Sample records for surgical instruments

  1. Encapsulation process sterilizes and preserves surgical instruments (United States)

    Montgomery, L. C.; Morelli, F. A.


    Ethylene oxide is blended with an organic polymer to form a sterile material for encapsulating surgical instruments. The material does not bond to metal and can be easily removed when the instruments are needed.

  2. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams. (United States)

    Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

    The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

  3. Endotoxins in surgical instruments of hip arthroplasty


    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães


    Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

  4. Endotoxins in surgical instruments of hip arthroplasty

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    Vania Regina Goveia


    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  5. 21 CFR 870.4500 - Cardiovascular surgical instruments. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiovascular surgical instruments. 870.4500 Section 870.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... surgical instruments. (a) Identification. Cardiovascular surgical instruments are surgical instruments that...

  6. Recent technological advancements in laparoscopic surgical instruments (United States)

    Subido, Edwin D. C.; Pacis, Danica Mitch M.; Bugtai, Nilo T.


    Laparoscopy was a progressive step to advancing surgical procedures as it minimised the scars left on the body after surgery, compared to traditional open surgery. Many years later, single-incision laparoscopic surgery (SILS) was created where, instead of having multiple incisions, only one incision is made or multiple small incisions in one location. SILS, or laparoendoscopic single-site surgery (LESS), may produce lesser scars but drawbacks for the surgeons are still present. This paper aims to present related literature of the recent technological developments in laparoscopic tools and procedure particularly in the vision system, handheld instruments. Tech advances in LESS will also be shown. Furthermore, this review intends to give an update on what has been going on in the surgical robot market and state which companies are interested and are developing robotic systems for commercial use to challenge Intuitive Surgical's da Vinci Surgical System that currently dominates the market.

  7. 21 CFR 888.4540 - Orthopedic manual surgical instrument. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Orthopedic manual surgical instrument. 888.4540... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4540 Orthopedic manual surgical instrument. (a) Identification. An orthopedic manual surgical instrument is a nonpowered hand-held device...

  8. [History of surgical instruments. 9. Surgical instruments and development of surgical technique of lithotomy incision]. (United States)

    Sachs, M; Peters, J


    Lithotomy, i.e. the surgical method of cutting for stone in the bladder, belongs to the oldest and, due to the high risk, most notorious operating techniques. Records of stone-cuttings date as far back as Ancient Greece. The first detailed description of the procedure and instrumentation of lithotomy is to be found by Celsus (1. century AD). The patient in the lithotomy position, the neck of the bladder is approached by a median incision of the perineum. Celsus is also the first to mention special stone-hooking instruments ("uncus") to aid in extracting the bladder-stones. Medico-historical development lead to constant changes in the technique as well as in the instrumentation, since the lack of analgesia and anaesthesia necessitated quick operations of only a few minutes. A key step in the progress of operation was the introduction of so-called path-finders and directing probes in the 16th century. The opening of the bladder from the perineal incision was now accompanied by the simultaneous admission of a metal catheter into the bladder via urethra, thus providing the "Lithotomist", through manual control of the catheter, with an enhanced orientation towards the position of urethra and bladder. At that time, the dissection was conducted bluntly and without direct view of the situation, i.e. without an exact representation of the structures to be separated. Thanks to the improved instrumentation, the instruments could now be guided along a probe directly into the bladder, thus alleviating the tedious search for the opening after changing instruments, all the while with an agitated, pressing patient. Famous names in the development of the lithotomy with an perineal incision are the medical doctor Mariano Santo (around 1488-1564), the barber-surgeon Frère Jacques de Beaulieu (1651-1719) and later Johann Jakob Rau M.D. (1668-1719). Only later, to avoid injury to the perineum, the suprasymphyseal approach ("Sectio alta") was adopted (primarily by Pierre Franco 1556

  9. Endotoxins in surgical instruments of hip arthroplasty. (United States)

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães


    To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

  10. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification (United States)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas


    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

  11. Minimizing electromagnetic interference from surgical instruments on electromagnetic surgical navigation. (United States)

    Stevens, Faustin; Conditt, Michael A; Kulkarni, Nikhil; Ismaily, Sabir K; Noble, Philip C; Lionberger, David R


    Electromagnetic computer-assisted surgery (EM-CAS) can be affected by various metallic or ferromagnetic factors. We determined to what extent metals interfere with accuracy and identified measures to prevent interference from occurring. Using an EM-CAS system, we made six standard measurements of tibiofemoral position and alignment on a surrogate knee. A stainless steel mallet was positioned 10 cm from the stylus, and then 10 cm from the localizer to create errors attributable to electromagnetic interference. The experiment was repeated with bars of different metals placed 10 cm from the stylus. The maximum errors recorded with a mallet were: varus/valgus alignment, -2.7 degrees and 2.4 degrees; flexion/extension, -5.8 degrees and 3.0 degrees; lateral resection level, -3.1 and 7.5 mm; and medial resection level, -4.0 and 2.3 mm, respectively. The smallest errors were recorded with cylinders of titanium, cobalt-chrome alloy, and stainless steels. When moved more than 10 cm away from the stylus, errors became negligible. The accuracy of EM navigation systems is affected substantially by the size, type, proximity, and shape of metal objects. Stainless steel objects, such as cutting blocks and trial prostheses, should be kept more than 10 cm from EM-CAS instruments to minimize error.

  12. Evaluation of Sensor Configurations for Robotic Surgical Instruments (United States)

    Gómez-de-Gabriel, Jesús M.; Harwin, William


    Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS) is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included. PMID:26516863

  13. Left-handed surgical instruments - a guide for cardiac surgeons. (United States)

    Burdett, Clare; Theakston, Maureen; Dunning, Joel; Goodwin, Andrew; Kendall, Simon William Henry


    For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.

  14. Surgical site infections following instrumented stabilization of the spine

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    Dapunt U


    Full Text Available Ulrike Dapunt,1 Caroline Bürkle,1 Frank Günther,2 Wojciech Pepke,1 Stefan Hemmer,1 Michael Akbar1 1Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 2Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University, Heidelberg, Germany Background: Implant-associated infections are still a feared complication in the field of orthopedics. Bacteria attach to the implant surface and form so-called biofilm colonies that are often difficult to diagnose and treat. Since the majority of studies focus on prosthetic joint infections (PJIs of the hip and knee, current treatment options (eg, antibiotic prophylaxis of implant-associated infections have mostly been adapted according to these results. Objective: The aim of this study was to evaluate patients with surgical site infections following instrumented stabilization of the spine with regard to detected bacteria species and the course of the disease. Patients and methods: We performed a retrospective single-center analysis of implant-associated infections of the spine from 2010 to 2014. A total of 138 patients were included in the study. The following parameters were evaluated: C-reactive protein serum concentration, microbiological evaluation of tissue samples, the time course of the disease, indication for instrumented stabilization of the spine, localization of the infection, and the number of revision surgeries required until cessation of symptoms. Results: Coagulase-negative Staphylococcus spp. were most commonly detected (n=69, 50%, followed by fecal bacteria (n=46, 33.3%. In 23.2% of cases, no bacteria were detected despite clinical suspicion of an infection. Most patients suffered from degenerative spine disorders (44.9%, followed by spinal fractures (23.9%, non-degenerative scoliosis (20.3%, and spinal tumors (10.1%. Surgical site infections occurred predominantly within 3

  15. Femoral Test Bed for Impedance Controlled Surgical Instrumentation

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    Christian Brendle


    Full Text Available The risk for patients during the standard procedure of revision of cemented artificial hip joints is unsatisfactorily highdue to its high level of invasiveness and limited access to the operative field. To reduce this risk we are developing anImpedance Controlled Surgical Instrumentation (ICOS system, which aims to establish real-time control during a BoneCement (BC milling process. For this, the relationship between the thickness of the BC and its frequency-dependentelectrical impedance is used to estimate the residual BC thickness. The aim is to avoid unintended cutting of boneby detecting the passage of the BC/bone boundary layer by the milling head. In a second step, an estimation of theresidual BC thickness will be used to improve process control. As a first step towards demonstrating the feasibility ofour approach, presented here are experimental studies to characterize the BC permittivity and to describe the process indetail. The results show that the permittivity properties of BC are dominated by its polymethyl methacrylate (PMMAfraction. Thus, PMMA can be used as a substitute for future experiments. Furthermore, a Femoral Test Bed (FTB wasdesigned. Using this setup we show it is feasible to accurately distinguish between slightly different thicknesses of BC.

  16. Applying lean methods to improve quality and safety in surgical sterile instrument processing. (United States)

    Blackmore, C Craig; Bishop, Robbi; Luker, Samuel; Williams, Barbara L


    Surgical instrument processing is critical to safe, high-quality surgical care but has received little attention in the medical literature. Typical hospitals have inventories in the tens of thousands of surgical instruments organized into thousands of instrument sets. The use of these instruments for multiple procedures per day leads to millions of instrument sets being reprocessed yearly in a single hospital. Errors in the processing of sterile instruments may lead to increased operative times and costs, as well as potentially contributing to surgical infections and perioperative morbidity. At Virginia Mason Medical Center (Seattle), a quality monitoring approach was developed to identify and categorize errors in sterile instrument processing, through use of a daily defect sheet. Lean methods were used to improve the quality of surgical instrument processing through redefining operator roles, alteration of the workspace, mistake-proofing, quality monitoring, staff training, and continuous feedback. To study the effectiveness of the quality improvement project, a before/after comparison of prospectively collected sterile processing error rates during a 37-month time frame was performed. Before the intervention, instrument processing errors occurred in 3.0% of surgical cases, decreasing to 1.5% at the final follow-up (p instrument processing errors are a barrier to the highest quality and safety in surgical care but are amenable to substantial improvement using Lean techniques.

  17. Computational modeling and design of a new open clip surgical instrument. (United States)

    Li, Jeremy Zheng


    This research introduces a new surgical clip instrument with improved mechanism to apply the metal clips to patient's vessel/tissues in the surgical operations. The improved clip delivery system has been designed and developed in the instrument to improve the clip distal move from clip channel into jaw guide track and resolve the problems of clip accidental shooting out when clip is being loaded into jaw pair by compression spring that has been normally used in some current surgical clip instruments. With this improvement, this new surgical open clip instrument can prevent patient's vessels and tissues from being damaging because the distal move of clips is well controlled without clip drop-off incident. Plus the operational force to form the clip is lower than regular surgical instruments due to new mechanism design. In addition to the above, the manufacturing and product cost can be decreased because the dimensional tolerance of components, such as clip channel and jaw guide track, can be wider due to this new instrument design. The prototype of this new instrument is analyzed and optimized through computer aided modeling and simulation, in order to prove its feasible function, reliable performance, and mechanical advantage. All these improved features have also been tested and verified through the prototype. With some further improvement to this new instrument design and valuable evaluations from surgeon and clinical fields in next several months, the commercial availability of this surgical clip instrument will be anticipate in 1-2 years.

  18. Research on seamless development of surgical instruments based on biological mechanisms using CAD and 3D printer. (United States)

    Yamamoto, Ikuo; Ota, Ren; Zhu, Rui; Lawn, Murray; Ishimatsu, Takakazu; Nagayasu, Takeshi; Yamasaki, Naoya; Takagi, Katsunori; Koji, Takehiko


    In the area of manufacturing surgical instruments, the ability to rapidly design, prototype and test surgical instruments is critical. This paper provides a simple case study of the rapid development of two bio-mechanism based surgical instruments which are ergonomic, aesthetic and were successfully designed, prototyped and conceptually tested in a very short period of time.

  19. Medical Devices; General and Plastic Surgery Devices; Classification of the Magnetic Surgical Instrument System. Final order. (United States)


    The Food and Drug Administration (FDA) is classifying the Magnetic Surgical Instrument System into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the magnetic surgical instrument system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  20. Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical instruments

    NARCIS (Netherlands)

    Wu, G.; Yu, X.F.


    Our study assessed the factors that influence the resistance of blood residues on dental surgical instruments to washer‐disinfector-based cleaning procedures in a clinical setting. The use of 2 additional cleaning methods—presoaking and scrubbing by hand—and the use of newer and/or less structurally

  1. An Instrumented Minimally Invasive Surgical Tool: Design and Calibration

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    Philip R. Roan


    Full Text Available Minimally invasive surgical procedures have improved the standard of patient care by reducing recovery time, chance of infection, and scarring. A recent review estimates that leaks occur in 3% to 6% of bowel anastomoses, resulting in “increased morbidity and mortality and adversely [affecting] length of stay, cost, and cancer recurrence” [23]. Many of these leaks are caused by poor handling and ischemic tissue.

  2. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

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    Liv-Helen Heggland


    Full Text Available The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items, formulation of options (4 items, integration of information (4 items, and control (3 items. The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation.

  3. Surgical Site Infection Following Posterior Instrumented Surgery for Thoracolumbar Burst Fractures

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    A Zulkefli


    Full Text Available OBJECTIVES: To study the prevalence and the risk factors for surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures. METHODOLOGY: Retrospective review of cases operated between year 2006 and 2007. The final end point is the detection of surgical site infection within one year. RESULTS: A total of 38 cases were reviewed. Surgical site infection occurred in 5 cases. Only one had deep infection. The onset of infection occurred within one month in all cases. The risk factors studied were smoking, timing of surgery, duration of surgery, neurological deficit, associated injuries and high dose methylprednisolone administration. None of them were statistically significant as risk factors for surgical site infection. CONCLUSION: The prevalence of surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures was 13%.

  4. Identification of surgical instruments using UHF-RFID technology

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    Bourouah Mohamed


    Full Text Available The paper presents research, development and advantage of Radio Frequency IDentification (RFID technology based system for medical instrument management and safe usage. The system is developed for two scenarios. In the first scenario, a Ultra High Frequency (UHF is used and the UHF–interrogator system with UHF-antennas is constructed to work as conveyor-belt and instruments are placed between two antennas. Second scenario, suitable for the operating rooms, includes four antennas, placed under the table with instruments, system’s phase shifter, inserted between the antenna and reader in order to reduce the effect of dead spots, caused by the electromagnetic reflections. High reliable identification rate is achieved by synchronizing phase shifters with particular interrogator. The system is software calibrated and can be re-calibrated at run-time to achieve high efficiency of power transmission to the antenna and in order to enable the receiver to decode the tag signals. With currently on the market available RFID tags and previously mentioned technology approaches, detection rate of 87.5% can be achieved.

  5. Factors determining the potential for onward transmission of variant Creutzfeldt–Jakob disease via surgical instruments (United States)

    Garske, Tini; Ward, Hester J.T; Clarke, Paul; Will, Robert G; Ghani, Azra C


    While the number of variant Creutzfeldt–Jakob disease (vCJD) cases continues to decline, concern has been raised that transmission could occur directly from one person to another through routes including the transfer of blood and shared use of surgical instruments. Here we firstly present data on the surgical procedures undertaken on vCJD patients prior to onset of clinical symptoms, which supports the hypothesis that cases via this route are possible. We then apply a mathematical framework to assess the potential for self-sustaining epidemics via surgical procedures. Data from hospital episode statistics on the rates of high- and medium-risk procedures in the UK were used to estimate model parameters, and sensitivity to other unknown parameters about surgically transmitted vCJD was assessed. Our results demonstrate that a key uncertainty determining the scale of an epidemic and whether it is self-sustaining is the number of times a single instrument is re-used, alongside the infectivity of contaminated instruments and the effectiveness of cleaning. A survey into the frequency of re-use of surgical instruments would help reduce these uncertainties. PMID:17015298

  6. A Historical Glance at the Arabo-Islamic Surgical Instruments During the Ages. (United States)

    Tsoucalas, Gregory; Sgantzos, Markos


    Arabo-Islamic physicians demonstrated exceptional skill and innovation in surgery, by having used the instruments introduced by ancient Greeks and Greco-Roman surgeons. In many cases they have manufactured their own innovative designs promoting further the success of the difficult surgical operations of their era. The surgical instruments and the surgeon's boxes, used to regularise the plethora of the metallic items, were decorated with fine designs, in order to depict the Arab civilisation. For the first time surgery became a separate medical art, while Arabo-Islamic medicine re-introduced ancient Greek and Byzantine surgery to the world.

  7. Validation of cleaning evaluation of surgical instruments with RFID tags attached based on cleaning appraisal judgment guidelines. (United States)

    Yamashita, Kazuhiko; Kusuda, Kaori; Tokuda, Yoko; Onishi, Akiko; Tanaka, Kiyohito; Shimizu, Masatake; Kanda, Ryohei; Honda, Hiroshi; Komino, Masaru; Iwakami, Yumi; Ohta, Yuji; Okubo, Takashi


    In medical institutions, the threat of infection is closely focused, in particular, inspections regarding surgical site infections (SSI) are carried out. In this study, development of the application of Radio frequency identification (RFID) tags for surgical instrument has been promoted. It enables traceability and individual management of surgical instruments. An experiment was carried out following the cleaning Appraisal guidelines, which contaminated surgical instruments, and using the washer-disinfector (WD) as the main cleaner for surgical instruments with developed RFID tags attached to them. As a result, all of the instruments with RFID tags, the amount of residual protein was less than the recommended acceptable level of 100µg. If WD is used correctly, a sufficient cleaning effect can be expected. From this result, it became evident that the secondary infection risk is low from surgical instrument with RFID tags attached.

  8. Development and validation of an objective instrument to measure surgical performance at tonsillectomy. (United States)

    Roberson, David W; Kentala, Erna; Forbes, Peter


    The goals of this project were 1) to develop and validate an objective instrument to measure surgical performance at tonsillectomy, 2) to assess its interobserver and interobservation reliability and construct validity, and 3) to select those items with best reliability and most independent information to design a simplified form suitable for routine use in otolaryngology surgical evaluation. Prospective, observational data collection for an educational quality improvement project. The evaluation instrument was based on previous instruments developed in general surgery with input from attending otolaryngologic surgeons and experts in medical education. It was pilot tested and subjected to iterative improvements. After the instrument was finalized, a total of 55 tonsillectomies were observed and scored during academic year 2002 to 2003: 45 cases by residents at different points during their rotation, 5 by fellows, and 5 by faculty. Results were assessed for interobserver reliability, interobservation reliability, and construct validity. Factor analysis was used to identify items with independent information. Interobserver and interobservation reliability was high. On technical items, faculty substantially outperformed fellows, who in turn outperformed residents (P reliability and good construct validity. Factor analysis demonstrated that patient care is a distinct domain in surgical skill. Although the interobserver reliability for some patient care items reached statistical significance, it was not high enough for "high stakes testing" purposes. Using reliability and factor analysis results, we propose a simplified instrument for use in evaluating trainees in otolaryngologic surgery.

  9. Cost Savings of Standardization of Thoracic Surgical Instruments: The Process of Lean. (United States)

    Cichos, Kyle H; Linsky, Paul L; Wei, Benjamin; Minnich, Douglas J; Cerfolio, Robert J


    Our objective is to show the effect that standardization of surgical trays has on the number of instruments sterilized and on cost. We reviewed our most commonly used surgical trays with the 3 general thoracic surgeons in our division and agreed upon the least number of surgical instruments needed for mediastinoscopy, video-assisted thoracoscopic surgery, robotic thoracic surgery, and thoracotomy. We removed 59 of 79 instruments (75%) from the mediastinoscopy tray, 45 of 73 (62%) from the video-assisted thoracoscopic surgery tray, 51 of 84 (61%) from the robotic tray, and 50 of 113 (44%) from the thoracotomy tray. From January 2016 to December 2016, the estimated savings by procedure were video-assisted thoracoscopic surgery (n = 398) $21,890, robotic tray (n = 231) $19,400, thoracotomy (n = 163) $15,648, and mediastinoscopy (n = 162) $12,474. Estimated total savings were $69,412. The weight of the trays was reduced 70%, and the nonsteamed sterilization rate (opened trays that needed to be reprocessed) decreased from 2% to 0%. None of the surgeons requested any of the removed instruments. Standardization of thoracic surgical trays is possible despite having multiple thoracic surgeons. This process of lean (the removal of nonvalue steps or equipment) reduces the number of instruments cleaned and carried and reduces cost. It may also reduce the incidence of "wet loads" that require the resterilization of instruments. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Reduction and standardization of surgical instruments in pediatric inguinal hernia repair. (United States)

    Koyle, Martin A; AlQarni, Naif; Odeh, Rakan; Butt, Hissan; Alkahtani, Mohammed M; Konstant, Louis; Pendergast, Lisa; Koyle, Leah C C; Baker, G Ross


    To standardize and reduce surgical instrumentation by >25% within a 9-month period for pediatric inguinal hernia repair (PIHR), using "improvement science" methodology. We prospectively evaluated instruments used for PIHR in 56 consecutive cases by individual surgeons across two separate subspecialties, pediatric surgery (S) and pediatric urology (U), to measure actual number of instruments used compared with existing practice based on preference cards. Based on this evaluation, a single preference card was developed using only instruments that had been used in >50% of all cases. A subsequent series of 52 cases was analyzed to assess whether the new tray contained the ideal instrumentation. Cycle time (CT), to sterilize and package the instruments, and weights of the trays were measured before and after the intervention. A survey of operating room (OR) nurses and U and S surgeons was conducted before and after the introduction of the standardized tray to assess the impact and perception of standardization. Prior to creating the standardized tray, a U PIHR tray contained 96 instruments with a weight of 13.5 lbs, while the S set contained 51, weighing 11.2 lbs. The final standardized set comprised 28 instruments and weighed 7.8 lbs. Of 52 PIHRs performed after standardization, in three (6%) instances additional instruments were requested. CT was reduced from 11 to 8 min (U and S respectively) to instrumentation for other common surgeries. Standardization of surgical equipment can be employed across disciplines with the potential to reduce costs and positively impact quality, safety, and efficiencies. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  11. Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility. (United States)

    Weld, Kyle J; Dryer, Stephen; Ames, Caroline D; Cho, Kuk; Hogan, Chris; Lee, Myonghwa; Biswas, Pratim; Landman, Jaime


    We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility. The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles >500 nm and Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories. The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components. The aerosol produced by the Bipolar Macroforceps obscured visibility the least (relative visibility 0.887) among the instruments tested. Particles from the Harmonic Scalpel resulted in a relative visibility of 0.801. Monopolar-based instruments produced plumes responsible for the poorest relative visibility (Floating Ball 0.252; Monopolar Shears 0.026). Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.

  12. 3D printing of surgical instruments for long-duration space missions. (United States)

    Wong, Julielynn Y; Pfahnl, Andreas C


    The first off-Earth fused deposition modeling (FDM) 3D printer will explore thermoplastic manufacturing capabilities in microgravity. This study evaluated the feasibility of FDM 3D printing 10 acrylonitrile butadiene styrene (ABS) thermoplastic surgical instruments on Earth. Three-point bending tests compared stiffness and yield strength between FDM 3D printed and conventionally manufactured ABS thermoplastic. To evaluate the relative speed of using four printed instruments compared to conventional instruments, 13 surgeons completed simulated prepping, draping, incising, and suturing tasks. Each surgeon ranked the performance of six printed instruments using a 5-point Likert scale. At a thickness of 5.75 mm or more, the FDM printing process had a less than 10% detrimental effect on the tested yield strength and stiffness of horizontally printed ABS thermoplastic relative to conventional ABS thermoplastic. Significant weakness was observed when a bending load was applied transversely to a 3D printed layer. All timed tasks were successfully performed using a printed sponge stick, towel clamp, scalpel handle, and toothed forceps. There was no substantial difference in time to completion of simulated surgical tasks with control vs. 3D printed instruments. Of the surgeons, 100%, 92%, 85%, 77%, 77%, and 69% agreed that the printed smooth and tissue forceps, curved and straight hemostats, tissue and right angle clamps, respectively, would perform adequately. It is feasible to 3D print ABS thermoplastic surgical instruments on Earth. Loadbearing structures were designed to be thicker, when possible. Printing orientations were selected so that the printing layering direction of critical structures would not be transverse to bending loads.

  13. Highly sensitive rapid fluorescence detection of protein residues on surgical instruments

    International Nuclear Information System (INIS)

    Kovalev, Valeri I; Bartona, James S; Richardson, Patricia R; Jones, Anita C


    There is a risk of contamination of surgical instruments by infectious protein residues, in particular, prions which are the agents for Creutzfeldt-Jakob Disease in humans. They are exceptionally resistant to conventional sterilization, therefore it is important to detect their presence as contaminants so that alternative cleaning procedures can be applied. We describe the development of an optimized detection system for fluorescently labelled protein, suitable for in-hospital use. We show that under optimum conditions the technique can detect ∼10 attomole/cm 2 with a scan speed of ∼3-10 cm 2 /s of the test instrument's surface. A theoretical analysis and experimental measurements will be discussed

  14. On using an array of fiber bragg grating sensors for closed-loop control of flexible minimally invasive surgical instruments

    NARCIS (Netherlands)

    Roesthuis, Roy; Janssen, Sander; Misra, Sarthak


    Flexible minimally invasive surgical instruments can be used to target difficult-to-reach locations within the human body. Accurately steering these instruments requires information about the three-dimensional shape of the instrument. In the current study, we use an array of Fiber Bragg Grating

  15. A novel 4-DOF surgical instrument with modular joints and 6-Axis Force sensing capability. (United States)

    Li, Kun; Pan, Bo; Zhang, Fuhai; Gao, Wenpeng; Fu, Yili; Wang, Shuguo


    It is difficult for surgeons to exert appropriate forces during delicate operations due to lack of force feedback in robot-assisted minimally invasive surgery (RMIS). A 4-DOF surgical grasper with a modular wrist and 6-axis force sensing capability is developed. A grasper integrated with a miniature force and torque sensor based on the Stewart platform is designed, and a cable tension decomposition mechanism is designed to alleviate influence of the cable tension to the sensor. A modularized wrist consisting of four joint units is designed to facilitate integration of the sensor and eliminate coupled motion of the wrist. Sensing ranges of this instrument are ±10 N and ±160 N mm, and resolutions are 1.2% in radial directions, 5% in axial direction, and 4.2% in rotational directions. An ex vivo experiment shows that this instrument prototype successfully measures the interaction forces. A 4-DOF surgical instrument with modular joints and 6-axis force sensing capability is developed. This instrument can be used for force feedback in RMIS. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. A Clinical Trial of Contamination of Surgical Instruments with Staphylococcus aureus During Long Time Orthopedic Surgeries

    Directory of Open Access Journals (Sweden)

    Mojgan Pirmoradian


    Full Text Available Background and Objectives: Approximately 5% of patients undergoing surgery develop surgical site infections (SSI, which prolong the length of hospital stay to 9.7 days. This study was performed aimed to determine the amount of contamination of sterile surgical instruments with Staphylococcus aureus during long time orthopedic surgeries.Methods: In This study done as a prospective study, 245 sterile surgical instruments were sampled. The contaminated samples at every hour were excluded from samples of next hour. Then, antibiotic susceptibility of Staphylococcus aureus strains was tested by 14 antibiotics using disk diffusion method according to the recommendations of CLSI. The MIC of the strains towards methicillin was tested through microdilution method, and PCR was done on mecA gene. Data and results were analyzed by chi-square statistical test and significance level was considered to be p<0/05.Results: Out of a total of 110 specimens obtained immediately after opening the sterile covering, 5 cultures were positive (4.54%; 10 (10.98% in 91 samples taken after surgery; 5 (15.62% in 32 samples taken 2 hours after surgery; and 1 (8.33% 1 in 12 samples taken 3 hours after surgery. The highest resistance of the isolates was against ceftazidime (85.71%, and all strains were sensitive to vancomycin (100%. In MIC test, 52.38% of the strains were resistant to methicillin, and 66.66% of the strains had mecA gene in the PCR method.Conclusion: Considering high contamination rate of surgical instruments with S. aureus, it is recommended that the covering of the sterile trays should not be opened until they are specifically needed during the procedure.

  17. Surgical guides (patient-specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction. (United States)

    Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis


    To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  18. Surgical Guides (Patient-Specific Instruments for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

    Directory of Open Access Journals (Sweden)

    Laura Bellanova


    Full Text Available To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI and computerized tomography (CT were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  19. An integrated approach to endoscopic instrument tracking for augmented reality applications in surgical simulation training. (United States)

    Loukas, Constantinos; Lahanas, Vasileios; Georgiou, Evangelos


    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.

  20. Evaluation of the Unit Rod surgical instrumentation in Duchenne scoliosis. A retrospective study. (United States)

    Nedelcu, T; Georgescu, I


    The article represents a retrospective clinical and radiological study. Objectives. Evaluating the safety and efficiency of the surgical treatment by using the Unit Rod for scoliosis in adolescents and children presenting Duchenne's muscular dystrophy. Summary. Surgical management of myopathic scoliosis still causes controversies regarding the timing of surgery (patient's age), the pelvic inclusion in the arthrodesis or the advantages of surgery over the conservatory treatment. The patients are very fragile and a long surgery with massive blood loss could lead to serious complications. Unit Rod instrumentation is simple, confers excellent stability and has a low rate of complications. Methods. This is a retrospective clinical and radiological study with a medium follow-up of 6.9 years including 13 patients diagnosed with Duchenne myopathy. All investigated patients were non-ambulatory at the time of surgery and have been treated by the Unit Rod technique at the University Hospital of Rouen between 2002 and 2008. Spinal fusion was, in all cases, realized from T2 to pelvis. Galveston technique of pelvic fixation and Luque's sublaminar wire instrumentation of the spine were used. Results. The results obtained with this treatment and post-surgery complications were analyzed and compared with those from literature. The advantages of this technique consist mostly in a good and stable pelvic fixation, a short interventional time, a minimal blood loss and few complications. Cobb angle correction is similar to that obtained by other surgical procedures. Conclusions. Using the Unit Rod instrumentation of scoliosis in Duchenne's muscular dystrophy is safe, has excellent outcomes, brings post-surgery improvements, and has minor intra and post-surgery complications. The low cost of this treatment could make it a first choice for medical health systems with financial problems.

  1. 21 CFR 878.4810 - Laser surgical instrument for use in general and plastic surgery and in dermatology. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Laser surgical instrument for use in general and plastic surgery and in dermatology. 878.4810 Section 878.4810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4810 Laser...

  2. Highly sensitive rapid fluorescence detection of protein residues on surgical instruments

    Energy Technology Data Exchange (ETDEWEB)

    Kovalev, Valeri I [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Bartona, James S [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Richardson, Patricia R [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom); Jones, Anita C [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom)


    There is a risk of contamination of surgical instruments by infectious protein residues, in particular, prions which are the agents for Creutzfeldt-Jakob Disease in humans. They are exceptionally resistant to conventional sterilization, therefore it is important to detect their presence as contaminants so that alternative cleaning procedures can be applied. We describe the development of an optimized detection system for fluorescently labelled protein, suitable for in-hospital use. We show that under optimum conditions the technique can detect {approx}10 attomole/cm{sup 2} with a scan speed of {approx}3-10 cm{sup 2}/s of the test instrument's surface. A theoretical analysis and experimental measurements will be discussed.

  3. Design and control of a 3-DOF hydraulic driven surgical instrument

    Directory of Open Access Journals (Sweden)

    Cuntz Timo


    Full Text Available Although the use of minimally invasive surgery techniques has steadily increased, the development of new tools for these procedures has stagnated. Indeed a new generation of surgical instruments, with tips that have multiple degrees of freedom, has been developed. However, they are facing so many technical problems that none have been able to establish themselves in the medical market. To overcome the problems these instruments are facing, a micro hydraulic power transmission system has been developed and been presented in [1]. With these driving units it was possible to design an instrument for minimally invasive surgery with a tip which is movable in 3 degrees of freedom (DOF and that is light in weight, small in size and powerful in movements and gripping. This paper presents the mechanical setup (including dimensions and materials, describes the theoretical basis for the control with the inverse kinematic model, discusses the external drives setup and gives first performance data of this novel hydraulically actuated laparoscopic instrument with 3 degrees of freedom.

  4. Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions. (United States)

    Kassahun, Yohannes; Yu, Bingbin; Tibebu, Abraham Temesgen; Stoyanov, Danail; Giannarou, Stamatia; Metzen, Jan Hendrik; Vander Poorten, Emmanuel


    Advances in technology and computing play an increasingly important role in the evolution of modern surgical techniques and paradigms. This article reviews the current role of machine learning (ML) techniques in the context of surgery with a focus on surgical robotics (SR). Also, we provide a perspective on the future possibilities for enhancing the effectiveness of procedures by integrating ML in the operating room. The review is focused on ML techniques directly applied to surgery, surgical robotics, surgical training and assessment. The widespread use of ML methods in diagnosis and medical image computing is beyond the scope of the review. Searches were performed on PubMed and IEEE Explore using combinations of keywords: ML, surgery, robotics, surgical and medical robotics, skill learning, skill analysis and learning to perceive. Studies making use of ML methods in the context of surgery are increasingly being reported. In particular, there is an increasing interest in using ML for developing tools to understand and model surgical skill and competence or to extract surgical workflow. Many researchers begin to integrate this understanding into the control of recent surgical robots and devices. ML is an expanding field. It is popular as it allows efficient processing of vast amounts of data for interpreting and real-time decision making. Already widely used in imaging and diagnosis, it is believed that ML will also play an important role in surgery and interventional treatments. In particular, ML could become a game changer into the conception of cognitive surgical robots. Such robots endowed with cognitive skills would assist the surgical team also on a cognitive level, such as possibly lowering the mental load of the team. For example, ML could help extracting surgical skill, learned through demonstration by human experts, and could transfer this to robotic skills. Such intelligent surgical assistance would significantly surpass the state of the art in surgical

  5. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. (United States)

    Bastian, J D; Savic, M; Cullmann, J L; Zech, W D; Djonov, V; Keel, M J


    As an alternative to the modified Stoppa approach, the Pararectus approach is used clinically for treatment of acetabular fractures involving the anterior column. The current study assessed the surgical exposure and the options for instrumentation using both of these approaches. Surgical dissections were conducted on five human cadavers (all male, mean age 88 years (82-97)) using the modified Stoppa and the Pararectus approach, with the same skin incision length (10cm). Distal boundaries of the exposed bony surfaces were marked using a chisel. After removal of all soft-tissues, distances from the boundaries in the false and true pelvis were measured with reference to the pelvic brim. The exposed bone was coloured and calibrated digital images of each inner hemipelvis were taken. The amount of exposed surface using both approaches was assessed and represented as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal quadrilateral buttress plate was used. Screw lengths were documented, and three-dimensional CT reconstructions were performed to assess screw trajectories qualitatively. Wilcoxon's signed rank test for paired groups was used (level of significance: pfracture fixation in the posterior pelvic ring and allows for the option to extend the approach without a new incision. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Tung-Yi Lin


    Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

  7. Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani


    Full Text Available Background: Lumbar degenerative spondylolisthesis (LDS is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. Methods: This before-after study was carried out on 45 patients (37 female and 8 male with LDS operated from August 2008 to January 2011. The patients’ pain and disability were assessed by visual analogue scale (VAS and Oswestry disability index (ODI questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement.

  8. Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation. (United States)

    Mundy, Lily R; Miller, H Catherine; Klassen, Anne F; Cano, Stefan J; Pusic, Andrea L


    Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential. The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development. The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain. PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www

  9. Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review. (United States)

    Schnock, Kumiko O; Biggs, Bonnie; Fladger, Anne; Bates, David W; Rozenblum, Ronen


    Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated. Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety. A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000-2016). Relevant articles were selected and reviewed by 4 researchers. After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow. Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.

  10. Is there a role for the use of aviation assessment instruments in surgical training preparation? A feasibility study. (United States)

    Stolk-Vos, Aline C; Heres, Marion H; Kesteloo, Jasper; Verburg, Dick; Hiddema, Frans; Lie, Desiree A; de Korne, Dirk F


    Selection for surgical residency programmes could potentially be improved through pretraining preparation, after assessment of surgical candidates' sensorimotor skills and personality traits. Existing aviation pilot selection instruments are available to test sensorimotor skills and personality traits. This study examined selected instruments to assess medical trainees' sensorimotor skills and personality traits. Aviation's validated computer-based Computerized Pilot Aptitude and Screening System (COMPASS) and Checklist Professional Profile (CPP) were applied to 166 final year medical students during a surgical clerkship between 2013 and 2015. All trainees completed COMPASS and CPP within the prescribed 2 hours. Compared with an age-matched and gender-matched cohort of 165 pilot candidates, medical trainees scored significantly higher on eye-hand coordination (peye-hand-foot coordination (p<0.001), spatial orientation (p<0.001), persuasiveness (p<0.001), stress tolerance (p<0.001), dominance (p<0.001), ambition (p<0.001) and resilience (p<0.001). Final year medical trainees from one medical school were able to complete aviation's sensorimotor skills and personality traits selection instruments within the set time frame. They scored differently from aviation trainees on selected skills and personality traits. The applicability and utility of aviation instruments to presurgical training preparation remains to be tested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


    Directory of Open Access Journals (Sweden)

    M. V. Mikhailovsky


    Full Text Available Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.Material and methods. Since 2008 year 127 patients (64 girls, 63 boys aged (4.5 ± 2.1 years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1 years.Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9, secondary curve (42.8 ± 16.0, thoracic kyphosis (46.3 ± 27.4, lumbar lordosis (54.6 ± 14. Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20 (correction 31.7%, at followup to (56.5 ± 18.5, secondary curve (31.8 ± 12.8 (25.7%, at follow-up to (32.4 ± 18.4, thoracic kyphosis (36.8 ± 20.8 (20,5%, at follow-up to (41.8 ± 21.0, lumbar lordosis (45.4 ± 12.7 (16,9%, at follow-up to (48.2 ± 11.7 (p < 0.05. Space available for lung before surgery was (84.5 ± 8.7 %, after surgery was (94.8 ± 6.7%, at follow-up increased to (98.6 ± 5.4 % (p < 0.05. Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6, secondary curve (47.8 ± 4.6, thoracic kyphosis (61.4 ± 10.4, lumbar lordosis (61.8 ± 4.9. Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%, at follow-up to (66.1 ± 6.3

  12. [Surgical instruments for impossible births in the Museum of History of Medicine in Roma]. (United States)

    Caruso, Claudia; Marinozzi, Silvia


    The Museum of History of Medicine of Rome collects gynaecological and obstetrical instruments. Forceps and embriotomy instruments illustrate the evolution of a sort of an "obstetrical speciality", from antiquity to XIX century. The article focuses mainly on the gradual transformation of forceps's use, from abortive to useful instrument for childbirth.

  13. Surgical instrument biocontaminant fluorescence detection in ambient lighting conditions for hospital reprocessing and sterilization department (Conference Presentation) (United States)

    Baribeau, François; Bubel, Annie; Dumont, Guillaume; Vachon, Carl; Lépine, André; Rochefort, Stéphane; Massicotte, Martin; Buteau-Vaillancourt, Louis; Gallant, Pascal; Mermut, Ozzy


    Hospitals currently rely on simple human visual inspection for assessing cleanliness of surgical instruments. Studies showed that surgical site infections are in part attributed to inadequate cleaning of medical devices. Standards groups recognize the need to objectively quantify the amount of residues on surgical instruments and establish guidelines. We developed a portable technology for the detection of contaminants on surgical instruments through fluorescence following cleaning. Weak fluorescence signals are usually detected in the obscurity only with the lighting of the excitation source. The key element of this system is that it works in ambient lighting conditions, a requirement to not disturb the normal workflow of hospital reprocessing facilities. A biocompatible fluorescent dye is added to the detergent and labels the proteins of organic residues. It is resistant to the harsh environment in a washer-disinfector. Two inspection devices have been developed with a 488nm laser as the excitation source: a handheld scanner and a tabletop station using spectral-domain and time-domain ambient light cancellation schemes. The systems are eye safe and equipped with image processing and interfacing software to provide visual or audible warnings to the operator based on a set of adjustable signal thresholds. Micron-scale residues are detected by the system which can also evaluate soil size and mass. Unlike swabbing, it can inspect whole tools in real-time. The technology has been validated in an independent hospital decontamination research laboratory. It also has potential applications in the forensics, agro-food, and space fields. Technical aspects and results will be presented and discussed.

  14. Evaluation of the Unit Rod surgical instrumentation in Duchenne scoliosis. A retrospective study


    Nedelcu, T; Georgescu, I


    The article represents a retrospective clinical and radiological study. Objectives. Evaluating the safety and efficiency of the surgical treatment by using the Unit Rod for scoliosis in adolescents and children presenting Duchenne?s muscular dystrophy. Summary. Surgical management of myopathic scoliosis still causes controversies regarding the timing of surgery (patient?s age), the pelvic inclusion in the arthrodesis or the advantages of surgery over the conservatory treatment. The patients a...

  15. Instrumentation

    International Nuclear Information System (INIS)

    Prieur, G.; Nadi, M.; Hedjiedj, A.; Weber, S.


    This second chapter on instrumentation gives little general consideration on history and classification of instrumentation, and two specific states of the art. The first one concerns NMR (block diagram of instrumentation chain with details on the magnets, gradients, probes, reception unit). The first one concerns precision instrumentation (optical fiber gyro-meter and scanning electron microscope), and its data processing tools (programmability, VXI standard and its history). The chapter ends with future trends on smart sensors and Field Emission Displays. (D.L.). Refs., figs

  16. The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments 1 (United States)

    Bruna, Camila Quartim de Moraes; de Souza, Rafael Queiroz; Massaia, Irineu Francisco Silva; Cruz, Áurea Silveira; Graziano, Kazuko Uchikawa


    ABSTRACT Objectives: to determine if there are differences on the safety of the preparation of clean surgical instruments using different types of gloves and bare hands and evaluate the microbiological load of these preparations without gloves. Method: laboratory procedure with a pragmatic approach, in which the samples were handled with different types of gloves and bare hands. In addition, cytotoxicity assays were carried out by means of the agar diffusion method. Further samples were subjected to microbiological analysis after being handled without gloves. Results: none of the samples showed cytotoxic effect. All microbiological cultures showed growth of microorganisms, but no microorganism has been recovered after autoclaving. Conclusion: there were no differences in the cytotoxic responses regarding the use of different types of gloves and bare hands in the handling of clean surgical instruments, which could entail iatrogenic risk. It is noteworthy that the use of gloves involves increase in the costs of process and waste generation, and the potential allergenic risk to latex. PMID:27737375

  17. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray for...

  18. Segmental Pedicle Screw Instrumentation and Fusion Only to L5 in the Surgical Treatment of Flaccid Neuromuscular Scoliosis. (United States)

    Takaso, Masashi; Nakazawa, Toshiyuki; Imura, Takayuki; Fukuda, Michinari; Takahashi, Kazuhisa; Ohtori, Seiji


    A retrospective cohort study was performed. The purpose of this study was to determine the efficacy and safety of stopping segmental pedicle screw instrumentation constructs at L5 in the treatment of neuromuscular scoliosis. Duchenne muscular dystrophy and spinal muscular atrophy are flaccid neuromuscular disorders in which gradual deterioration is the hallmark and have a lot of characteristics in common despite differences in etiology. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of flaccid neuromuscular scoliosis and recommended to correct pelvic obliquity. However, the caudal extent of instrumentation and fusion in the surgical treatment of flaccid neuromuscular scoliosis has remained a matter of considerable debate and there have been few studies on the use of segmental pedicle screw instrumentation for flaccid neuromuscular scoliosis. From 2005 to 2007, a total of 27 consecutive patients with neuromuscular disorders (20 Duchenne muscular dystrophy and 7 spinal muscular atrophy), aged 11 to 17 years, underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. Minimum 2-year follow-up was required for inclusion in this study. Twenty patients were enrolled in this study. No patient was lost to follow-up. All patients had L5 tilt of less than 15° and a coronal curve with apex L2 or higher preoperatively. Preoperative coronal curve averaged 70° (range: 51°-88°), with a postoperative mean of 15° (range: 5°-25°) and 17° (range: 6°-27°) at the last follow-up. The pelvic obliquity improved from 15° (range: 9°-25°) preoperatively to 5° (range: 3°-8°) postoperatively and 6° (range: 3°-8°) at the last follow-up. The L5 tilt improved from 9° (range: 2°-14°) preoperatively to 2° (range: 0°-4°) postoperatively and 2° (range: 0°-5°) at the last follow-up. Physiologic sagittal plane alignment was recreated after surgery

  19. Instrumentation

    International Nuclear Information System (INIS)

    Decreton, M.


    SCK-CEN's research and development programme on instrumentation involves the assessment and the development of sensitive measurement systems used within a radiation environment. Particular emphasis is on the assessment of optical fibre components and their adaptability to radiation environments. The evaluation of ageing processes of instrumentation in fission plants, the development of specific data evaluation strategies to compensate for ageing induced degradation of sensors and cable performance form part of these activities. In 2000, particular emphasis was on in-core reactor instrumentation applied to fusion, accelerator driven and water-cooled fission reactors. This involved the development of high performance instrumentation for irradiation experiments in the BR2 reactor in support of new instrumentation needs for MYRRHA, and for diagnostic systems for the ITER reactor

  20. Instrumentation

    Energy Technology Data Exchange (ETDEWEB)

    Decreton, M


    SCK-CEN's research and development programme on instrumentation involves the assessment and the development of sensitive measurement systems used within a radiation environment. Particular emphasis is on the assessment of optical fibre components and their adaptability to radiation environments. The evaluation of ageing processes of instrumentation in fission plants, the development of specific data evaluation strategies to compensate for ageing induced degradation of sensors and cable performance form part of these activities. In 2000, particular emphasis was on in-core reactor instrumentation applied to fusion, accelerator driven and water-cooled fission reactors. This involved the development of high performance instrumentation for irradiation experiments in the BR2 reactor in support of new instrumentation needs for MYRRHA, and for diagnostic systems for the ITER reactor.

  1. Instrumentation

    International Nuclear Information System (INIS)

    Decreton, M.


    SCK-CEN's R and D programme on instrumentation involves the development of advanced instrumentation systems for nuclear applications as well as the assessment of the performance of these instruments in a radiation environment. Particular emphasis is on the use of optical fibres as umbilincal links of a remote handling unit for use during maintanance of a fusion reacor, studies on the radiation hardening of plasma diagnostic systems; investigations on new instrumentation for the future MYRRHA accelerator driven system; space applications related to radiation-hardened lenses; the development of new approaches for dose, temperature and strain measurements; the assessment of radiation-hardened sensors and motors for remote handling tasks and studies of dose measurement systems including the use of optical fibres. Progress and achievements in these areas for 2001 are described

  2. Instrumentation

    Energy Technology Data Exchange (ETDEWEB)

    Decreton, M


    SCK-CEN's R and D programme on instrumentation involves the development of advanced instrumentation systems for nuclear applications as well as the assessment of the performance of these instruments in a radiation environment. Particular emphasis is on the use of optical fibres as umbilincal links of a remote handling unit for use during maintanance of a fusion reacor, studies on the radiation hardening of plasma diagnostic systems; investigations on new instrumentation for the future MYRRHA accelerator driven system; space applications related to radiation-hardened lenses; the development of new approaches for dose, temperature and strain measurements; the assessment of radiation-hardened sensors and motors for remote handling tasks and studies of dose measurement systems including the use of optical fibres. Progress and achievements in these areas for 2001 are described.

  3. Instrumentation

    International Nuclear Information System (INIS)

    Umminger, K.


    A proper measurement of the relevant single and two-phase flow parameters is the basis for the understanding of many complex thermal-hydraulic processes. Reliable instrumentation is therefore necessary for the interaction between analysis and experiment especially in the field of nuclear safety research where postulated accident scenarios have to be simulated in experimental facilities and predicted by complex computer code systems. The so-called conventional instrumentation for the measurement of e. g. pressures, temperatures, pressure differences and single phase flow velocities is still a solid basis for the investigation and interpretation of many phenomena and especially for the understanding of the overall system behavior. Measurement data from such instrumentation still serves in many cases as a database for thermal-hydraulic system codes. However some special instrumentation such as online concentration measurement for boric acid in the water phase or for non-condensibles in steam atmosphere as well as flow visualization techniques were further developed and successfully applied during the recent years. Concerning the modeling needs for advanced thermal-hydraulic codes, significant advances have been accomplished in the last few years in the local instrumentation technology for two-phase flow by the application of new sensor techniques, optical or beam methods and electronic technology. This paper will give insight into the current state of instrumentation technology for safety-related thermohydraulic experiments. Advantages and limitations of some measurement processes and systems will be indicated as well as trends and possibilities for further development. Aspects of instrumentation in operating reactors will also be mentioned.

  4. Instruments

    Energy Technology Data Exchange (ETDEWEB)

    Buehrer, W. [Paul Scherrer Inst. (PSI), Villigen (Switzerland)


    The present paper mediates a basic knowledge of the most commonly used experimental techniques. We discuss the principles and concepts necessary to understand what one is doing if one performs an experiment on a certain instrument. (author) 29 figs., 1 tab., refs.

  5. Three-dimensional modeling of physiological tremor for hand-held surgical robotic instruments. (United States)

    Tatinati, Sivanagaraja; Yan Naing Aye; Pual, Anand; Wei Tech Ang; Veluvolu, Kalyana C


    Hand-held robotic instruments are developed to compensate physiological tremor in real-time while augmenting the required precision and dexterity into normal microsurgical work-flow. The hardware (sensors and actuators) and software (causal linear filters) employed for tremor identification and filtering introduces time-varying unknown phase-delay that adversely affects the device performance. The current techniques that focus on three-dimensions (3D) tip position control involves modeling and canceling the tremor in 3-axes (x, y, and z axes) separately. Our analysis with the tremor data recorded from surgeons and novice subjects show that there exists significant correlation in tremor motion across the dimensions. Motivated by this, a new multi-dimensional modeling approach based on extreme learning machines (ELM) is proposed in this paper to correct the phase delay and to accurately model tremulous motion in three dimensions simultaneously. A study is conducted with tremor data recorded from the microsurgeons to analyze the suitability of proposed approach.

  6. Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation

    Directory of Open Access Journals (Sweden)

    Satoshi Kato


    Full Text Available Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

  7. The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments. (United States)

    Bruna, Camila Quartim de Moraes; Souza, Rafael Queiroz de; Massaia, Irineu Francisco Silva; Cruz, Áurea Silveira; Graziano, Kazuko Uchikawa


    to determine if there are differences on the safety of the preparation of clean surgical instruments using different types of gloves and bare hands and evaluate the microbiological load of these preparations without gloves. laboratory procedure with a pragmatic approach, in which the samples were handled with different types of gloves and bare hands. In addition, cytotoxicity assays were carried out by means of the agar diffusion method. Further samples were subjected to microbiological analysis after being handled without gloves. none of the samples showed cytotoxic effect. All microbiological cultures showed growth of microorganisms, but no microorganism has been recovered after autoclaving. there were no differences in the cytotoxic responses regarding the use of different types of gloves and bare hands in the handling of clean surgical instruments, which could entail iatrogenic risk. It is noteworthy that the use of gloves involves increase in the costs of process and waste generation, and the potential allergenic risk to latex. determinar se existe diferenças na segurança do preparo de instrumentais cirúrgicos relacionada ao uso de distintos tipos de luvas e das mãos nuas no preparo, e avaliar a carga microbiológica destes preparados sem luvas. experimento laboratorial com abordagem pragmática, onde amostras foram manipuladas com diferentes tipos de luvas e com as mãos nuas, elaborado teste de citotoxicidade por meio da difusão em ágar. Outras Amostras sofreram análise microbiológica após serem manipuladas sem luvas. nenhuma das amostras apresentou efeito citotóxico. Todas as culturas microbiológicas apresentaram crescimento de microrganismos, embora nenhum microrganismo tenha sido recuperado após a autoclavação. não houve diferenças nas respostas citotóxicas relacionadas ao uso de diferentes tipos de luvas e das mãos nuas na manipulação do instrumental cirúrgico limpo que sinalizasse risco de iatrogenia. Ressalta-se que o uso de luvas

  8. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. (United States)

    Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf


    Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

  9. A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India

    Directory of Open Access Journals (Sweden)

    Tirthankar Ghosh


    Full Text Available Background: It is important to understand what motivates workers and the extent to which the organization and other contextual variables satisfy them. The aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry. Materials and Methods: Fifty male surgical blacksmiths each of the skilled and unskilled groups of the forging section were selected. Organizational Role Stress Scale was used to measure the individuals′ role stress and several forms of conflict within an organization. Also, the organizational culture and personal involvement in an organization was measured among the surgical blacksmiths. Results: The mean score for total role stress for Skilled was 71.7 and for unskilled was 77.2. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market and clan culture. Conclusion: This study shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of the employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

  10. A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India. (United States)

    Ghosh, Tirthankar; Das, Banibrata; Gangopadhyay, Somnath


    It is important to understand what motivates workers and the extent to which the organization and other contextual variables satisfy them. The aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry. Fifty male surgical blacksmiths each of the skilled and unskilled groups of the forging section were selected. Organizational Role Stress Scale was used to measure the individuals' role stress and several forms of conflict within an organization. Also, the organizational culture and personal involvement in an organization was measured among the surgical blacksmiths. The mean score for total role stress for Skilled was 71.7 and for unskilled was 77.2. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market and clan culture. This study shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of the employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

  11. Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method. (United States)

    Zhao, Zijian; Voros, Sandrine; Weng, Ying; Chang, Faliang; Li, Ruijian


    Worldwide propagation of minimally invasive surgeries (MIS) is hindered by their drawback of indirect observation and manipulation, while monitoring of surgical instruments moving in the operated body required by surgeons is a challenging problem. Tracking of surgical instruments by vision-based methods is quite lucrative, due to its flexible implementation via software-based control with no need to modify instruments or surgical workflow. A MIS instrument is conventionally split into a shaft and end-effector portions, while a 2D/3D tracking-by-detection framework is proposed, which performs the shaft tracking followed by the end-effector one. The former portion is described by line features via the RANSAC scheme, while the latter is depicted by special image features based on deep learning through a well-trained convolutional neural network. The method verification in 2D and 3D formulation is performed through the experiments on ex-vivo video sequences, while qualitative validation on in-vivo video sequences is obtained. The proposed method provides robust and accurate tracking, which is confirmed by the experimental results: its 3D performance in ex-vivo video sequences exceeds those of the available state-of -the-art methods. Moreover, the experiments on in-vivo sequences demonstrate that the proposed method can tackle the difficult condition of tracking with unknown camera parameters. Further refinements of the method will refer to the occlusion and multi-instrumental MIS applications.

  12. Surgical Instrument Decontamination Unit (United States)


    Assoc, Sci Ed 37:246, 1948. 31. Toledo RT, Escher FE, Ayers JC: "Sporicidal properties of hydrogen peroxide against food spoilage organisms," Appl...chemical disinfectants utilized was formaldehyde which combines chemically with critical bacterial cell components to prevent their replication. As the...formaldehyde which combines chemically with critical bacterial cell components to prevent their replication. As the health effects of formaldehyde

  13. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis


    Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Zhang, Yupeng; Liu, Zheng


    Objective: The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation.Methods: Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reco...

  14. Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study. (United States)

    Imagama, Shiro; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Morozumi, Masayoshi; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Nakashima, Hiroaki; Nishida, Yoshihiro; Matsuyama, Yukihiro; Ishiguro, Naoki


    Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. To identify factors for good surgical outcomes with prospective and comparative study. Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and good outcome were analyzed. Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P good surgical outcome. This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes. Copyright © 2017 by the Congress of Neurological Surgeons

  15. Comparison of functional outcomes following surgical decompression and posterolateral instrumented fusion in single level low grade lumbar degenerative versus isthmic spondylolisthesis. (United States)

    Omidi-Kashani, Farzad; Hasankhani, Ebrahim Ghayem; Rahimi, Mohammad Dawood; Khanzadeh, Reza


    The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 ± 6.1 years, and group B included 52 patients with a mean age of 47.3 ± 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

  16. Development and initial validation of a virtual reality haptically augmented surgical knot-tying trainer for the Autosuture ENDOSTITCH instrument. (United States)

    Kurenov, Sergei; Punak, Sukitti; Peters, Jorg; Lee, Constance; Cendan, Juan


    The Autosuture Endostitch device (Covidien, CT) is difficult to learn. In particular, the handle requires the use of a toggle which is unique in this instrument. We have developed a virtual reality trainer for the device that offers the use of the actual instrument handle while creating a visible virtual instrument tip complete with virtual needle and suture on a monitor. This report represents the development and initial validation experiments for the device.

  17. Minimally invasive surgical instruments with an accessory channel capable of integrating fibre-optic cable for optical biopsy: a review of the state of the art. (United States)

    Jelínek, Filip; Arkenbout, Ewout A; Sakes, Aimée; Breedveld, Paul


    This review article provides a comprehensive overview and classification of minimally invasive surgical instruments with an accessory channel incorporating fibreoptics or another auxiliary device for various purposes. More specifically, this review was performed with the focus on the newly emerging field of optical biopsy, its objective being to discuss primarily the instruments capable of carrying out the optical biopsy and subsequent tissue resection. Instruments housing the fibreoptics for other uses, as well as instruments with an accessory channel capable of housing the fibreoptics instead of their original auxiliary device after relevant design modifications, supplement the review. The entire Espacenet and Scopus databases were searched, yielding numerous patents and articles on conceptual and existing instruments satisfying the criteria. The instruments were categorised based on the function the fibreoptics or the auxiliary device serves. On the basis of their geometrical placement with respect to the tissue resector or manipulator, the subcategories were further defined. This subdivision was used to identify the feasibility of performing the optical biopsy and the tissue resection in an accurate and successive fashion. In general, the existing concepts or instruments are regarded as limited with regard to such a functionality, either due to the placement of their accessory channel with or without the fibreoptics or due to the operational restrictions of their tissue manipulators. A novel opto-mechanical biopsy harvester, currently under development at Delft University of Technology, is suggested as a promising alternative, ensuring a fast and accurate succession of the optical and the mechanical biopsies of a flat superficial tissue. © IMechE 2014.

  18. Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery. (United States)

    Boetto, J; Chan-Seng, E; Lonjon, G; Pech, J; Lotthé, A; Lonjon, N


    Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. The Medical Vestment and Surgical Instruments of Saint Cosmas and Damian on Sinai Icons From the Seventh to the Eighteenth Century. (United States)

    Beldekos, Dimitris; Karamanou, Marianna; Poulakou-Rebelakou, Effie; Ploumpidis, Dimitris; Androutsos, George


    The iconography of the doctor saints Cosmas and Damian and the artistic representations of their miracles are important sources for the history of medicine. Within the sphere of physician-saints, Cosmas and Damian have the greatest number of iconographic depictions in Byzantine and Post-Byzantine art. In most of their representations, they wear long robes as a sort of professional mantles and carry surgical instruments and boxes indicating their status as doctors. The progress of Byzantine surgery could be attested by these objects, some of them mentioned in collections of miracle stories and documented in medical sources.

  20. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis. (United States)

    Al-Moraissi, E A; Elmansi, Y A; Al-Sharaee, Y A; Alrmali, A E; Alkhutari, A S


    A systematic review and meta-analysis was conducted to answer the clinical question "Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments?" A systematic and electronic search of several databases with specific key words, a reference search, and a manual search were performed from respective dates of inception through November 2014. The inclusion criteria were clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing the piezoelectric surgical osteotomy technique to the standard rotary instrument technique in lower third molar surgery. Postoperative sequelae (oedema, trismus, and pain), the total number of analgesics taken, and the duration of surgery were analyzed. A total of nine articles were included, six RCTs, two CCTs, and one retrospective study. Six studies had a low risk of bias and three had a moderate risk of bias. A statistically significant difference was found between piezoelectric surgery and conventional rotary instrument surgery for lower third molar extraction with regard to postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken (P=0.0001, P=0.0001, Psurgery time was required in the piezoelectric osteotomy group (Psurgery significantly reduced the occurrence of postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken compared to the conventional rotary instrument technique in lower third molar surgery, but required a longer surgery time. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Comparison of drugs use according to surgical procedures as instrument for budgeting and improvement of prescription efficiency. (United States)

    Closon, M C


    Making an effort to control health expenditure's escalation, especially in hospital, the Belgian government is planning and experimenting with prospective budgeting. A research financed by the Ministry of Public Health allows us to point out the structure of the pathologies treated as well as other variables included in the medical MBDS like urgency, number of diseased systems, ... and explains a high percentage of the variance (62%) in drugs expenditures of the surgical cases. These variables have to be used in order to calibrate hospital drugs budgets. The Interdisciplinary Centre in Health Economics has developed tools to compare drugs prescriptions by type of surgical procedures in order to help hospitals to evaluate their performance should such drugs budgets be progressively introduced.

  2. Health hazards of child labor in the leather products and surgical instrument manufacturing industries of Sialkot, Pakistan. (United States)

    Junaid, Muhammad; Malik, Riffat Naseem; Pei, De-Sheng


    Child labor is a major challenge in the developing countries and comprehensive health hazard identification studies on this issue are still lacking. Therefore, the current study is an effort to highlight the health concerns of child labor exposed in the key small scale industries of Sialkot, Pakistan. Our findings revealed jolting levels of heavy metals in the urine, blood, serum, saliva, and hair samples collected from the exposed children. For example, in the urine samples, Cd, Cr, Ni, and Pb were measured at the respective concentrations of 39.17, 62.02, 11.94 and 10.53 μg/L in the surgical industries, and 2.10, 4.41, 1.04 and 5.35 μg/L in the leather industries. In addition, source apportionment revealed polishing, cutting, and welding sections in the surgical industries and surface coating, crusting, and stitching sections in the leather industries were the highest contributors of heavy metals in the bio-matrices of the exposed children, implying the dusty, unhygienic, and unhealthy indoor working conditions. Further, among all the bio-matrices, the hair samples expressed the highest bioaccumulation factor for heavy metals. In accordance with the heavy metal levels reported in the exposed children, higher oxidative stress was found in the children working in the surgical industries than those from the leather industries. Moreover, among heavy metals' exposure pathways, inhalation of industrial dust was identified as the primary route of exposure followed by the ingestion and dermal contact. Consequently, chemical daily intake (CDI), carcinogenic and non-carcinogenic hazard quotients (HQs) of heavy metals were also reported higher in the exposed children and were also alarmingly higher than the corresponding US EPA threshold limits. Taken all together, children were facing serious health implications in these industries and need immediate protective measures to remediate the current situation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. [Surgical instruments and the emblems of Alsatien craftsmen and the archives of Obernai (16th-17th centuries)]. (United States)

    Muller, Christine


    This study presents some original data concerning the instruments used by Alsatian surgeons-barbers from the 16th to the 18th century. Emblems of professions frequently appear on private houses in Alsace, and 35 emblems of surgeons-barbers have been discovered; six, particularly chararacteristic, are analysed here (Soultz 1568, Marlenheim 1581, Sainte-Croix-en-Plaine 1587, Rosheim 1681, Rosheim 1733, and Wasselonne 1738). The razor (Schermesser), the lancet (Lanzette), and the "flame" (Lasseisen, Fliete) are the most frequently represented instruments. Unpublished inventories after death also bring instructive data and in particular those of the barbers Hans Artz of Molsheim (1597) and Jacob Pflieger of Obernai (c. 1608-1609). At last, are evoked unpublished mentions concerning two barbers originating from Obernai who exercised in Eastern Europe (Sebald Korn around 1583, and Johannes Baur around 1637).

  4. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis. (United States)

    Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Liu, Zheng; Zhang, Yupeng


    The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

  5. Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance? (United States)

    Yamaçake, Kleiton Gabriel Ribeiro; Nakano, Elcio Tadashi; Soares, Iva Barbosa; Cordeiro, Paulo; Srougi, Miguel; Antunes, Alberto Azoubel


    To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.

  6. Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology. (United States)

    Paim, Crislaine Pires Padilha; Goldmeier, Silvia


    Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom's taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. The development of the game called "Playing with Tweezers" was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. The "digital" nursing student needs engagement, stimulation, reality, and entertainment, not just readings. "Playing with Tweezers" is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not

  7. Accuracy of a direct drill-guiding system with minimal tolerance of surgical instruments used for implant surgery: a prospective clinical study. (United States)

    Lee, Du-Hyeong; An, Seo-Young; Hong, Min-Ho; Jeon, Kyoung-Bae; Lee, Kyu-Bok


    A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses. For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (α=.05). The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually. The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

  8. Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases (United States)

    Gomez-Moreta, Juan A.; Hernandez-Vicente, Javier


    Background We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. Method We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. Results The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery. PMID:26196029

  9. Investigation of Structural, Compositional and Anti-Microbial Properties of Copper Thin Film Using Direct Current Magnetron Sputtering for Surgical Instruments (United States)

    Kalaiselvam, S.; Sandhya, J.; Krishnan, K. V. Hari; Kedharnath, A.; Arulkumar, G.; Roseline, A. Ameelia

    Surgical instruments and other bioimplant devices, owing to their importance in the biomedical industry require high biocompatibility to be used in the human body. Nevertheless, issues of compatibility, bacterial infections are quite common in such devices. Hence development of surface coatings on various substrates for implant applications is a promising technique to combat the issues arising in these implant materials. The present investigation aims at coating copper on stainless steel substrate using DC Magnetron sputtering which is used to achieve film of required thickness (0.5-8μm). The deposition pressure, substrate temperature, power supply, distance between the specimen and target are optimized and maintained constant, while the sputtering time (30-110min) is varied. The sputtered copper thin film’s morphology, composition are characterized by SEM and EDAX. X-ray diffraction analysis shows copper oriented on (111) and (002) and copper oxide on (111) planes. The contact angle of copper thin film is 92∘ while AISI 316L shows 73∘. The antimicrobial studies carried in Staphylococcus aureus, Escherichia Coli, Klebsiella pneumonia and Candida albicans show that the maximum reduction was seen upto 35, 26, 54, 39CFU/mL, respectively after 24h. The cell viability is studied by MTT assay test on Vero cell line for 24h, 48h and 72h and average cell viability is 43.85%. The copper release from the thin film to the culture medium is 6691μg/L (maximum) is estimated from AAS studies. The copper coated substrate does not show much reaction with living Vero cells whereas the bacteria and fungi are found to be destroyed.

  10. Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study

    Directory of Open Access Journals (Sweden)

    Simone D. Aspriello


    Full Text Available OBJECTIVE: The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique. MATERIAL AND METHODS: Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearson's χ2 with significance predetermined at α=0.001. RESULTS: Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils. CONCLUSIONS: The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion.

  11. Laparoendoscopic single-site (LESS retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: Technical considerations and surgical outcomes

    Directory of Open Access Journals (Sweden)

    Chen-Hsun Ho


    Conclusion: Our results clearly demonstrate that LESS retroperitoneal partial adrenalectomy can be performed safely and effectively using a custom-made single-access platform and standard laparoscopic instruments.

  12. Abortion - surgical (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. ...

  13. Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments. (United States)

    Dias, Luis Augusto; Angelis, Geisa de; Teixeira, Wagner Afonso; Casulari, Luiz Augusto


    We aimed to evaluate long-term surgical outcomes in patients treated for mesial temporal lobe epilepsy compared with a similar group of patients who underwent a preoperative evaluation. Patient interviews were conducted by an independent neuropsychologist and included a sociodemographic questionnaire and validated versions of the Beck Depression Inventory-II, Adverse Events Profile, Quality of Life in Epilepsy-31, and Rey Auditory Verbal Learning Test. Seventy-one patients who underwent surgery and 20 who underwent mesial temporal lobe epilepsy preoperative evaluations were interviewed. After an 81-month mean postoperative follow-up, 44% of the surgical patients achieved complete seizure relief according to the Engel classification and 68% according to the International League Against Epilepsy classification. The surgical group had a significantly lower prevalence of depression (P = 0.002) and drug-related adverse effects (P = 0.002). Improvement on unemployment (P = 0.02) was achieved but not on driving or education. Delayed verbal memory recall was impaired in 76% of the surgical and 65% of the control cases (P = 0.32). Regarding the Quality of Life in Epilepsy-31, the operated patients scored higher in their total score (mean, 75.44 vs. mean, 60.08; P life. Our study found that, although surgical treatment was effective, its impact on social indicators was modest. Moreover, the self-reported quality of life relied not only on seizure control but also on depressive symptoms and antiepileptic drug burden. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  14. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. (United States)

    Merola, Andrew A; Haher, Thomas R; Brkaric, Mario; Panagopoulos, Georgia; Mathur, Samir; Kohani, Omid; Lowe, Thomas G; Lenke, Larry G; Wenger, Dennis R; Newton, Peter O; Clements, David H; Betz, Randal R


    A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis. A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. Using the SRS 24 questionnaire, seven scoliosis centers agreed to prospectively assess outcome for surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P adolescent scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with

  15. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel


    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  16. Shift and Duty Scheduling of Surgical Technicians in Naval Hospitals

    National Research Council Canada - National Science Library

    Nurse, Nigel


    Surgical technicians at Naval hospitals provide a host of services related to surgical procedures that include handing instruments to surgeons, assisting operating room nurses, prepping and cleaning...

  17. Transforaminal intrathecal delivery of nusinersen using cone-beam computed tomography for children with spinal muscular atrophy and extensive surgical instrumentation: early results of technical success and safety. (United States)

    Weaver, John J; Natarajan, Niranjana; Shaw, Dennis W W; Apkon, Susan D; Koo, Kevin S H; Shivaram, Giri M; Monroe, Eric J


    Nusinersen, the only treatment approved by the United States Food and Drug Administration for spinal muscular atrophy (SMA), is delivered intrathecally. Many children with SMA have extensive spinal instrumentation and deformities, often precluding the use of standard approaches for gaining intrathecal access. Furthermore the anatomical distortion that often occurs with rotoscoliosis can complicate the use of fluoroscopic guidance. Compared to fluoroscopy, CT affords superior guidance for complex needle placements. This opens up alternatives to the posterior (interlaminar) technique, including transforaminal and caudal approaches. This study describes the early results of technical success, complications and radiation dose of intrathecal delivery of nusinersen using cone-beam CT guidance with two-axis fluoroscopic navigational overlay. We conducted a retrospective review of 15 consecutive nusinersen injections performed in four children with SMA and extensive spinal hardware precluding standard posterior lumbar puncture techniques. These children were treated using transforaminal thecal access employing cone-beam CT with navigational overlay. We analyzed results including technical success, complications and total fluoroscopy time. All procedures were technically successful. No major complications and one minor complication were reported; the minor complication was a post-procedural neuropathic headache that was attributed to procedural positioning and was treated successfully with gabapentin. The average procedural fluoroscopy time and air kerma were 1.9 min and 55.8 mGy, respectively. Cone-beam CT guidance with two-axis navigational overlay is a safe, effective method for gaining transforaminal intrathecal access in children with spinal abnormalities and hardware precluding the use of standard techniques.

  18. Scoliosis research society outcome instrument in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients. (United States)

    Helenius, Ilkka; Lamberg, Tommi; Osterman, Kalevi; Schlenzka, Dietrich; Yrjönen, Timo; Tervahartiala, Pekka; Seitsalo, Seppo; Poussa, Mikko; Remes, Ville


    A retrospective follow-up study of low-grade (slip Society questionnaire and compare it with Oswestry Disability Index and radiographic parameters in patients with isthmic spondylolisthesis. A few studies have examined long-term patient outcome using validated questionnaires or compared it with radiographic parameters after surgery for isthmic spondylolisthesis in young patients. The Scoliosis Research Society questionnaire provides patient-oriented information on back pain, cosmetic aspects, patient satisfaction, and level of activity and might therefore be suitable for evaluation of surgical outcome after isthmic spondylolisthesis in young patients. However, there are no studies assessing the usefulness of the Scoliosis Research Society questionnaire for these patients. One hundred and eight patients treated at a mean (range) age of 15.9 (range, 8.1-19.8) years with posterior (n = 29) or posterolateral (n = 79) in situ fusion for isthmic spondylolisthesis participated in the present study. The follow-up rate was 83% after a mean of 20.8 (range, 15.1-25.9) years. The mean age at follow-up observation was 36.7 years. Radiographs were obtained before surgery, at 2-year follow-up observation, and at final follow-up review. The Scoliosis Research Society and Oswestry Disability Index questionnaires were completed, and a physical examination was performed at the final follow-up visit. Nonunion after primary operation was found in 10 (34%) patients after posterior fusion and in 10 (13%) patients after posterolateral fusion (P = 0.0017). The mean (range) anterior slip was 25.2% (0-50%) before surgery and 24.2% (0-78%) at final follow-up observation. Lumbosacral kyphosis increased significantly during the follow-up period. The Scoliosis Research Society questionnaire yielded a total of 94.0 (range, 44-114) points. On the Scoliosis Research Society questionnaire, 14 (14%) patients reported back pain often or very often at rest. The Oswestry Disability Index scores averaged

  19. Surgical Audit

    African Journals Online (AJOL)


    Jan 6, 2010 ... A good way to describe the first surgical audits is that they were 'polite, restrained discussions'. This was the situation before the development of quality assurance in the business world. As this slowly infiltrated into the medical profession the discussions changed to more cri- teria based surgical audits.

  20. Attracting students to surgical careers: preclinical surgical experience. (United States)

    Antiel, Ryan M; Thompson, Scott M; Camp, Christopher L; Thompson, Geoffrey B; Farley, David R


    Along with a decline in interest in general surgery among United States medical school graduates, reports indicate a decrease in the amount of time students are spending on their surgical clerkship. In an effort to offer early exposure to general surgery as well as to equip students with the basic surgical skills that will enhance their third-year clerkship experience, we developed a preclinical surgical experience. Students were surveyed to determine whether the surgical selective changed student level of comfort with basic surgical skills. Surveys were administered, preexperience and postexperience to the medical students enrolled in the surgery selective. The students were asked to rate their comfort level with 12 unique surgical skills. Comfort with the task was evaluated using a 10-point Likert scale. Analyses were conducted to evaluate the impact of the surgical experience on student comfort levels with the surgical skills. The self-reported comfort levels of students increased significantly after the experience in all 12 areas. The greatest change in comfort level (greater than or equal to mean difference of 4) occurred in the surgical technique categories: knot tying (mean difference: 4.9, p < 0.0001), suturing (mean difference: 4.85, p < 0.0001), correctly making an incision (mean difference: 4.95, p < 0.0001), using a needle driver (mean difference: 5.35, p < 0.0001), holding pickups (mean difference: 4.6, p < 0.0001), use of laparoscopic instruments (mean difference: 4.8, p < 0.0001), and use of surgical simulators (mean difference: 6.0, p < 0.0001). Our preclinical surgical experience serves as a model of an effective modality providing early exposure to general surgery. The experience provides trainees with basic surgical skills well before they begin their third-year clerkships. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Radioisotope instruments

    CERN Document Server

    Cameron, J F; Silverleaf, D J


    International Series of Monographs in Nuclear Energy, Volume 107: Radioisotope Instruments, Part 1 focuses on the design and applications of instruments based on the radiation released by radioactive substances. The book first offers information on the physical basis of radioisotope instruments; technical and economic advantages of radioisotope instruments; and radiation hazard. The manuscript then discusses commercial radioisotope instruments, including radiation sources and detectors, computing and control units, and measuring heads. The text describes the applications of radioisotop


    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.


    African Journals Online (AJOL)

    Conclusion:Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our ... of the spine also referred to as. (HIV/AIDS) further challenge the outcome. These .... treatment; or for spinal cord or nerve root from 2 weeks depending on patient ...

  4. Surgical speech disorders. (United States)

    Shen, Tianjie; Sie, Kathleen C Y


    Most speech disorders of childhood are treated with speech therapy. However, two conditions, ankyloglossia and velopharyngeal dysfunction, may be amenable to surgical intervention. It is important for surgeons to work with experienced speech language pathologists to diagnose the speech disorder. Children with articulation disorders related to ankyloglossia may benefit from frenuloplasty. Children with velopharyngeal dysfunction should have standardized clinical evaluation and instrumental asseessment of velopharyngeal function. Surgeons should develop a treatment protocol to optimize speech outcomes while minimizing morbidity. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan


    body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients......Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications...... surgery, skull-base surgery, and foreign body removal were the areas of interests. Results: The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign...

  6. Estudo anatômico da cóclea para confecção de instrumental para a cirurgia de implante coclear com 2 feixes de eletrodos em cócleas ossificadas Cochlear anatomy study used to design surgical instruments for cochlear implants with two bundles of electrodes in ossified cochleas

    Directory of Open Access Journals (Sweden)

    Mariana Bogar


    distances between cochleostomies and ICA in cadaver temporal bones. 2 Design an instrument that can be used in cochlear implant surgery to introduce an implant with two bundles of electrodes. STUDY DESIGN: Experimental prospective. MATERIALS AND METHODS: In 21 temporal bones from cadavers we performed: 1 canal wall down mastoidectomy; 2 cochleostomy in the cochlear basal and middle turns; 3 ICA identification; 4 Length determination between the cochleostomies and the artery. RESULTS: the average distance ± standard deviation obtained for the upper tunnel was of 8.2 ± 1.1 mm and for the lower tunnel it was of 8.1± 1.3 mm. The shortest distance found was of 6.5 mm for the upper tunnel and 6.0 mm for the lower tunnel. CONCLUSION: Despite the values calculated, we concluded that the best value to be considered in creating a surgical instrument are the minimum lengths obtained for each one of the cochlear turns, because this is the safest way to avoid damaging the ICA, that can be fatal.

  7. Instrumentation Facility (United States)

    Federal Laboratory Consortium — Provides instrumentation support for flight tests of prototype weapons systems using a vast array of airborne sensors, transducers, signal conditioning and encoding...

  8. Time-action analysis of instrument positioners in laparoscopic cholecystectomy

    NARCIS (Netherlands)

    den Boer, K. T.; Bruijn, M.; Jaspers, J. E.; Stassen, L. P. S.; Erp, W. F. M.; Jansen, A.; Go, P. M. N. Y. H.; Dankelman, J.; Gouma, D. J.


    BACKGROUND: Instrument positioners can position and lock a laparoscopic instrument. This study uses time-action analysis to evaluate objectively whether IPs can substitute for a surgical assistant efficiently and safely. METHODS: In four hospitals, 78 laparoscopic cholecystectomies were randomly

  9. Surgical endodontics. (United States)

    Carrotte, P


    Root canal treatment usually fails because infection remains within the root canal. An orthograde attempt at re-treatment should always be considered first. However, when surgery is indicated, modern microtechniques coupled with surgical magnification will lead to a better prognosis. Careful management of the hard and soft tissues is essential, specially designed ultrasonic tips should be used for root end preparation which should ideally be sealed with MTA. All cases should be followed up until healing is seen, or failure accepted, and should form a part of clinical audit.

  10. Modelling of non-linear elastic tissues for surgical simulation

    NARCIS (Netherlands)

    Misra, Sarthak; Ramesh, K.T.; Okamura, Allison M.


    Realistic modelling of the interaction between surgical instruments and human organs has been recognised as a key requirement in the development of high-fidelity surgical simulators. Primarily due to computational considerations, most of the past real-time surgical simulation research has assumed

  11. Evaluating the Relational Coordination instrument

    DEFF Research Database (Denmark)

    Edwards, Kasper; Lundstrøm, Sanne Lykke


    and surgical performance. This has prompted the attention of both practitioners and politicians some of who perceive relational coordination as a means to attain better performance. The relational coordination instrument has been validated as a measure of teamwork from the following perspectives: internal...... consistency, interrater agreement and reliability, structural validity, content validity. However as relational coordination is being used as a diagnostics tool it is important to examine further if the instrument can measure changes. Indeed we need to know how precise and sensitive the instrument is when...

  12. Evolution of surgical skills training (United States)

    Roberts, Kurt E; Bell, Robert L; Duffy, Andrew J


    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education’s (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients. PMID:16718842


    Directory of Open Access Journals (Sweden)

    Danny Kurniawan Darianto


    Full Text Available A patient undergoing surgery faces great physiologic and psychologic stress. so nutritional demands are greatly increased during this period and deficiencies can easily develop. If these deficiencies are allowed to develop and are not in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met, complications are less likely developing. Natural resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutition, burns, and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders, and use of supplements can hasten wound healing and shorten recovery times.

  14. Luminescence Instrumentation

    DEFF Research Database (Denmark)

    Jain, Mayank; Bøtter-Jensen, Lars


    This chapter gives an introduction to instrumentation for stimulated luminescence studies, with special focus on luminescence dating using the natural dosimeters, quartz and feldspars. The chapter covers basic concepts in luminescence detection, and thermal and optical stimulation, and reference...

  15. Instrumental analysis

    International Nuclear Information System (INIS)

    Kim, Seung Jae; Seo, Seong Gyu


    This textbook deals with instrumental analysis, which consists of nine chapters. It has Introduction of analysis chemistry, the process of analysis and types and form of the analysis, Electrochemistry on basic theory, potentiometry and conductometry, electromagnetic radiant rays and optical components on introduction and application, Ultraviolet rays and Visible spectrophotometry, Atomic absorption spectrophotometry on introduction, flame emission spectrometry and plasma emission spectrometry. The others like infrared spectrophotometry, X-rays spectrophotometry and mass spectrometry, chromatography and the other instrumental analysis like radiochemistry.

  16. Surgical management of Gerhardt syndrome. (United States)

    Chirilă, M; Mureşan, R; Cosgarea, M; Tomescu, E


    Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

  17. 21 CFR 872.4565 - Dental hand instrument. (United States)


    ..., operative dental amalgam carver, surgical bone chisel, operative amalgam and foil condenser, endodontic... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Dental hand instrument. 872.4565 Section 872.4565...) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4565 Dental hand instrument. (a) Identification. A...

  18. Instrumental Capital

    Directory of Open Access Journals (Sweden)

    Gabriel Valerio


    Full Text Available During the history of human kind, since our first ancestors, tools have represented a mean to reach objectives which might otherwise seemed impossibles. In the called New Economy, where tangibles assets appear to be losing the role as the core element to produce value versus knowledge, tools have kept aside man in his dairy work. In this article, the author's objective is to describe, in a simple manner, the importance of managing the organization's group of tools or instruments (Instrumental Capital. The characteristic conditions of this New Economy, the way Knowledge Management deals with these new conditions and the sub-processes that provide support to the management of Instrumental Capital are described.

  19. Innovative instrumentation

    International Nuclear Information System (INIS)



    At this year's particle physics conference at Brighton, a parallel session was given over to instrumentation and detector development. While this work is vital to the health of research and its continued progress, its share of prime international conference time is limited. Instrumentation can be innovative three times — first when a new idea is outlined, secondly when it is shown to be feasible, and finally when it becomes productive in a real experiment, amassing useful data rather than operational experience. Hyams' examples showed that it can take a long time for a new idea to filter through these successive stages, if it ever makes it at all

  20. Instrumented SSH

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, Scott; Campbell, Scott


    NERSC recently undertook a project to access and analyze Secure Shell (SSH) related data. This includes authentication data such as user names and key fingerprints, interactive session data such as keystrokes and responses, and information about noninteractive sessions such as commands executed and files transferred. Historically, this data has been inaccessible with traditional network monitoring techniques, but with a modification to the SSH daemon, this data can be passed directly to intrusion detection systems for analysis. The instrumented version of SSH is now running on all NERSC production systems. This paper describes the project, details about how SSH was instrumented, and the initial results of putting this in production.

  1. Active instruments

    DEFF Research Database (Denmark)

    Lim, Miguel Antonio; Ørberg, Jakob Williams


    ) show the dynamic nature of policy processes, and (3) consider the search for policy reference points among the different actors. We present rankers in motion, policies in motion, and finally the complex nature of the ranking device that needs to be both a relevant and malleable policy instrument...

  2. Seismic instrumentation

    International Nuclear Information System (INIS)

    Maubach, K.


    For better understanding of the specification for seismic instrumentation of a nuclear power plant, the lecture gives some fundamental remarks to the seismic risk in the Federal Republic of Germany and to the data characterizing an earthquake event. Coming from the geophysical properties of an earthquake, the quantities are explained which are used in the design process of nuclear power plants. This process is shortly described in order to find the requirements for the specification of the seismic instrumentation. In addition the demands of licensing authorities are given. As an example the seismic instrumentation of KKP-1, BWR, is shown. The paper deals with kind and number of instruments, their location in the plant and their sensitivity and calibration. Final considerations deal with the evaluation of measured data and with plant operation after an earthquake. Some experience concerning the earthquake behaviour of equipment not designed to withstand earthquake loads is mentioned. This experience has initiated studies directed to quantification of the degree of conservatism of the assumptions in the seismic design of nuclear power plants. A final garget of these studies are more realistic design rules. (RW)

  3. Retained Surgical Foreign Bodies after Surgery

    Directory of Open Access Journals (Sweden)

    Valon A. Zejnullahu


    Full Text Available The problem of retained surgical bodies (RSB after surgery is an issue for surgeons, hospitals and the entire medical team. They have potentially harmful consequences for the patient as they can be life threatening and usually, a further operation is necessary. The incidence of RSB is between 0.3 to 1.0 per 1,000 abdominal operations, and they occur due to a lack of organisation and communication between surgical staff during the process. Typically, the RSB are surgical sponges and instruments located in the abdomen, retroperitoneum and pelvis.

  4. Instrumentation development

    International Nuclear Information System (INIS)



    Areas being investigated for instrumentation improvement during low-level pollution monitoring include laser opto-acoustic spectroscopy, x-ray fluorescence spectroscopy, optical fluorescence spectroscopy, liquid crystal gas detectors, advanced forms of atomic absorption spectroscopy, electro-analytical chemistry, and mass spectroscopy. Emphasis is also directed toward development of physical methods, as opposed to conventional chemical analysis techniques for monitoring these trace amounts of pollution related to energy development and utilization

  5. Nuclear instrumentation

    International Nuclear Information System (INIS)

    Weill, Jacky; Fabre, Rene.


    This article sums up the Research and Development effort at present being carried out in the five following fields of applications: Health physics and Radioprospection, Control of nuclear reactors, Plant control (preparation and reprocessing of the fuel, testing of nuclear substances, etc.), Research laboratory instrumentation, Detectors. It also sets the place of French industrial activities by means of an estimate of the French market, production and flow of trading with other countries [fr

  6. Comparação do poder de correção do instrumental de Luque-Galveston e do parafuso pedicular no tratamento cirúrgico da escoliose neuromuscular Comparación del poder de corrección del instrumental de Luque-Galveston y del tornillo pedicular en el tratamiento quirúrgico de la escoliosis neuromuscular Comparison between deformity correction of Luque-Galveston instrumentation and pedicle screw fixation in the surgical treatment of neuromuscular scoliosis

    Directory of Open Access Journals (Sweden)

    Murilo Tavares Daher


    (p=0.045. CONCLUSIONS: postoperative major curve correction was similar with pedicle screws and Luque-Galveston instrumentation, but pelvic obliquity correction was greater when pedicle screw was used in the surgical treatment of neuromuscular scoliosis.

  7. Surgical treatment of degenerative spondylolisthesis. (United States)

    Guigui, P; Ferrero, E


    Degenerative spondylolisthesis is a common pathology, often causing lumbar canal stenosis. There is, however, no strong consensus regarding the various medical and surgical treatments available. Surgery is indicated mainly for perceived functional impairment; when the indication is accepted, several questions determine the choice of surgical strategy. Improvement in neurological symptoms is one of the main treatment objectives. For this, it is useful to perform radicular decompression. Some authors recommend indirect decompression by interbody fusion (ALIF, TLIF, XLIF), others by means of an interspinous spacer but the most frequent technique is direct posterior decompression. In degenerative spondylolisthesis, functional results seem to be improved by associating stabilization to decompression, to prevent secondary destabilization. The following risk factors for destabilization are recognized: anteroposterior hypermobility, angular hypermobility and large disc height. Two stabilization techniques have been described: "dynamic" stabilization and (more frequently) fusion. Spinal instrumentation is frequently associated to fusion, in which case, it is essential for fusion position and length to take account of pelvic incidence and the patient's overall pattern of balance. Posterolateral fusion may be completed by interbody fusion (PLIF or TLIF). This has the theoretic advantage of increasing graft area and stability, restoring local lordosis and opening the foramina. Surgical treatment of degenerative spondylolisthesis usually consists in posterior release associated to instrumented fusion, but some cases can be more complex. It is essential for treatment planning to take account of the patient's general health status as well as symptomatology and global and segmental alignment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. 21 CFR 872.4120 - Bone cutting instrument and accessories. (United States)


    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4120 Bone cutting instrument and accessories. (a) Identification. A bone cutting instrument and accessories is a metal device intended for use... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone cutting instrument and accessories. 872.4120...

  9. 21 CFR 882.4275 - Dowel cutting instrument. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Dowel cutting instrument. 882.4275 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4275 Dowel cutting instrument. (a) Identification. A dowel cutting instrument is a device used to cut dowels of bone for bone grafting. (b...

  10. Micro-surgical endodontics. (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I


    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  11. Surgical Treatment of Tattoo Complications. (United States)

    Sepehri, Mitra; Jørgensen, Bo


    With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

  12. Surgical handicraft: teaching and learning surgical skills. (United States)

    Barnes, R W


    Surgeons choose their profession with a strong desire to excel at manual therapeutic skills. Although we mime our mentors, we have often received the torch of technique in the absence of a systematic program to optimally develop our manual dexterity. The operating room is the ultimate arena to refine one's technical ability, but a surgical skills laboratory should assume increasing importance in introducing the trainee to the many nuances of the fine manual motor skills necessary for optimal surgical technique. Surgical educators should address the science of surgical handicraft in a manner similar to the science of preoperative and postoperative surgical principles that have been espoused over the past 40 years. Although it has been euphemistically said that "you can teach a monkey to operate," few of us have broken the process down into the basic elements to accomplish such a goal. In view of the increasing complexity of operations and equipment, the constraints on animal laboratories and teaching caseloads, and the mounting economic and medico-legal pressures, the development of optimal surgical skills should be a major objective of every surgical training program. By developing novel programs and scientifically evaluating the results of such endeavors, surgical faculties may find increased academic rewards for being a good teacher.

  13. Virtual reality in surgical education. (United States)

    Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J


    Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.

  14. Abortion - surgical - aftercare (United States)

    ... this page: // Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  15. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin


    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  16. American Pediatric Surgical Association (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  17. Seismic instrumentation

    International Nuclear Information System (INIS)


    RFS or Regles Fondamentales de Surete (Basic Safety Rules) applicable to certain types of nuclear facilities lay down requirements with which compliance, for the type of facilities and within the scope of application covered by the RFS, is considered to be equivalent to compliance with technical French regulatory practice. The object of the RFS is to take advantage of standardization in the field of safety, while allowing for technical progress in that field. They are designed to enable the operating utility and contractors to know the rules pertaining to various subjects which are considered to be acceptable by the Service Central de Surete des Installations Nucleaires, or the SCSIN (Central Department for the Safety of Nuclear Facilities). These RFS should make safety analysis easier and lead to better understanding between experts and individuals concerned with the problems of nuclear safety. The SCSIN reserves the right to modify, when considered necessary, any RFS and specify, if need be, the terms under which a modification is deemed retroactive. The aim of this RFS is to define the type, location and operating conditions for seismic instrumentation needed to determine promptly the seismic response of nuclear power plants features important to safety to permit comparison of such response with that used as the design basis

  18. Three-Dimensional Printing Surgical Applications. (United States)

    AlAli, Ahmad B; Griffin, Michelle F; Butler, Peter E


    Three-dimensional printing, a technology used for decades in the industrial field, gains a lot of attention in the medical field for its potential benefits. With advancement of desktop printers, this technology is accessible and a lot of research is going on in the medical field. To evaluate its application in surgical field, which may include but not limited to surgical planning, surgical education, implants, and prosthesis, which are the focus of this review. Research was conducted by searching PubMed, Web of science, and other reliable sources. We included original articles and excluded articles based on animals, those more than 10 years old, and those not in English. These articles were evaluated, and relevant studies were included in this review. Three-dimensional printing shows a potential benefit in surgical application. Printed implants were used in patient in a few cases and show successful results; however, longer follow-up and more trials are needed. Surgical and medical education is believed to be more efficient with this technology than the current practice. Printed surgical instrument and surgical planning are also believed to improve with three-dimensional printing. Three-dimensional printing can be a very powerful tool in the near future, which can aid the medical field that is facing a lot of challenges and obstacles. However, despite the reported results, further research on larger samples and analytical measurements should be conducted to ensure this technology's impact on the practice.

  19. Modeling of tool-tissue interactions for computer-based surgical simulation: a literature review

    NARCIS (Netherlands)

    Misra, Sarthak; Ramesh, K.T.; Okamura, Allison M.


    Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in robot-assisted surgery for pre- and intra-operative planning. Accurate modeling of the interaction between surgical instruments and organs has been recognized as a key requirement in


    Directory of Open Access Journals (Sweden)

    Марія ТЕЛЕКИ


    Full Text Available Тeleky Mariia. Proper names in multicomponent eponyms of surgical instruments. The article represents а general characteristic of proper names in multicomponent eponymic names of surgical instruments for general and special purpose that operate in Ukrainian language; their terminological status has been clarified, the description of extra linguistic factors that determine the creation, appearance and functioning of eponymic terms has been carried out; lexico-semantic and pragmatic features of eponymic terms have been characterized; thematic groups of analysed proper names in multicomponent eponyms and their productive derivational models have been singled out. With the development of medical sciences and technological progress new eponymical terms more often get into the sphere of professional use, in the base of which are the inventions, the creators of which are single scientists and whole scientific schools. There is a need for specialized reference books, dictionaries, the use of which considerably reduces the time of medical specialist for interpretation the eponymical term. Research questions of proper names in multicomponent eponyms continue to be urgent today. The research allows promoting cross-language coordination and ensuring comparability of medical terminological vocabulary, enriching the terminological system, exchanging the scientific information and improving the quality process in professional communication. The proper names composed of multicomponent eponyms are special names that respond the main signs of the term. 1. Eponymical terms of proper names represent complex of medical concepts and they are the part of the language of surgical medicine. They are the reflection of the development of medical knowledge and revealing of professional activities. 2. Among the eponymic terms, the most productive by the number of components is the word – formation model of "a noun in the nominative case + proper name in the genitive

  1. Computer-Assisted Technique for Surgical Tooth Extraction

    Directory of Open Access Journals (Sweden)

    Hosamuddin Hamza


    Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  2. Image-guided surgical navigation in otology. (United States)

    Kohan, Darius; Jethanamest, Daniel


    To evaluate the efficacy of image-guided surgical navigation (IGSN) in otologic surgery and establish practice guidelines. Prospective study. Between January 2003 and January 2010, all patients requiring complicated surgery for chronic otitis media, glomus jugulare, atresia, cerebrospinal fluid leak with or without encephalocele, and cholesterol granuloma of the petrous apex were offered IGSN. The accuracy of IGSN relative to pertinent pathology and 11 anatomic landmarks was established. Additionally IGSN-related operative time, complications, and surgical outcome were recorded. In the study period there were 820 otologic procedures, among 94 patients (96 ears) with disease meeting proposed criteria. Thirteen patients (15 procedures) consented to the use of IGSN. All patients had a minimum 6 months of follow-up. The average additional operative time required was 36.7 minutes. The mean accuracy error was 1.1 mm laterally at the tragus but decreased to 0.8 mm medially at the level of the oval window. The mean accuracy of IGSN was within 1 mm in 10 of the 11 targeted surgical anatomic landmarks. Interactive image-guided surgical navigation during complex otologic surgery may improve surgical outcome and decrease morbidity by providing an accurate real-time display of surgical instrumentation relative to patient anatomy and pathology. In select cases, the extra cost of imaging immediately prior to surgery and extra operating room time may be compensated by enhancing the ability to distinguish distorted anatomy relative to disease, potentially improving surgical outcome. IGSN, although useful, does not replace surgical expertise and experience. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  3. Deriving DICOM surgical extensions from surgical workflows (United States)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.


    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  4. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.


    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  5. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.


    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  6. Surgical management of pain

    African Journals Online (AJOL)

    the spinal cord.[4] In this article, the reader is referred back to this illustration to understand the surgical techniques used to manage pain. Pain is caused by ... Injured dorsal root neurons discharge at higher frequencies and more spontaneously than normally. Surgical techniques. The physician should ensure that treat-.

  7. Surgical site infections

    African Journals Online (AJOL)

    the development of SSI. Complications associated with surgical site infections7. • Longer hospital stay with risk of acquiring other hospital acquired infections like pneumonia. • Require more surgical procedures. • Risk for development of resistance to antibiotics. • Risk for development of necrotizing fasciitis with skin loss.

  8. Low activated incore instrument (United States)

    Ekeroth, D.E.


    Instrumentation is described for nuclear reactor head-mounted incore instrumentation systems fabricated of low nuclear cross section materials (i.e., zirconium or titanium). The instrumentation emits less radiation than that fabricated of conventional materials. 9 figures.

  9. Evaluating musical instruments

    International Nuclear Information System (INIS)

    Campbell, D. Murray


    Scientific measurements of sound generation and radiation by musical instruments are surprisingly hard to correlate with the subtle and complex judgments of instrumental quality made by expert musicians

  10. Evaluating musical instruments

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, D. Murray


    Scientific measurements of sound generation and radiation by musical instruments are surprisingly hard to correlate with the subtle and complex judgments of instrumental quality made by expert musicians.

  11. Instrumented stabilization in spinal tuberculosis. (United States)

    Jain, Anil Kumar; Jain, Saurabh


    Spinal tuberculosis (TB) produces neurological complications and grotesque spinal deformity, which in children increases even with treatment and after achieving healing. Long-standing, severe deformity leads to painful costo-pelvic impingement, respiratory distress, risk of developing late-onset paraplegia and consequent reduction in quality and longevity of life. The treatment objective is to avoid the sequelae of neural complications and achieve the healed status with a near-normal spine. In TB, the spine may become unstable if all three columns are diseased. Pathological fracture/dislocation of a diseased vertebral body may occur secondary to mechanical insult. Surgical decompression adds further instability, as part of the diseased vertebral body is excised. The insertion of a metallic implant is to provide mechanical stability and the use of an implant in tubercular infection is safe. Indications for instrumented stabilisation can be categorised as: (a) pan vertebral disease, in which all three columns are diseased; (b) long-segment disease, in which after surgical decompression a bone graft >5 cm is inserted with instrumentation to prevent graft-related complications and consequent progression of kyphosis and neural complications and (c) when surgical correction of a kyphosis is performed when both anterior decompression and posterior column shortening is required. The implant choice should be individualised according to the case. Pedicle screw fixation in kyphus correction in healed disease is a most suitable implant. Hartshill sublaminar wiring stabilisation in active disease is a suitable implant to stabilise the spine, taking purchase against healthy posterior complex of the vertebral body to save a segment.

  12. Surgical ethics: surgical virtue and more. (United States)

    Vercler, Christian J


    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  13. Simple and surgical exodontia. (United States)

    DeBowes, Linda J


    Preemptive and postoperative pain management is part of patient care when performing extractions. Simple extractions can become complicated when tooth roots are fractured. Adequate lighting,magnification, and surgical techniques are important when per-forming surgical (complicated) extractions. Radiographs should be taken before extractions and also during the procedure to assist with difficult extractions. Adequate flap design and bone removal are necessary when performing surgical extractions. Complications, including ocular trauma, jaw fracture, and soft tissue trauma, are avoided or minimized with proper patient selection and technique.

  14. IOT Overview: IR Instruments (United States)

    Mason, E.

    In this instrument review chapter the calibration plans of ESO IR instruments are presented and briefly reviewed focusing, in particular, on the case of ISAAC, which has been the first IR instrument at VLT and whose calibration plan served as prototype for the coming instruments.

  15. Health physics instrument manual

    International Nuclear Information System (INIS)

    Gupton, E.D.


    The purpose of this manual is to provide apprentice health physics surveyors and other operating groups not directly concerned with radiation detection instruments a working knowledge of the radiation detection and measuring instruments in use at the Laboratory. The characteristics and applications of the instruments are given. Portable instruments, stationary instruments, personnel monitoring instruments, sample counters, and miscellaneous instruments are described. Also, information sheets on calibration sources, procedures, and devices are included. Gamma sources, beta sources, alpha sources, neutron sources, special sources, a gamma calibration device for badge dosimeters, and a calibration device for ionization chambers are described

  16. Astronomical Instruments in India (United States)

    Sarma, Sreeramula Rajeswara

    The earliest astronomical instruments used in India were the gnomon and the water clock. In the early seventh century, Brahmagupta described ten types of instruments, which were adopted by all subsequent writers with minor modifications. Contact with Islamic astronomy in the second millennium AD led to a radical change. Sanskrit texts began to lay emphasis on the importance of observational instruments. Exclusive texts on instruments were composed. Islamic instruments like the astrolabe were adopted and some new types of instruments were developed. Production and use of these traditional instruments continued, along with the cultivation of traditional astronomy, up to the end of the nineteenth century.

  17. Ambulatory Surgical Measures - Facility (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  18. Ambulatory Surgical Measures - State (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  19. Surgical Treatments for Fibroids (United States)

    ... NICHD Research Information Find a Study More Information Preeclampsia and Eclampsia About NICHD Research Information Find a ... Treatments Share Facebook Twitter Pinterest Email Print Surgical Treatments for Fibroids If you have moderate or severe ...

  20. Ambulatory Surgical Measures - National (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  1. [Surgical treatment of ulcer]. (United States)

    Ungeheuer, E; Schröder, D; Lüders, K


    The standard of today in surgical treatment of the duodenal and gastric ulcer in Germany is shown. Positive and negative aspects of the different methods are discussed. Special technics are recommended for the different types of gastroduodenal ulcera.

  2. Disruptive visions: surgical education. (United States)

    Satava, R M


    Technological change, decreased financial support for medical education, and social oversight (in the form of the "To Err Is Human" report, HIPPA, and reduced work hours) are forcing a rethinking of the traditional model of surgical education to improve patient safety. New approaches to evaluating surgical competence, such as objective assessment, in combination with new technologies, such as the Internet and surgical simulators, provide the tools to effect a revolution in surgical education and training. Competency based upon quantifiable criteria measures must replace the traditional subjective assessment. The implementation requires accurately defining the elements of training, establishing new quantifiable metrics, stringently measuring performance against criterion, and reporting outcomes throughout the career of a surgeon.

  3. Surgical Critical Care Initiative (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  4. Troubleshooting in nuclear instruments

    International Nuclear Information System (INIS)


    This report on troubleshooting of nuclear instruments is the product of several scientists and engineers, who are closely associated with nuclear instrumentation and with the IAEA activities in the field. The text covers the following topics: Preamplifiers, amplifiers, scalers, timers, ratemeters, multichannel analyzers, dedicated instruments, tools, instruments, accessories, components, skills, interfaces, power supplies, preventive maintenance, troubleshooting in systems, radiation detectors. The troubleshooting and repair of instruments is illustrated by some real examples

  5. Laparoscopic adrenalectomy: Surgical techniques

    Directory of Open Access Journals (Sweden)

    Matthew J Mellon


    Full Text Available Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This article reviews the surgical techniques for the laparoscopic adrenalectomy.

  6. Níveis de ansiedade de alunos de graduação em enfermagem frente à primeira instrumentação cirúrgica Niveles de ansiedad de los alumnos de pregrado en enfermería delante de la primera instrumentación quirúrgica Nursing undergraduates' anxiety about the first surgical instrumentation

    Directory of Open Access Journals (Sweden)

    Rachel de Carvalho


    ' anxiety about the first surgical instrumentation. The sample consisted of 30 sixth-period students who were enrolled in the subject Surgical Nursing. Data were collected through the STAI (State-Trait Anxiety Inventory. We identified that 90% of the students demonstrated low levels of trait anxiety. As to state anxiety, the most frequent observations were: low anxiety level on the first day of theoretical class (76.7%. medium anxiety level at the lab (53% and medium anxiety level during supervised training (80%. Furthermore, we identified a small number of students with high anxiety levels. The statistical analysis shows significant differences among the mean levels of state-anxiety during the three data collection phases.

  7. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

  8. Mentoring console improves collaboration and teaching in surgical robotics. (United States)

    Hanly, Eric J; Miller, Brian E; Kumar, Rajesh; Hasser, Christopher J; Coste-Maniere, Eve; Talamini, Mark A; Aurora, Alexander A; Schenkman, Noah S; Marohn, Michael R


    One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

  9. Training program for fundamental surgical skill in robotic laparoscopic surgery. (United States)

    Suh, Irene; Mukherjee, Mukul; Oleynikov, Dmitry; Siu, Ka-Chun


    Although the use of robotic laparoscopic surgery has increased in popularity, training protocols for gaining proficiency in robotic surgical skills are not well established. The purpose of this study was to examine a fundamental training program that provides an effective approach to evaluate and improve robotic surgical skills performance using the da Vinci(™) Surgical System. Fifteen medical students without any robotic surgical experience were recruited. Participants went through a 4-day training program for developing fundamental robotic surgical skills and received a retention test 1 day after the completion of training. Data analysis included time to task completion, average speed, total distance traveled and movement curvature of the instrument tips, and muscle activities of the participants' forearms. Surgical performance was graded by the modified Objective Structured Assessment of Technical Skills for robotic laparoscopic surgery. Finally, participants evaluated their own performance after each session through questionnaires. Significant training effects were shown for the time to task completion (p movement curvature (p mastery, familiarity, and self-confidence and less difficulty in performing fundamental tasks with the surgical robot in both post-testing and retention sessions. Our 4-day training program comprising of a series of training tasks from fundamental to surgical skill levels was effective in improving surgical skills. Further studies are required to verify these findings with a longer period of retention. Copyright © 2011 John Wiley & Sons, Ltd.

  10. The International Association of Student Surgical Societies: creation and dissemination. (United States)

    Chandauka, Tinashe; Leusink, Astrid; Hsiao, Marvin; Kahn, Delawir; Azzie, Georges


    While initiatives exist to address the worldwide need for surgeons, none involve a student-driven solution from low- and middle-income countries (LMICs). In response to falling surgical residency enrolment in South Africa, the students at the University of Cape Town (UCT) founded the UCT Surgical Society and were subsequently instrumental in creating the International Association of Student Surgical Societies (IASSS). The IASSS currently includes 25 societies in 15 countries. Its primary objectives are building sustainable networks for mutually beneficial exchanges, supporting student-driven projects, understanding issues impacting student interest in surgery, promoting global fellowship, creating an elective database and providing assistance to student surgical societies. The IASSS is a unique student-led initiative trying to improve surgical care in LMICs.

  11. Surgical Emphysema: A Rare Complication of a Simple Surgical Dental Extraction Without the Use of an Air-Driven Rotor. (United States)

    Gowans, Keegan; Patel, Muneer; Lewis, Khari


    Surgical emphysema is a rare complication of dental extractions, often associated with the use of high-speed air rotors. This report describes a case of extensive surgical emphysema following a simple surgical extraction of a LL6 under local anaesthetic. There was no use of air-driven handpieces during the procedure. The patient developed extensive surgical emphysema bi-laterally in both cervical neck and facial planes. After prophylactic antibiotics with careful monitoring in a secondary care setting, the patient made a full unremarkable recovery. Clinical relevance: Simple extraction of teeth is a procedure carried out daily by most general dental practitioners. However, the risk of surgical emphysema without the use of high-speed air rotors or instruments using pressurized air/water is not well known or documented.

  12. 21 CFR 884.4520 - Obstetric-gynecologic general manual instrument. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic general manual instrument... Surgical Devices § 884.4520 Obstetric-gynecologic general manual instrument. (a) Identification. An obstetric-gynecologic general manual instrument is one of a group of devices used to perform simple...

  13. Surgical implantation of transmitters into fish (United States)

    Mulcahy, Daniel M.


    Although the Animal Welfare Act does not cover poikilotherms, individual institutions and policies and legal requirements other than the Animal Welfare Act (e.g., the US Public Health Service and the Interagency Research Animal Committee's Principles for the Utilization and Care of Vertebrate Animals Used in Testing, Research, and Training) require the review of projects involving fish by institutional animal care and use committees (IACUCs). IACUCs may, however, lack the knowledge and experience to evaluate fish projects judiciously, especially when the projects are in field settings. Surgeries involving implantation of transmitters and other instruments into the coelom, which now comprise a very common research tool in the study of free-ranging fishes, are examples of surgeries that use a broad spectrum of surgical and anesthetic techniques, some of which would not be considered acceptable for similar work on mammals. IACUCs should apply the standards they would expect to be used for surgeries on homeotherms to surgeries on fish. Surgeons should be carefully trained and experienced. Surgical instruments and transmitters should be sterile. Regulations and laws on the use of drugs in animals should be followed, particularly those concerned with anesthetics and antibiotics used on free-ranging fish. Exceptions to surgical procedures should be made only when circumstances are extreme enough to warrant the use of less than optimal procedures.

  14. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

    Northern Uganda to offer free surgical services and to teach basic surgical skills to up-country doctors. The team, consisting of 10 surgeons in various specialities, two anaesthetists and two surgical residents, saw 500 patients, of whom 272 had surgery. This was the frrst such surgical camp organised by the Ugandan.

  15. 3D Surgical Simulation (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  16. Surgical skills training restructured for the 21st century. (United States)

    Morris, Michael; Caskey, Robert; Mitchell, Marc; Sawaya, David


    Few if any medical schools have a comprehensive surgical skills program taking medical students from learning basic knot tying and surgical skills to performing these skills at a level adequate for function during a primary care, surgical, or subspecialty residency. We have designed and continue to refine a program, which consists of five workshops focused on basic surgical skills, which are applicable to all medical and surgical disciplines. During the first workshop students learn how to tie both one- and two-handed surgical knots. The second workshop involves teaching students differences in suture type and use, instrument handling, and suturing techniques. The third workshop is used to address problems and refine techniques previously learned in the first two sessions. The fourth workshop comprises a final examination to evaluate suture and knot tying skills. The fifth session is a voluntary knot tying and suturing competition with awards for speed, finesse, aesthetics, and the watertightness of a vascular surgical repair. Surgical faculty and house staff are present at each workshop to provide direction and constructive criticism. Fifty-seven third-year medical students have completed the surgical skills curriculum. Statistical analysis demonstrates significant improvement in both knot tying and suturing (P < 0.05) for these students. Forty-four percent of students have successfully sewn a watertight anastomosis. We hypothesize that this curriculum will produce medical students with basic surgical skills, appreciation of surgical technique, and the confidence to perform basic surgical skills at completion of the curriculum. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Research reactor instrumentation

    International Nuclear Information System (INIS)

    Boeck, H.; Villa, M.


    This is a textbook on research reactor instrumentation for training purposes, it gives a survey on research reactor instrumentation requirements and eight exercises covering the major aspects of this topic are presented. (author)

  18. Building a framework for ergonomic research on laparoscopic instrument handles. (United States)

    Li, Zheng; Wang, Guohui; Tan, Juan; Sun, Xulong; Lin, Hao; Zhu, Shaihong


    Laparoscopic surgery carries the advantage of minimal invasiveness, but ergonomic design of the instruments used has progressed slowly. Previous studies have demonstrated that the handle of laparoscopic instruments is vital for both surgical performance and surgeon's health. This review provides an overview of the sub-discipline of handle ergonomics, including an evaluation framework, objective and subjective assessment systems, data collection and statistical analyses. Furthermore, a framework for ergonomic research on laparoscopic instrument handles is proposed to standardize work on instrument design. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Performing the Super Instrument

    DEFF Research Database (Denmark)

    Kallionpaa, Maria


    The genre of contemporary classical music has seen significant innovation and research related to new super, hyper, and hybrid instruments, which opens up a vast palette of expressive potential. An increasing number of composers, performers, instrument designers, engineers, and computer programmers...... provides the performer extensive virtuoso capabilities in terms of instrumental range, harmony, timbre, or spatial, textural, acoustic, technical, or technological qualities. The discussion will be illustrated by a composition case study involving augmented musical instrument electromagnetic resonator...

  20. Instrument Modeling and Synthesis (United States)

    Horner, Andrew B.; Beauchamp, James W.

    During the 1970s and 1980s, before synthesizers based on direct sampling of musical sounds became popular, replicating musical instruments using frequency modulation (FM) or wavetable synthesis was one of the “holy grails” of music synthesis. Synthesizers such as the Yamaha DX7 allowed users great flexibility in mixing and matching sounds, but were notoriously difficult to coerce into producing sounds like those of a given instrument. Instrument design wizards practiced the mysteries of FM instrument design.

  1. Surgical Treatment of Atrial Fibrillation: A Review

    Directory of Open Access Journals (Sweden)

    Nadine Hiari


    Full Text Available Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1 reduce embolic complications, particularly stroke, (2 alleviate symptoms, and (3 prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

  2. Aeroacoustics of Musical Instruments

    NARCIS (Netherlands)

    Fabre, B.; Gilbert, J.; Hirschberg, Abraham; Pelorson, X.


    We are interested in the quality of sound produced by musical instruments and their playability. In wind instruments, a hydrodynamic source of sound is coupled to an acoustic resonator. Linear acoustics can predict the pitch of an instrument. This can significantly reduce the trial-and-error process

  3. Procedure simplification: the role of single-use instruments in total knee arthroplasty. (United States)

    Bhadra, Arup K; Kwiecien, Grzegorz J; Harwin, Steven F; Johnson, Aaron J; Mont, Michael A; Malkani, Arthur L


    In orthopaedic surgery, surgical site contamination leading to periprosthetic infections is a major concern with important morbidity, financial and emotional burden. Single-use instruments developed for total knee arthroplasties are intended to simplify the surgical procedure, decrease the number of surgical trays that require sterilization and reprocessing, decrease the incidence of possible contamination through breaks in surgical wraps, and improve operating room efficiency. As the demand for total knee arthroplasty continues to rise, a greater burden on the healthcare system may be created. The use of single-use instruments, cutting guides, and trials will play an increasing role in total knee arthroplasty through improved operating room efficiency.

  4. Costs associated with instrument sterilization in gynecologic surgery. (United States)

    Van Meter, Mary M; Adam, Rony A


    With rising health care expenditures, hospitals must contain costs in ways that maintain high-quality patient care. A significant portion of perioperative costs are associated with materials and supplies; many reusable instruments on surgical trays go unused, which may account for significant annual excess processing costs. Reorganizing gynecologic trays to contain fewer instruments can result in significant cost savings. In the field of operative gynecology, there has been considerable attention to the various costs and surgical outcomes that are associated with hysterectomy performed in the abdominal, vaginal, and laparoscopic approaches; however, little research has been done on the cost differences that are associated with the reusable instruments that are used in these approaches. This study aimed to identify the percent usage of instruments within gynecologic surgery and to identify differences by surgical approach. We further aimed to estimate the costs of sterilizing surgical instruments and estimate the excess costs that are associated with processing unused instruments. This was a single site observational study. Specific instruments that were used from incision to closure were recorded on operating room count sheets via direct observation of surgeries that were performed in the gynecologic operating rooms by a trained investigator. Cost data on instrument transportation, employee wages, and instrument replacement was obtained from institutional supply chain management. In total, 28 surgical cases (5 abdominal, 11 laparoscopic, and 12 vaginal) were analyzed, with an average of 2 hours 37 minutes operating room time and 5.4 instrument trays for each case. One hundred fifty trays were observed. Trays had an average of 38 instruments per tray (range, 1-141). Surgeons used an average of 36.7 instruments of 184 available instruments per case, for a usage rate of 20.5±2.8%. A significant difference was noted between usage rates in abdominal cases (26.3±6

  5. A Surgical Treatment Of

    African Journals Online (AJOL)


    Email: Snoring is now seen as one end of sleep-related breathing disorder resulting ultimately in obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP) is the first surgical procedure specifically designed to alleviate the abnormalities, although the use of laser appears to be the new trend.


    African Journals Online (AJOL)


    1 Dept.of Veterinary Surgery and Medicine 2Veterinary Teaching Hospital Ahmadu Bello University. Zaria .... unnecessary suffering., Administration of poisons .... way that humans are. Vivisection/ Surgical Training And Research. Animal model use: In both the human and veterinary medical practice, there continue to be ...

  7. Joseph Lister's surgical revolution. (United States)

    Toledo-Pereyra, Luis H


    Joseph Lister (1827-1912), renowned British surgeon-scientist, introduced to the world the use and appreciation of the antiseptic method for the prevention of wound sepsis. Armed with the ideas of Louis Pasteur (1822-1895) regarding the role of microorganisms in infections or the so-called germ theory of disease, he advanced the surgical field by using antiseptics, such as carbolic acid, in the treatment of contaminated wounds. These developments constituted a real surgical revolution. No breakthrough before Lister's, except perhaps the discovery of anesthesia, had contributed to such an incredible advancement in relationship to the surgical arena. After 1867, the year in which Lister published his remarkable paper in Lancet, it was possible to appropriately treat or prevent wound infections with the use of antiseptics at the site of the operated wound. Lister's method was complicated but produced its desired effect--to diminish wound morbidity and patient mortality. His contribution was secured for future generations and a surgical revolution had begun!

  8. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Eika, Berit; Langebæk, Rikke; Jensen, A.L.


    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... Skills); both courses were offered in multiple classes (with a total of 171 students in 2009 and 156 students in 2010). All classes in 2009 participated in the SSL stage of the Basic Surgical Skills course before performing live-animal surgery, and one class (28 students) in 2010 did not. Two validated...

  9. Clinical Performance of Emergency Surgical Officers in Southern ...

    African Journals Online (AJOL)


    The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs' clinical decision making, surgical skill ...

  10. Surgical Robotics Research in Cardiovascular Disease

    International Nuclear Information System (INIS)

    Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles


    This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ( 31 P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery devices

  11. Hydraulic Robotic Surgical Tool Changing Manipulator. (United States)

    Pourghodrat, Abolfazl; Nelson, Carl A; Oleynikov, Dmitry


    Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique to perform "scarless" abdominal operations. Robotic technology has been exploited to improve NOTES and circumvent its limitations. Lack of a multitasking platform is a major limitation. Manual tool exchange can be time consuming and may lead to complications such as bleeding. Previous multifunctional manipulator designs use electric motors. These designs are bulky, slow, and expensive. This paper presents design, prototyping, and testing of a hydraulic robotic tool changing manipulator. The manipulator is small, fast, low-cost, and capable of carrying four different types of laparoscopic instruments.

  12. Surgical Robotics Research in Cardiovascular Disease

    Energy Technology Data Exchange (ETDEWEB)

    Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles


    This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ({sup 31}P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery

  13. Removal of surgical smear layer. (United States)

    Fabiani, Cristiano; Franco, Vittorio; Covello, Francesco; Brambilla, Eugenio; Gagliani, Massimo M


    During apicoectomy and retrograde cavity preparation, a smear layer, which contains microorganisms and necrotic pulpal tissues, is formed on the dentinal surfaces cut by the instruments. Bacteria can survive and proliferate inside or below the smear layer. The purpose of this study was to evaluate in vitro two different procedures for the removal of the smear layer in retrocavities prepared with ultrasonic retrotips. Twenty-eight single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and sealer. The apical 3 mm of each root were cut with a carbide bur, and retrograde cavities were prepared with ProUltra ultrasonic retrotips (Maillefer Dentsply, Baillagues, Switzerland) at a depth of 3 mm. Teeth in group A were treated with a gel of 35% orthophosphoric acid for 15 seconds, and teeth in group B were treated with a gel of 24% EDTA at a neutral pH for 2 minutes. The samples were prepared for scanning electron microscopic observation and scored for the presence of the smear layer on the retrocavity walls. Eighty percent of the teeth in group A showed an optimal degree of cleanliness of the walls, with dentinal tubules completely open. The majority of analyzed samples coming from group B showed dentinal tubules covered with the smear layer. The analysis of the samples showed that orthophosphoric acid is more effective than EDTA in removing surgical smear layer even with less time of action. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Instrumentation for accelerators

    International Nuclear Information System (INIS)

    Sen, T.J.; De, T.K.; Ranganathan, M.K.; Basak, G.C.


    Along with the various system development for the accelerator, it was necessary to develop the instrumentation facility for the cyclotron. It started with the development of various vacuum instruments like ionization gauge control unit for measurement of pressure from 10 -4 torr to 10 -9 torr, discharge gauge control unit from 10 -4 torr to 10 -7 torr, thermocouple gauge control unit from 1 torr to 10 -3 torr. Process control instrumentation includes temperature measurement for freon cooled baffle and als o for low conductivity water. Control console required various digital panel meters for measurement of various parameters of the cyclotron. Various radiation monitoring instruments are also taken care of by the instrumentation facility. This paper describes in brief these various instruments. (author). 3 f igs

  15. Instrumentation a reader

    CERN Document Server

    Pope, P


    This book contains a selection of papers and articles in instrumentation previously pub­ lished in technical periodicals and journals of learned societies. Our selection has been made to illustrate aspects of current practice and applications of instrumentation. The book does not attempt to be encyclopaedic in its coverage of the subject, but to provide some examples of general transduction techniques, of the sensing of particular measurands, of components of instrumentation systems and of instrumentation practice in two very different environments, the food industry and the nuclear power industry. We have made the selection particularly to provide papers appropriate to the study of the Open University course T292 Instrumentation. The papers have been chosen so that the book covers a wide spectrum of instrumentation techniques. Because of this, the book should be of value not only to students of instrumen­ tation, but also to practising engineers and scientists wishing to glean ideas from areas of instrumen...

  16. Radiation measurement instruments

    International Nuclear Information System (INIS)



    The requirements and characteristics of radiation measurement instruments vary according to the circumstances under which they are used (field, area, laboratory conditions) and according to their purpose (radiation survey, personal monitoring, use in emergencies, or alpha, beta or gamma counting). In fact, radiation measurement instruments are so varied that only an overview has been presented here. Groups of instruments for these and other conditions or uses are presented in tabular form together with their operational characteristics and requirements. While examples of calibrations, efficiencies and variability of all the listed instruments are not given in this chapter, these parameters are illustrated for the most important types of gamma and beta survey instruments, in some cases with a specific instrument used as an example. Some of the important parameters that need to be considered for laboratory counting of alpha and beta particles are presented. Charts for determination of optimum sample and background counting times, errors and statistics are given

  17. Parapharyngeal Tumours - Surgical Expertise

    Directory of Open Access Journals (Sweden)

    Kinjal Shankar Majumdar


    Full Text Available Introduction We present our experience in the management of parapharyngeal tumours. A conservative trans-cervical approach was found to be feasible and effective in majority of the cases over radical ones, which may be required in malignancies and skull-base involvement.   Methods Fifteen patients with parapharyngeal tumours treated surgically in the Department of ENT, Nilratan Sircar Medical College in last 3 years were included in the study. 80% of the cases were benign, most common being Schwannoma. Most important investigation was found to be MRI.   Conclusion The study gives an overview regarding the surgical approach, based upon the extent and histology of the tumour. Trans-cervical approachwas found to be the most effective.

  18. Radiation protection instrument 1993

    International Nuclear Information System (INIS)


    The Radiation Protection Instrument, 1993 (Legislative Instrument 1559) prescribes the powers and functions of the Radiation Protection Board established under the Ghana Atomic Energy Commission by the Atomic Energy Commission (Amendment) Law, 1993 (P.N.D.C. Law 308). Also included in the Legislative Instrument are schedules on control and use of ionising radiation and radiation sources as well as procedures for notification, licensing and inspection of ionising radiation facilities. (EAA)

  19. Parapharyngeal Tumours - Surgical Expertise


    Kinjal Shankar Majumdar


    Introduction We present our experience in the management of parapharyngeal tumours. A conservative trans-cervical approach was found to be feasible and effective in majority of the cases over radical ones, which may be required in malignancies and skull-base involvement.   Methods Fifteen patients with parapharyngeal tumours treated surgically in the Department of ENT, Nilratan Sircar Medical College in last 3 years were included in the study. 80% of the cases were benign, mos...

  20. Ocean Optics Instrumentation Systems (United States)

    Federal Laboratory Consortium — FUNCTION: Provides instrumentation suites for a wide variety of measurements to characterize the ocean’s optical environment. These packages have been developed to...

  1. Networked Instrumentation Element (United States)

    National Aeronautics and Space Administration — Armstrong researchers have developed a networked instrumentation system that connects modern experimental payloads to existing analog and digital communications...

  2. Creating a Super Instrument

    DEFF Research Database (Denmark)

    Kallionpää, Maria; Gasselseder, Hans-Peter


    interested in different ways of "supersizing" acoustic instruments in order to open up previously-unheard instrumental sounds. This leads us to the question of what constitutes a super instrument and what challenges does it pose aesthetically and technically? Although the classical music performers have......Thanks to the development of new technology, musical instruments are no more tied to their existing acoustic or technical limitations as almost all parameters can be augmented or modified in real time. An increasing number of composers, performers, and computer programmers have thus become...

  3. Instrument validation project

    International Nuclear Information System (INIS)

    Reynolds, B.A.; Daymo, E.A.; Geeting, J.G.H.; Zhang, J.


    Westinghouse Hanford Company Project W-211 is responsible for providing the system capabilities to remove radioactive waste from ten double-shell tanks used to store radioactive wastes on the Hanford Site in Richland, Washington. The project is also responsible for measuring tank waste slurry properties prior to injection into pipeline systems, including the Replacement of Cross-Site Transfer System. This report summarizes studies of the appropriateness of the instrumentation specified for use in Project W-211. The instruments were evaluated in a test loop with simulated slurries that covered the range of properties specified in the functional design criteria. The results of the study indicate that the compact nature of the baseline Project W-211 loop does not result in reduced instrumental accuracy resulting from poor flow profile development. Of the baseline instrumentation, the Micromotion densimeter, the Moore Industries thermocouple, the Fischer and Porter magnetic flow meter, and the Red Valve Pressure transducer meet the desired instrumental accuracy. An alternate magnetic flow meter (Yokagawa) gave nearly identical results as the baseline fischer and Porter. The Micromotion flow meter did not meet the desired instrument accuracy but could potentially be calibrated so that it would meet the criteria. The Nametre on-line viscometer did not meet the desired instrumental accuracy and is not recommended as a quantitative instrument although it does provide qualitative information. The recommended minimum set of instrumentation necessary to ensure the slurry meets the Project W-058 acceptance criteria is the Micromotion mass flow meter and delta pressure cells

  4. Instrument performance evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Swinth, K.L.


    Deficiencies exist in both the performance and the quality of health physics instruments. Recognizing the implications of such deficiencies for the protection of workers and the public, in the early 1980s the DOE and the NRC encouraged the development of a performance standard and established a program to test a series of instruments against criteria in the standard. The purpose of the testing was to establish the practicality of the criteria in the standard, to determine the performance of a cross section of available instruments, and to establish a testing capability. Over 100 instruments were tested, resulting in a practical standard and an understanding of the deficiencies in available instruments. In parallel with the instrument testing, a value-impact study clearly established the benefits of implementing a formal testing program. An ad hoc committee also met several times to establish recommendations for the voluntary implementation of a testing program based on the studies and the performance standard. For several reasons, a formal program did not materialize. Ongoing tests and studies have supported the development of specific instruments and have helped specific clients understand the performance of their instruments. The purpose of this presentation is to trace the history of instrument testing to date and suggest the benefits of a centralized formal program.

  5. Surgical management of obesity. (United States)

    Torres-Landa, Samuel; Kannan, Umashankkar; Guajardo, Isabella; Pickett-Blakely, Octavia E; Dempsey, Daniel T; Williams, Noel N; Dumon, Kristoffel R


    Obesity is a spreading epidemic associated with significant morbidity and mortality with a prevalence of over 36% worldwide. In the face of a growing epidemic, increasing medical costs, and the disappointing limitations of medical and lifestyle modification bariatric surgery was found to consistently lead to significant weight loss and improvement in obesity-associated comorbidities when compared to non-surgical interventions. Bariatric procedures fall within three basic categories: restrictive procedures, malabsorptive procedures, and procedures that combine both restrictive and malabsorptive mechanisms. Four major procedures are currently performed (most often laparoscopically): Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch, adjustable gastric banding, and sleeve gastrectomy. Although the laparoscopic Roux-en-Y gastric bypass was the most frequently performed bariatric procedure, the laparoscopic sleeve gastrectomy has since become the most popular. Bariatric surgery currently has similar mortality rates to standard general surgical operations. Morevoer, bariatric surgery reduces mortality by the improvement and remission of obesity-related comorbidities. Newer minimally-invasive weight loss procedures and endoscopic methods continue to evolve as we expand our understanding of the intricacies of obesity and the effects of currently available surgical treatments.

  6. [Surgical robotics in neurosurgery]. (United States)

    Haidegger, Tamás; Benyó, Zoltán


    Surgical robotics is one of the most dynamically advancing areas of biomedical engineering. In the past few decades, computer-integrated interventional medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for nephrectomy, cholecystectomy, as well as in orthopedics and radiosurgery. Estimates show that 70% of the radical prostatectomies were performed with the da Vinci robot in the United States last year. Robot-aided procedures offer remarkable advantages in neurosurgery both for the patient and the surgeon, making microsurgery and Minimally Invasive Surgery a reality, and even complete teleoperation accessible. This paper introduces surgical robotic systems developed primarily for brain and spine applications, besides, it focuses on the different research strategies applied to provide smarter, better and more advanced tools to surgeons. A new system is discussed in details that we have developed together with the Johns Hopkins University in Baltimore. This cooperatively-controlled system can assist with skull base drilling to improve the safety and quality of neurosurgery while reducing the operating time. The paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research.

  7. Allergy to Surgical Implants. (United States)

    Pacheco, Karin A


    Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Fuzzy-logic-assisted surgical planning in adolescent idiopathic scoliosis. (United States)

    Nault, Marie-Lyne; Labelle, Hubert; Aubin, Carl-Eric; Sangole, Archana; Balazinski, Marek


    Selection of appropriate curve fusion levels for surgery in adolescent idiopathic scoliosis (AIS) is a complex and difficult task and, despite numerous publications, still remains a highly controversial topic. To evaluate a fuzzy-logic-based surgical planning tool by comparing the results suggested by the software with the average outcome recommended by a panel of 5 expert spinal deformity surgeons. It is hypothesized that, given the same information, the fuzzy-logic tool will perform as favorably as the surgeons. Proof-of-concept study evaluating the use of a fuzzy-logic-assisted surgical planning tool in AIS to select the appropriate spinal curve to be instrumented. A cohort of 30 AIS surgical cases with a main thoracic curve was used. Each case included standard measurements recorded from preoperative standing postero-anterior and lateral, supine side bending, and 1-year postoperative standing radiographs. Five experienced spinal deformity surgeons evaluated each case independently and gave their preferred levels of instrumentation and fusion. The cases were then presented to the fuzzy-logic tool to determine whether the high thoracic and/or lumbar curves were to be instrumented. For each case, a percentage value was obtained indicating inclusion/exclusion of the respective curves in the surgical instrumentation procedure. Kappa statistics was used to compare the model output and the average decision of the surgeons. Kappa values of 0.71 and 0.64 were obtained, respectively, for the proximal thoracic and lumbar curves models, thus suggesting a good agreement of the fusion recommendations made by the fuzzy-logic tool and the surgeons. Given the same information, the fuzzy-logic-assisted recommendation of the curve to be instrumented compared favorably with the collective decision of the surgeons. The findings thus suggest that a fuzzy-logic approach is helpful in assisting surgeons with the preoperative selection of curve instrumentation and fusion levels in AIS.

  9. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

    The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...

  10. Instrumentation Design and Development Facilities (United States)

    Federal Laboratory Consortium — RTTC has facilities for design, development and fabrication of: custominstrumentation, mobile instrumentation, miniaturized instrumentation, wirelessinstrumentation,...

  11. Clinical Performance of Emergency Surgical Officers in Southern Ethiopia. (United States)

    Gobeze, Abera A; Kebede, Zelalem; Berhan, Yifru; Ghosh, Biku


    Serious shortage of gynecologists and surgeons for several decades leading to a three-year masters level training was initiated in 2009. However, systematic analysis was not done to assess the graduates' performance. The purpose of this study was to assess improvement in access to emergency surgical and obstetrical care services. Both quantitative and qualitative methods were employed to assess the competence of emergency surgical officers (ESOs) in their decision making and surgical skills in eight hospitals between 2012 and 2014. Anesthesia time, post-operative hospital stay and change in hemoglobin level were, among others, used as proxy indicators of their surgical skills. A total of 4075 obstetric and surgical operations was performed in the study hospitals. Of which, 93% were done on emergency base. Of the total emergency procedures, 3570(94%) were done by ESOs. Nearly two-thirds (63%) of all the emergency operations were cesarean sections, which were done by ESOs. Out of 239 uterine ruptures, hysterectomy was done for 58%. The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs' clinical decision making, surgical skill and commitment to discharge their responsibilities were in the best possible. The study showed that deployment of ESOs made the emergency surgery services accessible to the majority, and their clinical decision making and surgical skills were remarkable.

  12. The effect of music on robot-assisted laparoscopic surgical performance. (United States)

    Siu, Ka-Chun; Suh, Irene H; Mukherjee, Mukul; Oleynikov, Dmitry; Stergiou, Nick


    Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

  13. Overview of LOFT instrumentation

    International Nuclear Information System (INIS)

    Bixby, W.W.


    A description of instrumentation used in the Loss-of-Fluid Test (LOFT) large break Loss-of-Coolant Experiments is presented. Emphasis is placed on hydraulic and thermal measurements in the primary system piping and components, reactor vessel, and pressure suppression system. In addition, instrumentation which is being considered for measurement of phenomena during future small break testing is discussed

  14. Trends in the Surgical Correction of Gynecomastia (United States)

    Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey


    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results. PMID:26528088

  15. Surgical consideration of cervical dumbbell tumors. (United States)

    Tomii, Masato; Itoh, Yasunobu; Numazawa, Shinichi; Watanabe, Kazuo


    Nineteen patients with cervical dumbbell tumors treated surgically were analyzed retrospectively. Surgical strategies for dumbbell tumor were discussed from the perspective of safe, less-invasive surgery. Patients included 6 men and 13 women, with a mean age at the time of surgery of 48.3 years (range, 25-70 years). Underlying pathologies included 16 schwannomas, 2 neurofibromas, and 1 double tumor (schwannoma and meningioma). According to Eden's classification, one patient was classified as Type 1, 5 as Type 2, 8 as Type 3, and 5 as Type 4. In 13 cases, tumors were excised through the posterior approach alone, compared to five cases using the anterior approach. One case was excised using combined anterior and posterior approaches. Facetectomy was not performed in 18 cases. In one case, the facet joint on one side had already destroyed and needed instrumentation. Tumors were totally excised in all cases. Postoperatively, the patients did not display any further neurological deficit, with the exception of transient radiculopathy in two patients. Major surgical complications and cerebrospinal fluid leakage were not seen. Tumor recurrence and spinal segmental instability were not found during follow-up period (mean, 41.6 months). Dumbbell tumor surgery requires sufficient debulking of the epidural and paravertebral mass, using intraoperative nerve stimulation and Doppler ultrasonography to detect the vertebral artery. When using a posterior approach, recapping laminoplasty using an ultrasonic bone curette is very useful to remove tumor without sacrificing facet joints.

  16. [Changing surgical therapy because of clinical studies?]. (United States)

    Schwenk, W; Haase, O; Müller, J M


    The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.

  17. Voice tuning with new instruments for type II thyroplasty in the treatment of adductor spasmodic dysphonia. (United States)

    Sanuki, Tetsuji; Yumoto, Eiji; Toya, Yutaka; Kumai, Yoshihiko


    Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type II thyroplasty differs from previous treatments in that this surgery does not involve any surgical intervention into the laryngeal muscle, nerve or vocal folds. Type II thyroplasty intervenes in the thyroid cartilage, which is unrelated to the lesion. This procedure, conducted with the aim of achieving lateralization of the vocal folds, requires utmost surgical caution due to the extreme delicacy of the surgical site, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages at a correct position. During surgery, the correct separation of the incised cartilage edges with voice monitoring is the most important factor determining surgical success and patient satisfaction. We designed new surgical instruments: a thyroid cartilage elevator for undermining the thyroid cartilage, and spacer devices to gauge width while performing voice monitoring. These devices were designed to prevent surgical complications, and to aid in selecting the optimal size of titanium bridges while temporally maintaining a separation during voice monitoring. We designed new surgical instruments, including a thyroid cartilage elevator and spacer devices. Precise surgical procedures and performing voice tuning during surgery with the optimal separation width of the thyroid cartilage are key points for surgical success. We introduce the technique of voice tuning using these surgical tools in order to achieve a better outcome with minimal surgical complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.


    With the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal invasive surgery. During such procedures, surgeons have to manoeuver the instruments from outside the patient while looking at the monitor. Long and

  19. Modified rotatory instruments for transphenoidal surgery: technical note. (United States)

    Marino Júnior, R


    A series of modified gyratory bayonets instruments is described. They have the advantage to allow any adjustable position within a 360 degree rotation angle, during the various surgical steps of transphenoidal surgery, thus keeping the surgeon's hand always at the same position.

  20. Modified rotatory instruments for transphenoidal surgery: technical note

    Directory of Open Access Journals (Sweden)

    Raul Marino Jr


    Full Text Available A series of modified gyratory bayonets instruments is described. They have the advantage to allow any adjustable position within a 360° rotation angle, during the various surgical steps of transphenoidal surgery, thus keeping the surgeon's hand always at the same position.

  1. The importance of protecting surgical instrument tables from intraoperative contamination in clean surgeries Importancia de la protección de la mesa de instrumentos quirúrgicos en la contaminación intraoperatoria de cirugías limpias Importância da proteção da mesa de instrumentais cirúrgicos na contaminação intraoperatória de cirurgias limpas

    Directory of Open Access Journals (Sweden)

    Aline Mesquita Amaral


    Full Text Available OBJECTIVE: to compare the degree of bacterial contamination of surgical instrument tables used in clean surgical procedures, either protected with plastic fields, sterilized with ethylene oxide, or disinfected with 70% alcohol and 1% iodine solutions. This is a randomized clinical trial in which samples were collected from the surfaces of surgical instrument tables before and after each procedure. Microbiological analysis was performed to identify microorganisms and their respective antimicrobial resistance. RESULTS: Bacterial growth in the surgeries using sterilized plastic was 5.71% before and 28.6% after surgery and, 2.9% and 45.7% respectively in surgeries using disinfection with 70% alcohol and 1% iodine solutions; no statistical difference was found between the methods. CONCLUSION: both methods present similar protection, however, 70% alcohol and 1% iodine do not generate solid waste.El objetivo del estudio fue analizar el grado de contaminación bacteriana de la mesa de instrumentos quirúrgicos en dos casos, después del uso: cubierta protectora plástico de la mesa quirúrgica esterilizada con óxido de etileno o desinfección con solución de alcohol a 70% y yodo a 1%, en procedimientos quirúrgicos limpios. Se trata de un experimento clínico aleatorio, con recolección de muestras de las superficies de las mesas de instrumentos quirúrgicos, antes y después de cada procedimiento, con posterior análisis microbiológica para identificar los microorganismos y la resistencia antimicrobiana. En las cirugías en que el plástico esterilizado fue utilizado, el crecimiento bacteriano fue de 5,71% antes y 28,6% después de la cirugía, en cuanto que en las desinfecciones con solución de alcohol a 70% y yodo a 1%, el crecimiento fue de 2,9% antes y 45,7% después, lo que indica que no hubo diferencia significativa entre los métodos empleados. Los dos métodos tienen poder de protección semejante, considerando que el alcohol a 70% y yodo a

  2. Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women


    El Ayadi, Alison; Nalubwama, Hadija; Barageine, Justus; Neilands, Torsten B.; Obore, Susan; Byamugisha, Josaphat; Kakaire, Othman; Mwanje, Haruna; Korn, Abner; Lester, Felicia; Miller, Suellen


    Background Obstetric fistula is a debilitating and traumatic birth injury affecting 2?3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. Metho...

  3. [What's new in instrumental dermatology?]. (United States)

    Amici, J-M


    This "What's new in instrumental dermatology" focuses on cutaneous oncologic surgery, base on a review of the 2012-2014 literature. First, the ability of dermatologists to make a good "oncologic reading of tumors" is the key of radical surgical treatment. Advantages and disadvantages of the biopsy are discussed. Then, the second message is the management of anticoagulants, that should not be interrupted for skin surgery. Despite recommendations, this practice is not followed in 40% of cases; this point is critical because bleeding complications are minor compared to potential morbidity of thrombotic events when stopping these medications. Regarding infection, nasal carriage of Staphylococcus aureus is identified as a risk factor for wound infection. A preoperative shower with chlorhexidine and mupirocin topical decolonization of nostril reduces this risk. Surgical techniques are trying to reach minimalism, by reducing undermining and scarring. On the trunk, using deep slow resorbable sutures improve scarring. In addition using adhesive sutures (strip) reduce the wideness of scar. On the face, the lower third of the nose is the most challenging because of the free edges, which are deformable. In this location bilobed or trilobed transposition flap offer the advantage of remaining in the nasal aesthetic unit and not disturbing the free edges of the nasal orifices. Regarding scarring, early hypertrophic scar is now well defined and linked with transposition flaps of the nasal region. An early treatment with intralesional corticosteroid injection appears to be effective. Finally, the biological mechanism of the effectiveness of compression in the prevention and treatment of dystrophic scar is now clear. The mechanotransduction explain how a mechanical stress of the skin activates biological cell pathways, which regulate the quality of collagen synthesis and the arrangement of skin fibrosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S


    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious extra...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma.......Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious...

  5. [Surgical methods of abortion]. (United States)

    Linet, T


    A state of the art of surgical method of abortion focusing on safety and practical aspects. A systematic review of French-speaking or English-speaking evidence-based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A). In women under 25 years, doxycycline is preferred (grade C) due to the high prevalence of Chlamydia trachomatis. Systematic cervical preparation is recommended for reducing the incidence of complications from vacuum aspiration (grade A). Misoprostol is a first-line agent (grade A). When misoprostol is used before a vacuum aspiration, a dose of 400 mcg is recommended. The choice of vaginal route or sublingual administration should be left to the woman: (i) the vaginal route 3 hours before the procedure has a good efficiency/safety ratio (grade A); (ii) the sublingual administration 1 to 3 hours before the procedure has a higher efficiency (EL1). The patient should be warned of more common gastrointestinal side effects. The addition of mifepristone 200mg 24 to 48hours before the procedure is interesting for pregnancies between 12 and 14 weeks gestations (EL2). The systematic use of nonsteroidal anti-inflammatory drugs is recommended for limiting the operative and postoperative pain (grade B). Routine vaginal application of an antiseptic prior to the procedure cannot be recommended (grade B). The type of anesthesia (general or local) should be left up to the woman after explanation of the benefit-risk ratio (grade B). Paracervical local anesthesia (PLA) is recommended before performing a vacuum aspiration under local anesthesia (grade A). The electric or manual vacuum methods are very effective, safe and acceptable to women (grade A). Before 9 weeks gestation

  6. Remote instrument telemaintenance. (United States)

    Laugier, A; Allahwerdi, N; Baudin, J; Gaffney, P; Grimson, W; Groth, T; Schilders, L


    In the past decade, great technological progress has been made in telemaintenance of mainframe and mini computers. As hardware technology is now available at an acceptable cost, computer aided trouble-shooting can be adapted to laboratory instrumentation in order to significantly improve repair time, avoid instrument downtime by taking advantage of predictive methods, and provide general diagnostic assistance. Depending on the size of the instrument, the telemaintenance facility can be dedicated to a single instrument or alternatively a telemaintenance server can manage multiple distributed small instruments through a Local Area Network. As complex failures can occur, the local diagnosis capabilities may be exceeded and automatic dialing for connection to computerized Remote Maintenance Centers is needed. The main advantages of such a centre, as compared to local diagnosis systems, are the increased access to more information and experience of failures from instrument installations, and consequently the provision of training data updates for Artificial Neural Networks and Knowledge Based Systems in general. When an abnormal situation is detected or anticipated by a diagnosis module, an automatic alert is given to the user, local diagnosis is activated, and for simple solutions, instructions are given to the operator. In the last resort, a human expert can be alerted who, with remote control tools, can attend to the failures. For both local and remote trouble-shooting, the data provided by the instrument and connected workstation is of paramount importance for the efficiency and accuracy of the diagnosis. Equally, the importance of standardization of telemaintenance communication protocols is addressed.

  7. Medical instruments in museums

    DEFF Research Database (Denmark)

    Söderqvist, Thomas; Arnold, Ken


    This essay proposes that our understanding of medical instruments might benefit from adding a more forthright concern with their immediate presence to the current historical focus on simply decoding their meanings and context. This approach is applied to the intriguingly tricky question of what...... actually is meant by a "medical instrument." It is suggested that a pragmatic part of the answer might lie simply in reconsidering the holdings of medical museums, where the significance of the physical actuality of instruments comes readily to hand....

  8. Instrumentation reference book

    CERN Document Server

    Boyes, Walt


    Instrumentation is not a clearly defined subject, having a 'fuzzy' boundary with a number of other disciplines. Often categorized as either 'techniques' or 'applications' this book addresses the various applications that may be needed with reference to the practical techniques that are available for the instrumentation or measurement of a specific physical quantity or quality. This makes it of direct interest to anyone working in the process, control and instrumentation fields where these measurements are essential.* Comprehensive and authoritative collection of technical information* Writte

  9. Microcomputers for nuclear instrumentation

    International Nuclear Information System (INIS)

    Byrd, J.S.


    Small, desk-top Commodore PET computers are being used to solve nuclear instrumentation problems at the Savannah River Laboratory (SRL). The ease of operating, programing, interfacing, and maintaining the PET computer makes it a cost-effective solution to many real-time instrumentation problems that involve both data acquisition and date processing. The IEEE-488 GPIB (General Purpose Instrument Bus) is an integral part of the PET hardware. This paper reviews GPIB design concepts and discusses SRL applications that use the PET computer as a GPIB controller. 11 figures, 2 tables

  10. The latest radiation instrument

    International Nuclear Information System (INIS)

    Kang, Se Sik; Gwon, Dal Gwan; Kim, Gyeong Geum


    This book deals with the latest radiation instrument, which is comprised of eight chapters. It explains X rays instrument for medial treatment, X-ray tube instrument and permissible burden with its history, structure and characteristic high voltage apparatus with high voltage rectifier circuit, X-ray control apparatus for medical treatment, X-ray image equipment X-ray television apparatus and CCD 205, X-ray apparatus of install and types, Digital X-ray apparatus with CR 261 and DR 269, performance management on X-ray for medical treatment with its history, necessity and management in the radiation field.

  11. Soil monitoring instrumentation

    International Nuclear Information System (INIS)

    Umbarger, C.J.


    The Los Alamos Scientific Laboratory (LASL) has an extensive program for the development of nondestructive assay instrumentation for the quantitative analysis of transuranic (TRU) materials found in bulk solid wastes generated by Department of Energy facilities and by the commercial nuclear power industry. Included are wastes generated in decontamination and decommissioning of outdated nuclear facilities as well as wastes from old waste burial ground exhumation programs. The assay instrumentation is designed to have detection limits below 10 nCi/g wherever practicable. Because of the topic of this workshop, only the assay instrumentation applied specifically to soil monitoring will be discussed here. Four types of soil monitors are described

  12. Soil monitoring instrumentation

    International Nuclear Information System (INIS)

    Umbarger, C.J.


    The Los Alamos Scientific Laboratory (LASL) has an extensive program for the development of nondestructive assay instrumentation for the quantitative analysis of transuranic (TRU) materials found in bulk solid wastes generated by Department of Energy facilities and by the commercial nuclear power industry. Included are wastes generated in decontamination and decommissioning of outdated nuclear facilities, as well as from old waste-burial-ground exhumation programs. The assay instrumentation is designed to have detection limits below 10 nCi/g wherever practicable. The assay instrumentation that is applied specifically to soil monitoring is discussed

  13. Reducing healthcare costs facilitated by surgical auditing: a systematic review. (United States)

    Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria


    Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

  14. Journal of Surgical Technique and Case Report

    African Journals Online (AJOL)

    The aim of Journal of Surgical Technique and Case Report is to advance surgical knowledge and practice by promoting the reporting of innovative and reproducible surgical techniques and illustrative surgical cases on various surgical disciplines. The journal encourages authoritative synthesis of current surgical literature ...

  15. Pneumatic-type surgical robot end-effector for laparoscopic surgical-operation-by-wire. (United States)

    Lee, Chiwon; Park, Woo Jung; Kim, Myungjoon; Noh, Seungwoo; Yoon, Chiyul; Lee, Choonghee; Kim, Youdan; Kim, Hyeon Hoe; Kim, Hee Chan; Kim, Sungwan


    Although minimally invasive surgery (MIS) affords several advantages compared to conventional open surgery, robotic MIS systems still have many limitations. One of the limitations is the non-uniform gripping force due to mechanical strings of the existing systems. To overcome this limitation, a surgical instrument with a pneumatic gripping system consisting of a compressor, catheter balloon, micro motor, and other parts is developed. This study aims to implement a surgical instrument with a pneumatic gripping system and pitching/yawing joints using micro motors and without mechanical strings based on the surgical-operation-by-wire (SOBW) concept. A 6-axis external arm for increasing degrees of freedom (DOFs) is integrated with the surgical instrument using LabVIEW® for laparoscopic procedures. The gripping force is measured over a wide range of pressures and compared with the simulated ideal step function. Furthermore, a kinematic analysis is conducted. To validate and evaluate the system's clinical applicability, a simple peg task experiment and workspace identification experiment are performed with five novice volunteers using the fundamentals of laparoscopic surgery (FLS) board kit. The master interface of the proposed system employs the hands-on-throttle-and-stick (HOTAS) controller used in aerospace engineering. To develop an improved HOTAS (iHOTAS) controller, 6-axis force/torque sensor was integrated in the special housing. The mean gripping force (after 1,000 repetitions) at a pressure of 0.3 MPa was measured to be 5.8 N. The reaction time was found to be 0.4 s, which is almost real-time. All novice volunteers could complete the simple peg task within a mean time of 176 s, and none of them exceeded the 300 s cut-off time. The system's workspace was calculated to be 11,157.0 cm3. The proposed pneumatic gripping system provides a force consistent with that of other robotic MIS systems. It provides near real-time control. It is more durable than the

  16. Modern spinal instrumentation. Part 1: Normal spinal implants

    International Nuclear Information System (INIS)

    Davis, W.; Allouni, A.K.; Mankad, K.; Prezzi, D.; Elias, T.; Rankine, J.; Davagnanam, I.


    The general radiologist frequently encounters studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation or as incidental to a study performed for another purpose. There are various surgical approaches and devices used in spinal surgery with an increased understanding of spinal and spinal implant biomechanics drives development of modern fixation devices. It is, therefore, important that the radiologist can recognize commonly used devices and identify their potential complications demonstrated on imaging. The aim of part 1 of this review is to familiarize the reader with terms used to describe surgical approaches to the spine, review the function and normal appearances of commonly used instrumentations, and understand the importance of the different fixation techniques. The second part of this review will concentrate on the roles that the different imaging techniques play in assessing the instrumented spine and the recognition of complications that can potentially occur.

  17. Carbon Footprint Reduction Instruments (United States)

    This page outlines the major differences between Renewable Energy Certificates (REC) and Project Offsets and what types of claims each instrument allows the organization to make in regards to environmental emissions claims.

  18. CCAT Heterodyne Instrument Development (United States)

    National Aeronautics and Space Administration — This work will extend and proof-out the design concept for a high pixel count (128 pixels in 2 bands) submillimeter-wave heterodyne receiver array instrument for the...

  19. Fiber Optics Instrumentation Development (United States)

    Chan, Patrick Hon Man; Parker, Allen R., Jr.; Richards, W. Lance


    This is a general presentation of fiber optics instrumentation development work being conducted at NASA Dryden for the past 10 years and recent achievements in the field of fiber optics strain sensors.

  20. Medical instruments in museums

    DEFF Research Database (Denmark)

    Söderqvist, Thomas; Arnold, Ken


    This essay proposes that our understanding of medical instruments might benefit from adding a more forthright concern with their immediate presence to the current historical focus on simply decoding their meanings and context. This approach is applied to the intriguingly tricky question of what a...... actually is meant by a "medical instrument." It is suggested that a pragmatic part of the answer might lie simply in reconsidering the holdings of medical museums, where the significance of the physical actuality of instruments comes readily to hand.......This essay proposes that our understanding of medical instruments might benefit from adding a more forthright concern with their immediate presence to the current historical focus on simply decoding their meanings and context. This approach is applied to the intriguingly tricky question of what...

  1. Challenges in marine instrumentation

    Digital Repository Service at National Institute of Oceanography (India)

    Afzulpurkar, S.; Desa, E.; Joseph, A.; Chakraborty, B.; Nayak, M.R.; Ranade, G.

    challenge for technology. Biosensors which can detect bioluminescence and other biological activities would play a major role. Autonomous instrumentation outfitted with different types of in-situ sensors would collect data without disturbing the system...

  2. Nuclear instrument technician training

    International Nuclear Information System (INIS)

    Wollesen, E.S.


    This paper reports on Nuclear Instrument Technician (NIT) training that has developed at an accelerated rate over the past three decades. During the 1960's commercial nuclear power plants were in their infancy. For that reason, there is little wonder that NIT training had little structure and little creditability. NIT training, in many early plants, was little more than On-The Job Training (OJT). The seventies brought changes in Instrumentation and Controls as well as emphasis on the requirements for more in depth training and documentation. As in the seventies, the eighties saw not only changes in technologies but tighter requirements, standardized training and the development of accredited Nuclear Instrument Training; thus the conclusion: Nuclear Instrument Training Isn't What It Used To Be

  3. Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units. (United States)

    Smith, Gordon Wg; Goldie, Frank; Long, Steven; Lappin, David F; Ramage, Gordon; Smith, Andrew J


    The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. Residual protein was detected on 72% (n = 136) of instruments reprocessed centrally and 90% (n = 170) of instruments reprocessed locally. Significantly less protein (p podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency.

  4. Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units

    Directory of Open Access Journals (Sweden)

    Ramage Gordon


    Full Text Available Abstract Background The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. Methods The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. Results Residual protein was detected on 72% (n = 136 of instruments reprocessed centrally and 90% (n = 170 of instruments reprocessed locally. Significantly less protein (p Conclusions Overall, the results show the superiority of central reprocessing for complex podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency.

  5. VIRUS instrument collimator assembly (United States)

    Marshall, Jennifer L.; DePoy, Darren L.; Prochaska, Travis; Allen, Richard D.; Williams, Patrick; Rheault, Jean-Philippe; Li, Ting; Nagasawa, Daniel Q.; Akers, Christopher; Baker, David; Boster, Emily; Campbell, Caitlin; Cook, Erika; Elder, Alison; Gary, Alex; Glover, Joseph; James, Michael; Martin, Emily; Meador, Will; Mondrik, Nicholas; Rodriguez-Patino, Marisela; Villanueva, Steven; Hill, Gary J.; Tuttle, Sarah; Vattiat, Brian; Lee, Hanshin; Chonis, Taylor S.; Dalton, Gavin B.; Tacon, Mike


    The Visual Integral-Field Replicable Unit Spectrograph (VIRUS) instrument is a baseline array 150 identical fiber fed optical spectrographs designed to support observations for the Hobby-Eberly Telescope Dark Energy Experiment (HETDEX). The collimator subassemblies of the instrument have been assembled in a production line and are now complete. Here we review the design choices and assembly practices used to produce a suite of identical low-cost spectrographs in a timely fashion using primarily unskilled labor.

  6. Maintenance of scientific instruments

    International Nuclear Information System (INIS)

    Lucero, E.


    During the last years Colombia has increased the use of nuclear techniques, instruments and equipment in ambitious health programs, as well as in research centers, industry and education; this has resulted in numerous maintenance problems. As an alternative solution IAN has established a Central Maintenance Laboratory for nuclear instruments within an International Atomic Energy Agency program for eight Latin American and nine Asian Countries. Established strategies and some results are detailed in this writing

  7. Guideline Implementation: Surgical Smoke Safety. (United States)

    Fencl, Jennifer L


    Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  8. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg


    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  9. Future of radiological instrumentation

    International Nuclear Information System (INIS)

    Lucas, A.C.


    Future trends in the development of radiation protection instrumentation can be expected to be closely related to current trends in political and social activity that drive legislation, rule-making, and standard practice, with assistance provided by trends in material and electronic technology. Wide-range performance will be emphasized to arm the daily worker with instruments that routinely log background rates and, at the same time, are prepared to measure accident rates. Separate and simultaneous accumulation of data from several sensors to ensure complete coverage of the radiation types will be common. Mathematical manipulation of data will provide for summary data logging and, in some cases, solutions to integral equations to provide corrections to experimental data. Instruments will become more reliable by way of self-checking and correction. Miniaturization and large-scale integration of measuring instruments will provide some instrumentation for the people at large. To be effective, the instruments will necessarily cover a wide range and be very reliable. The net result of these several trends will provide for a widespread understanding of radiation protection and an implementation of as low as reasonably achievable among large segments of the population

  10. [The instrument for thermography]. (United States)

    Hamaguchi, Shinsuke


    Thermography is an imaging method using the instrument to detect infrared rays emitted from the body surface, and to plot them as a distribution diagram of the temperature information. Therefore, a thermographic instrument can be assumed to measure the skin temperature of the diseased region. Such an instrument is a useful device for noninvasive and objective assessment of various diseases. Examination using a thermographic instrument can assess the autonomic dysfunction by measuring the skin blood flow involved with the sympathetic innervation. Thermography is useful in assisting the determination of the therapeutic effect. However, autonomic dysfunction should be confirmed correctly with the assessment of thermatome that shows abnormal thermal distribution in the region of the disease. Thermography should make noticeable the difference between the body temperature of abnormal and normal sites, and show the alteration of temperature. Monitoring using thermography is useful to determine the effect of sympathetic nerve block. If a thermographic instrument is used, it is important that examiners should understand the function of the instrument, as well as its advantages and disadvantages.

  11. Problems with radiological surveillance instrumentation

    International Nuclear Information System (INIS)

    Swinth, K.L.; Tanner, J.E.; Fleming, D.M.


    Many radiological surveillance instruments are in use at DOE facilities throughout the country. These instruments are an essential part of all health physics programs, and poor instrument performance can increase program costs or compromise program effectiveness. Generic data from simple tests on newly purchased instruments shows that many instruments will not meet requirements due to manufacturing defects. In other cases, lack of consideration of instrument use has resulted in poor acceptance of instruments and poor reliability. The performance of instruments is highly variable for electronic and mechanical performance, radiation response, susceptibility to interferences and response to environmental factors. Poor instrument performance in these areas can lead to errors or poor accuracy in measurements

  12. The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

    Directory of Open Access Journals (Sweden)

    Vasconcelos Belmiro CE


    Full Text Available Abstract Background Temporomandibular joint disorders (TMJD are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1 identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2 evaluate their methodological quality, and (3 evaluate the evidence grade within the systematic reviews. Methods A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July. Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. Results The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd. In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. Conclusion The results indicate that in spite of the widespread impact of TMJD, and the multitude of

  13. Global curriculum in surgical oncology. (United States)

    Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A


    The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

  14. Surgical treatment of aortic coarctation


    Omeje, IC; Poruban, R; ?ag?t, M; Nos?l, M; Hra?ka, V


    Coarctation of the aorta accounts for about 8% of all congenital heart diseases. Since the first successful case of surgical treatment in 1944 by Crafoord and Nylin1 in Sweden, several surgical techniques have been employed in the treatment of this anomaly. This article reviews by illustration the various surgical options in coarctation of the aorta with emphasis on our preferred technique – the extended resection and end-to-end anastomosis. Why the extended resection technique? Our exper...

  15. Modelling and evaluation of surgical performance using hidden Markov models. (United States)

    Megali, Giuseppe; Sinigaglia, Stefano; Tonet, Oliver; Dario, Paolo


    Minimally invasive surgery has become very widespread in the last ten years. Since surgeons experience difficulties in learning and mastering minimally invasive techniques, the development of training methods is of great importance. While the introduction of virtual reality-based simulators has introduced a new paradigm in surgical training, skill evaluation methods are far from being objective. This paper proposes a method for defining a model of surgical expertise and an objective metric to evaluate performance in laparoscopic surgery. Our approach is based on the processing of kinematic data describing movements of surgical instruments. We use hidden Markov model theory to define an expert model that describes expert surgical gesture. The model is trained on kinematic data related to exercises performed on a surgical simulator by experienced surgeons. Subsequently, we use this expert model as a reference model in the definition of an objective metric to evaluate performance of surgeons with different abilities. Preliminary results show that, using different topologies for the expert model, the method can be efficiently used both for the discrimination between experienced and novice surgeons, and for the quantitative assessment of surgical ability.

  16. Tophi - surgical treatment. (United States)

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  17. 21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic specialized manual... Gynecological Surgical Devices § 884.4530 Obstetric-gynecologic specialized manual instrument. (a) Identification. An obstetric-gynecologic specialized manual instrument is one of a group of devices used during...

  18. Surgical gesture classification using Dynamic Time Warping and affine velocity. (United States)

    Cifuentes, Jenny; Minh Tu Pham; Moreau, Richard; Prieto, Flavio; Boulanger, Pierre


    Minimally Invasive Surgery (MIS) has become widespread as an important surgical technique due to its advantages related to pain relief and short recovery time periods. However, this approach implies the acquisition of special surgical skills, which represents a challenge in the objective assessment of surgical gestures. In this way, several studies shown that kinematics and kinetic analysis of hand movement is a valuable assessment tool of basic surgical skills in MIS. In addition, recent researches proved that human motion performed during surgery can be described as a sequence of constant affine velocity movements. In this paper, we present a novel method to classify gestures based on an affine velocity analysis of 3D motion and an implementation of the Dynamic Time Warping algorithm. In particular, affine velocity calculation correlates kinematics and geometrical variables such as curvature, torsion, and euclidean velocity, reducing the dimension of the conventional 3D problem. In this way, using the simplicity of dynamic time warping algorithm allows us to perform an accurate classification, easier to implement and understand. Experimental validation of the algorithm is presented based on the position and orientation data of a laparoscope instrument, determiMinimally Invasive Surgery (MIS) has become widespread as an important surgical technique due to its advantages related to pain relief and short recovery time periods. However, this approach implies the acquisition of special surgical skills, which represents a challenge in the objective assessment of surgical gestures. In this way, several studies shown that kinematics and kinetic analysis of hand movement is a valuable assessment tool of basic surgical skills in MIS. In addition, recent researches proved that human motion performed during surgery can be described as a sequence of constant affine velocity movements. In this paper, we present a novel method to classify gestures based on an affine velocity

  19. GPU based real-time instrument tracking with three dimensional ultrasound. (United States)

    Novotny, Paul M; Stoll, Jeffrey A; Vasilyev, Nikolay V; del Nido, Pedro J; Dupont, Pierre E; Howe, Robert D


    Real-time 3D ultrasound can enable new image-guided surgical procedures, but high data rates prohibit the use of traditional tracking techniques. We present a new method based on the modified Radon transform that identifies the axis of instrument shafts as bright patterns in planar projections. Instrument rotation and tip location are then determined using fiducial markers. These techniques are amenable to rapid execution on the current generation of personal computer graphics processor units (GPU). Our GPU implementation detected a surgical instrument in 31 ms, sufficient for real-time tracking at the 26 volumes per second rate of the ultrasound machine. A water tank experiment found instrument tip position errors of less than 0.2 mm, and an in vivo study tracked an instrument inside a beating porcine heart. The tracking results showed good correspondence to the actual movements of the instrument.

  20. Reactor instrumentation and control

    International Nuclear Information System (INIS)

    Wach, D.; Beraha, D.


    The methods for measuring radiation are shortly reviewed. The instrumentation for neutron flux measurement is classified into out-of-core and in-core instrumentation. The out-of-core instrumentation monitors the operational range from the subcritical reactor to full power. This large range is covered by several measurement channels which derive their signals from counter tubes and ionization chambers. The in-core instrumentation provides more detailed information on the power distribution in the core. The self-powered neutron detectors and the aeroball system in PWR reactors are discussed. Temperature and pressure measurement devices are briefly discussed. The different methods for leak detection are described. In concluding the plant instrumentation part some new monitoring systems and analysis methods are presented: early failure detection methods by noise analysis, acoustic monitoring and vibration monitoring. The presentation of the control starts from an qualitative assessment of the reactor dynamics. The chosen control strategy leads to the definition of the part-load diagram, which provides the set-points for the different control systems. The tasks and the functions of these control systems are described. In additiion to the control, a number of limiting systems is employed to keep the reactor in a safe operating region. Finally, an outlook is given on future developments in control, concerning mainly the increased application of process computers. (orig./RW)

  1. Instrumental analysis, second edition

    International Nuclear Information System (INIS)

    Christian, G.D.; O'Reilly, J.E.


    The second edition of Instrumental Analysis is a survey of the major instrument-based methods of chemical analysis. It appears to be aimed at undergraduates but would be equally useful in a graduate course. The volume explores all of the classical quantitative methods and contains sections on techniques that usually are not included in a semester course in instrumentation (such as electron spectroscopy and the kinetic methods). Adequate coverage of all of the methods contained in this book would require several semesters of focused study. The 25 chapters were written by different authors, yet the style throughout the book is more uniform than in the earlier edition. With the exception of a two-chapter course in analog and digital circuits, the book purports to de-emphasize instrumentation, focusing more on the theory behind the methods and the application of the methods to analytical problems. However, a detailed analysis of the instruments used in each method is by no means absent. The book has the favor of a user's guide to analysis

  2. Instrumentation for environmental monitoring

    International Nuclear Information System (INIS)

    McLaughlin, R.D.; Hunt, M.S.; Murphy, D.L.; Chen, C.R.


    In the last few years a much greater emphasis has been placed upon understanding, controlling and monitoring the environmental effects of the advancing technologies. This has resulted in rapid advances in techniques for environmental monitoring. To aid the concerned scientist in keeping abreast of these developments, the Lawrence Berkeley Laboratory publishes a collection of volumes entitled Instrumentation for Environmental Monitoring. Separated into four volumes covering four media, AIR, WATER, RADIATION, and BIOMEDICAL, they provide a source book for three types of material: (1) Monitoring Rationale. They describe the characteristics, forms, and effects of a wide variety of pollutants and the means of controlling them. Federal regulations are explained and summarized. (2) Analytical Techniques. Methods of determining specific pollutants are described with special emphasis on the principles that form the basis of instrumental methods. (3) Commercial Instrumentation. The features of most commercially available instrumentation used for the determination and monitoring of each pollutant are presented in a manner that facilitates instrumental comparisons. Examples of the types of material in the volumes and the use of the volumes are presented

  3. Acute Perioperative Comparison of Patient-Specific Instrumentation versus Conventional Instrumentation Utilization during Bilateral Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jerrod A. Steimle


    Full Text Available Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition. A total of 49 patients with standard instrumentation and 31 patients with patient-specific instrumentation were retrospectively reviewed in a two-year period at one facility. At baseline, the groups were comparable with respect to age, ASA, BMI, and comorbid conditions. We analyzed data on operative time, blood loss, hemoglobin change, need for transfusion, pain medication use, length of stay, and discharge disposition. There was no statistically significant difference between groups in regards to these parameters. Patient-specific instrumentation in the setting of bilateral total knee arthroplasty did not provide any immediate perioperative benefit compared to conventional instrumentation.

  4. Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units (United States)


    Background The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. Methods The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. Results Residual protein was detected on 72% (n = 136) of instruments reprocessed centrally and 90% (n = 170) of instruments reprocessed locally. Significantly less protein (p decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency. PMID:21219613

  5. Biochemistry Instrumentation Core Technology Center (United States)

    Federal Laboratory Consortium — The UCLA-DOE Biochemistry Instrumentation Core Facility provides the UCLA biochemistry community with easy access to sophisticated instrumentation for a wide variety...

  6. Heat Flux Instrumentation Laboratory (HFIL) (United States)

    Federal Laboratory Consortium — Description: The Heat Flux Instrumentation Laboratory is used to develop advanced, flexible, thin film gauge instrumentation for the Air Force Research Laboratory....

  7. Computer based policy making in draining old surgical techniques. (United States)

    Dragomirescu, E; Stavri, E; Dimitriu, R; Belu, I


    The discopathy disease has an important incidence all over the world affecting more men than women and is influenced by social factors. The treatment has often surgical indication. The operating techniques on one hand are dependent on the equipment, instruments and expertise and on the other hand they are related to the specificity of the case, surgeon's inspiration etc. These factors are influencing the postoperative patient evolution.

  8. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart


    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated

  9. Mortality in Emergency Surgical Oncology

    NARCIS (Netherlands)

    Bosscher, M. R. F.; van Leeuwen, B. L.; Hoekstra, H. J.

    Cancer patients can experience problems related to their disease or treatment. This study evaluated reasons for presentation at the emergency room (ER) and outcome of surgical oncology patients. A retrospective chart review for all surgical oncology patients who presented at the ER of the UMCG for

  10. Surgical innovation : The ethical agenda

    NARCIS (Netherlands)

    Broekman, Marike L.|info:eu-repo/dai/nl/343152347; Carrière, Michelle E.; Bredenoord, Annelien L.|info:eu-repo/dai/nl/240834666


    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on

  11. Surgical residency: A tenant's view

    African Journals Online (AJOL)

    'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...

  12. Instrumentation Video Systems (United States)

    Lida, Hitoshi


    The use of video equipment as instrumentation has been increasing steadily over the past decade. An indication of this trend can be found close to home: notice how rapidly the number of television (TV) displays has grown at our technical exhibits. It is this exhibited equipment and other equipment like it which form the subject of this summary. We will limit our discussions to readily available hardware (and a little software) and leave reports of the leading edge development work to other issues of this journal. We hope, in this manner, to present useful information to those who need to apply video to their instrumen-tation problems now. Along the way we will occasionally indicate what equipment might soon result from current research, but our clear emphasis will be on the state of the art of accessible instrumentation video.

  13. The IKARUS instrument

    International Nuclear Information System (INIS)

    Gerster, H.J.; Stein, G.


    When the Federal Government decided on a 25% reduction of CO 2 emissions till 2005 in 1990 the necessity resulted that an instrument has to be developed for the analysis and assessment of the ecological, economic and energetic impact of different reduction strategies. The development task was awarded by the BMFT to the Research Centre Juelich in cooperation with well-known institutions of energy system research. The total instrument is scheduled to be finished by the end of 1994. For the decentral use of the instrument by a wide specialist public the developed models and data banks which are equipped with a user-friendly surface are suited for larger PCs (486, 16 MB RAM/500-1000 MB ROM). (orig.) [de

  14. Calibration of Geodetic Instruments

    Directory of Open Access Journals (Sweden)

    Marek Bajtala


    Full Text Available The problem of metrology and security systems of unification, correctness and standard reproducibilities belong to the preferred requirements of theory and technical practice in geodesy. Requirements on the control and verification of measured instruments and equipments increase and the importance and up-to-date of calibration get into the foreground. Calibration possibilities of length-scales (of electronic rangefinders and angle-scales (of horizontal circles of geodetic instruments. Calibration of electronic rangefinders on the linear comparative baseline in terrain. Primary standard of planar angle – optical traverse and its exploitation for calibration of the horizontal circles of theodolites. The calibration equipment of the Institute of Slovak Metrology in Bratislava. The Calibration process and results from the calibration of horizontal circles of selected geodetic instruments.

  15. Aethalometer™ Instrument Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Sedlacek, Arthur J. [Brookhaven National Lab. (BNL), Upton, NY (United States)


    The Aethalometer is an instrument that provides a real-time readout of the concentration of “Black” or “Elemental” carbon aerosol particles (BC or E) in an air stream (see Figure 1 and Figure 2). It is a self-contained instrument that measures the rate of change of optical transmission through a spot on a filter where aerosol is being continuously collected and uses the information to calculate the concentration of optically absorbing material in the sampled air stream. The instrument measures the transmitted light intensities through the “sensing” portion of the filter, on which the aerosol spot is being collected, and a “reference” portion of the filter as a check on the stability of the optical source. A mass flowmeter monitors the sample air flow rate. The data from these three measurements is used to determine the mean BC content of the air stream.


    Directory of Open Access Journals (Sweden)

    Cristian GHEORGHE


    Full Text Available The rules laid down by Romanian Capital Market Law and the regulations put in force for its implementation apply to issuers of financial instruments admitted to trading on the regulated market established in Romania. But the issuers remain companies incorporated under Company Law of 1990. Such dual regulations need increased attention in order to observe the legal status of the issuers/companies and financial instruments/shares. Romanian legislator has chosen to implement in Capital Market Law special rules regarding the administration of the issuers of financial instruments, not only rules regarding admitting and maintaining to a regulated market. Thus issuers are, in Romanian Law perspective, special company that should comply special rule regarding board of administration and general shareholders meeting.

  17. Surgical procedures for voice restoration (United States)

    Nawka, Tadeus; Hosemann, Werner


    Surgical procedures for voice restoration serve to improve oral communication by better vocal function. They comprise of phonomicrosurgery, with direct and indirect access to the larynx; laryngoplasty; laryngeal injections; and surgical laryngeal reinnervation. The basis for modern surgical techniques for voice disorders is the knowledge about the ultrastructure of the vocal folds and the increasing experience of surgeons in voice surgery, while facing high social and professional demands on the voice. Vocal activity limitation and participation restriction has become more important in the artistic and social areas. A number of surgical methods that have been developed worldwide for this reason, are presented in this article. Functional oriented surgery has to meet high standards. The diagnostics of vocal function has to be multi-dimensional in order to determine the indication and the appropriate surgical intervention. PMID:22073062

  18. Surgical Management of Calcaneal Malunion

    Directory of Open Access Journals (Sweden)

    Guang-Rong Yu


    Full Text Available Calcaneal malunion is a common complication after conservative treatment or incorrect surgical treatment of calcaneal fracture. The typical pathoanatomies of calcaneal malunion are subtalar joint incongruity, loss of calcaneal height, arch collapse, varus or valgus deformity of the calcaneus, heel widening and so on. Calcaneal malunion often needs to be treated surgically. The classification of calcaneal malunion and the detailed clinical and radiographical assessment play important roles for surgical option. The main surgical methods include in situ subtalar arthrodesis, reconstruction of calcaneal thalamus and subtalar arthrodesis, calcaneal osteotomy with subtalar arthrodesis, corrective calcaneal osteotomy without subtalar arthrodesis. Each option has its different indications, advantages and disadvantages. Thus, the surgical treatment should be individualised.

  19. Virtual Sensor Test Instrumentation (United States)

    Wang, Roy


    Virtual Sensor Test Instrumentation is based on the concept of smart sensor technology for testing with intelligence needed to perform sell-diagnosis of health, and to participate in a hierarchy of health determination at sensor, process, and system levels. A virtual sensor test instrumentation consists of five elements: (1) a common sensor interface, (2) microprocessor, (3) wireless interface, (4) signal conditioning and ADC/DAC (analog-to-digital conversion/ digital-to-analog conversion), and (5) onboard EEPROM (electrically erasable programmable read-only memory) for metadata storage and executable software to create powerful, scalable, reconfigurable, and reliable embedded and distributed test instruments. In order to maximize the efficient data conversion through the smart sensor node, plug-and-play functionality is required to interface with traditional sensors to enhance their identity and capabilities for data processing and communications. Virtual sensor test instrumentation can be accessible wirelessly via a Network Capable Application Processor (NCAP) or a Smart Transducer Interlace Module (STIM) that may be managed under real-time rule engines for mission-critical applications. The transducer senses the physical quantity being measured and converts it into an electrical signal. The signal is fed to an A/D converter, and is ready for use by the processor to execute functional transformation based on the sensor characteristics stored in a Transducer Electronic Data Sheet (TEDS). Virtual sensor test instrumentation is built upon an open-system architecture with standardized protocol modules/stacks to interface with industry standards and commonly used software. One major benefit for deploying the virtual sensor test instrumentation is the ability, through a plug-and-play common interface, to convert raw sensor data in either analog or digital form, to an IEEE 1451 standard-based smart sensor, which has instructions to program sensors for a wide variety of

  20. Robotic technologies in surgical oncology training and practice. (United States)

    Orvieto, Marcelo A; Marchetti, Pablo; Castillo, Octavio A; Coelho, Rafael F; Chauhan, Sanket; Rocco, Bernardo; Ardila, Bobby; Mathe, Mary; Patel, Vipul R


    The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons wishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. One-step (standard) versus two-step surgical approach in adolescent idiopathic scoliosis posterior spinal fusion: Which is better? (United States)

    Ramirez, Norman; Valentin, Pablo; García-Cartagena, Manuel; Samalot, Solais; Iriarte, Ivan


    A retrospective cohort study with IRB approval. Significant blood loss remains an important concern in terms of the performance of the posterior spinal fusion in adolescent idiopathic scoliosis. Several strategies have been reported to minimize blood loss during surgery. In order to address the need to minimize blood loss without sacrificing the quality of the fusion, in our hospital, we adopted a two-step surgical approach. This surgical approach consist of the exposure and instrumentation of the lumbar region prior to and followed by an extension of the surgical incision to the thoracic region for its subsequent instrumentation. The main purpose of this study was to compare a two-step surgical approach with the one-step (standard) approach. This study was a review of all the data on consecutive posterior spinal fusion surgeries performed by a specific two-surgeon team during 2004-2013. Demographics, surgical variables, radiographic findings, and outcomes regarding blood loss, morbidity, and the duration of the procedure were evaluated. Eighty-five patients underwent the standard surgical exposure, and 41 patients underwent the two-step surgical technique. With the exception of BMI, neither group showed any statistically preoperative variable significant differences. None of the postoperative outcome variables were statistically significant between both surgical approaches. No differences were detected in terms of using a two-step surgical approach versus the one-step standard surgical approach regarding perioperative blood loss, surgical time, or complications. Level of evidence III.

  2. Non-surgical management of periodontal disease. (United States)

    Darby, I


    Non-surgical removal of plaque and calculus has been part of the initial phase of the management of patients with gingivitis and periodontitis for decades. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits. The purpose of this review was to assess recent changes. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. It also comments on full-mouth disinfection, the use of lasers and host modulation. Modern technology has made removal of microbial deposits by the patient and dental professionals more efficient. However, other advancements need to be used in conjunction with mechanical debridement at this time.

  3. Interfacing to accelerator instrumentation

    International Nuclear Information System (INIS)

    Shea, T.J.


    As the sensory system for an accelerator, the beam instrumentation provides a tremendous amount of diagnostic information. Access to this information can vary from periodic spot checks by operators to high bandwidth data acquisition during studies. In this paper, example applications will illustrate the requirements on interfaces between the control system and the instrumentation hardware. A survey of the major accelerator facilities will identify the most popular interface standards. The impact of developments such as isochronous protocols and embedded digital signal processing will also be discussed

  4. Spectroelectrochemical Instrument Measures TOC (United States)

    Kounaves, Sam


    A spectroelectrochemical instrument has been developed for measuring the total organic carbon (TOC) content of an aqueous solution. Measurements of TOC are frequently performed in environmental, clinical, and industrial settings. Until now, techniques for performing such measurements have included, various ly, the use of hazardous reagents, ultraviolet light, or ovens, to promote reactions in which the carbon contents are oxidized. The instrument now being developed is intended to be a safer, more economical means of oxidizing organic carbon and determining the TOC levels of aqueous solutions and for providing a low power/mass unit for use in planetary missions.

  5. Standard NIM instrumentation system

    CERN Document Server


    NIM is a standard modular instrumentation system that is in wide use throughout the world. As the NIM system developed and accommodations were made to a dynamic instrumentation field and a rapidly advancing technology, additions, revisions and clarifications were made. These were incorporated into the standard in the form of addenda and errata. This standard is a revision of the NIM document, AEC Report TID- 20893 (Rev 4) dated July 1974. It includes all the addenda and errata items that were previously issued as well as numerous additional items to make the standard current with modern technology and manufacturing practice.

  6. Instrumentation Cables Test Plan

    Energy Technology Data Exchange (ETDEWEB)

    Muna, Alice Baca [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); LaFleur, Chris Bensdotter [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    A fire at a nuclear power plant (NPP) has the potential to damage structures, systems, and components important to safety, if not promptly detected and suppressed. At Browns Ferry Nuclear Power Plant on March 22, 1975, a fire in the reactor building damaged electrical power and control systems. Damage to instrumentation cables impeded the function of both normal and standby reactor coolant systems, and degraded the operators’ plant monitoring capability. This event resulted in additional NRC involvement with utilities to ensure that NPPs are properly protected from fire as intended by the NRC principle design criteria (i.e., general design criteria 3, Fire Protection). Current guidance and methods for both deterministic and performance based approaches typically make conservative (bounding) assumptions regarding the fire-induced failure modes of instrumentation cables and those failure modes effects on component and system response. Numerous fire testing programs have been conducted in the past to evaluate the failure modes and effects of electrical cables exposed to severe thermal conditions. However, that testing has primarily focused on control circuits with only a limited number of tests performed on instrumentation circuits. In 2001, the Nuclear Energy Institute (NEI) and the Electric Power Research Institute (EPRI) conducted a series of cable fire tests designed to address specific aspects of the cable failure and circuit fault issues of concern1. The NRC was invited to observe and participate in that program. The NRC sponsored Sandia National Laboratories to support this participation, whom among other things, added a 4-20 mA instrumentation circuit and instrumentation cabling to six of the tests. Although limited, one insight drawn from those instrumentation circuits tests was that the failure characteristics appeared to depend on the cable insulation material. The results showed that for thermoset insulated cables, the instrument reading tended to drift

  7. [VIPoma: surgical treatment]. (United States)

    Procacciante, F; Picozzi, P; Fantini, A; Pacifici, M; Di Nardo, A; Ribotta, G; Delle Fave, G; Catani, M; Ruggeri, S; Romeo, F


    This paper reports a case of pancreatic VIPoma with widespread hepatic metastasis which was treated for approximately 2 years with a synthetic somatostatin analog (SMS 201/995). The treatment of choice in cases in which the tumour was fully removable is surgical resection. This occurred rarely since approximately 80% of VIPomas are malignant and are operated late when local infiltration is already widespread; in addition, 50% of cases are already metastasised at diagnosis. In this case, due to the infiltration of the superior mesenteric artery by the primary tumour it was necessary to carry out a left pancreasectomy which included two-thirds of the neoplastic mass. This was justified by slow tumour growth and also facilitated control of diarrhea and ensured a greater efficacy of possible postoperative chemotherapy. The use of synthetic somatostatin analog (SMS 201/995) enabled diarrhea to be satisfactorily controlled and is therefore specifically indicated for this type of tumour. NSE serum assay (neuron specific enolase) allowed the evolution of disease to be monitored during follow-up.

  8. Surgical treatment of thymoma. (United States)

    Miller, Quintessa; Moulton, Michael J; Pratt, Jerry


    A case report is presented of a 66-year-old white woman with a 3-month history of atypical chest pain and shortness of breath. A lateral chest radiograph demonstrated an anterior mediastinal density. A subsequent computed tomography (CT) scan revealed a mass in the right anterolateral mediastinum. Fine-needle aspiration (FNA) revealed tumor cells positive for cytokeratin and negative for leukocyte common antigen. The differential diagnosis at that time included thymoma versus thymic carcinoid. She underwent a median sternotomy with complete thymectomy. The pathology revealed a large thymoma with microinvasion into the surrounding adipose tissue. She had an uneventful postoperative course and later underwent adjuvant radiation therapy. Surgical treatment of thymoma is discussed, with emphasis on diagnosis and treatment. Although some patients may present with symptoms caused by involvement of surrounding structures, most thymomas are discovered incidentally on chest radiograph. Various diagnostic procedures can aid the surgeon in ruling out other neoplasms, such as lymphoma or germ cell tumors. Prognosis is not based on histology, but on the tumor's gross characteristics at operation. Benign tumors are noninvasive and encapsulated. All patients with potentially resectable lesions should undergo en-bloc excision. Radiation or chemotherapy should be instituted in more advanced tumors.

  9. Inspector-instrument interface in portable NDA instrumentation

    International Nuclear Information System (INIS)

    Halbig, J.K.; Klosterbuer, S.F.


    Recent electronics technology advances make it possible to design sophisticated instruments in small packages for convenient field implementation. This report describes an inspector-instrument interface design which allows communication of procedures, responses, and results between the instrument and user. The interface has been incorporated into new spent-fuel instrumentation and a battery-powered multichannel analyzer

  10. [Nutritional status of elderly surgical patients]. (United States)

    Damuleviciene, Gyte; Lesauskaite, Vita; Macijauskiene, Jūrate


    The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it. A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0. Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (Pcognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, Pfunctional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P0.05). Malnutrition was diagnosed more frequently in elderly surgical patients than in middle-aged patients. Obesity was more common in women than in men. The prevalence of obesity was not associated with age. Malnutrition in elderly surgical patients was associated with poor functional status, impaired cognitive function, and urgent operation.

  11. Integrating Nephelometer Instrument Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Uin, J. [Brookhaven National Lab. (BNL), Upton, NY (United States)


    The Integrating Nephelometer (Figure 1) is an instrument that measures aerosol light scattering. It measures aerosol optical scattering properties by detecting (with a wide angular integration – from 7 to 170°) the light scattered by the aerosol and subtracting the light scattered by the carrier gas, the instrument walls and the background noise in the detector (zeroing). Zeroing is typically performed for 5 minutes every day at midnight UTC. The scattered light is split into red (700 nm), green (550 nm), and blue (450 nm) wavelengths and captured by three photomultiplier tubes. The instrument can measure total scatter as well as backscatter only (from 90 to 170°) (Heintzenberg and Charlson 1996; Anderson et al. 1996; Anderson and Ogren 1998; TSI 3563 2015) At ARM (Atmospheric Radiation Measurement), two identical Nephelometers are usually run in series with a sample relative humidity (RH) conditioner between them. This is possible because Nephelometer sampling is non-destructive and the sample can be passed on to another instrument. The sample RH conditioner scans through multiple RH values in cycles, treating the sample. This kind of setup allows to study how aerosol particles’ light scattering properties are affected by humidification (Anderson et al. 1996). For historical reasons, the two Nephelometers in this setup are labeled “wet” and “dry”, with the “dry” Nephelometer usually being the one before the conditioner and sampling ambient air (the names are switched for the MAOS measurement site due to the high RH of the ambient air).

  12. AC resistance measuring instrument (United States)

    Hof, P.J.


    An auto-ranging AC resistance measuring instrument for remote measurement of the resistance of an electrical device or circuit connected to the instrument includes a signal generator which generates an AC excitation signal for application to a load, including the device and the transmission line, a monitoring circuit which provides a digitally encoded signal representing the voltage across the load, and a microprocessor which operates under program control to provide an auto-ranging function by which range resistance is connected in circuit with the load to limit the load voltage to an acceptable range for the instrument, and an auto-compensating function by which compensating capacitance is connected in shunt with the range resistance to compensate for the effects of line capacitance. After the auto-ranging and auto-compensation functions are complete, the microprocessor calculates the resistance of the load from the selected range resistance, the excitation signal, and the load voltage signal, and displays of the measured resistance on a digital display of the instrument. 8 figs.

  13. Measurement and Instrumentation

    Energy Technology Data Exchange (ETDEWEB)

    Kirkham, Harold


    This is a chapter for a book called the Standard Handbook for Electrical Engineering. Though it is not obvious from the title, the book deals mainly with power engineering. The first chapter (not mine) is about the fundamental quantities used in measurement. This chapter is about the process and the instrumentation.

  14. Instruments for Everyone. (United States)

    Perkins-Bosarge, Sarah


    Thanks to an entrepreneurial principal, nearly 75% of a rural New York State school's upper-division students participate in band. To ensure access, the principal bargains with second-hand dealers for instruments (using fees from photo profits) and charges kids a fee of $1 to $15 yearly. Consulting with the music teacher avoids duplication and…

  15. Economic Policy Instruments

    DEFF Research Database (Denmark)

    Klemmensen, Børge


    Økonomiske instrumenter begrundes med behovet for politiske indgreb, der muliggør internaliseringen af omkostningerne ved de miljøpåvirkninger, produktion and levevis afstedkommer, således at hensyntagen til miljøet bliver en del af virksomheders og husholdningers omkostninger og dermed en tilsky...

  16. Designing Intelligent Instruments (United States)

    Knuth, Kevin H.; Erner, Philip M.; Frasso, Scott


    Remote science operations require automated systems that can both act and react with minimal human intervention. One such vision is that of an intelligent instrument that collects data in an automated fashion, and based on what it learns, decides which new measurements to take. This innovation implements experimental design and unites it with data analysis in such a way that it completes the cycle of learning. This cycle is the basis of the Scientific Method. The three basic steps of this cycle are hypothesis generation, inquiry, and inference. Hypothesis generation is implemented by artificially supplying the instrument with a parameterized set of possible hypotheses that might be used to describe the physical system. The act of inquiry is handled by an inquiry engine that relies on Bayesian adaptive exploration where the optimal experiment is chosen as the one which maximizes the expected information gain. The inference engine is implemented using the nested sampling algorithm, which provides the inquiry engine with a set of posterior samples from which the expected information gain can be estimated. With these computational structures in place, the instrument will refine its hypotheses, and repeat the learning cycle by taking measurements until the system under study is described within a pre-specified tolerance. We will demonstrate our first attempts toward achieving this goal with an intelligent instrument constructed using the LEGO MINDSTORMS NXT robotics platform.

  17. The tropospheric monitoring instrument

    NARCIS (Netherlands)

    Voert, M.J. te; Brakel, R. van; Witvoet, G.


    Thermal and opto-mechanical design and analysis work has been done on the Tropospheric Monitoring Instrument (TROPOMI), a spectrometer on the Copernicus Sentinel 5 Precursor satellite. To verify compliance with the stringent opto-mechanical stability requirements, detailed thermal and

  18. University Reactor Instrumentation Program

    International Nuclear Information System (INIS)

    Vernetson, W.G.


    Recognizing that the University Reactor Instrumentation Program was developed in response to widespread needs in the academic community for modernization and improvement of research and training reactors at institutions such as the University of Florida, the items proposed to be supported by this grant over its two year period have been selected as those most likely to reduce foreed outages, to meet regulatory concerns that had been expressed in recent years by Nuclear Regulatory Commission inspectors or to correct other facility problems and limitations. Department of Energy Grant Number DE-FG07-90ER129969 was provided to the University of Florida Training Reactor(UFTR) facility through the US Department of Energy's University Reactor Instrumentation Program. The original proposal submitted in February, 1990 requested support for UFTR facility instrumentation and equipment upgrades for seven items in the amount of $107,530 with $13,800 of this amount to be the subject of cost sharing by the University of Florida and $93,730 requested as support from the Department of Energy. A breakdown of the items requested and total cost for the proposed UFTR facility instrumentation and equipment improvements is presented

  19. Analytical chemistry instrumentation

    International Nuclear Information System (INIS)

    Laing, W.R.


    Separate abstracts were prepared for 48 papers in these conference proceedings. The topics covered include: analytical chemistry and the environment; environmental radiochemistry; automated instrumentation; advances in analytical mass spectrometry; Fourier transform spectroscopy; analytical chemistry of plutonium; nuclear analytical chemistry; chemometrics; and nuclear fuel technology

  20. Advanced instrumentation and teleoperation

    International Nuclear Information System (INIS)

    Decreton, M.


    SCK-CEN's advanced instrumentation and teleoperation project aims at evaluating the potential of a telerobotic approach in a nuclear environment and, in particular, the use of remote-perception systems. Main achievements in 1997 in the areas of R and D on radiation tolerance for remote sensing, optical fibres and optical-fibre sensors, and computer-aided teleoperation are reported

  1. Analytical chemistry instrumentation

    International Nuclear Information System (INIS)

    Laing, W.R.


    In nine sections, 48 chapters cover 1) analytical chemistry and the environment 2) environmental radiochemistry 3) automated instrumentation 4) advances in analytical mass spectrometry 5) fourier transform spectroscopy 6) analytical chemistry of plutonium 7) nuclear analytical chemistry 8) chemometrics and 9) nuclear fuel technology

  2. The Surgical Treatment of Mycetoma.

    Directory of Open Access Journals (Sweden)

    Suleiman Hussein Suleiman


    Full Text Available Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  3. Surgical treatment of bronchiectasis

    Directory of Open Access Journals (Sweden)

    Miguel S. Guerra


    Full Text Available While the prevalence of bronchiectasis has decreased significantly over recent decades in developed countries, resection for bronchiectasis still plays an important part in thoracic surgery practice in some countries, such as Portugal. Between 1994 and 2004, 51 patients (29 female and 22 male with a mean age of 38.6 years (range 4–65 years underwent pulmonary resection for bronchiectasis. Mean duration of symptoms was 4.8 years. Surgery was indicated because of unsuccessful medical therapy in 25 patients (49.1%, haemoptysis in 12 (23.5%, lung mass in 9 (17.6% and lung abscess in 5 (9.8%. The surgical treatment was pulmonectomy in 7 patients, bilobectomy in 3, lobectomy in 36 and segmentectomy in 5. There was no operative mortality. Complications occurred in 8 patients and the morbidity rate was 15.7%. Follow-up was complete in 45 (88.2% patients with a mean of 3.4 years. Overall, 35 (77.7% patients were asymptomatic after surgery, symptoms were improved in 7 (15.6%, and unchanged or worse in 3 (6.7%. Unsuccessful medical therapy was still our main indication for surgery of bronchiectasis, despite aggressive antibiotic therapy. Surgical resection was performed with acceptable morbidity and morbidity and markedly improved symptoms in the majority of patients. Resumo: A prevalência das bronquiectasias diminuiu significativamente nas últimas décadas, principalmente nos países desenvolvidos. Contudo, a ressecção cirúrgica é ainda a alternativa terapêutica para um número significativo de doentes em alguns países, tais como Portugal. Entre 1994 e 2004, operámos 51 doentes com bronquiectasias (29 mulheres e 22 homens, com idades compreendidas entre os 4 e os 65 anos (média= 38,6 anos. A duração média dos sintomas foi de 4,8 anos e a indicação cirúrgica foi: insucesso do tratamento médico (49,1%, hemoptises (23,5%, massa pulmonar (17,6% e abcesso (9,8%. Foram realizadas 7 pneumectomias, 3

  4. Prevention of Surgical Malpractice Claims by Use of a Surgical Safety Checklist

    NARCIS (Netherlands)

    de Vries, Eefje N.; Eikens-Jansen, Manon P.; Hamersma, Alice M.; Smorenburg, Susanne M.; Gouma, Dirk J.; Boermeester, Marja A.


    Objective: To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist. Background: Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System

  5. The Science of String Instruments

    CERN Document Server

    Rossing, Thomas D


    Many performing musicians, as well as instrument builders, are coming to realize the importance of understanding the science of musical instruments. This book explains how string instruments produce sound. It presents basic ideas in simple language, and it also translates some more sophisticated ideas in non-technical language. It should be of interest to performers, researchers, and instrument makers alike.

  6. Cost-effectiveness of decompression according to Gill versus instrumented spondylodesis in the treatment of sciatica due to low grade spondylolytic spondylolisthesis: A prospective randomised controlled trial [NTR1300

    NARCIS (Netherlands)

    M.P. Arts (Mark); M.J.T. Verstegen (Marco); R. Brand (René); B.W. Koes (Bart); M.E. van den Akker-van Marle (Elske); W.C. Peul (Wilco)


    textabstractBackground. Nerve root decompression with instrumented spondylodesis is the most frequently performed surgical procedure in the treatment of patients with symptomatic low-grade spondylolytic spondylolisthesis. Nerve root decompression without instrumented fusion, i.e. Gill's procedure,

  7. LED Light Characteristics for Surgical Shadowless Lamps and Surgical Loupes


    Ide, Takeshi; Kinugawa, Yoshitaka; Nobae, Yuichi; Suzuki, Toshihiro; Tanaka, Yoshiyuki; Toda, Ikuko; Tsubota, Kazuo


    Background: Blue light has more energy than longer wavelength light and can penetrate the eye to reach the retina. When surgeons use magnifying loupes under intensive surgical shadowless lamps for better view of the surgical field, the total luminance is about 200 times brighter than that of typical office lighting. In this study, the effects of 2 types of shadowless lamps were compared. Moreover, the effect of various eyeglasses, which support magnifying loupes, on both the light energy and ...

  8. Surgical Skills Beyond Scientific Management. (United States)

    Whitfield, Nicholas


    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

  9. The surgical management of the rheumatoid spine: Has the evolution of surgical intervention changed outcomes?

    Directory of Open Access Journals (Sweden)

    Robin Bhatia


    Full Text Available Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%. Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time.

  10. netherland hydrological modeling instrument (United States)

    Hoogewoud, J. C.; de Lange, W. J.; Veldhuizen, A.; Prinsen, G.


    Netherlands Hydrological Modeling Instrument A decision support system for water basin management. J.C. Hoogewoud , W.J. de Lange ,A. Veldhuizen , G. Prinsen , The Netherlands Hydrological modeling Instrument (NHI) is the center point of a framework of models, to coherently model the hydrological system and the multitude of functions it supports. Dutch hydrological institutes Deltares, Alterra, Netherlands Environmental Assessment Agency, RWS Waterdienst, STOWA and Vewin are cooperating in enhancing the NHI for adequate decision support. The instrument is used by three different ministries involved in national water policy matters, for instance the WFD, drought management, manure policy and climate change issues. The basis of the modeling instrument is a state-of-the-art on-line coupling of the groundwater system (MODFLOW), the unsaturated zone (metaSWAP) and the surface water system (MOZART-DM). It brings together hydro(geo)logical processes from the column to the basin scale, ranging from 250x250m plots to the river Rhine and includes salt water flow. The NHI is validated with an eight year run (1998-2006) with dry and wet periods. For this run different parts of the hydrology have been compared with measurements. For instance, water demands in dry periods (e.g. for irrigation), discharges at outlets, groundwater levels and evaporation. A validation alone is not enough to get support from stakeholders. Involvement from stakeholders in the modeling process is needed. There fore to gain sufficient support and trust in the instrument on different (policy) levels a couple of actions have been taken: 1. a transparent evaluation of modeling-results has been set up 2. an extensive program is running to cooperate with regional waterboards and suppliers of drinking water in improving the NHI 3. sharing (hydrological) data via newly setup Modeling Database for local and national models 4. Enhancing the NHI with "local" information. The NHI is and has been used for many

  11. Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients


    Lee, Jin-Young; Moon, Seong-Hwan; Suh, Bo-Kyung; Yang, Myung Ho; Park, Moon Soo


    Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE s...

  12. [Surgical emergencies in elderly patients]. (United States)

    Cohen-Bittan, Judith; Lazareth, Helene; Zerah, Lorene; Forest, Anne; Boddaert, Jacques


    Surgical emergencies represent a diverse combination of common and particularly severe pathologies in elderly patients. This severity is due in part to concurrent comorbidities and sometimes atypical clinical presentations, causing delay in diagnosis and treatment.

  13. Retained surgical sponge: Medicolegal aspects. (United States)

    Gualniera, Patrizia; Scurria, Serena


    Retained surgical sponge events continue to occur despite the implementation of preventive surgical count policies, procedures, and adjunct technologies to manual counting. Such intraoperative mistakes can cause chronic nonspecific symptoms during the early postoperative period. When discovered years after surgery, they raise thorny medicolegal questions. We describe two cases from our practice that illustrate the need to identify the responsibility of the surgical team, as delineated in ministerial directives and the current legal framework, as well as the difficulty in evaluating clinical actions taken at different times and in different settings, with regard to the permanent health damage incurred by sponge retention. Finally, we discuss prevention actions operating room staff should take to reduce the risk of retained surgical sponges. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Surgical morbidity in obese children

    Directory of Open Access Journals (Sweden)

    Stylianos Roupakias


    Full Text Available In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly overweight. Little data exist regarding the surgical challenges of obese children. This review study was designed to examine the relationship of obesity to surgical comorbidities, postoperative complications, and perioperative outcome in children, and to pediatric trauma. Obesity seems to be an independent risk factor in surgical-related pediatric morbidity and should be considered an important variable when looking at surgical outcomes in the pediatric population. Identification by and awareness among pediatric surgeons, of increased risk factors for peri/postoperative complications, will be crucial in optimizing the hospital stay and outcome of these children.

  15. Patient-specific surgical simulation. (United States)

    Soler, Luc; Marescaux, Jacques


    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  16. The UVISI instrument. (United States)

    Heffernan, K. J.; Heiss, J. E.; Boldt, J. D.; Darlington, E. H.; Peacock, K.; Harris, T. J.; Mayr, M. J.


    The Ultraviolet and Visible Imagers and Spectrographic Imagers (UVISI) instrument is a complex of nine sensor units (five spectrographic imagers and four imagers) and multiple processors that will provide detailed images and spectra of targets for the Midcourse Space Experiment mission. Imaging and spectroscopy each cover the range from 110 nm (far ultraviolet) to 900 nm (near infrared). UVISI is intended to investigate a multitude of celestial, atmospheric, and point sources over its planned 4-year lifetime. At 104 W and 211 kg, it is not only the largest free-flying instrument ever built at APL, but is also larger than 47 of the 55 APL-built spacecraft and more complex than many of them. This article discusses the specifications of UVISI and its hardware and software features. It also attempts to give the reader a sense of the design trade-offs made during UVISI development that resulted in its present configuration.

  17. Data acquisition instruments: Psychopharmacology

    Energy Technology Data Exchange (ETDEWEB)

    Hartley, D.S. III


    This report contains the results of a Direct Assistance Project performed by Lockheed Martin Energy Systems, Inc., for Dr. K. O. Jobson. The purpose of the project was to perform preliminary analysis of the data acquisition instruments used in the field of psychiatry, with the goal of identifying commonalities of data and strategies for handling and using the data in the most advantageous fashion. Data acquisition instruments from 12 sources were provided by Dr. Jobson. Several commonalities were identified and a potentially useful data strategy is reported here. Analysis of the information collected for utility in performing diagnoses is recommended. In addition, further work is recommended to refine the commonalities into a directly useful computer systems structure.

  18. Superfluid helium tanker instrumentation

    Energy Technology Data Exchange (ETDEWEB)

    Woodhouse, C.E. (Johns Hopkins Univ., Baltimore, MD (USA). School of Medicine); Kashani, A. (Sterling Federal Systems, Inc., NASA/Ames Research Center, Moffett Field, CA (US)); Lukemire, A.T. (National Aeronautics and Space Administration, Greenbelt, MD (USA). Goddard Space Flight Center)


    An instrumentation system for a 1992 space shuttle flight demonstration of a superfluid helium (SFHe) tanker and transfer technology is presented. This system provides measurement of helium temperatures, pressures, flow rates, mass, and the presence of liquid or vapor. The instrumentation system described consists of analog and digital portions which provide a space qualified electronics system that is fault tolerant, compact, and relatively lightweight. The data processing hardware and software are ground commandable, perform measurements asynchronously, and format telemetry for transmission to the ground. The novel heat pulse mass gaging technique is described. A new liquid/vapor sensor is presented. Flowmeters for SFHe are discussed. A SFHe fountain effect pump is described. Results of tests to date are presented.

  19. Virtual Reality Musical Instruments

    DEFF Research Database (Denmark)

    Serafin, Stefania; Erkut, Cumhur; Kojs, Juraj


    The rapid development and availability of low-cost technologies have created a wide interest in virtual reality. In the field of computer music, the term “virtual musical instruments” has been used for a long time to describe software simulations, extensions of existing musical instruments......, and ways to control them with new interfaces for musical expression. Virtual reality musical instruments (VRMIs) that include a simulated visual component delivered via a head-mounted display or other forms of immersive visualization have not yet received much attention. In this article, we present a field...... overview of VRMIs from the viewpoint of the performer. We propose nine design guidelines, describe evaluation methods, analyze case studies, and consider future challenges....

  20. Radiation measuring instrument

    International Nuclear Information System (INIS)

    Genrich, V.


    A highly sensitive and compactly structured radiation measuring instrument for detecting ionizing radiation, in particular for measuring dose rates and contamination. The laminar structure of the associated counter tube, using only a few, simple plastic parts and a highly elastic counter wire, makes it possible to use the simplest manufacturing techniques. The service life of the counter tube construction, which is completely and permanently sealed and filled with gas, is expected to be more than 12 years. The described counter tube can be adapted in optimal fashion to the available space in a pocket instrument if it is used in combination with a specialized high-voltage generator which is low in interference voltage and with a pulse evaluation circuit having a means of compensating for interference voltage

  1. Surgical Treatment of Calcaneal Spur.


    Eduardo Sarmiento Sánchez; Horacio Suárez Monzón; Rolando Delgado Figueredo; Juan Carlos Cabrera Suárez


    Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level...

  2. Instrumentation Engineers Handbook (United States)


    White Sands Missile Range New Mexico 88002-5110 This page intentionally left blank. Instrumentation Engineers Handbook, RCC Document 121-13...Range Commanders Council ATTN: TEDT-WS-RCC 1510 Headquarters Avenue White Sands Missile Range, New Mexico 88002-5110 Telephone: (575) 678-1107...multiplying that by the C/D ratio, where C is a dimensional constant and D is density: ( ) D PPC V Tpp − = Eqn. 5-8 When the flow rate is obtained by

  3. Radon-Instrumentation

    International Nuclear Information System (INIS)

    Moreno y Moreno, A.


    The presentation of the active and passive methods for radon, their identification and measure, instrumentation and characteristics are the objectives of this work. Active detectors: Active Alpha Cam Continuous Air Monitor, Model 758 of Victoreen, Model CMR-510 Continuous Radon Monitor of the Signature Femto-Tech. Passive detectors: SSNTD track detectors in solids Measurement Using Charcoal Canisters, disk of activated coal deposited in a metallic box Electrets Methodology. (Author)

  4. Virtual reality musical instruments

    DEFF Research Database (Denmark)

    Serafin, Stefania; Erkut, Cumhur; Kojs, Juraj


    The rapid development and availability of low cost technologies has created a wide interest in virtual reality (VR), but how to design and evaluate multisensory interactions in VR remains as a challenge. In this paper, we focus on virtual reality musical instruments, present an overview of our...... design and evaluation guidelines, and examine historical case studies. Our main contribution is to inform the design and evaluation of the future VRMIs and consider the challenges....

  5. Surgical and procedural skills training at medical school - a national review. (United States)

    Davis, Christopher R; Toll, Edward C; Bates, Anthony S; Cole, Matthew D; Smith, Frank C T


    This national study quantifies procedural and surgical skills training at medical schools in the United Kingdom (UK), a stipulated requirement of all graduates by the General Medical Council (GMC). A questionnaire recorded basic procedural and surgical skills training provided by medical schools and surgical societies in the UK. Skills were extracted from (1) GMC Tomorrows Doctors and (2) The Royal College of Surgeons Intercollegiate Basic Surgical Skills (BSS) course. Data from medical school curricula and extra-curricular student surgical societies were compared against the national GMC guidelines and BSS course content. Data were analysed using Mann-Whitney U tests. Representatives from 23 medical schools completed the survey (71.9% response). Thirty one skills extracted from the BSS course were split into 5 categories, with skills content cross referenced against GMC documentation. Training of surgical skills by medical schools was as follows: Gowning and gloving (72.8%), handling instruments (29.4%), knot tying (17.4%), suturing (24.7%), other surgical techniques (4.3%). Surgical societies provided significantly more training of knot tying (64.4%, P = 0.0013) and suturing (64.5%, P = 0.0325) than medical schools. Medical schools provide minimal basic surgical skills training, partially supplemented by extracurricular student surgical societies. Our findings suggest senior medical students do not possess simple surgical and procedural skills. Newly qualified doctors are at risk of being unable to safely perform practical procedures, contradicting GMC Guidelines. We propose a National Undergraduate Curriculum in Surgery and Surgical Skills to equip newly qualified doctors with basic procedural skills to maximise patient safety. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Nuclear reactor instrumentation

    International Nuclear Information System (INIS)

    Duncombe, E.; McGonigal, G.


    Reference is made to the instrumentation of liquid metal cooled fast reactors. In order to ensure the safe operation of such reactors it is necessary to constantly monitor the coolant flowing through the fuel assemblies for temperature and rate of flow, requiring a large number of sensors. An improved and simplified arrangement is claimed in which the fuel assemblies feed a fraction of coolant to three instrument units arranged to sense the temperature and rate of flow of samples of coolant. Each instrument unit comprises a sleeve housing a sensing unit and has a number of inlet ducts arranged for receiving coolant from a fuel assembly together with a single outlet. The sensing unit has three thermocouple hot junctions connected in series, the hot junctions and inlet ducts being arranged in pairs. Electromagnetic windings around an inductive core are arranged to sense variation in flow of liquid metal by flux distortion. Fission product sensing means may also be provided. Full constructional details are given. (U.K.)

  7. Instrumentation and diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Nakaishi, C.V.; Bedick, R.C.


    This Technology Status Report describes research and accomplishments for the Instrumentation and Diagnostics (I D) Projects within the Advanced Research and Technology Development (AR TD) Program of the United States Department of Energy (DOE) Office of Fossil Energy (FE). Process understanding and control can be improved through the development of advanced instrumentation and diagnostics. The thrust of the I D Projects is to further develop existing measurement and control techniques for application to advanced coal-based technologies. Project highlights are: an inductively coupled plasma (ICP) instrument has been developed to analyze trace elements in gasification and combustion process streams. An in situ two-color Mie scattering technique with LSS can simultaneously measure the size, velocity, and elemental composition of coal particles during combustion. A high-temperature, fluorescence thermometry technique has accurately measured gas temperatures during field testing in combustion and gasification environments. Expert systems have been developed to improve the control of advanced coal-based processes. Capacitance flowmeters were developed to determine the mass flowrate, solid volume fraction, and particle velocities of coal slurries. 32 refs., 9 figs.

  8. Mandolin Family Instruments (United States)

    Cohen, David J.; Rossing, Thomas D.

    The mandolin family of instruments consists of plucked chordophones, each having eight strings in four double courses. With the exception of the mandobass, the courses are tuned in intervals of fifths, as are the strings in violin family instruments. The soprano member of the family is the mandolin, tuned G3-D4-A4-E5. The alto member of the family is the mandola, tuned C3-G3-D4-A4. The mandola is usually referred to simply as the mandola in the USA, but is called the tenor mandola in Europe. The tenor member of the family is the octave mandolin, tuned G2-D3-A3-E4. It is referred to as the octave mandolin in the USA, and as the octave mandola in Europe. The baritone member of the family is the mandocello, or mandoloncello, tuned C2-G2-D3-A3. A variant of the mandocello not common in the USA is the five-course liuto moderno, or simply liuto, designed for solo repertoire. Its courses are tuned C2-G2-D3-A3-E4. A mandobass was also made by more than one manufacturer during the early twentieth century, though none are manufactured today. They were fretted instruments with single string courses tuned E1-A1-D2-G2. There are currently a few luthiers making piccolo mandolins, tuned C4-G4-D5-A5.

  9. Particle filtering in the Hough space for instrument tracking. (United States)

    Climent, Joan; Hexsel, Roberto A


    In this paper we present a real-time tracking system of surgical instruments in laparoscopic operations. We combine Condensation tracking, with the Hough Transform in order to obtain an efficient and accurate tracking. The Condensation algorithm performs well in heavy clutter, and the Hough Transform is robust under illumination changes, occlusion and distractions. The Hough array is computed using the gradient direction image obtained by means of a Principal Component Analysis. This improves accuracy in the determination of edge orientation and speeds up computation of the Hough Transform. The experiments on image sequences of actual laparoscopic surgical operations show that the instrument tip is located even in the presence of smoke, occlusions or motion blurring. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter


    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  11. Minimizing surgical skin incision scars with a latex surgical glove. (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun


    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  12. FHR Process Instruments

    Energy Technology Data Exchange (ETDEWEB)

    Holcomb, David Eugene [ORNL


    Fluoride salt-cooled High temperature Reactors (FHRs) are entering into early phase engineering development. Initial candidate technologies have been identified to measure all of the required process variables. The purpose of this paper is to describe the proposed measurement techniques in sufficient detail to enable assessment of the proposed instrumentation suite and to support development of the component technologies. This paper builds upon the instrumentation chapter of the recently published FHR technology development roadmap. Locating instruments outside of the intense core radiation and high-temperature fluoride salt environment significantly decreases their environmental tolerance requirements. Under operating conditions, FHR primary coolant salt is a transparent, low-vapor-pressure liquid. Consequently, FHRs can employ standoff optical measurements from above the salt pool to assess in-vessel conditions. For example, the core outlet temperature can be measured by observing the fuel s blackbody emission. Similarly, the intensity of the core s Cerenkov glow indicates the fission power level. Short-lived activation of the primary coolant provides another means for standoff measurements of process variables. The primary coolant flow and neutron flux can be measured using gamma spectroscopy along the primary coolant piping. FHR operation entails a number of process measurements. Reactor thermal power and core reactivity are the most significant variables for process control. Thermal power can be determined by measuring the primary coolant mass flow rate and temperature rise across the core. The leading candidate technologies for primary coolant temperature measurement are Au-Pt thermocouples and Johnson noise thermometry. Clamp-on ultrasonic flow measurement, that includes high-temperature tolerant standoffs, is a potential coolant flow measurement technique. Also, the salt redox condition will be monitored as an indicator of its corrosiveness. Both

  13. A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick. (United States)

    Kim, Myungjoon; Lee, Chiwon; Park, Woo Jung; Suh, Yun Suhk; Yang, Han Kwang; Kim, H Jin; Kim, Sungwan


    Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. The NMI was operated for 185 min and reflected the surgeon's decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. Various experiments were conducted and it is verified that the proposed assistant

  14. Instrumentation for environmental monitoring: biomedical

    International Nuclear Information System (INIS)


    An update is presented to Volume four of the six-volume series devoted to a survey of instruments useful for measurements in biomedicine related to environmental research and monitoring. Results of the survey are given as descriptions of the physical and operating characteristics of available instruments, critical comparisons among instrumentation methods, and recommendations of promising methodology and development of new instrumentation. Methods of detection and analysis of gaseous organic pollutants and metals, including Ni and As are presented. Instrument techniques and notes are included on atomic spectrometry and uv and visible absorption instrumentation

  15. [Surgical treatment of pancreatic pseudocysts]. (United States)

    Martínez-Ordaz, José Luis; Toledo-Toral, Carlos; Franco-Guerrero, Norma; Tun-Abraham, Mauro; Souza-Gallardo, Luis Manuel


    A pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects the pancreatic duct. Clinical presentation is variable. Management includes percutaneous, endoscopic or surgical drainage and resection. Review of a cohort of patients with pancreatic pseudocyst in a third level hospital. An analysis was performed on the demographic data, aetiology, clinical presentation, radiological and laboratory findings, type of surgical procedure, complications, recurrence and mortality. The statistical analysis was performed using Chi squared and Student t tests, with a p<0.05. A total of 139 patients were included, of whom 58% were men and 42% were women, with median age of 44.5 years. Chronic pancreatitis was the most common aetiology, present in 74 patients (53%). The main complaint was abdominal pain in 73% of patients. Median size was 18cm (range 7-29) and the most frequent location was body and tail of the pancreas. Internal surgical drainage was selected in 111 (80%) patients, of whom 96 were cystojejunostomy, 20 (14%) had external surgical drainage, and 8 (6%) resection. Complications were, pancreatic fistula (12%), haemorrhage (4%), infection (4%), and other non-surgical complications (4%). Complication rate was higher if the cause was chronic pancreatitis or if the management was external surgical drainage. Recurrence rate was 6%, and a mortality rate of 1%. Surgical management is a viable option for the management of pancreatic pseudocyst with a low complication and recurrence rate. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. How many people work in your operating room? An assessment of factors associated with instrument recounts within plastic surgery. (United States)

    Reformat, Derek D; David, Joshua A; Diaz-Siso, J Rodrigo; Plana, Natalie M; Wang, Annie; Brownstone, Nicholas D; Ceradini, Daniel J


    Intraoperative instrument recounts are performed to avoid retained foreign surgical items. These additional counts, however, beget risks of their own, including prolonged operative times, exposure to radiation, and increased cost. Our study aimed to identify factors that increase the likelihood of instrument recounts during plastic surgery procedures, and use our findings to guide potential solutions for preventing unnecessary recounts across all surgical fields. This is a retrospective review of all plastic surgical cases in the main operating setting at New York University Langone Medical Center (NYULMC) between March 2014 and February 2015. Of 1285 plastic surgery cases, 35 (2.7%) reported a missing instrument necessitating a recount. Of all subspecialties within plastic surgery, only microsurgery conferred an increased risk of a recount event. We identified multiple factors that increased the odds of a recount event, including increased operative time, number of surgical sites, and intraoperative instrument handoffs. Instrument recounts, although designed to prevent inadvertently retained surgical items, present inherent risks of their own. In a large retrospective review of plastic surgery cases at our medical center, we identified many factors that increased the likelihood of an instrument recount. On the basis of our findings and prior literature, we recommend limiting the number of staff handling instrument, the number of handoffs, and a heightened awareness by surgeons and perioperative staff of specific procedures and factors that increase the risk of a miscount event. Copyright © 2017. Published by Elsevier Ltd.

  17. ZBLAN Viscosity Instrumentation (United States)

    Kaukler, William


    The past year's contribution from Dr. Kaukler's experimental effort consists of these 5 parts: a) Construction and proof-of-concept testing of a novel shearing plate viscometer designed to produce small shear rates and operate at elevated temperatures; b) Preparing nonlinear polymeric materials to serve as standards of nonlinear Theological behavior; c) Measurements and evaluation of above materials for nonlinear rheometric behavior at room temperature using commercial spinning cone and plate viscometers available in the lab; d) Preparing specimens from various forms of pitch for quantitative comparative testing in a Dynamic Mechanical Analyzer, Thermal Mechanical Analyzer; and Archeological Analyzer; e) Arranging to have sets of pitch specimens tested using the various instruments listed above, from different manufacturers, to form a baseline of the viscosity variation with temperature using the different test modes offered by these instruments by compiling the data collected from the various test results. Our focus in this project is the shear thinning behavior of ZBLAN glass over a wide range of temperature. Experimentally, there are no standard techniques to perform such measurements on glasses, particularly at elevated temperatures. Literature reviews to date have shown that shear thinning in certain glasses appears to occur, but no data is available for ZBLAN glass. The best techniques to find shear thinning behavior require the application of very low rates of shear. In addition, because the onset of the thinning behavior occurs at an unknown elevated temperature, the instruments used in this study must provide controlled low rates of shear and do so for temperatures approaching 600 C. In this regard, a novel shearing parallel plate viscometer was designed and a prototype built and tested.

  18. Diamonds for beam instrumentation

    International Nuclear Information System (INIS)

    Griesmayer, Erich


    Diamond is perhaps the most versatile, efficient and radiation tolerant material available for use in beam detectors with a correspondingly wide range of applications in beam instrumentation. Numerous practical applications have demonstrated and exploited the sensitivity of diamond to charged particles, photons and neutrons. In this paper, a brief description of a generic diamond detector is given and the interaction of the CVD diamond detector material with protons, electrons, photons and neutrons is presented. Latest results of the interaction of sCVD diamond with 14 MeV mono-energetic neutrons are shown.

  19. Biomagnetic instrumentation and measurement (United States)

    Iufer, E. J.


    The instruments and techniques of biomagnetic measurement have progressed greatly in the past 15 years and are now of a quality appropriate to clinical applications. The paper reports on recent developments in the design and application of SQUID (Superconducting Quantum Interference Device) magnetometers to biomagnetic measurement. The discussion covers biomagnetic field levels, magnetocardiography, magnetic susceptibility plethysmography, ambient noise and sensor types, principles of operation of a SQUID magnetometer, and laboratory techniques. Of the many promising applications of noninvasive biomagnetic measurement, magnetocardiography is the most advanced and the most likely to find clinical application in the near future.

  20. Maintenance of nuclear instruments

    International Nuclear Information System (INIS)

    Oliveira Rebelo, A.M. de; Santos, C.J.F. dos; Jesus, E.F.O. de; Silva, L.E.M.C.; Borges, J.C.


    A program to design and repairing of nuclear instruments for teaching and research was founded in the UFRJ to find solutions for technical support problem - The GEMD-RADIACOES. This group has assisted to several groups of the University in recuperation and conservation of devices like: Linear scanner, Cromatograph and system of radiation detection in general. Recuperation of these devices had required a study of theirs operations modes, to make it possible the setting up of a similar system. Recuperation also involves operation tests, calibration and technical for users, orienting them to get the best performance. (Author) [pt

  1. Payment Instrument Characteristics

    DEFF Research Database (Denmark)

    Holst, Jacques; Kjeldsen, Martin; Hedman, Jonas


    Over the last decade, we have witnessed payment innovations that fundamentally have changed the ways we pay. Payment innovations, such as mobile payments and on-line banking, include characteristics or features that are essential to understand if we want to know how and why payers choose among...... payment innovations. Using the Repertory Grid technique to explore 15 payers’ perception of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and on-line banking, we identify 16 payment characteristics. The characteristics aggregate seventy-six unique...

  2. Instrumentation for tomograph positioning

    International Nuclear Information System (INIS)

    Frenkel, A.D.B.; Castello Branco, L.M.; Reznik, D.S.; Santos, C.A.C.; Borges, J.C.


    The COPPE's Nuclear Instrumentation Lab. has been developing researches directed towards the implementation of a Computer-Based Tomography System. Basically, the system reported in this paper can be divided into three major parts: the mechanical part, responsible for the physical movement (Stepper-Motors, table, etc.); the electronic part, which controls the mechanical part and handles the data-acquisition process (microcomputer, interfaces, etc.); and finally, the support of a software-oriented system, including control programs and information processing routines. (Author) [pt

  3. Pesticide reducing instruments

    DEFF Research Database (Denmark)

    Jacobsen, Lars-Bo; Jensen, Jørgen Dejgård; Andersen, Martin


    of a key species of farmland bird, caused to changes in production and landscape. The results from the agricultural sector model are also used in evaluation of pesticide usage and the leaching of pesticides to ground water. First we analyze the implication of three different scenarios in all of the above...... for improving bio-diversity and securing drinking water. That is, combining economic modeling with physical biological modeling and geological evaluation allows us to select unsprayed field margins as the most effective instrument. Sensitivity analysis conducted on bio-diversity suggest that this result...

  4. Leir beam instrumentation

    CERN Document Server

    Bal, C; Burger, S; Dutriat, C; Gasior, M; Lefèvre, T; Lenardon, F; Odier, P; Raich, U; Soby, L; Tan, J; Tranquille, G; Vuitton, C


    The Low Energy Ion Ring (LEIR) is central to the “Ions for LHC” project. Its role is to transform a serie of long low intensity ion pulses from Linac 3, into short high density pulses, which will be further accelerated in the PS and SPS rings, before injection into LHC. To do so the injected pulses are stacked and phase space cooled using electron cooling, before acceleration to the ejection energy of 72 MEV/u. This note describes different types of instruments which will be installed in the LEIR ring and transfer lines.

  5. Calibration of "Babyline" RP instruments

    CERN Multimedia


      If you have old RP instrumentation of the “Babyline” type, as shown in the photo, please contact the Radiation Protection Group (Joffrey Germa, 73171) to have the instrument checked and calibrated. Thank you. Radiation Protection Group

  6. A unique instrumental malfunction during robotic prostatectomy. (United States)

    Park, Sung Yul; Ahn, Jenny Jin-Kyung; Jeong, Wooju; Ham, Won Sik; Rha, Koon Ho


    Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical System, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy.

  7. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke


    teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...... this a relatively low budget solution with a big ethical benefit....

  8. [Surgical problems of homeless people]. (United States)

    Witkiewicz, Wojciech; Gnus, Jan Janusz; Stankiewicz, Zuzanna; Kocot, Marta; Rasiewicz, Marcin


    Estimated quantity of homeless people in Poland is about 30.000. Health conditions of homeless depends on poor living conditions, alcohol abuse and lack of medical care. The aim of the study was to present surgical problems of homeless people at St. Brother Albert's Aid Society Shelter in Szczodre. In years 2009-2011 in St. Brother Albert's Aid Society Shelter in Szczodre 1053 homeless were provided outpatient surgical care. The frequency of occurrence of diseases rated on the basis of the medical examination, medical history and medical records. The patients were aged 20-82 years (median: 46 years). The most common surgical problem of homeless people was skin infectious such as scabies, lice, tinea and lower limb ulceration due to underlying chronic vanous insufficiency or due to sustained injury. Other problems requiering surgical care were: frostbite, abscesses, phlegmon, unhealed wounds, back pain and pain due to sustained injuries. Most frequent causes of homelessness were family problems, alcohol abuse, conflict with the law, loss of ocupation or loss of home. Surgical diseases of homeless people have multifactorial etiology. The most frequent diseases in our patients were skin infectious and lower limb ulcerations. Medical care oriented on specific needs of homeless people is particulary important because poor health condition is not only consequence but could also be the cause of homelessness.

  9. Surgical Management of Localized Scleroderma. (United States)

    Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang


    Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

  10. Nuclear instrumentation for research reactors

    International Nuclear Information System (INIS)

    Hofer, Carlos G.; Pita, Antonio; Verrastro, Claudio A.; Maino, Eduardo J.


    The nuclear instrumentation for research reactors in Argentina was developed in 70'. A gradual modernization of all the nuclear instrumentation is planned. It includes start-up and power range instrumentation, as well as field monitors, clamp, scram and rod movement control logic. The new instrumentation is linked to a computer network, based on real time operating system for data acquisition, display and logging. This paper describes the modules and whole system aspects. (author). 2 refs

  11. Calibration philosophy for reactor instrumentation

    International Nuclear Information System (INIS)

    Saroja, A.R.; Ilango Sambasivan, S.; Swaminathan, P.


    All electronic test and measuring systems and process control instruments constitute a critical and important area of instrumentation in the nuclear and conventional power plant, process plant and research laboratories. All these instruments need periodic calibration. Therefore standards laboratories is one of the essential tools in enforcing quality. Calibration of these instruments plays a vital role in the performance, reliability, and quality of the target to be achieved. Thus calibration is a must if need speed and quality. (author)

  12. PC Calibration of Measuring Instrument


    Gold, Ayoola


    Calibration involves the adjustment of measuring instruments basically by comparing the values obtained from a measuring instrument with a standard instrument whose output value is known. This project is focused at developing an application used to calibrate measuring instruments (oscilloscope) in the laboratory. This application eases the traditional inputting of output value manually from the calibrator (Fluke 5500A in this case) to the oscilloscope (Agilent DSO5012A oscilloscope in this ca...

  13. UC Merced NMR Instrumentation Acquisition (United States)


    UC Merced NMR Instrumentation Acquisition For the UC Merced NMR Instrumentation Acquisition proposal, a new 400 MHz and an upgraded 500 MHz NMR...valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. University of California - Merced 5200 North Lake Road Merced , CA 95343...UC Merced NMR Instrumentation Acquisition Report Title For the UC Merced NMR Instrumentation Acquisition proposal, a new 400 MHz and an upgraded 500

  14. Incore instrument device

    International Nuclear Information System (INIS)

    Sakima, Naoki


    An incore instrument device has an integrally disposed touch panel having a function of displaying an operation indication method such as for setting of conditions for incore measurement and information processing and results of the incore measurement and a function capable of conducting operation indication such as for setting conditions and information processing for incore measurement relative to a control section upon touching an information position on a displayed information. In addition, an information processing section comprising a man-machine function program formed so as to recognize the content of the operation indication for the incore measurement by touching and let the control section to conduct it is disposed to the outside by way of a communication interface. In addition, a programming device is disposed for forming and rewriting the program of the man-machine function relative to the information processing section. Then, when various indication operations are conducted upon performing incore measurement, a view point can be concentrated to one predetermined point thereby enabling to improve the operationability without danger. In addition, the programming of the man-machine function does not apply unnecessary load to the control section in the incore instrumentation device. (N.H.)

  15. The QUIET Instrument

    Energy Technology Data Exchange (ETDEWEB)

    Bischoff, C.; et al.


    The Q/U Imaging ExperimenT (QUIET) is designed to measure polarization in the Cosmic Microwave Background, targeting the imprint of inflationary gravitational waves at large angular scales ({approx}1{sup o}). Between 2008 October and 2010 December, two independent receiver arrays were deployed sequentially on a 1.4m side-fed Dragonian telescope. The polarimeters which form the focal planes use a highly compact design based on High Electron Mobility Transistors (HEMTs) that provides simultaneous measurements of the Stokes parameters Q, U, and I in a single module. The 17-element Q-band polarimeter array, with a central frequency of 43.1 GHz, has the best sensitivity (69 {mu}Ks{sup 1/2}) and the lowest instrumental systematic errors ever achieved in this band, contributing to the tensor-to-scalar ratio at r < 0:1. The 84-element W-band polarimeter array has a sensitivity of 87 {mu}Ks{sup 1/2} at a central frequency of 94.5 GHz. It has the lowest systematic errors to date, contributing at r < 0:01. The two arrays together cover multipoles in the range {ell} {approx} 25 -- 975. These are the largest HEMT-based arrays deployed to date. This article describes the design, calibration, performance of, and sources of systematic error for the instrument.

  16. Balances instruments, manufacturers, history

    CERN Document Server

    Robens, Erich; Kiefer, Susanne


    The book deals mainly with direct mass determination by means of a conventional balances. It covers the history of the balance from the beginnings in Egypt earlier than 3000 BC to recent developments. All balance types are described with emphasis on scientific balances. Methods of indirect mass determination, which are applied to very light objects like molecules and the basic particles of matter and celestial bodies, are included.  As additional guidance, today’s manufacturers are listed and the profile of important companies is reviewed. Several hundred photographs, reproductions and drawings show instruments and their uses. This book includes commercial weighing instruments for merchandise and raw materials in workshops as well as symbolic weighing in the ancient Egyptian’s ceremony of ‘Weighing of the Heart’, the Greek fate balance, the Roman  Justitia, Juno Moneta and Middle Ages scenes of the Last Judgement with Jesus or St. Michael and of modern balances. The photographs are selected from the...

  17. Rio de Janeiro: Instrumentation school

    International Nuclear Information System (INIS)



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

  18. Instrument Remote Control via the Astronomical Instrument Markup Language (United States)

    Sall, Ken; Ames, Troy; Warsaw, Craig; Koons, Lisa; Shafer, Richard


    The Instrument Remote Control (IRC) project ongoing at NASA's Goddard Space Flight Center's (GSFC) Information Systems Center (ISC) supports NASA's mission by defining an adaptive intranet-based framework that provides robust interactive and distributed control and monitoring of remote instruments. An astronomical IRC architecture that combines the platform-independent processing capabilities of Java with the power of Extensible Markup Language (XML) to express hierarchical data in an equally platform-independent, as well as human readable manner, has been developed. This architecture is implemented using a variety of XML support tools and Application Programming Interfaces (API) written in Java. IRC will enable trusted astronomers from around the world to easily access infrared instruments (e.g., telescopes, cameras, and spectrometers) located in remote, inhospitable environments, such as the South Pole, a high Chilean mountaintop, or an airborne observatory aboard a Boeing 747. Using IRC's frameworks, an astronomer or other scientist can easily define the type of onboard instrument, control the instrument remotely, and return monitoring data all through the intranet. The Astronomical Instrument Markup Language (AIML) is the first implementation of the more general Instrument Markup Language (IML). The key aspects of our approach to instrument description and control applies to many domains, from medical instruments to machine assembly lines. The concepts behind AIML apply equally well to the description and control of instruments in general. IRC enables us to apply our techniques to several instruments, preferably from different observatories.

  19. A triangulating operating platform enhances bimanual performance and reduces surgical workload in single-incision laparoscopy. (United States)

    Rieder, Erwin; Martinec, Danny V; Cassera, Maria A; Goers, Trudie A; Dunst, Christy M; Swanstrom, Lee L


    Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a novel, single-port, triangulating surgical platform (SPSP) might enhance performance by improving bimanual coordination and decreasing the surgeon's mental workload. Fourteen participants, proficient in basic laparoscopic skills, were tested on their ability to perform a validated intracorporeal suturing task by either an SSL approach with crossed articulated instruments or a novel SPSP, providing true-right and true-left manipulation. Standard laparoscopic (SL) access served as control. Sutures were evaluated using validated scoring methods and the National Aeronautics and Space Administration Task Load Index was used to rate mental workload. All participants proficiently performed intracorporeal knots by SL (mean score 99.0; 95% CI 97.0 to 100.9). Performance decreased significantly (more than 50%, p mental workload when using true-right and true-left manipulation. This study objectively assessed SSL performance and current attempts for instrumentation improvement in single-site access. While SSL significantly impairs basic laparoscopic skills, surgical platforms providing true-left and true-right maneuvering of instruments appear to be more intuitive and address some of the current challenges of SSL that may otherwise limit its widespread acceptance. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Adjacent segment disease in degenerative pathologies with posterior instrumentation

    Directory of Open Access Journals (Sweden)

    Ana Guadalupe Ramírez Olvera


    Full Text Available OBJECTIVE: To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as the functional results. METHODS: a retrospective case series study with level of evidence IIB, in a sample of 179 patients diagnosed with stenosis of the lumbar spine, spondylolisthesis and degenerative scoliosis, submitted to surgery in the period 2005 to December 2013, with posterior instrumentation and posterolateral fusion, with follow-up from 2007 until May 2014, in which the symptomology and radiographic findings were evaluated, to establish the diagnosis and treatment. RESULTS: the study included 179 patients diagnosed with stenosis of the lumbar spine (n=116, isthmic and degenerative spondylolisthesis (n=50 and degenerative scoliosis (n=13; during the study, 20 cases of adjacent level segment were identified, 80% of which were treated surgically with extension of the instrumentation, while 20% were treated conservatively with NSAIDs and therapeutic blocks. CONCLUSION: An incidence of 11% was found, with an average of 3.25 years in diagnosis and treatment, a prevalence of females and diagnosis of stenosis of the lumbar canal on posterior instrumentation, a predominance of levels L4-L5; 80% were treated with extension of the instrumentation. The complications were persistent radiculopathy, infection of the surgical wound, and one death due to causes not related to the lumbar pathology.

  1. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

    van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen


    by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p...OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted...

  2. Blepharoplasty and periorbital surgical rejuvenation

    Directory of Open Access Journals (Sweden)

    Milind Naik


    Full Text Available The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist′s point of view.

  3. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Eika, Berit; Langebæk, Rikke; Tanggaard, L.


    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  4. Surgical implantation techniques for electronic tags in fish

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Glenn N.; Cooke, Steven J.; Brown, Richard S.; Deters, Katherine A.


    Intracoelomic implantation of transmitters into fish requires making a surgical incision, incision closure, and other surgery related techniques; however, the tools and techniques used in the surgical process vary widely. We review the available literature and focus on tools and techniques used for conducting surgery on juvenile salmonids because of the large amount of research that is conducted on them. The use of sterilized surgical instruments properly selected for a given size of fish will minimize tissue damage and infection rates, and speed the wound healing of fish implanted with transmitters. For the implantation of transmitters into small fish, the optimal surgical methods include making an incision on the ventral midline along the linea alba (for studies under 1 month), protecting the viscera (by lifting the skin with forceps while creating the incision), and using absorbable monofilament suture with a small-swaged-on swaged-on tapered or reverse-cutting needle. Standardizing the implantation techniques to be used in a study involving particular species and age classes of fish will improve survival and transmitter retention while allowing for comparisons to be made among studies and across multiple years. This review should be useful for researchers working on juvenile salmonids and other sizes and species of fish.

  5. Modern approaches to non-surgical biofilm management. (United States)

    Apatzidou, Danae Anastasia


    The subgingival dental plaque is a microbial biofilm consisting of highly variable bacterial microcolonies embedded within a self-produced matrix of extracellular polymeric substance. In contrast to microorganisms growing in a planktonic state, the inhabitants of a biofilm are effectively protected within this dense structure from host defense mechanisms and from therapeutic agents, including antimicrobials. The mechanical removal of the microbial biofilm and the establishment of meticulous plaque control measures comprise the key elements for the success of non-surgical periodontal treatment. Ultrasonic devices are effective in disrupting the biofilm, and carefully remove soft and hard deposits from a root surface with minimal trauma to the tooth structure. Controversies and modern trends in non-surgical periodontal therapy - such as quadrant-wise treatment modalities versus full-mouth approaches, hand-versus power-driven instrumentation, and the time frame of non-surgical periodontal therapy - are discussed here in depth in order to provide an insight into modern approaches to non-surgical biofilm management. Clinical, microbiological and immunological findings following different treatment protocols, in addition to cost-effective benefits of these clinical modalities, are discussed. Copyright © 2012 S. Karger AG, Basel.

  6. Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical Residents: The Missing Piece in Multidisciplinary Team Training. (United States)

    Sparks, Jessica L; Crouch, Dustin L; Sobba, Kathryn; Evans, Douglas; Zhang, Jing; Johnson, James E; Saunders, Ian; Thomas, John; Bodin, Sarah; Tonidandel, Ashley; Carter, Jeff; Westcott, Carl; Martin, R Shayn; Hildreth, Amy


    The human patient simulators that are currently used in multidisciplinary operating room team training scenarios cannot simulate surgical tasks because they lack a realistic surgical anatomy. Thus, they eliminate the surgeon's primary task in the operating room. The surgical trainee is presented with a significant barrier when he or she attempts to suspend disbelief and engage in the scenario. To develop and test a simulation-based operating room team training strategy that challenges the communication abilities and teamwork competencies of surgeons while they are engaged in realistic operative maneuvers. This pre-post educational intervention pilot study compared the gains in teamwork skills for midlevel surgical residents at Wake Forest Baptist Medical Center after they participated in a standardized multidisciplinary team training scenario with 3 possible levels of surgical realism: (1) SimMan (Laerdal) (control group, no surgical anatomy); (2) "synthetic anatomy for surgical tasks" mannequin (medium-fidelity anatomy), and (3) a patient simulated by a deceased donor (high-fidelity anatomy). Participation in the simulation scenario and the subsequent debriefing. Teamwork competency was assessed using several instruments with extensive validity evidence, including the Nontechnical Skills assessment, the Trauma Management Skills scoring system, the Crisis Resource Management checklist, and a self-efficacy survey instrument. Participant satisfaction was assessed with a Likert-scale questionnaire. Scenario participants included midlevel surgical residents, anesthesia providers, scrub nurses, and circulating nurses. Statistical models showed that surgical residents exposed to medium-fidelity simulation (synthetic anatomy for surgical tasks) team training scenarios demonstrated greater gains in teamwork skills compared with control groups (SimMan) (Nontechnical Skills video score: 95% CI, 1.06-16.41; Trauma Management Skills video score: 95% CI, 0.61-2.90) and

  7. Astronomical Instrumentation System Markup Language (United States)

    Goldbaum, Jesse M.


    The Astronomical Instrumentation System Markup Language (AISML) is an Extensible Markup Language (XML) based file format for maintaining and exchanging information about astronomical instrumentation. The factors behind the need for an AISML are first discussed followed by the reasons why XML was chosen as the format. Next it's shown how XML also provides the framework for a more precise definition of an astronomical instrument and how these instruments can be combined to form an Astronomical Instrumentation System (AIS). AISML files for several instruments as well as one for a sample AIS are provided. The files demonstrate how AISML can be utilized for various tasks from web page generation and programming interface to instrument maintenance and quality management. The advantages of widespread adoption of AISML are discussed.

  8. Instrumented Pipeline Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Thomas Piro; Michael Ream


    This report summarizes technical progress achieved during the cooperative agreement between Concurrent Technologies Corporation (CTC) and U.S. Department of Energy to address the need for a for low-cost monitoring and inspection sensor system as identified in the Department of Energy (DOE) National Gas Infrastructure Research & Development (R&D) Delivery Reliability Program Roadmap.. The Instrumented Pipeline Initiative (IPI) achieved the objective by researching technologies for the monitoring of pipeline delivery integrity, through a ubiquitous network of sensors and controllers to detect and diagnose incipient defects, leaks, and failures. This report is organized by tasks as detailed in the Statement of Project Objectives (SOPO). The sections all state the objective and approach before detailing results of work.

  9. FMIT diagnostic instrumentation

    International Nuclear Information System (INIS)

    Gilpatrick, J.D.; Chamberlin, D.D.


    The Fusion Materials Irradiation Test facility (FMIT) cw prototype accelerator has noninterceptive beamline instrumentation to measure beam parameters. The transverse emittances and beam profiles are measured with an array of photodiode sensors viewing light emitted from the beam region. Tomographic reconstructions of both spatial-density distributions and of transverse-emittance distributions are performed throughout a quadrupole focusing section. Beam bunches passing through capacitive probes produce bipolar waveforms whose zero crossing corresponds to the bunch's longitudinal centroid. By measuring the time required for a bunch to travel the known distance between two probes, velocity and energy are determined. A toroidal transformer measures the average ac beam current. Beam spill is measured by a set of movable jaws that intercept the beam edges. Each jaw contains a water flow channel whose flow rate and differential temperature are measured to derive a transverse power distribution. Beam centroid position is measured by a four-lobe, magnetic-loop pickup. 5 refs., 6 figs

  10. Transgressive or Instrumental?

    DEFF Research Database (Denmark)

    Chemi, Tatiana


    Contemporary practices that connect the arts with learning are widespread at all level of educational systems and in organisations, but they include very diverse approaches, multiple methods and background values. Regardless of explicit learning benefits, the arts/learning partnerships bring about...... a specific approach to learning, which is embodied, sensory and aesthetic and makes use of metaphors, mediation, meaning-making and sense-making. I will make the point that the arts establish an alternative learning environment, which is different from the formal educational systems by offering multiple...... creativity and the other on practices of arts-integration. My final point rests on the belief that the opposition of transgression and instrumentality is a deceiving perspective on the arts, against the background of the aesthetic plurality and hybridity....

  11. BOMBAY: Instrumentation school

    International Nuclear Information System (INIS)



    Full text: Promising students had a foretaste of the latest laboratory techniques at the ICFA 1993 India School on Instrumentation in High Energy Physics held from February 15-26 and hosted by the Tata Institute of Fundamental Research (TIFR), Bombay. The scientific programme was put together by the ICFA Panel for Future Instrumentation, Innovation and Development, chaired by Tord Ekelof (Uppsala). The programme included lectures and topical seminars covering a wide range of detector subjects. In small groups, students got acquainted with modern detector technologies in the laboratory sessions, using experimental setups assembled in various institutes world-wide and shipped to Bombay for the School. The techniques covered included multiwire proportional chambers for detection of particles and photons, gaseous detectors for UV photons and X-ray imaging, the study of charge drift in silicon detectors, measurement of the muon lifetime using liquid scintillators, tracking using scintillating fibres, and electronics for sensitive detectors. The India School was attended by around 80 students from 20 countries; 34 came from Indian universities. It was the fifth in this series, previous Schools having been at Trieste (1987, 1989 and 1991) organized by the ICFA Panel and hosted and sponsored by the International Centre for Theoretical Physics, and in 1990, organized at Rio de Janeiro in collaboration with the Centro Brasileiro de Pesquisas Fisicas. The School was jointly directed by Suresh Tonwar (TIFR), Fabio Sauli (CERN) and Marleigh Sheaff (University of Wisconsin), and sponsored by TIFR and DAE (India), CERN (Switzerland), ICTP and INFN (Italy), British Council and RAL (UK), NSF and DOE (USA), KEK (Japan), IPP (Canada) and DESY (Germany)

  12. The surgical stress response: should it be prevented?

    DEFF Research Database (Denmark)

    Kehlet, H


    clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving......Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed...... to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled...

  13. [The criteria of choice of the surgical treatment method in the injured persons with intrapleural post-traumatic hemorrhage in the closed thoracic trauma]. (United States)

    Boĭko, V V; Zamiatin, P N; Khashchina, V A; Zamiatin, D P


    The role of clinic-instrumental methods of investigation for establishment of criteria in the choice in the injured persons surgical treatment with intrapleural posttraumatic hemorrhage as a consequence of the closed thoracic trauma was studied up.

  14. Automatic data-driven real-time segmentation and recognition of surgical workflow. (United States)

    Dergachyova, Olga; Bouget, David; Huaulmé, Arnaud; Morandi, Xavier; Jannin, Pierre


    With the intention of extending the perception and action of surgical staff inside the operating room, the medical community has expressed a growing interest towards context-aware systems. Requiring an accurate identification of the surgical workflow, such systems make use of data from a diverse set of available sensors. In this paper, we propose a fully data-driven and real-time method for segmentation and recognition of surgical phases using a combination of video data and instrument usage signals, exploiting no prior knowledge. We also introduce new validation metrics for assessment of workflow detection. The segmentation and recognition are based on a four-stage process. Firstly, during the learning time, a Surgical Process Model is automatically constructed from data annotations to guide the following process. Secondly, data samples are described using a combination of low-level visual cues and instrument information. Then, in the third stage, these descriptions are employed to train a set of AdaBoost classifiers capable of distinguishing one surgical phase from others. Finally, AdaBoost responses are used as input to a Hidden semi-Markov Model in order to obtain a final decision. On the MICCAI EndoVis challenge laparoscopic dataset we achieved a precision and a recall of 91 % in classification of 7 phases. Compared to the analysis based on one data type only, a combination of visual features and instrument signals allows better segmentation, reduction of the detection delay and discovery of the correct phase order.

  15. Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation. (United States)

    Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin


    Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Multi-Institutional Development of a Mastoidectomy Performance Evaluation Instrument. (United States)

    Kerwin, Thomas; Hittle, Brad; Stredney, Don; De Boeck, Paul; Wiet, Gregory

    A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15-element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14-element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. Twelve otolaryngological surgical training programs in the United States. A total of 14 surgeons from 12 different institutions took part in the construction of the instrument. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize "safe" as opposed to "proper" technique. A second rating instrument was developed based on this feedback. Using a consensus-building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.


    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

  18. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael


    a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...

  19. Thoracic disc herniation: Surgical treatment. (United States)

    Court, C; Mansour, E; Bouthors, C


    Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40% of the spinal canal. A surgical procedure is indicated when the patient has severe back pain, stubborn intercostal neuralgia or neurological deficits. Selection of the surgical approach is essential. Mid-line calcified hernias are approached from a transthoracic incision, while lateralized soft hernias can be approached from a posterolateral incision. The complication rate for transthoracic approaches is higher than that of posterolateral approaches; however, the former are performed in more complex herniation cases. The thoracoscopic approach is less invasive but has a lengthy learning curve. Retropleural mini-thoracotomy is a potential compromise solution. Fusion is recommended in cases of multilevel herniation, herniation in the context of Scheuermann's disease, when more than 50% bone is resected from the vertebral body, in patients with preoperative back pain or herniation at the thoracolumbar junction. Along with complications specific to the surgical approach, the surgical risks are neurological worsening, dural breach and subarachnoid-pleural fistulas. Giant calcified herniated discs are the largest contributor to myelopathy, intradural extension and postoperative complications. Some of the technical means that can be used to prevent complications are explored, along with how to address these complications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi


    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  1. [Surgical Treated Spondylodiscitis Epidemiological Study]. (United States)

    Soares do Brito, Joaquim; Tirado, António; Fernandes, Pedro


    The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013. Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient. We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and Mycobacterium tuberculosis the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to Staphylococcus aureus and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients. In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to Staphylococcus aureus seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases. Spinal infections requiring surgical treatment are still an important clinical condition. Mycobacterium tuberculosis and Staphylococcus aureus represent the main pathogens with a growing incidence for the latest.

  2. The Dutch surgical colorectal audit

    NARCIS (Netherlands)

    van Leersum, N. J.; Snijders, H. S.; Henneman, D.; Kolfschoten, N. E.; Gooiker, G. A.; ten Berge, M. G.; Eddes, E. H.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.; Bemelman, W. A.; van Dam, R. M.; Elferink, M. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Lemmens, V. E. P. P.; Rutten, H. J. T.; Manusama, E. R.; van de Velde, C. J. H.; Meijerink, W. J. H. J.; Wiggers, Th; van der Harst, E.; Dekker, J. W. T.; Boerma, D.


    In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch

  3. The dutch surgical colorectal audit

    NARCIS (Netherlands)

    Leersum, N.J. van; Snijders, H.S.; Henneman, D.; Kolfschoten, N.E.; Gooiker, G.A.; Berge, M.G. Ten; Eddes, E.H.; Wouters, M.W.; Tollenaar, R.A.E.M.; Bemelman, W.A.; Dam, R.M. van; Elferink, M.A.; Karsten, T.M.; Krieken, J.H. van; Lemmens, V.E.; Rutten, H.J.; Manusama, E.R.; Velde, C.J. van de; Meijerink, W.J.H.J.; Wiggers, T.; Harst, E. van der; Dekker, J.W.T.; Boerma, D.


    INTRODUCTION: In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated

  4. Surgical Lasers In Veterinary Medicine (United States)

    Newman, H. C.


    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  5. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    While training non-physicians and non- surgeon physicians to operate may work, they must be trained and supervised well. Ojuka in this issue argues for reassessment of surgical training with emphasis on the non-technical skills and innovation. (11). Whatever shape our efforts to expand the supply of “surgeons” will take, ...

  6. Surgical Training in the Netherlands

    NARCIS (Netherlands)

    Borel Rinkes, I.H.M.; Gouma, D.J.; Hamming, J.F.


    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently,

  7. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.


    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of

  8. A Surgical Re-tread

    African Journals Online (AJOL)

    FROM THE COLLEGE OF MEDICINE. A Surgical Re-tread. J Lawrie. It is given to few to be at the foundation of two new. Departments of Surgery, in two new Medical. Schools, in two different parts of Mrica. Such has been my good fortune. Back during the. Nigerian civil war, still disrupting the South, it was decided that the ...

  9. Surgical treatment for incessant pericarditis (United States)

    Hota, Susy S; Chow, ChiMing; Bonneau, Daniel; Chisholm, Robert J


    A case of chronic relapsing pericarditis is presented in which all forms of medical therapy failed. Pericardectomy was performed as a last resort, with complete resolution of symptoms. Incessant pericarditis, as distinguished from recurrent intermittent pericarditis, may respond favourably to surgical removal, especially in the presence of recurrent pericardial effusion. PMID:19279984


    African Journals Online (AJOL)

    for ophthalmic surgical procedures (1-7). Regional anaesthetic techniques eliminate the need for some routine investigations like chest X-ray, ECG,as well as risk associated with general anaesthesia (8) they are more tolerable for elderly patients, ill patients, they are cheaper and generally more useful for ambulatory ...

  11. [Clinical manifestation and surgical treatment of spinal osteoblastoma]. (United States)

    Li, Zhong-hai; Ma, Hui; Fu, Qiang; Hou, Tie-sheng


    To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma. From June 2006 to July 2010, 11 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 7 males and 4 females with an average age of 23.5 years (range, 16 - 34 years). The tumors were located at C(5) in 3, C(6) in 4, C(7) in 2, C(6) ~ T(1) in 1 and T(11) in 1. Based on WBB classification, 9 were 1 - 3 or 10 - 12 and 2 were 4 - 9 and 1 - 3. All the operations had been performed with en-bloc resection. The posterior approach was used for 9 patients, and combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 8 patients. To evaluate the change of pain before and after the operation by visual analogue scales (VAS), and to assess functional status of the spine by McCormick scale. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones. All cases were followed up for 12 - 64 months (average, 28.4 months). The average surgical time was 130.5 minutes (range, 90 - 210 minutes), with the average intraoperative blood loss of 560 ml (range, 300 - 1000 ml). During the follow-up period, the VAS grade reduced from 6.3 ± 1.1 to 2.5 ± 1.0 (t = 8.48, P osteoblastoma has its own specific radiographic feature. There are some recurrence in simple curettage of tumor lesion. The thoroughly en-bloc resection of tumor or spondylectomy, bone fusion and strong in ter fixation are the key points for successful surgical treatment.

  12. A Novel Surgical Pre-suturing Technique for the Management of ...

    African Journals Online (AJOL)

    social movements of tongue like licking an ice‑cream, sucking, playing musical instrument particularly wood wind or kissing, etc. Several conservative, as well as surgical options, exist for the management of tongue tie. It includes observation, speech therapy, otolaryngotherapy, frenotomy, frenectomy,. Z‑plasty and laser ...

  13. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD


    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  14. Pancreatitis Quality of Life Instrument: Development of a new instrument


    Wassef, Wahid; Bova, Carol; Barton, Bruce; Hartigan, Celia


    Objectives: The goal of this project was to develop the first disease-specific instrument for the evaluation of quality of life in chronic pancreatitis. Methods: Focus groups and interview sessions were conducted, with chronic pancreatitis patients, to identify items felt to impact quality of life which were subsequently formatted into a paper-and-pencil instrument. This instrument was used to conduct an online survey by an expert panel of pancreatologists to evaluate its content validity. Fi...

  15. Surgical travellers: tapestry to Bayeux. (United States)

    Hedley-Whyte, John; Milamed, Debra R


    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  16. Virtual Instrument Simulator for CERES (United States)

    Chapman, John J.


    A benchtop virtual instrument simulator for CERES (Clouds and the Earth's Radiant Energy System) has been built at NASA, Langley Research Center in Hampton, VA. The CERES instruments will fly on several earth orbiting platforms notably NASDA's Tropical Rainfall Measurement Mission (TRMM) and NASA's Earth Observing System (EOS) satellites. CERES measures top of the atmosphere radiative fluxes using microprocessor controlled scanning radiometers. The CERES Virtual Instrument Simulator consists of electronic circuitry identical to the flight unit's twin microprocessors and telemetry interface to the supporting spacecraft electronics and two personal computers (PC) connected to the I/O ports that control azimuth and elevation gimbals. Software consists of the unmodified TRW developed Flight Code and Ground Support Software which serves as the instrument monitor and NASA/TRW developed engineering models of the scanners. The CERES Instrument Simulator will serve as a testbed for testing of custom instrument commands intended to solve in-flight anomalies of the instruments which could arise during the CERES mission. One of the supporting computers supports the telemetry display which monitors the simulator microprocessors during the development and testing of custom instrument commands. The CERES engineering development software models have been modified to provide a virtual instrument running on a second supporting computer linked in real time to the instrument flight microprocessor control ports. The CERES Instrument Simulator will be used to verify memory uploads by the CERES Flight Operations TEAM at NASA. Plots of the virtual scanner models match the actual instrument scan plots. A high speed logic analyzer has been used to track the performance of the flight microprocessor. The concept of using an identical but non-flight qualified microprocessor and electronics ensemble linked to a virtual instrument with identical system software affords a relatively inexpensive

  17. Instruments and method of air navigation (United States)


    Topics discussed include magnetic and astronavigation instruments; flight beyond ground visibility; aircraft radio navigation instruments and communication radio sets; instrument landing systems; and ground controlled landing systems.

  18. Pilot study of design method for surgical robot using workspace reproduction system. (United States)

    Seno, Hiroto; Kawamura, Kazuya; Kobayashi, Yo; Fujie, Masakatsu G


    Recent development methods for surgical robots have an inherent problem. The user-friendliness of operating robot cannot be revealed until completion of the robot. To assist the design of a surgical robot that is user-friendly in terms of surgeon's operation, we propose a system that considers the operation manner of surgeon during the design phase of the robot. This system includes the following functionality: 1) a master manipulator that measures the operation manner of the surgeon (operator), and 2) a slave simulator in which the mechanical parameters can be configured freely. The operator can use the master manipulator to operate the slave simulator. Using this system, we investigate the necessity of considering the operator's manner when developing a surgical robot. In the experiment, we used three instruments with mechanisms that differed with respect to the length between bending joints and measured the trajectory of each instrument tip position during the surgical task. The results show that there are differences in the trajectories of each mechanism. Based on the results, changes in the mechanism of the surgical robot influenced the operator's manner. Therefore, when designing the mechanism for a surgical robot, there is a need to consider how this influences the operator's manner.

  19. Instrumentation for astronomy (United States)

    Sun, Yin Sheng


    The aim of this thesis was to develop two new infrared astronomical instruments, the University of New South Wales Infrared Fabry-Perot spectrometer (UNSWIRF) and the Infrared Camera of the University of New South Wales (IRC-UNSW), and modify an optics for one existing astronomical instrument, the Automated Patrol Telescope (APT). The optical modification of the APT overcame the problem of a curved focal plane and increased the flat field of view from 0.9° to 5°, twice as big as our original goal. In addition, glass filters of 5-mm thickness can now be inserted into its f/1 beam without image blurring. The simulation, analysis and redesign of the optical system are presented in detail. Several results from testing on the sky are presented as well. UNSWIRF is a near-infrared tunable imaging spectrometer used in conjunction with IRIS on the Anglo-Australian Telescope (AAT). It is the first successful infrared Fabry-Perot spectrometer developed in Australia. Its many challenging features, such as the wide field of view, high spectral and spatial resolution and wide tunable range have been rewarded by exciting observing results obtained during commissioning in February 1996. A major contribution of this thesis has been in the calibration of the Fabry-Perot etalon. IRC-UNSW is a new near-infrared camera with a tunable Fabry-Perot for infrared astronomy. IRC-UNSW is designed for use on the 4-m Anglo-Australian Telescope (AAT) and the 2.3-m telescope of the Australian National University. The camera optics use a novel design of three off-axis mirrors, allowing correction of the off-axis aberrations in the telescopes themselves, and producing images with FWHM blur circles of 10 mm or less over a wide field of view without chromatic affects. An external Fabry- Perot etalon is used as a high-resolution spectrometer. In its opto-mechanical design, the performance of the camera with respect to thermal effects, stray light, misalignment and manufacturing errors have been

  20. Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures


    Yurac, Ratko; Marré, Bartolomé; Urzua, Alejandro.; Munjin, Milan; Lecaros, Miguel A.


    The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of...

  1. Industrial instrumentation principles and design

    CERN Document Server

    Padmanabhan, Tattamangalam R


    Pneumatic, hydraulic and allied instrumentation schemes have given way to electronic schemes in recent years thanks to the rapid strides in electronics and allied areas. Principles, design and applications of such state-of-the-art instrumentation schemes form the subject matter of this book. Through representative examples, the basic building blocks of instrumentation schemes are identified and each of these building blocks discussed in terms of its design and interface characteristics. The common generic schemes synthesized with such building blocks are dealt with subsequently. This forms the scope of Part I. The focus in Part II is on application. Displacement and allied instrumentation, force and allied instrumentation and process instrumentation in terms of temperature, flow, pressure level and other common process variables are dealt with separately and exhaustively. Despite the diversity in the sensor principles and characteristics and the variety in the applications and their environments, it is possib...

  2. Impact Disdrometers Instrument Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Bartholomew, Mary Jane [Brookhaven National Lab. (BNL), Upton, NY (United States)


    To improve the quantitative description of precipitation processes in climate models, the U.S. Department of Energy’s Atmospheric Radiation Measurement (ARM) Climate Research Facility has been collecting observations of the drop size spectra of rain events since early in 2006. Impact disdrometers were the initial choice due to their reliability, ease of maintenance, and relatively low cost. Each of the two units deployed was accompanied by a nearby tipping bucket. In 2010, the tipping buckets were replaced by weighing buckets rain gauges. Five video disdrometers were subsequently purchased and are described in ARM’s VDIS Handbook.1 As of April 2011, three of the weighing bucket instruments were deployed, one was to travel with the second ARM Mobile Facility, and the fifth was a spare. Two of the video disdrometers were deployed, a third was to be deployed later in the spring of 2011, one was to travel with the second ARM Mobile Facility, and the last was a spare. Detailed descriptions of impact disdrometers and their datastreams are provided in this document.

  3. Measurement, instrumentation, and sensors handbook

    CERN Document Server

    Eren, Halit


    The Second Edition of the bestselling Measurement, Instrumentation, and Sensors Handbook brings together all aspects of the design and implementation of measurement, instrumentation, and sensors. Reflecting the current state of the art, it describes the use of instruments and techniques for performing practical measurements in engineering, physics, chemistry, and the life sciences and discusses processing systems, automatic data acquisition, reduction and analysis, operation characteristics, accuracy, errors, calibrations, and the incorporation of standards for control purposes. Organized acco

  4. GPU based real-time instrument tracking with three-dimensional ultrasound. (United States)

    Novotny, Paul M; Stoll, Jeff A; Vasilyev, Nikolay V; del Nido, Pedro J; Dupont, Pierre E; Zickler, Todd E; Howe, Robert D


    Real-time three-dimensional ultrasound enables new intracardiac surgical procedures, but the distorted appearance of instruments in ultrasound poses a challenge to surgeons. This paper presents a detection technique that identifies the position of the instrument within the ultrasound volume. The algorithm uses a form of the generalized Radon transform to search for long straight objects in the ultrasound image, a feature characteristic of instruments and not found in cardiac tissue. When combined with passive markers placed on the instrument shaft, the full position and orientation of the instrument is found in 3D space. This detection technique is amenable to rapid execution on the current generation of personal computer graphics processor units (GPU). Our GPU implementation detected a surgical instrument in 31 ms, sufficient for real-time tracking at the 25 volumes per second rate of the ultrasound machine. A water tank experiment found instrument orientation errors of 1.1 degrees and tip position errors of less than 1.8mm. Finally, an in vivo study demonstrated successful instrument tracking inside a beating porcine heart.

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

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


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

  6. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for

  7. Virtual Surgical Planning: The Pearls and Pitfalls

    Directory of Open Access Journals (Sweden)

    Johnny I. Efanov, MD


    Conclusion:. Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.

  8. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred


    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...

  9. Insufficient joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery. (United States)

    Jeong, Chang Wook; Kim, Sung Hoon; Kim, Hyung Tae; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Lee, Sang Eun


    The current articulating instruments used in laparoendoscopic single-site surgery do not appear to provide the joint forces required. Thus, we measured the joint forces of first-generation articulating laparoscopic instruments. To compare these forces with those necessary in the surgical context, we evaluated the forces sufficient to produce secure surgical ties in an animal model. The articulating instruments tested were Laparo-Angle (Cambridge Endoscopic Devices Inc, Framingham, MA), RealHand (Novare Surgical Systems Inc, Cupertino, CA), and Roticulator (Covidien Inc, Mansfield, MA). For each, we measured the angle between the end-effector and the shaft in proportion to the articulating force using a push-pull gauge. Two fixed-position configurations of the instruments were predetermined: the neutral and the fully articulated positions. The forces required to secure surgical ties for the ureter, renal artery, and renal vein were evaluated using kidneys harvested from a female pig. The bending forces required to bend from the neutral position to 30° were 5.6 ± 1.2 and 4.7 ± 1.0 N with the Laparo-Angle and RealHand, respectively. Furthermore, the slippage forces in the fully articulated state were 1.8 ± 0.3, 1.6 ± 0.2, and 1.5 ± 0.2 N in the above order. In contrast, the mean forces to produce surgical ties of the ureter, renal artery, and renal vein were 14.5 ± 2.3, 11.5 ± 0.8, and 10.3 ± 2.3 N, respectively. The joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery are not sufficient to meet the usual operative needs. Improved articulating instruments with greater articulating forces should be developed.

  10. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark


    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  11. [Surgical treatment of mental disorders]. (United States)

    Harat, Marek; Rudaś, Marcin


    The surgical treatment of mental disorders--the authors present the neuroanatomical base of stereotactic operations on the limbic system in patients with the mental disorders. Four main procedures are discussed: anterior cinguotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy. On the ground of available literature the authors present the results of these operations which are performed with the use of stereotactic equipment guided by MRI and CT. In this article the indications for different surgical procedures are presented and refer mainly to depression, obsessive-compulsive disorder and anxiety. The authors present the principles of qualification and the exclusion criteria of the patients in the countries in which these kinds of operations are performed.

  12. [Immediate complications of surgical abortion]. (United States)

    Soulat, C; Gelly, M


    While medical abortion is now available in non hospital facilities, abortions by vacuum aspiration remain illegal in non hospital settings. It is therefore important to assess through the literature the real risks associated with this method. All the most recent and large-scale studies showed that legal abortion by vacuum aspiration is an extremely safe procedure. It is less risky than other medical or surgical procedures performed outside the hospital. According to the studies, the death rate varies from 0 to 0.7 per 100,000 abortions, and is smaller when the procedure is done under local anesthesia than general anesthesia. The overall early complication rate (hemorrhage, uterine perforation, cervical injury) is between 0.01 and 1.16%. Complications are not more frequent than with medical abortions. In view of these low complication rates, surgical abortion by vacuum aspiration could be performed outside the hospital setting in France, as it is the case in many other countries.

  13. Error reduction in surgical pathology. (United States)

    Nakhleh, Raouf E


    Because of its complex nature, surgical pathology practice is inherently error prone. Currently, there is pressure to reduce errors in medicine, including pathology. To review factors that contribute to errors and to discuss error-reduction strategies. Literature review. Multiple factors contribute to errors in medicine, including variable input, complexity, inconsistency, tight coupling, human intervention, time constraints, and a hierarchical culture. Strategies that may reduce errors include reducing reliance on memory, improving information access, error-proofing processes, decreasing reliance on vigilance, standardizing tasks and language, reducing the number of handoffs, simplifying processes, adjusting work schedules and environment, providing adequate training, and placing the correct people in the correct jobs. Surgical pathology is a complex system with ample opportunity for error. Significant error reduction is unlikely to occur without a sustained comprehensive program of quality control and quality assurance. Incremental adoption of information technology and automation along with improved training in patient safety and quality management can help reduce errors.

  14. Surgical treatment of pathological obesity

    International Nuclear Information System (INIS)

    Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana


    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  15. Virtual Surgical Planning and Piezoelectric Surgery in Tumor Extirpative Surgery Aimed at Inferior Alveolar Nerve Preservation

    Directory of Open Access Journals (Sweden)

    Eric L. Chung


    Full Text Available A myriad of extirpative surgical protocols for the management of benign tumors of the jaws have been presented in the literature. Through significant advancements in computer-aided design and computer-aided manufacturing (CAD/CAM technology and surgical instrumentation, today surgeons have at their disposal robust technology-driven techniques that are aimed at improving surgical outcomes. Our goal is to investigate the benefits of implementing virtual surgical planning (VSP in conjunction with piezoelectric surgery (PES to ensure success while minimizing the risk of complications during extirpation of tumors of the mandible. This case report describes the successful extirpation of an ossifying fibroma of the mandible in an adult patient using both VSP and PES.

  16. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul


    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  17. A surgical sabbatical in France. (United States)

    Sutherland, F; Launois, B


    During my stay in France I had the unique opportunity to meet surgical professors from all over the world and made many friends and contacts in the field of hepatobiliary surgery. Brittany is a beautiful province of France, having unique way of life and approach to social and societal problems. The cultural enrichment that I received from my year there will last a lifetime, as well the many fond memories of the people, the culinary delights and the spectacular seashore.

  18. Endometriosis in a surgical wound

    Directory of Open Access Journals (Sweden)

    José Arimatéia dos Santos Júnior


    Endometriosis commonly affects the ovaries, uterine ligaments, rectovaginal septum and pelvic peritoneum. Extrapelvic endometriosis is less common, but may affect some sites, such as the lungs, appendix, nose, navel, peritoneum and even the intestines. The most common form of extrapelvic endometriosis is the cutaneous scars primarily in obstetrical or gynecological surgery. This paper aims to describe a clinical picture characterized by endometriosis surgical site in a young patient.

  19. Tattoo preservation during surgical procedures


    Tenna S; Delle Femmine PF; Pendolino AL; Brunetti B; Persichetti P


    Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgic...

  20. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred


    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys......INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic...

  1. Uncommon surgical emergencies in neonatology

    Directory of Open Access Journals (Sweden)

    R. Angotti


    Full Text Available Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies.

  2. Descending necrotizing mediastinitis: surgical management. (United States)

    Papalia, E; Rena, O; Oliaro, A; Cavallo, A; Giobbe, R; Casadio, C; Maggi, G; Mancuso, M


    Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces. Between April 1994 and April 2000, 13 patients, mean age 39.23+/-18.47 (median 38, range 16-67) years, with DNM were submitted to surgical treatment. Primary odontogenic abscess occurred in six, peritonsillar abscess in five and post-traumatic cervical abscess in two patients. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of the cervico-mediastinal regions by a bilateral collar incision associated with right thoracotomy in ten cases. Six patients out of 13 required reoperation. Two patients previously submitted only to cervical drainage required thoracotomy; four patients, which have been submitted to cervico-thoracic drainage, underwent contralateral thoracotomy in two cases and ipsilateral reoperation in two cases. Ten patients evolved well and were discharged without major sequelae; three patients died of multiorgan failure related to septic shock. Mortality rate was 23%. Early diagnosis by CT of the neck and chest suggest a rapid indication of surgical approach to DNM. Ample cervicotomy associated with mediastinal drainage via large thoracotomic incision is essential in managing these critically ill patients and can significantly reduce the mortality rate for this condition, often affecting young people, to acceptable values.

  3. Surgical Treatment of Skin Tumors

    Directory of Open Access Journals (Sweden)



    Full Text Available When we mention about surgical treatment of any tumor residing on the skin independent of its benign or malignant nature, the first method we recall is excision. Elliptical excision is the mainstay of the dermatologic surgery. Each excision ends with a defect for which we are responsible to repair functionally and cosmetically. The diameter of the tumor we excised and the safety margin used for excision determine the diameter of the final defect. After achieving tumor free lateral and deep margins with the appropriate surgical method, we decide between the repair options of second intention healing, primary repair, flaps, full or split thickness grafts, considering the diameter and the anatomic localization of the defect, for the best functional and cosmetic result for that specific defect. This review overviews not only the most common dermatologic surgical methods, but also Mohs surgery which is a method rarely used in our country, although it is the treatment of choice for the treatment of high risk basal cell carcinoma (BCC and squamous cell carcinoma (SCC.

  4. Surgical treatment for myelodysplastic clubfoot,

    Directory of Open Access Journals (Sweden)

    Alexandre Zuccon


    Full Text Available Objective:To analyze the results from surgical treatment of 69 cases of clubfoot in 43 patients with myelodysplasia according to clinical and radiographic criteria, at our institution between 1984 and 2004.Methods:This was a retrospective study involving analysis of medical files, radiographs and consultations relating to patients who underwent surgical correction of clubfoot. The surgical technique consisted of radical posteromedial and lateral release with or without associated talectomy.Results:The patients' mean age at the time of the surgery was four years and two months, and the mean length of postoperative follow-up was seven years and two months. Satisfactory results were achieved in 73.9% of the feet and unsatisfactory results in 26.1% (p < 0.0001.Conclusion:Residual deformity in the immediate postoperative period was associated with unsatisfactory results. Opening of the Kite (talocalcaneal angle in feet that only underwent posteromedial and lateral release, along with appropriate positioning of the calcaneus in cases that underwent talectomy, was the radiographic parameter that correlated with satisfactory results.

  5. Acute diverticulitis and surgical treatment. (United States)

    Roig, José V; Sánchez-Guillén, Luis; García-Armengol, Juan J


    Diverticulitis is a common condition in industrialized countries and an important cause of hospital admissions. Its growing trend is a challenge for the surgeons who perform emergency surgery, because approximately 15-25% of the patients will require surgery, being the surgical management of complicated acute diverticulitis controversial. The past decade has seen a paradigm shift in the treatment of sigmoid diverticulitis based on new epidemiological studies and refinement of surgical techniques that has produced a reassessment of our guidelines. CT imaging and sepsis scores allows to stratify the patients and better define the therapeutic strategies in each case. Special considerations must also be made for patients with a high surgical risk, such as immunosuppressed ones. The recommendations to perform surgery after two episodes of uncomplicated diverticulitis have been re-evaluated and the belief that new episodes may be complicated and associated with high morbidity and mortality has been rejected, since the clinical manifestations of this disease are usually defined by the first attack. In complicated cases, more patients can be treated with resection and primary anastomosis with or without an associated stoma, whose reversal rate is much higher than that of a Hartmann's procedure. Likewise, laparoscopic surgery performing a peritoneal lavage and drainage without associated resection may have an increasing role in the management of these patients, although with controversial results, having become laparoscopic colon resection the approach of choice for the treatment of this pathology in elective settings.

  6. Surgical smoke and ultrafine particles

    Directory of Open Access Journals (Sweden)

    Nowak Dennis


    Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

  7. Is surgical workforce diversity increasing? (United States)

    Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B


    We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.

  8. Simulation-based surgical education. (United States)

    Evgeniou, Evgenios; Loizou, Peter


    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  9. Quantification of surgical blood loss. (United States)

    Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T


    To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.

  10. Ethical issues in surgical innovation. (United States)

    Miller, Megan E; Siegler, Mark; Angelos, Peter


    Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients.

  11. Fighting surgical site infections in small animals

    DEFF Research Database (Denmark)

    Verwilghen, Denis; Singh, Ameet


    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  12. Surgical Competence: Assessing, Acquiring, Maintaining, and ...

    African Journals Online (AJOL)

    Hp 630 Dual Core

    (prerequisites for successful passage through surgical training) to either pass or fail at the final summative assessment would allow better identification of those areas that need investment in training and education by surgical colleges for different cohorts of surgical trainees. Figure 1. UK University acceptances 2004 2012.

  13. Tricuspid valve interventions: surgical techniques and outcomes. (United States)

    Starck, Christoph T; Kempfert, Jörg; Falk, Volkmar


    The surgical treatment of isolated and concomitant tricuspid valve disease, especially functional tricuspid valve regurgitation, remains controversial. Functional tricuspid regurgitation may be classified into defined stages, and surgical treatment may be tailored to the extent of the disease. This report describes current surgical techniques for tricuspid valve surgery and their results.

  14. 14 CFR 27.1337 - Powerplant instruments. (United States)


    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Powerplant instruments. 27.1337 Section 27... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Equipment Instruments: Installation § 27.1337 Powerplant instruments. (a) Instruments and instrument lines. (1) Each powerplant instrument line must meet the...

  15. 14 CFR 29.1337 - Powerplant instruments. (United States)


    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Powerplant instruments. 29.1337 Section 29... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Equipment Instruments: Installation § 29.1337 Powerplant instruments. (a) Instruments and instrument lines. (1) Each powerplant and auxiliary power unit instrument...

  16. 14 CFR 25.1337 - Powerplant instruments. (United States)


    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Powerplant instruments. 25.1337 Section 25... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Instruments: Installation § 25.1337 Powerplant instruments. (a) Instruments and instrument lines. (1) Each powerplant and auxiliary power unit instrument...


    Directory of Open Access Journals (Sweden)

    Ayrana Soares Aires

    Full Text Available ABSTRACT Objective: This study describes the use of materials for modern cervical instrumentation, evaluating its viability in children and adolescents, and the techniques used in different cases. The efficacy of the techniques was analyzed through improvement of pain, maintenance of cervical range of motion, recovery of craniocervical stability, bone consolidation, and spinal stenosis in the postoperative follow-up. Method: Retrospective study of the clinical and radiological parameters of 27 patients aged two to 16 years with cervical spine diseases. Results: Two patients had chronic dislocation in C1-C2, one had congenital axis spondylolisthesis, two had congenital dislocation in C1-C2, three had tumors, one had kyphosis after laminectomy, one had post-infection kyphosis, one had fracture, 11 were syndromic with instabilities, and five had congenital cervical scoliosis. As to surgical approaches, two patients were transorally operated, three by anterior approach, 15 by posterior approach, two by anterior and posterior approaches, and five were treated in three stages (anterior, posterior and anterior approaches. Regarding the technique of cervical stabilization, seven patients were treated by Goel-Harms technique, two received Goel’s facet distraction, and three, Wright translaminar screws. There were complications in four cases. Two patients in the instrumentation of C1 lateral mass due to poor positioning, one with cerebrospinal fluid fistula and one with surgical wound infection. Conclusion: Modern cervical instrumentation in pediatric patients is a safe and effective technique for the treatment of cervical instability.

  18. Experimenting with String Musical Instruments (United States)

    LoPresto, Michael C.


    What follows are several investigations involving string musical instruments developed for and used in a "Science of Sound & Light" course. The experiments make use of a guitar, orchestral string instruments and data collection and graphing software. They are designed to provide students with concrete examples of how mathematical formulae, when…

  19. Atomic absorption instrument functional description

    International Nuclear Information System (INIS)

    Bystroff, R.I.; Boyle, W.G. Jr.; Barton, G.W. Jr.


    This report describes a proposed system for automating atomic absorption analysis. The system consists of two atomic absorption instruments and an automatic sampler that can be attached to either instrument. A computer program controls the sampling and gathers data. The program then uses the data to perform bookkeeping, data processing, and report writing

  20. Developing a workplace resilience instrument. (United States)

    Mallak, Larry A; Yildiz, Mustafa


    Resilience benefits from the use of protective factors, as opposed to risk factors, which are associated with vulnerability. Considerable research and instrument development has been conducted in clinical settings for patients. The need existed for an instrument to be developed in a workplace setting to measure resilience of employees. This study developed and tested a resilience instrument for employees in the workplace. The research instrument was distributed to executives and nurses working in the United States in hospital settings. Five-hundred-forty completed and usable responses were obtained. The instrument contained an inventory of workplace resilience, a job stress questionnaire, and relevant demographics. The resilience items were written based on previous work by the lead author and inspired by Weick's [1] sense-making theory. A four-factor model yielded an instrument having psychometric properties showing good model fit. Twenty items were retained for the resulting Workplace Resilience Instrument (WRI). Parallel analysis was conducted with successive iterations of exploratory and confirmatory factor analyses. Respondents were classified based on their employment with either a rural or an urban hospital. Executives had significantly higher WRI scores than nurses, controlling for gender. WRI scores were positively and significantly correlated with years of experience and the Brief Job Stress Questionnaire. An instrument to measure individual resilience in the workplace (WRI) was developed. The WRI's four factors identify dimensions of workplace resilience for use in subsequent investigations: Active Problem-Solving, Team Efficacy, Confident Sense-Making, and Bricolage.

  1. Instruments to assess integrated care

    DEFF Research Database (Denmark)

    Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte


    INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to mea...... was prevalent. It is uncertain whether development of a single 'all-inclusive' model for assessing integrated care is desirable. We emphasise the continuing need for validated instruments embedded in theoretical contexts.......INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how...... to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...

  2. Surface Meteorological Instrumentation for BOBMEX

    Indian Academy of Sciences (India)

    Although India has a long experience in ship-borne experiments and oceanographic instrumentation, the atmospheric component has not received much attention in the past. In this paper, the basis of the atmospheric instrumentation system assembled for use on board ORV Sagar Kanya for the BOBMEX- Pilot experiment ...

  3. A Database Management Assessment Instrument (United States)

    Landry, Jeffrey P.; Pardue, J. Harold; Daigle, Roy; Longenecker, Herbert E., Jr.


    This paper describes an instrument designed for assessing learning outcomes in data management. In addition to assessment of student learning and ABET outcomes, we have also found the instrument to be effective for determining database placement of incoming information systems (IS) graduate students. Each of these three uses is discussed in this…

  4. Two, four, six, eight... stop and count before it is too late! An audit on swab, needle and instrument counts in theatre.

    LENUS (Irish Health Repository)

    Donnelly, T.


    A concurrent audit was conducted over a four week period to determine if the counting of swabs, needles and instruments for surgery adhered to local policy and recommended guidelines. Data were collected on 30 abdominal surgical procedures. This audit highlighted failings in the count process. It identified poor communication within the multidisciplinary team. There needs to be an increased awareness about local policy, national and international guidelines regarding the counting of swabs, needles and instruments for all surgical procedures.

  5. Instrumentation and control system design

    International Nuclear Information System (INIS)

    Saito, Kenji; Sawahata, Hiroaki; Homma, Fumitaka; Kondo, Makoto; Mizushima, Toshihiko


    The instrumentation and control system of the high temperature engineering test reactor consists of the instrumentation, control equipments and safety protection systems. There are not many differences in the instrumentation and control equipments design between the HTTR and light water reactors except for some features. Various kinds of R and D of reactor instrumentation were performed taking into account the HTTR operational conditions, and a plant dynamic analysis was carried out considering the operational conditions of the HTTR in order to design the control system. These systems are required to have a high reliability in respect to safety. In the rise-to-power test it was confirmed that the instrumentation has a high reliability and the control system has a high stability and reasonable damped characteristics for various disturbances

  6. Smart antennas for nuclear instruments

    International Nuclear Information System (INIS)

    Jain, Ranjan Bala; Singhi, B.M.


    The advances in the field of computer and communications are leading to the development of smart embedded nuclear instruments. These instruments have highly sophisticated signal-processing algorithms based on FPGA and ASICS, provisions of present day connectivity and user interfaces. The developments in the connectivity, standards and bus technologies have made possible to access these instruments on LAN and WAN with suitable reliability and security. To get rid of wires i.e. in order to access these instruments, without wires at any place, wireless technology has evolved and become integral part of day-to-day activities. The environment monitoring can be done remotely, if smart antennas are incorporated on these instruments

  7. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. (United States)

    Matsuoka, Hidenori; Itoh, Yasunobu; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo; Hirano, Yoshitaka; Nakagawa, Hiroshi


    The authors present a novel method of the recapping hemilaminoplasty in a retrospective study of patients with spinal surgical disorders. This report describes the surgical technique and the results of hemilaminoplasty using an ultrasonic bone curette. The aim of this study was to examine the safety and effectiveness of the hemilaminoplasty technique with ultrasonic bone curette. Between April 2003 and July 2011, 33 patients with various spinal diseases (17 spinal tumors, 5 dural arteriovenous fistulas, 3 syringomyelia, 2 sacral perineural cysts, and 2 arachnoid cysts) were treated microsurgically by using an ultrasonic bone curette with scalpel blade and lightweight handpiece. The ultrasonic bone curette was used for division of lamina. After resection of the lesion, the excised lamina was replaced exactly in situ to its original anatomic position with a titanium plate and screw. Additional fusion technique was not required and the device was easy to handle. All patients were observed both neurologically and radiologically by dynamic plain radiographs and computed tomography (CT) scan. The operation was performed successfully and there were no instrument-related complications such as dural laceration, nerve root injury, and vessels injury. The mean number of resected and restored lamina was 1.7. CT confirmed primary bone fusion in all patients by 12 months after surgery. The ultrasonic bone curette is a useful instrument for recapping hemilaminoplasty in various spinal surgeries. This method allows anatomical reconstruction of the excised bone to preserve the posterior surrounding tissues.

  8. Instrumental variables and Mendelian randomization with invalid instruments (United States)

    Kang, Hyunseung

    Instrumental variables (IV) methods have been widely used to determine the causal effect of a treatment, exposure, policy, or an intervention on an outcome of interest. The IV method relies on having a valid instrument, a variable that is (A1) associated with the exposure, (A2) has no direct effect on the outcome, and (A3) is unrelated to the unmeasured confounders associated with the exposure and the outcome. However, in practice, finding a valid instrument, especially those that satisfy (A2) and (A3), can be challenging. For example, in Mendelian randomization studies where genetic markers are used as instruments, complete knowledge about instruments' validity is equivalent to complete knowledge about the involved genes' functions. The dissertation explores the theory, methods, and application of IV methods when invalid instruments are present. First, when we have multiple candidate instruments, we establish a theoretical bound whereby causal effects are only identified as long as less than 50% of instruments are invalid, without knowing which of the instruments are invalid. We also propose a fast penalized method, called sisVIVE, to estimate the causal effect. We find that sisVIVE outperforms traditional IV methods when invalid instruments are present both in simulation studies as well as in real data analysis. Second, we propose a robust confidence interval under the multiple invalid IV setting. This work is an extension of our work on sisVIVE. However, unlike sisVIVE which is robust to violations of (A2) and (A3), our confidence interval procedure provides honest coverage even if all three assumptions, (A1)-(A3), are violated. Third, we study the single IV setting where the one IV we have may actually be invalid. We propose a nonparametric IV estimation method based on full matching, a technique popular in causal inference for observational data, that leverages observed covariates to make the instrument more valid. We propose an estimator along with

  9. Under the microscope: assessing surgical aptitude of otolaryngology residency applicants. (United States)

    Carlson, Matthew L; Archibald, David J; Sorom, Abraham J; Moore, Eric J


    Application to otolaryngology residency is a highly competitive process. Programs identify the best candidates by evaluating academic performance in medical school, board scores, research experience, performance during an interview, and letters of recommendation. Unfortunately, none of these metrics completely assess an applicant's capacity to learn and perform surgical skills. We describe a direct assessment of an applicant's ability for rapid surgical skill acquisition, manual dexterity, and response to stress that can be performed during the interview process. A retrospective study at an academic otolaryngology residency program. After orientation, applicants were seated at a microsurgical training station and allotted 20 minutes to suture an incision using 10-0 nylon suture on a latex practice card. Their performance was graded using a 1-to-5 scoring system for the following categories: microscope use, respect for tissue, instrument handling, knot tying and suture control, skills acquisition, and attitude toward the exercise. Applicants were given some instruction and assessed on their ability to incorporate what they had learned into their technique. The average total applicant score was 23.2, standard deviation (SD) 3.6 (maximum 30); 13.4% of applicants scored 1 SD above the mean. The value of applicant screening tests in predicting surgical competency is controversial. We describe a direct assessment tool that may prove useful in identifying outliers, both high and low, to aid in final applicant ranking.

  10. [Penal liability from retained foreign body inside the surgical site]. (United States)

    Angiò, L G; Ventura Spagnolo, E; Pirrone, G; Cardia, G


    The Authors focus on the liability of the surgery team members in the case they inadvertently forget behind in the patient's body a foreign object, which causes injuries and/or death. The Authors underline that, according to the current case law regarding medical malpractice, both the main surgeon and their assistant/subordinate are liable for engaging in a markedly imprudent and/or negligent conduct, such as not double-checking scrupulously the surgical site before its closure in order to highlight forgotten foreign bodies. As well, the Authors underline that either the circulator nurse or the theatre nurse can be considered punishable by law when that medical error occurs, even if they are responsible for the count of the instruments used in the course of the surgery. Conversely, the main surgeon and his or her assistant are always directly responsible, due to the fact that the nurses' count procedure represents merely an additional control measure, without substituting at all the check the surgeons must obligatory conduct on the surgical site. Finally, the Authors point out that, as the count procedure is performed by the members of a surgical team, where a hierarchy-based relationship rules, the main surgeon is the liable for any preventable and avoidable adverse event provoked by the nursing staff as a consequence of the objective responsibility due to culpa in eligendo and culpa in vigilando.

  11. Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology. (United States)

    Kranzfelder, Michael; Schneider, Armin; Fiolka, Adam; Schwan, Elena; Gillen, Sonja; Wilhelm, Dirk; Schirren, Rebecca; Reiser, Silvano; Jensen, Brian; Feussner, Hubertus


    A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments. The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as "not in use." Once it was handed to the surgeon, it was considered to be "in use." Temporal miscounts (incorrect number of instruments "in use") were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation. A total of 110 distinct instrument applications ("in use" versus "not in use") were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54). The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Surgical airway in emergency department intubation. (United States)

    Reid, Lindsay A; Dunn, Mark; Mckeown, Dermot W; Oglesby, Angela J


    To determine the frequency of and primary indication for surgical airway during emergency department intubation. Prospectively collected data from all intubations performed in the emergency department from January 1999 to July 2007 were analysed to ascertain the frequency of surgical airway access. Original data were collected on a structured proforma, entered into a regional database and analysed. Patient records were then reviewed to determine the primary indication for a surgical airway. Emergency department intubation was undertaken in 2524 patients. Of these, only five patients (0.2%) required a surgical airway. The most common indication for a surgical airway was trauma in four of the five patients. Two patients had attempted rapid sequence induction before surgical airway. Two patients had gaseous inductions and one patient received no drugs. In all five patients, surgical airway was performed secondary to failed endotracheal intubation attempt(s) and was never the primary technique used. In our emergency department, surgical airway is an uncommon procedure. The rate of 0.2% is significantly lower than rates quoted in other studies. The most common indication for surgical airway was severe facial or neck trauma. Our emergency department has a joint protocol for emergency intubation agreed by the Departments of Emergency Medicine, Anaesthesia and Critical Care at the Edinburgh Royal Infirmary. We believe that the low surgical airway rate is secondary to this collaborative approach. The identified low rate of emergency department surgical airway has implications for training and maintenance of skills for emergency medicine trainees and physicians.

  13. Improved transoral dissection of the tongue base with a next-generation robotic surgical system. (United States)

    Chen, Michelle M; Orosco, Ryan K; Lim, Gil Chai; Holsinger, F Christopher


    To describe the application of a novel, flexible, single-port robotic surgical system for transoral tongue base resection, and compare it to the current multiport, rigid-arm robotic surgical system. Preclinical anatomic study using four human cadavers. Transoral resection of the tongue base using the da Vinci Sp and the Si robotic surgical systems. A standardized operative procedure is outlined, and operative parameters were compared between robotic systems. Successful completion of tongue base resection was achieved in all cadavers using both the Sp and the Si systems. The optimal entry guide and instrument position for the Sp system was with the cannula rotated 180° from the standard position so that the camera was in the most inferior (caudal) channel. In the optimal configuration, no instrument exchanges were needed with the Sp system, but use of the Si system required one instrument exchange. This is the first preclinical anatomic study of robotic tongue base resection that compares a novel single-port robotic system to the current multiarm system. Surgical workflow was more streamlined with the da Vinci Sp system, and the new capabilities of simultaneous dissection, traction, and counter traction allowed for improved dissection and vessel control. NA. Laryngoscope, 128:78-83, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation. (United States)

    Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter


    To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Mac-Thiong Jean-Marc


    Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

  16. Intrasurgical Human Retinal Imaging With Manual Instrument Tracking Using a Microscope-Integrated Spectral-Domain Optical Coherence Tomography Device. (United States)

    Hahn, Paul; Carrasco-Zevallos, Oscar; Cunefare, David; Migacz, Justin; Farsiu, Sina; Izatt, Joseph A; Toth, Cynthia A


    To characterize the first in-human intraoperative imaging using a custom prototype spectral-domain microscope-integrated optical coherence tomography (MIOCT) device during vitreoretinal surgery with instruments in the eye. Under institutional review board approval for a prospective intraoperative study, MIOCT images were obtained at surgical pauses with instruments held static in the vitreous cavity and then concurrently with surgical maneuvers. Postoperatively, MIOCT images obtained at surgical pauses were compared with images obtained with a high-resolution handheld spectral-domain OCT (HHOCT) system with objective endpoints, including acquisition of images acceptable for analysis and identification of predefined macular morphologic or pathologic features. Human MIOCT images were successfully obtained before incision and during pauses in surgical maneuvers. MIOCT imaging confirmed preoperative diagnoses, such as epiretinal membrane, full-thickness macular hole, and vitreomacular traction and demonstrated successful achievement of surgical goals. MIOCT and HHOCT images obtained at surgical pauses in two cohorts of five patients were comparable with greater than or equal to 80% correlation in 80% of patients. Real-time video-imaging concurrent with surgical manipulations enabled, for the first time using this device, visualization of dynamic instrument-retina interaction with targeted OCT tracking. MIOCT is successful for imaging at surgical pauses and for real-time image guidance with implementation of targeted OCT tracking. Even faster acquisition speeds are currently being developed with incorporation of a swept-source MIOCT engine. Further refinements and investigations will be directed toward continued integration for real-time volumetric imaging of surgical maneuvers. Ongoing development of seamless MIOCT systems will likely transform surgical visualization, approaches, and decision-making.

  17. Torsional resistance of retreatment instruments. (United States)

    Lopes, Hélio P; Elias, Carlos N; Vedovello, Gislaine A F; Bueno, Carlos E S; Mangelli, Marcelo; Siqueira, José F


    This study compared the torsional resistance of two brands of rotary nickel-titanium (NiTi) instruments indicated for endodontic retreatment. Mtwo retreatment instruments #15 and #25 (VDW, Munich, Germany) and ProTaper Universal retreatment instruments D2 and D3 (Maillefer/Dentsply, Ballaigues, Switzerland) were subjected to a torsional assay in clockwise rotation. The two parameters evaluated were maximum torque and angular deflection at failure. Fractured instruments had their fractured surfaces and helical shafts examined by scanning electron microscopy. The results indicated that the angular deflection at fracture decreased in the following order: Mtwo retreatment file #15 > Mtwo retreatment file #25 > ProTaper Universal retreatment file D2 > ProTaper Universal retreatment file D3. As for the maximum torque values, the results revealed the following descending order: ProTaper Universal file D2 > Mtwo retreatment file #25 > ProTaper Universal file D3 > Mtwo retreatment file #15. Scanning electron microscopic analysis revealed that plastic deformation occurred along the helical shaft of the fractured instruments. Fractured surfaces were of the ductile type. The instruments tested showed different torsional behavior depending on the parameter evaluated. If one considers that high angular deflection values may serve as a safety factor, then the Mtwo retreatment instruments showed significantly better results. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  18. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. (United States)

    Brox, Jens Ivar; Nygaard, Øystein P; Holm, Inger; Keller, Anne; Ingebrigtsen, Tor; Reikerås, Olav


    To compare the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain. Two merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry disability index. At 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. 15 (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI -5.9 to 8.2, according to the intention-to-treat analysis and -1.6; 95% CI -8.9 to 5.6 in the as-treated analysis. There was no difference in return to work. Long-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises.

  19. Tattoo preservation during surgical procedures

    Directory of Open Access Journals (Sweden)

    Tenna S


    Full Text Available Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical field may be a problem for both the patient and the surgeon. However, the relevant literature is mostly based on complications related to application of tattoos or methods used to remove them. To date, few reports have focused on the importance of preserving a tattoo during a surgical procedure, and no organized studies could be found. The aim of this paper is to provide an overview of the range of solutions that surgeons can use to preserve tattoos during surgery. A PubMed database search was done to assess other surgeons' experience. The terms "tattoo" in combination with "incision", "surgery", "surgical", or "operative" were used as key words. Following a review of the literature, photographs of patients presenting with a tattoo in the last 5 years at University Campus Bio-Medico of Rome were identified in order to determine the frequency of patients presenting with tattoos in our department. The patients were classified according to sex, age, type of surgery, number of tattoos, and tattoo location. Specific requests to preserve tattoos were recorded. Finally, an algorithm of treatment according to tattoo dimension and location is proposed. Knowledge of all the strategies available for saving tattoos is important for plastic and cosmetic surgeons. If a tattooed area needs to be operated on, surgeons should attempt, when possible, to avoid altering the tattoo in order to maximize the final cosmetic result. Keywords: tattoo incision, body contouring, surgery

  20. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas


    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  1. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia. (United States)

    Dydykin, Sergey; Kapitonova, Marina


    Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

  2. Surgical treatment of cleft lip

    Directory of Open Access Journals (Sweden)

    Mateus Domingues Miachon

    Full Text Available We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1 the severity of the cleft will indicate the technique presenting more advantages; 2 the different approaches indicate that there is no consensus on the optimal technique; and 3 the surgeon experience contributes to choosing the best option.

  3. Surgical castration, coercion and ethics

    DEFF Research Database (Denmark)

    Ryberg, Jesper; Petersen, Thomas Søbirk


    John McMillan's detailed ethical analysis concerning the use of surgical castration of sex offenders in the Czech Republic and Germany is mainly devoted to considerations of coercion.1 This is not surprising. When castration is offered as an option to offenders and, at the same time, constitutes...... the only means by which these offenders are likely to be released from prison, it is reasonable—and close to the heart of modern medical ethics—to consider whether the offer involves some kind of coercion. However, despite McMillan's seemingly careful consideration of this question, it appears to us...

  4. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M


    was cured by percutaneous ethanol injection and one was reoperated and cured in another hospital. Three patients with persistent hypercalcaemia refused reoperation. Transitory hypocalcaemia with a median duration of 15 days was found in 36 patients, and permanent hypocalcaemia in two patients (1.......9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism...

  5. Surgical Treatment of Tattoo Complications

    DEFF Research Database (Denmark)

    Sepehri, Mitra; Jørgensen, Bo


    With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern...... surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases...... on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented....

  6. Instrumentation in elementary particle physics

    International Nuclear Information System (INIS)

    Fabjan, C.W.; Pilcher, J.E.


    The first International Committee for Future Accelerators Instrumentation School was held at the International Centre for Theoretical Physics, Trieste, Italy from 8 to 19 June 1987. The School was attended by 74 students of whom 45 were from developing countries, 10 lecturers and 9 laboratory instructors. The next generation of elementary particle physics experiments would depend vitally on new ideas in instrumentation. This is a field where creativity and imagination play a major role and large budgets are not a prerequisite. One of the unique features was the presentation of four laboratory experiments using modern techniques and instrumentation. Refs, figs and tabs

  7. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.


    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  8. Digitalisation of optical lever instruments

    Energy Technology Data Exchange (ETDEWEB)

    Romeo, G. [Istituto Nazionale di Geofisica, Rome (Italy)


    Some classical old fashioned instruments (such as the Wood-Anderson seismometers), as well as some modern instruments (like the all-quartz made Verbaandert-Melchior tiltmeters), conventionally require an impractical recording system obtained by a photographic drum recorder in a darkroom. Simple electronic equipment (made by readily available, low cost electronics) may help in using such kind of instruments allowing a useful digital recording. This will reduce the time-hour in data acquisition and storage (and the manual error) and will increase the accuracy. The theory of operations and some results obtained using the described equipment are shown.

  9. Digitization of optical lever instruments

    Directory of Open Access Journals (Sweden)

    G. Romeo


    Full Text Available Some classical old-fashioned instruments (such as the Wood-Anderson seismometers, as well as some modern instruments (like the all-quartz made Verbaandert-Melchior tiltmeters, conventionally require an impractical recording system obtained by a photographic drum recorder in a darkroom. Simple electronic equipment (made by readily available, low cost electronics may help in using such kind of instruments allowing a useful digital recording. This will reduce the time-hour in data acquisition and storage (and the manual error, and will increase the accuracy. The theory of operations and some results obtained using the described equipment are shown.

  10. Commissioning Instrument for the GTC (United States)

    Cuevas, S.; Sánchez, B.; Bringas, V.; Espejo, C.; Flores, R.; Chapa, O.; Lara, G.; Chavolla, A.; Anguiano, G.; Arciniega, S.; Dorantes, A.; González, J. L.; Montoya, J. M.; Toral, R.; Hernández, H.; Nava, R.; Devaney, N.; Castro, J.; Cavaller-Marqués, L.


    During the GTC integration phase, the Commissioning Instrument (CI) will be a diagnostic tool for performance verification. The CI features four operation modes: imaging, pupil imaging, Curvature WFS, and high resolution Shack-Hartmann WFS. This instrument was built by the Instituto de Astronomía UNAM and the Centro de Ingeniería y Desarrollo Industrial (CIDESI) under GRANTECAN contract after a public bid. In this paper we made a general instrument overview and we show some of the performance final results obtained when the Factory Acceptance tests previous to its transport to La Palma.

  11. Steam 80 steam generator instrumentation

    International Nuclear Information System (INIS)

    Carson, W.H.; Harris, H.H.


    This paper describes two special instrumentation packages in an integral economizer (preheater) steam generator of one of the first System 80 plants scheduled to go into commercial operation. The purpose of the instrumentation is to obtain accurate operating information from regions of the secondary side of the steam generator inaccessible to normal plant instrumentation. In addition to verification of the System 80 steam generator design predictions, the data obtained will assist in verification of steam generator thermal/hydraulic computer codes developed for generic use in the industry

  12. Comparison between carbondioxide laser and cold instruments in treatment of vocal nodule

    International Nuclear Information System (INIS)

    Kundi, N.A.; Qayyum, A.; Ahmed, B.; Raza, M.


    Background: Vocal cord nodules are one of the most frequent disorders in both children and adults who use their voice excessively. Main symptom with which patient presents is hoarseness of voice. The treatment in early stages is voice therapy. Various methods are used for its treatment e.g. surgical removal with cold instruments and carbon dioxide laser ablation. Response to the treatment is measured by improvement in voice quality. Objective: To compare the results of Carbon dioxide laser and cold instruments in the treatment of vocal nodule. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at Otolaryngology Department Combined Military Hospital Rawalpindi. Patients and Methods: In this study 50 patients undergoing treatment of vocal cord nodule were included, 25 patients were treated by surgical removal with cold instruments and 25 patients were treated with carbon dioxide laser ablation. The main comparative outcomes were measured by patients' perception of voice quality (worse, same, improved) one week post operatively. Results: Improvement in voice quality with carbon dioxide laser was found to be clinically superior. Voice quality was significantly improved as compared to cold surgical instruments. Conclusion: Carbon dioxide laser causes early improvement in quality of voice as compared to cold instruments in the treatment of vocal nodules. (author)

  13. Proximal instrumented vertebral body chance fracture after pedicle screw instrumentation in a thoracic kyphosis patient with osteoporosis. (United States)

    Hu, Xiaobang; Lieberman, Isador H


    We present a case of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a 67-year-old woman with osteoporosis and thoracic kyphosis. To report the rare and unique complication of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a kyphosis patient. Pedicle screw instrumentation has been associated with complications not limited to neurological or vascular injury, loss of curve correction, intraoperative pedicle fracture or loosening, dural laceration, deep infection, and pseudarthrosis. To the best of our knowledge, there are no previous reports describing a chance-type fracture generated by a pedicle screw fixation at the proximal end of a construct. A 67-year-old woman suffered from progressive thoracic kyphosis and mid thoracic pain presented 2 weeks after pedicle screw instrumentation and correction. She developed a vertebral body fracture at the proximal end of the instrumentation construct. Surgical intervention, including removal of the screws in the fractured vertebrae and extension of the instrumented fusion across the cervicothoracic junction, effectively restored the physiological sagittal alignment. Postoperatively, at 12-month follow-up, the patient is doing exceptionally well with near-complete relief of back pain and an excellent maintenance of correction. Chance fracture in osteoporotic bone at the proximal end of a construct due to a pedicle screw is a rare complication but it may result in catastrophic consequences. Early recognition of this complication, reduction of the fraction-dislocation, and an extension of the instrumentation can be utilized for realignment and long-term stabilization.

  14. A computerized bioskills system for surgical skills training in total knee replacement. (United States)

    Conditt, M A; Noble, P C; Thompson, M T; Ismaily, S K; Moy, G J; Mathis, K B


    Although all agree that the results of total knee replacement (TKR) are primarily determined by surgical skill, there are few satisfactory alternatives to the 'apprenticeship' model of surgical training. A system capable of evaluating errors of instrument alignment in TKR has been developed and demonstrated. This system also makes it possible quantitatively to assess the source of errors in final component position and limb alignment. This study demonstrates the use of a computer-based system to analyse the surgical skills in TKR through detailed quantitative analysis of the technical accuracy of each step of the procedure. Twelve surgeons implanted a posterior-stabilized TKR in 12 fresh cadavers using the same set of surgical instruments. During each procedure, the position and orientation of the femur, tibia, each surgical instrument, and the trial components were measured with an infrared coordinate measurement system. Through analysis of these data, the sources and relative magnitudes of errors in position and alignment of each instrument were determined, as well as its contribution to the final limb alignment, component positioning and ligament balance. Perfect balancing of the flexion and extension gaps was uncommon (0/15). Under standardized loading, the opening of the joint laterally exceeded the opening medially by an average of approximately 4 mm in both extension (4.1 +/- 2.1 mm) and flexion (3.8 +/- 3.4 mm). In addition, the overall separation of the femur and the tibia was greater in flexion than extension by an average of 4.6 mm. The most significant errors occurred in locating the anterior/posterior position of the entry point in the distal femur (SD = 8.4 mm) and the correct rotational alignment of the tibial tray (SD = 13.2 degrees). On a case-by-case basis, the relative contributions of errors in individual instrument alignments to the final limb alignment and soft tissue balancing were identified. The results indicate that discrete steps in the

  15. [Amebiasis. Surgical treatment in 1989]. (United States)

    Sigler Morales, L; Mier y Díaz, J; Melgoza Ortiz, C; Blanco Benavides, R; Medina González, E


    Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.

  16. [Surgical treatment of morbid obesity]. (United States)

    Aasheim, Erlend T; Mala, Tom; Søvik, Torgeir T; Kristinsson, Jon; Bøhmer, Thomas


    Patients with morbid obesity are prone to weight-related disease, reduced quality of life and shortened life expectancy. Long-term weight loss is unsatisfactory with conservative treatment and weight-reducing surgery is increasingly performed in all Norwegian health regions. This review is based on electronic database searches. We describe the two procedures most commonly performed in Norway, i.e. gastric bypass and biliopancreatic diversion with duodenal switch, including preoperative workup and expected results after surgery. The domestic use of different surgical techniques is also outlined. In Norway, around 750 bariatric procedures were planned in 2006. Gastric bypass yields a weight reduction of 30% two years after the operative. Resolution of type 2-diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea has been demonstrated in most patients. A majority of patients report improved quality of life. Procedure-related mortality is less than 1% and surgical complications occur in approximately 20%. Nutritional deficiencies are frequent. Weight loss is somewhat greater after biliopancreatic diversion with duodenal switch, but the procedure is more complex. Life-long follow-up is recommended after bariatric surgery. In selected patients with morbid obesity, bariatric surgery is a viable treatment. However, prospective long- term studies are needed.

  17. Surgical Treatment of Acute Pancreatitis. (United States)

    Werner, Jens; Uhl, Waldemar; Büchler, Markus W.


    Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

  18. Cardiothoracic surgical experience in Ghana. (United States)

    Tettey, Mark; Tamatey, Martin; Edwin, Frank


    Ghana is one of the few low-to-middle-income countries in sub-Saharan Africa able to consistently sustain a cardiothoracic program with locally trained staff for more than two decades. Cardiothoracic surgery practice in Ghana started in 1964 but faltered from a combination of political and the economic problems. In 1989, Dr. Kwabena Frimpong-Boateng, a Ghanaian cardiothoracic surgeon trained in Hannover, rekindled interest in cardiothoracic surgery and in establishing a National Cardiothoracic Centre. His vision and leadership has brought cardiothoracic surgery practice in Ghana to its current high level. As a result, the medical landscape of what is achievable locally in both pediatric and adult patients has changed substantially: outbound medical travel that used to be common among Ghanaian cardiovascular patients has been reduced drastically. Ghana's National Cardiothoracic Center (NCTC), the only tertiary center in the country for cardiothoracic surgical pathology manages all such patients that were previously referred abroad. The NCTC has become a medical/surgical hub in the West African sub-region providing service, training, and research opportunities to neighboring countries. The Centre is accredited by the West African College of Surgeons as a center of excellence for training specialists in cardiothoracic surgery. Expectedly, practicing cardiothoracic surgery in such a resource-poor setting has peculiar challenges. This review focuses on the history, practice, successes, and challenges of cardiovascular and thoracic surgery in Ghana.

  19. [Surgical treatment of primary thymoma]. (United States)

    Zhi, Xiu-yi; Liu, Bao-dong; Xu, Qing-sheng; Zhang, Yi; Su, Lei; Wang, Ruo-tian; Hu, Mu; Liu, Lei


    To summarize the clinical and pathologic features of thymoma and assess surgical treatment thereof. The clinical data of 66 thymoma patients, 35 males and 31 females, aged 40.8 (30 approximately 59), who underwent surgical treatment in the past 20 years, were analyzed. By Masaoka staging system, underwent extensive or radical or palliative operation, most commonly performed through a median sternotomy and frequently requires en-bloc resection of one or more adjacent structures. Fourteen of the 66 patients had associated myasthenia gravis (MG). The most common symptoms included chest pain, MG, cough, and dyspnea; only 11 of the 66 (16.7%) patients had no symptom. Masaoka staging revealed stage I in 29 patients (43.9%), stage II in 16 (24.2%), stage III in 19 (28.8%), and stage IV in 2 (3.0%). Fourteen of the 66 patients underwent radical resection, resection of the whole thymus and thymoma, 40 underwent simple resection of thymus, 5 underwent palliative resection of thymoma, and 6 underwent thymectomy exploration. Recurrence of tumor was observed in 4 patients. Postoperative radiotherapy and chemotherapy were performed 24 h after the operation, mainly in the cases of invasive or metastatic thymoma. One patient died within 30 days after the operation. Resection and postoperative radiotherapy or chemotherapy are necessary in treatment of thymoma, particularly complete thymectomy.

  20. Surgical infections: a microbiological study

    Directory of Open Access Journals (Sweden)

    Santosh Saini

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  1. Intelligent instrumentation principles and applications

    CERN Document Server

    Bhuyan, Manabendra


    With the advent of microprocessors and digital-processing technologies as catalyst, classical sensors capable of simple signal conditioning operations have evolved rapidly to take on higher and more specialized functions including validation, compensation, and classification. This new category of sensor expands the scope of incorporating intelligence into instrumentation systems, yet with such rapid changes, there has developed no universal standard for design, definition, or requirement with which to unify intelligent instrumentation. Explaining the underlying design methodologies of intelligent instrumentation, Intelligent Instrumentation: Principles and Applications provides a comprehensive and authoritative resource on the scientific foundations from which to coordinate and advance the field. Employing a textbook-like language, this book translates methodologies to more than 80 numerical examples, and provides applications in 14 case studies for a complete and working understanding of the material. Beginn...

  2. Technical Training seminar: Texas Instruments

    CERN Multimedia


    Monday 6 November TECHNICAL TRAINING SEMINAR 14:00 to 17:30 - Training Centre Auditorium (bldg. 593) Texas Instruments Technical Seminar Michael Scholtholt, Field Application Engineer / TEXAS INSTRUMENTS (US, D, CH) POWER - A short approach to Texas Instruments power products Voltage mode vs. current mode control Differentiating DC/DC converters by analyzing control and compensation schemes: line / load regulation, transient response, BOM, board space, ease-of-use Introduction to the SWIFT software FPGA + CPLD power solutions WIRELESS / CHIPCON Decision criteria when choosing a RF platform Introduction to Texas Instruments wireless products: standardized platforms proprietary platforms ( 2.4 GHz / sub 1 GHz) development tools Antenna design: example for 2.4 GHz questions, discussion Industrial partners: Robert Medioni, François Caloz / Spoerle Electronic, CH-1440 Montagny (VD), Switzerland Phone: +41 24 447 0137, email:, Language: English. Free s...

  3. PEP instrumentation and control system

    Energy Technology Data Exchange (ETDEWEB)

    Melen, R.


    This paper describes the operating characteristics of the primary components that form the PEP Instrumentation and Control System. Descriptions are provided for the computer control system, beam monitors, and other support systems.

  4. PEP instrumentation and control system

    International Nuclear Information System (INIS)

    Melen, R.


    This paper describes the operating characteristics of the primary components that form the PEP Instrumentation and Control System. Descriptions are provided for the computer control system, beam monitors, and other support systems

  5. Survey of instruments for micrometeorology

    National Research Council Canada - National Science Library

    Monteith, John Lennox


    ... have been developed for micrometeorological measurements. Many of these instruments can be used by ecologists to measure and define the environment of plants and animals and to explore the ways in which organisms modify the environment they are exposed...

  6. Compact Formaldehyde Fluorescence Instrument Element (United States)

    National Aeronautics and Space Administration — The successful completion of this IRAD will deliver a fully functional instrument at TRL 6.  The key characteristics that we will demonstrate are simplicity,...

  7. Survey of instruments for micrometeorology

    National Research Council Canada - National Science Library

    Monteith, John Lennox


    .... Meteorologists are concerned with the behaviour of the boundary layer because it determines the input of heat, water vapour and momentum to the lower atmosphere and a large number of instruments...

  8. Vertebral coplanar alignment technique: a surgical option for correction of adult thoracic idiopathic scoliosis. (United States)

    He, Shouyu; Bao, Hongda; Zhu, Zezhang; Qiu, Yong; Zhu, Feng; Zhou, Hengcai; Sun, Xu; Wang, Bin


    Previous studies have demonstrated vertebral coplanar alignment (VCA) as an effective surgical option for adolescent idiopathic scoliosis (AIS). The purpose of this study is to analyze the outcome of VCA for the surgical correction of adult idiopathic scoliosis (AdIS). 35 AdIS patients (mean age: 24.2 years) undergoing VCA-instrumentation were reviewed. The main thoracic curve and thoracic kyphosis (TK, T5-T12) were evaluated preoperatively, immediate postoperatively, and at the final follow-up (>1 year). All patients were stratified by the TK modifier before surgery: "+" (TK, >40°), "-" (TK, scoliosis with sagittal malalignment.

  9. Surgical management of an endodontic retreatment failure of a mandibular first molar

    Directory of Open Access Journals (Sweden)

    Kinjal M Gathani


    Full Text Available One of the common endodontic iatrogenic mishaps is the extrusion of obturation material which has a negative effect on the long-term prognosis of the tooth. Surgical endodontics has enabled us to save teeth with persistent infections and extrusions when orthograde treatment has been unsuccessful. Apicoectomy of the molars is not frequently performed even though its success rate can reach that of anteriors and premolars. This case report describes the orthograde and surgical management of a mandibular first molar with external root resorption, instrument separation in the canal, and extruded obturation material, which had been unresponsive to endodontic retreatment.

  10. Laminectomy without instrumentation for surgical treatment of metastatic spinal cord compression


    Borges, Paulo Alvim; Teixeira, William Gemio Jacobsen; Narazaki, Douglas Kenji; Cristante, Alexandre Fogaça; Ghilardi, Cesar Salge; Teixeira, Manoel Jacobsen; Camargo, Olavo Pires de; Barros Filho, Tarcisio Eloy Pessoa de


    OBJECTIVE: To analyze the development of mechanical complications as a result of spinal decompression or cauda equina in patients with metastatic tumors of the spine via laminectomy or laminoartrectomy without fixation. METHODS: We studied the medical records of all patients submitted to spine decompression with laminectomy without fixation. The decompression was indicated to treat cord compression or cauda equina caused by metastatic tumors. Patients were evaluated for the development of p...

  11. Luminescence techniques: Instrumentation and methods

    DEFF Research Database (Denmark)

    Bøtter-Jensen, L.


    This paper describes techniques, instruments and methods used in luminescence dating and environmental dosimetry in many laboratories around the world. These techniques are based on two phenomena - thermally stimulated luminescence and optically stimulated luminescence. The most commonly used...... luminescence stimulation and detection techniques are reviewed and information is given on recent developments in instrument design and on the stale of the art in luminescence measurements and analysis. (C) 1998 Elsevier Science Ltd. All rights reserved....

  12. Dynamic Optimization of Bytecode Instrumentation


    Zheng Yudi; Bulej Lubomír; Zhang Cheng; Kell Stephen; Ansaloni Danilo; Binder Walter


    Accuracy completeness and performance are all major concerns in the context of dynamic program analysis. Emphasizing one of these factors may compromise the other factors. For example improving completeness of an analysis may seriously impair performance. In this paper we present an analysis model and a framework that enables reducing analysis overhead at runtime through adaptive instrumentation of the base program. Our approach targets analyses implemented with code instrumentation technique...

  13. Notes on instrumentation and control

    CERN Document Server

    Roy, G J


    Notes on Instrumentation and Control presents topics on pressure (i.e., U-tube manometers and elastic type gauges), temperature (i.e. glass thermometer, bi-metallic strip thermometer, filled system thermometer, vapor pressure thermometer), level, and flow measuring devices. The book describes other miscellaneous instruments, signal transmitting devices, supply and control systems, and monitoring systems. The theory of automatic control and semi-conductor devices are also considered. Marine engineers will find the book useful.

  14. The instrumental design of Elmer (United States)

    Garcia Vargas, M.; Sánchez-Blanco, M.; Cavaller, L.; Martín-Fleitas, J.; Kohley, R.; Medina, M.; Rosich, J.; Hammersley, P. L.; Ronquillo, B.; Vega, M.

    ELMER is a visible imager spectrograph currently scheduled to be in operation at the GTC on Day One. This paper covers engineering aspects of the instrument and summarizes five poster contributions presented at this conference. ELMER is an instrument managed directly by the GTC Project Office, which has developed the preliminary design and large part of the detailed design. The detailed design, manufacturing, and testing of the structure and mechanisms is being undertaken by the join venture MEDIA-SPASA.

  15. Accounting Issues On Financial Instruments


    Shiba, Kenji


    Financial Instruments should be measured at the present value by using the current effective yield as the discount rate by reference to the current market interest rate and the risk premium. The fair value or the current market price are surrogates of the present value. The present value determined by using the historical effective yield as the discount rate is allowed under limited circumstances. However, the historical cost is not allowed as a measurement basis of financial instruments. Thi...

  16. Instrumental development and data processing

    International Nuclear Information System (INIS)

    Franzen, J.


    A review of recent developments in mass spectrometry instrumentation is presented under the following headings: introduction (scope of mass spectrometry compared with neighbouring fields); ion sources and ionization techniques; spectrometers (instrumental developments); measuring procedures; coupling techniques; data systems; conclusions (that mass spectrometry should have a broader basis and that there would be mutual profit from a better penetration of mass spectrometry into fields of routine application). (U.K.)

  17. Pediatric surgical diseases. A radiological surgical case study approach

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, Ciro [Federico II Univ. of Naples (Italy). Chair of Pediatric Surgery; Esposito, Giovanni (eds.) [Federico II Univ. of Naples (Italy). School of Medicine


    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  18. Sulfur Dioxide Analyzer Instrument Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Springston, Stephen R. [Brookhaven National Lab. (BNL), Upton, NY (United States)


    The Sulfur Dioxide Analyzer measures sulfur dioxide based on absorbance of UV light at one wavelength by SO2 molecules which then decay to a lower energy state by emitting UV light at a longer wavelength. Specifically, SO2 + hυ1 →SO2 *→SO2 + hυ2 The emitted light is proportional to the concentration of SO2 in the optical cell. External communication with the analyzer is available through an Ethernet port configured through the instrument network of the AOS systems. The Model 43i-TLE is part of the i-series of Thermo Scientific instruments. The i-series instruments are designed to interface with external computers through the proprietary Thermo Scientific iPort Software. However, this software is somewhat cumbersome and inflexible. Brookhaven National Laboratory (BNL) has written an interface program in National Instruments LabView that both controls the Model 43i-TLE Analyzer AND queries the unit for all measurement and housekeeping data. The LabView vi (the software program written by BNL) ingests all raw data from the instrument and outputs raw data files in a uniform data format similar to other instruments in the AOS and described more fully in Section 6.0 below.

  19. Isotope-equipped measuring instruments

    International Nuclear Information System (INIS)

    Miyagawa, Kazuo; Amano, Hiroshi


    In the steel industry, though the investment in isotope-equipped measuring instruments is small as compared with that in machinery, they play important role in the moisture measurement in sintering and blast furnaces, the thickness measurement in rolling process and others in automatic control systems. The economic aspect of the isotope-equipped measuring instruments is described on the basis of the practices in Kimitsu Works of Nippon Steel Corporation: distribution of such instruments, evaluation of economic effects, usefulness evaluation in view of raising the accuracy, and usefulness evaluation viewed from the failure of the isotope instruments. The evaluation of economic effects was made under the premise that the isotope-equipped measuring instruments are not employed. Then, the effects of raising the accuracy are evaluated for a γ-ray plate thickness gauge and a neutron moisture gauge for coke in a blast furnace. Finally, the usefulness was evaluated, assuming possible failure of the isotope-equipped measuring instruments. (J.P.N.)

  20. Enhancing surgical performance by adopting expert musicians' practice and performance strategies. (United States)

    Rui, Mei; Lee, Jeffrey E; Vauthey, Jean-Nicolas; Conrad, Claudius


    Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience. Surgeons operate with surgical instruments, whereas musicians perform with musical instruments. Both perform in high-stress, high-risk work environments, where small errors in motor performance or judgment can have immediate negative consequences. While there is abundant literature on musical performance and their impact on outcome, little similar research has been published in the field of surgery. We aimed at identifying expert musicians' practice and performance strategies that may aid surgeons to enhance their surgical performance. In the study, 82 relevant English-language articles from 1974 to 2017 matched applicable search terms. Nominal Group Technique was applied to identify 5 key domains that comprise important parallels between surgical and expert musical performance. The 5 key domains identified were: (1) extensive training and deliberate practice, (2) dexterity and ambidexterity, (3) performance evaluation and competition, (4) performance-related injuries, and (5) performance anxiety. We found focused and mindful training in motor performance, not performing immediately after a hiatus from practice, training to improve the precision and responsiveness of the nondominant hand, continuous and critical self-evaluation, training in injury recognition and prevention, and pharmacologic factors to be of utmost importance. Critical parallels exist between surgical and expert musical performance that may improve surgical outcomes by adopting musicians' strategies for combating physiological and psychologic performance-related issues. Raising surgeons' awareness for this subject content may improve surgical performance and patient outcomes, as well as help prevent occupational injuries. Copyright © 2017 Elsevier Inc. All rights reserved.