini-)laparotomy and its morbidities. Finally, suturing of the vault using interrupted delayed absorbable monofilament sutures was not associated with vaginal cuff dehiscence. Early evaluation of evolving minor technical and surgical approaches was associated with low morbidity, and appears to benefit patients undergoing robotic surgery for gynaecologic cancers.

  19. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes.

    Science.gov (United States)

    Malikova, Hana; Kramska, Lenka; Vojtech, Zdenek; Liscak, Roman; Sroubek, Jan; Lukavsky, Jiri; Druga, Rastislav

    2014-01-01

    Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results. © 2014 S. Karger AG, Basel.

  20. Factors Affecting Medical Services Utilization: A Behavioral Approach.

    Science.gov (United States)

    Kelly, Terence F.; Schieber, George J.

    This study describes behavioral response--both its theoretical specification and its estimation--which relates health service utilization and expenditures to a number of variables: demographic, psychological, economic, medical, and policy-related. By incorporating these behavioral relations into a recently developed microsimulation model, national…

  1. Prognostic biopsy of choroidal melanoma: an optimised surgical and laboratory approach.

    Science.gov (United States)

    Angi, Martina; Kalirai, Helen; Taktak, Azzam; Hussain, Rumana; Groenewald, Carl; Damato, Bertil E; Heimann, Heinrich; Coupland, Sarah E

    2017-08-01

    Accurate survival prognostication for patients with uveal melanoma (UM) enables effective patient counselling and permits personalised systemic surveillance for the early detection of metastases and, in high-risk patients, enrolment in any trials of systemic adjuvant therapy. The aim of this work is to determine the success of prognostic UM tumour biopsy using an improved surgical approach and optimised sample handling workflow. Patients with UM treated by primary radiotherapy between 2011 and 2013 and who underwent a prognostic biopsy with cytology, multiplex ligation-dependent probe amplification and/or microsatellite analysis were included. The main outcomes and measures were success of cytology and genetic studies, and surgical complications. The cohort comprised 232 patients with UM having a median age of 59 years (range, 25-82) at treatment. The median largest basal diameter was 11.4 mm (range, 4.1-20.8) and tumour height was 3.4 mm (range, 0.7-10.3). Ciliary body involvement was noted in 42 cases. Treatment consisted of Ru-106 brachytherapy in 151 cases (65%) and proton beam radiotherapy in 81 cases (35%). With improvements in surgical techniques and laboratory methods over time, cytology success increased from 92% (131/142) to 99% (89/90) and the numbers of samples with sufficient DNA for genetic testing increased from 79% (104/131) to 93% (83/89). Overall, chromosome 3 loss was noted in 64/187 (34%) cases. Surgical complications, including transient localised bleeding, vitreous haemorrhage and retinal perforation, decreased over time. Eight patients required additional surgery. Improved surgical techniques and laboratory methods yielded successful cytology and genetic information in the majority of cases. Analysis of data from 232 patients with uveal melanoma undergoing prognostic tumour biopsy demonstrated that improved surgical techniques and laboratory methods yielded successful cytology and genetic information in 99% and 89% of cases, respectively

  2. Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

    Directory of Open Access Journals (Sweden)

    Mauro Neiva Fernandes

    2008-05-01

    Full Text Available Situs inversus totalis (SIT is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  3. Three-port laparoscopic cholecystectomy in a brazilian Amazon woman with situs inversus totalis: surgical approach.

    Science.gov (United States)

    Fernandes, Mauro Neiva; Neiva, Ivan Nazareno Campos; de Assis Camacho, Francisco; Meguins, Lucas Crociati; Fernandes, Marcelo Neiva; Meguins, Emília Maíra Crociati

    2008-05-24

    Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  4. A conservative surgical approach for management of iatrogenic pulmonary artery perforation

    Directory of Open Access Journals (Sweden)

    Monodeep Biswas

    2012-01-01

    Full Text Available Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.

  5. Thinking Beyond Counterinsurgency: The Utility of a Balanced Approach to Amnesty, Reconciliation and Reintegration

    Science.gov (United States)

    2008-05-22

    successful and has often involved ex-prisoners, thereby aiding their reintegration in the community. The Reintegration of Political Prisoners This aspect...Thinking Beyond Counterinsurgency: The Utility of a Balanced Approach to Amnesty, Reconciliation and Reintegration A Monograph by MAJ John L...GRANT NUMBER 4. TITLE AND SUBTITLE Thinking Beyond Counterinsurgency: The Utility of a Balanced Approach to Amnesty, Reconciliation and Reintegration

  6. Is de novo stress incontinence after sacrocolpopexy related to anatomical changes and surgical approach?

    Science.gov (United States)

    LeClaire, Edgar L; Mukati, Marium S; Juarez, Dianna; White, Dena; Quiroz, Lieschen H

    2014-09-01

    The objective was to investigate the relationship between new onset postoperative stress urinary incontinence (SUI) after sacrocolpopexy (SCP) and anatomical change/surgical approach. We analyzed a retrospective cohort of patients with negative preoperative testing for SUI who underwent SCP from 2005 to 2012. Our primary outcome was new onset postoperative SUI. Logistic regression was used to examine the relationship among anatomical change, defined as ΔAa, ΔBa, ΔC, and ΔTVL, and surgical approach, categorized as abdominal (ASCP) for open cases and minimally invasive (MISCP) for laparoscopic and robot-assisted cases, and postoperative SUI. Of 795 cases, 33 ASCP (43%) and 44 MISCP (57%) met the inclusion criteria for analysis. New onset SUI was demonstrated by 15 patients (45%) of the ASCP group and 7 patients (15%) of the MISCP group (p = 0.005). New onset SUI was significantly associated with route of SCP and ΔAa (p = 0.006 and p = 0.033 respectively). Controlling for ΔAa, the odds of new onset SUI were 4.4 times higher in the ASCP group compared with the MISCP group (OR 4.37, 95% CI 1.42, 13.48). Controlling for route of SCP, the odds of new onset SUI were 2.2 times higher with moderate ΔAa compared with low ΔAa (OR 2.16 95% CI 1.07, 4.38). The odds of new onset SUI was 4.7 times higher in those with high ΔAa than in those with low ΔAa (OR 4.67 95% CI 1.14, 19.22). ΔBa, ΔC, and ΔTVL were not associated with new onset SUI. Greater reduction in point Aa and abdominal surgical route are risk factors for new onset postoperative SUI after SCP.

  7. Traumatic diaphragmatic ruptures: clinical presentation, diagnosis and surgical approach in adults

    Directory of Open Access Journals (Sweden)

    Hofmann, Sabine

    2012-01-01

    Full Text Available Objective: Traumatic diaphragmatic injuries are rare, but potentially life-threatening due to herniation of abdominal organs into the pleural cavities. They can be easily overlooked on initial diagnostics and a high index of suspicion is required. The aim of this retrospective study was to analyze the clinical presentation, diagnostic methods and surgical management of patients with diaphragmatic rupture at our institution. Methods: A retrospective study was performed to analyze our experience with patients suffering from traumatic diaphragmatic rupture. Charts were reviewed for sex, age, side-location, concomitant injuries, time-to-diagnosis, diagnostic methods, surgical approach and outcome. Results: Fourteen patients (median age: 46 yrs, range 18–71, 9 male, 5 female with diaphragmatic injuries (left side: 10, right side: 4 were treated between July 2003 and September 2011. Mechanism of injury was a penetrating trauma (14%, blunt trauma (50% and others (36%. Associated abdominal injuries included spleen rupture (n=3, liver laceration (n=2, abdominal wall laceration (n=2 and gastric perforation (n=1. Computed tomography was the most sensitive diagnostic method. All patients underwent trans-abdominal repair of the diaphragmatic defect (direct suture: 10, prosthetic mesh insertion: 4. Associated abdominal procedures included splenectomy (n=3, liver packing (n=2, abdominal wall reconstruction (n=2 and partial gastric resection (n=1. Morbidity and hospital mortality rate were 36% and 0%, respectively. Median postoperative hospital stay was 17 days (range: 7–40 days. Conclusion: Morbidity and mortality of diaphragmatic ruptures are mainly determined by associated injuries or complications of diaphragmatic herniation like incarceration of viscera or lung failure. Early diagnosis helps to prevent severe complications. Spiral CT-scan is the most reliable tool for acute diagnosis of diaphragmatic rupture and associated visceral lacerations

  8. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

    Directory of Open Access Journals (Sweden)

    Gillespie BM

    2015-10-01

    Full Text Available Brigid M Gillespie,1 Evelyn Kang,1 Shelley Roberts,1 Frances Lin,1,2 Nicola Morley,3 Tracey Finigan,3 Allison Homer,3 Wendy Chaboyer1 1National Health and Medical Research Council Research Centre for Clinical Excellence in Nursing Interventions (NCREN and Centre for Healthcare Practice Innovation (HPI, Menzies Health Institute, 2School of Nursing and Midwifery, Griffith University, 3Surgical and Procedural Services, Gold Coast University Hospital, Gold Coast, QLD, Australia Purpose: To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs.Materials and methods: An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI.Results and discussion: In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention

  9. Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

    Institute of Scientific and Technical Information of China (English)

    WU Han; WANG Chun-xin; GU Chang-yue; ZHANG Zi-yan; TONG Shen; YAN Hua-dong; WANG Jin-cheng

    2013-01-01

    Objective:The main treatment method used for thoracolumbar fractures is open reduction and internal fixation.Commonly there are three surgical approaches:anterior,posterior and paraspinal.We attempt to compare the three approaches based on our clinical data analysis.Methods:A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study.These patients were treated by anterior-,posterior-or paraspinal-approach reduction with or without decompression.The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients),screw and rod system via posterior approach (38 patients) or paraspinal approach (32 patients).Clinical evaluations included operation duration,blood loss,incision length,preoperative and postoperative Oswestry disability index (ODI).Results:The average operation duration (94.1 min±13.7min),blood loss (86.7 ml±20.0 ml),length of incision (9.3mm± 0.7 mm) and postoperative ODI (6±0.5) were significandy lower (P<0.05) in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min,blood loss 143.3 ml±28.3 ml,length of incision 15.4 cm±2.1 cm and ODI 12±0.7) and anterior approach group (operation duration 176.3 min±20.7 min,blood loss 255.1 m1±38.4 ml,length of incision 18.6 cm±2.4 cm and OD113±2.4).There was not statistical difference in terms of Cobb angle on radiographs among the three approaches.Conclusion:The anterior approach surgery is convenient for resection of the vertebrae and reconstruction of vertebral height,but it is more complicated and traumatic.Hence it is mostly used for severe Denis type B fracture.The posterior approach is commonly applied to most thoracolumbar fractures and has fewer complications compared with the anterior approach,but it has some shortcomings as well.The paraspinal approach has great advantages compared with the other two approaches.It is in accordance with

  10. An alternative surgical approach reduces variability following filament induction of experimental stroke in mice

    Directory of Open Access Journals (Sweden)

    Melissa Trotman-Lucas

    2017-07-01

    Full Text Available Animal models are essential for understanding the pathology of stroke and investigating potential treatments. However, in vivo stroke models are associated, particularly in mice, with high variability in lesion volume. We investigated whether a surgical refinement where reperfusion is not reliant on the Circle of Willis reduced outcome variability. Mice underwent 60 min of transient middle cerebral artery occlusion avoiding ligation of the external carotid artery. During reperfusion, the common carotid artery was either ligated (standard approach, or it was repaired to allow re-establishment of blood flow through the common carotid artery. All mice underwent MRI scanning for assessment of infarct volume, apparent diffusion coefficient and fractional anisotropy, along with terminal assessment of infarct volume by 2,3,5-triphenyltetrazolium chloride (TTC staining. Repairing the common carotid artery following middle cerebral artery occlusion enhanced reperfusion (P<0.01 and reduced the variability seen in both total (histological analysis, P=0.008; T2-weighted MRI, P=0.015 and core (diffusion tensor MRI, P=0.043 lesion volume. Avoiding external carotid artery ligation may improve animal wellbeing, through reduced weight loss, while using an alternative surgical approach that enabled reperfusion through the common carotid artery decreased the variability in lesion volume seen within groups.

  11. A guided surgical approach and novel fixation method for arthroscopic Latarjet.

    Science.gov (United States)

    Boileau, Pascal; Gendre, Patrick; Baba, Mohammed; Thélu, Charles-Édouard; Baring, Toby; Gonzalez, Jean-François; Trojani, Christophe

    2016-01-01

    Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications. Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit. At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%). A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Surgical anatomy of the diaphragm in the anterolateral approach to the spine: a cadaveric study.

    Science.gov (United States)

    Baaj, Ali A; Papadimitriou, Kyriakos; Amin, Anubhav G; Kretzer, Ryan M; Wolinsky, Jean-Paul; Gokaslan, Ziya L

    2014-06-01

    Laboratory cadaveric study. To delineate the pertinent surgical anatomy of the diaphragm during access to the anterolateral thoracolumbar junction. The general anatomy of the thoracic diaphragm is well described. The specific surgical anatomy as it pertains to the lateral and thoracoabdominal approaches to the thoracolumbar junction is not well described. Dissections were performed on adult fresh cadaveric specimens. Special attention was paid to the diaphragmatic attachments to the lower rib cage and to the spinal thoracolumbar junction. The pertinent diaphragmatic attachments to the rib cage are at the 11th and 12th ribs. Whether the diaphragm is incised or mobilized ventrally, the pertinent spinal attachments are the lateral and medial arcuate ligaments. Identifying and sectioning these structures allows for direct access to the thoracolumbar junction, particularly the L1 vertebral body. An understanding of the diaphragmatic-costal and diaphragmatic-spinal attachments is key for the safe and effective implementation of diaphragm mobilization during the lateral and thoracoabdominal approaches to the spine.

  13. Alternative surgical approach for the management of uterine prolapse in young women: preliminary results.

    Science.gov (United States)

    Karatayli, Rengin; Balci, Osman; Gezginç, Kazim; Yildirim, Pinar; Karanfil, Fikriye; Acar, Ali

    2013-10-01

    To demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. The study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. Mean age of patients was 35.5 ± 4.1 years (range, 28-41). Mean parity in the study group was 2.6 ± 1.0 (range, 1-5). Mean operation time was 32.0 ± 5.2 min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 ± 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. Abdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  14. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.

    Science.gov (United States)

    Carrel, Thierry P; Berdat, Pascal A; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg

    2004-10-01

    Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.

  15. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches.

    Science.gov (United States)

    Fay, Emily E; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa

    2016-04-01

    Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.

  16. Spherical mechanism analysis of a surgical robot for minimally invasive surgery -- analytical and experimental approaches.

    Science.gov (United States)

    Rosen, Jacob; Lum, Mitch; Trimble, Denny; Hannaford, Blake; Sinanan, Mika

    2005-01-01

    Recent advances in technology have led to the fusion of MIS techniques and robot devices. However, current systems are large and cumbersome. Optimizing the surgical robot mechanism will eventually lead to its integration into the operating room (OR) of the future becoming the extended presence of the surgeon and nurses in a room occupied by the patient alone. By optimizing a spherical mechanism using data collected in-vivo during MIS procedures, this study is focused on a bottom-up approach to developing a new class of surgical robotic arms while maximizing their performance and minimizing their size. The spherical mechanism is a rotational manipulator with all axes intersecting at the center of the sphere. Locating the rotation center of the mechanism at the MIS port makes this class of mechanism a suitable candidate for the first two links of a surgical robot for MIS. The required dexterous workspace (DWS) is defined as the region in which 95% of the tool motions are contained based on in-vivo measurements. The extended dexterous workspace (EDWS) is defined as the entire abdominal cavity reachable by a MIS instruments. The DWS is defined by a right circular cone with a vertex angle of 60 degrees and the EDWS is defined by a cone with an elliptical cross section created by two orthogonal vertex angles of 60 degrees and 90 degrees. A compound function based on the mechanism's isotropy and the mechanism stiffness was considered as the performance metric cost function. Optimization across both the DWS and the EDWS lead to a serial mechanism configuration with link length angles of 74 degrees and 60 degrees for a serial configuration. This mechanism configuration maximized the kinematic performance in the DWS while keeping the EDWS as its reachable workspace. Surgeons, using a mockup of two mechanisms in a MIS setup, validated these results experimentally. From these experiments the serial configuration was deemed most applicable for MIS robotic applications compared

  17. Utilizing Distributed Resources in Smart Grids - A Coordination Approach

    DEFF Research Database (Denmark)

    Juelsgaard, Morten

    2014-01-01

    The Danish electricity grid is expected to face numerous challenges in the future. These are the combined effect of several factors, such as an increased use of renewable resources for power production; an increased use of electricity for previously fossil-fueled consumption; and an increase...... as well as its limitations. Enforcing coordination through temporal shifts of consumption and production requires the problems we consider to be solved across some predefined time-horizon. Utilizing flexibility of consumers through coordination, is known as demand management, and considers how consumers...

  18. An Approach to Ethics Utilizing the Experience of Women.

    Science.gov (United States)

    Ferguson, Marianne

    1996-01-01

    Delineates a generalized difference between men and women in approaches to ethics. Reiterates Carol Gilligan's theory that men generally believe in a morality of rights whereas women subscribe to a morality of relationships. Discusses other aspects of this dichotomy including ideas of good, evil, and sin. (MJP)

  19. A Utility-Based Approach to Some Information Measures

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    Sven Sandow

    2007-01-01

    Full Text Available We review a decision theoretic, i.e., utility-based, motivation for entropy and Kullback-Leibler relative entropy, the natural generalizations that follow, and various properties of thesegeneralized quantities. We then consider these generalized quantities in an easily interpreted spe-cial case. We show that the resulting quantities, share many of the properties of entropy andrelative entropy, such as the data processing inequality and the second law of thermodynamics.We formulate an important statistical learning problem – probability estimation – in terms of ageneralized relative entropy. The solution of this problem reflects general risk preferences via theutility function; moreover, the solution is optimal in a sense of robust absolute performance.

  20. Clinical application of plasma thermograms. Utility, practical approaches and considerations.

    Science.gov (United States)

    Garbett, Nichola C; Mekmaysy, Chongkham S; DeLeeuw, Lynn; Chaires, Jonathan B

    2015-04-01

    Differential scanning calorimetry (DSC) studies of blood plasma are part of an emerging area of the clinical application of DSC to biofluid analysis. DSC analysis of plasma from healthy individuals and patients with various diseases has revealed changes in the thermal profiles of the major plasma proteins associated with the clinical status of the patient. The sensitivity of DSC to the concentration of proteins, their interactions with other proteins or ligands, or their covalent modification underlies the potential utility of DSC analysis. A growing body of literature has demonstrated the versatility and performance of clinical DSC analysis across a range of biofluids and in a number of disease settings. The principles, practice and challenges of DSC analysis of plasma are described in this article.

  1. A Novel Approach for Improving Communication by Wavelength Utilization

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    Shrangesh Dahat

    2012-06-01

    Full Text Available Optical networks using wavelength division multiplexing (WDM technology modulate multiple channels over a single fiber. The most common architecture utilized for establishing communication in WDM optical networks is wavelength routing, where the communication between a source and a destination node is performed by setting up optical channels between them, called light-paths from the network perspective. In optical WDM networks, transmission of information along optical lines is advantageous since it has high transmission capacity, scalability, feasibility and also high reliability. But since large amount of information is being carried, any problem during transmission can lead to severe damage to the data being carried. In this paper, we propose to develop a routing and wavelength utilization algorithm which considers two constraints for selecting the best path. The two constraints are based on the available free load and the number of wavelength used in the link. Based on these constraints, two cost functions on load and wavelength are determined, which yields a combined cost function. For each pair of source and destination, the path with the minimum combined cost function is selected as the primary path for data transmission, allocating the sufficient wavelength. This study paper proposes a RWU algorithm for the problem of establishing the set of efficient light paths for a given set of connection requests. The effectiveness of the proposed RWU algorithm is demonstrated by simulation. This study divides the routing and wavelength allocation process in two step problem with a goal of minimizing Number of wavelength channel and number of wavelength conversion required. This algorithm thus provides a reliable path for the data transmission.

  2. Subtrochanteric osteotomy for femoral mal-torsion through a surgical dislocation approach

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    Kamath, Atul F.; Ganz, Reinhold; Zhang, Hong; Grappiolo, Guido; Leunig, Michael

    2015-01-01

    Missed torsional femur deformities may contribute to reasons for failure after open and more likely arthroscopic hip preservation surgery. A number of surgical approaches have been described for addressing torsion abnormalities. This report describes a subtrochanteric osteotomy technique in a consecutive series of patients with complex hip pathologies, for which intertrochanteric osteotomy is not suitable and precise derotation is required. Subtrochanteric derotation was performed, always in combination with a surgical hip dislocation, in accordance with the authors’ preferred technique. Before osteotomy, a localized decortication was executed. Application of a 4.5-mm broad or narrow plate was undertaken with dynamic compression of the osteotomy. Twenty-eight consecutive subtrochanteric derotational osteotomies were performed in 26 patients. Twenty-one females and five males were treated at an average age of 21.4 years (range, 12–43). Underlying diagnoses included dysplasia, arthrogryposis, cerebral palsy, Down’s syndrome, instability and impingement. The decision to perform derotation was for antetorsion over 20° or less than 0° (retrotorsion). Patients were followed clinically and radiographically till final follow-up. All patients went on to successful osteotomy union. There were two initial failures: one delayed union prompting revision fixation in a chronic smoker and one plate failure due to self-accelerated weight-bearing in a patient status post successful contralateral derotational osteotomy. Rotational deformity of the femur must be considered in the patient undergoing hip preservation surgery. This technique of subtrochanteric derotational osteotomy, with adjunctive surgical hip dislocation, is applicable and reproducible in the setting of complex hip pathologies. Level of evidence: IV, case series. PMID:27011816

  3. Simulation of petrous bone drilling in subtemporal approach utilizing virtual reality system

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    TANG Ke

    2012-12-01

    osseus crus of semicircular canal and superior margin of glomus jugulare was measured as (4.74 ± 0.20 mm, and the angle between internal acoustic meatus and groove of greater superficial petrosal nerve was (51.34 ± 3.29° . Conclusion Accurate, objective and measurable results can be obtained in the simulation of petrous bone drilling in subtemporal approach utilizing virtual reality system, and could guide surgical practice in dealing with petroclival lesions.

  4. Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement.

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    Gabor Erdoes

    Full Text Available To investigate the periprocedural inflammatory response in patients with isolated aortic valve stenosis undergoing surgical aortic valve replacement (SAVR or transcatheter aortic valve implantation (TAVI with different technical approaches.Patients were prospectively allocated to one of the following treatments: SAVR using conventional extracorporeal circulation (CECC, n = 47 or minimized extracorporeal circulation (MECC, n = 15, or TAVI using either transapical (TA, n = 15 or transfemoral (TF, n = 24 access. Exclusion criteria included infection, pre-procedural immunosuppressive or antibiotic drug therapy and emergency indications. We investigated interleukin (IL-6, IL-8, IL-10, human leukocyte antigen (HLA-DR, white blood cell count, high-sensitivity C-reactive protein (hs-CRP and soluble L-selectin (sCD62L levels before the procedure and at 4, 24, and 48 h after aortic valve replacement. Data are presented for group interaction (p-values for inter-group comparison as determined by the Greenhouse-Geisser correction.SAVR on CECC was associated with the highest levels of IL-8 and hs-CRP (p<0.017, and 0.007, respectively. SAVR on MECC showed the highest descent in levels of HLA-DR and sCD62L (both p<0.001 in the perioperative period. TA-TAVI showed increased intraprocedural concentration and the highest peak of IL-6 (p = 0.017. Significantly smaller changes in the inflammatory markers were observed in TF-TAVI.Surgical and interventional approaches to aortic valve replacement result in inflammatory modulation which differs according to the invasiveness of the procedure. As expected, extracorporeal circulation is associated with the most marked pro-inflammatory activation, whereas TF-TAVI emerges as the approach with the most attenuated inflammatory response. Factors such as the pre-treatment patient condition and the extent of myocardial injury also significantly affect inflammatory biomarker patterns. Accordingly, TA-TAVI is to be classified not

  5. The endoscopic endonasal approach to the Meckel's cave tumors: surgical technique and indications.

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    Jouanneau, Emmanuel; Simon, Emile; Jacquesson, Timothée; Sindou, Marc; Tringali, Stéphane; Messerer, Mahmoud; Berhouma, Moncef

    2014-12-01

    Many benign and malignant tumors as well as other inflammatory or vascular diseases may be located in the areas of Meckel's cave or the cavernous sinus. Except for typical features such as for meningiomas, imaging may not by itself be sufficient to choose the best therapeutic option. Thus, even though modern therapy (chemotherapy, radiotherapy, or radiosurgery) dramatically reduces the field of surgery in this challenging location, there is still some place for surgical biopsy or tumor removal in selected cases. Until recently, the microscopic subtemporal extradural approach with or without orbitozygomatic removal was classically used to approach Meckel's cave but with a non-negligible morbidity. Percutaneous biopsy using the Hartel technique has been developed for biopsy of such tumors but may fail in the case of firm tumors, and additionally it is not appropriate for anterior parasellar tumors. With the development of endoscopy, the endonasal route now represents an interesting alternative approach to Meckel's cave as well as the cavernous sinus. Through our experience, we describe the modus operandi and discuss what should be the appropriate indication of the use of the endonasal endoscopic approach for Meckel's cave disease in the armamentarium of the skull base surgeon.

  6. Introductory geology for elementary education majors utilizing a constructivist approach

    Science.gov (United States)

    Brown, L.M.; Kelso, P.R.; Rexroad, C.B.

    2001-01-01

    "Field Excursions in Earth Science" is designed as a non-prerequisite field-based course for elementary education majors. Classic Canadian Shield and Michigan Basin outcrops and Quaternary features are used to teach those Earth science objectives considered most important for K-8 teachers by the Michigan State Board of Education and by others. We integrated these objectives into five conceptual pathways rather than presenting them as discrete pieces of information. A variety of teaching techniques based on constructivist educational theory are employed, so that pre-service teachers experience active-learning strategies in the context of how science is practiced. Our learning strategies address the cognitive and affective domains and utilize personal experiences in conjunction with pre- and post-experience organizers to allow students to develop individual meanings. We place emphasis on observations and concepts and we encourage students to explain their understanding of concepts verbally and in a variety of written formats. Activities address spatial concepts and map reading; mineral, rock, and fossil identification; formation of rocks; surficial processes and landform development; structural deformation and plate tectonics; and environmental issues. Students keep field notes and have daily projects. They address the pedagogical structure of the course in a daily diary.

  7. Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach

    Science.gov (United States)

    Abel, Mark F; Singla, Anuj; Feger, Mark A; Sauer, Lindsay D; Novicoff, Wendy

    2016-01-01

    AIM To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3). METHODS A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01. RESULTS For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches. CONCLUSION Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve. PMID:27672568

  8. A non-surgical approach for male germ cell mediated gene transmission through transgenesis.

    Science.gov (United States)

    Usmani, Abul; Ganguli, Nirmalya; Sarkar, Hironmoy; Dhup, Suveera; Batta, Suryaprakash R; Vimal, Manoj; Ganguli, Nilanjana; Basu, Sayon; Nagarajan, P; Majumdar, Subeer S

    2013-01-01

    Microinjection of foreign DNA in male pronucleus by in-vitro embryo manipulation is difficult but remains the method of choice for generating transgenic animals. Other procedures, including retroviral and embryonic stem cell mediated transgenesis are equally complicated and have limitations. Although our previously reported technique of testicular transgenesis circumvented several limitations, it involved many steps, including surgery and hemicastration, which carried risk of infection and impotency. We improved this technique further, into a two step non-surgical electroporation procedure, for making transgenic mice. In this approach, transgene was delivered inside both testes by injection and modified parameters of electroporation were used for in-vivo gene integration in germ cells. Using variety of constructs, germ cell integration of the gene and its transmission in progeny was confirmed by PCR, slot blot and immunohistochemical analysis. This improved technique is efficient, requires substantially less time and can be easily adopted by various biomedical researchers.

  9. Survival of a patient with trauma-induced mucormycosis using an aggressive surgical and medical approach.

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    Van Sickels, Nicholas; Hoffman, Jordan; Stuke, Lance; Kempe, Kelly

    2011-02-01

    Mucormycosis is a deadly angioinvasive fungal infection that is increasing in incidence. Gastrointestinal and abdominal involvement is rare, has higher mortality rates, and is frequently diagnosed late. We report a patient who sustained multiple gunshot wounds to the chest and abdomen and subsequently developed omental and hepatic mucormycosis. He underwent 14 abdominal washouts and several liver debridements, and he received combination therapy with amphotericin B and micafungin. The patient survived the disease, with negative cultures and pathology at the last washout, and underwent skin grafting. He is clinically improved and remains on oral antifungals as an outpatient. Mucormycosis should be considered in trauma patients with persistent signs of infection after lavage and antibiotics, especially when necrosis or atypical wound presentations are noted. Approaches such as ours using aggressive surgical management and intensive antifungal administration should be instituted once the diagnosis is suspected.

  10. Tiroides lingual: un nuevo abordaje quirúrgico Lingual thyroid: a new surgical approach

    Directory of Open Access Journals (Sweden)

    I. Zubillaga Rodríguez

    2004-10-01

    Full Text Available El tiroides lingual es una rara anomalía congénita del desarrollo tiroideo resultante de la ausencia de descenso del mismo desde el foramen caecum hasta la localización prelaríngea habitual. Presentamos el caso de una paciente en edad postmenopáusica con diagnóstico anatomopatológico de tiroides lingual de gran tamaño y localización profunda en la base de la lengua que producía disfagia y dificultad respiratoria crecientes. Asimismo, planteamos un nuevo abordaje quirúrgico para la resección combinando cervicotomía media, pull-through lingual y glosotomía media. Se discuten las distintas pruebas complementarias para llegar a su diagnóstico y se revisan las diferentes técnicas quirúrgicas habitualmente empleadas en su tratamiento concluyendo con las ventajas del abordaje empleado en este caso.Lingual thyroid is an uncommon congenital disorder of thyroid gland development, resulting in a lack of descend of the gland from the foramen caecum to his normal prelaringeal location. In this paper we present a case of a postmenopausic patient presenting with a big size lingual thyroid deeply located in the base of the tongue, suffering increasing disphagia and respiratory impairment. For tumor resection, we chose a surgical approach combining a cervical submental incision, lingual pull- through and midline glossotomy. We discuss the different image studies recommended for proper diagnosis also reviewing the most common surgical techniques used for treatment, as compared with the approach we have described in this case.

  11. The minimally invasive approach is associated with reduced surgical site infections in obese patients undergoing proctectomy.

    Science.gov (United States)

    Pasam, R T; Esemuede, I O; Lee-Kong, S A; Kiran, R P

    2015-12-01

    While laparoscopic colorectal resection may be underused in technically challenging circumstances, the minimally invasive approach may in fact maximally benefit patients at the greatest risk of complications. Obesity and proctectomy pose particular technical challenges during laparoscopic resection and are also associated with the greatest risks of complications, especially surgical site infections (SSIs). We evaluated the role of laparoscopy in minimizing SSI in such patients. From the American College of Surgeons-National Surgical Quality Improvement Program database, outcomes for obese [body mass index (BMI) ≥ 30 kg/m(2)] and non-obese (BMI laparoscopy on SSI for obese patients undergoing proctectomy. OC patients were more likely than OP, LC, and LP, respectively, to undergo emergency operation and have an American Society of Anesthesiologists (ASA) score of 3-5. Overall SSI rates after OC, OP, LC, and LP were 15.2, 17.6, 8.6, and 10.1 %, respectively (p obese patients, the rates were 18.7, 22.3, 10.7, and 13.3 % (p obesity, proctectomy, younger age, race, steroid use, diabetes, chronic obstructive pulmonary disease, prior wound infection, transfusion history, previous operation within 30 days, coronary artery or vascular disease, ASA class 3-5, tobacco use, resident involvement, male gender, albumin Laparoscopy reduced the risk of SSI by at least 35 % across all BMI classes and procedures, an effect that persisted on multivariate analysis even in obese patients undergoing proctectomy. In colorectal surgery, an already high-risk outlier for SSI, obesity and proctectomy are associated with the highest risk of SSI. Despite the particular technical challenges of laparoscopy in these circumstances, the minimally invasive approach attenuates the risk of SSI in these high-risk patients and thus should be strongly considered during treatment planning.

  12. New approaches to non-surgical sterilization for dogs and cats: Opportunities and challenges.

    Science.gov (United States)

    Rhodes, Linda

    2016-11-28

    Over the last 40 years, researchers have explored methods to non-surgically suppress fertility in animals. Immunocontraception has been used to control wildlife populations but does not confer long-term immunity. The gonadotropin-releasing hormone (GnRH) agonist deslorelin, formulated as an implant to provide 6-month to 1-year suppression of fertility in male dogs, is available commercially in some countries. Neither of these approaches provide permanent sterility. A single-dose, permanent treatment would be a valuable tool in dog and cat population control. The Michelson Prize and Grants (MPG) programme was initiated "to eliminate shelter euthanasia of healthy, adoptable companion animals and reduce populations of feral and free-roaming cats and dogs" offering a $25 million US prize for a non-surgical sterilant that is effective as a single treatment in both male and female dogs and cats. Michelson Prize and Grants programme has offered US $50 million in grant money for research and has attracted scientists worldwide. Approaches under study include gene therapy, small interfering RNA to inhibit reproductive targets and delivery of cytotoxins to pituitary gonadotrophs or GnRH producing neurons in the hypothalamus. Research in implant technology that could deliver compounds over an animal's lifetime is also underway. Details of funded grants and results to date can be found at: http://www.michelsonprizeandgrants.org/michelson-grants/research-findings. The next steps are translating the most promising research into products. The Alliance for Contraception of Cats and Dogs (ACC&D) is helping to research practical methods of marking sterilized animals to avoid costly retreatment and population modelling that will help guide field workers in use of resources for sterilization programmes.

  13. The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy.

    Science.gov (United States)

    Pearce, Shane M; Pariser, Joseph J; Patel, Sanjay G; Steinberg, Gary D; Shalhav, Arieh L; Smith, Norm D

    2016-03-01

    To examine the effect of surgical approach on regional lymphadenectomy (LND) performance and inpatient complications for radical nephroureterectomy (NU) using a national administrative database. The National Inpatient Sample (2009-2012) was used to identify patients who underwent NU for urothelial carcinoma. Cohorts were stratified by performance of LND. Covariates included patient demographics, comorbidity, hospital characteristics, hospital volume, performance of LND, surgical approach (open [ONU], laparoscopic [LNU], or robotic [RNU]), and complications. Multivariable logistic regression was used to identify factors associated with LND performance and complications. A weighted population of 14,059 (85%) without LND and 2,560 (15%) with LND was identified. LND was more common in RNU (27%) compared with ONU (15%) and LNU (10%) (PONU, RNU was associated with increased odds of LND performance (odds ratio [OR] = 1.9, 95% CI: [1.3-2.8]; P = 0.001), whereas LNU was associated with decreased odds of LND performance (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.004). Multivariable analysis of risk factors for complications demonstrated lower odds of complications with RNU (OR = 0.6, 95% CI: [0.4-0.8]; P = 0.001), whereas performance of LND increased the risk of complications (OR = 1.3, 95% CI: [1.001-1.7]; P = 0.049). When compared with ONU, RNU increased the odds of LND performance and had a lower inpatient complication rate, whereas LNU reduced the odds of LND performance and had no significant effect on inpatient complication rates. Performance of LND was independently associated with higher inpatient complication rates. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Comparison of subtemporal versus presigmoidal approaches for exposing petrous apex utilizing virtual reality technique

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    Ke TANG

    2016-08-01

    Full Text Available Objective To perform quantitative comparison of microanatomical features between subtemporal and presigmoidal minimally invasive approaches for exposing petrous apex on the basis of virtual reality image model.  Methods CT and MRI were performed on 15 adult cadaver heads (30 sides to establish virtual reality three-dimensional anatomical model of petrous apex. The superior edge of the root of temporal bone zygomatic process and the mastoidale on the calvaria were selected as landmark points of craniotomy through subtempral and presigmoidal approaches. Petrous apex was selected as exposure landmark point on the skull base. The lines between craniotomy and exposure landmark points were used as axis to outline a cylinder simulating surgical routes of subtemporal and presigmoidal approaches. Anatomical exposures in two surgical routes were observed and measured. Statistical comparison was launched by paired t test.  Results Surgical route of subtemporal approach passed through middle skull base and temporal lobe, and then reached petrous apex. Petrous bone drilling was performed to expose internal acoustic meatus, facial nerve and labyrinth. Then, trigeminal nerve, superior petrous sinus and cavernous sinus were exposed. Surgical route of presigmoidal approach was performed by drilling petrous bone through mastoid and passing vertical segment of facial nerve. Then, glomus jugulare, the lower cranial nerves, ossicular chain, labyrinth and internal carotid artery (ICA were exposed in turn. Reaching internal acoustic meatus, the route exposed anterior inferior cerebellar artery (AICA and facial-acoustic nerve complex. Reaching petrous apex, the route involved superior cerebellar artery, superior petrous sinus, inferior petrous sinus, cavernous sinus, trigeminal nerve and partial temporal lobe. The volumes of route, osseous structures, facial-acoustic complex, labyrinth and vein involved in presigmoidal approach were more than those in subtemporal

  15. Frontal sinus mucocele with orbital complications: Management by varied surgical approaches

    Science.gov (United States)

    Aggarwal, Sushil Kumar; Bhavana, Kranti; Keshri, Amit; Kumar, Raj; Srivastava, Arun

    2012-01-01

    A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach. PMID:23293669

  16. Obesity and cancer: Mendelian randomization approach utilizing the FTO genotype.

    Science.gov (United States)

    Brennan, Paul; McKay, James; Moore, Lee; Zaridze, David; Mukeria, Anush; Szeszenia-Dabrowska, Neonilia; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Mates, Dana; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Chow, Wong-Ho; Rothman, Nathaniel; Chabrier, Amélie; Gaborieau, Valérie; Timpson, Nic; Hung, Rayjean J; Smith, George Davey

    2009-08-01

    Obesity is a risk factor for several cancers although appears to have an inverse association with cancers strongly related to tobacco. Studying obesity is difficult due to numerous biases and confounding. To avoid these biases we used a Mendelian randomization approach incorporating an analysis of variants in the FTO gene that are strongly associated with BMI levels among 7000 subjects from a study of lung, kidney and upper-aerodigestive cancer. The FTO A allele which is linked with increased BMI was associated with a decreased risk of lung cancer (allelic odds ratio (OR) = 0.92, 95% confidence interval (CI) 0.84-1.00). It was also associated with a weak increased risk of kidney cancer, which was more apparent before the age of 50 (OR = 1.44, CI 1.09-1.90). Our results highlight the potential for genetic variation to act as an unconfounded marker of environmentally modifiable factors, and offer the potential to obtain estimates of the causal effect of obesity. However, far larger sample sizes than studied here will be required to undertake this with precision.

  17. Detection of selection utilizing molecular phylogenetics: a possible approach.

    Science.gov (United States)

    Yang, Ming; Wyckoff, Gerald J

    2011-05-01

    The neutral theory of molecular evolution (Kimura 1985) is the basis for most current statistical tests for detecting selection, mainly using polymorphism data within species, divergence data between species, and/or genomic structures like linkage disequilibrium (Wang et al. 2006). In most cases informative tests can only be constructed with ample variations within these parameters and many common tests are difficult to formulate when identity-by-descent is not clear, for example in gene families or repetitive elements. With the current progress being made toward whole-genome sequencing and re-sequencing efforts, as well as protein sequencing via tandem mass spectrometry where genomic sequencing is lacking, we felt it was necessary to re-visit possible methods for rapid screening and detection of evolutionary outliers. These outliers might be of interest for other research, such as candidate gene association studies or genome annotations, drug- and disease-target searches, and functional studies. We focused on methods that would work on both protein and nucleotide data, could be used on large gene or protein domain families, and could be generated quickly in order for "first pass" annotation of large scale data. For these reasons, we chose properties of trees generated routinely in molecular phylogenetic studies; genetic distance, tree shape and balance, and internal node statistics (Heard 1992). Our current research looking at protein domain family data and phylogenetic trees from PFAM (Finn et al. 2008) suggests this approach towards detecting evolutionary outliers is feasible, but additional work will be necessary to determine the parameters that suggest either positive or negative selection is occurring in specific gene families. This is particularly true when other factors such as rapid duplication and deletion of genes containing these domains is taking place, and we suggest phylogenetic statistics may be useful in combination with existing methodologies for

  18. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach.

    Science.gov (United States)

    Jingarwar, Mahesh; Pathak, Anuradha; Bajwa, Navroop Kaur; Kalaskar, Ritesh

    2015-01-01

    This paper reports case of pediatric localized gingival recession (LGR) in mandibular anterior region which was treated by using new innovative surgical approach, i.e. combination of frenectomy and vestibular extension. These interceptive surgeries not only gained sufficient width of attached gingival but also lower the attachment of labial frenum. How to cite this article: Jingarwar M, Pathak A, Bajwa NK, Kalaskar R. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach. Int J Clin Pediatr Dent 2015;8(3):224-226.

  19. Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

    Science.gov (United States)

    Woo, Russell K; Skarsgard, Erik D

    2015-06-01

    Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Surgical approach to right colon cancer: From open technique to robot. State of art.

    Science.gov (United States)

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  1. An integrated approach to endoscopic instrument tracking for augmented reality applications in surgical simulation training.

    Science.gov (United States)

    Loukas, Constantinos; Lahanas, Vasileios; Georgiou, Evangelos

    2013-12-01

    Despite the popular use of virtual and physical reality simulators in laparoscopic training, the educational potential of augmented reality (AR) has not received much attention. A major challenge is the robust tracking and three-dimensional (3D) pose estimation of the endoscopic instrument, which are essential for achieving interaction with the virtual world and for realistic rendering when the virtual scene is occluded by the instrument. In this paper we propose a method that addresses these issues, based solely on visual information obtained from the endoscopic camera. Two different tracking algorithms are combined for estimating the 3D pose of the surgical instrument with respect to the camera. The first tracker creates an adaptive model of a colour strip attached to the distal part of the tool (close to the tip). The second algorithm tracks the endoscopic shaft, using a combined Hough-Kalman approach. The 3D pose is estimated with perspective geometry, using appropriate measurements extracted by the two trackers. The method has been validated on several complex image sequences for its tracking efficiency, pose estimation accuracy and applicability in AR-based training. Using a standard endoscopic camera, the absolute average error of the tip position was 2.5 mm for working distances commonly found in laparoscopic training. The average error of the instrument's angle with respect to the camera plane was approximately 2°. The results are also supplemented by video segments of laparoscopic training tasks performed in a physical and an AR environment. The experiments yielded promising results regarding the potential of applying AR technologies for laparoscopic skills training, based on a computer vision framework. The issue of occlusion handling was adequately addressed. The estimated trajectory of the instruments may also be used for surgical gesture interpretation and assessment. Copyright © 2013 John Wiley & Sons, Ltd.

  2. Management approach and surgical strategies for retrorectal tumours: a systematic review.

    Science.gov (United States)

    Toh, J W T; Morgan, M

    2016-04-01

    The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  3. SELECTION OF SURGICAL APPROACH TO TREAT TRAUMATIC INSTABILITY OF SUBAXIAL CERVICAL SPINE

    Institute of Scientific and Technical Information of China (English)

    CAO Peng; LIANG Yu; GONG Yao-cheng; ZHENG Tao; ZHANG Xing-kai; WU Wen-jian

    2008-01-01

    Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods according to the allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included.Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group.Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.

  4. Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

    Science.gov (United States)

    Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

    2017-01-01

    Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. [Surgical treatment of ptosis by resection of the superior tarsal muscle employing a cutaneous approach (author's transl)].

    Science.gov (United States)

    Morax, S

    1982-01-01

    A simple technique for resection of the superior tarsal muscle through a cutaneous approach, for the surgical treatment of ptosis, was employed in severe or moderate, congenital and acquired forms of the affection. Muller's muscle and the aponeurotic fascia are removed in a single piece, while conserving the tarsus.

  6. Behavioral approach with or without surgical intervention to the vulvar vestibulitis syndrome : A prospective randomized and non randomized study

    NARCIS (Netherlands)

    Schultz, WCMW; Gianotten, WL; vanderMeijden, WI; vandeWiel, HBM; Blindeman, L; Chadha, S; Drogendijk, AC

    1996-01-01

    This article describes the outcome of a behavioral approach with or without preceding surgical intervention in 48 women with the vulvar vestibulitis syndrome. In the first part of the study, 14 women with the vulvar vestibulitis syndrome were randomly assigned to one of two treatment programs: eithe

  7. Delayed eruption of maxillary permanent central incisors as a consequence of mesiodens: a surgical re-treatment approach.

    Science.gov (United States)

    Moraes, Renata Simões; Farinhas, João Alfredo; Gleiser, Rogerio; Primo, Laura Guimarães

    2004-01-01

    The presence of mesiodens can cause some clinical problems. This paper reports a case of delayed eruption of permanent central incisors in a nine-year-old male as a consequence of a mesiodens and three surgical approaches prior to the eruption of incisors, which occurred after the third surgery when the crown was exposed and submitted to a gentle luxation.

  8. In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach.

    Science.gov (United States)

    Ronay, Valerie; Merlini, Andrea; Attin, Thomas; Schmidlin, Patrick R; Sahrmann, Philipp

    2017-02-01

    To assess the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy in vitro. One-hundred-and-eighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing peri-implantitis defects with angulations of 30, 60, and 90° covered by a custom-made artificial mucosa. Implants were treated by a dental school graduate and a board-certified periodontist for 120 s with following instruments: Gracey curette, ultrasonic scaler, and an air powder abrasive device with a nozzle for sub-mucosal use utilizing glycine powder. All procedures were repeated 10 times for each instrumentation and defect morphology respectively. Images of the implant surface were taken. Areas with color remnants were planimetrically determined and their cumulative surface area was calculated. Results were tested for statistical differences using two-way anova and Bonferroni correction. Micro-morphologic surface changes were analyzed on scanning electron microscope (SEM) images. The areas of uncleaned surfaces (%, mean ± standard deviations) for curettes, ultrasonic tips, and air abrasion accounted for 74.70 ± 4.89%, 66.95 ± 8.69% and 33.87 ± 12.59% respectively. The air powder abrasive device showed significantly better results for all defect angulations (P instrumentation with Gracey curettes and ultrasonic devices, whereas glycine powder did not result in any surface alterations. A complete surface cleaning could not be achieved regardless of the instrumentation method applied. The air powder abrasive device showed a superior cleaning potential for all defect angulations with better results at wide defects. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery.

    Science.gov (United States)

    Neumaier, Felix; Paterno, Mario; Alpdogan, Serdar; Tevoufouet, Etienne E; Schneider, Toni; Hescheler, Jürgen; Albanna, Walid

    2017-01-01

    Brain surgery to promote behavioral or affective changes in humans remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience, and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and careful appraisal of its 2 sides is warranted: namely, the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude freehand operations into a multidisciplinary treatment of last resort. This goal is accomplished by a detailed reassessment of numerous case reports and small-scale open or controlled trials in their historical and social context. The different surgical approaches, their rationale, and their scientific merit are discussed in a manner comprehensible to readers lacking extensive knowledge of neurosurgery or psychiatry, yet with sufficient documentation to provide a useful resource for practitioners in the field and those wishing to pursue the topic further. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Surgical Excision of Benign Papillomas Diagnosed with Core Biopsy: A Community Hospital Approach

    Directory of Open Access Journals (Sweden)

    Eka Rozentsvayg

    2011-01-01

    Full Text Available Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma was diagnosed in five (7% patients. Surgery revealed high-risk lesions in 8 (12% patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19% upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma.

  11. A comprehensive five-step surgical management approach to penetrating liver injuries that require complex repair.

    Science.gov (United States)

    Ordoñez, Carlos Alberto; Parra, Michael W; Salamea, Juan Carlos; Puyana, Juan Carlos; Millán, Mauricio; Badiel, Marisol; Sanjuán, Juán; Pino, Luis F; Scavo, David; Botache, Wilmer; Ferrada, Ricardo

    2013-08-01

    The objective of this study was to describe a comprehensive five-step surgical management approach for patients with penetrating liver trauma based on our collective institutional experience. A prospective consecutive study of all penetrating liver traumas from January 2003 to December 2011 at a regional Level I trauma center in Cali, Colombia, was conducted. A total of 538 patients with penetrating thoracoabdominal trauma were operated on at our institution. Of these, 146 had penetrating liver injuries that satisfied the inclusion criteria for surgical intervention to manage their hepatic and/or associated injuries. Eighty-eight patients (60%) had an American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) of Grade III (54 patients, 37%), Grade IV (24 patients, 16%), and Grade V (10 patients, 7%). This group of patients required advanced "complex" techniques of hemostasis such as the Pringle maneuver (PM), perihepatic liver packing (PHLP), and/or hepatotomy with selective vessel ligation (SVL). The focus of our study was this subgroup of patients, which we further divided into two as follows: those who required only PM + PHLP (55 patients, 63%) to obtain control of their liver hemorrhage and those who required PM + PHLP + SVL (33 patients, 37%). Of the patients who required PM + PHLP + SVL, 10 (27%) required ligation of major intrahepatic branches, which included suprahepatic veins (n = 4), portal vein (n = 4), retrohepatic vena cava (n = 1), and hepatic artery (n = 1). The remaining 23 patients (73%) required direct vessel ligation of smaller intraparenchymal vessels. The overall mortality was 15.9% (14 of 88), with 71.4% (10 of 14) related to coagulopathy. Mortality rates for Grade III was 3.7% (2 of 54), for Grade IV was 20.8% (5 of 24), and for Grade V was 70% (7 of 10). The mortality in the PM + PHLP + SVL group was higher compared with the PM + PHLP group (12 [36.4%] vs. 2 [3.6%], p = 0.001]. For those patients who fail to respond to PM

  12. Surgical outcomes of lateral approach for jugular foramen schwannoma: postoperative facial nerve and lower cranial nerve functions.

    Science.gov (United States)

    Cho, Yang-Sun; So, Yoon Kyoung; Park, Kwan; Baek, Chung-Hwan; Jeong, Han-Sin; Hong, Sung Hwa; Chung, Won-Ho

    2009-01-01

    The lateral surgical approach to jugular foramen schwannomas (JFS) may result in complications such as temporary facial nerve palsy (FNP) and hearing loss due to the complicated anatomical location. Ten patients with JFS surgically treated by variable methods of lateral approach were retrospectively reviewed with emphasis on surgical methods, postoperative FNP, and lower cranial nerve status. Gross total removal of the tumors was achieved in eight patients. Facial nerves were rerouted at the first genu (1G) in six patients and at the second genu in four patients. FNP of House-Brackmann (HB) grade III or worse developed immediately postoperatively in six patients regardless of the extent of rerouting. The FNP of HB grade III persisted for more than a year in one patient managed with rerouting at 1G. Among the lower cranial nerves, the vagus nerve was most frequently paralyzed preoperatively and lower cranial nerve palsies were newly developed in two patients. The methods of the surgical approach to JFS can be modified depending on the size and location of tumors to reduce injury of the facial nerve and loss of hearing. Careful manipulation and caution are also required for short facial nerve rerouting as well as for long rerouting to avoid immediately postoperative FNP.

  13. Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

    Directory of Open Access Journals (Sweden)

    Barz Thomas

    2008-06-01

    Full Text Available Abstract Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc. and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc. modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost

  14. Molecular targeting of dermatofibrosarcoma protuberans: a new approach to a surgical disease.

    Science.gov (United States)

    McArthur, Grant A

    2007-05-01

    Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignancy of the skin and subcutaneous tissues that only rarely forms distant metastases. More than 90% of cases are associated with a chromosomal translocation involving the COL1A1 gene on chromosome 17 and the platelet-derived growth factor B gene on chromosome 22. Management of this disease is primarily surgical with excellent rates of local control obtained using either wide local excision or Mohs micrographic surgery. Data have recently shown that inhibiting platelet-derived growth factor receptors (PDGFR) with imatinib can induce high rates of clinical response in patients with unresectable or metastatic DFSP. These data have led to approval of imatinib by the U.S. Food and Drug Administration for treating uresectable DFSP. Although wide surgical excision remains standard care, patients with locally advanced disease not suitable for surgical excision can be treated with the PDGFR-inhibitor imatinib, which sometimes allows residual DFSP to be surgically excised.

  15. The Utility of Synthetic-based Approach of Writing among Iranian EFL Learners

    Directory of Open Access Journals (Sweden)

    Nasrin Derakhshandeh

    2014-05-01

    Full Text Available The present study intends to examine the utility of synthetic-based approach versus traditional approaches of writing among Iranian EFL learners. To achieve this end, ninety students at Upper-Intermediate level were randomly chosen from the English population of Kish and Gooyesh English Institutes. The students were divided into three groups. Group1 was asked to do a writing task based on product-based approach. A writing task based on process-oriented approach was administered to Group2; later on, Group 3 was invited to write a composition to assess their performance based on synthetic-based approach. The result of the t test and two-way ANOVA revealed that the students performed better in writing using synthetic approach rather than traditional approaches to writing.

  16. A Consortium Approach to Surgical Education in a Developing Country: Educational Needs Assessment.

    Science.gov (United States)

    Cook, Mackenzie; Howard, Benjamin M; Yu, Angela; Grey, Douglas; Hofmann, Paul B; Moren, Alexis M; Mchembe, Mabula; Essajee, Abbas; Mndeme, Omari; Peck, James; Schecter, William P

    2015-11-01

    Surgical disease is a global health priority, and improving surgical care requires local capacity building. Single-institution partnerships and surgical missions are logistically limited. The Alliance for Global Clinical Training (hereafter the Alliance) is a consortium of US surgical departments that aims to provide continuous educational support at the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS). To our knowledge, the Alliance is the first multi-institutional international surgical collaboration to be described in the literature. To assess if the Alliance is effectively responding to the educational needs of MUHAS and Muhimbili National Hospital surgeons. During an initial 13-month program (July 1, 2013, to August 31, 2014), faculty and resident teams from 3 US academic surgical programs rotated at MUHAS as physicians and teachers for 1 month each. To assess the value of the project, we administered anonymous surveys. Anonymous surveys were analyzed on a 5-point Likert-type scale. Free-text answers were analyzed for common themes. During the study period, Alliance members were present at MUHAS for 8 months (1 month each). At the conclusion of the first year of collaboration, 15 MUHAS faculty and 22 MUHAS residents completed the survey. The following 6 areas of educational needs were identified: formal didactics, increased clinical mentorship, longer-term Alliance presence, equitable distribution of teaching time, improved coordination and language skills, and reciprocal exchange rotations at US hospitals. The MUHAS faculty and residents agreed that Alliance members contributed to improved patient care and resident education. A multi-institutional international surgical partnership is possible and leads to perceived improvements in patient care and resident learning. Alliance surgeons must continue to focus on training Tanzanian surgeons. Improving the volunteer surgeons' Swahili-language skills would be an asset. Future

  17. User centric approach to itemset utility mining in Market Basket Analysis

    Directory of Open Access Journals (Sweden)

    Jyothi Pillai

    2011-01-01

    Full Text Available Business intelligence is information about a company's past performance that is used to help predict the company's future performance. It can reveal emerging trends from which the company might profit [31]. Data mining allows users to sift through the enormous amount of information available in data warehouses; it is from this sifting process that business intelligence gems may be found [31]. Within the area of data mining, the problem of deriving associations from data has received a great deal of attention. This problem is referred as “market-basket problem”. Association Rule Mining (ARM, a well-studied technique in the data mining field, identifies frequent itemsets from databases and generates association rules by assuming that all items have the same significance andfrequency of occurrence in a record. However, items are actually different in many aspects in a number of real applications such as retail marketing, nutritional pattern mining, etc [26]. Rare items are less frequent items [32]. For many real world applications, however, utility of rare itemsets based on cost, profit or revenue is of importance. For extracting rare itemsets, the equal frequency based approaches like Apriori approach suffer from “rare item problem dilemma”. Utility mining aims at identifying rare itemsets with high utility. The main objective of Utility Mining is to identify the itemsets with highest utilities, by considering profit, quantity, costor other user preferences [40]. Also valuable patterns cannot be discovered by traditional non-temporal data mining approaches that treat all the data as one large segment, with no attention paid to utilizing the time information of transactions. Now, as increasingly complex real-world problems are addressed, temporal rare itemset utility problem, are taking center stage. In many real-life applications, high-utility itemsets consist of rare items. Rare itemsets provide useful information in different decision

  18. A case-comparison study of automatic document classification utilizing both serial and parallel approaches

    Science.gov (United States)

    Wilges, B.; Bastos, R. C.; Mateus, G. P.; Dantas, M. A. R.

    2014-10-01

    A well-known problem faced by any organization nowadays is the high volume of data that is available and the required process to transform this volume into differential information. In this study, a case-comparison study of automatic document classification (ADC) approach is presented, utilizing both serial and parallel paradigms. The serial approach was implemented by adopting the RapidMiner software tool, which is recognized as the worldleading open-source system for data mining. On the other hand, considering the MapReduce programming model, the Hadoop software environment has been used. The main goal of this case-comparison study is to exploit differences between these two paradigms, especially when large volumes of data such as Web text documents are utilized to build a category database. In the literature, many studies point out that distributed processing in unstructured documents have been yielding efficient results in utilizing Hadoop. Results from our research indicate a threshold to such efficiency.

  19. Utility maximization with partial information: Hamilton-Jacobi-Bellman equation approach

    Institute of Scientific and Technical Information of China (English)

    BAI Lihua; GUO Junyi

    2007-01-01

    This paper deals with the problem of maximizing the expected utility of the terminal wealth when the stock price satisfies a stochastic differential equation with instantaneous rates of return modelled as an Ornstein-Uhlenbeck process.Here, only the stock price and interest rate can be observable for an investor.It is reduced to a partially observed stochastic control problem.Combining the filtering theory with the dynamic programming approach, explicit representations of the optimal value functions and corresponding optimal strategies are derived. Moreover, closed-form solutions are provided in two cases of exponential utility and logarithmic utility.In particular, logarithmic utility is considered under the restriction of shortselling and borrowing.

  20. Different approaches to estimating transition costs in the electric- utility industry

    Energy Technology Data Exchange (ETDEWEB)

    Baxter, L.W.

    1995-10-01

    The term ``transition costs`` describes the potential revenue shortfall (or welfare loss) a utility (or other actor) may experience through government-initiated deregulation of electricity generation. The potential for transition costs arises whenever a regulated industry is subject to competitive market forces as a result of explicit government action. Federal and state proposals to deregulate electricity generation sparked a national debate on transition costs in the electric-utility industry. Industry-wide transition cost estimates range from about $20 billion to $500 billion. Such disparate estimates raise important questions on estimation methods for decision makers. This report examines different approaches to estimating transition costs. The study has three objectives. First, we discuss the concept of transition cost. Second, we identify the major cost categories included in transition cost estimates and summarize the current debate on which specific costs are appropriately included in these estimates. Finally, we identify general and specific estimation approaches and assess their strengths and weaknesses. We relied primarily on the evidentiary records established at the Federal Energy Regulatory Commission and the California Public Utilities Commission to identify major cost categories and specific estimation approaches. We also contacted regulatory commission staffs in ten states to ascertain estimation activities in each of these states. We refined a classification framework to describe and assess general estimation options. We subsequently developed and applied criteria to describe and assess specific estimation approaches proposed by federal regulators, state regulators, utilities, independent power companies, and consultants.

  1. Aortic dissection - when classical surgical approach, when endoluminal repair?; Die Aortendissektion - Wann operieren, wann endoluminal therapieren?

    Energy Technology Data Exchange (ETDEWEB)

    Richter, G.M.; Hansmann, J. [Heidelberg Univ. (Germany). Abt. Radiodiagnostik; Allenberg, J.R.; Schumacher, H. [Heidelberg Univ. (Germany). Chirurgische Universitaetsklinik, Abt. Gefaesschirurgie; Vahl, C.; Hagl, S. [Heidelberg Univ. (Germany). Chirurgische Universitaetsklinik, Abt. Herzchirurgie

    2001-08-01

    Goal. To demonstrate the Heidelberg results of the previous 2 years in patients referred for acute aortic dissection. Material and Methods. 93 patients referred for acute aortic dissection were treated by cardiac surgery, vascular surgery and interventional radiology according to a novel therapeutic algorithm including stent-grafts and combined open and interventional procedures and conservative medical therapy when no malperfusion syndrome was present or patients were considered prohibitive for even minor surgical procedures. Stent-graft placements were done assisted by short term cardiac arrest to facilitate correct device deployment. Results. 36 patients presented with type A and the other 57 with type B dissection. 32 of the A patients were operated and 20 of the B patients, respectively. 12 patients with B dissection were treated with stent-grafts. 3 required additional interventional therapy for organ malperfusion. The mortality was 0% in these 12 patients. The overall mortality rate in the A group was close to 40% mainly as a result of postoperative organ malperfusion while it was 15% in the B group. In both groups mortality was highest in the respective untreated patient subgroup (3/4 and 8/37, respectively). The main mortality factor was visceral (mesenteric or liver) ischemia. Paraplegic complications occured in neither group. In 4 patients a combined approach applying cardiac surgery of the ascending aorta and endluminal stent-graft placement for the residual B dissection was successfully performed. In one patient this was done simultaneously. Discussion. Acute aortic dissection of type A with or without valve involvement, coronary artery ischemia can be treated with high technical success rates. However, remaining distal aortic dissection associated with true lumen collapse and organ malperfusion is the main causative factor for clinical failures. Successful combination of open proximal aortic surgery with endoluminal treatment of residual B dissection

  2. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach

    OpenAIRE

    Jingarwar, Mahesh; Pathak, Anuradha; Bajwa, Navroop Kaur; Kalaskar, Ritesh

    2015-01-01

    ABSTRACT This paper reports case of pediatric localized gingival recession (LGR) in mandibular anterior region which was treated by using new innovative surgical approach, i.e. combination of frenectomy and vestibular extension. These interceptive surgeries not only gained sufficient width of attached gingival but also lower the attachment of labial frenum. How to cite this article: Jingarwar M, Pathak A, Bajwa NK, Kalaskar R. Vestibular Extension along with Frenectomy in Management of Locali...

  3. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature

    Science.gov (United States)

    George, Bernard

    2007-01-01

    Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. After detailing the relevant anatomy of the foramen magnum area, we will explain our classification system based on the compartment of development, the dural insertion, and the relation to the vertebral artery. The compartment of development is most of the time intradural and less frequently extradural or both intraextradural. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate ligament, anterior to the dentate ligament, and anterior to the dentate ligament with extension over the midline. This classification system helps to define the best surgical approach and the lateral extent of drilling needed and anticipate the relation with the lower cranial nerves. In our department, three basic surgical approaches were used: the posterior midline, the postero-lateral, and the antero-lateral approaches. We will explain in detail our surgical technique. Finally, a review of the literature is provided to allow comparison with the treatment options advocated by other skull base surgeons. PMID:17882459

  4. Accuracy of a novel photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

    Science.gov (United States)

    Gandhi, Neeraj; Kim, Sungmin; Kazanzides, Peter; Lediju Bell, Muyinatu A.

    2017-03-01

    Minimally invasive surgery carries the deadly risk of rupturing major blood vessels, such as the internal carotid arteries hidden by bone in endonasal transsphenoidal surgery. We propose a novel approach to surgical guidance that relies on photoacoustic-based vessel separation measurements to assess the extent of safety zones during these type of surgical procedures. This approach can be implemented with or without a robot or navigation system. To determine the accuracy of this approach, a custom phantom was designed and manufactured for modular placement of two 3.18-mm diameter vessel-mimicking targets separated by 10-20 mm. Photoacoustic images were acquired as the optical fiber was swept across the vessels in the absence and presence of teleoperation with a research da Vinci Surgical System. When the da Vinci was used, vessel positions were recorded based on the fiber position (calculated from the robot kinematics) that corresponded to an observed photoacoustic signal. In all cases, compounded photoacoustic data from a single sweep displayed the four vessel boundaries in one image. Amplitude- and coherence-based photoacoustic images were used to estimate vessel separations, resulting in 0.52-0.56 mm mean absolute errors, 0.66-0.71 mm root mean square errors, and 65-68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Results indicate that with further development, photoacoustic image-based measurements of anatomical landmarks could be a viable method for real-time path planning in multiple interventional photoacoustic applications.

  5. Computational approaches to metabolic engineering utilizing systems biology and synthetic biology.

    Science.gov (United States)

    Fong, Stephen S

    2014-08-01

    Metabolic engineering modifies cellular function to address various biochemical applications. Underlying metabolic engineering efforts are a host of tools and knowledge that are integrated to enable successful outcomes. Concurrent development of computational and experimental tools has enabled different approaches to metabolic engineering. One approach is to leverage knowledge and computational tools to prospectively predict designs to achieve the desired outcome. An alternative approach is to utilize combinatorial experimental tools to empirically explore the range of cellular function and to screen for desired traits. This mini-review focuses on computational systems biology and synthetic biology tools that can be used in combination for prospective in silico strain design.

  6. A Computer Simulation Modeling Approach to Estimating Utility in Several Air Force Specialties

    Science.gov (United States)

    1992-05-01

    AL-TR-1992-0006 AD-A252 322 /II" A COMPUTER SIMULATION MODELING A APPROACH TO ESTIMATING UTILITY IN R SEVERAL AIR FORCE SPECIALTIES M Brice M. Stone...I 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED IU 1Q::l.n1 Umrjh 1100 4. TITLE AND SUBTITLE S. FUNDING NUMBERS A Computer Simulation Modeling Approach...I DTIC TAB 0 Unannounced 0 justificatlon- By Distribut On . Availability Codes Avai an /r Dist Special v A COMPUTER SIMULATION MODELING APPROACH TO

  7. Platelet-rich plasma: a biomimetic approach to enhancement of surgical wound healing.

    Science.gov (United States)

    Fernandez-Moure, Joseph S; Van Eps, Jeffrey L; Cabrera, Fernando J; Barbosa, Zonia; Medrano Del Rosal, Guillermo; Weiner, Bradley K; Ellsworth, Warren A; Tasciotti, Ennio

    2017-01-01

    Platelets are small anucleate cytoplasmic cell bodies released by megakaryocytes in response to various physiologic triggers. Traditionally thought to be solely involved in the mechanisms of hemostasis, platelets have gained much attention due to their involvement wound healing, immunomodulation, and antiseptic properties. As the field of surgery continues to evolve so does the need for therapies to aid in treating the increasingly complex patients seen. With over 14 million obstetric, musculoskeletal, and urological and gastrointestinal surgeries performed annually, the healing of surgical wounds continues to be of upmost importance to the surgeon and patient. Platelet-rich plasma, or platelet concentrate, has emerged as a possible adjuvant therapy to aid in the healing of surgical wounds and injuries. In this review, we will discuss the wound healing properties of platelet-rich plasma and various surgical applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach

    Institute of Scientific and Technical Information of China (English)

    Song Wu; Liu Yuyi; Ye Jinning; Peng Jianjun; He Weiling; Chen Jianhui; Chen Chuangqi

    2014-01-01

    Background As a common form of gastric cancer migration,lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer.Surgery is the fundamental curative option for gastric cancer that varies depending on different stages.The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.Methods In our retrospective study,the data of 328 patients of proximal gastric cancer with different T stages were analyzed.By comparing the differences of lymph node metastatic rate and ratio,we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes.Also,we were especially interested in the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage.Results The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4% and 23.3%,respectively.The tumors of different T stages were statistically significant in size and differentiation degree (P <0.05),multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer (RR,12.025; 95% CI,2.326 to 62.157; P=0.003).The overall survival rate of patients with No.5,6 group lymph node metastasis and those without was significantly different,but the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage were not statistically significant.Conclusions Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis.D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare.Therefore the range of the

  9. Root resorption associated with an impacted mesiodens: a surgical and endodontic approach to treatment.

    Science.gov (United States)

    Zmener, Osvaldo

    2006-10-01

    This article describes a case of root resorption of a maxillary non-vital immature incisor associated with an impacted and angulated mesiodens. The impacted tooth was surgically removed and the compromised incisor was subsequently endodontically treated. Over a period of 27 months the tooth was medicated with repeated applications of calcium hydroxide. Radiographically after 18 months, an incomplete hard tissue barrier was observed with full apical closure at the conclusion of 27 months of treatment. Once the patient was comfortable after surgical removal of the mesiodens, the tooth was asymptomatic and remained so for the duration of the treatment and after definitive restorative work had been completed.

  10. The Effects of Rising Interest Rates on Electric Utility Stock Prices: Regulatory Considerations and Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Kihm, Steve [Seventhwave, Madison, WI (United States); Satchwell, Andrew [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Cappers, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-07-26

    This technical brief identifies conditions under which utility regulators should consider implementing policy approaches that seek to mitigate negative outcomes due to an increase in interest rates. Interest rates are a key factor in determining a utility’s cost of equity and investors find value when returns exceed the cost of equity. Through historical observations of periods of rising and falling interest rates and application of a pro forma financial tool, we identify the key drivers of utility stock valuations and estimate the degree to which those valuations might be affected by increasing interest rates.3 We also analyze the efficacy of responses by utility regulators to mitigate potential negative financial impacts. We find that regulators have several possible approaches to mitigate a decline in value in an environment of increasing interest rates, though regulators must weigh the tradeoffs of improving investor value with potential increases in customer costs. Furthermore, the range of approaches reflects today’s many different electric utility regulatory models and regulatory responses to a decline in investor value will fit within state-specific models.

  11. Cluster approach to the development of housing services and public utilities in the region

    Directory of Open Access Journals (Sweden)

    Sergey Ivanovich Bazhenov

    2012-03-01

    Full Text Available The ongoing crisis in the housing services and public utilities sphere determines the need to accelerate its integration into the market space. The author proposes to apply the cluster initiatives, which, in his opinion, provide the solution of housing services and public utilities problems in terms of their broader vision. This paper attempts to highlight the benefits of the cluster approach to the development of housing services and public utilities, and identifies the main provisions in the process of its implementation. The essence of the concept of «housing services and social cluster of the region» in terms of housing services and public utilities development is revealed, members of cluster unification are designated, its components are identified, the purpose of introducing the cluster model of housing services and public utilities reform management is determined, which essence is to change the mentality of the producers and consumers of housing services and public utilities in the direction of increasing responsibilities and respect for mutual interests in the market of housing services and public utilities. The main provisions and principles of formation of housing services and social cluster of the region are reviewed, as well as the characteristics and trends of its development. An authorial approach to the development of a strategy of forming a housing services and social cluster in the region in accordance with modern trends is presented. The leading role of several factors in establishing the basic prerequisites for sustainable operation of housing services and social cluster of the region is justified. These factors include governmental regulation of pricing and forms of support to small entrepreneurship development, creation of financial security system, development of public-private partnerships and implementation of innovative technologies. The role of non-governmental organizations and public associations in the formation of

  12. An innovative approach to diabetes education for a Hispanic population utilizing community health workers.

    Science.gov (United States)

    Valen, Mieca S; Narayan, Suzanne; Wedeking, Lorene

    2012-01-01

    Type 2 diabetes disproportionately affects the Hispanic population. New approaches are needed to provide effective education to this population. This evidence-based project utilized community health workers (CHWs) to deliver a culturally relevant diabetes education program to a Hispanic population at a migrant clinic. The program emphasized culturally relevant interventions to improve self-efficacy. Formative evaluation was used to develop and improve the program. Participants showed improvement in diabetes knowledge and diabetes related self-efficacy scores. Outcomes also included improvement in CHWs' diabetes knowledge and development of an educational program that could be utilized in other settings serving Hispanic populations with type 2 diabetes.

  13. Minimally invasive research of presigmoidal approach for exposure of jugular foramen region utilizing virtual reality system

    Directory of Open Access Journals (Sweden)

    Ke TANG

    2015-04-01

    Full Text Available Objective To discuss minimally invasive tactics for exposure of jugular foramen region in transpetrosal-presigmoidal approach based on virtual reality image model. Methods CT and MRI scans were performed to 15 adult cadaver heads (30 sides, and image data was inputted into Vitrea virtual reality system to establish three-dimensional anatomical model of jugular foramen region. The transpetrosal-presigmoidal approach was simulated with selecting osseous landmark points to draw a cylinder. Minimally invasive simulation was performed by reducing the diameter of cylinder. Anatomic exposures in surgical trajectory following minimally invasive design were observed, measured and compared.  Results Spacial sequence of nerves and vessels of jugular foramen region was exposured clearly with the route simulating transpetrosal-presigmoidal approach. Route before and after minimally invasive design passed through the interval between vertical segment of facial nerve and sigmoid sinus. There was a part of sigmoid sinus in the route. Cerebellar hemisphere was not included in the route. Data measurement and comparative analysis showed that volume of route, petrosal osseous structure and venous sinus involved in route before minimally invasive design was more than that after minimally invasive design. The differences reached statistical significance (P = 0.000. The volumes of lower cranial nerves between routes before and after minimally invasive design did not show significant differences (P = 0.552.  Conclusions Minimally invasive route of transpetrosal-presigmoidal approach is helpful to reduce surgical injury of vital structures in effective exposure for target structures of jugular foramen region. DOI: 10.3969/j.issn.1672-6731.2015.04.011

  14. Optimization of a spherical mechanism for a minimally invasive surgical robot: theoretical and experimental approaches.

    Science.gov (United States)

    Lum, Mitchell J H; Rosen, Jacob; Sinanan, Mika N; Hannaford, Blake

    2006-07-01

    With a focus on design methodology for developing a compact and lightweight minimally invasive surgery (MIS) robot manipulator, the goal of this study is progress toward a next-generation surgical robot system that will help surgeons deliver healthcare more effectively. Based on an extensive database of in-vivo surgical measurements, the workspace requirements were clearly defined. The pivot point constraint in MIS makes the spherical manipulator a natural candidate. An experimental evaluation process helped to more clearly understand the application and limitations of the spherical mechanism as an MIS robot manipulator. The best configuration consists of two serial manipulators in order to avoid collision problems. A complete kinematic analysis and optimization incorporating the requirements for MIS was performed to find the optimal link lengths of the manipulator. The results show that for the serial spherical 2-link manipulator used to guide the surgical tool, the optimal link lengths (angles) are (60 degrees, 50 degrees). A prototype 6-DOF surgical robot has been developed and will be the subject of further study.

  15. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches

    NARCIS (Netherlands)

    Bouma, Wobbe; van der Horst, Iwan C. C.; Wijdh-den Hamer, Inez J.; Erasmus, Michiel E.; Zijlstra, Felix; Mariani, Massimo A.; Ebels, Tjark

    2010-01-01

    Chronic ischaemic mitral regurgitation (CIMR) remains one of the most complex and unresolved aspects in the management of ischaemic heart disease. This review provides an overview of the present knowledge about the different aspects of CIMR with an emphasis on mechanisms, current surgical treatment

  16. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

    Directory of Open Access Journals (Sweden)

    George I. Mataliotakis

    2016-01-01

    Full Text Available Spinal deformity in patients with cystic fibrosis (CF is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.

  17. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

    Science.gov (United States)

    Fall, Andrew

    2016-01-01

    Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome. PMID:27413564

  18. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case.

    Science.gov (United States)

    Mataliotakis, George I; Tsirikos, Athanasios I; Pearson, Karen; Urquhart, Don S; Smith, Carolyn; Fall, Andrew

    2016-01-01

    Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.

  19. SURGICAL TREATMENT OF L5-SPONDYLOLISTHESIS VERTEBRAE IN CHILDREN. BENEFITS OF POSTERIOR APPROACH

    Directory of Open Access Journals (Sweden)

    Сергей Валентинович Виссарионов

    2014-09-01

    Full Text Available Objective to develop current options of surgical treatment of L5-spondylolisthesis in children. Materials and methods: 48 patients were observed and underwent surgical treatment at age of 10-17 years. In 9 patients spondylolisthesis of L5 was grade 2, in 14 - grade 3, in 12 - grade 4. 9 patients had spondyloptosis of the body of L5-vertebra. The article presents different options of surgical treatment of spondylolisthesis in children depending on the degree of vertebrae body shift and the main clinical manifestations. During surgery the anatomy of the vertebral canal and the normal interposition in the pathological segment were reconstructed. It resulted in normalization of the body balance and regression of neurological symptoms. Results: in spondylolisthesis grade 2 and 3 full reduction was achieved. In patients with grade 4 spondylolisthesis deformity was reduced to grade 2-3. Pain and radicular syndromes regressed in 2-3 days after surgery. In patients with monoparesis and contractures regression of neurological deficit took 1-1,5 months. Conclusions: The method of surgical treatment in patients with spondylolisthesis of L5 vertebrae depends on the degree of vertebrae shifting presence of segmental instability and neurological sighns.

  20. Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.

    Directory of Open Access Journals (Sweden)

    I. Ugenti

    2015-01-01

    Conclusion: Even when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision.

  1. Dumbbell trigeminal schwannoma in a child: complete removal by a one-stage pterional surgical approach.

    NARCIS (Netherlands)

    Verstappen, C.C.P.; Beems, T.; Erasmus, C.E.; Lindert, E.J. van

    2005-01-01

    OBJECTIVE: The objective was to describe a rare case of a trigeminal schwannoma in a child and the surgical procedure performed for therapy. PATIENT AND METHODS: A 6-year-old girl presented with tiredness, dysarthric speech and cerebellar symptoms. Imaging studies revealed a unilateral dumbbell-shap

  2. Large epidermal cyst of the clitoris: a novel diagnostic approach to assist in surgical removal.

    Science.gov (United States)

    Johnson, Lee T; Lara-Torre, Eduardo; Murchison, Amanda; Garcia, Evelyn M

    2013-04-01

    Epidermal cysts of the clitoris are uncommon and usually associated with previous trauma. Surgical removal is the preferred treatment with close attention to preserve sensation and vascular supply. The use of an alternative coil during Magnetic Resonance (MR) imaging to visualize the anatomy may improve surgical management and outcomes. A 15-year-old adolescent had a 2-year history of clitoral enlargement. Physical exam revealed a 4 × 5 cm clitoral cyst and normal hormonal evaluation. Initial MR with a pelvic coil showed poor resolution of neurovascular supply. MR was repeated using a small flex coil (commonly used on the wrist) placed as a sanitary napkin providing a higher resolution image of the neurovascular structures, which guided surgical intervention. The use of the MR small flex coil to better visualize the external genital structures and clitoral anatomy improved preoperative evaluation and guided surgical management of the clitorial cyst. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  3. [Modern minimal invasive combine surgical approach in varicose disease of lower limbs patients].

    Science.gov (United States)

    Berehovyĭ, O V; Hur'iev, A M; Kisel'ov, V O; Hrepachevs'kyĭ, V Ie; Sholokh, V M; Bon', D O

    2012-07-01

    The analysis of combine endovenous laser coagulations in 167 patients, treated from 2007 to 2011 with different types of chronic venous insufficiency of superficial veins of lower limbs varicous disease were analysed. The high efficiency of minimal invasive combine surgical treatment, using high energetic diode laser Dornier Medilas Fibertom with wave length of 940 nm was done.

  4. Nonsurgical deep uterine transfer of vitrified, in vivo-derived, porcine embryos is as effective as the default surgical approach.

    Science.gov (United States)

    Martinez, Emilio A; Martinez, Cristina A; Nohalez, Alicia; Sanchez-Osorio, Jonatan; Vazquez, Juan M; Roca, Jordi; Parrilla, Inmaculada; Gil, Maria A; Cuello, Cristina

    2015-06-01

    Surgical procedures are prevalent in porcine embryo transfer (ET) programs, where the use of vitrified embryos is quasi non-existent. This study compared the effectiveness of surgical vs nonsurgical deep uterine (NsDU) ET using vitrified, in vivo-derived embryos (morulae and blastocysts) on the reproductive performance and welfare of the recipients. The recipient sows (n=122) were randomly assigned to one of the following groups: surgical ET with 30 vitrified-warmed embryos (S-30 group, control); NsDU-ET with 30 vitrified-warmed embryos (NsDU-30 group) and NsDU-ET with 40 vitrified-warmed embryos (NsDU-40 group). Regardless of embryo stage, the NsDU-ET with 40 embryos presented similar rates of farrowing (72.7%) and litter size (9.9 ± 2.1 piglets) as the customary surgical procedure (75.0% and 9.6 ± 2.7 piglets). Numbers of ET-embryos appeared relevant, since the NsDU-ET with 30 embryos resulted in a decrease (P<0.05) in farrowing rates (38.9%) and litter sizes (5.7 ± 2.4 piglets). In conclusion, we demonstrate for the first time that farrowing rate and litter size following a NsDU-ET procedure increase in function of a larger number of transferred vitrified embryos, with fertility equalizing that obtained with the invasive surgical approach. The results open new possibilities for the widespread use of non-invasive ET in pigs.

  5. Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease.

    Science.gov (United States)

    Sheth, Jamie S; Belperio, John A; Fishbein, Michael C; Kazerooni, Ella A; Lagstein, Amir; Murray, Susan; Myers, Jeff L; Simon, Richard H; Sisson, Thomas H; Sundaram, Baskaran; White, Eric S; Xia, Meng; Zisman, David; Flaherty, Kevin R

    2017-02-01

    Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung disease (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high-resolution CT (HRCT) data leads to a confident diagnosis congruent to SLB and therefore avoids the need for SLB in some patients. We evaluated 33 patients being investigated for suspected ILD who underwent HRCT, TBB, and SLB. First, clinicians, radiologists, and a pathologist reviewed the clinical information and HRCT and TBB findings. Clinicians were asked to provide a diagnosis and were also asked if SLB was needed for a more confident diagnosis. Subsequently, the clinical, HRCT, and SLB data were reviewed, and the same participants were asked to provide a final diagnosis. Clinician consensus and overall agreement between TBB- and SLB-based diagnoses were calculated. Four patients had definite usual interstitial pneumonia (UIP) on HRCT and would not be considered for biopsy using current guidelines. Of the 29 patients without a definitive HRCT diagnosis, the clinicians felt confident of the diagnosis (ie, would not recommend SLB) in six cases. In these cases, there was 100% agreement between TBB and SLB diagnoses. UIP was the most common diagnosis (n = 3) and was associated with an HRCT diagnosis of possible UIP/nonspecific interstitial pneumonia-like. Agreement was poor (33%) between TBB and SLB diagnoses when confidence in the TBB diagnosis was low. Information from TBB, when combined with clinical and HRCT data, may provide enough information to make a confident and accurate diagnosis in approximately 20% to 30% of patients with ILD. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  6. Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach.

    Science.gov (United States)

    Ouali, Sana; Kortas, Chokri; Brockmeier, Konrad; Boughzela, Essia

    2011-12-01

    Combination of ruptured sinus of Valsalva aneurysm (SVA), and a coexisting asymptomatic adult aortic isthmic coarctation is extremely rare. The timing and sequence of surgical and/or interventional repair of these two pathologies are controversial. We present a case of a 37-year-old male who was admitted to our department because of severe acute congestive heart failure and signs of ruptured aneurysm of the SV into the right ventricle. Transthoracic and transoesophageal echocardiography confirmed the communication between an important right coronary SVA and right ventricle, bicuspid aortic valve, mild aortic regurgitation, and revealed severe aortic coarctation. Because of the severe dilation of right sinus of Valsalva a surgical repair of the ruptured aneurysm was performed. Aortic coarctation was treated four weeks later by a percutaneous stent-graft implantation. This case report supports the concept that hybrid approach is feasible in patients with ruptured SVA and aortic coarctation in adulthood.

  7. Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach.

    Science.gov (United States)

    Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin

    Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.

  8. A GA-Based Approach to Hide Sensitive High Utility Itemsets

    Directory of Open Access Journals (Sweden)

    Chun-Wei Lin

    2014-01-01

    Full Text Available A GA-based privacy preserving utility mining method is proposed to find appropriate transactions to be inserted into the database for hiding sensitive high utility itemsets. It maintains the low information loss while providing information to the data demanders and protects the high-risk information in the database. A flexible evaluation function with three factors is designed in the proposed approach to evaluate whether the processed transactions are required to be inserted. Three different weights are, respectively, assigned to the three factors according to users. Moreover, the downward closure property and the prelarge concept are adopted in the proposed approach to reduce the cost of rescanning database, thus speeding up the evaluation process of chromosomes.

  9. An estimation approach for dividable multiattribute utility of housing via questionnaires of consumers' ordinal multicriteria preferences

    Institute of Scientific and Technical Information of China (English)

    翟凤勇; 王要武

    2004-01-01

    multi-function characteristic. How to evaluate the multi-functional nature of housing is very useful in both theory and in application, yet it is often ignored in China. This paper introduces an approach to estimate the muhicriteria function of housing using multiattribute utility theory (MAUT) based on consumers' ordinal multicriteria peferences as determined via questionnaires. When compared with the classic framework in which MAUT is applied, this approach needs less prior information and subjective comparisons and thus can allay many of the operational difficulties involved in assessment. Some potential applications to the China housing market are also discussed.

  10. Dural Tail Sign in the Resection of Ventral Foramen Magnum Meningiomas via a Far Lateral Approach: Surgical Implications.

    Science.gov (United States)

    Wu, Bo; Shen, Shang-Hang; Chen, Long-Yi; Liu, Wei-Dong

    2015-11-01

    To investigate the implications of dural tail sign (DTS) in the tailored far lateral approach for resection of ventral foramen magnum meningiomas (FMMs). Clinical data for 16 patients treated surgically for ventral FMMs over 5 years were reviewed retrospectively. The DTS was positive in 11 cases (68.8%) and negative in 5 cases (31.2%). The most frequent form was a single cranial tail (7 of 11), followed by multiple tails consisting of a cranial tail and a caudal tail (3 of 11), and multiple tails composed of a cranial tail and a contralateral tail (1 of 11). The retrocondylar approach was carried out in 5 cases without DTS characterized by a narrow dural attachment and a partial transcondylar approach in 11 cases with DTS featuring a broad and hypervascular dural attachment. Drilling ranged from approximately one fifth to one third of the condyle with reference to the DTS form and tumor size. Total tumor removal was achieved in 16 patients. Postoperative complications were encountered in 25% of patients, predominantly associated with cranial nerve impairment. Follow-up ranging from 8 to 56 months (mean 24.4 months) showed no tumor recurrence. In addition to tumor dural attachment and tumor size, we propose that DTS should be considered as another factor in planning the surgical approach for ventral FMMs. Differentiation between a positive and negative DTS plays a role in the neurosurgical planning of ventral FMMs. Bone removal is warranted in tumors with DTS, particularly the multiple form with contralateral tails, to facilitate the surgical procedure and achieve a more radical resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy.

    Science.gov (United States)

    Souza, Bruno Gonçalves Schröder E; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel

    2015-01-01

    Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

  12. Hypertrophic Cardiomyopathy (HCM): How Flow Analysis May Drive Medical Management and Surgical Approach

    Science.gov (United States)

    Abraham, Theodore P.

    2011-11-01

    Hypertrophic Cardiomyopathy (HCM) is the most common inherited heart disease and occurs in 1 in 500 persons worldwide regardless of race, age and gender. It is the most common cause of sudden death in the young and also causes heart failure and cardiac arrhythmias. The primary anatomic abnormality is thickening of certain walls, or sometimes global thickening of the left or right ventricle. The patterns of thickening along with increased ventricular stiffness lead to suboptimal ventricular filling and inefficient ejection of blood from the ventricle. Treatment for HCM can be medical or surgical. The choice of therapy is driven by the presence and severity of outflow obstruction. Flow analysis could provide sophisticated information about outflow and inflow ventricular dynamics. These flow dynamics features may enable better medical choices and provide information that would allow superior surgical planning. Associate Professor of Medicine & Director, Hypertrophic Cardiomyopathy Clinic

  13. A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation

    OpenAIRE

    Nolte, L.-P.; Slomczykowski, M. A.; Berlemann, U.; Strauss, M. J.; Hofstetter, R; Schlenzka, D.; Laine, T.; Lund, T

    2000-01-01

    A new computer-based navigation system for spinal surgery has been designed. This was achieved by combining intraoperative fluoroscopy-based imaging using conventional C-arm technology with freehand surgical navigation principles. Modules were developed to automate digital X-ray image registration. This is in contrast to existing computed tomography- (CT) based spinal navigation systems, which require a vertebra-based registration procedure. Cross-referencing of the image intensifier with the...

  14. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

    OpenAIRE

    Gillespie BM; Kang E.; Roberts S; Lin F; Morley N; Finigan T; Homer A; Chaboyer W

    2015-01-01

    Brigid M Gillespie,1 Evelyn Kang,1 Shelley Roberts,1 Frances Lin,1,2 Nicola Morley,3 Tracey Finigan,3 Allison Homer,3 Wendy Chaboyer1 1National Health and Medical Research Council Research Centre for Clinical Excellence in Nursing Interventions (NCREN) and Centre for Healthcare Practice Innovation (HPI), Menzies Health Institute, 2School of Nursing and Midwifery, Griffith University, 3Surgical and Procedural Services, Gold Coast University Hospital, Gold Coast, QLD, Australia Purpose: To iden...

  15. Management of intrusive luxation in the primary dentition by surgical repositioning: an alternative approach.

    Science.gov (United States)

    Shanmugam, H V; Arangannal, P; Vishnurekha, C; Nichani, M H; Vijayaprabha, K

    2011-06-01

    Intrusive luxation is the most common trauma during early infancy which results in the displacement of the tooth into its alveolus. Depending on the severity of the intrusion, the American Academy of Pediatric Dentistry recommends either extraction or spontaneous re-eruption for the primary tooth. This case report provides a brief insight into surgical repositioning as an alternative treatment option for the management of intruded primary tooth in a 4-year-old girl.

  16. "I got it on Ebay!": cost-effective approach to surgical skills laboratories.

    Science.gov (United States)

    Schneider, Ethan; Schenarts, Paul J; Shostrom, Valerie; Schenarts, Kimberly D; Evans, Charity H

    2017-01-01

    Surgical education is witnessing a surge in the use of simulation. However, implementation of simulation is often cost-prohibitive. Online shopping offers a low budget alternative. The aim of this study was to implement cost-effective skills laboratories and analyze online versus manufacturers' prices to evaluate for savings. Four skills laboratories were designed for the surgery clerkship from July 2014 to June 2015. Skills laboratories were implemented using hand-built simulation and instruments purchased online. Trademarked simulation was priced online and instruments priced from a manufacturer. Costs were compiled, and a descriptive cost analysis of online and manufacturers' prices was performed. Learners rated their level of satisfaction for all educational activities, and levels of satisfaction were compared. A total of 119 third-year medical students participated. Supply lists and costs were compiled for each laboratory. A descriptive cost analysis of online and manufacturers' prices showed online prices were substantially lower than manufacturers, with a per laboratory savings of: $1779.26 (suturing), $1752.52 (chest tube), $2448.52 (anastomosis), and $1891.64 (laparoscopic), resulting in a year 1 savings of $47,285. Mean student satisfaction scores for the skills laboratories were 4.32, with statistical significance compared to live lectures at 2.96 (P online resources to purchase surgical equipment, surgical educators overcome financial obstacles limiting the use of simulation and provide learning opportunities that medical students perceive as beneficial. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Transoral surgical approach for treatment of symptomatic atlantoaxial cervical synovial cysts.

    Science.gov (United States)

    Lyons, Mark K; Birch, Barry

    2011-01-01

    Synovial cysts are relatively common in the lumbar spine and very uncommon in the cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. There are two distinct cervical spine synovial cyst categories: atlantoaxial and the subaxial cervical spine. The surgical treatments are very different. We report eleven patients undergoing transoral resection and posterior fusion for histologically confirmed symptomatic atlantoaxial synovial cysts. This represents a retrospective review over 18 years. The authors analyzed the literature of patients who underwent surgical treatment for symptomatic atlantoaxial synovial cysts. There were four male and seven female patients with a mean age of 76 years (range 54-84 years). All patients presented with cervical myelopathy. Patients were neurologically assessed pre- and postoperatively and outcome reported using the Modified Rankin Outcome score. Mean follow-up period was 22 months (range 6-120 months). Ten of the eleven patients had improvement in their postoperative assessment and one patient remained unchanged. Myelopathy is the presenting symptom in the vast majority of these patients. Surgical resection and decompression of the neural structures can be an effective treatment for symptomatic atlantoaxial synovial cysts.

  18. Surgical management of Eagle's syndrome: an approach to shooting craniofacial pain.

    Science.gov (United States)

    Kumai, Yoshihiko; Hamasaki, Tadashi; Yumoto, Eiji

    2016-10-01

    Eagle's syndrome (ES) and glossopharyngeal neuralgia (GPN) display very similar symptoms preoperatively. The objective of this study is to determine the surgical outcome of intraoral resection of the styloid process (IRSP) for ES, and to observe preoperative findings and treatment outcome of our cases presenting shooting craniofacial pain. In total, 14 symptomatic patients who presented with typical shooting craniofacial pain, had a styloid process longer than 25 mm, and underwent surgical intervention or medication alone from 2011 to 2015 were involved. They were divided into two groups: Group I included eight patients who underwent surgery following 3 months of medication failure, and Group II included six patients who received medication alone. Preoperative physical, radiographic findings and surgical outcomes were examined. In Group I patients, six cases received IRSP and five of those six cases experienced complete relief from symptoms and were confirmed as ES. Two other cases in Group I received microvascular decompression. One showed complete relief from symptoms, and was confirmed as GPN. The other case showed recurrence 1 year postoperatively, received IRSP with complete relief from symptoms, and was confirmed as ES. In Group II, three cases experienced complete relief from symptoms with 3 months of medication alone. IRSP is an effective treatment for ES. There was no clear difference in the preoperative findings for ES and GPN, suggesting the difficulty in making a preoperative differential diagnosis between the two conditions. Close cooperation between ENT and neurosurgery surgeons is needed.

  19. An Augmented Reality-Based Approach for Surgical Telementoring in Austere Environments.

    Science.gov (United States)

    Andersen, Dan; Popescu, Voicu; Cabrera, Maria Eugenia; Shanghavi, Aditya; Mullis, Brian; Marley, Sherri; Gomez, Gerardo; Wachs, Juan P

    2017-03-01

    Telementoring can improve treatment of combat trauma injuries by connecting remote experienced surgeons with local less-experienced surgeons in an austere environment. Current surgical telementoring systems force the local surgeon to regularly shift focus away from the operating field to receive expert guidance, which can lead to surgery delays or even errors. The System for Telementoring with Augmented Reality (STAR) integrates expert-created annotations directly into the local surgeon's field of view. The local surgeon views the operating field by looking at a tablet display suspended between the patient and the surgeon that captures video of the surgical field. The remote surgeon remotely adds graphical annotations to the video. The annotations are sent back and displayed to the local surgeon while being automatically anchored to the operating field elements they describe. A technical evaluation demonstrates that STAR robustly anchors annotations despite tablet repositioning and occlusions. In a user study, participants used either STAR or a conventional telementoring system to precisely mark locations on a surgical simulator under a remote surgeon's guidance. Participants who used STAR completed the task with fewer focus shifts and with greater accuracy. The STAR reduces the local surgeon's need to shift attention during surgery, allowing him or her to continuously work while looking "through" the tablet screen.

  20. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty.

    Science.gov (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H

    2017-08-01

    Background and purpose - Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods - We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5-0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation - Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

  1. Open and Arthroscopic with Mini-Open Surgical Hip Approaches for Treatment of Pigmented Villonodular Synovitis and Concomitant Hip Pathology

    Directory of Open Access Journals (Sweden)

    Bridget Ellsworth

    2017-01-01

    Full Text Available Background. Pigmented villonodular synovitis (PVNS is a rare benign tumor affecting large joints and prompts excision to prevent local destruction of the joint. The purpose of this case report is to describe two differing surgical approaches for management of PVNS of the hip in patients requiring concomitant treatment for additional hip pathology. Methods. This report discusses the presentation, clinical and radiographic findings, and operative management of two contrasting cases of PVNS of the hip. Case 1 describes a 31-year-old female with localized PVNS in addition to a labral tear treated with arthroscopic labral repair followed by tumor excision via a mini-open incision. Case 2 describes a 29-year-old male with more diffuse PVNS in addition to a cam deformity managed with open surgical dislocation of the hip, tumor excision, and restoration of the femoral head/neck junction. Results. This report demonstrates two cases of successful excision of PVNS of the hip in addition to addressing concomitant hip pathology in both cases. Conclusions. Open surgical dislocation of the hip or arthroscopic surgery with a mini-open incision may be used in appropriately selected patients to successfully excise PVNS lesions in addition to addressing concomitant hip pathology.

  2. Open and Arthroscopic with Mini-Open Surgical Hip Approaches for Treatment of Pigmented Villonodular Synovitis and Concomitant Hip Pathology.

    Science.gov (United States)

    Ellsworth, Bridget; Kamath, Atul F

    2017-01-01

    Background. Pigmented villonodular synovitis (PVNS) is a rare benign tumor affecting large joints and prompts excision to prevent local destruction of the joint. The purpose of this case report is to describe two differing surgical approaches for management of PVNS of the hip in patients requiring concomitant treatment for additional hip pathology. Methods. This report discusses the presentation, clinical and radiographic findings, and operative management of two contrasting cases of PVNS of the hip. Case 1 describes a 31-year-old female with localized PVNS in addition to a labral tear treated with arthroscopic labral repair followed by tumor excision via a mini-open incision. Case 2 describes a 29-year-old male with more diffuse PVNS in addition to a cam deformity managed with open surgical dislocation of the hip, tumor excision, and restoration of the femoral head/neck junction. Results. This report demonstrates two cases of successful excision of PVNS of the hip in addition to addressing concomitant hip pathology in both cases. Conclusions. Open surgical dislocation of the hip or arthroscopic surgery with a mini-open incision may be used in appropriately selected patients to successfully excise PVNS lesions in addition to addressing concomitant hip pathology.

  3. A new approach to the surgical treatment of parasitic cysts of the liver: Hepatectomy using the liver hanging maneuver

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To review 11 patients with parasitic cysts of the liver, who were treated by hepatic lobectomy using the liver hanging maneuver (LHM).METHODS: Between January 2003 and June 2006, we retrospectively analyzed patients who underwent surgical treatment due to parasitic cysts of the liver, at the Ege University School of Medicine, Department of General Surgery. Of these, the patients who underwent hepatic lobectomy using the LHM were reviewed and evaluated for surgical treatment outcome.RESULTS: Over a three-year period, there were 102 patients who underwent surgical treatment for parasitic cysts of the liver. Of these, 11 (10%) patients with parasitic cysts of the liver underwent hepatic lobectomy using the LHM. Presenting symptoms were abdominal pain, dyspepsia, and cholangitis. Cyst locations were as follows: right lobe filled with cyst, 7 (63%); segmental location, 2 (18%); and multiple locations, 2 patients (18%). All patients underwent hepatic lobectomy with an anterior approach using the LHM. The intraoperative blood transfusion requirement was one unit for 3 patients and two units for one patient. Postoperative complications included pulmonary atelectasy (2, 18%)and pleural effusion (2, 18%). No significant morbidity or mortality was observed.CONCLUSION: We concluded that hepatic lobectomy using the LHM should be considered, not only for hepatic tumors or donor hepatectomy, but also to treat parasitic cysts of the liver.

  4. CHOICE OF SURGICAL APPROACH FOR ACETABULAR COMPONENT’S IMPLANTATION USING CURRENT CLASSIFICATION FOR ARTHRITIS FOLLOWING ACETABULAR FRACTURE

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available Degenerative-dystrophic changes in hip after treatment of acetabular fracture, over the time, develops about in 60% of affected people. In such cases, total hip replacement is used. Existing classifications (for example AO or Letournel are good for fracture treatment, but not for arthritis following acetabular fracture. The group of patients, with post traumatic arthritis, is heterogeneous with severity of post traumatic anatomic changes. Basis for surgical approach, could be current classification for post traumatic changes – taking into account features of anatomic functional changes in hip and the bone defects of acetabulum. In this article is demonstrated X-ray and clinical basing for current classification.

  5. In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach

    OpenAIRE

    Ronay, Valerie; Merlini, Andrea; ATTIN, Thomas; Schmidlin, Patrick R.; Sahrmann, Philipp

    2017-01-01

    OBJECTIVES To assess the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy in vitro. MATERIALS AND METHODS One-hundred-and-eighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing peri-implantitis defects with angulations of 30, 60, and 90° covered by a custom-made artificial mucosa. Implants were treated by a dental school graduate and a board-certified periodontist for 120 s w...

  6. Advances in Research on the Approaches of Improving Water Utilization Efficiency in Rice

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ming-sheng; HUANG You-zhong; ZHANG Guo-ping

    2005-01-01

    Water shortage is increasingly an important factor limiting the sustainable development of global economy, posing a huge threat to social security and human existence. Water usage in agriculture accounts for about 70% of total water consumption in the world, and rice cultivation is in turn the largest water user, which accounts for about 50% of total water usage in agriculture. Therefore, it is quite important to improve water utilization efficiency to reduce water consumption in rice.Water stress causes severe inhibition of plant growth and development as well as yield reduction, however the extent of inhibition or reduction varies greatly with the growth stages, duration and severity of stress, and plant genotypes. In rice,drought resistance and water utilization efficiency might be improved by developing stress resistant cultivars and conducting proper agronomic practices. It is hence imperative to determine the suitable criteria in morphological and physiological traits for drought resistance and water utilization efficiency in conventional breeding of rice. At present, leaf rolling, leaf water potential and carbon isotope discrimination are commonly used criteria for the evaluation and identification of germplasm with high drought resistance or water utilization efficiency. With rapid development of molecular biology,marker-assisted selection has been used in rice breeding against water stress. In this review, therefore, the agronomic aspect of water saving techniques such as selection of suitable rice cultivars, planting pattern, mulching, deficit irrigation and alternative drying and moist irrigation are discussed and effective approaches are also recommended.

  7. Analyzing the barriers affecting the effective utilization of quality tools and techniques using Integrated ISM approach

    Directory of Open Access Journals (Sweden)

    Vivek Sharma

    2017-08-01

    Full Text Available The aim of this study is to recognize and scrutinize the barriers affecting the utilization of quality tools and techniques (QT&T in manufacturing organizations. For this purpose, twelve barriers af-fecting the execution of QT&T in manufacturing organizations have been identified from literature analysis and experts’ opinion (academicians and industrial. Questionnaire-based survey has been utilized for the validation of identified barriers. Afterwards, an integrated model of QT&T has been developed by using interpretive structural Modelling (ISM and Matriced Impacts Croisés Multi-plication Appliquée á un Classement (MICMAC approach. This research gives an apparent depic-tion to identify and handle the barriers by computing the effectiveness of each barrier. Barriers like accessibility of time and space, inability to change organizational culture and inadequate coordina-tion and teamwork are found to be the key barriers for utilization of QT&T in manufacturing organ-ization. The developed model will help the manufacturing organizations effectively utilize QT&T.

  8. Abordagens cirúrgicas para os osteomas dos seios paranasais Surgical approaches to the paranasal sinuses osteoma

    Directory of Open Access Journals (Sweden)

    Fernando O. Balieiro

    2004-04-01

    Full Text Available Os osteomas são os tumores benignos mais freqüentes dos seios paranasais, apresentam crescimento lento e são em sua maioria assintomáticos. O tratamento cirúrgico destes tumores, ainda, é um tema controverso no que tange suas indicações e a escolha da abordagem cirúrgica. Existem diversas opções cirúrgicas que vão desde as abordagens externas clássicas até as transnasais assistidas por vídeo-endoscopia. Não existem indicações formais para cada uma das abordagens devendo-se sempre levar em conta o tamanho do tumor no momento da escolha da abordagem a ser empregada. OBJETIVO: Neste estudo apresentaremos seis casos de osteomas dos seios paranasais operados no Hospital Prof. Edmundo Vasconcelos, São Paulo-SP com diferentes abordagens cirúrgicas em função de peculiaridades de cada caso, discutiremos as indicações da cirurgia e também as opções cirúrgicas mostrando as vantagens e desvantagens de cada abordagem. FORMA DE ESTUDO: Estudo de série.Osteomas are the most common benign tumors arising in the paranasal sinuses, they are slow growing tumors and most part of them are assymptomatic. The surgical treatment is a controversial issue concerning their indications and surgical approach. There are several options for surgical approaches ranging from classical external surgery to intranasal endoscopic surgery. There are no formal indications for each approach and we must consider the tumor size when indicating the best approach. AIM: In this paper we will present six cases of paranasal osteomas operated at Hospital Edmundo Vasconcelos, São Paulo-SP, Brazil, with different approaches. We are also going to discuss the indications for the surgery and these approaches concerning the advantages and disadvantages of each procedure. STUDY DESIGN: Series review.

  9. [Therapeutic approach in kidney trauma. Assessments of 49 patients treated at surgical emergencies clinics].

    Science.gov (United States)

    Velenciuc, I; Luncă, S; Romedea, N; Velenciuc, Natalia; Mihalache, St

    2010-01-01

    The aim of this study is to contribute to efficiency of therapeutical interventions, using an optimal stadialisation followed by a maximum preservation of renal function. A number of 49 cases with polytrauma, included urinary lesions, were studied between January, 2002 and December, 2009. Demographical, clinical, paraclinical data were collected, as well as those regarding therapeutical measures. From a number of 1436 cases with polytrauma, 49 (3.41%) suffered from urinary tract prejudices and 36 (73.46%) with major kidney lesions--11 (30.55%) severe at admission; 5 (13.89%) patients with multiple lesions and hypovolemic shock. The conservative treatment was applied in 24 (66.64%) cases and other types of surgical interventions for the other patients. The urinary apparatus is affected in aproximately 10% of cases of abdominal trauma due to road and falls from heights accidents, especially in patients of 26-50 age groups: 30.5% with severe lesions, 13.89% with hypovolemic shock at admission, and 1 death. The treatment was conservative in 66.64% of cases and various types of surgical interventions for the others patients.

  10. [Assessment of thoracic sympathectomy by transpleural posterolateral and thoracoscopic approach in surgical treatment of Raynaud's syndrome].

    Science.gov (United States)

    Czyzewski, Damian; Dobosz, Jolanta; Wojtacha, Jacek; Kozielski, Jerzy; Lipka, Mariusz; Lazar-Czyzewska, Barbara

    2004-01-01

    Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

  11. Genital Bowenʼs Disease in a Bulgarian Patient: Complete Remission after Surgical Approach

    Directory of Open Access Journals (Sweden)

    Georgi Tchernev

    2017-07-01

    Full Text Available A 60-year-old male patient presented with complaints of persistent red to a brown-colored plaque on his scrotum, with duration of approximately three years. The patient had been treated with oral and topical antifungals for inguinal tinea for several months and after that with topical corticosteroids for eczema for several more months. None of the regimens achieved any therapeutic effect. The histopathological evaluation revealed the presence of atypical keratinocytes in all layers of the epidermis with the altered epidermal pattern, spread parabasal mitotic activity, without secondary satellites, multiple dyskeratotic cells and multinucleated cells. The diagnosis of an intraepithelial non-invasive squamous cell carcinoma, associated with koilocytic dysplasia and hyperplasia was made, meeting the criteria for Bowen disease. An elliptic surgical excision of the lesion was made, while the defect was closed with single stitches, with excellent therapeutic and aesthetic result. First described by John T. Bowen in 1912, Bowen disease (BD represents a squamous cell carcinoma (SCC in situ with the potential for significant lateral spread. Treatment options include the application of topical 5-flurorouracil cream – useful in non-hairy areas, imiquimod cream or destructive methods such as radiation, curettage, cryotherapy, laser ablation and photodynamic therapy, especially useful in nail bed involvement. Despite the early lesions, surgical excision is the preferred treatment option, regarding the potential malignant transformation risk.

  12. Case of huge neurofibroma expanding extra- and intracranially through the enlarged jugular foramen. CT scan findings and surgical approach

    Energy Technology Data Exchange (ETDEWEB)

    Hanakita, Junya; Imataka, Kiyoharu; Handa, Hajime (Kyoto Univ. (Japan). Faculty of Medicine)

    1984-01-01

    The surgical approach to the jugular foramen has been considered to be very difficult and troublesome, because of the location in which important structures, such as the internal jugular vein, internal carotid artery and lower cranial nerves, converge in the narrow deep space. A case of huge neurofibroma, which extended from the tentorium cerebelli through the dilated jugular foramen to the level of the vertebral body of C/sub 3/ was presented. A 12-year-old girl was admitted with complaints of visual disturbance and palsy of the V-XII cranial nerves of the left side. Plain skull film showed prominent widening of the cranial sutures and enlargement of the sella turcica. Horizontal CT scan with contrast showed symmetrical ventricular dilatation and a heterogeneously enhanced mass, which was situated mainly in the left CP angle. Coronal CT scan with contrast revealed a huge mass and enlarged jugular foramen, through which the tumor extended to the level of the vertebral body of C/sub 3/. Occlusion of the sigmoid sinus and the internal jugular vein of the left side was noticed in the vertebral angiography. Two-stage approach, the first one for removal of the intracranial tumor and the second one for extracranial tumor, was performed for its huge tumor. Several authors have reported excellent surgical approaches for the tumors situated in the jugular foramen. By our approach, modifying Gardner's original one, a wide operative field was obtained to remove the tumor around the jugular foramen with success. Our approach for the jugular foramen was described with illustrations.

  13. The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

    Science.gov (United States)

    Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G

    2017-02-01

    Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Surgical treatment of subungual glomus tumors: Experience with lateral subperiosteal and transungual approaches

    Directory of Open Access Journals (Sweden)

    Fatih Kabakas

    2016-08-01

    Conclusion: As a result, early recovery occurs and postoperative nail deformity is unaccepted. The main advantages of lateral subperiosteal approach are reducing postoperative nail deformity and early recovery. However, not every glomus tumor is suitable for lateral subperiosteal approach. In peripherally located tumors, the lateral subperiosteal approach provides quick recovery of the cosmetic appearance and less deformation of the nail. [Hand Microsurg 2016; 5(2.000: 70-78

  15. Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection

    Institute of Scientific and Technical Information of China (English)

    WANG Lei; ZHANG Mao-zhi; ZHANG Wei; ZHAO Shang-feng; ZHAO Ji-zong; JIA Jin-xiu

    2005-01-01

    Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.

  16. A framework-based approach to designing simulation-augmented surgical education and training programs.

    Science.gov (United States)

    Cristancho, Sayra M; Moussa, Fuad; Dubrowski, Adam

    2011-09-01

    The goal of simulation-based medical education and training is to help trainees acquire and refine the technical and cognitive skills necessary to perform clinical procedures. When designers incorporate simulation into programs, their efforts should be in line with training needs, rather than technology. Designers of simulation-augmented surgical training programs, however, face particular problems related to identifying a framework that guides the curricular design activity to fulfill the particular requirements of such training programs. These problems include the lack of (1) an objective identification of training needs, (2) a systematic design methodology to match training objectives with simulation resources, (3) structured assessments of performance, and (4) a research-centered view to evaluate and validate systematically the educational effectiveness of the program. In this report, we present a process called "Aim - FineTune - FollowThrough" to enable the connection of the identified problems to solutions, using frameworks from psychology, motor learning, education and experimental design.

  17. [Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach].

    Science.gov (United States)

    Aranda-Narváez, José Manuel; Prieto-Puga Arjona, Tatiana; García-Albiach, Beatriz; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Sánchez-Pérez, Belinda; Titos-García, Alberto; Santoyo-Santoyo, Julio

    2014-02-01

    To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  18. Analysis of two different surgical approaches for fractures of the mandibular condyle

    Directory of Open Access Journals (Sweden)

    S Kumaran

    2012-01-01

    Results: Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean ± 18.12 minutes standard deviation (SD in the preauricular approach compared to 45.22 (mean ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

  19. Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

    Directory of Open Access Journals (Sweden)

    José Roberto Tonelli Filho

    Full Text Available ABSTRACT OBJECTIVE: To compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. METHODS: In this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound. RESULTS: There were no differences between the groups regarding other clinical variables. Mean lateral tilt of the patella was 3.1 degrees (SD ± 5.3 in the lateral approach group and 18 degrees (SD ± 10.2 in the medial approach group (p = 0.02. There were no differences regarding the secondary outcomes. CONCLUSION: Lateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.

  20. Arthrodesis of the subtalar and talonavicular joints through a medial surgical approach: a series of 15 cases.

    Science.gov (United States)

    Philippot, Rémi; Wegrzyn, Julien; Besse, Jean Luc

    2010-05-01

    We report a series of 15 double-hindfoot (subtalar and talonavicular joint) arthrodeses through a single medial approach on 14 patients. Mean age at surgery was 59.3 years. The chosen surgical technique was always identical using a medial approach and performed by a single surgeon. The average follow-up was 20.6 months. The mean Kitaoka score increased from 44 to 75, axis of the hindfoot decreased from 21 degrees to 11 degrees in valgus, arch foot angle decreased from 142 degrees to 134.4 degrees . Two failures have led to a secondary complementary arthrodesis of the talocrural joint. Throughout our study, subtalar and talonavicular arthrodesis in the treatment of painful valgus deformities of the hindfoot reveals to be a valuable and safe alternative. The chosen fixation method combined with a good articular surface avivement through medial approach guarantee a long-term fusion. Moreover, resort to a medial approach significantly reduces wound complications. This medial approach procedure permits the fusion without developing non-union and provides a significant correction of the fixed deformities.

  1. BEOS-A new approach to promote and organize industrial ISS utilization

    Science.gov (United States)

    Luttmann, Helmut; Buchholz, Henning; Bratke, Burkhard; Hueser, Detlev; Dittus, Hansjörg

    2000-01-01

    In order to develop and to market innovative services and products for the operation of the ISS and its utilization, three players have teamed up together and established an entity called BEOS (Bremen Engineering Operations Science). The team is made up of DaimlerChrysler Aerospace, OHB-System and ZARM, the Center of Applied Space Technology and Microgravity at the University of Bremen. It is the aim of BEOS to represent a competent industrial interface to potential ISS users from the space and non-space industries. In this effort BEOS is supporting and supplementing the activities of the space agencies, especially in the field of industrial and/or commercial ISS utilization. With this approach BEOS is creating new business opportunities not only for its team members but also for its customers from industry. Besides the fostering of industrial research in space, nontechnical fields of space utilization like entertainment, advertisement, education and space travel represent further key sectors for the marketing efforts of BEOS. .

  2. THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

    Directory of Open Access Journals (Sweden)

    MURILO TAVARES DAHER

    Full Text Available ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte. Methods: We evaluated thirteen patients (14 hernias treated by the posterior approach. Eight (61.5% patients were male and the mean age was 53 years (34-81. Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months. Of the 14 operated hernias, six (43% were lateral, 2 (14% paramedian, and 6 (43% central. Seven were soft (50% and seven were calcified. The transfacet approach was carried out in 5 cases (36%, transpedicular in 1 case (7%, transpedicular + partial body resection in 4 (29%, costotransversectomy in 3 (21%, and costotransversectomy + CAGE in one case (7%. The majority of patients with lateral hernia (5/6 were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

  3. 2013~2014年清洁手术抗菌药物使用率与切口感染率相关性分析%Correlation analysis of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision from 2013 to 2014

    Institute of Scientific and Technical Information of China (English)

    曹栋; 孙福生; 范春

    2015-01-01

    ObjectiveTo study the correlation between the utilization rate of antibacterials and surgical site infection rates in clean surgical incision.Methods All the clean surgical incisions in our hospital from January in 2013 to December in 2014 were enrolled in this study. The utilization rate of antibacterials and surgical site infection rates were retrospectively investigated according to each month. On the condition that the utilization rate of antibacterials and surgical site infection rates were independent variable and dependent variable alternately, with Pearson Correlation Analysis and scatter diagram, we studied the relationship of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision. Results Before logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.196,P=0.36>0.05.After logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.069, P=0.75>0.05. The results showed that there was no correlation between the utilization rate of antibacterials and surgical site infection rates, wether logarithmic transformation or not. The scatter diagram of the utilization rate of antibacterials and surgical site infection rates also demonstrated the same results. Conclusion To decrease the utilization rate of antibacterials in clean surgical incision not lead to increase of surgical site infection rates.%目的:探讨清洁手术抗菌药物使用率与切口感染率之间的相关性。方法对本院2013年1月至2014年12月清洁手术进行回顾性调查,按月份分别统计抗菌药物使用率和切口感染率。以抗菌药物使用率与切口感染率互为自变量与因变量,进行Pearson相关性分析和散点图评价。结果抗菌药物使用率与切口感染率对数转换前Pearson相关性分析,相关系数r=0.196, P

  4. FY1995 development of a endoscopic surgical system utilizing multi-modal functional images; 1995 nendo tashu kino gazo wo mochiiru teishinshu naishikyo shujutsu system no kaihatsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-05-01

    The purpose of this study is to develop an endoscope system for neurosurgery that can provide not only conventional endoscopic images but also ultraviolet-visible spectra, fluorescence spectra, near infrared spectra, and ultra-soundimages of tissue aiming for real-time identification of pathological tissue. The system also incorporates surgical manipulator and devices such as micro forceps and laser surgical instruments for endoscopic image guided surgery. Surgical Manipulator should be a high performance and easy to operate surgical instrument as well as conventional surgical tools such as scissors and knife. Since living tissue deforms during surgical operation, pre-operative three dimensional information for registration of pathological tissue should be modified based on information obtained during surgery. Thus surgical manipulator should be operated under guidance of surgeon's observation. Consequently, surgical manipulator should have various types of imaging and measurement devices such as an endoscope and an ultrasound imaging probe at its end effectors. Based on this concept, a prototype of a new multi channel surgical manipulator system CM cube (CM3, Computer aided Micro Multichannel Manipulator) that has various types of imaging and measurement devices such as ultra-violet-visible camera for spectroscopic measurement, ultra-sound imaging probe, three dimensional endoscope, together with micro surgical instruments and laser surgical systems has been developed. Its performance was evaluated through in vitro/in vivo experiments and clinical application. (NEDO)

  5. Assessing cost-utility of predictive biomarkers in oncology: a streamlined approach.

    Science.gov (United States)

    Safonov, Anton; Wang, Shiyi; Gross, Cary P; Agarwal, Divyansh; Bianchini, Giampaolo; Pusztai, Lajos; Hatzis, Christos

    2016-01-01

    Evaluation of cost-utility is critical in assessing the medical utility of predictive or prognostic biomarkers. Current methods involve complex state-transition models, requiring comprehensive data inputs. We propose a simplified decision-analytic tool to explore the relative effect of factors contributing to the cost-utility of a biomarker. We derived a cost-utility metric, the "test incremental cost-effectiveness ratio" (TICER) for biomarker-guided treatment compared to no biomarker use. This method uses data inputs readily accessible through clinical literature. We compared our results with traditional cost-effectiveness analysis of predictive biomarkers for established (HER2-guided trastuzumab, ALK-guided crizotinib, OncotypeDX-guided adjuvant chemotherapy) and emerging (ROS1-guided crizotinib) targeted treatments. We conducted sensitivity analysis to determine which factors had the greatest impact on TICER estimates. Base case TICER for HER2 was $149,600/quality-adjusted life year (QALY), for ALK was $22,200/QALY, and for OncotypeDX was $11,600/QALY, consistent with literature-reported estimates ($180,000/QALY, $202,800/QALY, $8900/QALY, respectively). Base case TICER for ROS1-guided crizotinib was $205,900/QALY. Generally, when treatment cost is considerably greater than biomarker testing costs, TICER is driven by clinical outcomes and health-related quality of life, while biomarker prevalence and treatment cost have a lesser effect. Our simplified decision-analytic approach produces values consistent with existing cost-effectiveness analyses. Our results suggest that biomarker value is mostly driven by the clinical efficacy of the targeted agent. A user-friendly web tool for complete TICER analysis has been made available for open use at http://medicine.yale.edu/lab/pusztai/ticer/ .

  6. Demonstrating a small utility approach to demand-side program implementation

    Energy Technology Data Exchange (ETDEWEB)

    1991-10-01

    The US DOE awarded a grant to the Burlington Electric Department (B.E.D.) to test a demand-side management (DSM) demonstration program designed to quickly save a significant amount of power with little disruption to the utility's customers or its normal operations. B.E.D. is a small municipal utility located in northern Vermont, with a lengthy history of successful DSM involvement. In our grant application, we proposed to develop a replicable program and approach to DSM that might be useful to other small utilities and to write a report to enable such replication. We believe that this DSM program and/or individual program components are replicable. This report is designed to allow other utilities interested in DSM to replicate this program or specific program design features to meet their DSM goals. We also wanted to use the opportunity of this grant to test the waters of residential heating fuel-switching. We hoped to test the application of one fuel-switching technology, and to benefit from the lessons learned in developing a full-scale DSM program for this end- use. To this end the pilot effort has been very successful. In the pilot pressure we installed direct-vent gas fired space heaters sized as supplemental heating units in 44 residences heated solely by electric resistance heat. We installed the gas space heating units at no cost to the owners or residents. We surveyed participating customers. The results of those surveys are included in this report and preliminary estimates of winter peak capacity load reductions are also noted in this report.

  7. Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach

    Directory of Open Access Journals (Sweden)

    Augestad KM

    2014-09-01

    Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

  8. Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study.

    Science.gov (United States)

    Wu, Ming-Ping; Long, Cheng-Yu; Huang, Kuan-Hui; Chu, Chin-Chen; Liang, Ching-Chung; Tang, Chao-Hsiun

    2012-07-01

    The interest of uterus-preserving surgery has been growing. Based on a nationwide database, we examined surgical procedures for uterine prolapse in Taiwan during the study period of 1997-2007, a total of 11 years. The operations, either uterine suspension or hysterectomy, due to the diagnosis of uterine prolapse were indentified into the study. Data on several parameters were collected for analysis, i.e., the surgical type, patient factors (age and concomitant anti-incontinence surgery), surgeon factors (age and gender), and hospital factors (accreditation level and ownership). Data of this study were obtained from the inpatient expenditures by admission files of the National Health Insurance Research Database (NHIRD). The NHIRD was established by the National Health Research Institute with the aim of promoting research into current and emerging medical issues in Taiwan. In total, 31,038 operations were identified for this study. There was a trend for increased use of uterine suspension with uterine preservation during the latter years, evidenced by joinpoint regression analyses. More women who were younger (uterine suspension. Younger surgeons (uterine suspensions. As for hospital accreditation, more uterine suspension surgeries were performed in regional hospitals, followed by local hospitals and medical centers. As for hospital ownership, more uterine suspension surgeries were performed in private hospitals, followed by not-for-profit and government-owned hospitals. There has been a considerable change in the surgical approach for uterine prolapse in Taiwan over the past 11 years. Patient age and concomitant anti-incontinence surgery, surgeon age and gender, and hospital accreditation and ownership may correlate with the choice of surgery for women with uterine prolapse.

  9. Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach

    OpenAIRE

    2013-01-01

    Introduction The standard treatment of colo-vesical fistula is the exeresis of fistula, suture of bladder wall, colic resection with or without temporary colostomy. Usually the approach is open because conversion rates and morbidity are lower than laparoscopy. The aim of video is to show the steps of a new mini-invasive approach of colo-vesical fistula without colic resection. Materials and Methods A 69 years old male underwent laparoscopic conservative treatment of colo-vesical fistula due ...

  10. Lateral Surgical Approach to Lumbar Intervertebral Discs in an Ovine Model

    OpenAIRE

    David Oehme; Tony Goldschlager; Jeffrey Rosenfeld; Andrew Danks; Peter Ghosh; Anne Gibbon; Graham Jenkin

    2012-01-01

    The sheep is becoming increasingly used as a large animal model for preclinical spine surgery studies. Access to the ovine lumbar intervertebral discs has traditionally been via an anterior or anterolateral approach, which requires larger wound incisions and, at times, significant abdominal retraction. We present a new minimally invasive operative technique for a far-lateral approach to the ovine lumbar spine that allows for smaller incisions, excellent visualisation of intervertebral discs,...

  11. Utilization of the Building-Block Approach in Structural Mechanics Research

    Science.gov (United States)

    Rouse, Marshall; Jegley, Dawn C.; McGowan, David M.; Bush, Harold G.; Waters, W. Allen

    2005-01-01

    In the last 20 years NASA has worked in collaboration with industry to develop enabling technologies needed to make aircraft safer and more affordable, extend their lifetime, improve their reliability, better understand their behavior, and reduce their weight. To support these efforts, research programs starting with ideas and culminating in full-scale structural testing were conducted at the NASA Langley Research Center. Each program contained development efforts that (a) started with selecting the material system and manufacturing approach; (b) moved on to experimentation and analysis of small samples to characterize the system and quantify behavior in the presence of defects like damage and imperfections; (c) progressed on to examining larger structures to examine buckling behavior, combined loadings, and built-up structures; and (d) finally moved to complicated subcomponents and full-scale components. Each step along the way was supported by detailed analysis, including tool development, to prove that the behavior of these structures was well-understood and predictable. This approach for developing technology became known as the "building-block" approach. In the Advanced Composites Technology Program and the High Speed Research Program the building-block approach was used to develop a true understanding of the response of the structures involved through experimentation and analysis. The philosophy that if the structural response couldn't be accurately predicted, it wasn't really understood, was critical to the progression of these programs. To this end, analytical techniques including closed-form and finite elements were employed and experimentation used to verify assumptions at each step along the way. This paper presents a discussion of the utilization of the building-block approach described previously in structural mechanics research and development programs at NASA Langley Research Center. Specific examples that illustrate the use of this approach are

  12. Surgical approaches to complex vascular lesions: the use of virtual reality and stereoscopic analysis as a tool for resident and student education.

    Science.gov (United States)

    Agarwal, Nitin; Schmitt, Paul J; Sukul, Vishad; Prestigiacomo, Charles J

    2012-08-01

    Virtual reality training for complex tasks has been shown to be of benefit in fields involving highly technical and demanding skill sets. The use of a stereoscopic three-dimensional (3D) virtual reality environment to teach a patient-specific analysis of the microsurgical treatment modalities of a complex basilar aneurysm is presented. Three different surgical approaches were evaluated in a virtual environment and then compared to elucidate the best surgical approach. These approaches were assessed with regard to the line-of-sight, skull base anatomy and visualisation of the relevant anatomy at the level of the basilar artery and surrounding structures. Overall, the stereoscopic 3D virtual reality environment with fusion of multimodality imaging affords an excellent teaching tool for residents and medical students to learn surgical approaches to vascular lesions. Future studies will assess the educational benefits of this modality and develop a series of metrics for student assessments.

  13. A NEW APPROACH TO SOLVING GENERAL ANAESTHESIA INDIVIDUALIZATION PROBLEM DURING SURGICAL OPERATIONS WITH CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    V. M. Magilevets

    2009-01-01

    Full Text Available The computerized system to control depth of anesthesia during surgical operation was developed in our research center. The depth of anesthesia is regulated by controlled intravenous infusion of propofol. The varied propofol rate is controlled by the closed-loop propofol system (CLPS with mean arterial pressure (MAP controller. MAP is used in the CLPS as input parameter and indicator of anesthesia depth. CLPS consists PC, invasive blood pressure (BP sensor and Graseby 3400 infusion pump. The C language computer program sets the propofol infusion rate based on empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP. The propofol concentrations are calculated by Runge–Kutta’s method PK/PD model differential equations solving with Marsh’s microconstants and Kazama’s BIS effect site microconstant and age depended BP effect site microconstants every 30 s. The designed CLPS was effective and useful for anesthesia maintenance during open-heart surgery, especially for early extubation. 

  14. Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width.

    Science.gov (United States)

    Baltacıoğlu, Esra; Bağış, Bora; Korkmaz, Fatih Mehmet; Aydın, Güven; Yuva, Pınar; Korkmaz, Yavuz Tolga

    2015-06-01

    The long-term efficacy of adequate keratinized mucosa (>2 mm) in dental implants is controversial. Peri-implant plastic surgeries are currently used because they increase keratinized mucosa width (KMW), helping to regain peri-implant health and maintaining it over the long-term. We present the clinical findings using free-gingival-graft (FGG) and free-periosteal-graft (FPG) techniques in peri-implant plastic surgery for implant rehabilitation patients. We included 20 patients with implant indications of inadequate KMW (KMW FGG or FPG techniques would be used was made. FGG/FPG was performed pre-implantation (before monocortical block-bone augmentation) or postimplantation (before/during/after stage 2 surgery). KMW was ≥ 2 mm after application of FGG/FPG pre- or post-implantation. Moreover, peri-implant tissue health was regained/maintained in all cases from 6 months to 4 years. Peri-implant plastic surgery techniques can prevent hard- and soft-tissue problems after implant rehabilitation and during treatment of developing problems. However, surgical design and timing, and an interdisciplinary perspective determine the success of peri-implant plastic surgery.

  15. Affect of surgical approaches on functional results of total hip arthroplasty in early postoperative period

    Directory of Open Access Journals (Sweden)

    D. V. Andreyev

    2013-01-01

    Full Text Available Minimally invasive approaches implies a less soft tissue damage and, therefore, more rapid recovery of the patient in the early postoperative period. The present study is a comparison of minimally invasive and standard approaches using biomechanical analysis of standing and walking patients before and after total hip arthroplasty, as well as an analysis of clinical outcomes in the early postoperative period. Fifty patients undergoing primary total hip arthroplasty using a minimally invasive and conventional techniques were divided into three groups. The first group consisted of patients operated on using the MIS AL (modified minimally invasive approach Watson-Jones (n = 17, the second - MDM (minimally invasive approach to the modified Mueller (n = 16 and in the third - with the use of transgluteal conventional approach by Harding (n = 17. The estimation of biomechanical parameters in static and dynamic patients before surgery and at 8-10 days after surgery. Also assessed clinical outcome postoperative visual analogue scale (VAS and Harris scale on day 10, 6 and 12 weeks and 1 year. When comparing the three groups of patients stabilometry best results were observed in groups of minimally invasive approaches MIS AL and MDM. When comparing the three groups significantly better (a moderate increase in the duration of the step, rolling the contralateral limb and a slight increase in the duration of the step the operated limb by increasing the duration of the roll-over were identified in the minimally invasive group MIS AL and MDM. In assessing the scale of Harris in the early postoperative period, higher rates were observed in groups of minimally invasive approaches. A year after the operation functional results become similar in all groups.

  16. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2006-02-01

    Full Text Available Abstract Background While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS, little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM and neural mobilization (NM. Methods This is a prospective consecutive case series with long term follow up (FU of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM and pain intensity was measured using the Three Level Numerical Rating Scale (NRS. Patients were also asked to rate their perceived percentage improvement. Results The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long

  17. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial) : design and rationale of a randomised controlled multicenter trial [ISRCTN09186711

    NARCIS (Netherlands)

    van Brunschot, Sandra; van Grinsven, Janneke; Voermans, Rogier P.; Bakker, Olaf J.; Besselink, Marc G. H.; Boermeester, Marja A.; Bollen, Thomas L.; Bosscha, Koop; Bouwense, Stefan A.; Bruno, Marco J.; Cappendijk, Vincent C.; Consten, Esther C.; Dejong, Cornelis H.; Dijkgraaf, Marcel G. W.; van Eijck, Casper H.; Erkelens, G. Willemien; van Goor, Harry; Hadithi, Mohammed; Haveman, Jan-Willem; Hofker, Hendrik; Jansen, Jeroen J. M.; Lameris, Johan S.; van Lienden, Krijn P.; Manusama, Eric R.; Meijssen, Maarten A.; Mulder, Chris J.; Nieuwenhuis, Vincent B.; Poley, Jan-Werner; de Ridder, Rogier J.; Rosman, Camiel; Schaapherder, Alexander F.; Scheepers, Joris J.; Schoon, Erik J.; Seerden, Tom; Spanier, B. W. Marcel; Straathof, Jan Willem A.; Timmer, Robin; Venneman, Niels G.; Vleggaar, Frank P.; Witteman, Ben J.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Fockens, Paul

    2013-01-01

    Background: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if

  18. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): Design and rationale of a randomised controlled multicenter trial [ISRCTN09186711

    NARCIS (Netherlands)

    S. van Brunschot (Sandra); J. van Grinsven (Janneke); R.P. Voermans (Rogier); O.J. Bakker (Olaf ); M.G. Besselink (Marc); M.A. Boermeester (Marja); T.L. Bollen (Thomas); K. Bosscha (Koop); S.A.W. Bouwense (Stefan); M.J. Bruno (Marco); V.C. Cappendijk; E.C. Consten (Esther); C.H. Dejong (Cees); M.G.W. Dijkgraaf (Marcel); C.H.J. van Eijck (Casper); D.W. Erkelens (Dirk Willem); H. van Goor (Harry); M. Hadithi (Muhammed); J.-W. Haveman (Jan-Willem); S.H. Hofker (Sijbrand); J.J.M. Jansen (Jeroen); J.S. Laméris (Johan ); K.P. van Lienden (Krijn); E.R. Manusama (Eric); M.A.C. Meijssen (Maarten); C.J.J. Mulder (Chris); V.B. Nieuwenhuis (Vincent); J.-W. Poley (Jan-Werner); R. de Ridder (Rogier); C. Rosman (Camiel); A.F.M. Schaapherder (Alexander); J.J. Scheepers (Joris); E.J. Schoon (Erik); T. Seerden (Tom); B.W.M. Spanier (Marcel); J.W.A. Straathof; R. Timmer (Robin); N.G. Venneman (Niels); F.P. Vleggaar (Frank); B.J.M. Witteman (Ben); H.G. Gooszen (Hein); H.C. van Santvoort (Hjalmar); P. Fockens (Paul)

    2013-01-01

    textabstractBackground: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage

  19. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): Design and rationale of a randomised controlled multicenter trial [ISRCTN09186711

    NARCIS (Netherlands)

    Brunschot, S. van; Grinsven, J. van; Voermans, R.P.; Bakker, O.J.; Besselink, M.G.; Boermeester, M.A.; Bollen, T.L.; Bosscha, K.; Bouwense, S.A.W.; Bruno, M.J.; Cappendijk, V.C.; Consten, E.C.; Dejong, C.H.; Dijkgraaf, M.G.; Eijck, C.H. van; Erkelens, G.W.; Goor, H. van; Hadithi, M.; Haveman, J.W.; Hofker, S.H.; Jansen, J.J.; Lameris, J.S.; Lienden, K.P. van; Manusama, E.R.; Meijssen, M.A.; Mulder, C.J.; Nieuwenhuis, V.B.; Poley, J.W.; Ridder, R.J. de; Rosman, C.; Schaapherder, A.F.; Scheepers, J.J.; Schoon, E.J.; Seerden, T.; Spanier, B.W.; Straathof, J.W.; Timmer, R.; Venneman, N.G.; Vleggaar, F.P.; Witteman, B.J.; Gooszen, H.G.; Santvoort, H.C. van; Fockens, P.; Study, G.

    2013-01-01

    BACKGROUND: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if

  20. Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

    Directory of Open Access Journals (Sweden)

    Jose M. Cabello

    2009-04-01

    Full Text Available INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

  1. An Alternative Evaluation Approach for the Problem-Solving Training Program: A Utilization-Focused Evaluation Process.

    Science.gov (United States)

    Patton, Michael Quinn

    1984-01-01

    A utilization-focused approach in evaluating a problem-solving skills training program (see TM 510 179) would have placed more emphasis on identifying evaluation users, their information needs, and likely use of findings. Other methods options are also discussed, along with how to prepare decision makers for utilization. (Author/BW)

  2. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP approach

    Directory of Open Access Journals (Sweden)

    Pankaj Amite

    2007-01-01

    Full Text Available Background: Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/migration of hardware, displacement/nonunion of osteotomy and triceps weakness. Triceps-reflecting anconeus pedicle (TRAP approach avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach. Materials and Methods: We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. There were 28 males and 12 females and the average age was 32 ± 4.5 years. The right elbow was involved in 27 patients and the left elbow in 13 patients. The mechanism of injury was a fall in 20 patients, a motor-vehicle accident in 16 patients and direct trauma in four patients. Results: At a minimum follow-up of 12 months (average 18 ± 4 months 35 (87.5% patients had good triceps strength. The average range of motion was 118.4 ± 7 degrees (range 80 o -130 o . The average time to union was 3.2 ± 1.6 months (range two to six months. No patient had triceps rupture, implant failure, neurovascular deficit or nonunion. Two patients needed removal of the implant because of subcutaneous prominence. Conclusions: The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications.

  3. Lateral Surgical Approach to Lumbar Intervertebral Discs in an Ovine Model

    Directory of Open Access Journals (Sweden)

    David Oehme

    2012-01-01

    Full Text Available The sheep is becoming increasingly used as a large animal model for preclinical spine surgery studies. Access to the ovine lumbar intervertebral discs has traditionally been via an anterior or anterolateral approach, which requires larger wound incisions and, at times, significant abdominal retraction. We present a new minimally invasive operative technique for a far-lateral approach to the ovine lumbar spine that allows for smaller incisions, excellent visualisation of intervertebral discs, and minimal abdominal retraction and is well tolerated by animals with minimal morbidity.

  4. Lateral surgical approach to lumbar intervertebral discs in an ovine model.

    Science.gov (United States)

    Oehme, David; Goldschlager, Tony; Rosenfeld, Jeffrey; Danks, Andrew; Ghosh, Peter; Gibbon, Anne; Jenkin, Graham

    2012-01-01

    The sheep is becoming increasingly used as a large animal model for preclinical spine surgery studies. Access to the ovine lumbar intervertebral discs has traditionally been via an anterior or anterolateral approach, which requires larger wound incisions and, at times, significant abdominal retraction. We present a new minimally invasive operative technique for a far-lateral approach to the ovine lumbar spine that allows for smaller incisions, excellent visualisation of intervertebral discs, and minimal abdominal retraction and is well tolerated by animals with minimal morbidity.

  5. Improving imaging utilization through practice quality improvement (maintenance of certification part IV): a review of requirements and approach to implementation.

    Science.gov (United States)

    Griffith, Brent; Brown, Manuel L; Jain, Rajan

    2014-04-01

    The purposes of this article are to review the American Board of Radiology requirements for practice quality improvement and to describe our approach to improving imaging utilization while offering a guide to implementing similar projects at other institutions, emphasizing the plan-do-study-act approach. There is increased emphasis on improving quality in health care. Our institution has undertaken a multiphase practice quality improvement project addressing the appropriate utilization of screening cervical spinal CT in an emergency department.

  6. Vascular anatomy of the patella: implications for total knee arthroplasty surgical approaches.

    Science.gov (United States)

    Lazaro, Lionel E; Cross, Michael B; Lorich, Dean G

    2014-06-01

    Iatrogenic disruption of the patellar vascular supply has been identified as a possible contributing factor to the commonly reported patellofemoral complications following total knee arthroplasty (TKA). We performed an anatomic cadaveric study evaluating the extra-osseous vascular anatomy of the patella, and correlated our findings to routine TKA surgical dissection to determine how to better preserve patellar vascularity. In twenty-one cadaveric knees arterial cannulas were placed proximally and distally to the patella. A polyurethane compound was then injected producing a visible arterial network. Specimens underwent gross dissection. In all 21 specimens, the supreme genicular (SGA), medial/lateral superior genicular (MSGA/LSGA), medial/lateral inferior genicular and anterior tibial recurrent arteries communicate forming a peripatellar anastomotic ring supplying the intraosseous patellar system. Both the SGA (24%) and MSGA (76%) demonstrated dual medial ring contribution. Relating the arterial location to common TKA exposures suggested severe compromise of patellar vascularity. The medial sided vessels seem to contribute more significantly to the peripatellar anastomotic ring when compared to the lateral sided vessels. Careful soft tissue management has the potential to preserve key vascular structures that could maintain the intraosseous vascular supply to the patella. Understanding the anatomic locations of major arterial systems around the knee joint can potentially help during hemostasis, and can minimize blood loss during TKA. Recognition of major arterial systems around the knee joint has the potential to minimize iatrogenic disruption of the vascular supply and the complications that can follow (patella devascularization and blood lost). Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Portal Vein Inflow From Enlarged Coronary Vein in Liver Transplantation: Surgical Approach and Technical Tips: A Case Report.

    Science.gov (United States)

    Safwan, M; Nagai, S; Abouljoud, M S

    2016-11-01

    Portal vein thrombosis is common in patients with end-stage liver disease, with an incidence as high as 26% in liver transplant candidates. It is known to be associated with a high risk of morbidity and mortality posttransplantation, and its management can be challenging. The management options range from a simple thrombendvenectomy to multivisceral transplantation in cases with diffuse portomesenteric thrombosis. We report a case of liver transplantation in which we performed a rare reconstruction of the portal vein. Briefly, the patient had diffuse portomesenteric thrombosis, calcified aneurysmosis, and a large collateral coronary vein, to which we directly anastomosed the donor portal vein in an end-to-side fashion. This report describes a unique surgical approach for similar cases of severe portal vein thrombosis in liver transplant candidates.

  8. A Modular Approach Utilizing Decision Tree in Teaching Integration Techniques in Calculus

    Directory of Open Access Journals (Sweden)

    Edrian E. Gonzales

    2015-08-01

    Full Text Available This study was conducted to test the effectiveness of modular approach using decision tree in teaching integration techniques in Calculus. It sought answer to the question: Is there a significant difference between the mean scores of two groups of students in their quizzes on (1 integration by parts and (2 integration by trigonometric transformation? Twenty-eight second year B.S. Computer Science students at City College of Calamba who were enrolled in Mathematical Analysis II for the second semester of school year 2013-2014 were purposively chosen as respondents. The study made use of the non-equivalent control group posttest-only design of quasi-experimental research. The experimental group was taught using modular approach while the comparison group was exposed to traditional instruction. The research instruments used were two twenty-item multiple-choice-type quizzes. Statistical treatment used the mean, standard deviation, Shapiro-Wilk test for normality, twotailed t-test for independent samples, and Mann-Whitney U-test. The findings led to the conclusion that both modular and traditional instructions were equally effective in facilitating the learning of integration by parts. The other result revealed that the use of modular approach utilizing decision tree in teaching integration by trigonometric transformation was more effective than the traditional method.

  9. Dual-window subscapularis-sparing approach: a new surgical technique for combined reconstruction of a glenoid bone defect or bankart lesion associated with a HAGL lesion in anterior shoulder instability.

    Science.gov (United States)

    Bhatia, Deepak N

    2012-03-01

    Combined bankart lesion and humeral avulsion of glenohumeral ligament lesion (HAGL) is a well-described pathologic complex in anterior shoulder instability; open surgical approaches with and without arthroscopic assistance have been suggested for simultaneous 1-stage repair of these lesions. Presence of a significant glenoid bone defect (inverted-pear glenoid) adds to the complexity of the problem and necessitates a bony reconstruction procedure. Open surgical approaches described for management of this combined lesion complex in anterior shoulder instability necessitate a subscapularis-cutting approach; suboptimal healing of the tenotomized subscapularis and subsequent delayed rehabilitation predisposes to late subscapularis dysfunction, and this compromises clinical outcomes. This study describes a new surgical technique that utilizes a dual-window approach through the subscapularis muscle; the dual window enables access to the glenoid and humeral lesions without the need for a subscapularis tenotomy. The approach can be used to perform a congruent-arc Latarjet procedure (for glenoid bone defects) or a Bankart repair (for capsulolabral lesions), in combination with a HAGL repair. Preliminary arthroscopy is essential to identify significant bone defects and HAGL lesions. The dual-window approach for reconstruction of the lesions involves (1) a lateral "subscapularis-sparing" window to identify and repair the HAGL lesion; (2) a medial "subscapularis muscle-splitting" window to perform either a glenoid capsulolabral reconstruction or a congruent-arc Latarjet procedure; and (3) a balanced inferior capsular shift and lateralization procedure of the glenohumeral capsule. Technical tips and guidelines to avoid complications are discussed, and a rehabilitation protocol is presented.

  10. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

    Science.gov (United States)

    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.

  11. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    Directory of Open Access Journals (Sweden)

    O'Neill Terry

    2006-04-01

    Full Text Available Abstract Background A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of "propensity" is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Methods Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Results Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Conclusion Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients.

  12. Canadian Optically-guided approach for Oral Lesions Surgical (COOLS trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Poh Catherine F

    2011-10-01

    Full Text Available Abstract Background Oral cancer is a major health problem worldwide. The 5-year survival rate ranges from 30-60%, and has remained unchanged in the past few decades. This is mainly due to late diagnosis and high recurrence of the disease. Of the patients who receive treatment, up to one third suffer from a recurrence or a second primary tumor. It is apparent that one major cause of disease recurrence is clinically unrecognized field changes which extend beyond the visible tumor boundary. We have previously developed an approach using fluorescence visualization (FV technology to improve the recognition of the field at risk surrounding a visible oral cancer that needs to be removed and preliminary results have shown a significant reduction in recurrence rates. Method/Design This paper describes the study design of a randomized, multi-centre, double blind, controlled surgical trial, the COOLS trial. Nine institutions across Canada will recruit a total of 400 patients with oral severe dysplasia or carcinoma in situ (N = 160 and invasive squamous cell carcinoma (N = 240. Patients will be stratified by participating institution and histology grade and randomized equally into FV-guided surgery (experimental arm or white light-guided surgery (control arm. The primary endpoint is a composite of recurrence at or 1 cm within the previous surgery site with 1 the same or higher grade histology compared to the initial diagnosis (i.e., the diagnosis used for randomization; or 2 further treatment due to the presence of severe dysplasia or higher degree of change at follow-up. This is the first randomized, multi-centre trial to validate the effectiveness of the FV-guided surgery. Discussion In this paper we described the strategies, novelty, and challenges of this unique trial involving a surgical approach guided by the FV technology. The success of the trial requires training, coordination, and quality assurance across multiple sites within Canada. The COOLS

  13. [Hydatid disease of the first rib treated surgically by the Roos approach].

    Science.gov (United States)

    Marghli, A; Smati, B; Abdelmalek, M; Attia, S; Djilani, H; Kilani, T

    2008-12-01

    Hydatid disease is a parasitic infection due to Echinococcus granulosus. Since involvement of the ribs and in particular the first rib is rare, diagnosis and treatment in these locations can pose special problems. The purpose of this report is to describe the case of a 27-year-old man in whom an apical left opacity was discovered by chance. Clinical examination was normal. Thoracic ultrasound demonstrated multilocular cyst in the left apical region of the thorax. Thoracic computed tomography (CT) demonstrated a hydatid cyst originating from the first rib. The patient was operated using the technique known as the Roos approach. The procedure consisted of cystectomy with resection of the first rib. The multiloculated appearance of the lesion and erosion at the first rib was consistent with hydatid cyst. The Roos approach is the technique of choice for the treatment of the first rib.

  14. Surgical technique: The intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions.

    Science.gov (United States)

    Darcy, Catharine M; Smit, Jeroen M; Audolfsson, Thorir; Acosta, Rafael

    2011-01-01

    The internal mammary vessels are one of the most frequently used recipient sites for microsurgical free-flap breast reconstruction, and an accepted technique to expose these vessels involves removal of a segment of costal cartilage of the rib. However, in some patients, cartilage removal may result in a visible medial chest-wall depression that requires corrective procedures. We, therefore, use an intercostal space approach to the internal mammary vessels, as there is minimal disturbance of the costal cartilage with this technique. We have developed and performed our technique over an 8-year period in 463 microvascular breast reconstructions, and present it here as it contains modifications not previously described that may be of interest to other surgeons. There was no serious morbidity associated with the intercostal space approach, the internal mammary vessels were reliably and safely exposed in all these cases and the flap success rate was 95.8%. Copyright © 2010. Published by Elsevier Ltd.

  15. [Surgical treatment of achalasia - endoscopic or laparoscopic? : Proposal for a tailored approach].

    Science.gov (United States)

    Rahden, B H A von; Filser, J; Al-Nasser, M; Germer, C-T

    2017-03-01

    Primary idiopathic achalasia is the most common form of the rare esophageal motility disorders. A curative therapy which restores the normal motility does not exist; however, the therapeutic principle of cardiomyotomy according to Ernst Heller leads to excellent symptom control in the majority of cases. The established standard approach is Heller myotomy through the laparoscopic route (LHM), combined with Dor anterior fundoplication for reflux prophylaxis/therapy. At least four meta-analyses of randomized controlled trials (RCTs) have demonstrated superiority of LHM over pneumatic dilation (PD); therefore, LHM should be used as first line therapy (without prior PD) in all operable patients. Peroral endoscopic myotomy (POEM) is a new alternative approach, which enables Heller myotomy to be performed though the endoscopic submucosal route. The POEM procedure has a low complication rate and also leads to good control of dysphagia but reflux rates can possibly be slightly higher (20-30%). Long-term results of POEM are still scarce and the results of the prospective randomized multicenter trial POEM vs. LHM are not yet available; however, POEM seems to be the preferred treatment option for certain indications. Within the framework of the tailored approach for achalasia management of POEM vs. LHM established in Würzburg, we recommend long-segment POEM for patients with type III achalasia (spasmodic) and other hypercontractile motility disorders and potentially type II achalasia (panesophageal compression) with chest pain as the lead symptom, whereas LHM can also be selected for type I. For sigmoid achalasia, especially with siphon-like transformation of the esophagogastric junction, simultaneous hiatal hernia and epiphrenic diverticula, LHM is still the preferred approach. The choice of the procedure for revisional surgery in case of recurrent dysphagia depends on the suspected mechanism (morphological vs. functional/neuromotor).

  16. Measuring the Capacity Utilization of Public District Hospitals in Tunisia: Using Dual Data Envelopment Analysis Approach

    Directory of Open Access Journals (Sweden)

    Chokri Arfa

    2017-01-01

    Full Text Available Background Public district hospitals (PDHs in Tunisia are not operating at full plant capacity and underutilize their operating budget. Methods Individual PDHs capacity utilization (CU is measured for 2000 and 2010 using dual data envelopment analysis (DEA approach with shadow prices input and output restrictions. The CU is estimated for 101 of 105 PDH in 2000 and 94 of 105 PDH in 2010. Results In average, unused capacity is estimated at 18% in 2010 vs. 13% in 2000. Of PDHs 26% underutilize their operating budget in 2010 vs. 21% in 2000. Conclusion Inadequate supply, health quality and the lack of operating budget should be tackled to reduce unmet user’s needs and the bypassing of the PDHs and, thus to increase their CU. Social health insurance should be turned into a direct purchaser of curative and preventive care for the PDHs.

  17. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach

    DEFF Research Database (Denmark)

    Rezaei, Hamed; Torp-Pedersen, Søren; af Klint, Erik;

    2014-01-01

    INTRODUCTION: This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. METHODS: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis...... by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints...... for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P

  18. New Approach to a Practical Quartz Crystal Microbalance Sensor Utilizing an Inkjet Printing System

    Directory of Open Access Journals (Sweden)

    Yusuke Fuchiwaki

    2014-10-01

    Full Text Available The present work demonstrates a valuable approach to developing quartz crystal microbalance (QCM sensor units inexpensively for reliable determination of analytes. This QCM sensor unit is constructed by inkjet printing equipment utilizing background noise removal techniques. Inkjet printing equipment was chosen as an alternative to an injection pump in conventional flow-mode systems to facilitate the commercial applicability of these practical devices. The results demonstrate minimization of fluctuations from external influences, determination of antigen-antibody interactions in an inkjet deposition, and quantification of C-reactive protein in the range of 50–1000 ng∙mL−1. We thus demonstrate a marketable application of an inexpensive and easily available QCM sensor system.

  19. Utilizing Soize's Approach to Identify Parameter and Model Uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Bonney, Matthew S. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Univ. of Wisconsin, Madison, WI (United States); Brake, Matthew Robert [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2014-10-01

    Quantifying uncertainty in model parameters is a challenging task for analysts. Soize has derived a method that is able to characterize both model and parameter uncertainty independently. This method is explained with the assumption that some experimental data is available, and is divided into seven steps. Monte Carlo analyses are performed to select the optimal dispersion variable to match the experimental data. Along with the nominal approach, an alternative distribution can be used along with corrections that can be utilized to expand the scope of this method. This method is one of a very few methods that can quantify uncertainty in the model form independently of the input parameters. Two examples are provided to illustrate the methodology, and example code is provided in the Appendix.

  20. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  1. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.

    Science.gov (United States)

    Matsuda, Takeru; Iwasaki, Takeshi; Mitsutsuji, Masaaki; Hirata, Kenro; Maekawa, Yoko; Tanaka, Tomoko; Shimada, Etsuji; Kakeji, Yoshihiro

    2015-04-01

    Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastrocolic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right colic vein (ARCV) as landmarks. After division of ARCV, SMV and middle colic vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the middle colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileocolic and right colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and middle colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.

  2. Evaluation of a systematic approach to pediatric back pain: the utility of magnetic resonance imaging.

    Science.gov (United States)

    Ramirez, Norman; Flynn, John M; Hill, Brian W; Serrano, Jose A; Calvo, Carlos E; Bredy, Rafael; Macchiavelli, Raul E

    2015-01-01

    Several studies have suggested that back pain in the majority of pediatric patients does not have an identifiable cause. Many children undergo extensive diagnostic workup that ultimately results in a nonconfirmative diagnosis. The purpose of this study was to (1) describe the prevalence of back pain seen in a pediatric orthopaedic clinic; (2) evaluate the efficacy of a systematic approach dependent on magnetic resonance imaging (MRI) in the diagnosis of pediatric back pain; and (3) analyze sensitivity, specificity, positive predictive value, and negative predictive value of various clinical signs and symptoms. For a 24-month period, all patients that presented with a chief complaint of back pain were prospectively enrolled in this study and evaluated in a systematic approach which utilized MRI for patients with constant pain, night pain, radicular pain, or abnormal neurological examination after an initial history, physical examination, and negative radiographic examination. The prevalence of chief complaint of back pain was 8.6% (261/3042 patients). Of the 261 patients, 34% had an identifiable pathology following the systematic approach. In 8.8% of patients, the diagnosis was established with the history, physical examination, and plain radiographs. MRI yielded a definitive diagnosis in another 25% of patients. It is noteworthy that of the 89 patients with a confirmed pathology, 26% were identified with plain radiographs and 74% with MRI. A systematic approach to diagnose pediatric back pain demonstrated that 34% of pediatric patients that present to an outpatient orthopaedic clinic complaining of back pain will have identifiable pathology. The diagnostic yield increased from 8.8% with the history, physical examination, and plain radiographs to 22% with the TCN Bone Scan to 36% with the use of the MRI. The clinician should be aware that the presences of lumbar pain or constant pain are red flags for the presence of underlying pathology. Level III.

  3. SURGICAL MANAGEMENT BY STANDING LAPAROSCOPY AND INGUINAL CELIOTOMY APPROACH OF THE CRYPTORCHID CANADIAN PONY STALLION – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Cornel Igna

    2016-11-01

    Full Text Available SURGICAL MANAGEMENT BY STANDING LAPAROSCOPY AND INGUINAL CELIOTOMY APPROACH OF THE CRYPTORCHID CANADIAN PONY STALLION – CASE REPORT   Cornel IGNA1*, Roxana DASCALU1, Daniel BUMB1, Bogdan Sicoe1, Larisa SCHUSZLER1 1 Banat’s University of Agricultural Science and Veterinary Medicine, “King Michael I of Romania” from Timisoara, Romania *Corresponding author, e-mail: ignacornel@gmail.com Keywords: cryptorchidectomy, inguinal celiotomy, laparoscopic, stallion pony Introduction: Laparoscopic surgery has become an accepted method of identification and removal of intra-abdominal testes in the horse. Wilson and Madison – 1989 describe the use of laparoscopy to diagnose an abdominal retained testes. Since then numerous laparoscopic cryptorchidectomy techniques have been described. Aims: In the encountered specialty literature there are few reports in which standing laparoscopic cryptorchidectomy could not be performed in stallions including miniature horse too. Because there are no informations regarding laparoscopic surgery in large animals in romanian literature this report describes the surgical management of a Canadian pony diagnosed with partial abdominal unilaterally cryptorchidism at which laparoscopic castration has failed and the removal of the retained testicle has been made through inguinal celiotomy. Materials and Methods: A 4-year-old unilaterally cryptorchid Canadian pony was admitted for castration. The left testis was in the scrotum, but neither the right testis nor the right epididymis could be located by external palpation of the right inguinal canal. The proposed treatment was laparoscopic cryptorchidectomy with pony standing in stock. With a long-handled forceps inserted into the abdominal cavity, the testis cord is gently grasped and moderate traction without success in bringing the testicle into the abdomen - retained testis. After the failure of laparascopic cryptorchidectomy but having an exact diagnosis - partial

  4. Biomechanics in Dentistry Evaluation of Different Surgical Approaches to Treat Atrophic Maxilla Patients

    CERN Document Server

    Ishak, Muhammad Ikman

    2013-01-01

    This book shows computational finite element simulations to analyse the strength of implant anchorage for intrasinus and extramaxillary approaches under various occlusal loading locations and directions. Three-dimensional model of the craniofacial area surrounding the region of interest, soft tissue and framework are developed using computed tomography image datasets.  The zygomatic and standard dental implants are modeled using a conventional computer-aided design software and placed at the appropriate location.  Material properties are assigned appropriately for the cortical, cancellous bones and implants with Masseter forces applied at the zygomatic arch and occlusal loadings applied on the framework surface.

  5. Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

    Science.gov (United States)

    Cheng, Xiao-Bing; Li, Yun-Peng; Lei, De-Lin; Li, Xiao-Dong; Tian, Lei

    2011-03-01

    Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

  6. Hyperbaric oxygen therapy in the surgical approach to an irradiated patient

    Directory of Open Access Journals (Sweden)

    Antônio Figueiredo Caubi

    2008-01-01

    Full Text Available Cancer is the terminology applied to a set of more than one hundred diseases that have disorderly cell growth in common. The treatmentof cancer can be performed by surgery, radiotherapy, chemotherapy, or bone marrow transplant. In the region of the head and neck,radiotherapy results in a series of complications in the patient, such as hypovascularization of the irradiated tissues, with reduced demand of oxygen and cells, and there is risk of the occurrence of osteoradionecrosis after tooth extraction, leading to the need for a differentiated approach to these patients. Of the therapeutic conduct adopted in the approach to irradiated patients, hyperbaric oxygen therapy is a well established resource, as the therapeutic principle of this modality enables the restoration of an adequate process of tissue repair. In this study, a clinical case is related, of the use of hyperbaric oxygen therapy as an adjuvant procedure, before and after multiple tooth extractions, in a patient irradiated in the head and neck region, obtaining success with cicatricial repair without complications.

  7. Testing the Utility of a Data-Driven Approach for Assessing BMI from Face Images.

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    Karin Wolffhechel

    Full Text Available Several lines of evidence suggest that facial cues of adiposity may be important for human social interaction. However, tests for quantifiable cues of body mass index (BMI in the face have examined only a small number of facial proportions and these proportions were found to have relatively low predictive power. Here we employed a data-driven approach in which statistical models were built using principal components (PCs derived from objectively defined shape and color characteristics in face images. The predictive power of these models was then compared with models based on previously studied facial proportions (perimeter-to-area ratio, width-to-height ratio, and cheek-to-jaw width. Models based on 2D shape-only PCs, color-only PCs, and 2D shape and color PCs combined each performed significantly and substantially better than models based on one or more of the previously studied facial proportions. A non-linear PC model considering both 2D shape and color PCs was the best predictor of BMI. These results highlight the utility of a "bottom-up", data-driven approach for assessing BMI from face images.

  8. Testing the Utility of a Data-Driven Approach for Assessing BMI from Face Images.

    Science.gov (United States)

    Wolffhechel, Karin; Hahn, Amanda C; Jarmer, Hanne; Fisher, Claire I; Jones, Benedict C; DeBruine, Lisa M

    2015-01-01

    Several lines of evidence suggest that facial cues of adiposity may be important for human social interaction. However, tests for quantifiable cues of body mass index (BMI) in the face have examined only a small number of facial proportions and these proportions were found to have relatively low predictive power. Here we employed a data-driven approach in which statistical models were built using principal components (PCs) derived from objectively defined shape and color characteristics in face images. The predictive power of these models was then compared with models based on previously studied facial proportions (perimeter-to-area ratio, width-to-height ratio, and cheek-to-jaw width). Models based on 2D shape-only PCs, color-only PCs, and 2D shape and color PCs combined each performed significantly and substantially better than models based on one or more of the previously studied facial proportions. A non-linear PC model considering both 2D shape and color PCs was the best predictor of BMI. These results highlight the utility of a "bottom-up", data-driven approach for assessing BMI from face images.

  9. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas.

    Science.gov (United States)

    Samii, Madjid; Alimohamadi, Maysam; Gerganov, Venelin

    2014-12-01

    Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging. To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA. A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared. Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor. The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

  10. Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach

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    Cochetti Giovanni

    2013-09-01

    Full Text Available Introduction The standard treatment of colo-vesical fistula is the exeresis of fistula, suture of bladder wall, colic resection with or without temporary colostomy. Usually the approach is open because conversion rates and morbidity are lower than laparoscopy. The aim of video is to show the steps of a new mini-invasive approach of colo-vesical fistula without colic resection. Materials and Methods A 69 years old male underwent laparoscopic conservative treatment of colo-vesical fistula due to endoscopic polipectomy in sigmoid diverticulum. 12 mm trocar for the camera was placed at the umbilicus, two 10 mm trocars were placed along bisiliac line and 5 mm port was placed along left emiclavear line; Trendelenburg position was 20°. The fistulous loop was carefully isolated, clipped with Hem-o-lock® clips and removed. Since diverticular disease appeared slight and no inflammation signs were evident, colon resection was not performed. We sutured and sinked the sigmoid wall; after curettage of the fistula site, the bladder wall was sutured. Fat tissue was placed between sigmoid and bladder wall to reduce the risk of fistula recurrence. Results Operative time, estimated blood loss, catheterization time, time to flatus and hospital stay were respectively 210 minutes, 300 mL, 10 days, 48 h and 8 days. The histological examination showed colonic inflammatory and necrotic tissue. No complications or fistula recurrence occurred at 54 months follow-up. Conclusions The laparoscopic conservative treatment of colo-vesical fistula is a safe and feasible technique, in particular when the diverticular disease is limited and the fistula is not due to diverticulitis.

  11. Anatomic study of the occipital condyle and its surgical implications in transcondylar approach

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    Sneha Guruprasad Kalthur

    2014-01-01

    Full Text Available Background: Craniovertebral surgeries require the anatomical knowledge of craniovertebral junction. The human occipital condyle (OC is unique bony structure connecting the cranium and the vertebral column. A lateral approach like transcondylar approach (TA requires understanding of the relationships between the OC, jugular tubercle, and hypoglossal canal. Hence, the aim of the present study was to analyze the morphological variations in OCs of dry adult human skull. Materials and Methods: The study was carried out on 142 OC of 71 adult human dry skulls (55 males and 16 females. Morphometric parameters such as length, width, thickness, intercondylar distances, and the distances from the OC to the foramen magnum, hypoglossal canal and jugular foramen were measured. In addition, the different locations of the hypoglossal canal orifices in relation to the OC and different shapes of the OC were also noted. Results: The average length, width and height of the OC were found to be 2.2, 1.1 and 0.9 cm. The anterior and posterior intercondylar distances were 2.1 and 3.9 cm, respectively. Maximum and minimum bicondylar distances were 4.5 and 2.6 cm, respectively. The intra-cranial orifice of the hypoglossal canal was found to be present in middle 1/3 rd in all skulls (100%, and extra-cranial orifice of the hypoglossal canal was found to be in anterior 1/3 rd (98% in relation to OC. The oval shaped OC (22.5% was the most predominant type of OC observed in these skulls. Conclusion: Occipital condyle is likely to have variations with respect to shape, length, width and its orientation. Therefore, knowledge of the variations in OC along with careful radiological analysis may help in safe TAs during skull base surgery.

  12. 'Start to finish trans-institutional transdisciplinary care': a novel approach improves colorectal surgical results in frail elderly patients.

    Science.gov (United States)

    Chia, C L K; Mantoo, S K; Tan, K Y

    2016-01-01

    The frail elderly surgical patient is at increased risk of morbidity after major surgery. A transdisciplinary Geriatric Surgery Service (GSS) has been shown to produce consistently positive results in our institution. A trans-institutional transdisciplinary Start to Finish (STF) programme was initiated incorporating seamless prehabilitation and rehabilitation to enhance the outcome further. Patients who underwent major colorectal resection in Khoo Teck Puat Hospital and were managed under the GSS from January 2007 to December 2014 were included in this prospective study. The STF programme was initiated from January 2012. The surgical outcome of patients managed under the GSS before the initiation of STF was compared with that after its implementation. There were 57 patients after the initiation of the STF programme compared with 60 patients managed before STF. There were 26.4% and 25% of frail patients in the STF group compared with the non-STF group (P = 0.874). The mean length of hospital stay was significantly shorter in the STF group (8.4 days vs 11.0 days, P = 0.029). Functional recovery in patients available for follow-up at 6 weeks showed 100% (46/46) recovery in the elective STF group who received prehabilitation and 95.7% (45/47) in the elective non-STF group who did not (P = 0.157). There were no significant differences in a Clavien-Dindo complication score of Grade 3 or more and 30-day mortality between the two groups. Through a trans-institutional transdisciplinary approach, we managed to achieve a significantly shorter hospital stay in frail patients having colorectal surgery. All elective patients who received prehabilitation achieved full functional recovery. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  13. [The constitutional approach to the choice of the surgical strategy for the treatment of chronic post-traumatic laryngeal stenoses].

    Science.gov (United States)

    Starostina, S V

    2017-01-01

    We have developed the algorithm for the choice of the surgical strategy for the treatment of chronic post-traumatic laryngeal stenosis with the purpose of enhancing the effectiveness of the management of the patients presenting with this condition. The proposed approach envisages obtaining anthropometric characteristics of the patients, determination of the type of his (her) neck and constitution, construction of the regressive models of the clinically significant laryngometric parameters based on the results of the clinical observations including the dimensions of the glottal fissure and the position of the vocal folds, calculations of the size of the autotransplant and the length of the T-shaped tube based on the results of the mathematical analysis of the anthropo- and organometric characteristics of the concrete patient, the laryngoplastic and prosthetic treatment of the newly formed laryngo-tracheal passage. The present study included 71 patients at the age from 23 to 68 years presenting with chronic paralytic (31%) and combined (69%) laryngeal stenosis. They were examined with the use of computed tomography of the larynx and the trachea, anthropometric, endoscopic, and spirometric techniques. The following methods were used to treat the patients: extralaryngeal laterofixation of the vocal fold (n=22), extralaryngeal laterofixation of the vocal fold with the stenting using a T-shaped silicone tube (n=43), dissection of the scars remaining after the previous laryngoplastic interventions with the redressement of the innominate cartilage and laryngeal stenting (n=6). The inclusion of the proposed algorithm in the program of the surgical treatment of chronic post-traumatic laryngeal stenosis taking into consideration the individual characteristics of the neck and the body constitution of the concrete patients made it possible to provide successful medical rehabilitation for 68 (95.8%) patients presenting with chronic paralytic and combined laryngeal stenosis.

  14. Outcome of Trans-Axillary Approach for Surgical Decompression of Thoracic Outlet: A Retrospective Study in a Tertiary Care Hospital

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    Mohd Riyaz Lattoo

    2014-05-01

    Full Text Available Objective: The aim of this study was to evaluate the trans-axillary surgical approach in patients with thoracic outlet syndrome. Methods: This retrospective study is comprised of data acquired from January 1998 until Oct 2008. Case histories of all the patients were reviewed from the Medical Records Department of Sher-i-Kashmir Institute. Relevant information and follow-up of the patients was carried out by examining the relevant clinical notes available by telephone interviews and personal contact whenever possible. All data was compiled and analyzed statistically. Results: There were a total of 139 patients. The female: male ratio was about 6:1. Pain was the most common presenting symptom followed by weakness and parasthesia. Nerve conduction velocity was abnormal in 111 patients. Twenty-eight patients had abnormal Doppler study of subclavian vessels. Preoperative symptoms persisted in 13 patients. Overall, 126 patients showed improvement in symptoms and no recurrence or persistence of symptoms on follow-up examination. Conclusion: Trans-axillary approach provides a good exposure and cosmesis in patients with thoracic outlet syndrome. It should be considered as the gold standard in the management of thoracic outlet syndrome.

  15. Utility of syndromic approach in management of sexually transmitted infections:public health perspective

    Institute of Scientific and Technical Information of China (English)

    Prateek Saurabh Shrivastava; Jegadeesh Ramasamy

    2014-01-01

    Sexually transmitted infections (STIs) are infections that are mainly transmitted from person-to-person through sexual contact. Untreated or inadequately treated STIs can have significant impact on the maternal and newborn health. An extensive search of all materials related to the topic was made using library sources including PubMed, Medline and World Health Organization website for a period of one month. Relevant documents, technical publication series, systematic reviews, research articles focusing on the practice of syndromic management in treatment of STIs published in the period 1995-2013 were included in the review. The identified articles were then re-grouped into different sections for better understanding. Keywords used in the search include syndromic management, sexually transmitted infections, women, reproductive age-group and pregnancy. There is an immense need for implementation of prevention and control of STIs because of the associated morbidity/mortality, association with HIV and adverse outcomes of pregnancy and burdening of the health system. Multiple socio-demographic determinants have been identified, which usually precipitates STIs. In addition, some of the barriers have been recognized which is hampering with the expected utilization of the health care services. To counter the high prevalence of reproductive tract infection/STI, especially in countries with limited resources, syndromic diagnostic approach has been adopted by countries for the standardized management of sexually transmitted disease cases. The aim of syndromic management is to identify a syndrome and treat it accordingly with combination therapy which will cover the main pathogens that cause it. Strategies have been suggested to overcome the limitations of the syndromic approach and bring the problem under control. To conclude, syndromic management is a rapid and cost-effective approach in reducing the transmission of STIs.

  16. Application of virtual reality in quantified analyses for cavernous sinus surgical approach%虚拟现实技术在海绵窦手术入路定量分析中的作用

    Institute of Scientific and Technical Information of China (English)

    汤可; 鲍圣德; 周敬安

    2011-01-01

    Objective To evaluate the utility of viaual reality system in quantitative comparison for cavernous sinus surgical approach.Method Image data of CT and MRI scan performed in five adult cadaver heads was inputted into the Destroscope virtual reality system to build 3 - D model of cavernous sinus.Surgical approaches for cavernous sinus from superolateral and inferolateral directions were simulated respectively in virtual reality system by lining landmark points selected on the calvaria and skull base to form special framework.Then,the two approaches were compared and analyzed according to the data measured for volume of anatomic structures and area of surgical entry.Results Images of anatomic structures related to cavemous sinus were displayed well in the operative space simulated successfully by the virtual reality system.The data measttring of volume for brain tissue,cranial nerves,intracavernous artery and area for operative entry was obtained and compared successfully.Conclusions Surgical approaches for cavernous sinus can be simulated in the virtual reality system with high fidelity.Data of correlative volume and area measuring is helpful for comparison between different surgical approaches.%目的 探讨虚拟现实系统在海绵窦手术量化比较中的应用价值.方法 5例尸头行CT 和MRI扫描,影像数据输入Dextroscope虚拟现实系统构建海绵窦三维解剖模型.选取颅盖和颅底骨性标识点连线形成空间框架,模拟经外上、外下两个方向入路,测量解剖结构体积和手术窗口面积,进行比较分析.结果 在海绵窦三维解剖模型中成功模拟手术入路,操作空间中可清楚显示解剖结构,成功测量脑组织、脑神经、颈内动脉等体积和手术窗口面积数据并进行比较.结论 虚拟现实解剖模型模拟海绵窦手术入路清晰逼真,相关体积和面积数据测量有助于不同手术入路的比较研究.

  17. Oncologic and functional results after transhyoid surgical approach for cancer of the base of tongue.

    Science.gov (United States)

    Rodrigo, Juan P; Díaz-Molina, Juan Pablo; Moreno, Carla; Suárez, Carlos

    2011-08-01

    The optimal treatment for base of tongue cancer remains unclear, especially in advanced stages. We retrospectively review 84 previously untreated patients that underwent a transhyoid resection of a base of tongue carcinoma. Sixty-four patients (76%) underwent postoperative radiotherapy. Five patients had stage II disease, 6 had stage III, 58 had stage IVA, and 15 had stage IVB. The overall recurrence rate was 68%. Five-year disease-specific survival rates by stage were 100%, 67%, 27%, and 8% for stage II to IVB, respectively (p = .0007). Multivariate analysis showed that the presence of lymph node metastases was an independent predictor of reduced disease-specific survival rates (p = .02). All patients maintained an intelligible voice, and oral alimentation was successfully recovered in 97.5% of them. The transhyoid approach allowed adequate resection of base of tongue cancers with low morbidity and acceptable functional results, but the oncologic outcomes in advanced stages are poor. Head Neck, 2011. Copyright © 2010 Wiley Periodicals, Inc.

  18. An integrated approach for the surgical treatment of patients with primary hyperparathyroidism

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    D D Dolidze

    2013-09-01

    Full Text Available This paper presents the treatment results of 75 patients with primary hyperparathyroidism (PHPT caused by a solitary parathyroid adenoma (SPA. Patients in Group 1 had PHPT with concomitant diseases of the thy roid gland (TG. Group 2 consisted of patients with PHPT without thyroid disease. Group 3 included patients with PHPT and concurrent diseases of the parathyroid glands (PG and thyroid gland, which were operated on without the use of the proposed integrated approach. Patients in groups 1 and 2 were operated on using the following techniques. Patients in group 1 underwent surgery usinga traditional incision with photodynamic visualization (PV of the PG and exposure of the recur rent and superior laryngeal nerves (LN (in some cases with the use of magnifying devices and neuromyog raphy. Patients in group 2 underwent surgery with minimally invasive access, utilizingendoscopic video devices and the universal retractor “Multifiks1”. During the intervention,PVof the PG and electrophysiolog ical monitoring (EMof the recurrent LN were carried out. In groups 1 and 2, adequacy of the operationwas determined by the change in the level of intraoperative parathyroid hormone (PTH and ionized calcium before and after the removal of the PG. Our proposed integrated method for the treatment of patients with PHPT allowed for a significant reduction in the risk of postoperative complications and consequently an improvement in quality of life.

  19. An intelligent approach to optimize the EDM process parameters using utility concept and QPSO algorithm

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    Chinmaya P. Mohanty

    2017-04-01

    Full Text Available Although significant research has gone into the field of electrical discharge machining (EDM, analysis related to the machining efficiency of the process with different electrodes has not been adequately made. Copper and brass are frequently used as electrode materials but graphite can be used as a potential electrode material due to its high melting point temperature and good electrical conductivity. In view of this, the present work attempts to compare the machinability of copper, graphite and brass electrodes while machining Inconel 718 super alloy. Taguchi’s L27 orthogonal array has been employed to collect data for the study and analyze effect of machining parameters on performance measures. The important performance measures selected for this study are material removal rate, tool wear rate, surface roughness and radial overcut. Machining parameters considered for analysis are open circuit voltage, discharge current, pulse-on-time, duty factor, flushing pressure and electrode material. From the experimental analysis, it is observed that electrode material, discharge current and pulse-on-time are the important parameters for all the performance measures. Utility concept has been implemented to transform a multiple performance characteristics into an equivalent performance characteristic. Non-linear regression analysis is carried out to develop a model relating process parameters and overall utility index. Finally, the quantum behaved particle swarm optimization (QPSO and particle swarm optimization (PSO algorithms have been used to compare the optimal level of cutting parameters. Results demonstrate the elegance of QPSO in terms of convergence and computational effort. The optimal parametric setting obtained through both the approaches is validated by conducting confirmation experiments.

  20. MOLECULAR APPROACHES FOR IN SITU IDENTIFCIATION OF NITRATE UTILIZATION BY MARINE BACTERIA AND PHYTOPLANKTON

    Energy Technology Data Exchange (ETDEWEB)

    Frischer, Marc E. [Skidaway Institute of Oceanography; Verity, Peter G.; Gilligan, Mathew R.; Bronk, Deborah A.; Zehr, Jonathan P.; Booth, Melissa G.

    2013-09-12

    Traditionally, the importance of inorganic nitrogen (N) for the nutrition and growth of marine phytoplankton has been recognized, while inorganic N utilization by bacteria has received less attention. Likewise, organic N has been thought to be important for heterotrophic organisms but not for phytoplankton. However, accumulating evidence suggests that bacteria compete with phytoplankton for nitrate (NO3-) and other N species. The consequences of this competition may have a profound effect on the flux of N, and therefore carbon (C), in ocean margins. Because it has been difficult to differentiate between N uptake by heterotrophic bacterioplankton versus autotrophic phytoplankton, the processes that control N utilization, and the consequences of these competitive interactions, have traditionally been difficult to study. Significant bacterial utilization of DIN may have a profound effect on the flux of N and C in the water column because sinks for dissolved N that do not incorporate inorganic C represent mechanisms that reduce the atmospheric CO2 drawdown via the ?biological pump? and limit the flux of POC from the euphotic zone. This project was active over the period of 1998-2007 with support from the DOE Biotechnology Investigations ? Ocean Margins Program (BI-OMP). Over this period we developed a tool kit of molecular methods (PCR, RT-PCR, Q-PCR, QRT-PCR, and TRFLP) and combined isotope mass spectrometry and flow-cytometric approaches that allow selective isolation, characterization, and study of the diversity and genetic expression (mRNA) of the structural gene responsible for the assimilation of NO3- by heterotrophic bacteria (nasA). As a result of these studies we discovered that bacteria capable of assimilating NO3- are ubiquitous in marine waters, that the nasA gene is expressed in these environments, that heterotrophic bacteria can account for a significant fraction of total DIN uptake in different ocean margin systems, that the expression of nasA is

  1. New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

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    Ehab M. Elzawawy

    2016-01-01

    Full Text Available Introduction. Submammary adipofascial flap (SMAF is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.

  2. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

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    Singh Surya Udai

    2009-05-01

    Although posterior-only approach using pedicle screw fixation had good correction rate, complications were similar to previous reports. There were few unusual complications like coccygodynia.

  3. Min-max optimization and the radial approach to the public service system design with generalized utility

    Directory of Open Access Journals (Sweden)

    Jaroslav Janáček

    2016-04-01

    Full Text Available The paper deals with the min-max public service system design, where the generalized utility is considered. In contrast to the formulations presented in the literature, the generalized utility defined for a public service system assumes that the user’s utility comes generally from more than one located service center and the individual contributions from relevant centers are weighted by reduction coefficients depending on a center order. Given that commercial IP-solvers often fail due to enormous computational times or extreme memory demands when resolving this issue, we suggested and compared several approaches based on a bisection process with the purpose of developing an effective max-min approach to the public service system design with a generalized utility.

  4. Clinical utility of machine learning approaches in schizophrenia: Improving diagnostic confidence for translational neuroimaging

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    Sarina eIwabuchi

    2013-08-01

    Full Text Available Machine-learning approaches are becoming commonplace in the neuroimaging literature as potential diagnostic and prognostic tools for the study of clinical populations. However, very few studies provide clinically informative measures to aid in decision-making and resource allocation. Head-to-head comparison of neuroimaging-based multivariate classifiers is an essential first step to promote translation of these tools to clinical practice. We systematically evaluated the classifier performance using back-to-back structural MRI in two field strengths (3-Tesla and 7-Tesla to discriminate patients with schizophrenia (n=19 from healthy controls (n=20. Grey (GM and white matter (WM images were used as inputs into a support vector machine (SVM to classify patients and control subjects. 7T classifiers outperformed the 3T classifiers with accuracy reaching as high as 77% for the 7T GM classifier compared to 66.6% for the 3T GM classifier. Furthermore, diagnostic odds ratio (a measure that is not affected by variations in sample characteristics and number needed to predict (a measure based on Bayesian certainty of a test result indicated superior performance of the 7T classifiers, whereby for each correct diagnosis made, the number of patients that need to be examined using the 7T GM classifier was one less than the number that need to be examined if a different classifier was used. Using a hypothetical example, we highlight how these findings could have significant implications for clinical decision-making. We encourage the reporting of measures proposed here in future studies utilizing machine-learning approaches. This will not only promote the search for an optimum diagnostic tool but also aid in the translation of neuroimaging to clinical use.

  5. A risk-based approach to management of leachables utilizing statistical analysis of extractables.

    Science.gov (United States)

    Stults, Cheryl L M; Mikl, Jaromir; Whelehan, Oliver; Morrical, Bradley; Duffield, William; Nagao, Lee M

    2015-04-01

    To incorporate quality by design concepts into the management of leachables, an emphasis is often put on understanding the extractable profile for the materials of construction for manufacturing disposables, container-closure, or delivery systems. Component manufacturing processes may also impact the extractable profile. An approach was developed to (1) identify critical components that may be sources of leachables, (2) enable an understanding of manufacturing process factors that affect extractable profiles, (3) determine if quantitative models can be developed that predict the effect of those key factors, and (4) evaluate the practical impact of the key factors on the product. A risk evaluation for an inhalation product identified injection molding as a key process. Designed experiments were performed to evaluate the impact of molding process parameters on the extractable profile from an ABS inhaler component. Statistical analysis of the resulting GC chromatographic profiles identified processing factors that were correlated with peak levels in the extractable profiles. The combination of statistically significant molding process parameters was different for different types of extractable compounds. ANOVA models were used to obtain optimal process settings and predict extractable levels for a selected number of compounds. The proposed paradigm may be applied to evaluate the impact of material composition and processing parameters on extractable profiles and utilized to manage product leachables early in the development process and throughout the product lifecycle.

  6. A unique in vivo approach for investigating antimicrobial materials utilizing fistulated animals

    Science.gov (United States)

    Berean, Kyle J.; Adetutu, Eric M.; Zhen Ou, Jian; Nour, Majid; Nguyen, Emily P.; Paull, David; McLeod, Jess; Ramanathan, Rajesh; Bansal, Vipul; Latham, Kay; Bishop-Hurley, Greg J.; McSweeney, Chris; Ball, Andrew S.; Kalantar-Zadeh, Kourosh

    2015-06-01

    Unique in vivo tests were conducted through the use of a fistulated ruminant, providing an ideal environment with a diverse and vibrant microbial community. Utilizing such a procedure can be especially invaluable for investigating the performance of antimicrobial materials related to human and animal related infections. In this pilot study, it is shown that the rumen of a fistulated animal provides an excellent live laboratory for assessing the properties of antimicrobial materials. We investigate microbial colonization onto model nanocomposites based on silver (Ag) nanoparticles at different concentrations into polydimethylsiloxane (PDMS). With implantable devices posing a major risk for hospital-acquired infections, the present study provides a viable solution to understand microbial colonization with the potential to reduce the incidence of infection through the introduction of Ag nanoparticles at the optimum concentrations. In vitro measurements were also conducted to show the validity of the approach. An optimal loading of 0.25 wt% Ag is found to show the greatest antimicrobial activity and observed through the in vivo tests to reduce the microbial diversity colonizing the surface.

  7. Utilization integrated Fuzzy-QFD and TOPSIS approach in supplier selection

    Directory of Open Access Journals (Sweden)

    2016-02-01

    Full Text Available Supplier selection is a typical multi-attribute problem that involves both qualitative and quantitative factors. To deal with this problem, different techniques have suggested. Being based on purely mathematical data, these techniques have significant drawbacks especially when we want to consider qualitative factors, which are very important in supplier selection and are not easy to measure. Some innovative approaches, based on artificial intelligence techniques such as Fuzzy Logic match very well with decision-making situations especially when decision makers express heterogeneous judgments. In this research, by the combination of Fuzzy logic and the House of Quality (HOQ, qualitative criteria are considered in the forward parts of car suppliers’ selection process in Sazehgostar SAIPA Company. Then, TOPSIS technique is adopted to consider quantitative metrics. Finally, by combining of Fuzzy QFD and TOPSIS techniques, these suppliers will be selected and ranked in this Company. Concern to the both qualitative and quantitative criteria, is the important point used in this research and also methodology utilized, counts innovative aspect. Limited number of experts associated with each piece and unavailability of some quantitative criteria has been limitations across of this study’s accomplishment.

  8. Argentinian pistachio oil and flour: a potential novel approach of pistachio nut utilization.

    Science.gov (United States)

    Martínez, Marcela Lilian; Fabani, María Paula; Baroni, María Verónica; Huaman, Rocío Nahime Magrini; Ighani, Marcelo; Maestri, Damián M; Wunderlin, Daniel; Tapia, Alejandro; Feresin, Gabriela Egly

    2016-05-01

    In order to searching a potential novel approach to pistachio utilization, the chemical and nutritional quality of oil and flour from natural, roasted, and salted roasted pistachios from Argentinian cultivars were evaluated. The pistachio oil has high contents of oleic and linoleic acid (53.5 - 55.3, 29 - 31.4 relative abundance, respectively), tocopherols (896 - 916 μg/g oil), carotenoids (48 - 56 μg/g oil) and chlorophylls (41 - 70 μg/g oil), being a good source for commercial edible oil production. The processing conditions did not affect significantly the fatty acid and minor composition of pistachio oil samples. The content of total phenolic (TP) and flavonoids (FL) was not significantly modified by the roasting process, whereas free radical scavenging (DPPH radical) and antioxidant power decreased in a 20% approximately. Furthermore, salted roasted pistachio flour (SRPF) showed a significant decrease in TP and FL content in comparison to others samples. The phenolic profile of pistachio flours evaluated by LC-ESI-QTOF-MS. The major compounds identified were (+)-catechin (38 - 65.6 μg/g PF d.w.), gallic acid (23 - 36 μg/g PF d.w.) and cyanidin-3-O-galactoside (21 - 23 μg/g PF d.w.). The treatments effects on the phenolics constituents of pistachio flour. Roasting caused a significant reduction of some phenolics, gallic acid and (+)- catechin, and increased others, naringenin and luteolin. Salting and roasting of pistachio increased garlic acid and naringenin content.

  9. A unique in vivo approach for investigating antimicrobial materials utilizing fistulated animals

    Science.gov (United States)

    Berean, Kyle J.; Adetutu, Eric M.; Zhen Ou, Jian; Nour, Majid; Nguyen, Emily P.; Paull, David; Mcleod, Jess; Ramanathan, Rajesh; Bansal, Vipul; Latham, Kay; Bishop-Hurley, Greg J.; McSweeney, Chris; Ball, Andrew S.; Kalantar-zadeh, Kourosh

    2015-01-01

    Unique in vivo tests were conducted through the use of a fistulated ruminant, providing an ideal environment with a diverse and vibrant microbial community. Utilizing such a procedure can be especially invaluable for investigating the performance of antimicrobial materials related to human and animal related infections. In this pilot study, it is shown that the rumen of a fistulated animal provides an excellent live laboratory for assessing the properties of antimicrobial materials. We investigate microbial colonization onto model nanocomposites based on silver (Ag) nanoparticles at different concentrations into polydimethylsiloxane (PDMS). With implantable devices posing a major risk for hospital-acquired infections, the present study provides a viable solution to understand microbial colonization with the potential to reduce the incidence of infection through the introduction of Ag nanoparticles at the optimum concentrations. In vitro measurements were also conducted to show the validity of the approach. An optimal loading of 0.25 wt% Ag is found to show the greatest antimicrobial activity and observed through the in vivo tests to reduce the microbial diversity colonizing the surface. PMID:26098413

  10. Surgical Treatment of Malar Bone Fracture by a Modified Preauricular Temporal Approach (Al-Kayat-Brameley method) : Report of 2 cases

    OpenAIRE

    1995-01-01

    Although there have been various reports on improving visibility and safety in the surgical approach to the malar bone, post-operative problems such as sensory loss over the distribution of the auriculotemporal region and undersirable cosmetic results are not uncommon. In 1979, Al-Kayat and Brameley reported on a modified preauricular approach to the malar arch and temporomandibular joint. Since 1990, we have applied this method to malar arch fractures and the result revealed that the method ...

  11. A Bayesian approach to utilizing prior data in new drug development.

    Science.gov (United States)

    Shen, Larry Z; Coffey, Todd; Deng, Wei

    2008-01-01

    In this paper we propose a Bayesian method to combine safety data collected from two separate drug development programs using the same active drug substance but for different indications, formulations, or patient populations. The objective of combining the data across the programs is to better define the level of safety risk associated with the new indication or target population. There may be adverse events (AEs) observed in the new program that represent new safety signals. Our method is to explore the AEs using data from both development programs. Our approach utilizes data collected previously to assist in analyzing safety data from the new program. It is assumed that the frequency of a certain AE follows a distribution with a parameter that characterizes the safety risk level. The parameter is assumed to follow a distribution function. In the Bayesian framework, this distribution function is called a prior distribution in the absence of data and posterior distribution when updated by real data. The key concept behind our method is to use data from the previous program to construct a posterior distribution that will in turn serve as a prior distribution for the new program. The construction of this updated prior down weights data from the previous program to emphasize the new program and thus avoids simple pooling of the data across programs. Such "soft use" of previous information minimizes the potential for undue influence of previous data on the analysis. Data from the new program are used to update the prior distribution and compute the posterior distribution for the new program. Key statistics are then calculated from the posterior distribution to quantify the risk level for the new program. We have tested the proposed approach using data from a real Phase 2 study that was conducted as part of a clinical development program for a new indication of an approved drug. The results indicate that the estimated risk level was affected both by the observed event

  12. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.

    2010-08-01

    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  13. An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

    Directory of Open Access Journals (Sweden)

    Ilaria Giovannacci

    2015-08-01

    Full Text Available Medication-Related Osteonecrosis of the Jaw (MRONJ therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT. After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.DOI: 10.14693/jdi.v22i2.486

  14. Assessing socioeconomic health care utilization inequity in Israel: impact of alternative approaches to morbidity adjustment

    Directory of Open Access Journals (Sweden)

    Balicer Ran D

    2011-08-01

    Full Text Available Background The ability to accurately detect differential resource use between persons of different socioeconomic status relies on the accuracy of health-needs adjustment measures. This study tests different approaches to morbidity adjustment in explanation of health care utilization inequity. Methods A representative sample was selected of 10 percent (~270,000 adult enrolees of Clalit Health Services, Israel's largest health care organization. The Johns-Hopkins University Adjusted Clinical Groups® were used to assess each person's overall morbidity burden based on one year's (2009 diagnostic information. The odds of above average health care resource use (primary care visits, specialty visits, diagnostic tests, or hospitalizations were tested using multivariate logistic regression models, separately adjusting for levels of health-need using data on age and gender, comorbidity (using the Charlson Comorbidity Index, or morbidity burden (using the Adjusted Clinical Groups. Model fit was assessed using tests of the Area Under the Receiver Operating Characteristics Curve and the Akaike Information Criteria. Results Low socioeconomic status was associated with higher morbidity burden (1.5-fold difference. Adjusting for health needs using age and gender or the Charlson index, persons of low socioeconomic status had greater odds of above average resource use for all types of services examined (primary care and specialist visits, diagnostic tests, or hospitalizations. In contrast, after adjustment for overall morbidity burden (using Adjusted Clinical Groups, low socioeconomic status was no longer associated with greater odds of specialty care or diagnostic tests (OR: 0.95, CI: 0.94-0.99; and OR: 0.91, CI: 0.86-0.96, for specialty visits and diagnostic respectively. Tests of model fit showed that adjustment using the comprehensive morbidity burden measure provided a better fit than age and gender or the Charlson Index. Conclusions Identification of

  15. Grid Computing: A Collaborative Approach in Distributed Environment for Achieving Parallel Performance and Better Resource Utilization

    Directory of Open Access Journals (Sweden)

    Sashi Tarun

    2011-01-01

    Full Text Available From the very beginning various measures are taken or consider for better utilization of available limited resources in the computer system for operational environment, this is came in consideration because most of the time our system get free and not able to exploit the system resource/capabilities as whole cause low performance. Parallel Computing can work efficiently, where operations are handled by multi-processors independently or efficiently, without any other processing capabilities. All processing unit’s works in a parallel fashioned and increases the system throughput without any resource allocation problem among different processing units. But this is limited and effective within a single machine. Today in this computing world, maintaining and establishing high speed computational work environment in a distributed scenario seems to be a challenging task because this environment made all operations by not depending on single resources but by interacting with otherresources in the vast network architecture. All current resource management system can only work smoothly if they apply these resources within their clusters, local organizations or disputed among many users who needs processing power, but for vast distributed environment performing various operational activities seems to be difficult because data is physically not maintained in a centralized location, it is geographically dispersed on multiple remote computers systems. Computers in the distributed environment have to depend on multiple resources for their task completion. Effective performance with high availability of resources to each computer in this speedy distributed computational environment is the major concern. To solve this problem a new approach is coined called “Grid Computing” environment. Grid uses a Middleware to coordinate disparate resources across a network, allows users to function as a virtual whole and make computing fast. In this paper I want to

  16. Surgical Assisting

    Science.gov (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  17. An informatics approach to assess pediatric pharmacotherapy: design and implementation of a hospital drug utilization system.

    Science.gov (United States)

    Zuppa, Athena; Vijayakumar, Sundararajan; Jayaraman, Bhuvana; Patel, Dimple; Narayan, Mahesh; Vijayakumar, Kalpana; Mondick, John T; Barrett, Jeffrey S

    2007-09-01

    Drug utilization in the inpatient setting can provide a mechanism to assess drug prescribing trends, efficiency, and cost-effectiveness of hospital formularies and examine subpopulations for which prescribing habits may be different. Such data can be used to correlate trends with time-dependent or seasonal changes in clinical event rates or the introduction of new pharmaceuticals. It is now possible to provide a robust, dynamic analysis of drug utilization in a large pediatric inpatient setting through the creation of a Web-based hospital drug utilization system that retrieves source data from our accounting database. The production implementation provides a dynamic and historical account of drug utilization at the authors' institution. The existing application can easily be extended to accommodate a multi-institution environment. The creation of a national or even global drug utilization network would facilitate the examination of geographical and/or socioeconomic influences in drug utilization and prescribing practices in general.

  18. [Lumbosciatica caused by spondylolisthesis. Results of the surgical treatment by facetolaminectomy and interbody arthrodesis by the posterior approach in a series of 66 cases].

    Science.gov (United States)

    Perrin, G; Goutelle, A; Fischer, G; Monib, H

    1984-01-01

    66 patients with spondylolisthesis were reviewed after surgical procedure with a follow-up period of more than a year postoperatively. The indication for the operation was disabling sciatica in all patients. 4 patients had undergone prior excision of the herniated disc. All the patients underwent a removal of the loose posterior element as suggested by the Gill procedure and intervertebral body fusion using a posterior surgical approach. The surgical procedures with only one regressive neurological complication are described. The results are considered from a clinical and anatomo-radiological point of view. In this series 86.5 percent of 66 patients became sciatica-free. 62 percent of the total series rated the end result as excellent or good. 92.4 percent of the patients demonstrated bony fusion between the two grafted vertebrae. The benefits of posterior laminectomy with interbody fusion are also attractive for spondylolisthesis with sciatica.

  19. Surgical treatment of synovial osteochondromatosis of the hip using a modified-Hardinge approach with a Z-shaped capsular incision

    Directory of Open Access Journals (Sweden)

    Yu Takeda

    2015-12-01

    Full Text Available Synovial osteochondromatosis of the hip is a rare condition, and the surgical treatment approach for this condition requires complete removal of loose bodies combined with synovectomy. While these, procedures are generally accepted as the optimal treatment method, this is still controversial topic. Recent studies have reported that open surgical procedures remain acceptable for synovial osteochondromatosis of the hip. These procedures include the dislocation of the femoral head, and complications such as femoral head necrosis and bursitis or great trochanter non-union due to trochanteric osteotomy have been reported. The present study reports a modified technique for surgical dislocation through a Z-shaped capsular incision without trochanteric flip osteotomy for the treatment of synovial osteochondromatosis of the hip.

  20. An intelligent approach to machine component health prognostics by utilizing only truncated histories

    Science.gov (United States)

    Lu, Chen; Tao, Laifa; Fan, Huanzhen

    2014-01-01

    Numerous techniques and methods have been proposed to reduce the production downtime, spare-part inventory, maintenance cost, and safety hazards of machineries and equipment. Prognostics are regarded as a significant and promising tool for achieving these benefits for machine maintenance. However, prognostic models, particularly probabilistic-based methods, require a large number of failure instances. In practice, engineering assets are rarely being permitted to run to failure. Many studies have reported valuable models and methods that engage in maximizing both truncated and failure data. However, limited studies have focused on cases where only truncated data are available, which is common in machine condition monitoring. Therefore, this study develops an intelligent machine component prognostics system by utilizing only truncated histories. First, the truncated Minimum Quantization Error (MQE) histories were obtained by Self-organizing Map network after feature extraction. The chaos-based parallel multilayer perceptron network and polynomial fitting for residual errors were adopted to generate the predicted MQEs and failure times following the truncation times. The feed-forward neural network (FFNN) was trained with inputs both from the truncated MQE histories and from the predicted MQEs. The target vectors of survival probabilities were estimated by intelligent product limit estimator using the truncation times and generated failure times. After validation, the FFNN was applied to predict the machine component health of individual units. To validate the proposed method, two cases were considered by using the degradation data generated by bearing testing rig. Results demonstrate that the proposed method is a promising intelligent prognostics approach for machine component health.

  1. Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis.

    Science.gov (United States)

    Miner, Jason; Gruber, Paul; Perry, Travis L

    2015-05-01

    Levamisole-adulterated cocaine as a cause of retiform purpura progressing to full-thickness skin necrosis was first documented in 2003 and currently comprises over 200 reported cases. Whereas, its presentation, pathophysiology, and diagnostic workup have been reasonably well-defined, only one publication has significantly detailed its surgical management. For this reason there exists a relative absence of data in comparison to its reported incidence to suggest a preferred treatment strategy. In the case mentioned, treatment emphasized delayed surgical intervention while awaiting lesion demarcation and the monitoring of autoantibodies. At our institution we offer an alternative approach and present the case of a 34 year old female who presented with 49% TBSA, levamisole-induced skin necrosis managed with early surgical excision and skin grafting. The patient presented three days following cocaine exposure with painful, purpura involving the ears, nose, buttocks, and bilateral lower extremities which quickly progressed to areas of full-thickness necrosis. Lab analysis demonstrated elevated p-ANCA and c-ANCA, as well as leukopenia, decreased C4 complement, and urinalysis positive for levamisole, corroborating the diagnosis. Contrasting the most thoroughly documented case in which the patient underwent first surgical excision on hospital day 36 and underwent 18 total excisions, our patient underwent first excision on hospital day 10 and received only one primary excision prior to definitive autografting. To our knowledge, this is the largest surface area surgically treated that did not result in surgical amputation or autoamputation of limbs or appendages, respectively. We contend that early excision and grafting provides optimal surgical management of this syndrome while avoiding the morbidity seen with delayed intervention.

  2. Empirical Approaches of the Public-Private Partnership in the Services of Public Utility

    Directory of Open Access Journals (Sweden)

    Lucica Matei

    2006-12-01

    Full Text Available The paper approaches from a theoretical and empirical perspective the public-private partnership in Romania with special reference to the services of public utility. The premises for the approach are as follows: 1. The economic-social development and the reform of the public sector in the world, with the corresponding budgetary constraints and cutting off the number of jobs in the public sector represent dimensions of the development of the change management, known on world level since the ’80s period. These issues have created the conditions and opportunities for new economic, managerial, social, political concepts and theories of law and have “invented” new models of public services to which specific models of management correspond. The theory is enriched with new dimensions switching from an immediate conception of the public sector reform and public services reform – that can be temporarily delimited in a political mandate – to a conception based on stages, with rules that are well thought, accepted and understood by all the involved actors (politicians, users-citizens, suppliers. 2. The development of the adequate institutional context for the promotion of the public-private partnership simultaneously with the stable, coherent legal context inscribes in extremely diverse backgrounds, differing from country to country and awarding a different place to the intervention of the public power, within the framework of the capacity building process. Therefore, the models promoted by the developed countries can be considered experiences, varying from a public service to another, from a city to another or from country to country, requiring contextual, cultural, economic, social adjustments. 3. The public authority through the public-private partnership seeks an improvement of the public service quality and the private operator seeks a profit proportional with the capital invested, with his competencies and risks. The diversity of the

  3. Estimating Utility

    DEFF Research Database (Denmark)

    Arndt, Channing; Simler, Kenneth R.

    2010-01-01

    an information-theoretic approach to estimating cost-of-basic-needs (CBN) poverty lines that are utility consistent. Applications to date illustrate that utility-consistent poverty measurements derived from the proposed approach and those derived from current CBN best practices often differ substantially......, with the current approach tending to systematically overestimate (underestimate) poverty in urban (rural) zones....

  4. Ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle: a case report and surgical approach.

    Science.gov (United States)

    Uscetin, Ilker; Bingol, Derya; Ozkaya, Ozay; Orman, Cagdas; Akan, Mithat

    2014-01-01

    Cubital tunnel syndrome is the second most common peripheral nerve compression syndrome. It is the most common peripheral neuropathy of the ulnar nerve. The surgical treatment of the cubital tunnel syndrome is widely described in the literature, however the variations of the standard muscular anatomy in the medial humeral epicondyle region may create technical difficulties during surgical management. The epitrochleoanconeus muscle, which is an aberrant muscle of this region, is a rare cause of cubital tunnel syndrome. A case with ulnar nerve compression at the elbow caused by an uncommon etiological factor, hypertrophic epitrochleoanconeus muscle, and its surgical management is reported.

  5. Can we delay the replacement of this component?-an asset management approach to the question [for electric utilities

    DEFF Research Database (Denmark)

    Østergaard, Jacob; Jensen, A. Norsk

    2001-01-01

    Asset management is emerging as a new approach on how to exploit an electric utility physical asset in the most profitable way. One of the major questions to answer by the asset management staff is when to do replacements? This is a difficult question, which require weighting of several parameter...

  6. Can we delay the replacement of this component?-an asset management approach to the question [for electric utilities

    DEFF Research Database (Denmark)

    Østergaard, Jacob; Jensen, A. Norsk

    2001-01-01

    Asset management is emerging as a new approach on how to exploit an electric utility physical asset in the most profitable way. One of the major questions to answer by the asset management staff is when to do replacements? This is a difficult question, which require weighting of several parameter...

  7. The utilization of an ultrasound-guided 8-gauge vacuum-assisted breast biopsy system as an innovative approach to accomplishing complete eradication of multiple bilateral breast fibroadenomas

    Directory of Open Access Journals (Sweden)

    Povoski Stephen P

    2007-10-01

    Full Text Available Abstract Background Ultrasound-guided vacuum-assisted breast biopsy technology is extremely useful for diagnostic biopsy of suspicious breast lesions and for attempted complete excision of appropriately selected presumed benign breast lesions. Case presentation A female patient presented with 16 breast lesions (eight within each breast, documented on ultrasound and all presumed to be fibroadenomas. Over a ten and one-half month period of time, 14 of these 16 breast lesions were removed under ultrasound guidance during a total of 11 separate 8-gauge Mammotome® excision procedures performed during seven separate sessions. Additionally, two of these 16 breast lesions were removed by open surgical excision. A histopathologic diagnosis of fibroadenoma and/or fibroadenomatous changes was confirmed at all lesion excision sites. Interval follow-up ultrasound imaging revealed no evidence of a residual lesion at the site of any of the 16 original breast lesions. Conclusion This report describes an innovative approach of utilizing ultrasound-guided 8-gauge vacuum-assisted breast biopsy technology for assisting in achieving complete eradication of multiple bilateral fibroadenomas in a patient who presented with 16 documented breast lesions. As such, this innovative approach is highly recommended in similar appropriately selected patients.

  8. A creative approach to the development of an agenda for knowledge utilization: outputs from the 11th international knowledge utilization colloquium (KU 11).

    Science.gov (United States)

    Wilkinson, Joyce E; Rycroft-Malone, Jo; Davies, Huw T O; McCormack, Brendan

    2012-12-01

    A group of researchers and practitioners interested in advancing knowledge utilization met as a colloquium in Belfast (KU 11) and used a "world café" approach to exploit the social capital and shared understanding built up over previous events to consider the research and practice agenda. We considered three key areas of relevance to knowledge use: (1) understanding the nature of research use, influence and impact; (2) blended and collaborative approaches to knowledge production and use; and (3) supporting sustainability and spread of evidence-informed innovations. The approach enabled the development of artifacts that reflected the three areas and these were analyzed using a creative hermeneutic approach. The themes that emerged and which are outlined in this commentary are not mutually exclusive. There was much overlap in the discussions and therefore of the themes, reflecting the complex nature of knowledge translation work. The agenda that has emerged from KU 11 also reflects the participatory and creative approach in which the meeting was structured and focused, and therefore emphasizes the processual, relational and contingent nature of some of the challenges we face. The past 20 years has seen an explosion in activity around understanding KU, and we have learned much about the difficulties. Whilst the agenda for the next decade may be becoming clearer, colloquia such as KU 11, using creative and engaging approaches, have a key role to play in dissecting, articulating and sharing that agenda. In this way, we also build an ever-expanding international community that is dedicated to working towards increasing the chances of success for better patient care. © 2012 Sigma Theta Tau International.

  9. Interactive 3D-PDF Presentations for the Simulation and Quantification of Extended Endoscopic Endonasal Surgical Approaches.

    Science.gov (United States)

    Mavar-Haramija, Marija; Prats-Galino, Alberto; Méndez, Juan A Juanes; Puigdelívoll-Sánchez, Anna; de Notaris, Matteo

    2015-10-01

    A three-dimensional (3D) model of the skull base was reconstructed from the pre- and post-dissection head CT images and embedded in a Portable Document Format (PDF) file, which can be opened by freely available software and used offline. The CT images were segmented using a specific 3D software platform for biomedical data, and the resulting 3D geometrical models of anatomical structures were used for dual purpose: to simulate the extended endoscopic endonasal transsphenoidal approaches and to perform the quantitative analysis of the procedures. The analysis consisted of bone removal quantification and the calculation of quantitative parameters (surgical freedom and exposure area) of each procedure. The results are presented in three PDF documents containing JavaScript-based functions. The 3D-PDF files include reconstructions of the nasal structures (nasal septum, vomer, middle turbinates), the bony structures of the anterior skull base and maxillofacial region and partial reconstructions of the optic nerve, the hypoglossal and vidian canals and the internal carotid arteries. Alongside the anatomical model, axial, sagittal and coronal CT images are shown. Interactive 3D presentations were created to explain the surgery and the associated quantification methods step-by-step. The resulting 3D-PDF files allow the user to interact with the model through easily available software, free of charge and in an intuitive manner. The files are available for offline use on a personal computer and no previous specialized knowledge in informatics is required. The documents can be downloaded at http://hdl.handle.net/2445/55224 .

  10. Three-dimensional endoscope-assisted surgical approach to the foramen magnum and craniovertebral junction: minimizing bone resection with the aid of the endoscope.

    Science.gov (United States)

    Anichini, Giulio; Evins, Alexander I; Boeris, Davide; Stieg, Philip E; Bernardo, Antonio

    2014-12-01

    To evaluate objectively the anatomic areas of the cranial base exposed by a three-dimensional (3D) endoscope-assisted far lateral approach. A series of far lateral approaches with only condyle resection, with only jugular tubercle resection, with both partial condyle and total jugular tubercle resection, and without occipital condyle and jugular tubercle resection were performed on 10 cadaveric heads (20 sides). To assess properly the exposure of major anatomic and neurovascular structures, the intradural anatomy of the exposed craniocervical junction was divided into 8 compartments, including 3 superior cranial compartments, 3 inferior cranial compartments, and 2 spinal compartments. The anteromedial compartments toward the midline were difficult to explore using the microscope and required the aid of the endoscope. The 3D endoscope provided general circumferential visualization of the anatomic structures, even without resection of the jugular tubercle, and afforded good visualization of the more lateral compartments. Safe and optimal surgical corridors for insertion of the endoscope were also identified. Use of a 3D endoscope allows for minimal resection of the condyle and jugular tubercle, better visualization of the surgical compartments toward the midline, and better in-depth surgical exploration of each intradural compartment. However, the 3D probe is still too large and restricts surgical maneuverability. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Surgical Treatment of a Case of Ledderhose’s Disease: A Safe Plantar Approach to Subtotal Fasciectomy

    OpenAIRE

    Souza, Bruno Gonçalves Schröder e; Gilberto Zaquine de Souza Júnior; Raíssa Mansilla Cabrera Rodrigues; Diogo Stelito Rezende Dias; Valdeci Manoel de Oliveira

    2015-01-01

    Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical t...

  12. Carbon footprint of forest and tree utilization technologies in life cycle approach

    Science.gov (United States)

    Polgár, András; Pécsinger, Judit

    2017-04-01

    In our research project a suitable method has been developed related the technological aspect of the environmental assessment of land use changes caused by climate change. We have prepared an eco-balance (environmental inventory) to the environmental effects classification in life-cycle approach in connection with the typical agricultural / forest and tree utilization technologies. The use of balances and environmental classification makes possible to compare land-use technologies and their environmental effects per common functional unit. In order to test our environmental analysis model, we carried out surveys in sample of forest stands. We set up an eco-balance of the working systems of intermediate cutting and final harvest in the stands of beech, oak, spruce, acacia, poplar and short rotation energy plantations (willow, poplar). We set up the life-cycle plan of the surveyed working systems by using the GaBi 6.0 Professional software and carried out midpoint and endpoint impact assessment. Out of the results, we applied the values of CML 2001 - Global Warming Potential (GWP 100 years) [kg CO2-Equiv.] and Eco-Indicator 99 - Human health, Climate Change [DALY]. On the basis of the values we set up a ranking of technology. By this, we received the environmental impact classification of the technologies based on carbon footprint. The working systems had the greatest impact on global warming (GWP 100 years) throughout their whole life cycle. This is explained by the amount of carbon dioxide releasing to the atmosphere resulting from the fuel of the technologies. Abiotic depletion (ADP foss) and marine aquatic ecotoxicity (MAETP) emerged also as significant impact categories. These impact categories can be explained by the share of input of fuel and lube. On the basis of the most significant environmental impact category (carbon footprint), we perform the relative life cycle contribution and ranking of each technologies. The technological life cycle stages examined

  13. A new approach of cascade utilization of the chemical energy of fuel

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; JIN Hongguang; LIN Rumou

    2006-01-01

    The indirect release of chemical energy of fuel is investigated, and a new mechanism is proposed to identify the cascade utilization of chemical energy of fuel more clearly. Based on the concept of energy level, the internal phenomenon of the indirect chemical energy release is disclosed, and the equations of energy level describing the utilization of chemical energy and thermal energy during the indirect chemical energy release process are obtained. From theoretical analysis, we find that the superiority of the indirect chemical energy release of fuel comes from the cascade utilization of the fuel's chemical energy. Moreover, the cascade utilization of chemical energy is verified by the investigation of CRGT (chemically recuperated gas turbine). As a result, the thermal exergy obtained from the chemical energy release of fuel increases by 2 % -3 %. The results obtained here may help a deeper understanding of indirect chemical energy release of fuel and provide a theoretical basis for the synthesis of innovative energy systems.

  14. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  15. Effects of Counselor Race and Counseling Approach on Asian Americans' Perceptions of Counselor Credibility and Utility

    Science.gov (United States)

    Atkinson, Donald R.; And Others

    1978-01-01

    Two studies are described in which Asian Americans rated a counselor's performance in a simulated counseling session with an Asian American student. The counselor was rated as more credible and approachable when employing a directive counseling approach than when using a nondirective counseling approach. (Author/MFD)

  16. Reducing post-surgical adhesions utilizing a drug-enhanced device: sodium carboxymethylcellulose aqueous gel/poly(p-dioxanone) and Tranilast.

    Science.gov (United States)

    Cui, Helen; Gensini, Michel; Kataria, Ram; Twaddle, Tricia; Zhang, John; Wadsworth, Scott; Petrilli, Janel; Rodgers, Kathleen; diZerega, Gere; Cooper, Kevin

    2009-02-01

    Post-surgical adhesion formation has numerous deleterious side effects in a wide variety of surgical settings. Physical barriers used together with laparoscopy were developed to reduce tissue trauma seen with open procedures. However, despite surgeons' meticulous techniques and the use of such barriers, adhesion formation remains a serious clinical problem, creating complications that cost the health care system over $1 billion annually. Our laboratories have combined a previously marketed drug, Tranilast, with a sodium carboxymethylcellulose (NaCMC) gel in a sustained release formulation using poly(p-dioxanone) (PDO) to provide a locally delivered medicated device that significantly reduces adhesions. This paper describes the preparation of the gel and the sustained release formulation, its key physical properties, and its sustained release kinetics. Pre-clinical data on inhibition of adhesion formation by the sustained release poly(p-dioxanone)/sodium carboxymethylcellulose/Tranilast drug enhanced device are also presented.

  17. Estimating health state utility values from discrete choice experiments--a QALY space model approach.

    Science.gov (United States)

    Gu, Yuanyuan; Norman, Richard; Viney, Rosalie

    2014-09-01

    Using discrete choice experiments (DCEs) to estimate health state utility values has become an important alternative to the conventional methods of Time Trade-Off and Standard Gamble. Studies using DCEs have typically used the conditional logit to estimate the underlying utility function. The conditional logit is known for several limitations. In this paper, we propose two types of models based on the mixed logit: one using preference space and the other using quality-adjusted life year (QALY) space, a concept adapted from the willingness-to-pay literature. These methods are applied to a dataset collected using the EQ-5D. The results showcase the advantages of using QALY space and demonstrate that the preferred QALY space model provides lower estimates of the utility values than the conditional logit, with the divergence increasing with worsening health states. Copyright © 2014 John Wiley & Sons, Ltd.

  18. Utilization of Brine Sludge in Nonstructural Building Components: A Sustainable Approach

    Directory of Open Access Journals (Sweden)

    Mridul Garg

    2014-01-01

    Full Text Available The characterization and influence of brine sludge on the properties of cement-fly ash-sludge binders are presented. The reaction products formed during the hydration of binder provide an interlocking framework to physically encapsulate the waste particles and are responsible for the development of strength. The utilization of brine sludge in making paver blocks and bricks and the effect of sludge concentration on the engineering properties of these products are also discussed. These results clearly exhibited that brine sludge up to 35 and 25% can safely be utilized for making paver blocks and bricks, respectively. The leachability studies confirm that the metals ions and impurities in the sludge are substantially fixed in the matrix and do not readily leach from there. The utilization of brine sludge in construction materials could serve as an alternative solution to disposal and reduce pollution.

  19. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches.

    Science.gov (United States)

    Elhage, Oussama; Challacombe, Ben; Shortland, Adam; Dasgupta, Prokar

    2015-02-01

    To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.

  20. Adaptive interaction a utility maximization approach to understanding human interaction with technology

    CERN Document Server

    Payne, Stephen J

    2013-01-01

    This lecture describes a theoretical framework for the behavioural sciences that holds high promise for theory-driven research and design in Human-Computer Interaction. The framework is designed to tackle the adaptive, ecological, and bounded nature of human behaviour. It is designed to help scientists and practitioners reason about why people choose to behave as they do and to explain which strategies people choose in response to utility, ecology, and cognitive information processing mechanisms. A key idea is that people choose strategies so as to maximise utility given constraints. The frame

  1. The Stability of the Constrained Utility Maximization Problem - A BSDE Approach

    CERN Document Server

    Mocha, Markus

    2011-01-01

    This article studies the sensitivity of the power utility maximization problem with respect to the investor's relative risk aversion, the statistical probability measure, the investment constraints and the market price of risk. We extend previous descriptions of the dual domain then exploit the link between the constrained utility maximization problem and continuous semimartingale quadratic BSDEs to reduce questions on sensitivity to results on stability for such equations. This then allows us to prove appropriate convergence of the primal and dual optimizers in the semimartingale topology.

  2. Approaches to Electric Utility Energy Efficiency for Low Income Customers in a Changing Regulatory Environment

    Energy Technology Data Exchange (ETDEWEB)

    Brockway, N.

    2001-05-21

    As the electric industry goes through a transformation to a more market-driven model, traditional grounds for utility energy efficiency have come under fire, undermining the existing mechanisms to fund and deliver such services. The challenge, then, is to understand why the electric industry should sustain investments in helping low-income Americans use electricity efficiently, how such investments should be made, and how these policies can become part of the new electric industry structure. This report analyzes the opportunities and barriers to leveraging electric utility energy efficiency assistance to low-income customers during the transition of the electric industry to greater competition.

  3. An Epidemiological Approach to Screening Gifted Students Utilizing WISC-R Subtests.

    Science.gov (United States)

    Fineman, Carol A.; Carran, Deborah H.

    1986-01-01

    Full Wechsler Intelligence Scale for Children-Revised evaluations have become a drain on school resources. A screening formula for gifted students, utilizing three WISC-R subtests, was evaluated using traditional epidemiological techniques. The screen correctly detected the majority of gifted students and could have major implications in terms of…

  4. E-Learning as a Knowledge Management Approach for Intellectual Capital Utilization

    Science.gov (United States)

    Shehabat, Issa; Mahdi, Saad A.; Khoualdi, Kamel

    2008-01-01

    This paper addresses human resources utilization at the university environment. We address the design issues of e-learning courses that can capture the teacher knowledge. The underlying objective is that e-learning is a key knowledge and major resources for many universities. Therefore, the design of e-learning should be an important part of the…

  5. A Quantitative Approach To Improve Classroom-Space Utilization. AIR 2001 Annual Forum Paper.

    Science.gov (United States)

    Abou-Sayf, Frank K.

    A study was conducted to assess classroom utilization at a university and to make recommendations to optimize the use of the space available. Seven steps were involved in the study: (1) preparing the inventory of space; (2) identifying the variables; (3) making assumptions for the study and changes to carry it out; (4) calculating mean numbers of…

  6. Utilization of pre-cleaned greige cotton in nonwovens: a sensible approach

    Science.gov (United States)

    Although cotton – a consumer-preferred, naturally sustainable fiber – has been extensively used in traditional textiles for centuries, its utilization in nonwoven fabrics has been minimal (~2% by weight). A major reason thus far for the cotton not being a preferred fiber for modern nonwovens has be...

  7. Excision and Patch Grafting of a Lateral Peyronie's Plaque—Utilizing a Longitudinal “Window” Approach

    Directory of Open Access Journals (Sweden)

    Kathy Lue, BS

    2015-06-01

    Conclusion: A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation. Lue K, Emtage JB, Martinez DR, Yang C, and Carrion R. Excision and patch grafting of a lateral Peyronie's plaque—Utilizing a longitudinal “window” approach. Sex Med 2015;3:86–89.

  8. Quantitative assessment of sensory functions after 3 surgical approaches for trigeminal neuralgia by current perception threshold measurement

    Institute of Scientific and Technical Information of China (English)

    Chen Ruoping; Ouyang Huoniu; Wang Bingyu; Ding Meixiu; Charles J. Hodge Jr.

    2008-01-01

    Objective: To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement (CPTM). Methods: In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression (MVD), peripheral nerve block with alcohol (PNB), or percutaneous radiofrequency thermocoagulation (PRFT). The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions.All 3 major cutaneous sensory fiber types, large myelinated fibers (A beta), small myelinated fibers (A delta) and unmyelinated fibers(C) were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance (single factor). Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results: PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion: Among the 3 major surgical procedures tested,only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers

  9. On Innovation: A Theoretical Approach on the Challenges of Utilities Marketing

    Directory of Open Access Journals (Sweden)

    Florina PÎNZARU

    2012-06-01

    Full Text Available One of the markets not long ago closed and completely regulated is now in the growing process of liberalization and deregulation: it is the utilities market we refer to (water, sewege, gas, electricity, waste collection. The deregulation of a market is usually followed by the appearance of competition expression conditions and, unassailably, the occurrence of specific marketing strategies. This paper investigates the specific of utilities marketing as it develops now, an bourgeoning domain, although with a rather discreet presence in this field’s theoretical analysis studies. Exploratory research on the analysis type products, promotional offers and communication of this market’s players shows an effervescent players practice, but also a continuous innovation necessary in a market where consumers are unfamiliar with bein persuaded by commercial means

  10. NEW APPROACH TO OIL PALM WOOD UTILIZATION FOR WOODWORKING PRODUCTION Part 1: Basic Properties

    Directory of Open Access Journals (Sweden)

    Jamal Balfas

    2006-03-01

    Full Text Available An explosive development in oil palm plantations in the country has produced a consequence in the generation of  plantation wastes. The  disposal of these wastes  has created  an  enormous environmental problem that some practical solution to their economic utilization has to  be sought.  A series of experiments have been accomplished to observe the possibility of converting the oil palm stem into valuable woodworking products. The  first stage of  this effort was determining basic characteristics of oil palm wood.  Results in general showed that the wood has a great characteristic variation across and along the stem, which may develop problems in its utilization. Characteristics of this wood also vary according to species variety.  Quality degradations of oil palm wood were mostly happened during drying process; hence, modifications to upgrade quality should be undertaken before or within the drying process.

  11. Utility Theory for Evaluation of Optimal Process Condition of SAW: A Multi-Response Optimization Approach

    Science.gov (United States)

    Datta, Saurav; Biswas, Ajay; Bhaumik, Swapan; Majumdar, Gautam

    2011-01-01

    Multi-objective optimization problem has been solved in order to estimate an optimal process environment consisting of optimal parametric combination to achieve desired quality indicators (related to bead geometry) of submerged arc weld of mild steel. The quality indicators selected in the study were bead height, penetration depth, bead width and percentage dilution. Taguchi method followed by utility concept has been adopted to evaluate the optimal process condition achieving multiple objective requirements of the desired quality weld.

  12. E-LEARNING AS A KNOWLEDGE MANAGEMENT APPROACH FOR INTELLECTUAL CAPITAL UTILIZATION

    Directory of Open Access Journals (Sweden)

    Issa SHEHABAT

    2008-01-01

    Full Text Available This paper addresses human resources utilization at the university environment. We address the design issues of e-learning courses that can capture the teacher knowledge. The underlying objective is that e-learning is a key knowledge and major resources for many universities. Therefore, the design of e-learning should be an important part of the university knowledge management process. Teachers' knowledge in any important topic or field should be managed in a way that the university can benefit from it in case of teacher leaving or retired. Hence, intellectual personal knowledge management will be explored through the development of e-learning systems. Some concepts from the Artificial Intelligence field can be used in developing such systems.The potential for utilizing human knowledge in the university environment will optimize the resources and can be of cost effective and quality assurance factors and provide the university with a sustainable competitive advantage.Assuring the proper knowledge management within the university environment is a more complex issue. This is due to the diverse of topics in one hand and the behavior of the student and the lecturers on the other hand. Effective implementation and success requires a lot of efforts that will guarantee the utilization of the intellectual capital within the university environment.

  13. E-LEARNING AS A KNOWLEDGE MANAGEMENT APPROACH FOR INTELLECTUAL CAPITAL UTILIZATION

    Directory of Open Access Journals (Sweden)

    Issa SHEHABAT

    2009-01-01

    Full Text Available This paper addresses human resources utilization at the university environment. We address the design issues of e-learning courses that can capture the teacher knowledge. The underlying objective is that e-learning is a key knowledge and major resources for many universities. Therefore, the design of e-learning should be an important part of the university knowledge management process. Teachers' knowledge in any important topic or field should be managed in a way that the university can benefit from it in case of teacher leaving or retired. Hence, intellectual personal knowledge management will be explored through the development of e-learning systems. Some concepts from the Artificial Intelligence field can be used in developing such systems. The potential for utilizing human knowledge in the university environment will optimize the resources and can be of cost effective and quality assurance factors and provide the university with a sustainable competitive advantage. Assuring the proper knowledge management within the university environment is a more complex issue. This is due to the diverse of topics in one hand and the behavior of the student and the lecturers on the other hand. Effective implementation and success requires a lot of efforts that will guarantee the utilization of the intellectual capital within the university environment.

  14. Site Assessment of Multiple-Sensor Approaches for Buried Utility Detection

    Directory of Open Access Journals (Sweden)

    Alexander C. D. Royal

    2011-01-01

    Full Text Available The successful operation of buried infrastructure within urban environments is fundamental to the conservation of modern living standards. Open-cut methods are predominantly used, in preference to trenchless technology, to effect a repair, replace or install a new section of the network. This is, in part, due to the inability to determine the position of all utilities below the carriageway, making open-cut methods desirable in terms of dealing with uncertainty since the buried infrastructure is progressively exposed during excavation. However, open-cut methods damage the carriageway and disrupt society's functions. This paper describes the progress of a research project that aims to develop a multi-sensor geophysical platform that can improve the probability of complete detection of the infrastructure buried beneath the carriageway. The multi-sensor platform is being developed in conjunction with a knowledge-based system that aims to provide information on how the properties of the ground might affect the sensing technologies being deployed. The fusion of data sources (sensor data and utilities record data is also being researched to maximize the probability of location. This paper describes the outcome of the initial phase of testing along with the development of the knowledge-based system and the fusing of data to produce utility maps.

  15. Net protein utilization during total parenteral nutrition of injured critically ill patients: an original approach.

    Science.gov (United States)

    Iapichino, G; Solca, M; Radrizzani, D; Zucchetti, M; Damia, G

    1981-01-01

    Traumatized critically ill patients with either a moderate or severe catabolic response were studied. Patients were randomly allocated to receive an intravenous solution which was either protein-free or contained protein and hypertonic glucose. The overall energy intake in both groups was equivalent to each patient's daily requirement. In both the moderately catabolic and severely catabolic patients the urinary nitrogen loss with the protein-free solution was negatively correlated to the energy intake/energy need ratio (p less than 0.01, moderate catabolism; p less than 0.001, severe catabolism). The ratio of energy intake/energy need was correlated with the nitrogen loss. From the resultant straight line, the obligatory nitrogen loss was determined for those patients receiving the protein containing solution (test diet). The net protein utilization was subsequently calculated using this value of the obligatory nitrogen loss. The net protein utilization was inversely correlated with the severity of trauma. It was significantly (p less than 0.005) greater in the patients with a moderate catabolic response. In the acute postinjury phase, the net protein utilization of infused amino acids was similar to that for protein fed orally to normal healthy subjects.

  16. Enhancement in xylose utilization using Kluyveromyces marxianus NIRE-K1 through evolutionary adaptation approach.

    Science.gov (United States)

    Sharma, Nilesh Kumar; Behera, Shuvashish; Arora, Richa; Kumar, Sachin

    2016-05-01

    The evolutionary adaptation was carried out on the thermotolerant yeast Kluyveromyces marxianus NIRE-K1 at 45 °C up to 60 batches to enhance its xylose utilization capability. The adapted strain showed higher specific growth rate and 3-fold xylose uptake rate and short lag phase as compared to the native strain. During aerobic growth adapted yeast showed 2.81-fold higher xylose utilization than that of native. In anaerobic batch fermentation, adapted yeast utilized about 91% of xylose in 72 h and produced 2.88 and 18.75 g l⁻¹ of ethanol and xylitol, respectively, which were 5.11 and 5.71-fold higher than that of native. Ethanol yield, xylitol yield and specific sugar consumption rate obtained by the adapted cells were found to be 1.57, 1.65 and 4.84-fold higher than that of native yeast, respectively. Aforesaid results suggested that the evolutionary adaptation will be a very effective strategy in the near future for economic lignocellulosic ethanol production.

  17. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dharmesh R Agrawal

    2013-01-01

    Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

  18. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report.

    Science.gov (United States)

    Mobbs, Ralph J; Coughlan, Marc; Thompson, Robert; Sutterlin, Chester E; Phan, Kevin

    2017-04-01

    OBJECTIVE There has been a recent renewed interest in the use and potential applications of 3D printing in the assistance of surgical planning and the development of personalized prostheses. There have been few reports on the use of 3D printing for implants designed to be used in complex spinal surgery. METHODS The authors report 2 cases in which 3D printing was used for surgical planning as a preoperative mold, and for a custom-designed titanium prosthesis: one patient with a C-1/C-2 chordoma who underwent tumor resection and vertebral reconstruction, and another patient with a custom-designed titanium anterior fusion cage for an unusual congenital spinal deformity. RESULTS In both presented cases, the custom-designed and custom-built implants were easily slotted into position, which facilitated the surgery and shortened the procedure time, avoiding further complex reconstruction such as harvesting rib or fibular grafts and fashioning these grafts intraoperatively to fit the defect. Radiological follow-up for both cases demonstrated successful fusion at 9 and 12 months, respectively. CONCLUSIONS These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalized prostheses and can ease the difficulty of complex spinal surgery. Possible future directions of research include the combination of 3D-printed implants and biologics, as well as the development of bioceramic composites and custom implants for load-bearing purposes.

  19. Surgical re-entry evaluation of regenerative efficacy of bioactive Gengigel™ and platelet-rich fibrin in the treatment of grade II furcation: A novel approach

    Directory of Open Access Journals (Sweden)

    Gurkirat Kaur Sandhu

    2015-01-01

    Full Text Available The furcation area creates situations in which routine periodontal procedures are somewhat limited, and surgical procedures are generally required. The introduction of bioactive agents, such as platelet concentrates, enamel matrix derivatives, bone morphogenic proteins, and matrix macromolecules such as hyaluronic acid has expanded the scope for better outcomes in furcation treatment. Hyaluronic acid is a naturally occurring nonsulfated high molecular weight glycosaminoglycan that forms a critical component of the extracellular matrix and contributes significantly to tissue hydrodynamics, cell migration, and proliferation. Platelet-rich fibrin (PRF is an immune and platelet concentrate containing all the constituents of a blood sample, which are favorable for healing and immunity. The purpose of the present case report was to assess through surgical re-entry, the regenerative capacity of Gengigel™ in conjunction with PRF in a patient with grade II furcation defect. It was observed that the combined approach resulted in significant furcation defect fill on re-evaluation at 6 months.

  20. Surgical correction of the "Popeye biceps" deformity: dual-window approach for combined subpectoral and deltopectoral access and proximal biceps tenodesis.

    Science.gov (United States)

    Bhatia, Deepak N; DasGupta, Bibhas

    2012-09-01

    "Popeye biceps" deformity represents the appearance of a distally retracted biceps muscle resulting from either a traumatic long biceps tendon (LBT) rupture or an iatrogenic LBT tenotomy. Cosmetic and functional problems associated with the deformity may necessitate surgical correction, and surgical exposure using multiple incisions is recommended. The technique presented here describes a novel mini-open approach using a single 1-in incision that provides access to 3 peripectoral anatomical zones. Preoperative sonographic localization of the ruptured and retracted LBT is used to guide incision placement, and facilitates intraoperative tendon retrieval via a limited incision and minimal dissection. Inferolateral retraction of the mini-incision window permits infrapectoral and subpectoral LBT mobilization and dissection. Deltopectoral access via superomedial retraction of the same skin window is used to expose the suprapectoral zone and is employed for LBT retrieval and proximal tenodesis. Technical tips for safe dissection via a mini-incision, and methods for biological LBT augmentation are discussed.

  1. A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

    Directory of Open Access Journals (Sweden)

    A. F. Ozer

    2013-01-01

    Full Text Available Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations.

  2. Assessment of management approaches in a public water utility: A case study of the Namibia water corporation (NAMWATER)

    Science.gov (United States)

    Ndokosho, Johnson; Hoko, Zvikomborero; Makurira, Hodson

    More than 90% of urban water supply and sanitation services in developing countries are provided by public organizations. However, public provision of services has been inherently inefficient. As a result a number of initiatives have emerged in recent years with a common goal to improve service delivery. In Namibia, the water sector reform resulted in the creation of a public utility called the Namibia Water Corporation (NAMWATER) which is responsible for bulk water supply countrywide. Since its inception in 1998, NAMWATER has been experiencing poor financial performance. This paper presents the findings of a case study that compared the management approaches of NAMWATER to the New Public Management (NPM) paradigm. The focus of the NPM approach is for the public water sector to mirror private sector methods of management so that public utilities can accrue the benefits of effectiveness, efficiency and flexibility often associated with private sector. The study tools used were a combination of literature review, interviews and questionnaires. It was found out that NAMWATER has a high degree of autonomy in its operations, albeit government approved tariffs and sourcing of external financing. The utility reports to government annually to account for results. The utility embraces a notion of good corporate culture and adheres to sound management practices. NAMWATER demonstrated a strong market-orientation indicated by the outsourcing of non-core functions but benchmarking was poorly done. NAMWATER’s customer-orientation is poor as evidenced by the lack of customer care facilities. NAMWATER’s senior management delegated operational authority to lower management to facilitate flexibility and eliminate bottlenecks. The lower management is in turn held accountable for performance by the senior management. There are no robust methods of ensuring sufficient accountability indicated by absence of performance contracts or service level agreements. It was concluded that

  3. Ophthalmic drug delivery utilizing two-photon absorption: a novel approach to treat posterior capsule opacification

    Science.gov (United States)

    Kim, H.-C.; Träger, J.; Zorn, M.; Haberkorn, N.; Hampp, N.

    2007-07-01

    Intraocular lens (IOL) implantation is the standard technique to treat cataract. Despite recent progress in surgical procedures, posterior capsule opacification is one of the sill remaining postoperative complications of cataract surgery. We present a novel strategy to reduce the incidence of posterior capsule opacification. A drug delivery polymer suitable for manufacturing intraocular lenses has been developed which enables repeated drug release in a non-invasive and controlled manner. The therapeutic molecules are attached through a UV light sensitive linkage to the polymer backbone which is mainly responsible for the optical properties of the intraocular lenses. However, UV light can not trigger the release of drug from the polymer due to the high absorption of the cornea. We developed linkers which enable drug release by two-photon absorption induced cleavage of the linker structure. Since the two-photon absorption requires high photon densities, this does not occur in ambient light conditions in daily life, but is easily triggered by focused laser beams from a pulsed laser. In this proof-of-principle study we have employed a cyclobutane type linker and investigated the properties of the therapeutic system with the approved drugs 5-fluorouracil and chlorambucil. The controlled drug delivery was successfully demonstrated in vitro and additional cell tests confirmed that the device itself shows no cytotoxicity until photochemical activation. This presented concept can provide a powerful method in ophthalmic drug delivery.

  4. Surgical Treatment of a Case of Ledderhose’s Disease: A Safe Plantar Approach to Subtotal Fasciectomy

    Directory of Open Access Journals (Sweden)

    Bruno Gonçalves Schröder e Souza

    2015-01-01

    Full Text Available Plantar fibromatosis, Ledderhose’s disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren’s disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

  5. A Component Approach to Collaborative Scientific Software Development: Tools and Techniques Utilized by the Quantum Chemistry Science Application Partnership

    Directory of Open Access Journals (Sweden)

    Joseph P. Kenny

    2008-01-01

    Full Text Available Cutting-edge scientific computing software is complex, increasingly involving the coupling of multiple packages to combine advanced algorithms or simulations at multiple physical scales. Component-based software engineering (CBSE has been advanced as a technique for managing this complexity, and complex component applications have been created in the quantum chemistry domain, as well as several other simulation areas, using the component model advocated by the Common Component Architecture (CCA Forum. While programming models do indeed enable sound software engineering practices, the selection of programming model is just one building block in a comprehensive approach to large-scale collaborative development which must also address interface and data standardization, and language and package interoperability. We provide an overview of the development approach utilized within the Quantum Chemistry Science Application Partnership, identifying design challenges, describing the techniques which we have adopted to address these challenges and highlighting the advantages which the CCA approach offers for collaborative development.

  6. LightForce Photon-Pressure Collision Avoidance: Updated Efficiency Analysis Utilizing a Highly Parallel Simulation Approach

    Science.gov (United States)

    Stupl, J.; Faber, N.; Foster, C.; Yang, F.; Nelson, B.; Aziz, J.; Nuttall, A.; Henze, C.; Levit, C.

    2014-09-01

    This paper provides an updated efficiency analysis of the LightForce space debris collision avoidance scheme. LightForce aims to prevent collisions on warning by utilizing photon pressure from ground based, commercial off the shelf lasers. Past research has proven that a few ground-based systems consisting of 10 kW class lasers directed by 1.5 m telescopes with adaptive optics could lower the expected number of collisions in Low Earth Orbit (LEO) by an order of magnitude. Our simulation approach utilizes the entire Two Line Element (TLE) catalogue in LEO for a given day as initial input. Least-squares fitting of a TLE time series is used for an improved orbit estimate. We then calculate the probability of collision for all LEO objects in the catalogue for a time step of the simulation. The conjunctions that exceed a threshold probability of collision are then engaged by a simulated network of laser ground stations. After those engagements, the perturbed orbits are used to re-assess the probability of collision and evaluate the efficiency. This paper describes new simulations with three updated aspects: 1) By utilizing a highly parallel simulation approach employing hundreds of processors, we have extended our analysis to a much broader dataset. The simulation time is extended to one year. 2) We analyze not only the efficiency of LightForce on conjunctions that naturally occur, but also take into account conjunctions caused by orbit perturbations due to LightForce engagements. 3) We use a new simulation approach that is regularly updating the LightForce engagement strategy, as it would be during actual operations. In this paper we present both our simulation approach to parallelize the efficiency analysis, its computational performance and the resulting expected efficiency of the LightForce collision avoidance system.

  7. Breaking down the barriers to efficiency improvements in the rental housing market: a comparison of two utility approaches

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Katherine (Johnson Consulting Group, Frederick, MD (United States)); Volker, Michael (Midwest Energy, Hays, KA (United States)); Shimoda, Wade; Willoughby, George (Hawaii Electric Company, Honolulu (United States))

    2009-07-01

    The rental market is a difficult segment to target for residential energy efficiency improvements. This is primarily due to the split-incentive in which the landlord has little interest in paying for energy efficiency improvements because the tenant pays the utility bills. However, that is changing since several utilities have implemented on-the-bill financing programs, patterned after the Pay-As-You-Save Program Model. This paper compares the approaches used by Midwest Energy and Hawaiian Electric. Midwest Energy debuted its How$mart SM Program in 2007 to provide renters and landlords a mechanism to pay for a variety of energy efficiency improvements. Hawaii Electric developed the SolarSaver Pilot Program in 2007 to encourage installations of solar water heaters. In both programs, the utility provides the upfront capital as a way to encourage the investment in these energy efficiency improvements. Other program features include: No upfront capital required by customer; Efficiency improvements are paid for through a surcharge on the utility bill; The surcharge is tied to the location, not to the individual customer; This paper compares the results from both programs based on their first-year program evaluations, and includes the following key metrics: Number of residences reached; Value of home improvements; Estimated energy savings; Strategies for targeting home improvement contractors; Lessons Learned. On-the-bill financing can be a successful program strategy to reach the underserved rental market.

  8. Experimental and Numerical Analysis of Triaxially Braided Composites Utilizing a Modified Subcell Modeling Approach

    Science.gov (United States)

    Cater, Christopher; Xiao, Xinran; Goldberg, Robert K.; Kohlman, Lee W.

    2015-01-01

    A combined experimental and analytical approach was performed for characterizing and modeling triaxially braided composites with a modified subcell modeling strategy. Tensile coupon tests were conducted on a [0deg/60deg/-60deg] braided composite at angles of 0deg, 30deg, 45deg, 60deg and 90deg relative to the axial tow of the braid. It was found that measured coupon strength varied significantly with the angle of the applied load and each coupon direction exhibited unique final failures. The subcell modeling approach implemented into the finite element software LS-DYNA was used to simulate the various tensile coupon test angles. The modeling approach was successful in predicting both the coupon strength and reported failure mode for the 0deg, 30deg and 60deg loading directions. The model over-predicted the strength in the 90deg direction; however, the experimental results show a strong influence of free edge effects on damage initiation and failure. In the absence of these local free edge effects, the subcell modeling approach showed promise as a viable and computationally efficient analysis tool for triaxially braided composite structures. Future work will focus on validation of the approach for predicting the impact response of the braided composite against flat panel impact tests.

  9. 达芬奇机器人手术系统再手术入路的选择%Selection of surgical approach for patients with reoperation using Da Vinci surgical system

    Institute of Scientific and Technical Information of China (English)

    陈军周; 周宁新; 刘全达; 张效东; 刘军桂; 陈蒈; 张涛

    2010-01-01

    Objective To summarize the clinical experience of operations with Da Vinci surgical system in 27 patients with previous abdominal surgery.Methods The clinical data of 27 patients with previous abdominal surgery who had received reoperation using Da Vinci surgical system at General Hospital of Second Artillery of PLA from January to December 2009 were retrospectively analysed.The distribution of trocars was designed according to the surgical sites and previous surgical incision sites.The operation was divided into 2 steps:firstly,intraabdominal adhesion was dissected and the robotic arms were set up;secondly,the lesions were resected.Experience in trocars placement,surgical approach and management of complications were summarized.Results Six approaches were designed according to previous incision sites.Of all patients,22 were with severe intraabdominal and hepatic hilar band adhesion,and 5 with strip adhesion.One patient who underwent intraabdominal radiotherapy and chemotherapy abandoned robotic surgery because of the failure in trocar placement and pneumoperitoneum establishment.Twenty-six patients had successfully undergone robotic surgery and the success rate was 96%(26/27).Of the 26 patients,1 was complicated with enterorrhexis intraoperatively and received repairment.No postoperative complication was observed.Conclusions Previous abdominal surgery has little influence on robotic surgery with Da Vinci system. Pneumoperitoneum establishment,insertion point of the first trocar and dissection of the intraabdominal adhesions are key points for success of operation.%目的 总结达芬奇机器人手术系统在27例有腹部手术史患者中应用的临床经验.方法 回顾性分析2009年1月至12月解放军第二炮兵总医院应用达芬奇机器人手术系统对27例有腹部手术史患者进行手术的临床资料.根据手术部位以及原手术切口的位置设计Trocar排布,整个手术过程分为两步,第1步游离腹

  10. Flight management research utilizing an oculometer. [pilot scanning behavior during simulated approach and landing

    Science.gov (United States)

    Spady, A. A., Jr.; Kurbjun, M. C.

    1978-01-01

    This paper presents an overview of the flight management work being conducted using NASA Langley's oculometer system. Tests have been conducted in a Boeing 737 simulator to investigate pilot scan behavior during approach and landing for simulated IFR, VFR, motion versus no motion, standard versus advanced displays, and as a function of various runway patterns and symbology. Results of each of these studies are discussed. For example, results indicate that for the IFR approaches a difference in pilot scan strategy was noted for the manual versus coupled (autopilot) conditions. Also, during the final part of the approach when the pilot looks out-of-the-window he fixates on his aim or impact point on the runway and holds this point until flare initiation.

  11. A non-equilibrium equation-of-motion approach to quantum transport utilizing projection operators.

    Science.gov (United States)

    Ochoa, Maicol A; Galperin, Michael; Ratner, Mark A

    2014-11-12

    We consider a projection operator approach to the non-equilibrium Green function equation-of-motion (PO-NEGF EOM) method. The technique resolves problems of arbitrariness in truncation of an infinite chain of EOMs and prevents violation of symmetry relations resulting from the truncation (equivalence of left- and right-sided EOMs is shown and symmetry with respect to interchange of Fermi or Bose operators before truncation is preserved). The approach, originally developed by Tserkovnikov (1999 Theor. Math. Phys. 118 85) for equilibrium systems, is reformulated to be applicable to time-dependent non-equilibrium situations. We derive a canonical form of EOMs, thus explicitly demonstrating a proper result for the non-equilibrium atomic limit in junction problems. A simple practical scheme applicable to quantum transport simulations is formulated. We perform numerical simulations within simple models and compare results of the approach to other techniques and (where available) also to exact results.

  12. Flight management research utilizing an oculometer. [pilot scanning behavior during simulated approach and landing

    Science.gov (United States)

    Spady, A. A., Jr.; Kurbjun, M. C.

    1978-01-01

    This paper presents an overview of the flight management work being conducted using NASA Langley's oculometer system. Tests have been conducted in a Boeing 737 simulator to investigate pilot scan behavior during approach and landing for simulated IFR, VFR, motion versus no motion, standard versus advanced displays, and as a function of various runway patterns and symbology. Results of each of these studies are discussed. For example, results indicate that for the IFR approaches a difference in pilot scan strategy was noted for the manual versus coupled (autopilot) conditions. Also, during the final part of the approach when the pilot looks out-of-the-window he fixates on his aim or impact point on the runway and holds this point until flare initiation.

  13. Recovery and Utilization of Lignin Monomers as Part of the Biorefinery Approach

    Directory of Open Access Journals (Sweden)

    Kirsten M. Davis

    2016-10-01

    Full Text Available Lignin is a substantial component of lignocellulosic biomass but is under-utilized relative to the cellulose and hemicellulose components. Historically, lignin has been burned as a source of process heat, but this heat is usually in excess of the process energy demands. Current models indicate that development of an economically competitive biorefinery system requires adding value to lignin beyond process heat. This addition of value, also known as lignin valorization, requires economically viable processes for separating the lignin from the other biomass components, depolymerizing the lignin into monomeric subunits, and then upgrading these monomers to a value-added product. The fact that lignin’s biological role is to provide biomass with structural integrity means that this heteropolymer can be difficult to depolymerize. However, there are chemical and biological routes to upgrade lignin from its native form to compounds of industrial value. Here we review the historical background and current technology of (thermo chemical depolymerization of lignin; the natural ability of microbial enzymes and pathways to utilize lignin, the current prospecting work to find novel microbial routes to lignin degradation, and some applications of these microbial enzymes and pathways; and the current chemical and biological technologies to upgrade lignin-derived monomers.

  14. Optimization in wire-cut EDM of Nimonic-80A using Taguchi's approach and utility concept

    Directory of Open Access Journals (Sweden)

    Amitesh Goswami

    2014-12-01

    Full Text Available In the present study a multi response optimization method using utility concept is proposed for wire electrical discharge machining (WEDM of Nimonic-80A alloy. The machining characteristics that are being investigated are material removal rate (MRR and surface roughness (SR along with surface topography of the machined surface. The study makes use of experimentation planned and executed as per Taguchi's robust design methodology. The Investigation indicated that material removal rate and surface roughness increases with increase in pulse-on time and decreases with increase in pulse-off time. Significant interactions have been found between pulse-on time (Ton and pulse-off time (Toff, pulse-on time (Ton and peak current (IP, pulse-off time (Toff and peak current (IP for material removal rate; and pulse-on time (Ton and peak current (IP for surface roughness. Multi-response optimization with utility concept provides the collective optimization of both responses for improving the mean of the process.

  15. Modeling and Optimizing Energy Utilization of Steel Production Process: A Hybrid Petri Net Approach

    Directory of Open Access Journals (Sweden)

    Peng Wang

    2013-01-01

    Full Text Available The steel industry is responsible for nearly 9% of anthropogenic energy utilization in the world. It is urgent to reduce the total energy utilization of steel industry under the huge pressures on reducing energy consumption and CO2 emission. Meanwhile, the steel manufacturing is a typical continuous-discrete process with multiprocedures, multiobjects, multiconstraints, and multimachines coupled, which makes energy management rather difficult. In order to study the energy flow within the real steel production process, this paper presents a new modeling and optimization method for the process based on Hybrid Petri Nets (HPN in consideration of the situation above. Firstly, we introduce the detailed description of HPN. Then the real steel production process from one typical integrated steel plant is transformed into Hybrid Petri Net model as a case. Furthermore, we obtain a series of constraints of our optimization model from this model. In consideration of the real process situation, we pick the steel production, energy efficiency and self-made gas surplus as the main optimized goals in this paper. Afterwards, a fuzzy linear programming method is conducted to obtain the multiobjective optimization results. Finally, some measures are suggested to improve this low efficiency and high whole cost process structure.

  16. Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-04-01

    Full Text Available Edward’s syndrome (trisomy 18 is an autosomal abnormality with dysmorphic face, visceral deformities and delayed mental and motor development including congenital heart disease. Challenges may arise during mask ventilation, laryngoscopy and/or intubation of the trachea due to dysmorphic face. Difficult airway cart should be kept ready. Left molar approach using a standard Macintosh blade improves the laryngoscopic view in patients with difficult midline laryngoscopy. We hereby present a case report of a 2 year old male child with Edward’s syndrome posted for evacuation and drainage of brain abscess, intubated successfully using left molar approach.

  17. A risk-based approach to maintenance planning utilizing in-line inspection data

    Energy Technology Data Exchange (ETDEWEB)

    Fenyvesi, L.L. [TransCanada PipeLines Ltd., Calgary, AB (Canada); Colquhoun, I.; Kania, R.; Gu, B. [GE Power Systems (Canada)

    2004-07-01

    The pipeline industry routinely performs in-line inspections (ILI) to manage external corrosion in pipelines. ILIs are followed by repairs of defects that fail a deterministic criterion. Re-inspection is then performed after a prescribed time interval has elapsed. However, due to uncertainties associated with magnetic flux leakage (MFL) defect sizing and corrosion growth rates, a deterministic repair and re-inspection may result in nonessential maintenance expenditure. In addition, critical features may sometimes remain unidentified. This paper suggested that in order to evaluate the sensitivity of a defect's failure probability more effectively, a better approach would be to evaluate corrosion defects by viewing the process as an analysis of a set of stochastic variables rather than deterministic values. Therefore, this paper outlined the proposed stochastic approach in which tool error and growth rate uncertainty were explicitly considered. Computer simulation was used along with a process for continuously improving the characterization of each variable through a feedback loop. In order to minimize analysis time, the paper also outlined alternative methods to Monte Carlo, such as Importance Sampling. The approach has been successfully applied in field situations. It was shown that the approach can incorporate new information through repeat inspections or field excavations. 6 refs., 10 figs.

  18. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

    Science.gov (United States)

    Delon, Sandra; Mackinnon, Blair

    2009-01-01

    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

  19. Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions, and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis Within Medicare Beneficiaries from 2000 to 2011.

    Science.gov (United States)

    Sclafani, Joseph A; Constantin, Alexandra; Ho, Pei-Shu; Akuthota, Venu; Chan, Leighton

    2017-02-15

    A retrospective, observational study. The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (ICD-9) diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) underwent spinal surgery, and one-third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. Interventional techniques and physical therapy are

  20. Orbital soft tissue surgery for patients with Treacher-Collins or Nager syndrome. A new surgical approach with early correction of soft tissue: prospective study.

    Science.gov (United States)

    Franchi, G; Kadlub, N; Diner, P A; Bandini, M; Vazquez, M-P; Picard, A

    2015-05-01

    Orbitopalpebral anomalies in mandibulofacial dysostosis (Treacher-Collins syndrome) can be difficult to correct surgically and most authors recommend correction of the malar bone after the age of 8 years. We propose a new, early surgical approach for periorbital defects that involves initial implantation of autologous fat and subperiosteal malar lift with a pedicled upper eyelid flap. We prospectively studied 5 children, 3 of whom had previously had orbital reconstruction. Initial fat graft into the periorbital area was followed by a subperiosteal malar lift with lateral canthopexy, and a pedicled upper eyelid flap if needed. Two surgeons independently assessed the patients' characteristics including scleral show before and after operation, antimongoloid palpebral fissures, canthal dystopia, number 6 cleft (Tessier classification), skin quality, and surgical and ophthalmic complications. Before operation 3 patients had had ophthalmic problems. Postoperative evaluation showed improvements in scleral show, canthal dystopia, and skin quality, and correction of antimongoloid palpebral fissures and subcutaneous number 6 clefts. There were no postoperative complications. The proposed protocol gave satisfactory aesthetic and functional results in children with Treacher-Collins syndrome. We recommend that it is considered for periorbital reconstruction in all patients with a mandibulofacial deformity.

  1. Mean-variance portfolio optimization by using time series approaches based on logarithmic utility function

    Science.gov (United States)

    Soeryana, E.; Fadhlina, N.; Sukono; Rusyaman, E.; Supian, S.

    2017-01-01

    Investments in stocks investors are also faced with the issue of risk, due to daily price of stock also fluctuate. For minimize the level of risk, investors usually forming an investment portfolio. Establishment of a portfolio consisting of several stocks are intended to get the optimal composition of the investment portfolio. This paper discussed about optimizing investment portfolio of Mean-Variance to stocks by using mean and volatility is not constant based on logarithmic utility function. Non constant mean analysed using models Autoregressive Moving Average (ARMA), while non constant volatility models are analysed using the Generalized Autoregressive Conditional heteroscedastic (GARCH). Optimization process is performed by using the Lagrangian multiplier technique. As a numerical illustration, the method is used to analyse some Islamic stocks in Indonesia. The expected result is to get the proportion of investment in each Islamic stock analysed.

  2. Estimation of melting points of large set of persistent organic pollutants utilizing QSPR approach.

    Science.gov (United States)

    Watkins, Marquita; Sizochenko, Natalia; Rasulev, Bakhtiyor; Leszczynski, Jerzy

    2016-03-01

    The presence of polyhalogenated persistent organic pollutants (POPs), such as Cl/Br-substituted benzenes, biphenyls, diphenyl ethers, and naphthalenes has been identified in all environmental compartments. The exposure to these compounds can pose potential risk not only for ecological systems, but also for human health. Therefore, efficient tools for comprehensive environmental risk assessment for POPs are required. Among the factors vital for environmental transport and fate processes is melting point of a compound. In this study, we estimated the melting points of a large group (1419 compounds) of chloro- and bromo- derivatives of dibenzo-p-dioxins, dibenzofurans, biphenyls, naphthalenes, diphenylethers, and benzenes by utilizing quantitative structure-property relationship (QSPR) techniques. The compounds were classified by applying structure-based clustering methods followed by GA-PLS modeling. In addition, random forest method has been applied to develop more general models. Factors responsible for melting point behavior and predictive ability of each method were discussed.

  3. Morphologic Study of Superior Temporal Sulcus-Amygdaloid Body and Lateral Fissure-Amygdaloid Body Surgical Approach by Using Magnetic Resonance Imaging Volume Rendering.

    Science.gov (United States)

    Qu, Yuan; Ren, Bichen; Chang, Xiaoyu; Zhang, Jinnan; Li, Youqiong; Duan, Haobo; Cheng, Kailiang; Wang, Jincheng

    2016-01-01

    In this research, 83 patients were measured by magnetic resonance imaging volume rendering technique. The authors acquired the curve length of the superior temporal sulcus and the lateral fissure on the cerebral hemisphere, the shortest distance from the superior temporal sulcus and the lateral fissure to the center of amygdaloid body separately, the vertical diameter, the transversal diameter, and the anteroposterior diameter of the amygdaloid body and the 2 approach angles between the median sagittal plane and the shortest segment from the superior temporal sulcus to the center of amygdaloid body and the shortest segment from lateral fissure to the center of the amygdaloid body. At the same time, we preliminarily oriented the 2 points of the superior temporal sulcus and the lateral fissure, which are closest to the center of amygdaloid body, aimed at finding out the best entrance points of surgical approach through the superior temporal sulcus and the lateral fissure to the amygdaloid body and reducing the damage to the nerve fibers or blood vessels during the operation. The results indicate that the point at the front side 1/4 of the superior temporal sulcus may be the ideal surgical approach entrance point and the point at the front side 1/3 of the lateral fissure. There is no difference between 2 cerebral hemispheres (P < 0.05).

  4. A new approach for modeling the peak utility impacts from a proposed CUAC standard

    Energy Technology Data Exchange (ETDEWEB)

    LaCommare, Kristina Hamachi; Gumerman, Etan; Marnay, Chris; Chan, Peter; Coughlin, Katie

    2004-08-01

    This report describes a new Berkeley Lab approach for modeling the likely peak electricity load reductions from proposed energy efficiency programs in the National Energy Modeling System (NEMS). This method is presented in the context of the commercial unitary air conditioning (CUAC) energy efficiency standards. A previous report investigating the residential central air conditioning (RCAC) load shapes in NEMS revealed that the peak reduction results were lower than expected. This effect was believed to be due in part to the presence of the squelch, a program algorithm designed to ensure changes in the system load over time are consistent with the input historic trend. The squelch applies a system load-scaling factor that scales any differences between the end-use bottom-up and system loads to maintain consistency with historic trends. To obtain more accurate peak reduction estimates, a new approach for modeling the impact of peaky end uses in NEMS-BT has been developed. The new approach decrements the system load directly, reducing the impact of the squelch on the final results. This report also discusses a number of additional factors, in particular non-coincidence between end-use loads and system loads as represented within NEMS, and their impacts on the peak reductions calculated by NEMS. Using Berkeley Lab's new double-decrement approach reduces the conservation load factor (CLF) on an input load decrement from 25% down to 19% for a SEER 13 CUAC trial standard level, as seen in NEMS-BT output. About 4 GW more in peak capacity reduction results from this new approach as compared to Berkeley Lab's traditional end-use decrement approach, which relied solely on lowering end use energy consumption. The new method has been fully implemented and tested in the Annual Energy Outlook 2003 (AEO2003) version of NEMS and will routinely be applied to future versions. This capability is now available for use in future end-use efficiency or other policy analysis

  5. The diagnostic utility of 3D-ESI rotating and moving dipole methodology in the pre-surgical evaluation of MRI-negative childhood epilepsy due to focal cortical dysplasia.

    Science.gov (United States)

    Russo, Angelo; Lallas, Matt; Jayakar, Prasanna; Miller, Ian; Hyslop, Ann; Dunoyer, Catalina; Resnick, Trevor; Duchowny, Michael

    2016-09-01

    This study investigates whether a combined rotating dipole (RD) and moving dipole (MD) solution enhances three-dimensional electroencephalography (EEG) source imaging (3D-ESI) localization in magnetic resonance imaging (MRI)-negative pediatric patients with focal cortical dysplasia (FCD). We retrospectively selected 14 MRI-negative patients with FCD from a cohort of 60 pediatric patients previously used to evaluate the diagnostic utility of 3D-ESI in epilepsy surgery. Patients were younger than 18 years at time of surgery and had at least 1 year of outcome data. RD and MD models were constructed for each interictal spike or sharp wave, and it was determined whether each inverse algorithm localized within the surgical resection cavity (SRC). We also compared the 3D-ESI findings and surgical outcome with positron emission tomography (PET) and ictal single photon emission computed tomography (iSPECT). RD analyses revealed a high concordance with the SRC (78.6%), particularly for temporal lobe resection (100.0%), and showed superior localization compared to PET and iSPECT, with the highest correlation in FCD type I and temporal lobe resection. Furthermore, the RD method was superior to iSPECT in FCD type II cases and to PET in extratemporal resections. RD and MD results were comparable, but in 18.2% of patients with FCD type I with localizing RDs, the MD solution was only partially within the SRC; in all of these patients 3D-ESI also correlated with superior surgical outcome compared to PET and iSPECT, especially when RD and MD solutions were analyzed together. 3D-ESI in MRI-negative cases showed superior localization compared to iSPECT or PET, especially in FCD type I and temporal lobe epilepsy, and correlated with superior surgical outcome compared to iSPECT and PET at 1 year and 2 years postoperatively, especially when RD and MD solutions were analyzed together. These findings suggest that 3D-ESI based on a combined RD-MD solution improves surgical accuracy in

  6. Imaging MALDI MS of Dosed Brain Tissues Utilizing an Alternative Analyte Pre-extraction Approach

    Science.gov (United States)

    Quiason, Cristine M.; Shahidi-Latham, Sheerin K.

    2015-06-01

    Matrix-assisted laser desorption ionization (MALDI) imaging mass spectrometry has been adopted in the pharmaceutical industry as a useful tool to detect xenobiotic distribution within tissues. A unique sample preparation approach for MALDI imaging has been described here for the extraction and detection of cobimetinib and clozapine, which were previously undetectable in mouse and rat brain using a single matrix application step. Employing a combination of a buffer wash and a cyclohexane pre-extraction step prior to standard matrix application, the xenobiotics were successfully extracted and detected with an 8 to 20-fold gain in sensitivity. This alternative approach for sample preparation could serve as an advantageous option when encountering difficult to detect analytes.

  7. AN UTILITIES BASED APPROACH FOR MULTI-PERIOD DYNAMIC PORTFOLIO SELECTION

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    This paper proposed a multi-period dynamic optimal portfolio selection model. Assumptions were made to assure the strictness of reasoning. This Approach depicted the developments and changing of the real stock market and is an attempt to remedy some of the deficiencies of recent researches. The model is a standard form of quadratic programming. Furthermore, this paper presented a numerical example in real stock market.

  8. Analysis on potential approaches to utilize genic male sterility in plant hybrid breeding

    Institute of Scientific and Technical Information of China (English)

    Li Xinqi; Yuan Longping; Xiao Jinhua; Xie fangming

    2005-01-01

    @@ The exploitation of plant heterosis is an effective approach to increasing the food production. The heterotic hybrid varieties in major crops such as rice,cotton, and wheat can show more than 20% yield advantage over best conventional ones under the same cultivation conditions. The difficulties in breeding elite male sterile lines and the inconveniences for commercial hybrid seed production are hampering the development of hybrid crops breeding.

  9. LightForce Photon-Pressure Collision Avoidance: Updated Efficiency Analysis Utilizing a Highly Parallel Simulation Approach

    Science.gov (United States)

    Stupl, Jan; Faber, Nicolas; Foster, Cyrus; Yang, Fan Yang; Nelson, Bron; Aziz, Jonathan; Nuttall, Andrew; Henze, Chris; Levit, Creon

    2014-01-01

    This paper provides an updated efficiency analysis of the LightForce space debris collision avoidance scheme. LightForce aims to prevent collisions on warning by utilizing photon pressure from ground based, commercial off the shelf lasers. Past research has shown that a few ground-based systems consisting of 10 kilowatt class lasers directed by 1.5 meter telescopes with adaptive optics could lower the expected number of collisions in Low Earth Orbit (LEO) by an order of magnitude. Our simulation approach utilizes the entire Two Line Element (TLE) catalogue in LEO for a given day as initial input. Least-squares fitting of a TLE time series is used for an improved orbit estimate. We then calculate the probability of collision for all LEO objects in the catalogue for a time step of the simulation. The conjunctions that exceed a threshold probability of collision are then engaged by a simulated network of laser ground stations. After those engagements, the perturbed orbits are used to re-assess the probability of collision and evaluate the efficiency of the system. This paper describes new simulations with three updated aspects: 1) By utilizing a highly parallel simulation approach employing hundreds of processors, we have extended our analysis to a much broader dataset. The simulation time is extended to one year. 2) We analyze not only the efficiency of LightForce on conjunctions that naturally occur, but also take into account conjunctions caused by orbit perturbations due to LightForce engagements. 3) We use a new simulation approach that is regularly updating the LightForce engagement strategy, as it would be during actual operations. In this paper we present our simulation approach to parallelize the efficiency analysis, its computational performance and the resulting expected efficiency of the LightForce collision avoidance system. Results indicate that utilizing a network of four LightForce stations with 20 kilowatt lasers, 85% of all conjunctions with a

  10. A modular approach for the construction and modification of glyco-SAMs utilizing 1,3-dipolar cycloaddition.

    Science.gov (United States)

    Kleinert, Mike; Winkler, Tobias; Terfort, Andreas; Lindhorst, Thisbe K

    2008-06-21

    We report the synthesis of a broad variety of functionalized molecules for assembly on gold, allowing the formation of biologically relevant SAMs by a modular approach: either utilizing 1,3-dipolar cycloaddition of alkynes and azides in solution or by 'click on SAM'. Extensive studies into the various parameters of SAM formation and stability have been carried out, leading us to deduce reliable conditions under which glyco-decorated self-assembled monolayers can be formed and studied such as in SPR-supported binding assays.

  11. A building extraction approach for Airborne Laser Scanner data utilizing the Object Based Image Analysis paradigm

    Science.gov (United States)

    Tomljenovic, Ivan; Tiede, Dirk; Blaschke, Thomas

    2016-10-01

    In the past two decades Object-Based Image Analysis (OBIA) established itself as an efficient approach for the classification and extraction of information from remote sensing imagery and, increasingly, from non-image based sources such as Airborne Laser Scanner (ALS) point clouds. ALS data is represented in the form of a point cloud with recorded multiple returns and intensities. In our work, we combined OBIA with ALS point cloud data in order to identify and extract buildings as 2D polygons representing roof outlines in a top down mapping approach. We performed rasterization of the ALS data into a height raster for the purpose of the generation of a Digital Surface Model (DSM) and a derived Digital Elevation Model (DEM). Further objects were generated in conjunction with point statistics from the linked point cloud. With the use of class modelling methods, we generated the final target class of objects representing buildings. The approach was developed for a test area in Biberach an der Riß (Germany). In order to point out the possibilities of the adaptation-free transferability to another data set, the algorithm has been applied "as is" to the ISPRS Benchmarking data set of Toronto (Canada). The obtained results show high accuracies for the initial study area (thematic accuracies of around 98%, geometric accuracy of above 80%). The very high performance within the ISPRS Benchmark without any modification of the algorithm and without any adaptation of parameters is particularly noteworthy.

  12. Commentary: Utilizing Community-Engaged Approaches to Investigate and Address Hmong Women’s Cancer Disparities

    Directory of Open Access Journals (Sweden)

    Shannon M.A. Sparks

    2014-12-01

    Full Text Available Cancer is a growing concern for women in the Hmong community. Hmong women experience poor health outcomes for both cervical and breast cancer, largely due to low rates of screening and resultant late-stage at diagnosis. Both breast and cervical cancer screening are complicated by a multitude of social, cultural and environmental factors which influence health care decision-making and can otherwise serve to restrict access. We argue that community-engaged research, an orientation which prioritizes collaborative, equitable partnerships and community voice in identifying both problems and solutions, can be a valuable approach to helping address cancer health disparities for Hmong women. Using the Milwaukee-based “Healthy Hmong Women” project as a case example, we detail how the community-engaged approach implemented by the project partners was critical in identifying factors contributing to Hmong cancer disparities and appropriate interventions, as well as the overall acceptance and success of the project. Specifically, we discuss how this approach: (1 promoted community investment and ownership in the project; (2 facilitated the integration of local perspectives and experiences; (3 built capacity to address cancer screening disparities; (4 facilitated the creation of interventions targeting multiple ecological levels; and (5 framed the community as the foundation and driver of positive change.

  13. Novel anaesthetic approach for surgical access and haemodynamic management during off-pump coronary artery bypass through a left thoracotomy

    Directory of Open Access Journals (Sweden)

    Madan Mohan Maddali

    2012-01-01

    Full Text Available For myocardial revascularization on a beating heart through a thoracotomy, a properly deployed endobronchial blocker (EBB provides ideal conditions for surgical access. In addition, adequate volume replacement to achieve optimal cardiac performance is a primary goal of haemodynamic management in patients undergoing off-pump coronary artery bypass grafting. To achieve both these ends, this case report describes the combined use of a left-sided EBB along with a volumetric pulmonary artery catheter in a patient who underwent a successful off-pump coronary artery bypass surgery through an anterolateral thoracotomy.

  14. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial.

    Science.gov (United States)

    Alam, Murad; Roongpisuthipong, Wanjarus; Kim, Natalie A; Goyal, Amita; Swary, Jillian H; Brindise, Renata T; Iyengar, Sanjana; Pace, Natalie; West, Dennis P; Polavarapu, Mahesh; Yoo, Simon

    2016-09-01

    Guided imagery and music can reportedly reduce pain and anxiety during surgery, but no comparative study has been performed for cutaneous surgery to our knowledge. We sought to determine whether short-contact recorded guided imagery or relaxing music could reduce patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures. Subjects were adults undergoing excisional surgery for basal and squamous cell carcinoma. Randomization was to guided imagery (n = 50), relaxing music (n = 54), or control group (n = 51). Primary outcomes were pain and anxiety measured using visual analog scale and 6-item short-form of the State-Trait Anxiety Inventory, respectively. Secondary outcomes were anxiety of surgeons measured by the 6-item short-form of the State-Trait Anxiety Inventory and physical stress of patients conveyed by vital signs, respectively. There were no significant differences in subjects' pain, anxiety, blood pressure, and pulse rate across groups. In the recorded guided imagery and the relaxing music group, surgeon anxiety was significantly lower than in the control group. Patients could not be blinded. Short-contact recorded guided imagery and relaxing music appear not to reduce patient pain and anxiety during excisional procedures under local anesthetic. However, surgeon anxiety may be reduced when patients are listening to such recordings. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Carbohydrate-active enzymes from pigmented Bacilli: a genomic approach to assess carbohydrate utilization and degradation

    Directory of Open Access Journals (Sweden)

    Henrissat Bernard

    2011-09-01

    Full Text Available Abstract Background Spore-forming Bacilli are Gram-positive bacteria commonly found in a variety of natural habitats, including soil, water and the gastro-intestinal (GI-tract of animals. Isolates of various Bacillus species produce pigments, mostly carotenoids, with a putative protective role against UV irradiation and oxygen-reactive forms. Results We report the annotation of carbohydrate active enzymes (CAZymes of two pigmented Bacilli isolated from the human GI-tract and belonging to the Bacillus indicus and B. firmus species. A high number of glycoside hydrolases (GHs and carbohydrate binding modules (CBMs were found in both isolates. A detailed analysis of CAZyme families, was performed and supported by growth data. Carbohydrates able to support growth as the sole carbon source negatively effected carotenoid formation in rich medium, suggesting that a catabolite repression-like mechanism controls carotenoid biosynthesis in both Bacilli. Experimental results on biofilm formation confirmed genomic data on the potentials of B. indicus HU36 to produce a levan-based biofilm, while mucin-binding and -degradation experiments supported genomic data suggesting the ability of both Bacilli to degrade mammalian glycans. Conclusions CAZy analyses of the genomes of the two pigmented Bacilli, compared to other Bacillus species and validated by experimental data on carbohydrate utilization, biofilm formation and mucin degradation, suggests that the two pigmented Bacilli are adapted to the intestinal environment and are suited to grow in and colonize the human gut.

  16. A Neurodynamic Approach for Real-Time Scheduling via Maximizing Piecewise Linear Utility.

    Science.gov (United States)

    Guo, Zhishan; Baruah, Sanjoy K

    2016-02-01

    In this paper, we study a set of real-time scheduling problems whose objectives can be expressed as piecewise linear utility functions. This model has very wide applications in scheduling-related problems, such as mixed criticality, response time minimization, and tardiness analysis. Approximation schemes and matrix vectorization techniques are applied to transform scheduling problems into linear constraint optimization with a piecewise linear and concave objective; thus, a neural network-based optimization method can be adopted to solve such scheduling problems efficiently. This neural network model has a parallel structure, and can also be implemented on circuits, on which the converging time can be significantly limited to meet real-time requirements. Examples are provided to illustrate how to solve the optimization problem and to form a schedule. An approximation ratio bound of 0.5 is further provided. Experimental studies on a large number of randomly generated sets suggest that our algorithm is optimal when the set is nonoverloaded, and outperforms existing typical scheduling strategies when there is overload. Moreover, the number of steps for finding an approximate solution remains at the same level when the size of the problem (number of jobs within a set) increases.

  17. Carbohydrate-active enzymes from pigmented Bacilli: a genomic approach to assess carbohydrate utilization and degradation

    Science.gov (United States)

    2011-01-01

    Background Spore-forming Bacilli are Gram-positive bacteria commonly found in a variety of natural habitats, including soil, water and the gastro-intestinal (GI)-tract of animals. Isolates of various Bacillus species produce pigments, mostly carotenoids, with a putative protective role against UV irradiation and oxygen-reactive forms. Results We report the annotation of carbohydrate active enzymes (CAZymes) of two pigmented Bacilli isolated from the human GI-tract and belonging to the Bacillus indicus and B. firmus species. A high number of glycoside hydrolases (GHs) and carbohydrate binding modules (CBMs) were found in both isolates. A detailed analysis of CAZyme families, was performed and supported by growth data. Carbohydrates able to support growth as the sole carbon source negatively effected carotenoid formation in rich medium, suggesting that a catabolite repression-like mechanism controls carotenoid biosynthesis in both Bacilli. Experimental results on biofilm formation confirmed genomic data on the potentials of B. indicus HU36 to produce a levan-based biofilm, while mucin-binding and -degradation experiments supported genomic data suggesting the ability of both Bacilli to degrade mammalian glycans. Conclusions CAZy analyses of the genomes of the two pigmented Bacilli, compared to other Bacillus species and validated by experimental data on carbohydrate utilization, biofilm formation and mucin degradation, suggests that the two pigmented Bacilli are adapted to the intestinal environment and are suited to grow in and colonize the human gut. PMID:21892951

  18. Carbohydrate-active enzymes from pigmented Bacilli: a genomic approach to assess carbohydrate utilization and degradation.

    Science.gov (United States)

    Manzo, Nicola; D'Apuzzo, Enrica; Coutinho, Pedro M; Cutting, Simon M; Henrissat, Bernard; Ricca, Ezio

    2011-09-05

    Spore-forming Bacilli are gram-positive bacteria commonly found in a variety of natural habitats, including soil, water and the gastro-intestinal (GI)-tract of animals. Isolates of various Bacillus species produce pigments, mostly carotenoids, with a putative protective role against UV irradiation and oxygen-reactive forms. We report the annotation of carbohydrate active enzymes (CAZymes) of two pigmented Bacilli isolated from the human GI-tract and belonging to the Bacillus indicus and B. firmus species. A high number of glycoside hydrolases (GHs) and carbohydrate binding modules (CBMs) were found in both isolates. A detailed analysis of CAZyme families, was performed and supported by growth data. Carbohydrates able to support growth as the sole carbon source negatively effected carotenoid formation in rich medium, suggesting that a catabolite repression-like mechanism controls carotenoid biosynthesis in both Bacilli. Experimental results on biofilm formation confirmed genomic data on the potentials of B. indicus HU36 to produce a levan-based biofilm, while mucin-binding and -degradation experiments supported genomic data suggesting the ability of both Bacilli to degrade mammalian glycans. CAZy analyses of the genomes of the two pigmented Bacilli, compared to other Bacillus species and validated by experimental data on carbohydrate utilization, biofilm formation and mucin degradation, suggests that the two pigmented Bacilli are adapted to the intestinal environment and are suited to grow in and colonize the human gut.

  19. Utility of an Automated Thermal-Based Approach for Monitoring Evapotranspiration

    Directory of Open Access Journals (Sweden)

    Timmermans Wim J.

    2015-12-01

    Full Text Available A very simple remote sensing-based model for water use monitoring is presented. The model acronym DATTUTDUT (Deriving Atmosphere Turbulent Transport Useful To Dummies Using Temperature is a Dutch word which loosely translates as “it’s unbelievable that it works”. DATTUTDUT is fully automated and only requires a surface temperature map, making it simple to use and providing a rapid estimate of spatially- distributed fluxes. The algorithm is first tested over a range of environmental and land-cover conditions using data from four short-term field experiments and then evaluated over a growing season in an agricultural region. Flux model output is in satisfactory agreement with observations and established remote sensing-based models, except under dry and partial canopy cover conditions. This suggests that DATTUTDUT has utility in identifying relative water use and as an operational tool providing initial estimates of ET anomalies in data-poor regions that would be confirmed using more robust modeling techniques.

  20. Application of Taguchi approach and Utility Concept in solving the Multi-objective Problem when

    Directory of Open Access Journals (Sweden)

    M. Kaladhar

    2011-01-01

    Full Text Available The traditional Taguchi method is widely used for optimizing the process parameters of a single response problem. Optimizationof a single response results the non-optimum values for remaining. But, the performance of the manufactured products isoften evaluated by several quality characteristics/responses. Under such circumstances, multi-characteristics response optimizationmay be the solution to optimize multi-responses simultaneously. In the present work, a multi-characteristics responseoptimization model based on Taguchi and Utility concept is used to optimize process parameters, such as speed, feed, depthof cut, and nose radius on multiple performance characteristics, namely, surface roughness (Ra and material removal rate(MRR during turning of AISI 202 austenitic stainless steel using a CVD coated cemented carbide tool. Taguchi’s L8 orthogonalarray (OA is selected for experimental planning. The experimental result analysis showed that the combination of higherlevels of cutting speed, depth of cut, and nose radius and lower level of feed is essential to achieve simultaneous maximizationof material removal rate and minimization of surface roughness. The ANOVA and F-tests are used to analyze the results.Further, the confirmation tests are conducted and the results are found to be within the confidence interval.

  1. A novel approach in organic waste utilization through biochar addition in wood/polypropylene composites

    Energy Technology Data Exchange (ETDEWEB)

    Das, Oisik [Department of Civil and Environmental Engineering, University of Auckland, Auckland 1142 (New Zealand); Sarmah, Ajit K., E-mail: a.sarmah@auckland.ac.nz [Department of Civil and Environmental Engineering, University of Auckland, Auckland 1142 (New Zealand); Bhattacharyya, Debes [Department of Mechanical Engineering, Center for Advanced Composite Materials, University of Auckland, Auckland 1142 (New Zealand)

    2015-04-15

    Highlights: • Biochar made from waste wood was added with wood polypropylene composites. • 24% biochar gave the best mechanical properties. • 6% biochar had no effect on physico-mechanical properties of composites. • Coupling agent remained unreacted in composites having higher amount of biochar. - Abstract: In an attempt to concurrently address the issues related to landfill gas emission and utilization of organic wastes, a relatively novel idea is introduced to develop biocomposites where biochar made from pyrolysis of waste wood (Pinus radiata) is added with the same wood, plastic/polymer (polypropylene) and maleated anhydride polypropylene (MAPP). Experiments were conducted by manufacturing wood and polypropylene composites (WPCs) mixed with 6 wt%, 12 wt%, 18 wt%, 24 wt%, and 30 wt% biochar. Though 6 wt% addition had similar properties to that of the control (composite without biochar), increasing biochar content to 24 wt% improved the composite’s tensile/flexural strengths and moduli. The biochar, having high surface area due to fine particles and being highly carbonised, acted as reinforcing filler in the biocomposite. Composites having 12 wt% and 18 wt% of biochar were found to be the most ductile and thermally stable, respectively. This study demonstrates that, WPCs added with biochar has good potential to mitigate wastes while simultaneously producing biocomposites having properties that might be suited for various end applications.

  2. An Approach for Enhancing Adoption, Use and Utility of Shared Digital Health Records in Rural Australian Communities.

    Science.gov (United States)

    Almond, Helen; Cummings, Elizabeth; Turner, Paul

    2017-01-01

    Internationally, shared digital health records are considered an important addition to improving modern health care provision. Australia launched its version, My Health Record (MyHR), in 2012 but has experienced low adoption and challenges in practical implementation and evaluation. Individuals living with complex and chronic conditions in rural and remote communities often experience challenges in obtaining equitable access to health care provision. They are also supposed to face additional barriers to adopting and using eHealth services. This paper reports on research investigating adoption, use and utility of MyHR, in rural remote Australian community settings. Based on this research an approach for improving national roll out of MyHR is presented. The approach highlights a means to understand and engage communities with complex care needs, to support their adoption and use of digital tools. It also draws attention to holistic methods for evaluating and assessing impact at individual, community and health care provision levels.

  3. Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects.

    Science.gov (United States)

    Aslan, Serhat; Buduneli, Nurcan; Cortellini, Pierpaolo

    Primary wound closure and uneventful early wound stability over the biomaterials are the most critical elements of successful periodontal regeneration. Yet the surgical elevation of the interdental papilla to access deep and wide intrabony defects entails an impairment of the papillary blood supply that can result in difficult healing due to a lack of primary closure in the early healing period. This negative event might complicate the healing process, favoring bacterial contamination. A novel modified tunnel surgical technique designed to maintain the integrity of the interdental papilla is presented in this article, with the aim of providing an optimal environment for wound healing in regenerative procedures. Entire papilla preservation is described and applied in three different cases, in association with the use of a combination of bone substitutes and enamel matrix derivative for periodontal regeneration. The entire papilla preservation technique was successfully applied to the three selected cases, resulting in an uneventful postsurgical period and a substantial defect fill over the 8-month follow-up. This tunnel-like technique can be recommended for further research to support the success identified in this case series.

  4. Photodynamic therapy for angiosarcoma of scalp as alternative approach for surgical treatment in patient with severe co-morbidity

    Directory of Open Access Journals (Sweden)

    E. V. Yaroslavtseva-Isaeva

    2014-01-01

    Full Text Available A case of successful photodynamic therapy in patient of 86 y.o. with diagnosis: angiosarcoma of right temporal-parietal region stage IIA (Т2вN0M0 is reported. The tumor was as soft tissue round shape lesion with tuberous contours 3.4х3.4х1.1 cm in size, located in subcutaneous tissue in right parietal region with no scull bone invasion. The patient was refused to surgical treatment with general anesthesia due to severe cardiovascular co-morbidity. The patient underwent a course of photodynamic therapy with Photolon. The photosensitizer was intravenousely introduced for 3 h before irradiation at dose of 1 mg/kg body weight. The parameters of irradiation were as follows: output power – 0.8 W, light dose – 150 J/cm2, 4 irradiation fields 2.5 cm in diameter. During the irradiation there were moderate pain which did not require drug management. After PDT complete regression of the tumor was achieved. For nowadays (11 months after treatment the patient is observed with no recurrence. The reported case shows that photodynamic therapy may be successfully used for alternative treatment of soft tissue angiosarcoma in patients with no ability for surgical treatment. 

  5. Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases.

    Science.gov (United States)

    Paolini, Sergio; Ciappetta, Pasquale; Raco, Antonino; Missori, Paolo; Delfini, Roberto

    2006-05-01

    Large lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression. Surgical management of these lesions may be difficult. A traditional interlaminar approach usually brings into view only the paramedian portion of the intervertebral disc, unless the lateral bone removal is considerably increased. Conversely, the numerous far-lateral approaches proposed for removing foraminal or extraforaminal disc herniations would decompress the exiting nerve root only. Overall, these approaches share the drawback of controlling the neuroforamen on one side alone. A combined intra-extraforaminal exposure is a useful yet rarely reported approach. Over a 3-year period, 15 patients with bi-radicular symptoms due to large disc herniations of the lumbar spine underwent surgery through a combined intra-extracanal approach. A standard medial exposure with an almost complete hemilaminectomy of the upper vertebra was combined with an extraforaminal exposure, achieved by minimal drilling of the inferior facet joint, the lateral border of the pars interarticularis and the inferior margin of the superior transverse process. The herniated discs were removed using key maneuvers made feasible by working simultaneously on both operative windows. In all cases the disc herniation could be completely removed, thus decompressing both nerve roots. Radicular pain was fully relieved without procedure-related morbidity. The intra-extraforaminal exposure was particularly useful in identifying the extraforaminal nerve root early. Early identification was especially advantageous when periradicular scar tissue hid the nerve root from view, as it did in patients who had undergone previous surgery at the same site or had long-standing radicular symptoms. Controlling the foramen on both sides also reduced the risk of leaving residual disc fragments. A curved probe was used to push the disc material outside the foramen. In conclusion, specific

  6. Global financial crisis and surgical practice: the Greek paradigm.

    Science.gov (United States)

    Karidis, Nikolaos P; Dimitroulis, Dimitrios; Kouraklis, Gregory

    2011-11-01

    Apart from the significant implications of recent financial crisis in overall health indices and mortality rates, the direct effect of health resources redistribution in everyday clinical practice is barely recognized. In the case of Greece, health sector reform and health spending cuts have already had a major impact on costly interventions, particularly in surgical practice. An increase in utilization of public health resources, lack of basic and advanced surgical supplies, salary deductions, and emerging issues in patient management have contributed to serious dysfunction of a public health system unable to sustain current needs. In this context, significant implications arise for the surgeons and patients as proper perioperative management is directly affected by reduced public health funding. The surgical community has expressed concerns about the quality of surgical care and the future of surgical progress in the era of the European Union. Greek surgeons are expected to support reform while maintaining a high level of surgical care to the public. The challenge of cost control in surgical practice provides, nevertheless, an excellent opportunity to reconsider health economics while innovation through a more traditional approach to the surgical patient should not be precluded. A Greek case study on the extent of the current situation is presented with reference to health policy reform, serving as an alarming paradigm for the global community under the pressure of a profound financial recession.

  7. Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields.

    Science.gov (United States)

    Wolf, Benjamin; Ganzer, Roman; Stolzenburg, Jens-Uwe; Hentschel, Bettina; Horn, Lars-Christian; Höckel, Michael

    2017-08-01

    Based on ontogenetic-anatomic considerations, we have introduced total mesometrial resection (TMMR) and laterally extended endopelvic resection (LEER) as surgical treatments for patients with cancer of the uterine cervix FIGO stages I B1 - IV A. For a subset of patients with locally advanced disease we have sought to develop an operative strategy characterized by the resection of additional tissue at risk for tumor infiltration as compared to TMMR, but less than in LEER, preserving the urinary bladder function. We conducted a prospective single center study to evaluate the feasibility of extended mesometrial resection (EMMR) and therapeutic lymph node dissection as a surgical treatment approach for patients with cervical cancer fixed to the urinary bladder and/or its mesenteries as determined by intraoperative evaluation. None of the patients received postoperative adjuvant radiotherapy. 48 consecutive patients were accrued into the trial. Median tumor size was 5cm, and 85% of all patients were found to have lymph node metastases. Complete tumor resection (R0) was achieved in all cases. Recurrence free survival at 5years was 54.1% (95% CI 38.3-69.9). The overall survival rate was 62.6% (95% CI 45.6-79.6) at 5years. Perioperative morbidity represented by grade II and III complications (determined by the Franco-Italian glossary) occurred in 25% and 15% of patients, respectively. We demonstrate in this study the feasibility of EMMR as a surgical treatment approach for patients with locally advanced cervical cancer and regional lymph node invasion without the necessity for postoperative adjuvant radiation. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Social Media Impact: Utility of Reflective Approach in the Practice of Surgery.

    Science.gov (United States)

    Mohiuddin, Zia; Shahid, Hassan; Shuaib, Waqas

    2015-12-01

    Social media is rapidly being incorporated into medical education. We created a small group, reflective practice sessions by integrating specific medical cases to improve awareness about professionalism on social media. Medical scenarios were generated for reflective practice sessions on social media professionalism. Anonymous pre/post-session surveys evaluated residents' use of social media and gathered their opinions on the session. Thirty-eight of 48 (79 %) residents replied to the presession survey with 50 % (19/38) reporting daily digital media use, 76 % (29/38) witnessed unprofessional postings on social media, and 21 % (8/38) posted unprofessional content themselves. Of the 79 % (30/38) residents who attended the session, 74 % (28/38) completed the post-session survey. Residents reported the session added to the longevity of their professional career 4.11, 95 % CI (3.89-4.36). As a result of the session, they were more conscious of using the social media more professionally 3.47, 95 % CI (2.88-3.96) and would be proactive in protecting patient privacy and confidentiality on social media sites 3.96, 95 % CI (3.50-4.37). In summary, reflective practice-based sessions regarding the impact of social media on professionalism in surgery was well favored by the residents. The majority agreed that it had important implications for the longevity of their professional career. Participants reported having an increased awareness to protect patient privacy and utilize social media more professionally.

  9. Phytoremediation: a novel approach for utilization of iron-ore wastes.

    Science.gov (United States)

    Mohanty, Monalisa; Dhal, Nabin Kumar; Patra, Parikshita; Das, Bisweswar; Reddy, Palli Sita Rama

    2010-01-01

    Large quantities of iron-ore tailings are being generated annually in the world from mining and processing of iron ores. It has been estimated that around 10-15% of the iron ore mined in India has remained unutilized and discarded as slimes during mining and subsequent processing. Soil contamination resulting from mining activities affects surrounding flora and fauna and presents a large clean-up challenge to the mining industry. Innovative new methodologies have been proposed and among the most promising are those that rely on new phytoremediation technology. In this paper we address and review the status of phytoremediation as a technology to reduce and control contaminated mine wastes. Several different approaches and different plant species are used to remove environmentally toxic metals from mine waste sites. Such approaches have the objective of restoring mining waste sites to human and animal use, or at least, to curtail or eliminate the off-site movement of toxic entities that potentially could reach humans. How well phytoremediation performs as an alternative soil restoration technology depends on several factors, including the composition of soil, toxicity level of the contaminant, degree to which plant species fit natural local growth patterns and type of concentration of metal/contaminant in such plants. Phytoremediation has opened prospects for less costly, yet practicable approaches to clean-up contaminated waste sites, particularly those associated with mineral extraction mining. We discuss several plant species that are capable of phytoextracting and/or phytostabilizing harmful elements from contaminated soil and water; such processes are prospectively effective for addressing waste problems that derive from mining and processing activities, as well as those that derive from mitigating the threat posed by waste that surrounds mining sites. Unfortunately, phytoremediation is still in the embryonic stage, and more research is needed to find the plant

  10. Elastic Model Transitions: a Hybrid Approach Utilizing Quadratic Inequality Constrained Least Squares (LSQI) and Direct Shape Mapping (DSM)

    Science.gov (United States)

    Jurenko, Robert J.; Bush, T. Jason; Ottander, John A.

    2014-01-01

    A method for transitioning linear time invariant (LTI) models in time varying simulation is proposed that utilizes both quadratically constrained least squares (LSQI) and Direct Shape Mapping (DSM) algorithms to determine physical displacements. This approach is applicable to the simulation of the elastic behavior of launch vehicles and other structures that utilize multiple LTI finite element model (FEM) derived mode sets that are propagated throughout time. The time invariant nature of the elastic data for discrete segments of the launch vehicle trajectory presents a problem of how to properly transition between models while preserving motion across the transition. In addition, energy may vary between flex models when using a truncated mode set. The LSQI-DSM algorithm can accommodate significant changes in energy between FEM models and carries elastic motion across FEM model transitions. Compared with previous approaches, the LSQI-DSM algorithm shows improvements ranging from a significant reduction to a complete removal of transients across FEM model transitions as well as maintaining elastic motion from the prior state.

  11. Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach

    Science.gov (United States)

    Lue, Kathy; Emtage, Justin B; Martinez, Daniel R; Yang, Christopher; Carrion, Rafael

    2015-01-01

    Introduction Peyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. Aims The aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. Methods A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting. Main Outcome Measures The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair. Results The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous

  12. Two Comments to Utilization of Structure Function Approach in Deep Inelastic Scattering Experiments

    CERN Document Server

    Kuraev, E A; Ilichev, A S

    2002-01-01

    The "returning to resonance" mechanism can be used to obtain the simple procedure of taking radiative corrections (RC) to deep inelastic scattering (DIS) cross sections into account in the framework of Drell-Yan picture. Iteration procedure is proposed. Kinematical region y\\to 1 can be described in the framework of Drell-Yan picture using the structure function approach. The large RC in the lowest order reflect the Sudakov form factor suppression, which can be taken into account in all orders of perturbation theory. Based on explicit calculation in two lowest orders of perturbation theory we construct the cross section in y\\to 1 region obeying renormalization group equations and including the Sudakov-like form factor suppression.

  13. Improved Approach for Utilization of FPGA Technology into DAQ, DSP, and Computing Applications

    Energy Technology Data Exchange (ETDEWEB)

    Isenhower, Larry Donald

    2009-01-28

    Innovation Partners proposed and successfully demonstrated in this SBIR Phase I grant a software/hardware co-design approach to reduce both the difficulty and time to implement Field Programmable Gate Array (FPGA) solutions to data acquisition and specialized computational applications. FPGAs can require excessive time for programming and require specialized knowledge that will be greatly reduced by the company's solution. Not only are FPGAs ideal for DAQ and embedded solutions, they can also be the best solution to specialized signal processing to replace Digital Signal Processors (DSPs). By allowing FPGA programming to be done in C with the equivalent of a simple compilation, algorithm changes and improvements can be implemented decreasing the life-cycle costs and allow subsitution of new FPGA designs staying above the technological details.

  14. Identifying the Critical Links in Road Transportation Networks: Centrality-based approach utilizing structural properties

    Energy Technology Data Exchange (ETDEWEB)

    Chinthavali, Supriya [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-04-01

    Surface transportation road networks share structural properties similar to other complex networks (e.g., social networks, information networks, biological networks, and so on). This research investigates the structural properties of road networks for any possible correlation with the traffic characteristics such as link flows those determined independently. Additionally, we define a criticality index for the links of the road network that identifies the relative importance in the network. We tested our hypotheses with two sample road networks. Results show that, correlation exists between the link flows and centrality measures of a link of the road (dual graph approach is followed) and the criticality index is found to be effective for one test network to identify the vulnerable nodes.

  15. Testing the Utility of a Data-Driven Approach for Assessing BMI from Face Images

    DEFF Research Database (Denmark)

    Wolffhechel, Karin Marie Brandt; Hahn, Amanda C.; Jarmer, Hanne Østergaard

    2015-01-01

    Several lines of evidence suggest that facial cues of adiposity may be important for human social interaction. However, tests for quantifiable cues of body mass index (BMI) in the face have examined only a small number of facial proportions and these proportions were found to have relatively low...... predictive power. Here we employed a data-driven approach in which statistical models were built using principal components (PCs) derived from objectively defined shape and color characteristics in face images. The predictive power of these models was then compared with models based on previously studied...... facial proportions (perimeter-to-area ratio, width-to-height ratio, and cheek-to-jaw width). Models based on 2D shape-only PCs, color-only PCs, and 2D shape and color PCs combined each performed significantly and substantially better than models based on one or more of the previously studied facial...

  16. Population health-based approaches to utilizing digital technology: a strategy for equity.

    Science.gov (United States)

    Graham, Garth N; Ostrowski, MaryLynn; Sabina, Alyse B

    2016-11-01

    Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing. Projects range from the broad-childhood education, lifestyle modification, health IT training, and nutrition education, to the specific-local healthy foods, stroke rehabilitation, and collection of city-level data. We describe our approaches to grantmaking and discuss lessons learned and their implications. When combined with sound policy strategies, emerging, scalable, digital technologies will likely become powerful allies for improving health and reducing health disparities.

  17. Review of remediation techniques for arsenic (As) contamination: a novel approach utilizing bio-organisms.

    Science.gov (United States)

    Rahman, Shahedur; Kim, Ki-Hyun; Saha, Subbroto Kumar; Swaraz, A M; Paul, Dipak Kumar

    2014-02-15

    Arsenic (As) contamination has recently become a worldwide problem, as it is found to be widespread not only in drinking water but also in various foodstuffs. Because of the high toxicity, As contamination poses a serious risk to human health and ecological system. To cope with this problem, a great deal of effort have been made to account for the mechanisms of As mineral formation and accumulation by some plants and aquatic organisms exposed to the high level of As. Hence, bio-remediation is now considered an effective and potent approach to breakdown As contamination. In this review, we provide up-to-date knowledge on how biological tools (such as plants for phytoremediation and to some extent microorganisms) can be used to help resolve the effects of As problems on the Earth's environment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Complete remission of recalcitrant genital warts with a combination approach of surgical debulking and oral isotretinoin in a patient with systemic lupus erythematosus.

    Science.gov (United States)

    Yew, Yik Weng; Pan, Jiun Yit

    2014-01-01

    Genital warts in immunocompromised patients can be extensive and recalcitrant to treatment. We report a case of recalcitrant genital warts in a female patient with systemic lupus erythematosus (SLE), who achieved complete remission with a combination approach of surgical debulking and oral isotretinoin at an initial dose of 20 mg/day with a gradual taper of dose over 8 months. She had previously been treated with a combination of topical imiquimod cream and regular fortnightly liquid nitrogen. Although there was partial response, there was no complete clearance. Her condition worsened after topical imiquimod cream was stopped because of her pregnancy. She underwent a combination approach of surgical debulking and oral isotretinoin after her delivery and achieved full clearance for more than 2 years duration. Oral isotretinoin, especially in the treatment of recalcitrant genital warts, is a valuable and feasible option when other more conventional treatment methods have failed or are not possible. It can be used alone or in combination with other local or physical treatment methods.

  19. Computational intelligence approach for NO{sub x} emissions minimization in a coal-fired utility boiler

    Energy Technology Data Exchange (ETDEWEB)

    Zhou Hao, E-mail: zhouhao@cmee.zju.edu.c [State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou 310027 (China); Zheng Ligang; Cen Kefa [State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou 310027 (China)

    2010-03-15

    The current work presented a computational intelligence approach used for minimizing NO{sub x} emissions in a 300 MW dual-furnaces coal-fired utility boiler. The fundamental idea behind this work included NO{sub x} emissions characteristics modeling and NO{sub x} emissions optimization. First, an objective function aiming at estimating NO{sub x} emissions characteristics from nineteen operating parameters of the studied boiler was represented by a support vector regression (SVR) model. Second, four levels of primary air velocities (PA) and six levels of secondary air velocities (SA) were regulated by using particle swarm optimization (PSO) so as to achieve low NO{sub x} emissions combustion. To reduce the time demanding, a more flexible stopping condition was used to improve the computational efficiency without the loss of the quality of the optimization results. The results showed that the proposed approach provided an effective way to reduce NO{sub x} emissions from 399.7 ppm to 269.3 ppm, which was much better than a genetic algorithm (GA) based method and was slightly better than an ant colony optimization (ACO) based approach reported in the earlier work. The main advantage of PSO was that the computational cost, typical of less than 25 s under a PC system, is much less than those required for ACO. This meant the proposed approach would be more applicable to online and real-time applications for NO{sub x} emissions minimization in actual power plant boilers.

  20. Computational intelligence approach for NO{sub x} emissions minimization in a coal-fired utility boiler

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Hao; Zheng, Ligang; Cen, Kefa [State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou 310027 (China)

    2010-03-15

    The current work presented a computational intelligence approach used for minimizing NO{sub x} emissions in a 300 MW dual-furnaces coal-fired utility boiler. The fundamental idea behind this work included NO{sub x} emissions characteristics modeling and NO{sub x} emissions optimization. First, an objective function aiming at estimating NO{sub x} emissions characteristics from nineteen operating parameters of the studied boiler was represented by a support vector regression (SVR) model. Second, four levels of primary air velocities (PA) and six levels of secondary air velocities (SA) were regulated by using particle swarm optimization (PSO) so as to achieve low NO{sub x} emissions combustion. To reduce the time demanding, a more flexible stopping condition was used to improve the computational efficiency without the loss of the quality of the optimization results. The results showed that the proposed approach provided an effective way to reduce NO{sub x} emissions from 399.7 ppm to 269.3 ppm, which was much better than a genetic algorithm (GA) based method and was slightly better than an ant colony optimization (ACO) based approach reported in the earlier work. The main advantage of PSO was that the computational cost, typical of less than 25 s under a PC system, is much less than those required for ACO. This meant the proposed approach would be more applicable to online and real-time applications for NO{sub x} emissions minimization in actual power plant boilers. (author)

  1. Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms

    Directory of Open Access Journals (Sweden)

    Taisia Vitkovski

    2015-01-01

    Full Text Available Background: Increasingly, as in our institution, operating rooms are located in hospitals and the pathology suite is located at a distant location because of off-site consolidation of pathology services. Telepathology is a technology which bridges the gap between pathologists and offers a means to obtain a consultation remotely. We aimed to evaluate the utility of telepathology as a means to assist the pathologist at the time of intraoperative consultation of lung nodules when a subspecialty pathologist is not available to directly review the slide. Methods: Cases of lung nodules suspicious for a neoplasm were included. Frozen sections were prepared in the usual manner. The pathologists on the intraoperative consultation service at two of our system hospitals notified the thoracic pathologist of each case after rendering a preliminary diagnosis. The consultation was performed utilizing a Nikon™ Digital Sight camera and web-based Remote Medical Technologies™ software with live video streaming directed by the host pathologist. The thoracic pathologist rendered a diagnosis without knowledge of the preliminary interpretation then discussed the interpretation with the frozen section pathologist. The interpretations were compared with the final diagnosis rendered after sign-out. Results: One hundred and three consecutive cases were included. The frozen section pathologist and a thoracic pathologist had concordant diagnoses in 93 cases (90.2%, discordant diagnoses in nine cases (8.7%, and one case in which both deferred. There was an agreement between the thoracic pathologist′s diagnosis and the final diagnosis in 98% of total cases including 8/9 (88.9% of the total discordant cases. In two cases, if the thoracic pathologist had not been consulted, the patient would have been undertreated. Conclusions: We have shown that telepathology is an excellent consultation tool in the frozen section diagnosis of lung nodules.

  2. World Climate Classification and Search: Data Mining Approach Utilizing Dynamic Time Warping Similarity Function

    Science.gov (United States)

    Stepinski, T. F.; Netzel, P.; Jasiewicz, J.

    2014-12-01

    We have developed a novel method for classification and search of climate over the global land surface excluding Antarctica. Our method classifies climate on the basis of the outcome of time series segmentation and clustering. We use WorldClim 30 arc sec. (approx. 1 km) resolution grid data which is based on 50 years of climatic observations. Each cell in a grid is assigned a 12 month series consisting of 50-years monthly averages of mean, maximum, and minimum temperatures as well as the total precipitation. The presented method introduces several innovations with comparison to existing data-driven methods of world climate classifications. First, it uses only climatic rather than bioclimatic data. Second, it employs object-oriented methodology - the grid is first segmented before climatic segments are classified. Third, and most importantly, the similarity between climates in two given cells is performed using the dynamic time warping (DTW) measure instead of the Euclidean distance. The DTW is known to be superior to Euclidean distance for time series, but has not been utilized before in classification of global climate. To account for computational expense of DTW we use highly efficient GeoPAT software (http://sil.uc.edu/gitlist/) that, in the first step, segments the grid into local regions of uniform climate. In the second step, the segments are classified. We also introduce a climate search - a GeoWeb-based method for interactive presentation of global climate information in the form of query-and-retrieval. A user selects a geographical location and the system returns a global map indicating level of similarity between local climates and a climate in the selected location. The results of the search for location: "University of Cincinnati, Main Campus" are presented on attached map. The results of the search for location: "University of Cincinnati, Main Campus" are presented on the map. We have compared the results of our method to Koeppen classification scheme

  3. Content-oriented Approach to Organization of Theories and Its Utilization

    Science.gov (United States)

    Hayashi, Yusuke; Bourdeau, Jacqueline; Mizoguch, Riichiro

    In spite of the fact that the relation between theory and practice is a foundation of scientific and technological development, the trend of increasing the gap between theory and practice accelerates in these years. The gap embraces a risk of distrust of science and technology. Ontological engineering as the content-oriented research is expected to contribute to the resolution of the gap. This paper presents the feasibility of organization of theoretical knowledge on ontological engineering and new-generation intelligent systems based on it through an application of ontological engineering in the area of learning/instruction support. This area also has the problem of the gap between theory and practice, and its resolution is strongly required. So far we proposed OMNIBUS ontology, which is a comprehensive ontology that covers different learning/instructional theories and paradigms, and SMARTIES, which is a theory-aware and standard-compliant authoring system for making learning/instructional scenarios based on OMNIBUS ontology. We believe the theory-awareness and standard-compliance bridge the gap between theory and practice because it links theories to practical use of standard technologies and enables practitioners to easily enjoy theoretical support while using standard technologies in practice. The following goals are set in order to achieve it; computers (1) understand a variety of learning/instructional theories based on the organization of them, (2) utilize the understanding for helping authors' learning/instructional scenario making and (3) make such theoretically sound scenarios interoperable within the framework of standard technologies. This paper suggests an ontological engineering solution to the achievement of these three goals. Although the evaluation is far from complete in terms of practical use, we believe that the results of this study address high-level technical challenges from the viewpoint of the current state of the art in the research area

  4. The utility of cadaver-based approaches for the teaching of human anatomy: A survey of British and Irish anatomy teachers.

    Science.gov (United States)

    Balta, Joy Y; Cronin, Michael; Cryan, John F; O'Mahony, Siobhain M

    2017-03-01

    Utilizing reality anatomy such as dissection and demonstrating using cadavers has been described as a superior way to create meaning. The chemicals used to embalm cadavers differentially alter the tissue of the human body, which has led to the usage of different processes along the hard to soft-fixed spectrum of preserved cadavers. A questionnaire based approach was used to gain a better insight into the opinion of anatomists on the use of preserved cadavers for the teaching of human anatomy. This study focused on anatomy teachers in the United Kingdom and Ireland. From the 125 participating anatomists, 34.4% were medically qualified, 30.4% had a PhD in a non-anatomical science and 22.4% had a PhD in an anatomical science, these figures include ten anatomists who had combinations of MD with the two other PhD qualifications. The main findings from the questionnaire were that 61.6% of participants agreed that hard-fixed formalin cadavers accurately resemble features of a human body whereas 21.6% disagreed. Moreover, anatomists rated the teaching aids on how accurately they resemble features of the human body as follows: plastic models the least accurate followed by plastinated specimens, hard fixed cadavers; soft preserved cadavers were considered to be the most accurate when it comes to resembling features of the human body. Though anatomists considered soft preserved cadavers as the most accurate tool, further research is required in order to investigate which techniques or methods provide better teaching tool for a range of anatomical teaching levels and for surgical training. Anat Sci Educ 10: 137-143. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

  5. Preserving the socket dimensions with bone grafting in single sites: an esthetic surgical approach when planning delayed implant placement.

    Science.gov (United States)

    Irinakis, Tassos; Tabesh, Moe

    2007-01-01

    Recent advancements in barrier membranes, bone grafting substitutes, and surgical techniques have led to a predictable arsenal of treatment methods for clinicians who practice implant dentistry. The contemporary clinician is supplied with proven knowledge, substantiated materials, and instrument inventory that allows implant placement in cases that used to be reserved for the specialist in the past because of their complexity. Nowadays, postextraction alveolar ridge maintenance can be a predictable procedure and can certainly aid the clinician in preventing ridge collapse, thereby allowing for implant placement in a position that satisfies esthetics and function. Extraction socket maintenance for future implant therapy does not rule out immediate implant placement but rather provides an additional option when treatment planning implant patients. This article will focus on the concept of extraction socket preservation using regenerative materials. It will describe a technique suggested by the authors to resist bone resorption and soft tissue shrinkage following tooth extraction.

  6. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  7. An alternative approach for choice models in transportation: Use of possibility theory for comparison of utilities

    Directory of Open Access Journals (Sweden)

    Dell’orco Mauro

    2004-01-01

    Full Text Available Modeling of human choice mechanism has been a topic of intense discussion in the transportation community for many years. The framework of modeling has been rooted in probability theory in which the analyst’s uncertainty about the integrity of the model is expressed in probability. In most choice situations, the decision-maker (traveler also experiences uncertainty because of the lack of complete information on the choices. In the traditional modeling framework, the uncertainty of the analyst and that of the decision-maker are both embedded in the same random term and not clearly separated. While the analyst's uncertainty may be represented by probability due to the statistical nature of events, that of the decision maker, however, is not always subjected to randomness; rather, it is the perceptive uncertainty. This paper proposes a modeling framework that attempts to account for the decision maker’s uncertainty by possibility theory and then the analyst's uncertainty by probability theory. The possibility to probability transformation is performed using the principle of uncertainty invariance. The proposed approach accounts for the quality of information on the changes in choice probability. The paper discusses the thought process, mathematics of possibility theory and probability transformation, and examples.

  8. Biosynthesis of Silver Nanoparticles from Desmodium triflorum: A Novel Approach Towards Weed Utilization.

    Science.gov (United States)

    Ahmad, Naheed; Sharma, Seema; Singh, V N; Shamsi, S F; Fatma, Anjum; Mehta, B R

    2011-01-01

    A single-step environmental friendly approach is employed to synthesize silver nanoparticles. The biomolecules found in plants induce the reduction of Ag(+) ions from silver nitrate to silver nanoparticles (AgNPs). UV-visible spectrum of the aqueous medium containing silver ions demonstrated a peak at 425 nm corresponding to the plasmon absorbance of silver nanoparticles. Transmission electron microscopy (TEM) showed the formation of well-dispersed silver nanoparticles in the range of 5-20 nm. X-ray diffraction (XRD) spectrum of the AgNPs exhibited 2θ values corresponding to the silver nanocrystal. The process of reduction is extracellular and fast which may lead to the development of easy biosynthesis of silver nanoparticles. Plants during glycolysis produce a large amount of H(+) ions along with NAD which acts as a strong redoxing agent; this seems to be responsible for the formation of AgNPs. Water-soluble antioxidative agents like ascorbic acids further seem to be responsible for the reduction of AgNPs. These AgNPs produced show good antimicrobial activity against common pathogens.

  9. Public service allocation, social utility and spillover effects: a revised benefit incidence approach

    Directory of Open Access Journals (Sweden)

    Stefano Mainardi

    2015-12-01

    Full Text Available In many developing countries, public service provision continues to fall short of demand. In the presence of severe infrastructure backlogs and different returns on public investment expenditure, marginal benefit incidence theory envisages that measures aimed at maximizing average access rates have contradictory impacts in the medium term. While relatively uniform expansion of access coverage across target areas can be achieved in some sectors, geographical disparities may persist or worsen in others. This study revises and extends a previous modeling approach by testing for endogenous eligibility, geographically-varying functional relationships, and number of uncompensated losers (numbers effect as an additional social welfare objective. Relative to medium-term changes in access rates in primary schools and healthcare, spatial and geographically weighted regression models are applied to districts in Niger. Results point to an eligibility threshold which exceeds the average coverage rate for primary education, some evidence of numbers effect as a target for healthcare, and substantial spatial heterogeneity particularly for primary schools.

  10. A large health system's approach to utilization of the genetic counselor CPT® 96040 code.

    Science.gov (United States)

    Gustafson, Shanna L; Pfeiffer, Gail; Eng, Charis

    2011-12-01

    : In 2007, CPT® code 96040 was approved for genetic counseling services provided by nonphysician providers. Because of professional recognition and licensure limitations, experiences in direct billing by genetic counselors for these services are limited. A minority of genetics clinics report using this code because of limitations, including perceived denial of the code and confusion regarding compliant use of this code. We present results of our approach to 96040 billing for genetic counseling services under a supervising physicians National Provider ID number in a strategy for integration of genetics services within nongenetics specialty departments of a large academic medical center. : The 96040 billing encounters were tracked for a 14-month period and analyzed for reimbursement by private payers. Association of denial by diagnosis code or specialty of genetics service was statistically analyzed. Descriptive data regarding appointment availability are also summarized. : Of 350 encounters January 2008 to February 2009, 289 (82%) were billed to private payers. Of these, 62.6% received some level of reimbursement. No association was seen for denial when analyzed by the diagnosis code or by genetics focus. Through this model, genetics appointment availability minimally doubled. : Using 96040 allowed for expanding access to genetics services, increased appointment availability, and was successful in obtaining reimbursement for more than half of encounters billed.

  11. Biosynthesis of Silver Nanoparticles from Desmodium triflorum: A Novel Approach Towards Weed Utilization

    Directory of Open Access Journals (Sweden)

    Naheed Ahmad

    2011-01-01

    Full Text Available A single-step environmental friendly approach is employed to synthesize silver nanoparticles. The biomolecules found in plants induce the reduction of Ag+ ions from silver nitrate to silver nanoparticles (AgNPs. UV-visible spectrum of the aqueous medium containing silver ions demonstrated a peak at 425 nm corresponding to the plasmon absorbance of silver nanoparticles. Transmission electron microscopy (TEM showed the formation of well-dispersed silver nanoparticles in the range of 5–20 nm. X-ray diffraction (XRD spectrum of the AgNPs exhibited 2θ values corresponding to the silver nanocrystal. The process of reduction is extracellular and fast which may lead to the development of easy biosynthesis of silver nanoparticles. Plants during glycolysis produce a large amount of H+ ions along with NAD which acts as a strong redoxing agent; this seems to be responsible for the formation of AgNPs. Water-soluble antioxidative agents like ascorbic acids further seem to be responsible for the reduction of AgNPs. These AgNPs produced show good antimicrobial activity against common pathogens.

  12. Combining psychological and engineering approaches to utilizing social robots with children with autism.

    Science.gov (United States)

    Dickstein-Fischer, Laurie; Fischer, Gregory S

    2014-01-01

    It is estimated that Autism Spectrum Disorder (ASD) affects 1 in 68 children. Early identification of an ASD is exceedingly important to the introduction of an intervention. We are developing a robot-assisted approach that will serve as an improved diagnostic and early intervention tool for children with autism. The robot, named PABI® (Penguin for Autism Behavioral Interventions), is a compact humanoid robot taking on an expressive cartoon-like embodiment. The robot is affordable, durable, and portable so that it can be used in various settings including schools, clinics, and the home. Thus enabling significantly enhanced and more readily available diagnosis and continuation of care. Through facial expressions, body motion, verbal cues, stereo vision-based tracking, and a tablet computer, the robot is capable of interacting meaningfully with an autistic child. Initial implementations of the robot, as part of a comprehensive treatment model (CTM), include Applied Behavioral Analysis (ABA) therapy where the child interacts with a tablet computer wirelessly interfaced with the robot. At the same time, the robot makes meaningful expressions and utterances and uses stereo cameras in eyes to track the child, maintain eye contact, and collect data such as affect and gaze direction for charting of progress. In this paper we present the clinical justification, anticipated usage with corresponding requirements, prototype development of the robotic system, and demonstration of a sample application for robot-assisted ABA therapy.

  13. Empirical Green's Function Approach for Utilizing Millisecond Focal and Pupil Plane Telemetry in Exoplanet Imaging

    CERN Document Server

    Frazin, Richard A

    2016-01-01

    Millisecond focal plane telemetry is now becoming practical due to a new generation of near-IR detector arrays with sub-electron noise that are capable of kHz readout rates. Combining these data with those simultaneously available from the wavefront sensing system allows the possibility of self-consistently determining the optical aberrations (the cause of quasi-static speckles) and the planetary image. This approach may be especially advantageous for finding planets within about 3 $\\lambda / D$ of the star where differential imaging is ineffective. As shown in a recent article by the author (J. Opt. Soc. Am. A., 33, 712, 2016), one must account for unknown aberrations in several non-conjugate planes of the optical system, which, in turn, requires ability to computational propagate the field between these planes. These computations are likely to be difficult to implement and expensive. Here, a far more convenient alternative based on empirical Green's functions is provided. It is shown that the empirical Gree...

  14. Determinants of brain cell metabolic phenotypes and energy substrate utilization unraveled with a modeling approach.

    Directory of Open Access Journals (Sweden)

    Aitana Neves

    Full Text Available Although all brain cells bear in principle a comparable potential in terms of energetics, in reality they exhibit different metabolic profiles. The specific biochemical characteristics explaining such disparities and their relative importance are largely unknown. Using a modeling approach, we show that modifying the kinetic parameters of pyruvate dehydrogenase and mitochondrial NADH shuttling within a realistic interval can yield a striking switch in lactate flux direction. In this context, cells having essentially an oxidative profile exhibit pronounced extracellular lactate uptake and consumption. However, they can be turned into cells with prominent aerobic glycolysis by selectively reducing the aforementioned parameters. In the case of primarily oxidative cells, we also examined the role of glycolysis and lactate transport in providing pyruvate to mitochondria in order to sustain oxidative phosphorylation. The results show that changes in lactate transport capacity and extracellular lactate concentration within the range described experimentally can sustain enhanced oxidative metabolism upon activation. Such a demonstration provides key elements to understand why certain brain cell types constitutively adopt a particular metabolic profile and how specific features can be altered under different physiological and pathological conditions in order to face evolving energy demands.

  15. Surgical patients' needs and actual utilization of community nursing services%手术出院患者社区护理需求与实际利用状况

    Institute of Scientific and Technical Information of China (English)

    张玉萍; 黄素芳; 李秀云

    2010-01-01

    Objective To investigate the surgical patients' needs of community nursing services and actual utilization within one week of out hospital. Methods Sampled 257 adults surgical patients from certain general hospital, interviewed them by self-designed queostionnair to know their needs of community nursing services and actual utilization within one week after out of hospital. Results There were 96% pa-tients required community nursing services at the point of discharge. The content of services needs included dise ases cares, health teaching and prevention services. Different moded of community nursing cares were required. The actual utilization rate within one week was 16.5%, there were 54.5% and 63.6% of patients received wound care and medication administration separately, which were mainly provided by center visit. Conclusions There is a contradiction between the needs and actual utilization of com-munity nursing services. It is meaningful to enhance the utilization rate, extend the content and perfect the modes of community nursing services so as to satisfy discharged surgical patients' needs.%目的 调查手术患者出院时社区护理服务需求及出院1周内实际利用社区护理服务的状况.方法 采用整群抽样的方法选取某综合医院257例手术患者为研究对象,运用自制调查表,在患者出院当日调查社区护理服务需求情况,在患者出院1周时电话随访社区护理服务实际利用情况.结果 96.0%的手术患者出院时存在社区护理需求;需求的社区护理服务项目涉及疾病护理、健康指导及预防保健类服务;需求多种服务方式.出院1周内社区护理实际利用率为16.5%;分别有54.5%和63.6%的患者利用了伤口护理和给药护理服务,服务内容以疾病护理为主,服务方式以社区卫生服务中心(站)护理为主.结论 手术出院患者对社区护理服务的需求状况与实际利用情况两者存在矛盾.积极开展手术患者社区护理服

  16. 90Sr liquid scintillation urine analysis utilizing different approaches for tracer recovery.

    Energy Technology Data Exchange (ETDEWEB)

    Piraner, Olga; Preston, Rose T.; Shanks, Sonoya Toyoko; Jones, Robert

    2010-08-01

    90Sr is one of the isotopes most commonly produced by nuclear fission. This medium lived isotope presents serious challenges to radiation workers, the environment, and following a nuclear event, the general public. Methods of identifying this nuclide have been in existence for a number of years (e.g. Horwitz, E.P. [1], Maxwell, S.L.[2], EPA 905.0 [3]) which are time consuming, requiring a month or more for full analysis. This time frame is unacceptable in the present security environment. It is therefore important to have a dependable and rapid method for the determination of Sr. The purposes of this study are to reduce analysis time to less than half a day by utilizing a single method of radiation measurement while continuing to yield precise results. This paper presents findings on three methods that can meet this criteria; (1) stable Sr carrier, (2) 85Sr by gamma spectroscopy, and (3) 85Sr by LSC. Two methods of analyzing and calculating the 85Sr tracer recovery were investigated (gamma spectroscopy and a low energy window-Sr85LEBAB by LSC) as well as the use of two different types of Sr tracer (85Sr and stable Sr carrier). Three separate stock blank urine samples were spiked with various activity levels of 239Pu, 137Cs, 90Sr /90Y to determine the effectiveness of the Eichrome Sr-spec resin 2mL extractive columns. The objective was to compare the recoveries of 85Sr versus a stable strontium carrier, attempt to compare the rate at which samples can be processed by evaluating evaporation, neutralization, and removing the use of another instrument (gamma spectrometer) by using the LSC spectrometer to obtain 85Sr recovery. It was found that when u